Goshen: A Gift from God

“A great name among men is as letters traced in sand, but a spotless character will endure to all eternity.”

~EGW, God’s Amazing Grace, p. 81~

 

I first met Goshen when she was about 8 months old.  She was admitted onto the pediatric ward, from emergency, with a diagnosis of pneumonia due to pulmonary hypertension and bad heart.  She was being breastfed at the time and the trick was to maneuver a way in which her twin sister, Shiloh could also breastfeed, without getting sick herself.  After about two weeks, Goshen was off oxygen and fit enough to go home. 

About six months later, our dear Goshen, was back in the hospital for the same thing.  She had been seeing the cardiologist, Dr. Priester, for her heart condition and, along with Dr. Varona and her parents, we were working on a way to have her see a pediatric cardiologist in South Africa or India, for further assessment and possible treatment.  Just like when she was admitted before, even though there were no bilateral crackles in the chest or fevers, Goshen’s biggest issue was weaning her off oxygen.  Other than that, she was pretty much a happy baby. You could walk into the room, find her standing, talking, eating and playing and her oxygen saturation would be 50-60 percent (she’d manage to remover her nasal cannula)… her lips would give her away (they’d be a little blue and dusky).  She learned to cope with her hypoxia. After about two and half to three weeks, she was discharged. 

A year had passed since I last saw the spunky and energetic, Ms. Goshen.  I remember coming into work that Monday morning, receiving the report and saying, “I know this little girl!” (Her name was too unique to forget and I loved it!) Yet, this time, when she was admitted, she was worse.  It seemed as if, she was not going to make it through the night or at least before the week was out.  Considering Goshen’s current condition, medical history, and council from the pediatric cardiologist, Dr. Kennedy, even Dr. Varona prepared the parents for the worst.  However, by Thursday, Goshen had improved drastically.  By week three to four, after not seeing any change in her ability to be weaned off oxygen, Dr. Varona decided that was most likely an issue that was chronic and would not be easily remedied. Therefore, she’d have to go home on oxygen. 

Goshen faced other challenges, as the days tarried.  Her health seemed to be on a see-saw; teetering up and down, over and over again.  She’d develop fever or have to be on high oxygen flow; not to mention, the fluid in her lungs or the wheezes never seemed to really go away (it just wasn’t as much).  We used the maximum dosages of bronchodilators, vasodilators, medications to decrease the pulmonary hypertension in the lungs, and increase the contractility of the heart. We exhausted every option when it came to the battling infections…

REGRETS

Sabbath morning (less than two weeks ago), I had made an unannounced visit to the pediatric ward to see Goshen.  I had baked some banana nut muffins, accompanied by a homemade card.  As I entered room six and stood before the last bed near the window, I remember seeing how happy she was.  She was standing on the bed, playing, while looking at the window, people watching.  She seemed to be in her own little imaginary world, content at being 2 ½ years old.  I said hello, played with her a bit, and had a word of prayer, and thanked God for His goodness and Goshen’s will to live. She had beaten so many odds (That day she was on 3.5 liters of oxygen, instead of the 13.5 I saw her on that Thursday). I was happy.  However, I felt as if the Holy Spirit was prompting me to go ahead and take a picture with my little friend, because I may not have another opportunity to do so.

I never took that photo.

Regret. 

Goshen is gone today and all I have are memories. I’m heartbroken.  Yet, I am grateful I was her nurse those almost 2 years ago and the same nurse before she left this world 2 years later.  I will remember the good times and those funny and intimate quiet moments that she and I shared. I will remember the times we smiled together, played together, and how she finally saw me as her friend; someone she could trust. 

It’s very difficult to write this little memoir without crying.  She had such beautifully contagious spirit, that she affected the lives of all she came in contact.  From housekeep, to kitchen staff; theatre, the hospital chaplain and orderlies; from nurses (old wing/new wing/ICU), to lab technicians, doctors, and her fellow pediatric inmates J ; Goshen was our longest staying patient.  She made friends with all and she will be greatly missed.

As I stood with Mrs. Chaputera, transporting her tiny body to be sent to the College of Medicines mortuary, I couldn’t help but notice all the love that surrounded this little girl.  I had never seen so many people gather outside to pay their final respects.  Parents of other children on the ward, who had a chance to befriend Goshen, as well as nurses from other areas of the hospital.  Goshen will be missed, but not forgotten.  I can’t wait for the day to be reunited with her and others we’ve lost along the way in heaven.  Death is but a sleep!

