And so it begins...

May 21, 2012

Today we began our journey into the world of nursing in Swaziland. We haven’t officially introduced our group, so I’ll do that first. As you know, Professor Inge Corless is here with us and her knowledge and experience is proving invaluable. There are five students from the IHP Direct Entry Nursing program: Aisha has graduated with a concentration in Adult/Women’s Health; Patty and Alex both walked at graduation but have a few more credits to complete this summer before receiving their degrees in Adult/Gerontology and Adult/Women’s Health, respectively; and Martha and I are rising third year students, and both of us are in the Acute Care track.

We also want to introduce our colleagues here from the St. Louis College of Pharmacy. Katie and Belma are both in their 6th (of 6) year of school to be pharmacists. They traveled here with one of their professors, Dr. Ken. The three of them will be working with the Swazi Ministry of Health to develop a pharmacy technician program for the country, and they are also spending time in the hospital pharmacy. We’re enjoying getting to know them and we are learning from each other every day. Dr. Kevin Mallinson, a nursing professor in St. Louis, is our host here in Swaziland. Dr. Mallinson will be living for the next year as he works with a nursing school as well as local health care facilities with a focus on HIV/AIDS research.

This morning, Martha and Patty headed off to the Wellness Center with the goal of participating in outreach in one of the rural Swazi communities. The Wellness Center is specifically designed for health care workers and their families, and they have a van that serves as a mobile clinic and travels around the country providing care to those who need it. Unfortunately, the van broke down last week and the repair shop was without power today, so Martha and Patty ended up at the hospital with the rest of us. More to come about the Wellness Center in subsequent posts!

Raleigh Fitkin Memorial (RFM) Hospital is affiliated with the Nazarene Church and is considered the best hospital in the country of Swaziland. This is where we nurses will spend the majority of our time during the next two weeks. Dr. Bichong, Chief Medical Officer of RFM, gave us a tour when we arrived this morning. RFM is quite extensive, though just a brief walk through the grounds will demonstrate that it is vastly under-resourced. The hospital includes two pharmacies, an antiretroviral therapy (ART) clinic for HIV/AIDS patients (one for adults and one for children), male medical ward, female medical ward, pediatric ward, post-partum ward, labor and delivery, emergency department, a new intensive care unit/renal dialysis unit, two pharmacies, several different outpatient departments, operating theaters, and likely a few other units we didn’t see. There are also private medical wards for which patients can pay an additional fee. For example, a female patient can pay less than US$1 per day for the general female ward, or about US$40 per day for the private ward; this is a luxury that very few Swazis can afford.

Today when we toured the wards the pediatric and premature infant areas touched our hearts the most. The premature baby breastfeeding room has large glass windows through which the mothers can be seen feeding their babies. One mother held up her pint-sized baby for our group to see, and it was heartbreaking. We can only hope that this baby will receive the nutrition and medical attention he or she needs to survive. In the pediatric unit, the mothers of the children sang a beautiful song in siSwati, the local language, which nearly moved some of us to tears.

Alex and Aisha spent the day in the female medical ward, where they saw many patients with HIV/AIDS and opportunistic infections, along with hypertension (high blood pressure) and cerebrovascular accidents (CVA or stroke). More to come on the wards as we spend more time there.

Martha, Patty, Inge and I spent the day in the emergency department. Today a group of Swazi nursing students were in the ED, so it was a bit chaotic, but many of the nurses and physicians were very welcoming and willing to explain things to us as we shadowed them. Sister Ntombi, the lovely ED charge nurse, gave us a wonderful tour that helped us understand how the ED functions and the policies of the unit. For instance, there is an unlocked medication room, and only recently a daily medication log was started. In theory, every patient entering the ED must be asked their HIV status, and this information is recorded in the log book along with their name, reason for ED visit, etc. If the patient’s status is unknown, staff is required to counsel the patient on his or her right to be tested during their visit to the ED; unfortunately, we observed today that this does not always occur. For those who are unfamiliar with Swaziland, more than one third of the adult population is infected with HIV/AIDS, and 50% of 25 year olds are infected. There is a small HIV Testing and Counseling room in the ED (HTC room) where patients may be brought for testing and counseling. We didn’t see this room used today.

We did see a number of patients affected by motor vehicle accidents (MVA), which isn’t surprising given some of the fast-paced, erratic driving we’ve witnessed thus far. Two girls who were walking to afternoon classes were hit by a truck, and we helped to comfort them while their wounds were cleaned and dressed. Another man was in an MVA last fall and as a result has a suprapubic catheter, which I saw changed today (left  unsutured and “hanging in the breeze,” so to speak). Another young woman presented with burns to her forehead from a work-related injury. A huge number of children and a few adults presented for asthma exacerbations and sat in the unit receiving nebulizer treatments. We are unsure why the rate of uncontrolled asthma appears to be so high, but there are likely many factors at work here: lack of resources for regular care, lack of compliance with prescribed medications, exhaust fumes, and fumes from cooking fires and lamp fuels, among others; the approach of winter and the cool temperatures we’re currently experiencing also contribute to this.

In a very sad turn of events, a young woman six months pregnant presented to the ED with severe eclampsia (pregnancy-induced hypertension) and seizures. In the US, at six months a fetus is considered viable and can often be kept alive through the amazing technology we have at our disposal. Here in Swaziland, the best option the doctors could present to this young woman in order to save her life was to terminate the pregnancy by inducing labor. As it turns out, this is the second such pregnancy this patient has had terminated as a result of eclampsia.

Last but certainly not least, we saw a patient today who was at work on Saturday and injured her foot. She did not seek treatment, but came to the hospital today with a foot that was painful and extremely swollen. After giving pain medication, the physician made an incision in the patient’s foot and proceeded to remove a four-inch long piece of wood from the woman’s foot. Suffice it to say that none of us saw that coming. Though the patient clenched her fists and buried her head against my chest in pain, she hardly made a sound. The strength and resilience of the Swazi people has dumbfounded us all.

We don’t share these patients’ stories with you because we want you to offer them your pity. Instead, we hope that by sharing our experiences with you, we will help you to gain some insight into these people’s lives and daily struggles, to better appreciate the many things you have that they may not, and to consider both what we can learn from them and also how we as a community can help to improve this world for all who live in it.

We are working on getting photos uploaded for you all to see, but our internet connection has proven challenging. We’ll keep trying!

For those of you who are following our blog, “siyabonga” (“we thank you” in siSwati). We appreciate you taking the time to be a part of our experience here!

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