Pediatrics

One of my pediatric patients had said to me after witnessing another family, “when is my mom going to pick me up?”  I could not answer her question, instead I witnessed a nurse provide this patient with the upmost love and support in hugs and kisses, as if this nurse was their caregiver.  The nurse gave the patient unconditional support to feel safe and nurtured while no one else was with them.  I do not have the emotional bandwidth for this type of nursing.  I cannot go to work every day and feel sad because a child looks to not be loved, or maybe they are loved, but I can’t see it.

Pediatrics was a difficult clinical rotation, more challenging than all the other rotations to date.  I did not enjoy working on the floor due to the psycho-social component of care.  I could not understand the circumstances that would leave a child to be alone in a hospital without family support or to have family support but to not have it be great.

Tomorrow, we go to UK-Kenya-Tanzania, where I will giving health assessments to 100-200 orphans, all should be mostly healthy.

Malaria and mosquito nets

Many years ago, I read an article in the New York Times about organizations doing good work – places to donate to during the holidays.  I remember reading, it takes less than $5 to buy a mosquito net to prevent malaria in Africa.  I remember telling, myself, that’s amazing, only $5 to help save someone’s life.  I’ll donate to this cause and tell everyone about it.

Some time in the recent past, in class, we watched a TED talk about malaria.  The talk equated malaria in Africa to how we, in North America deal with the flu during flu season.  It’s just something you might get, and need to get over.  The speaker said, in Africa, malaria is thought of in the same way to the local people, it’s something you might get, and have to deal with.  Local people don’t consider it a big deal, in the same way, many of us might think of colds or the flu.

Imagine, you get the flu, and someone says to you, to fight the flu, you should put a heavy bed net over your bed that does not allow for any cool air to circulate while you sleep.  You accept the net, but decide it might serve a better purpose by using it to fish in the lake to make money at the market.  But, the net is covered in a toxic bug repellent and makes all the fish die.  Instead of helping these people, with your great ideas of how they should improve their lives, you instead have created an environmental problem.

I am guilt of this thinking – and years ago, I donated money to this idea of buying mosquito nets for people in Africa.  I failed to realize the idea of malaria had to be resolved by their own people in a way they think is effective.  They need the motivation themselves.  Just like, I cannot convince anyone to go to the gym if they don’t want to go.

I leave for Africa in 11 days and will remember, my purpose is not to bring interventions to a community but instead help serve in ways that support their independence.

Pakistan, my refugee family

My refugee family is from Pakistan.  When I think about it, I’m not sure if I’ve ever met anyone from Pakistan.  Pakistan is bordered by Afghanistan (west), India (east), Iran (southwest) and China (far northeast).  The official language is Urdu and English, but many people speak Arabic, Punjabi, Hindi and other languages.  In 1947, Pakistan became an independent country for Indian Muslims.  (FYI: Islam refers to the religion or faith, and Muslim is someone who follows or practices Islam.)  In 1956, Pakistan became an Islamic republic, with many cultural identities adopted from the British.  The school system is modeled after the one in the UK and Pakistan students must pass A-levels to enter university.  At my refugee families home, the mom served us British tea and cake.

An ethnic civil war in 1971 resulted with East Pakistan, seceding to a new country Bangladesh.  This is all I know of Pakistan – and I vaguely remember reading a book about Benzair Bhutto a long time ago, the former Prime Minister who championed women’s rights.  This is a sad state of my knowledge gap when all I know about another country is a paragraph.

I don’t know about the political instability that led my family to leave their country but I would guess that it might have been related to Taliban rule, as was the case of Malala (the young girl who won the Nobel Peace Prize for championing girls education).  Malala is now 20 years old and recently made the news for returning for a visit to Pakistan this week for the first time since she fled.  My family, like many refugees relocated to other countries, before arriving in the US and also has been unable to return, leaving behind family members.