Even so, come Lord Jesus!

“A great name among men is as letters traced in sand, but a spotless character will endure to all eternity.” (EGW, God’s Amazing Grace, p. 81)

 

 

Moments Like These

 “Sons [and daughters] are a heritage from the Lord, children a reward from Him.” 

~Psalm 127:3~

I’m not perfect. I must admit that I don’t always know what I’m doing. I’m not always patient, nor do I display the best poise when relating to others…especially at work. Sometimes I just can’t wait for the day to be over (it has more to do with the people I’m working with…sadly)! However, despite everything I know I’m called to be here in Malawi and I do my best to enjoy the unique/priceless experience.  When I’m there with the kids on the pediatric ward, I make it my duty to do my best; to give that child my all.

One good thing about working in a small hospital is that often times you bump into the same patients and their guardians when they return for checkups (Sometimes I’ll see them in town… Blantyre is a small city).  I could blame in on my “Americaness” as to why they are so happy to see me or why they thank me over and over again for the care I gave their child; as if I was the sole person who helped restore their child to health. They comment on how I was “so nice” or that I was “always there”.  Yet I can’t take the credit. I always say that it was a team effort; the doctor(s) and nurses all played a role.  It’s God’s love shining through.  It’s in moments like these that I forget the fatigue and the various frustrations, and I say to myself, “It’s all worth it! I love what I do. I love being a nurse.”

The other day I was able to spend some quality time with Idah, one of the young mothers on the unit.  Her daughter, Angel, was born at 28 weeks and it was their last night in the hospital before going home after a 6 week stay.  I was busy the entire day with my 4 patient load (I’m horrible, I know it! Can barely handle 3! Novice indeed!!!) and promised Idah that I’d spend time with her and the baby doing Kangaroo Care .  However, the only free I had was after work.  So when the shift ended, I quickly ran home, washed up, and changed into some “germ free” clothes and headed back to the hospital. 

It was nice. Since I wasn’t in uniform/on duty, I wasn’t pressed for time and my attention wasn’t divided on other patients. The moment was intimate.  As Idah held the naked Angel to her bare chest, she talked and I listened. She talked about her first impression of me.  How she thought I was stern and mean, but how it quickly changed when I quickly seemed to be “always” there in those critical moments(I guess I tend to have my game-face on when I’m working…I need to lighten up! J)… And many of the times Angel wasn’t even one of my patients! I listened to how, not only grateful she was for the care, but for the miracle and grace God has shown her family.  Angel is her first child and, as a brand new mother and newlywed barely celebrating her 1 year anniversary, having a baby born 12 weeks early was a lot to take in!

Idah’s from the northern part of Malawi and was on holiday when she came down to the south to see her husband, Ndiza.  Ndiza left only a few days later for a project in Mozambique, when the bleeding and lower abdominal pains started.  Alone, save for one older sister, she had to borrow a neighbor’s car to drive herself to the hospital.  Within 24 hours after admission, the tiny 900+ gram baby Angel was born. 

Idah described how scared she was; how she cried herself to sleep every night.  How she didn't think she was strong enough and thought her baby would die (Malawi's infant mortality rate is #9 in the world!).  She told herself Angel was just way too small!  However, Angel is a fighter! As each week passed, she became stronger and stronger. She no longer needed intravascular fluids.   She no longer needed her nasogastric tube and could now be fed with the bottle; then the breast. She was able to sleep in a bassinet, instead of the incubator (I still remember when they Idah and her husband got to hold Angel for the first time! It was so emotional!).  Her little lungs started to mature, to where she was weaned off oxygen completely (that actually happened when I was caring for her!)!  She even has a preferred side she liked to sleep on! Now she’s smiling in her sleep. God is sooo AWESOME!!! The best part about this is that Idah and Ndiza are able to see and experience God’s goodness and mercy! We are all humbled, especially when we consider the number of term babies , over the last 6 weeks, who didn't make it (little Aryan was one of them)!

In those 20 minutes of uninterrupted time, Idah and I learned a lot about each other. It’s in those rare moments that I thank God for calling me to this special work.  He has allowed me to see glimpses of how sweet heaven will be. He uses me despite all my many short comings.  He’s merciful, gracious, long-suffering, faithful and just plain old amazing! I’m humbled.

