Africa Mercy - A Challenging Week: One Nurse's Journey

This is a running post about my friend's journey to Africa and work as a nurse on the Africa Mercy. Click here to learn more about the nurses and doctors on this ship. Here is her latest email!





3/30/13

It has been a challenging week. 

The good news is, I've learned how to slither in and out of my upper  bunk fairly reliably now, I got a nice wool blanket to keep me warm,  and I plugged the vent with a plastic bag so that it blows away from me  instead of on my head. My roommates are all really nice and really  thoughtful about the mechanics of four people living together in a  small space.  I've put away my belongings, and I can find them again,  mostly without too much digging.  So the basics of ship living are  whipped into shape.

The next challenge came when I discovered that I had been assigned to be a ward nurse instead of admissions nurse for the first month.  I sort of freaked out at that.  Fortunately, my Gateway friends (the folks I've been with in school and in field service for the last seven weeks) rallied round and encouraged me.  Still, I'm afraid I spent a lot of emotional energy being scared and feeling unprepared.  Once I actually started orienting, I settled down quite a bit, but still...

The third challenge came in the form of illness.  I had some abdominal cramping on field service, but on Thursday, it suddenly got much worse. The doctor says it's just traveler's diarrhea, a common occurrence for newcomers here.  But still, I haven't been able to eat anything except a little toast for three days so far, and I've had to call in sick for my first three shifts of post-orientation work--not a good beginning. The people at work seem understanding, though--I guess it happens frequently.

What shall I tell you about ward nursing?  There are four wards, plus recovery and ICU.  I am in Ward A, the least critical patients, at least at the moment.  Normally we handle general surgery--lots of hernias and tumors, I think--but this week we are overflow for plastic surgery (burn scar releases) and for max fax patients (clef lips/palates, facial reconstructions).  There are ten beds in the ward, occupied by both male and female patients, adults, children, and infants, all in the same room.  Children must have a caregiver with them; the caregivers sleep under the beds.  There are two bathrooms for all these people.  Teaching them how to use a western toilet is part of the game.

Language is "interesting."  A lot of people speak French as a second language, but not all.  The patients come from several tribes; there are at least three commonly used tribal languages, and they don't overlap.

We have day workers who function as translators.  Any given worker knows English, probably French, and hopefully one or two tribal languages. The languages of the patient are posted on the wall, so you try to find a translator who can speak that language.  Occasionally you have to use another patient as translator.  Patient right to privacy has to be a little lax on the ward to make it all work.  No one seems to mind.

Medications are also interesting.  Almost all the patients are on vitamins, iron, and supplements to promote healing.  Antibiotics and pain meds, of course, and a surprising number have sky-high blood pressures, which we medicate.  Medications are in stock bottles, and nurses just dispense what they need.  Of course, since the medications are largely donated from various countries, reading the labels can be a challenge... And figuring pediatric dosing can be a challenge...  And dealing with donated IV tubing of various drop rates can be a challenge... And just finding room at the cabinet to get your meds can be a challenge..And knowing what to reuse (eg plastic medicine cups), and how to dispose of trash (make medication containers and IV bags unusable so they don't get refilled with bogus meds and sold)... But we have cheat sheets to help, and we double check each other's calculations, and somehow, it all seems to work out OK.  But it takes time!

One of the fun things that happens on day shift is taking all the patients who are able up to Deck 7 for a little fresh air.  It's quite a parade, but they really enjoy it.  Another fun thing is when the singing team comes through the ward singing a few African songs about mid-morning.  In the evenings, the patients can have visitors, so the ward gets really full of people then.  Lights go out at 10:00 and everyone goes to sleep--even if the baby is wailing away in the corner bed all night.

Now I'm going to make all my nursing friends envious:  charting is basically ticking the boxes on the printed pre-op and post-op pathway for that particular surgery.  Meds are on one sheet; vital signs and assessments on another.  Everything you want to know is right there in the chart, on easily turned pages.  No computers.  Sorry, friends...paper charting is the way to go!

Enough for now.  When I actually have to work a shift without a preceptor, I may sing another tune, but right now, enjoying the joyous patients (they're thrilled to get surgery and thankful to be here) and working with other volunteer nurses who love being here--well, it's just about as good as nursing ever gets.  Despite my initial apprehensions, I'm thankful for this time on the ward.

M