At least I knew this wasn't going to be easy

There is a scene from the movie Gone With the Wind where the character Scarlett O'Hara is working in  the military hospital in Atlanta during the Civil War. In the scene she is hot, sweaty, and overwhelmed with death and dying. After witnessing one particularly gruesome amputation, she runs out of the hospital, stating that she has had enough. Today I felt like Scarlett O'Hara in that scene. The excitement of being in an ER in Africa has slightly worn off, I've learned my way around, and I'm starting to see how little resources they have here. Don't get me wrong- this is an amazing experience, and I'm quite sure that it has been a major turning point in where I want to go in my career. But it definitely hit me that while KATH has come a long way, they still have a very long way to go. And I can't sweep in for three weeks from Atlanta and change everything, save everyone's life, and fix the problem. It was a humbling experience.

Last week I hung around the RED unit where the most critical patients are located. The care still needs a lot of improvement, but it is more organized and there are less patients than the ORANGE and YELLOW units. Today I rotated around all three of these areas, helping the nursing students assess the patients, give medications, and question the physicians regarding care. I'm not sure how to describe ORANGE and YELLOW other than large rooms with stretchers crammed in every corner in no apparent organization. It's hot, dirty, and people are really really sick. Labs may or may not have been drawn, medications may or may not have been given, hell- the patient may or may not be alive. My anxiety level was at an all time high. Every chart I opened had several things that were not addressed: High blood sugars, low blood pressures, altered mental statuses, etc. I finally had to take a step back and realize that I am not God. I cannot control the amount of resources this hospital has, and how they allocate them. But I can do my best to work with the nurses so that they can better care of patients in this environment.

I recognized that there is a bit of missing piece when it comes to the nurse's assessment of their patients. The patient is seen initially by a triage nurse, but after that there is no clearly defined assessment tool to continuously re-evaluate the patients' status. The nurses are wonderful about putting in IV lines, starting IV fluids, placing a catheter, putting on oxygen, etc. initially, but they seldom come back and re-assess, put pieces together, and trend vital signs. A lot of this has to do with the number of patients vs. the number of nurses. There are also very little resources. Everything is re-used, oxygen tubing, URINALS, thermometers. A quick spray of some alcohol and it gets passed along! But they have no choice! And they are doing a great job with what they do have. Taking this into consideration, I've started working on some assessment tools for the nurses. Just a few pieces of paper that I hope can be implemented into their charting system, or lack there of, so that they can better detect a patients' decline. More often the not, the patients are in such bad shape when someone finally recognizes it, and there is little that can be done to save them. It may be a futile effort, but I want to at least give it shot!

On a more pleasant note- I've been really enjoying Kumasi. I've had several walking tours with friends I've met here. I'm much more comfortable walking around, and have not been lost once in 4 days :)


How I first felt in Kumasi:

How I felt today:

And now for a few pictures from dinner!