I still continue to pray for the precious little ones that come through my care.  Many times, because I’m human, I forget their names, but their faces I cannot.

• Fatima (Upper respiratory tract infection/Croup/malnutrition)…..1 y/o
• Aryan R. (Sever Asthma/Pneumonia)………..2 ½ months; passed on
• Michelle (Pneumonia with a PDA)…9 months; heart surgery July 7, 2013
• Zaninge (Aspiration pneumonia/seizures/MRCP)…....5 y/o; passed on
• Josefina B. (Severe anemia/HIV)…………11 y/o; from Mozambique
• Charles (B cell Lymphoma)……...........……9 y/o; from Mozambique
• Wantwa S. (Sickle Cell Crisis)…………….....................…….8 y/o
• Shamma (Appendicitis /Appendectomy)..................................10 y/o
• Asante (Typhoid fever)……………………..................…… 10 y/o
• Forever and the gang (Malaria +’s)…………..............8 y/o & 7 y/o
• Angel Nyirenda (premature, 28 wks)……..6 weeks and counting! J
• And many, many more!

Tu hijita,

Joya

Princess Josefina and I. After 3 blood transfusions, looking good!

Ndiza (lt.), Idah (rt.), and baby Angel getting ready to go home!

Angel and the proud auntie Julie :)

In this picture Angels about 1.45 kg (3.2 lbs), but she's eating
and sleeping like crazy! No oxygen therapy

Awake and stretching! :)

Death of an Angel

“Ele enxugará de seus olhos toda lágrima; e não haverá mais morte, nem haverá mais pranto, nem lamento, nem dor; porque já as primeiras coisas são passadas.”

~Apocalipse 21:4~

Today I received news that one of my little angels, Aryan Rahaman, died Wednesday evening.  He was a beautiful 2 ½ month old baby boy who came to Blantyre Adventist Hospital (BAH) two weeks ago from Mozambique.  I first met Aryan in the Emergency Department after doing my rounds around the hospital, trying to make myself useful. That particular day that I came on duty was very slow; 9 patients in the entire hospital, including him.  He was hooked up to the portable oxygen tank at 8 Liters per minute (he was suffering from severe respiratory distress... trachial tugging, substernal retractions, wheezing...); a machine monitoring his oxygen saturation and heart rate, which beeped like crazy; and an intravenous drip, by gravity... (I fought to get an IVAC machine to accurately regulate the rate of infusion so the poor little guy wouldn't suffer from overload! Folks couldn't spare 1 of the 3 unused and working ones, for fear it would get damaged … I practically yelled EXPLAINING how we had a critical patient who needed it NOW…So what’s the problem??? And you’re worried about your equipment… Uhhh!!!)  After being exam pediatrician, the x-ray, blood tests, STAT doses of IV medications and nebulizations, Aryan was diagnosed with aspiration pneumonia and cardiomegaly (the cardiac issue was resolved after an ECO, done by Dr. Priester, showed nothing wrong).  We later concluded that the aspiration pneumonia was due to the fact that he suffered from severe asthma (his parents are asthmatic) and mostly likely had an acute broncho spasm when feeding.

Aryan’s regiment included vital signs, taken every 2 hours; a strict course of antibiotics, nebulizations (nebs), random blood sugar tests (because he was initially NPO= nothing by mouth), strict I & O’s (measuring/weighing what went into the patient; including feeds, IV fluids, IV medications, etc. and all that came out of the patient; includes waste, blood, vomit, drainage…), chest physio, suctioning, you name it! We even cut out dairy, when he was able to eat (milk and dairy tend to worsen asthma due to the increased mucus production).   I don’t know how many times I got up, just to check his alarm! I can say it was a constant prayer.  You worried when he started to desaturate to the 70’s and 80’s or when his heart rate shot up above 200 (sometimes around 220-235… due to the side effects of the neb treatments and his illness).  You worried at night, when the temperature dropped (the cold air exacerbated the acute broncho spasms… there is no thermal regulators in the hospital, save blankets or a closed window… but what do you do when your kid as a fever or 39.1°C and he’s wheezing?). You worried when he had a sudden spike in temperature.  In the two weeks that he was at BAH, I spent so much time with Aryan and his family, that I even memorized the hospital admission number! I just knew, each time I’d report to work, I’d be assigned to them/him.  He knew my voice. Aryan was my little boy.

