A Nurse's Day
Most of my time at St. Gabriel's has been spent on "Female Ward", assisting the one and only nurse. Female Ward is the second busiest ward in the hospital after paediatrics. There are 3 bays of 8 beds plus an adjoining ward of an 8 bed tuberculosis wing and 2 airy, open isolation rooms. When admission rates climb, it is not uncommon to admit patients to "floor space" between beds. Thus, you can have Bed 1, Floor Bed 1, Bed 2, Floor Bed 2 etc. etc.
Hospital report begins at 0730 sharp, when night nurses from each unit read out the census for their unit and report on critical cases or new admissions. Report takes place in the hospital boardroom and is atended by Matron, Chief doctor, medical volunteers, and clinical and medical officers (usually late). Malawian nurses are soft spoken by nature, speak rapid accented English, and often end report with "Condition - very sick". I usually cannot follow report, nor can any of the other volunteers. Chief doctor, Dr. Heim, seems to pick up on one or two salient issues and often presses the staff on improving clinical observations and quality of care. There is never any response. A short Bible reading by a clinician always follows report.
After report I head to the Female Ward (FW) and begin to assist with vital signs on every patient. I try to grab some information from their charts - my only chance to find out diagnoses. There is no time for the nurse to fill me in. The hospital has a tight rein on supplies and each ward often runs out, necessitating order sheets to be filled out. By 0900, rounds begin with a clinical officer. Common diagnoses - Pneumonia/Empyema r/t Stage 4 HIV, Anaemia r/t Malaria (so many blood transfusions occur every day!!), Gastroenteritis with Sepsis, Malaria, Incomplete Miscarriages, Cirrhosis r/t Hepatitis B, Diabetes. Patients with serious cardiac or renal problems are admitted to palliative care, There is no treatment for them at present.
I. V. starts, infusions, glucometer readings, catheterizations, trips to the lab, med. records done by hand, admissions, discharges, are how the morning is spent.
Challenging for a volunteer nurse is that patients do not wear I.D. bands. Patients also wear day clothes, usually a blouse and chitenji cloth in layers. It's amazing to me that patients and guardians seem to know what's going on and can assist with identifying the right patient.
I really like and admire the women patients. They are so stoic, quiet, resolute and dignified. I've never heard so much as a whimper from them, even after all the prods and pokes and procedures they go through. When I first arrived, I was an anomaly. Now, I'm greeted with smiles.
So far, we have had one death on my day shift. After the ward assistants prepare the body - wrapped in chitenji cloth, all the guardians from the whole ward form a procession behind the stretcher and accompany the body to the mortuary. The grieving family walks behind - a rhythmic keening and wailing chant sung over and over. It is such a moving sight, and catches my heart, especially when I see a long line of guardian mothers accompany a deceased child and her parents on their final journey.
A Nurse's Day ends with clerical duties, preparing for the night shift and completing any required treatments. I leave at 1700, the nurse about 1745. It's a fast moving environment, with a high level of acuity. The nurse seems to take it all in stride. I am ready for a break! What an experience.
Impression: Malawian nurses are tops!
Hospital report begins at 0730 sharp, when night nurses from each unit read out the census for their unit and report on critical cases or new admissions. Report takes place in the hospital boardroom and is atended by Matron, Chief doctor, medical volunteers, and clinical and medical officers (usually late). Malawian nurses are soft spoken by nature, speak rapid accented English, and often end report with "Condition - very sick". I usually cannot follow report, nor can any of the other volunteers. Chief doctor, Dr. Heim, seems to pick up on one or two salient issues and often presses the staff on improving clinical observations and quality of care. There is never any response. A short Bible reading by a clinician always follows report.
After report I head to the Female Ward (FW) and begin to assist with vital signs on every patient. I try to grab some information from their charts - my only chance to find out diagnoses. There is no time for the nurse to fill me in. The hospital has a tight rein on supplies and each ward often runs out, necessitating order sheets to be filled out. By 0900, rounds begin with a clinical officer. Common diagnoses - Pneumonia/Empyema r/t Stage 4 HIV, Anaemia r/t Malaria (so many blood transfusions occur every day!!), Gastroenteritis with Sepsis, Malaria, Incomplete Miscarriages, Cirrhosis r/t Hepatitis B, Diabetes. Patients with serious cardiac or renal problems are admitted to palliative care, There is no treatment for them at present.
I. V. starts, infusions, glucometer readings, catheterizations, trips to the lab, med. records done by hand, admissions, discharges, are how the morning is spent.
Challenging for a volunteer nurse is that patients do not wear I.D. bands. Patients also wear day clothes, usually a blouse and chitenji cloth in layers. It's amazing to me that patients and guardians seem to know what's going on and can assist with identifying the right patient.
I really like and admire the women patients. They are so stoic, quiet, resolute and dignified. I've never heard so much as a whimper from them, even after all the prods and pokes and procedures they go through. When I first arrived, I was an anomaly. Now, I'm greeted with smiles.
So far, we have had one death on my day shift. After the ward assistants prepare the body - wrapped in chitenji cloth, all the guardians from the whole ward form a procession behind the stretcher and accompany the body to the mortuary. The grieving family walks behind - a rhythmic keening and wailing chant sung over and over. It is such a moving sight, and catches my heart, especially when I see a long line of guardian mothers accompany a deceased child and her parents on their final journey.
A Nurse's Day ends with clerical duties, preparing for the night shift and completing any required treatments. I leave at 1700, the nurse about 1745. It's a fast moving environment, with a high level of acuity. The nurse seems to take it all in stride. I am ready for a break! What an experience.
Impression: Malawian nurses are tops!