Amelia inspecting a placenta after delivering a baby

 Dana listening to lung sounds on a baby

3 days in Choma...

Hello-

     
Well, we successfully finished our first week at Choma General. Overall it was a great experience. If I'm not mistaken there are about 200 beds available, and about 84 are being used currently. There is a female and male ward, pediatrics, psychiatry, theatre (OR), outpatient, ART clinic (clinic for HIV/AIDS patients) and a dental clinic. The majority of our patients do have HIV/AIDS, they call it RVD (retro viral disease) here. They go to an ART clinic as prescribed to get there medications, children and adults. One of the doctors told me that 70% of HIV patients will get TB also. In the adult wards we see a variety of diseases such as: HIV, TB, pneumonia, malaria, burns, sepsis, meningitis, measles, liver failure and various heart diseases. In pediatrics we see alot of burns in the toddler age due to lack of supervision, broken bones in the elementary school age, malaria, HIV, pneumonia, severe dehydration, malnutrition and various other diseases. We see alot of burn patients, and unfortunately, most of them have died. Yesterday 3 of us were in the peds ward caring for an 11 yer old boy burned in a house fire (both of his siblings died), we left for lunch at 1200, and he died at 1215 from collapsing. One thing that is hard for us is often feeling different about the treatment for these patients. We are taught that edema  (swelling) does not mean a patient is well hydrated, it just means the fluid is in the wrong place. With a patient who has been burned, it is priority to give them fluids because of the damage done to their cells, they are leaking fluids and their heart will no longer have fluid to pump around the body without proper hydration. However, when a person comes in with burns here, and they are swollen, the nurses are under the impression they don't need fluids, and this patient normally collapses and dies soon due to hypovolemic shock (not enough fluids in the body). As a nurse, this is really hard to handle. The doctor said that patients with at least 40% of their body burned, will not live, they just don't have the resources. 
     

The students have had a myriad of experiences. Blood draw, IV starts, catheters, delivering babies, debriding wounds, mourning with families, bathing patients, holding babies, reading X-rays, scrubbing into surgery, handing medications out at the pharmacy and tons of other stuff. The students will come back torn, frustrated and enlightened. They all have a new perspective on life and have definitely been changed, we all have been.

Bethany

post from Taylor

I survived another few days with no internet! Haha I am getting used to spotty or no internet at all. I wont know what to do with my self when I get home to high speed internet! Anyways, the past few days have been packed full of learning. Here is the play-by-play.
Tuesday:
Today we had class in the morning and then did some mock interviews in the afternoon. I rocked that interview and was told that I would have been hired if it was a real position! Yay! (Thanks dad for the help with all the prep work!)
We then headed to Zimba for the week. The house here is really nice. It feels very homey and is super clean! Tomorrow we start clinicals bright and early! I am excited to get going.
The past few days have been so hot. The heat has not bugged me up to this point, but as of lately, I am starting to be tired of dripping sweat 24 hours a day! Ugh! I am getting dehydrated sitting in one place! Haha I am so ready for snow!
Wednesday:
Well today was an exciting and fun day! I was on the peds ward and I loved it. Zimba hospital is such a great hospital. I am impressed with the cleanliness and organization of the hospital. In the morning we were given a tour of the hospital and then sent to the ward of our choice. Liz and I went to the peds ward because we wanted to work on profession development project. I had the chance to work with a lot of kids with pretty diverse diagnosis. There was Malaria, Jaundice, Anemia, Protein Malnutrition, pre/post op, and nephritic syndrome. I enjoyed assessing the kids and learning about each case. During the med pass I found an IV that was not good, so I took it out and restarted it. It was a great IV restart, I had a little trouble at first but I trouble shooted and got it in to the vain with minimal digging! That was my first IV start on a child. I think this has been my favorite peds ward, so far, on this trip.
Thursday:
Not even sure where to start! I chose to go to the out patient clinic and loved every minute of it. In the beginning we were taking vitals on everyone and practicing blood pressures on the kids. I loved being able to just sit and talk to everyone. A few of them laughed at my Tonga but I am getting better at it everyday! All the excitement started when a women was wheeled up to us in a wheel chair. She was lethargic and slumped over. Someone went to find the nurse while I started to take her vitals. Her BP and temp was with in normal limits and her pulse was about 120. The nurse told us to take her right to the female ward. As we were getting ready to take her to female ward she took a quick turn for the worse. She twitched/seized for a sec and we all jumped up. (Katana, Emily and I were the 3 students in out patient at the time.) We immediately moved to protect her head, but shortly someone (some things are a blur) said “I don’t think she is breathing. She is not breathing.” Katana jumped right into checking her pulse. After one try and not finding it we decided to move her to the ground. On the way down Katana and I both tried again to find a pulse, still nothing by the time we got her down. So I jumped right into chest compressions! Emily went running to find a bag mask and Katana did the head tilt chin lift. I made it to 52 compressions (since I didn’t have a bag mask, I just did compressions) and she started to have eye movements and breath on her own! The nurse came running in with a pediatric mask and attempted to give her rescue breathing. I calmly explain that the breaths he was given we not going in and that I was pretty sure (I was actually really sure) that she was breathing on her own. By that time someone had brought a gurney and we got her on that and they whisked her away to the female ward. I learned later that she had had a spontaneous abortion 2 weeks ago and had been bleeding since then. Later in the day she was taken for emergency surgery to clean out the uterus of the tissue left from the failed pregnancy. It was a crazy experience that I am still trying to figure out. I do not totally understand that physiology of what happened.
It was a little challenging recovering from that, but I was able to pull my self together after a few seconds! I finished the day in outpatient and then floated to peds to check on some of the patients. After we left the hospital we went to the market and, of course, I bought a new chitenge. Class got canceled so the rest of the night was left for homework.
Friday:
In the morning I rounded with the doctor. It was an awesome learning experience. It really helped me piece together the diagnosis with the symptoms, and the medications. As we rounded with the doctor we also filled the orders. So I did multiple blood draws, hung an IV bag, and watched a paracentesis. After rounds I spent sometime in Out Patient and then bounced back and forth between pediatrics and OB.
After lunch I stayed back to work on some homework while the house was quiet. Then before dinner, the power went out, leaving us a candle light dinner! We did not get any homework done because laptops were dying. So we all played games and watched a movie. I went to bed early but got up around 4 to find that we had no water. By the time everyone else woke up and discovered this, the leaders decided to evacuate. So we packed up and were out with in 30 minutes.
We are now back in Choma till we make our way home. I cant believe it is only 23 days! It is weird to be thinking about the end. I am definitely ready to go home, but I don’t know if I am ready to leave!