I had a front row seat to the tenderness and genuine love both the mother and father have for their child. Save for a sister-in-law from the dad’s side also living in Mozambique, the family had no other relative living on the African continent.  Everyone else lived in Bangladesh. The kisses, rocking to sleep, doting, questions, tears, and prayers; they are universal. They barely slept!   Though at times their requests and expectations where sometimes overwhelming (more so out of fear…at first, they were scared to touch Aryan, because they felt they might hurt him…), the Rahaman’s and I really bonded.   They trusted me and sincerely appreciated the care and attention I gave their son.  All eyes, hopes, and prayers where on precious baby Aryan.

Sunday, April 21 would be my last time holding Aryan in my arms.  He had improved so much and I could see the joy and relief that were on his parents’ faces.  They were even becoming more comfortable with his care and help participate. He wasn’t out of the woods, by any means, but he was no longer on high flowing oxygen and was tolerating blow-by oxygen at 2 liters per minute well.  He also had only one daily antibiotic and  one neb drug, Salbutamol, every 4 hours (he had 3 and was nebulized almost every 2 hours).  After the neb treatment, we’d see how long he could tolerate being on just room air.  The longest, on my watch, was 7 minutes (his parents claimed as long as 30 minutes, but I beg to differ).  He was now smiling and cooing again.

The problem:

BAH is a private hospital.  About 50 percent of the patients have health insurance; the other half pay with cash.  Aryan’s parents where cash paying customers and his two week high dependency stay became too much for them to afford (the bill was an estimated 1.65 million Malawian Kwatcha; equivalent to purchasing a really nice used car in the US… keep in mind, 80 percent of Malawians live on less than $1 a day… a slightly higher percentage than Mozambique). Hence, the doctors worked diligently to organize ways in which we could still manage his dependent condition and help ease the financial drain it was causing on the family. We thought of everything, from having them purchase their own oxygen tanks and medications; to hiring a home nurse while they stayed in at a friends’ house here in Blantyre.  Since Aryan just needed oxygen therapy and neb medications, the final decision was to transfer him to a hospital in Mozambique, near the border.

Aryan and his family left BAH Monday afternoon around 1 p.m. I was off duty and didn’t get to see them leave.  I arrived at work Tuesday happy to see the room, where the family once occupied, empty.  Aryan had improved and was stable enough for transfer. However, later that afternoon, we received a call from Mozambique stating that the parents were returning because they were not satisfied with the care there and it made them worry.  That day it was extremely busy.  Most of the beds were full and so was the nursery. I have to admit, I was hoping he would arrive after my shift was over. Just my “luck”, he didn’t show.  I figured, I’d see him Wednesday morning.  No Rahaman’s… “Perhaps the decided to stay in Mozambique because of the long drive?” were my thoughts. “After all, they won’t have an ambulance to escort them this time from Mozambique to Malawi.”

The News:

Thursday, the head of pediatrics and the medical council at BAH, Dr. Varona, pulled me aside and asked, “Did you hear about what happened to Aryan?” Immediately my heart sank. I didn't want to think about what she'd say next, though I prayed what I was about to hear wouldn't be true.  The news of his death stung and my thoughts raced back to the parents, especially the mom (she suffers from depression).   Apparently, Aryan did arrive in Blantyre... just to the free government hospital, Queen Elizabeth Central.  When he arrived his oxygen saturation levels were in the 50’s and 60’s.  The doctors did an ECO, confirmed that there was nothing wrong with his heart, and were about to place him on CPAP(continuous positive airway pressure—used to help treat his severe respiratory distress), when he had a cardiac arrest.  After CRP with rounds of epinephrine for more than 30 minutes, Aryan was pronounced dead.

My heart is heavy and I think of the parents and Aryan’s 5 year-old older brother.  I think about the emptiness and the unexplained answers the parents must have (because of the language barrier, it took them a while to understand that their son had died).  I think of the fact that they are so far away from their native country, Bangladesh.  They have no blood relative to visit them in this time of tragedy. I think of You… I think of heaven. One day, I will see baby Aryan again.  He will be healthy and his parents will no longer have to worry… but at this moment, I pray that You, oh Lord, will wrap Your loving arms around those that are grieving and give them hope and peace.

