Tuesday, June 26, 2012

Obule HC II

I was working out in Obule Health Center again yesterday. Word has finally gotten out a bit that I’m there so we were busy. For my nursing friends I wish I could explain what this is like but I’m not even sure how.  My day usually starts getting a brief review of what is going on in “the ward”.  This is just a small cement room that has 4 beds but when full usually sleeps between 8 and 12. As it is malaria season the ward is pretty often at capacity. Women, children, men, everyone sleeps there. If it is a child that is sick the mother sleeps with the child in the bed and usually also at least one sibling who is too young to be left at home alone. If it is a woman who is sick her caretaker, a sister, mother or aunt, sleeps with her or on the floor nearby. If it is a man who is sick his wife sleeps under the bed. If I arrive early enough and people are still sleeping it can take me a bit to sort out who the patients are.  And no one has a chart or anything to help me out. Because the sole nurse lives on the clinic compound she is able to keep track of everything. The problem is now that I’ve volunteered to help her out she often takes the day I’m there off and uses the few free hours to go to town. As she is on the clock 24/7 I really can't blame her. So the patients just tell me what is going on. Who has started treatment, how many doses they have received, when they are due for more fluids, that kind of thing. Anyway, after the ward I head to the next building where there are usually a few patients waiting to see me. Yesterday, there was an I&D of a hand waiting and a little kid with a pretty clear otitis media. But it got more complicated from that point on. The next was a young child, feverish with a mother who was insisting it was malaria. Up to this point I’ve been insisting on a positive malaria test before I’ll agree to treat because EVERYTHING here is called malaria and treated with quinine. For example- you stubbed you toe and fell then two days later your knee still aches? From the fall? Can’t be! Must be malaria! Two doses of quinine later (also two days later) and you feel much better. See? Must have been malaria, the quinine worked. Anyway, back to my young patient. I tested for malaria- negative. Then the mother told me that she’d given two doses of quinine already.  Back on Saturday. If it really was malaria, between now and then he should have received 6 doses and still been under treatment. But what she gave was enough to give a false negative test but not treat the disease. IF the child even had malaria-I wasn’t convinced. But untreated malaria in young kids is a killer. So I had to give something. But with lots of teaching to the mother that partial treatment is really a bad thing.
On top of everything else mondays are also antenatal days so I had several pregnancys waiting. I’ve learned over the past few weeks that women don’t really want to come to receive antenatal care but as I’ve been talking to women I’ve been encouraging them to come. The government of Uganda says they give free mosquito nets, tetanus shots, iron and folic acid supplements and malaria treatment to pregnant women. I’ve yet to see the clinic have those things to give away but I guess because I’ve been talking about it people thought I was going to provide. So women came yesterday. I did have a little iron and folic acid to give but not much and the clinic did have enough tetanus for all but I was told by the lab tec they need to receive 5 injections within the pregnancy. What? These women hardly come once. How are they supposed to come 5 times? And what kind of immunization takes 5 doses within 9 months? And most of these women have been pregnant 3 or more times (most like 8 or 9) so haven’t they received it before? I’ll need to find someone who can bring me up to speed on tetanus immunization in this country.  Mostly I did some teaching and tried to estimate their due dates. They all thought it was pretty funny that I would be trying to figure out when the baby will come. They come whenever they want right?
Anyway, that is enough writing for today. It is a challenge out there but like feeling like a nurse again.  I’m sure I’ll have some more stories next week!
My desk
The pharmacy
I'll try to do a better job next time getting more pictures

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