Taylor

alittle late...from Kat

     We have just arrived back in Choma concluding our time at Macha Mission Hospital in rural Zambia. It was an incredible experience full of heart break and joy. During our time at Macha we stayed in a guest house and we were able to walk to the hospital every morning and work in the various units.  It was so great! The hospital itself was started by a missionary and since then Johns Hopkins University has developed a Research Institute and is performing some incredible work that has almost eradicated malaria in this region. Before the institute began its research the hospital had a rate of 1,449 deaths due to malaria in 2000 in the CHILDREN'S WARD ALONE. In less than 10 years the institute has managed a 97% reduction and in 2009 there were only 46 deaths due to malaria in the same ward! This hospital works closely with medical schools and churches from the Netherlands so during our time we were able to get to know some of them and learn about the projects they have been doing. One incredible project is called the "Care House." Until recently the concept of palliative care (care for those dying of terminal illness) had not been prevalent in Zambia. The Care House was started by a few nurses from the Netherlands and in the past few years they have built a beautiful center where children with HIV can come and receive counseling, group therapy and play therapy can learn about effective HIV treatment and how to live positively with HIV. They also provide support groups, club sports, music lessons (as therapy), sewing classes and health education for children and families. This was one of the most encouraging things to see! The Care House plans on launching a full time children's ward once they get the funding for kids with special needs and those dying of AIDS and other terminal illness. This idea is revolutionary in Zambia and it was exciting to see this project take place!  Out of all the places we have gone so far, Macha has touched me the deepest and I hope we can go back there before leaving Zambia. For two weeks our team had been commuting there for clinical and then we stayed there last Sunday through yesterday. Over the course of those few weeks God opened up doors for me to build friendships with the nursing students, staff and patients. I was able to share the gospel and pray over patients - I am learning that prayer has the ability to transcend language barriers. Even though we could not understand each other – I found both myself and the patient were encourage and blessed through prayer. During the week I would go visit some of the patients when I was not working. I saw new life as we witnessed several births in the maternity ward (many of our students were able to deliver babies! This experience, though amazing, confirmed what I already believed to be true: I have no desire to be a labor and delivery nurse...ever. haha).  I saw life-saving surgeries. I was able to do multiple night shifts and assist with surgeries, do IV's, give medications, put down NG tubes, run malaria and HIV blood draws, participate in rural health clinics and clean many wounds. The staff was welcoming and we were given a lot of freedom to perform skills. I have seen culture where families are dedicated to caring for their sick and elderly.   I also witnessed and experienced some of the most horrific, heart-breaking, and severe human suffering I have ever encountered. I feel as though I saw glimpses of heaven and hell during my time in the hospital and I am forever changed as a person, a believer and a nurse because of what I experienced. One day I had the opportunity to be with an 18-year old girl as she went through labor and eventually surgery as she had to have a c-section. This baby would have been healthy but due to the negligence of a few nurses, lack of resources and poor surgery outcomes it took 10 minutes to resuscitate the baby girl in the OR and the child now has permanent brain damage and a seizure disorder. Several of the students on our team sat with the baby through the night shifts that followed and monitored her as she seized over and over again. No one else would do the assessments and it seemed as though they were just waiting to see if she would die.  I saw a 2-year old who was poorly sedated cry and drool as he was strapped to the table all the way through surgery because no one bothered to check and see if his IV was working when they gave him medication. Despite the meds they gave him halfway through surgery, he did not stop crying until he was sutured closed and sent back to the children's ward. I saw multiple burn victims be denied any pain medication before being debriding (scraping the burns to remove dead skin and infection). I had to clean and pack a gaping amputated leg stump on an elderly woman had been given a small dose of tylenol a few minutes before. I cared for many children and adults wasting away from TB, AIDS and malnutrition and I was entirely helpless to do anything to relieve their suffering and that was the most awful feeling.  