Tu hijita,

Joya

“And God shall wipe away all tears from their eyes; and there shall be no more death, neither sorrow, nor crying, neither shall there be any more pain; for the former things are passed away.”

~Revelation 21:4~

30

“For I know the plans I have for you, declares the Lord, plans to prosper you and not to harm you, plans to give you hope and a future.”

 ~Jeremiah 29:11~

I’m 30 today… I’m blessed to have made it thus far and just to be alive, but to be on the mission field… in Malawi… on the Sabbath! I remember an episode from “Mad About You”, where Jamie (played by Helen Hunt) starred into the mirror to “watch” herself turn 30 as soon as it hit midnight.  I found myself doing something similar; looking at pictures from last year and comparing them with the mugshots I took just a few hours ago on my Kindle… perhaps I’ll see some notable change in the way I look J (I’m hoping I take in my mom’s good genes of youthfulness).

March 2, 2012

Someone asked me today, “How does it feel, now that you’re 30?” as if there is supposed to be some sort of magical realization or superimposed wisdom of enlightenment (Nirvana).  Don’t get me wrong, I’m not saying that was a dumb question!  I ask my little sisters the same question at every birthday and I asked myself the same question. Do I feel any different now that I’ve exited my 20’s and entered my 30’s? Not really! I still feel like the same old Jewel…. Honestly, it’s hard for me see myself as a “30 year-old”.  I mean, I understand that I’m now 30 chronologically, but I still feel like I did 24 hours ago when I was 29. I think the only thing that “feels different” now that I’m “the BIG 3-0”, is that I’ve become more aware/reminded that I’m not getting any younger (especially in relation to health… and it doesn't help that I’m a nurse either!). I’m also reminded that I’m “missing out” on the definitive markers that come with adulthood (as defined by society & culture).   Last night, when speaking over Skype with my 17 year-old sister, Missie (whose b-day was this past Sunday, Feb. 24), my father called in and jokingly asked, “How does it feel to be a 30 year-old virgin?”  So, yes, I’m aware that I still haven’t met Mr. Right (not to say that I've had a dry spell in my social life); I don’t have any children (save the ones at the kids program, where I volunteered in Cali, or my little sisters J ); I don’t own a home or any large sums of money stashed away somewhere; I don’t’ own a car (the one I drove was under my father’s name)… I own nothing! I’m a single female nomad; naked I came, naked I shall return!

However, if someone were to ask me how I felt between the time I was 20 and now, I’d say a lot has changed.  I’m a lot more focused and grounded.  I know what I want and my purpose… most of the time! J I've changed, not just physically (I mean things don’t work or fall the way they use to J ), but spiritually, emotionally, and mentally.  When I tell people my new age, especially in Malawi (and within the Adventist circle) where most women are married by 22 and are working on their 2^nd or 3^rd child by the time they’re my age, the first question’s, 9/10 is, “Are you married?” My answer, “No”. “Do you have a boyfriend?” My answer, “No”.  Hence, the quest of “finding” me a husband (and, if they’re Malawian, that usually means themselves or a relative), as if my life isn't complete without a man or I’m more of a woman or have more value.  I don’t know… I can’t blame them; again, I’m guilty of doing the same thing…. And we will continue to do so at every stage of life.  You’re single, “Are you seeing anyone?” You’re dating, “When will you two get married?” You JUST got married, “You pregnant yet?” You’re still in your 4 to 6 weeks of recovery, “Thinking about having anymore?” And then begin the questions of grandchildren... and so on and so forth…. We are social beings and we take great joy in the milestones of others. 

29 3/4 :)

Yet, I think the most hurtful thing someone could say and has said/hinted to me was that I am at this point in my life (“single” and “childless”) because I’m selfish and that I’m “career chasing”. That I chose my career over family (or  I get the, “You’re too picky!”… I’m sorry if I don’t want to be with someone who has 3 children with 3 different women… I’m sure he loves Jesus and has “changed”… I’ll  just let someone else take that blessing… he’s not someone I prayed for). I’m not going to go in depth, but I will say that there is nothing wrong with goals (Proverbs 29:18).  As for me, my focus isn't on my career; my focus/aim is to please my Savior and follow Him wherever He leads me (Revelation 14:4) and in His time, when He sees that I’m ready, He’ll bless in that department.  I just need to be patient and wait (though, I have to admit, it can be challenging sometimes!). 

