August 28-September 8
My experience in Pediatric Oncology these last two weeks was absolutely unbelievable despite me having strange things going on with my health.
My first week was a weird week for me because I was having some serious GI complications. It made me miss 2 days at the hospital. It makes me really upset with myself when I miss work but you can’t take care of other people until you take care of yourself. Luckily, I’m all better now. However, this last week I actually had to go to the hospital for a minor operation. I’ll write about that in my next post. In this post I’ll talk about the Oncology Ward.
My first day on the Pediatric Oncology Unit was unbelievable. I absolutely fell in love with all of the children!
I’ve always heard people say how hard Oncology can be, especially Pediatric Oncology; however, I love it. Of course the children are very sick and it can break your heart. But, children have such a special place in my heart. So even though these children are sick and sometimes lifeless which is the exact opposite of how children should be, it’s when they need you the most. I’m so honored that so many parents and children knew me by my name! On Monday I was beside the medicine closest and a lady walked passed me. I remembered her face but couldn’t really remember anything else. I said hello and how was her morning and then she said both my first and last name! I probably met her once last week but she remembered my name and everything. There are two units in the Oncology Ward. There’s upendo and tumaini. Upendo means love and that’s where the really critical patients are. The Tumaini Ward means hope and that’s where the less critical patients go to or where patients from Updeno transfer to when they are improving. I spent most of my time in the Upendo Ward.
The children honestly make your heart grow 20 times bigger. Being with the children really made me want to know more Swahili so I could communicate with them and play with them more. Most children don’t understand you can’t speak Swahili. They’ll keep speaking to you. I realized though during a lot of the play time with children you don’t need words to communicate. It was so interesting getting to play with African children. For instance, there’s a playroom you can go in where the children have different things to play with. When you walk in all of the children smile ear to ear and just run up to you yelling, “Mzungu!!!!!” We were using clay and they were making food to eat like chipati’s or ugali. It was funny to me because that’s exactly what children would do in America except it’s just different foods. They’d also play doctor with me. They’d pretend to put an IV cannula in me and would tell me to not cry and shh. Since they’ve been in the hospital so much that’s what they’ve been exposed to so they were reenacting what they’ve had to do.
Sometimes the kids would also hurt you. Since I’m white they find me very interesting! They’ll get my hair out of my bun and just pull and pull on it trying to get it to come out. This one little girl kept jumping up and popping me in the eye. She would pull my arm hairs and all the children kept pinching my skin. No matter how much I would say no, hapana, they would literally mock me and just laugh. I had to hide in the nurses room so they would stop hurting me. But for the most part they were very sweet and loving. It was very interesting to see how they do some of the things in the ward compared to what I’m used to seeing in America. I was able to understand why we do a lot of the things we do in the states. For instance, there’s this big bottle of liquid morphine that just sits in the unlocked cupboard in the middle of all of the patients.
The parent will simply bring a cap size clear container to you which means there child is in pain and they need the morphine for them. Without documenting or anything you simply fill the cap to the top and that’s it. You don’t go assess the child or follow the parent with the medication to make sure the child actually takes it. In addition, the nurses typically give the parents the medications to administer to the children. No documenting is done (or at least any that I’ve seen). Of course the nurses administer IV medications and IV flushes and will put a check mark beside the action in the patients file but other than that the parents are in control of the actual pills.
I saw a situation where this went very bad due to miscommunication on various ends of the spectrum. Me and a doctor from Ireland named Rincy were looking at a patients lab values over the course of a week and documenting them on a chart so you could see a trend. However, the child’s K+ level was 2.4 two days ago... The lab value hadn’t been rechecked since then and the child was taking a potassium tablet. However, upon further investigation and talking with the Mom we discovered that the child had ran out of the tablets a few days ago. The mother simply didn’t understand. It was the mothers responsibility to tell the nurse or doctor that she ran out of the medication so they could order a new prescription. However, if it was properly documented and the nurse distributed the medication then this problem wouldn’t have occurred. The scary thing to think about is what would have happened if we hadn’t of caught that? Who would have? And when? A low potassium is critical and needs first priority.
This situation taught me the importance of patient advocacy. If you don’t advocate for your patient and truly know their chart then who else will? That responsibility falls on you. We are so lucky in America to have almost an entirely paperless system. There are far less accidents that occur. Another example is having to read the doctors orders on each patients chart. It’s very interesting how they do their orders. The doctor will write it inside each patients chart and then a nurse will go through all the charts and write all the orders in a notebook where all the orders are together in one spot rather than various folders. I did this job one day. Writing down all the orders literally almost took me all day.