Can you imagine what it is like to look into the sunken eyes of a child who looks like a skeleton corpse or a child with a bloated tummy whose skin is peeling off because of malnutrition when you are full from a good lunch? I watched a three year old have his broken femur set without pain medication. Many times there would be deaths in the male/female wards and the women would go and wail and roll around in the dirt to show their pain and loss. I saw multiple children and adults with serious burns covering most of their bodies – for some they will make it and others will not. My savior complex is being broken apart and it’s the most painful, yet holy thing to experience. It sounds strange but I do not know how else to explain. My heart breaks for the suffering and I have nothing to give them other than a compassionate touch, my prayers and my hope that this is not how we were meant to live and that Christ is coming again to make things right! No more starvation, grief, pain, tears, infection...wrongs will be righted and all because Christ had mercy on us and endured the ultimate affliction.I am still figuring it out...if you could pray for each of us on the team as we process things during these last four weeks. It is a strange phenomenon to have your heart so fulfilled and so crushed at the same time; to witness those suffering physical pain who are still praising God. Sometimes I am not sure yet what I am going to do with all I am learning but I know that God has called me to be here and to be experiencing these things and I am so glad He did. Please pray for physical health and protection for us. We are on the frontlines and our bodies are encountering a lot as we are caring for those with tuberculosis, HIV/AIDS, Meningitis, sepsis and a host of other things. One of our girls got a dirty needle stick but thank God the patient was HIV negative. Yesterday as I was finishing up a difficult night shift, I had an active Tuberculosis patient cough and vomit on me as I tried to help her take her medications (TB is a highly contagious disease spread by coughing).  In that moment, God just gave me such a peace: “Love like my son Jesus did and do not run away from the contagious and those who need my loving touch.” As I walked back after my shift the sun was coming up and it was a beautiful, clear morning. When I reached the house I found I was locked out of my room so I sat outside and opened my Bible to where I had been reading in Isaiah..nothing could have been more perfect: “For behold, I create new heavens and a new earth, and the former things shall not be remembered or come to mind. But be glad and rejoice forever in that which I create; for behold I create Jerusalem to be a joy, and her people to be a gladness…no more shall be heard in it the sound of weeping and the cry of distress. No more shall there be in it an infant who lives but a few days, or an old man who does not fill out his days” Isaiah 65:17-20. What a comfort and a joy. Thank you for being such a present encouragement and prayer support to me as I continue on in this experience. It means more than you will ever know.I hope and pray that God blesses you and encourages you today!

Leza Amuleleke/God Bless you!Kathryn

Zimba

Good Morning!

I am writing from Choma while the students are currently in class. We have had Jerilynn here with us for a little over a week now and things have been going great. She is teaching Leadership and Management and all that entails. Today after class, lunch, than more class we will be packing up one more time and heading to Zimba where we will be staying until Sunday afternoon. While we are in Zimba we will not have internet, so don’t be worried if you don’t hear from your child. We will be having some class time while in Zimba as well with clinical every day. The students are busy working on their leadership projects, and they have some great idea.  The great things about these projects are that the students can really make a difference. They can identify a problem or weakness that they see in the clinical setting, and implement a new strategy to improve it. We are really encouraging the students to not just think of these as another school project they get a grade on, but a way they can make an impact on their current community.

