I have been having a difficult time deciding whether I should blog about patients at the hospital or not. Being a nurse, I am supposed to respect the privacy and confidentiality of my patients, whether they are in Canada or Kenya. I do not want to disrespect them by publishing their stories without their permission or knowledge. Another reason is that we were told before we came that Kenyans do not want to be pitied: they are proud and happy people, and want to show their best face, always. But on the other hand, I am meeting so many special people and I want to share their stories- or at least what I know of their stories. Part of our role here in Kenya is to share our experiences with the people at home.
First, I will tell you a bit about the hospital. We live directly behind the hospital. It takes about 45 seconds to walk from our gate to the back door of the hospital. There are several buildings that make up the hospital, and everything is very open. The newest building houses the maternity and surgical units, and the surgical theater. There is a courtyard between the maternity and surgical units and we often see many of the patients sitting outside on plastic lawn chairs, or even laying on the grass. There is a television mounted on the wall in the hall of the maternity unit (which is open to the courtyard) and the men (the ones who can get out of bed) from the surgical unit are usually seated in front of it, watching the news.
The patients roam around freely. I will often see maternity patients walking around the medical unit, and every so often, we see patients standing outside the backdoor of the hospital, facing our home. I really like the openness of the hospital and find it comforting that the patients can sit outside in the sun. There is nothing more depressing than being stuck in a hospital room with a bunch of other sick people, and not having anywhere to go. The patients here have fresh air and sunshine all day. I think that is almost as important a treatment as medications.
For my first day on the job, I was on the maternity unit. The labour room has three beds: there can be three women giving birth at the same time, within feet from each other. I was there for about five minutes when I saw my first Kenyan baby being born, and a few minutes later, mom and babe were ushered off to their room. There was a woman in the next bed. I stayed with her and rubbed her back. Women in Kenya do not receive pain medication while in labour. While experiencing contractions, she prayed that God would release her, but between contractions, she spoke pleasantly. It is traditional in Kenya for women to labour alone: no husband, mother, friend, or nurse support the woman while her body painfully prepares present a new life to the world. You may think these practices are cruel, but we are learning quickly that culture is culture: this is the way that it has always been done here, and for these people, it works. The mothers do, however, express appreciation to us when we stay with them throughout their labouring process. Because we are used to providing labour support, it is difficult for us to leave the room when the other nurses do. I have a lot of mixed up memories about the births that I experienced, and I cannot remember if this mama had a boy or a girl. I do remember, however, that she was happy to have a mzungo present for the birth of her child.
I spent the next few days with Pasqualina. She is a nurse that kind of floats around from unit to unit. Officially, she is a maternity nurse, but when she is not busy, she will help out on surgery, or wherever. So, I think it was Tuesday; I helped her check the vitals of the patients on the surgical unit. I wandered into one room by myself and saw the most horrendous thing that I have ever seen in my entire life- or so I thought. There was a little 10-year-old girl, naked from the waist up, sitting on her bed, with her back to me. Her back was covered in burns. They looked fresh, but then I saw that her arms had also been burnt but looked like they were healing well, so I could only assume that the burns were not fresh. I hardly even responded, because I knew that if I did, I would start crying and would not be able to stop. So I smiled at her, took her roommates blood pressure and left the room, and tried not to think of it again- which proved to be a difficult task. We asked about her and were told that she is had been playing with friends around the fire and her shawl caught fire. She ran, which only made it worse. She had been in the hospital for about 3 or 4 months. Over the next few days, I saw her around the hospital, and each time, I smiled and waved. Sometimes she would smile back shyly, and other times she would look away. A few days later, I saw the most horrendous thing that I have ever seen- for real, this time.
Allison and I had just returned from lunch and were walking through the hall with Josephine. We heard blood curdling screaming coming from the little girl’s room. We went to her see what was happening. She was sitting on a chair, rocking back and forth and screaming like I have never heard anyone scream before. She had just received treatment for her burns. A topical antibiotic was applied, and as Josephine explained, with burns, the nerve endings are exposed, the treatment causes a lot of pain. I asked if she had been given anything for pain- she hadn’t. I asked if someone would please give her something now. I had been accepting and understanding of the cultural differences up until that point, but this was something that I could not watch without doing something. One of the nurses prepared an injection and administered it. Allison and I stayed and held the girl’s hands until she stopped crying. When I left the room, I cried for the first time since starting to work at the hospital.
Since coming to Kenya, we have been trying to think of things to do for people. One of our classmates, Emily, gave us packages to give to new mothers. Each package has a receiving blanket, teddy bear, sleeper and soother. We decided to make a little gift bag for the girl with the burns and her young roommate. We took two of the teddy bears, Canadian flags, and a whole bunch of candy and put them in little bags. We went over to the hospital to give the gifts. They were not in the room. We went looking for the girl and found her sitting outside. We handed her the bag but she would not take it. We asked her to come with us, but she didn’t understand us. So we went back to her room and set the bag on her bed. The older lady that shared the room with them told us that the other girl had been discharged. We decided to give the second bag to very cute young boy who had his appendix out the week before. We handed him the bag. As we walked away, we turned and saw him looking to see what was in the bag- and he had the hugest smile on his face.
The next day, yesterday, I had to stop by the hospital to pick something up to bring to Denis, our good friend that calls us fat. First, I saw the boy. He was still smiling. I asked him how he was feeling and he said: “Well. Very well.” He was beaming. What a sweet little child he is! Then I saw the little girl, sitting on a bench a little ways away. I waved to her and she waved back. I picked up the package and quickly returned home, as the driver was waiting for me. When I got to the vehicle, the other girls saw that the little girl had followed me to the back door of the hospital. We drove away and went to the children’s home. When we returned, about 5 hours later, she was still standing there. She walked up the driveway towards us and stood there, holding her shawl. We approached her smiling, and she kind of smiled back. We tried saying some Swahili words that we know, but she didn’t respond. I reached out my hand to shake hers. She shook hands with all of us- the traditional Kenyan greeting. We continued to say some words in Swahili and managed to get a little smile out of her before we returned home.
A week later, she is still shy, and will only sometimes wave or smile- not usually both. Yesterday, I was with her while a nurse applied the cream to her back. I asked about pain medication and the nurse said that they only administer analgesia when the girl begins to feel pain. I told her that in Canada, we usually provide analgesia before a painful procedure so that the patient does not feel pain in the first place (or at least they feel less pain than they would without analgesia). She disagreed with my method, so I promised myself (because I can’t communicate with the patient to make the promise to her) that I would return to check on her soon. Soon after, Allison, the head nurse and I joined Dr. Kiiura on his rounds. When we got to the girls room, we saw that she was definitely experiencing pain. I asked if I could prepare an injection for her then and the doctor agreed. While the medication they use is an anti-inflammatory used for mild pain, it seemed to help. She did smile at me when I left that time.
Everything is so different here. Sometimes it is difficult to appreciate the cultural differences, but we have to. Pain management is not a top priority here like it is in Canada. I think that is one of the most difficult things to deal with. In Canada, we are very nurturing and compassionate towards our patients, and it is not quite the same here. Of course, staff cares for their patients, but just not in the way that we are used to. The hospital motto, in fact, is “To Love and Serve” which amazing. That, I think, should be the motto of nurses everywhere.
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