Moreover, reading the doctors handwriting was absolutely horrendous sometimes! I could easily see how someone could write the orders down wrong. I would have to ask various nurses sometimes what the doctor was trying to say because the handwriting was quite horrific.
As far as infection goes I could see how easily a child could be infected due to germs of other children. The unit was a ward so there would typically be 6 children in one room. Now add family members and brothers and sisters and that’s a lot of people in one room that can transmit germs. One little boy was being tested for TB and he was still around all of the other children. Infection control was something I constantly worried about. Furthermore, all the patients share the same bathroom and toilet. Inside the ward there’s just the room and the communal showers are in a different room. The hospital cooked food for families that lived too far away and couldn’t bring food from home. However, if they did live close to the hospital they were expected to bring their own food from home.
On EID Day there was hardly anyone at the hospital. I didn’t even realize that Friday was a holiday. It’s a huge Muslim holiday. How people explained it to me is that it’s kind of like Easter to Christian’s. There was only one nurse on the Upendo Ward taking care of the patients. I found this to be my golden opportunity and I basically became this nurses side kick all day. Since there were very little hands and so much to do I was able to get a lot of experience that day. I helped prepare all of the IV flush medications. In America typically all the medications are already mixed for you. However, you prepare the entire medication. In the bottle it starts out as powder. You have to draw up a certain percentage of sterile saline (depending on which medication you have to dilute) and mix it with the powder. You even have to do normal saline flushes this way. They do not come pre-made. This is something I never even thought about having to do. We are so blessed in the US to have all of these things already made for us.
EID weekend was a very interesting weekend and we had to take extra precautions. There were lots of parties going on and the Work the World team warned us not to be out late because a lot of thieves are out and about during the holiday. There was a huge party at Coco Beach which is just down the street from where I live. I was meeting up with someone near by and as I left the house there were stampedes of people on the side of the road walking. It was evening time and they were all leaving the big celebration at Coco Beach. Most were all dressed in hijabs and typical Muslim clothing. There were probably 100 people walking down the street in the same direction I was trying to get to. I ended up walking on the road. About 2 minutes had passed by as I was walking and I just felt someone hit my arm. I turned around to find a Muslim woman glaring at me. She asked me why is it that American women (how she knew I was American I have no idea. Most people think I look either Greek or Italian here maybe due to the curly hair) think they can just walk so fast in front of everyone else? She spoke very good English but she was being very passive aggressive towards me and I actually got extremely worried because I was not in a safe environment. Of course I was wearing respectful clothes for the culture and I had done nothing wrong. I was walking on the road so I didn’t even push my way through people. It was a clear opening. People in Tanzania do tend to be very hakuna matata (no worries) and don’t typically rush. I’m just a fast walker in general. I explained as nice as I could that that’s not why I was walking fast. I was walking fast because I was late meeting a friend (which was true). In that moment I saw the friend out of the corner of my eye. I began to walk towards him and she just glared at me as if I owed it to her to continue having a conversation with her when she was practically yelling at me. I explained this is my friend right here. She just rolled her eyes and continued walking with her friends. That has honestly been the only bad encounter I’ve had with a Muslim person here. All of them are so sweet and kind. This situation just really caught me off guard and reminded me to always be cautious and safe with my surroundings.
The last thing I’d like to talk about are two little boys from Muhimbili. One is 15 (almost my little brothers age) and the other is 11. Both of them loved to draw. This reminded me exactly of my little brother, Grantley. He loves to draw as well and I could see the same passion Grantley has in these little boys eyes. They had their drawings on loose printer paper. That day after work I decided I’d run by the little grocery store and get them a sketch book and some art pencils. I honestly can’t not put into the words the feeling I got when the boys saw what I had got them. It humbled me so much. Their eyes lit up as if it was Christmas morning and they kept saying God Bless You. My last day at the hospital I got those boys each a football. They had asked me for one weeks ago but I didn’t know the place to get them. I asked Faraja (one of the staff members of Work the World) if he could get me some if I gave him the money and he said of course! As I pulled the footballs out of the bag (red and white for Simba colors of course) their eyes were even bigger than before when I gave them the art supplies. They grabbed the balls and they were off to go and play with them. That’s the last time I saw the two boys. Best moment ever.
I’m definitely going to miss all of those children.
And I’ll always remember the special moments like a child just running up to you to hold your hand and walk around the unit with you. Or when I had seven children just clinging to me for about 10 minutes. One of the grandparents had to tell them to let go of me so I could go to the nurses station.