I look over the past 10 years of my life and seen how God has blessed me to see and experience so much.  God is faithful and ALWAYS been there for me. I could see how His loving hand provided and took care of me when I faced tough challenges. Through following His leading, I've visited 10 different countries (some of which I've been to twice); I've been blessed to work on the mission field in the US where I've visited innumerable states/cities, sharing hope with the despondent and making friend for eternity;   I taught for two years; I earned two degrees… to further my skills to work on the mission field.  However, the most amazing thing I've seen God do in this past decade is to see how He used my mustard seed faith to inspire my family to have a closer walk with Him.  For this I am grateful. I am humbled and honored that He would consider me faithful to place me in the ministry!

30… what is that to eternity?  He’s only just begun!

Tu hijita,

Joya

March 2, 2013

Orientation

“If any of you lack wisdom, let him ask of God, that giveth to all men liberally, and upbraideth not.”

 ~James 1:5~

I began my first week of orientation at Blantyre Adventist Hospital (BAH) last week Thursday and my current location is on the "Old Wing".  My interest is in pediatrics, however, because BAH only has 4 pediatric beds (if that number's exceeded they'll stick them on another unit), Old Wing is also combined with obstetrics and gynecology.  Though much quieter and less hectic than the large government hospital down the road, Queen Elizabeth Central (nurse to patient ratio is somewhere around 1:35 or 1:40), it can become very busy and I can feel as though I bit off more than I can chew...especially as a newly graduated nurse!

BAH is one of the two private hospitals that serve the 700,000 population of Blantyre (the other is Mwaiwathu—phonetically <my-wah-too>).  It’s a Type 4 institution under SDA General Conference Policy… meaning it’s a self-supporting institution that doesn't receive any church subsidies. It was founded by an American couple, Dr. Elton and Dr. Rheeta Stecker in 1974, as an offspring of Malamulo Hospital to help raise revenue for Malamulo Hospital operations. In order to generate enough income to cover expenses and pay salaries in a very unstable economy, BAH tries to provide quality facilities and specialties that are not only offered at competitive prices, but that are unique to the country.  For instance, BAH houses the only cardiologist and head and neck doctor, and it also has one three OB/Gyn doctors in the country.  Other departments include, a 7 bed adult intensive care unit (there are only 2 other hospitals with ICU’s… but their bed capacity is less than that!), oncology, infectious disease, pediatric, outpatient clinic (it’s main operation),  2 operating theaters, dental clinic, optometry (I should have got my glasses here!), bakery (the bread’s A-MAZING!), and much more!  BAH caters more towards the middle and upper middle class clientele, who travel from various parts of the country to, even from neighboring Mozambique. It does pretty well for a small 40 bed hospital!

So, like I mentioned before, in comparison to Queens, I have it pretty nice… and other international volunteers are not shy of mentioning that to me, after I tell them I’m working for the "Adventists" (that's our nickname)!  However, it still isn't the US and there's lots of room for improvement. That’s why I’m here.  Don’t get me wrong, as brad new nurse and as someone coming from a country that has EVERYTHING at ones disposal, I have a lot to learn! For instance, I’m still learning how to juggle timely medication administration, assessments, and documentation on multiple patients.  Even with passing boards the first time in just 75 questions (the minimum is 75 and the maximum is 265 questions!), receiving a bachelors of nursing degree in 2 ½ years, making Deans List every quarter, or graduating nursing school with a 3.6 GPA (NOT trying to brag… just emphasizing a point!), there are many days when I feel like I know nothing!  There are diseases/illnesses I've never heard of. For example, today I learned of Black Water Fever.  It’s basically hemoglobin that’s released into the urine after an adverse reaction to the drug Quinine (Quinine is one of the primary drugs used to treat malaria).  I have to also relearn the medications and medical abbreviations , because all of Malawi is heavily influenced by the United Kingdom (i.e. FBC= full blood count, instead of CBC=complete blood count).  I keep wondering how long it will take for me to become comfortable in connecting the dots...the signs and symptoms for “this” is “that” and this is how you treat it.... I know, it will come with time... :)   

