Thursday, February 12, 2009

A Whirlwind of Emotions

Our second day above Nakuru, was unpleasant from the start, as we all were dreading the long, hot, and rough bus ride. We also knew there would be several hundred villagers waiting for us to arrive. Therefore, we were not surprised at the masses when we pulled into the village church. We quickly set-up and started see people as soon as we could. My interpreter, Peter, who spoke excellent English was there waiting to help me. All the interpreters were fantastic and gave of their time to help their people. About two hours into the medical screening and treatment a young mother with a three month old baby sat down in front of me. My first thoughts were this mother needed some education and guidance about caring for her baby. This young mother had her baby dressed and wrapped in seven layers. I explained to her that she was keeping her baby to hot and she need to take some of the clothing off. After which I ask her what I could do to help them. Through Peter, I learned the baby had ringworm as so many of children in Africa do. I ask to see the ringworm, thinking the mother was speaking of one or two small patches of ringworm. I was shocked to see this baby girl named, Lisa's trunk covered in ringworm. Some were old scars, some new semi healed patches and many were open, weeping, bleeding patches. This truly was the worse case of ringworm I've ever seen. Little Lisa had a sort of weak cry, but had been nursing and did not look dehydrated even though she had a low grade temperature. I treated her with Tylenol, de-wormer and antifungal cream mixed with Neo-sporin. I also gave the mother de-wormer and gave both a months worth of vitamins. I then instructed the mother if she was still feverish and acted worse in a few hours she needed to go to the hospital. After wrapping the baby in a blanket the mother left and I saw the next patient.

Only an hour later I heard a woman screaming, as I jumped to my feet and ran to the woman I saw it was Lisa and her mother. Lisa was unresponsive and lay lifeless in her mothers arm. Grabbing Lisa out of her mother arms, I ask for transportation to the nearest hospital. However, I was instructed the hospital was just next door. With Lisa in my arms I ran through a dense grassy field, over two barb wire fences, and through a patch of stinging nettle to get to the so called hospital. Once inside I ask for an IV set-up, they did have an IV cathlon, but no tourniquet, no fluids, and no resuscitation drugs. This so called hospital was so poorly equipped. I just kept thinking we at Mountain View ER throw away more in a day than this place had on hand. After doing CRP for three-four minutes, I said enough. Lisa died in my arms, while everyone else was on the floor screaming. I held Lisa for the next few minutes singing a lullaby to her and for me. After wrapping the baby in a women African scarf, I walked out of the hospital. I was so frustrated with the lack of supplies, the lack of knowledge, and what I considered a lack of compassion on the part of the staff of two. Later I learned that Lisa was born HIV+, and had been a very ill baby since her birth. Lisa was buried on the family's small piece of property that day, wrapped in the scarf I'd cradled her in. This death hit the entire AILC team hard, but it hit me very hard as I had done the initial assessment, and then CPR on this child. The HIV+ did explain her chronic illnesses, her poor immune system, the massive ringworm, her weak cry and possibly her early death.

Since that day high on a mountain in Africa, I have lived and relived that day. I have ask myself over and over, "Did I miss something, and could I have done something different?" However, I have come to the conclusion that I was suppose to be there in that mountain village on that day for Lisa and her family.

Over the past thirty five years I have learned that there are certain qualities, attributes, and belief's that define each and every nurse, and I am no exception. I strongly believe that everyone should be treated with dignity and respect, love and compassion. I also made a promise to myself thirty five years ago, that no one should die alone. I have embraced that promise and held many hands of patients, strangers, and family as they have taken their last breath. However, I never dreamed this promise would follow me to Africa.

An hour after Lisa's death, I picked myself up and brushed myself off and went back to work. There were still several hundred people who needed to be seen and they were getting restless. One of the first patients I saw after composing myself was a petite ten year old girl, with smile from ear to ear. Lucy, was a beautiful girl who for some reason thought I was funny. She laughed and giggled at everything I said and did. Though all she had was itchy eyes and only wanted some de-wormer she was such a breath of fresh air for me. I so hope she gets out of the village and is able to fulfill her life's dreams and isn't sentenced to a life of back breaking labor.

With only an hour of clinic time left, the villagers who had not yet been seen became restless and began pushing, shoving and demanding to be seen. It was a bit like "Defending the Alamo" as we were confined in a one room shack with no way out. One of the two men in the group was trying to maintain order, but he was having little success in doing so. We all came up with a plan to work as fast as possible, and if they broke down the doorway to let them take everything we had. The sad thing is they were willing to kill each other and us for a Tums and Tylenol.

After the hour past, we literally ran to the bus leaving people untreated. I had decided that if we were suppose treat people in this village the next day I was not coming. As my safety and sanity were more important and I had dealt with a whirlwind of emotions for two days.

2/12/09From Mom:
Oh what a sad, busy, and wild day. There were about 600-700 people waiting for us at the mountain village above Nakuru. The day started busy and just got worse. After about three hours I saw a three month old baby girl that was covered with ring worm and very ill. The mother had the child wrapped in six layers. After treating the child and instructing the mother how to take care of the baby, they left. One hour later the baby arrested. I did CPR on the child and the baby died in my arms. A very bad day. After seeing 1300 people in 2 days there were still over 200 left to see. They became very upset they were not going to see a "doctor" and started pushing and shoving nearly trampling a three year old to death. It was an exhausting day. I was so glad to lay my head on my pillow in a full sized bed next to a stranger.

The brightest part of my day was a 10 year old girl who thought I was funny. She laughed at everything I did. She was a beautiful little girl who has a very dim future. Love you all.

From Andi: I'm sorry you had to have that happen to you. What a dark part of your trip you will always have to remember. But, how lucky for that baby to have passed to her Heavenly Father from the arms of an angel. I love you. And, I miss you a lot. And, I know how that girl at the clinic feels because when I am with you all I want to do laugh. Keep your chin up and your bra tight. Maybe by the time you get home, we could put our asses together and we could be one heck of a Mormon. Love ya.