This morning at Handover, Taylor and I presented a lesson about cannulas and IV lines that went really well. All day long nurses were telling us how they liked the lesson, and Gay was telling me how nurses were correcting each other and encouraging them to do it the right way. I think on Monday when I present CPR part 2 that I’ll commend everyone on a job well done, and encourage them to keep helping each other. Gay also told me that she tried to show a nurse how she does it back home, as she is a hospice nurse back in Oklahoma, and the nurse said, “No, I can’t do it that way, because it’s not one of the ways that Taylor and Ali showed us in their presentation,” so I think I’ll also mention that there are more right ways to tape a cannula than we showed in our short presentation, and that we just gave two ways that are easy to remember and work well, but that they should still be open to other staff members and visitors who are nurses back home showing them new things, because that’s how we learn and get better.
After Handover Taylor, Danielle, and I decided we were going to follow Dr. ABD on rounds, which is always interesting but I think I had become a little desensitized to some of the gore and the crazy injuries and stories that come with them. Danielle was in awe at almost every patient, and filled an entire page front and back of regular notebook paper with little notes about what she was seeing and hearing. One woman who came in a little over a week ago with lesions all over her body, in her eyes, mouth, nose, ears, hands, feet, buttocks, and everywhere in between is improving a lot. She told the doctor that she had taken about six different medications but didn’t know what she’d taken, so Dr. ABD was pretty certain she had a skin reaction that he called Johnson’s Syndrome where the skin reactions badly to an overdose or reaction between medications. Most of the lesions on her face and ears are gone, and now she’s just got GV paint on her hands and feet. GV paint is a purple paste that is common here that is very strange, I’ve never seen something similar back home. It helps kill bacteria, and creates a seal against new bacteria getting into the wound. It also helps heal the area.
A woman who came in with a large sore on her foot that was diagnosed as a tropical ulcer is doing much better with daily wound cleanings and antibiotics. The area that is open is large, and Dr. ABD would like to do a skin graft, and thinks she’ll be ready for it soon. The woman who had her foot amputated looks fine, but she seems very confused and disoriented even though the anesthesia should have worn off by now, which concerns Dr. ABD. After a quick check through male ward on patients that CHO Alpha wanted him to review, Dr. ABD told us to go get ourselves some lunch and to meet back for surgery at 11h00 or 11h30.
After lunch they started surgery with a hernia repair on a young boy who had a strangulated hernia. Gay was very excited to get pictures of that particular surgery because one of her financial sponsors supplied the hospital with surgical mesh for hernia repairs, and asked her to take photos of hernia related surgery in hopes that they could use the photos to get even more funding for the hospital, which Dr. ABD and Dr. Erdi are very excited about.
After the hernia repair, they brought in a man who fell and broke his femur. The way they were treating him was appalling. Yelling at him for crying, moving him very roughly without caring if it hurt him, yelling at him when he asked if he could move himself because it hurt when they moved him, and all the time ridiculing him for not coming in sooner. It really upset me, and I ended up telling them that it is mean and unfair to yell at a patient for crying, especially when they have a broken femur and no care is being taken to move them carefully. The nurses just laughed at me and told me that he wouldn’t be in this situation if he had not waited two months to come in. That really made me mad, and I told them that if I knew that I would be treated like they were treating this man if I came in for treatment, I’d go to the traditional healer instead too. At least he’s here now, at least he’s trusting us now, and you’re yelling him and telling him he’s weak. What is he going to tell his family and friends when he goes back to his village? ‘Don’t go to Magbenteh Hospital, they’re mean and yell at you and they don’t care if they hurt you when they move you.’ If instead we told him, ‘Thank you for coming in, thank you for trusting us with your care, we’re glad you finally made it here, we can help you!’ He’d go back and tell his village, ‘I went to the hospital and had a great experience! You should all go there when you’re sick or hurt!” But even when I told them this, they either laughed or shook their heads like, ‘Stupid Apoto doesn’t understand.’ They kept making excuses about how much trouble he’s causing them by waiting, and Abi kept saying that he knows her and she’s upset because he didn’t ask her for help. It was so frustrating. That is one thing I’ll be happy to leave here when I come home.
They suspected that the fracture to the femur had become infected, so they made an incision and were going to inspect for pus and infection. When they got to the bone, Dr. ABD stated scraping at the bone, and pulling out shards of infected bone. It was so gross, I hate that sound of scraping on bone, it makes my teeth hurt, and every time he pulled out a piece of bone I just thought, “AH! That’s not supposed to happen!” I don’t know why bone injuries freak me out way more than soft tissue injuries, but it’s good to know that I would not do well as a doctor who sets bones or does surgery on bones. It just creeps me out and I’m going to leave it to someone else.
The last surgery of the day was an amputation of a necrotic big toe. Dr. ABD was a little anxious that he might be prematurely amputating the toe and that he might find that he needs to amputate the foot all together, but he also was hoping to save the foot and thought that getting the infected toe off would help keep the infection from spreading the woman would be able to keep her foot.
After surgery Dr. ABD took us to his clinic, which is right in front of his house and still under construction. He works all day at the hospital and then comes home to see patients in his clinic all night. Right now only the first floor is function, and when he gave us the tour he would say about almost every room, “This will be the_____, but right now I have to put patients in here because they are already showing up, and I can’t just turn them away.” It was very impressive, and the second floor is really starting to look like it could be a hospital someday. He hopes to have four floors when it’s finished, but he doesn’t know when that will happen because it depends on when the money is available.
Now that there are so many of us here in the guesthouse, it’s hard to get time on the modem since we’re all sharing it. I ended up missing my skype date with my Mamma, so I’ll try again tomorrow but I’ll be home in just six days, so it wont be long before I get to see everyone in person! I’m excited to go home, but I will definitely miss this place. I go through phases where I’m sad to be going home because this place is so cool, and then being anxious to get home sooner because I miss home so much! I have a few last things on my Sierra Leone bucket list to complete, and then I will definitely be ready to go home and be back with the people I love.
This post is dedicated to two children who passed in the night, one of malaria and pneumonia, one of malaria and typhoid.
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