Yesterday was the Zambian Independence day, and we were downtown to celebrate with our fellow Choma residents. It was definitely a cultural experience. There were traditional dancers, street vendors and intense HEAT. It has been very hot here, upper 90’s to 100’s. As soon as you take a shower, you are sweating again.  Since we have arrived back in Choma we have had another team here from Hamburg, N.Y. They are a church group who has been visiting trusts. They have been really great to get to know and we have enjoyed spending time with the last few days, they left this morning. When we get back to Choma this coming Sunday, there will be another team here so we will be sharing out living space again. The students are doing well, we have only one who has not been feeling well, but is on the mend with all the great nursing care she has been receiving J it can be helpful yet slightly annoying to have so many nursing students/nurses who are ordering you to rest and drink fluids. I will update you all more when we come back Sunday, hopefully it is a great experience, we are very excited. Right now the three of us (Jerilynn, Judy and I) are going to be conducting mock interviews for the students to prepare them for real job interviews.

On a side note we just finished interviewing the students, I got to play a manager who does not make eye contact and is very abrupt and uninterested…kind of the highlight of my day J They handled me well.

Sincerely, Bethany

Macha Memories

These past 3 weeks in Macha have been amazing. It has been great to meet nursing students and experience God’s power. There were many times where it was very evident God was in control because people who should not have gotten better were slowly improving. It was difficult not speaking the language but the patients and family members were gracious. It was difficult not being able to provide pain relief or explain myself. I was most heartbroken for the children who came to the HIV/AIDS clinic. It is so unfair they have this awful disease when they didn’t do anything to cause it. There is a women who has 3^rd degree burns on 54% of her body and helping with her wound dressing was difficult. Please pray for her as she has lost 2 children as well. She is a beautiful woman and has a difficult recovery ahead of her.

I had a fun time playing with a little girl in pediatrics and rounding with the Matron, Miriam. The community clinic was cool and the students taught a lot of valuable information. I was able (through a translator) to speak about Malaria. The best part was delivering a baby boy on Thursday morning after waiting with his mother all night! I wish I had been able to communicate with her because she looked scared and family members are not in the labor suite. It is also amazing the mother leaves after 6 hours if there are no complications and she did not have a C-section. The midwife said “Zambians are strong you should marry an Africa to have strong babies.” This morning’s plane ride was a treat. We head to Zimba next week and then are back in Choma for the last three. I cannot believe we only have a month left! It does not seem like November because it keeps getting warmer and warmer. Thanks for your prayers and encouragement!

Katana

Hello from Macha!

Each M, W, F we have been traveling about an hour to a mission hospital in a town called Macha. This week, we are staying at their “guest house,” (like a hotel) until Friday afternoon. Internet is limited, that’s why I haven’t been updating. I have so many stories I could tell you and different emotions that have been felt during this time here, but my mind nor fingers have enough energy to write it all down to you, so I’ll do my best to summarize and hopefully later the students can give you a more individualized story.

I think it would be safe to say the highlight of most the students experience has been delivering a baby. Almost every student (including myself last night!) have delivered one all by themselves, with another nursing student assisting, a Zambian nurse instructing and myself standing by. However, there are SOME stories of students doing night shifts, and babies being delivered into their hands unexpectedly with no nurse ;) I believe Taylor who has never even seen a birth, delivered her first baby last night all on her own, while Emily ran to find a nurse, when they came back the baby was in Taylor’s hands, cord still attached and all!

Some days have been rough. I believe we really have left our blood sweat and tears here in Zambia. It’s very hot right now. I personally opt to take cold showers just to cool off at night. We sweat a lot. There are frequent tears. We see adults, children, and infants dying. Sometimes all we can do it pray with them because without proper resources there is not much that can be done, but we can always be a presence in their life. The students have grown so much. Everyday there is a reason to be frustrated, confused and sad, but we are all learning together how to deal with them. Prof Pam Leslie is back at home now, and we have prof Jerilynn Spring who is  nurse practitioner. The students love having her here, she quizzes them and keeps them on their toes. There are many fun experiences the students get to enjoy while they are here too that are not all medical related (I will let them fill you in). It’s safe to say, things are going great! Hope you are enjoying your fall, we are all extremely jealous we don’t get to enjoy the falling leaves and pumpkin spice lattes! (okay that might just be me ;)

Sincerely, Bethany