So, being that I am again in the position of learning, what kinds of the things am I learning in my orientation process? For one, I am learning the value of the “Systems Model” form physical assessments.  Using the systems approach, when giving report/hand-over, helps the nurse understand everything that is or isn't going wrong with the patient by looking at all the major systems of the body (ie. Circulatory, respiratory, integumentary, etc).... Not particular value here... <sigh> I miss that! :-)  I've learned, from the moment I landed, that due to the shortage of doctors, nurses are expected to do more... including deliveries.  I've grown tired of explaining to Malawian nurses why I am not a midwife when I have a bachelors degree! Paper charting still isn't my best friend. I was spoiled in the States with the computer! I’m now having to write down everything descriptively, praying I’m the whole time that I’m spelling correctly!  I’m also learning some innovative techniques on "improving" quality patient care (some are safe and then there are some that are not so safe :) ), especially when things are in short supply… which is the story of Malawi’s life! And, one of the most valued lessons I’m learning, not just in orientation, but in the country of Malawi, is the value of community.  I've witnessed very few people suffer alone.  The old African proverb of, “It takes a village…” proves true to its name! For example, when someone dies in hospital, the community comes out to grieve with the family.  At Queens, every time there is a death (sadly, which was often), you can hear a harmonious choir of strangers singing hymns to comfort the bereaved family members.

Like I said, I’m still learning.  I haven’t arrived.  Yet, I know, because God has placed me here where I too contribute knowledge and skill. I know He will give me wisdom to do that which is required.

Tu hijita,

Joya

Looking through the charts

One of the fellow BAH nurses and I on duty... btw, one of the things Africa must improve on  are these ugly WHITE uniforms!!! Through back from the 80's! Yuck!

Assessing one of the newborns under the infant warmer 

For further information on Blantyre Adventist Hospital, visit: http://www.bah.mw

Lesson of Contentment

“Not that I speak in respect of want: for I have learned, in whatsoever state I am, [therewith] to be content.”

 ~Philippians 4:11-12 ~

I've been more than blessed while living in Malawi these past 6 weeks. My first introduction to international missions and global health was with the National Association for the Prevention of Starvation (NAPS- AWESOME ministry www.napsoc.org), living in tent in a rural village in Zambia.  There was no electricity and no running water, so when it came to toileting, you used the “squatie” (an outhouse with a hole in the ground; hence the name J) and prayed it was either really cold so the flies and smell wouldn't get you; and on a good day, depending on the water situation (there was always a water situation), we bucket bathed (for the other days we used baby wipes…we all ended up smelling the same by the end of the 5 ½ mission J).  We used the same coal as those living in the community and cooked our food outside on a brazier.  Yes, by most people’s standards, “We roughed it!”  However, these were some of the best and happiest days of my life!  As in Zambia and many countries that followed (India, Zimbabwe, Madagascar, Botswana, and Guyana), living simple and among the people, I not only learned to depend on God, but I was able to experience contentment on a whole new level!  I formed friendships for a lifetime and from all over the world! I gained a deeper appreciation for the country, the province/region/state/district, city, village, and for the families/individuals that occupied them.  It was like I could feel the pulse of the land.  Those countries became a part of me and I became a part of them. 

NAPS Zambia and America-Natukoma Village outside
our thatched wall compound (Zambia 2004)

Ernest and Regie- the tent where they slept for 5 1/2 weeks (Zambia 2004)

Keeping warm- the cooking brazier (Zambia 2004)

Fast forwarding 9 years later from my first overseas experience in Zambia, the scenery has changed.  Granted, it’s not home, but I can’t in the least bit complain! I’m not living in a tent in a rural village in the middle of “Nowhere” (yes, I know I’m being redundant… just emphasizing a point).  On the contrary, I live in a spacious guest flat (the British word for apartment) in the heart of Malawi’s city of commerce.  I don’t have to worry about flies attacking me when I want to use the restroom (not to mention the hike you have to take to get there… a beast when you have to go REALLY bad and it’s night!), I can get out of my comfy twin bed (not a sleeping bag!) and walk to my flushing porcelain toilet; then turn on the tap to wash my hands (Did I mention there’s running water???). And, yes, there’s hot water too!!! Yes, God is good!!!

my bedroom- very grateful for my mosquito net!

Variety of food choices and a table to set it on!

