.livinthedream

warning: the following blog long and in-cohesive:

.............drumroll........

A Day in the LIfe of a Pediatrics Nurse in Tchad, Africa in the Evening:

get to work

quinines uncovered (UV light destroys quinine....) X 2

sink crawling with huge ungodly larger than life killer ants

spray enough Rambo to start a 3rd world war and killer ants slowly die

use the last compress to clean the med cart/iv cart/trash cart/mobile nurses station which is a sticky disaster

see more bugs that need killing

kill them too

get report

oh and this one - they haven't bought the next quinine

neither has this one

this one doesn't have any meds left

this one needs quinine - hasn't bought it

....this one - waiting on the father to come buy meds - next quinine long overdue

can you please tell them in Nangere?? 

oh, they already know

this one throwing up

and that one

almost everyone

has malnutrition

varying degrees

of shrunken wrinkled skinniness

patchy hair

wide large eyes

see the first patient -


baby with possibly fungal rash covering body - they didn't give her the Miconazole creme at 13.... why not?  couldn't find it

and they have a point

sort of

an old plastic bag with old bandages and a jumble of old medicines

half eaten food

dirty pieces of cloth

everything covered

in flies - the mother to week from malaria and giardia to really do anything - laying there moaning -

if you want to know which baby is the sickest - follow the flies

the flies here are tenacious suckers

pure evil

they swarm the sickest, the weakest, the dying

no soap to wash the baby - no soap to wash the clothes -

do you have food??

 a little

 -  sometimes i think she is giving up - has been here 2 months, a sick baby, a blind 3 year old - husband abandoned her - every day she looks more haggard - her eyes are glazed - she is moaning - a low moan - and moans all night long - i should give her some soap

give the creme to the baby - which is really oral gel - out of creme at the pharmacy - i figure it must work a little right

next one - l'eau la - c'est fini........

get a translator - explain the next perfusion is in a couple hours - explain that it is pas grave -

and the next - arms to thin - belly to big for the skin - legs wrinkled - new patient -

painstakingly explain they need to mix up oral rehydration drink and give it to him every 1/2 hour - say it at least 5 times - they won't do it

the next - fever, 105 - then i drop the thermometer and break it

fantastic

and the next - fever persists - 104..... i tell the mom to fan her and sponge her with cool water - i give extra tylenol - not a big deal because she'll spit half of it out anyway - the mom glares at me - assures me she has already been cooling the girl down - I re-explain - she does it only once

they are convinced the child doesn't have malaria - are convinced something is wrong with the "core"  keep pointing to the chest - get a translator - (translator means any poor soul that speaks a bit of french) re-explain

get a new patient - have to stop rounding - text book malnutrition - Wendy cooked him up some pat d'arrachide bouille- peanut butter, salt, sugar - she gave it to the mom this morning - she hasn't really given any - despite being told to give it multiple times - put in the IV - I prefer putting IVs into skinny babies - easier than fat ones

bolus of fluid - the mom looks about 14

has no food - barely any belongings - walked here - has an old morton salt looking container for water - and thats it

i want to hate her

her baby is so sick and so weak

I want to believe its her fault

but its not

more and more malnutrition coming into pediatrics lately - MSF opening a malnutrition center in the southeast - we heard there wasn't much food this year...now we are starting to see it

next baby - dehydrated - fever - explain re-hydration - tell them to cool him down - i'm a broken record - guess what - they don't do it

give water now

they just look at me

give water now

right now??

yes.

NOW

do we give it or you give it??

YOU give it!!

duck as a bat swoops next to my head

everyone laughs


a mother comes up - a little blood has backflowed into the IV tubing - we get in a fight - i end up yelling at her that it is PAS GRAVE!!!!!  she yells back that it is.  I go cry because i shouldn't have yelled -

if there is any blood even the tiniest tinge, they get so upset here - they think its the biggest deal in the world

they also think that a 500 ml bottle of glucose and quinine is enough water and they don't have to give any....... every time i say its pas suffice they are astonished - and then they don't give water

and then an IV is infiltrated

i prescribe a new one

pas l'argent -

we argue for 15 minutes - i tell them their options - i tell them quinine IV is better - they still insist they have nothing - they refuse to buy the IV - i find out the kid isn't vomiting....looks kind of perky....i prescribe oral quinine.....they find the money

am putting in an IV when i get interrupted....we have no medicine and we want to leave.... all the medicine is gone and we have no money

he is grinning as he says this

he looks 16

i tell him there is medicine - he argues with me - i argue back - i go look - a half full bottle of Tylenol Syrup, Amoxi Sirup, Metro IV.....just not another Glucose to mix the quinine in - see, look - here is medicine.  Ah Bon??  as if he didn't know.  I tell him he is lying because he just wants to leave - the kid is still vomiting - the kid looks like crap.  the mother looks 15. 

you need to buy a serum glucose ...... pas l'argent

do you have a phone?? they can hold it as collateral.......

no.  no phone.

anyone in your family??? no, no phone

we trade in his IV B vitamins and an extra quinine and a seringue - come back - hang the drip - he promises to wait until morning

he is still grinning

i am not

5 minutes later - he comes looking for me

do you have a charger for a Nokia phone????? 