The plan for me and my team is to work with this family every week – on whatever needs they have relating to becoming U.S. citizens and assimilating to the U.S.  I think of how challenging it must be to find a new community and flee under such difficult circumstances as to leave your family behind.  Our immediate goals are to work with the mom on passing her driver’s learning permit exam and then finding resources for her to learn to drive.  For the children it is to work with finding them resources such as a playground, after school activities and getting a library card.

I continue to be surprised as to what it means to be a nurse.  Working with this family, brings me an unexpected education.

prepared, back to the gym

I often use the word, overwhelmed to describe how I feel.  The opposite of overwhelmed, might be prepared.

I went through this exercise where the facilitator said to think of a time when you feel overwhelmed.  Think about your emotions, your breath, every cell in your body – how does that feel, describe it, remember it.

Now, think about a time or a memory when you felt prepared, how did you feel?  What were your emotions?  How did your body feel?  What was different?  Remember this image and remember this moment.

He said when you feel overwhelmed, to think back to the moment when you felt prepared, conjure up that image and feel those thoughts, feel those emotions and think about how your body felt, down to each individual cell.

This imagery will help you overcome your feelings of overwhelmed.

When I thought about my moments of how and when I felt prepared – it was actually very physical. I felt physically strong when climbing Mt. Whitney.  Below is a photo after the second time I biked across the US when I felt capable.  The correlation might be that to feel prepared, I might need to be strong.

And so, I’ve joined a gym to get back into a routine of being strong.  I can’t get to the gym on my own free will, so I’m joined an expensive gym.  The workouts are different every day and you’ll never do the same workout twice.  I don’t have to come up with a play list, a workout routine, and someone is pushing me harder than I might be willingly to go myself.  Someone is holding me accountable for showing up.

I sign up for a class ahead of time and someone tells me what to do for 50 minutes or so.  They use heart rate monitors and even if I can’t quite see the details of the screen, I can see the colors.  They tell me I should always be in the red or orange colors.  Green or grey means I am not working hard enough.

If I cancel a class, I need to do it 8 hours in advance, otherwise, I am charged $12.  I wonder who thought of this pain point.  I’m ok with $5, maybe on a bad day $10, but $12 is past my limit of an acceptable waste of money.

When I signed my membership, the coach made sure to sign me up for 4 more classes this week.  Going from zero fitness to 4 – might be a little aggressive, but I need all the help I can get since I can’t motivate myself in this area of my life right now.

If I could have a personal coach for every area of my life, I would, but for now, here’s to losing the nursing freshman 15, and getting back to routine – of being strong and prepared.

strong

Pico de gallo

Pico de gallo

6 jalapeño peppers

2 small white onions

3 limes

2 tablespoons salt

4 large tomatoes

*Wear gloves when cutting the jalapeno peppers.

1. Cut the end/top of the pepper

2. Cut the pepper in half (long way)

3. Remove seeds

4. Slice in quarters

5. Slice again in eighths

6. Dice into very small pieces

7. Finely chop the two small onions

8. 3 limes – cut in half and squeeze

9. Add 2 generous tablespoons of salt

10. Dice 4 large tomatoes

Mix all and eat with everything.

4/7 of the days, I woke up before 5 am.  It was challenging to travel so far each day.  I am grateful for the learning, experiencing the dirt roads and understanding first hand why someone would not want to travel to a hospital.  I am grateful for observing the women who dedicate themselves to serving the undeserved.  I learned about poverty and although I may not be able to help many people, it only takes one person to create change.  I learned about a model of care where local people are invested in their own health and have ownership.  I witness a birth without interventions.  I observed poverty and will never forget the woman who only ate an avocado or the baby who will die before 5.  I felt many things this week, but I left with hope.

img_5647img_5534

Last day: a natural birth

I sat at the foot of the bed, drowsy from taking a NyQuil only an hour earlier.  I awoke from my slumber to the words, “she’s 14 years old.”  I don’t know what about those words woke me up from my deep sleep, but I got out of my pajamas, went downstairs to the clinic to witness a birth.

