orientation at Queen Elizabeths

The photo uploading is proving more difficult than I thought so I'm going to fill you in on what I've seen and done while I've been at Qu E instead - it makes frightening reading so, nurses especially, beware!

First joke was that although we'd been ordered up here, Matron wasn't expecting us and was in a meeting when we arrived so we didn't know where to go and what to do...I felt like a first year starting placements again! Anyway, we were shephered off to Children's A&E where Sister-In-Charge showed us around and then plonked all three of us in Triage where we sat trying desperately not to look like 3 lemons in uniform. We hadn't a clue what was being said half the time but we could see that most of the children were very sick, lots of malnutrition, lots of nasty chest infections/TB and of course lots of HIV related stuff too. A couple of emergencies came in which after a cursory look at the front desk were taken to resus...not that anyone seemed in the slightest hurry to find out what was wrong and do something about it. I saw tiny babies have cannulas jabbed every which way into them, little kiddies have injections launched at them with no warning and others pulled about and poked all over. Apart from hating all that the thing that really got me was that there was practically no communication between the staff and mothers/fathers about anything. No reassurance, no telling them what was going on and no consolation or anything after they watch their children die on a table in full view of everyone in the waiting room.
The three of us could hardly speak at lunchtime and by the time we left that afternoon, I was really doubting whether nursing care actually even exists here and if we'd be able to make any sort of impression on the students when the whole general attitude towards the job and patients is so far removed from what nursing really means. I do understand that there is such overwhelming need that the task in hand must just seem insurmountable at times but there is no excuse for going about your job looking like someone just crapped in your handbag!

I spent the rest of the week observing on the medical wards, visiting the ARV clinic and seeing what the palliative care service is like here. I was impressed by last two places but the medical admissions ward was something else! Patients are referred from the OPD and when they arrive have their name entered into a book and then waved in the general direction of the beds, where they chose one they like and then sit and wait for the Dr. Its first come, first served unless you're taking your last breath in which case the Dr might cast an eye over you from the other side of the room and then hopefully a nurse ambles by, fishes some nasal specs out a bucket of chlorine and slaps them round your face and wriggles the end onto the oxygen concentrator (of which there is 1 for the 60 beds!) Once the Dr has reviewed the patient, the nurses will spring into action(!), they whack in a cannula, take blood and give a first dose of drugs and then kick the pt out of bed and send then off to an appropriate ward. Once they get there, its again, first come, first served, if there is no bed, they must drag a mattress off the pile in the corridor and slot it inbetween the beds and hop onboard! The nurses have pretty much no idea whos who and what they have until the daily head count is done.

There is no nurse-patient allocation, students do most of the work completely unsupervised (including giving out drugs, fiddling with IVs, taking blood etc etc) Everything is completely haphazard. Drugs rounds are interesting - each patient's guardian must get the medical notes off the nail that is sticking out above the bed space and take it to the trolley - someone then shakes out the pills onto the paper or fishes a pre-drawn up syringe out the box and balances it on top. They then go back and wait by the bed for the student who is going round bed after bed, administering the IVs - ANTT?! You got to be kidding me! And the Obs rounds aren't much better - if they get done at all!

I just can't bring myself to write down what the wards look like and what the patients have to endure, I've been so close to tears so many times. But, for all the awful things, there have been some incredibly touching things too - the sense of community among the guardians is amazing, they all help eachother look after the patients, they share food, fetch water, help bring the screens to the bedside and i suppose provide the support that they so obviously don't get from the nurses. There have also been some extremely funny things - I was with the Palliative Care nurse and she was talking to a patient they were hoping to discharge home, she was telling the wife about how to care for him etc etc, I couldn't understand the chichewa so looked around the ward instead - i saw a woman (patients relative) go into the sluice and come out with long rubber gloves on, a roll of loo paper and a bedpan (stay with me on this!) a while later, after the obvious had happened, she popped out from behind the screens, moved them back to the end of the bay and then went back to the patient - she knelt down beside the bed and when she stood us had the bedpan carefully balanced on her head, with that she trotted back off to the sluice! I couldn't believe my eyes!