Gotcha!!!

i point out to him that not only is he a liar but I have just caught him in a lie

he starts laughing hysterically

i put in an IV

the mom keeps giving me deathstares

its not my fault a baby doesn't like needles

no money no money no money

a whole line of patients - quinine late - can't buy it

we trade seringes for tylenol......

they magically unearth money

I fill out a free form for the baby i put up the picture of - still a fever - not getting better -

and I can't stand the way they give everyone one day of IV ampicillin - just one day - no one finishes their antibiotic regimen here - they can't afford it

someone asks me to buy their medicine

i say no

the wind is slamming the windows shut -

dust is flying

people run inside - dragging mats

the floor is covered

they always know when its going to rain

and then the rain is fierce

liquid bullets pounding the mettle of the roof

ricocheting into mud

and the building shakes

and the thundergod shakes her rain rattle

and you scream if you want to be heard

and the windows are still slamming

open, shut, open, shut

pediatrics used to be a chapel -

but this is not a holy night

and the stars aren't brightly shining

i look at all the quinines

none of them are perfect

fiddle with all of them

half of the IVs are positional

at least no one's dying

that's a plus

l'eau la, c'est fini

c'est pas grave

I yell at people because they don't understand my french

you can go ahead and unpack how hypocritical that is on so many levels

people will pretend to understand that don't

people will pretend not to understand that do

I am tired of being lied to

I get lied to every day - varying levels

they call me nasara - white person

all night - i hear snatches of conversation - nasara, nasara, nasara

here, you don't even have a name

racism - i don't much like it -

I didn't sit down once all night - except to put in IVs.....

i started this night with the grandest intentions - kindness, carefulness

had the grand plan to explain everything so well so that I could sleep at night knowing that now, if it doesn't get done - its the parents fault

so i could stop getting mad over things that are not in my control -

well, tonight i explained all right - no one did a single thing i said to do...... 

the tchadians say you have to yell - get in the mother's face and MAKE her give the water - demand she does it this second.......  (not that they take the time to DO that...)
 
that they won't do it otherwise

honestly, I am completely baffled

why WOULDN'T you give it?????

cultural beliefs are so strong here.....tradition -

i'm going to go ahead and be colonialist for a second -

YOUR TRADITION OF GIVING BABIES WATER AND NOT GIVING IT TO KIDS SUCKS!!!!

balance - still looking for it

I am definitely not being the person i want to be of late

am definitely learning alot of lessons about how NOT to be

how NOT to act
how NOT to re-act

am definitely needing to re-define how i deal with stress and frustration

to re define how i deal with suffering - as if that could ever be defined anyway

its a shadowy gray that darts sluggish in and out of your conciousness - spewing fire or mopping your heart with lidocaine in slow widening circles - just depends on the minute really

sometimes you find the absence of emotion strangely curious - like watching someone die in slow motion and knowing you should be crying when instead your coldly evaluating the ramifications of your lack of human response -

or sometimes you care too much, like your whole heart is bursting with perfectly ripe mangoes - and this sentiment in fact begets the former one, although there is a form of courage and strength locked in its futility

or sometimes you get it just right - but your too busy to register it

or sometimes you break down in a completely isolated moment - like if someone steals your granola bar, or you get woken up too early in the morning by incessant sweeping and clouds of dust

the only thing you can do is to try to live as deeply in each moment as possible - if its a happy moment, a sad one, an angry one, a numb one -

thats what the tchadians do - thats how they survive -

they laugh the loudest

and weep the longest

but thats the whole point right -

to open yourself up to experience

to failure

to frustration

to happiness

to numbness

its a roller coaster

it will make you clench the bar in front of you white nuckled as you stare into the abyss

you will scream and feel your stomach drop down below sea level

you will laugh hysterically and feel like you are flying

you may vomit and lose your voice

and then, at the end - your breathless and winded

and ALIVE

....and you want to go again

its imperfect - and balance eludes you - but there is no parallel

to the knowing

to the feeling

of opening up your soul to experience

and feeling life rush through your veins

and tonight -

i have to open myself up to failure

and to frustration -

so that tomorrow

I can be a little bit better

of a person

of a a nurse

of a nasara


i only have one thing going for me tonight -

and that is that I'm doing my best



its nights like this I gotta remind myself.....

Your living the dream!!! 

You dreamed of this for over 6 years.....

there was no other place you wanted to go.....

you tried, failed, and got accepted the second time around.....

you spend a huge amount of money to get here

you worked long nights every weekend to be here

you dreamed of it....

prayed for it.....

sacrificed for it......

fought for it......

so even on nights like this......

Your living the dream..............