Yet, one would think that with my 9 years of NAPS training and 10 plus countries I've visited surely I wouldn’t have the remotest seed of discontentment when moving to my current residence in Blantyre, Malawi, right??? Sad to let you down, but yes! However, that quickly changed when I went to visit my bachelor’s earned account friend, Mary, this past Sabbath. 

Mary lives within walking distance of where I’m staying and we both work for the same Adventist hospital.  Like me, she could have chosen work anywhere else, making a lot more (Accounting is one of the top paying professions in the country), but she wanted to serve.  Like me, she is young and single.  Yet, unlike me, she lives in a very tiny, two room flat (one room’s for sleeping and the other’s for everything else; eating, washing clothes, cooking, etc…. by the way, there’s no indoor tap, fridge, or stove <she cooks on hot plates>). She has electricity (thank God!), but her toilet and shower are outside (and she has no hot water). So, considering that we are in the middle of Rainy Season, one can only imagine! Yet, despite the stark difference between our places of residence, Mary’s content.  Her tiny corner of a home (that’s probably the size of a standard American living room) is her space and she’s genuinely happy because she’s serving her Lord.  When I asked her if she ever considered moving (her mother lives nearby and is a very successful large-scale business owner), she said, “Yes, but, I know God has a purpose for me being here. Solomon was one of the wealthiest men of all time. David was a king and a man after God’s own heart. I’d like to think that there were other men/women, who had much less but, severed God just the same; people like John the Baptist, lived in the wilderness, wore camel’s hair, and ate locus and honey.   The prophet Jeremiah severed God while being beaten, jailed, and thrown in a cistern! He’s working on me and I want to be faithful” (basic summary of what Mary said). 

Humbled again!

“Not that I speak in respect of want: for I have learned, in whatsoever state I am, [therewith] to be content.”  Philippians 4:11-12

Tu hijita,

Joya

Unconventional Education

“If any of you lacks wisdom, he should ask God, who gives generously to all without finding fault, and it will be given to him.” 

~James 1:5~

The thing about living and working in a developing country is that you learn to make do with what you have.  Queen Elizabeth Central Hospital (QECH) is the largest government hospital in the southern region of Malawi, servicing close to six million people.  Yet, it struggles and in the 2 ½ weeks I've spent so far orienting, I've seen how the lack of resources brings out the creativity of people! So when I was prepping a patient for theater (the OR) and had to insert a foley catheter (mind you it was ANYTHING but 100% sterile… had no choice, granted on what was available!) and we ran out of catheter bags… one on the Malawian nurses handed me a surgical glove (we later changed it out for a tube feed bag J ).  When you run out of chucks (the blue, flat absorbency pads placed under patients in the hospitals), one uses a large adult diaper. Or, when your orthopedic patient is in Bucks traction and there are not enough metal weights… can you say bricks and, by the way, who cares if they’re touching the bed…right???

In my 2 years of AMERICAN nursing training, I’m discovering that I am having to  be “re-educated” on how to adapt what I've learned to not just a brand new culture , but to diseases I've never seen (like malaria) and to conditions that are so far advanced, that one wonders why someone wait so long to come to the hospital (many die)! Not to mention that I’m learning, very quickly, the importance of triage and prioritization with an overwhelming nurse patient ratio at 1:20 or 1:30 (sometimes 1:45… at least on the TB ward!).

Malawi is one of the poorest nations in the world.  At times it can be exciting to combine critical thinking and improvisation but, there are dangerous setbacks. The other day, for instance, a patient admitted for diabetic ketoacidosis (DKA) needed IV fluids. Ignorant of the admitting diagnosis, a nursing student saw that her IV was running low and decided to hang another bag. However, there was a problem; the ward ran out of normal saline and hung 5 percent Dextrose instead. Now, one can get mad at the student however, one has to remember the registered nurse to patient to ratio… who’s following up (the nurses are sometimes not available)?  Thank God, one of the doctors caught it and brought to their attention!  There are other challenges; lack of equipment (ex.  ONE ultra sound machine for the entire hospital!); lack of materials, like glove when there 80% of the patient population is HIV positive; lack of trained medical personnel (due to the shortage, nurses rely heavily on the guardians to inform them on a change in the patient’s condition and medication administration); lack of space (with some wards having more patients than beds, some patients sleep on the floor!) and of course, there is the problem with follow-up.

There’s apparent need and I’m just grateful I can be here to observe, learn, share, and, hopefully, make a difference!

Tu hijita,

Joya