The girl was 14 years old, a child in my eyes.  When I was 14 years old, I had not even matured into my adult body and grown childbearing hips yet.  This child before me was laying down, pulling on the rope above her head with each contraction.  She was dressed in her traditional skirt with thick blankets on top of her and a hat.  In the room was her mother, mother in law, boyfriend, two nurses and the midwife.  The young brothers of her boyfriend ran into and out of the room.  They were excited about what was to come.  There were no medical interventions, no beep-beep-beep from the electronic fetal heart monitor.  The girl mostly laid flat on her back, getting up to pee and walk-taking two turns down the hallway.

The nurse checked her cervix and announced she was fully dilated.  In a short time, she was already crowning and the baby was on its way.  I had no words to encourage her other than, “muy bien”… which I’m not even sure she understood since she spoke the local Mayan language.  I wanted to be encouraging.

She delivered without tearing and there were no fluids.  It was the easiest birth I had ever seen.  Her uterus clamped immediately and her fundus was firm.  The nurse gave her an IM shot of pitocin post delivery.  The placenta was put into a trash bag.  She delivered in her traditional skirt too.  She was vocal once and was silenced shortly after.  In their culture, it is better to be silent to not make the baby afraid.

The baby was wrapped in blankets and given to the mother in law.  Mom was attended too, but baby did not go skin-to-skin.  I’m not sure if that is a practice in their culture, since she was wearing so many layers of clothing.  After a short time, I asked if the mom wanted to see the baby, she shook her head, and so I took the baby from the mother in law and knelled over to present baby to mom.  I only held the baby there for a short time when she shook her head again, I returned the baby to the mother in law.

It was so powerful to witness a natural birth without intervention or complication.  From transition to the birth was a hour and half.  I’m sure her age helped with the delivery but more importantly she was calm, surrounded by loved ones and supported by others.

 

Project Site: Tuzlaj Coza

(Wednesday): Observed an adolescent class on self esteem in Calhuitz, tamale making, language class, cultural night (local kids dancing).

(Thursday): Another early morning, I awoke at 5:30 am to drive for two hours to the project site in Tuzlaj Goya.  (Photos: switchback mountains we crossed, me and classmates in the back of the truck.)

At the clinic, I was told they ran out of ibuprofen.  The next supply would be next month.  When I have a headache, I go into my backpack and take two ibuprofen.  This community would have to wait a month for a resupply.

Today, I followed two educators into the community to observe their home visits.  Home visits are really interesting.  At Casa Maternas, they follow a cascade model of care.  They first begin by taking a census of the community or a community health assessment, identifying the risks and needs of each house.  They map out the community and then begin their interventions.  At each Casa Maternas, the focus is on reaching women and children under the age of five – in the hopes of lowering the mortality rate.  The lead educator is from Casa Maternas.  She educates 7 facilitators who each go back to their districts/neighborhood and educate their community.  Eventually, one by one, each woman in the community is educated each month on a specific topic.  This month’s topic was danger signs of pregnancy.  This model of care is something I had never seen before but is so effective in its outcome.  It only takes one person to create change.

On the home visit, the baby was weighed, measured, and their records updated.  The facilitator educated on the importance of vaccines, birth control – depo is free by the government, family planning, hygiene and the monthly topic.  The mom asked engaging questions about… (social services – a nearby town gives away food, why doesn’t Casa Maternas?  She asked are vaccines truly helpful?  Free education classes at the clinic – she would want incentive like food.)  At the end of their conversation, the mom was asked to thumb print her name with ink instead of signing to acknowledge the conversation.  I thought that was a powerful record.  Even though she is likely illiterate, she was still able to participate in the health of her children in a meaningful way.  These facilitators went to her.  They went to her house to talk about the health of her children.   I walked away feeling like this baby was healthy and the children were happy.  (Photos: baby being weighed by a portable scale, art on the wall at the families’ home, children, a donkey walking down the road carrying sticks, and chickens in the yard.)

The next family was more resistant to our visit and her baby was severely malnourished.  I would have guessed this baby was a few months old, but instead it was one year old.  The mother said she feeds the baby with formula maybe once a day.  This baby will not live to five years.