The Hospital (2)

Some major differences in the hospitals here versus at home:

• The illnesses/conditions are more severe- As I had mentioned in the last post, on my ward, I see mostly hernias, hydroceles and goiters. The extent that some of these conditions have reached are unbelievable. Some of the patients have had these hernias for over 9 years and 11 years. The hydroceles are so large, its unfathomable to think that they have lived and worked with them for so long. Its so exciting to see that they can finally receive relief. Because of the decreased nutrition of all of the patients, wound healing is a huge issue. We have about 6 patients who have been with us for a long time, have gone home and then come back with infections, or who have developed other complications. Infections is a major issue because of lack of cleanliness. During discharge instructions, we have to emphasize the need to "shower" daily and to clean the wound with clean water. Yesterday we had a patient return to the ship after having increased pain post operatively. When asked when he last showered, he responded that it had been a few days. The incisional wounds and surgical wounds are taking a long time to heal. A major part of it is lack of nutrition. We do alot of education on what foods to eat to make one strong and to help with wound healing.  In addition, alot of our long term patients receive nutritional supplements such as Juven, Ensure, and Promod.
• On my first day I had a patient who had a large goiter and was s/p a partial thyroidectomy. She then came down with Malaria. The night after I took care of her, she became very febrile 41.3 degrees (which is like 106.3 degrees fahrenheit) and had chills and shaking. She became hypotensive and lethargic. She is now in our ICU. The malaria is really causing damage to her body. I don't know everything that is going on, but found out yesterday that she also has Typhoid. Another nurse told me that when talking to her, while she is mostly "out of it," she said that had she gone to any other hospital they would have just let her die and was thankful for all that we have been doing to help her get better. I did do some research on malaria and it is a really awful disease. We initially had been treating her with oral Co-artem and she wasn't responding to it so she is now on another antimalarial drug in addition to many more medications. Her thyroid surgery is not causing any problems. Thank the Lord and we are also thankful to Him for bringing her to the ship at such a time where she is able to get treatment for her malaria and typhoid. Please pray for her.
• The poverty, yet resiliency of the patients- Yesterday I discharged a patient. He had a bilateral inguinal hernia repair and was post op day 2. When going over discharge instructions, I asked him how he was going to get home. He said that he was going to walk to the town center and then get a taxi home. The patients have to hand in their transportation money on admission and it is kept in the safe until discharge. He didn't have any transportation money so I asked him how he would get the money to take a taxi and he said to me "I'll beg for it when I get to town." I then asked him if he had someone who he could call to maybe pick him up. He responded that yes he could call someone but they wouldn't pick him up. My heart was saddened, however we aren't nor can be responsible for the patient's transportation. I think of all my patients back home with the same operation and can't even begin to imagine any one of them wanting to walk home after having surgery and having staples remaining in both groins. Never would this happen. Pray for him.
• All the beds in one room- male and female together
• Bed to bed handover- I like this. As much as I thought of it as old fashioned before, I like going with the nurse to see and round on the patient. The chart is also reviewed and signed by both nurses to ensure all the orders are read and performed.
• Charting on paper
• IV drips to gravity- No IV pumps. This is challenging but i'm getting better at counting drops.
• Using the metric system- Kilograms and celsius are my biggest challenges.
• Having to encourage bathing
• Caregivers sleeping under the beds
• Prayer- I only wish we could incorporate prayer into the workplace. Prayer for the nursing staff, prayer for the surgeon and prayer for the patients. It is unlike anything else to have God such an evident part of healthcare and healing. Prayer truly changes the atmosphere and puts patient at ease, especially before surgery.
• Nurses devotion time
• Ward church services