NURSING CARDEX. voodoo.

In Kenya the line between witchcraft  and nursing was crossed decades ago. No matter how deep in the sand our heads are buried, there is no escaping from the fact that things need to change.

Thursdays and Fridays are the most understaffed days in my work station and this Thursday was no different. I get to work at 7.15 am just in time for the handing over. I received one client in active phase of labor. A primi_gravida, twenty years old with no history of any chronic illness although she was a little overweight.

After the brief pleasantries, the client and I went through the do’s and dont’s of labor. I was certain that my shift would end without incidents. The client was a delight to work with. She was quite the chatterbox, despite the very painful contractions she was experiencing, She talked about her unborn baby, husband and anything else that crossed her mind.

An hour and a half later, I requested her to accompany me to the examination couch for a repeat vaginal examination . During the assessment I noted that her cervix was completely dilated and the baby’s head had descend perfectly. The fetal and maternal heart rates were within the normal ranges, so was her temperature and urine readings. I however noted that her blood pressure readings were significantly higher than the readings I had recorded a little over an hour before. At 140/80 mmhg, with no other sign or symptom of pre_eclampsia, I reasoned that it was probably due to the fact that my client was anxious and experiencing very severe contractions. I called the doctor, and reported my findings to her. She assured me that she was making her way to the delivery room from the outpatient department. I was confident of conducting a quick spontaneous vaginal delivery despite the setback.

Twenty five minutes later the baby had not been born. There was no obvious reason for the delay. Apart from the slightly increased blood pressure the other parameters were okay. I decided to call the doctor to come back and as I was ungloving, the room fell into a deathly silence. The client who was writhing and screaming in pain had suddenly gone mute.

The events that transpired thereafter will forever be etched in my mind. My client was about to have a convulsion and I wasn’t prepared for the eventuality. Her body shook violently, she froathed as her eyes rolled into the back of her head. I was torn between holding her down to avoid a fatal fall from the delivery couch and running over to the cupboard, a few feet away, to fetch the emergency tray. I was scared. I Couldn’t fathom a maternal death during my shift. My heart raced and my brain pulled a rudisha move on me. I envisioned all manner of persecution ranging from expensive lawsuits and the notorious shaming by the media.

I don’t know how a loud scream involuntarily escaped from my mouth, all I know is that it was loud enough to be heard by the deputy nursing officer incharge. She left her office running and answered my distress call. She knew what to do the minute she saw me desperately trying to keep the convulsing client from falling off the couch. It seemed like an effort in futility, the bed rocked as another
convulsion started. The arrival of two more nurses was a comforting sight.

We managed to administer magnesium sulpate injection on her thighs and anxiously waited for the client to stabilize. The nursing staff, the doctor and anesthetist decided, after an all inclusive brief consultation that the client would be safely delivered through a caesarian section in the nearest referral hospital. The twenty minutes ambulance drive to the referral hospital was the longest, most scary and uncomfortable ride, even though the client was fully conscious and in stable condition.

The handing procedure at the referral hospital was brief, the theater staff were waiting for her. We were informed of the safe delivery of a live baby girl three hours later. The news was like music to my ears. Our sacrifice had borne great success. The injured wrist, headache and fatigue were worth it.

I am eagerly waiting for the day, the relevant authorities will realize that quality nursing care is unachievable with the current understaffing in the public hospitals. It’s like draining a lake into a pond. This is witchcraft, the patient is the voodoo doll and the unfortunate nurse is the broom straddling ‘witch’ .

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NURSING CARDEX. pay up or ship out.

The transition from nursing school  to nursing proper was very challenging for me. It was like trending on slippery grounds. I realized that there were tough realities  that  I had not prepared for. Lessons that I was to learn the hard way. Getting my practicing license was particularly exciting and in no time I got a  job in a mid_level private health institution. Nothing was going to hold me back, I was ready to take any challenge head on, or so I thought.

On the reporting date, a comprehensive orientation session was conducted by the nursing officer in charge. I was apprehensive with the twelve hours day shifts. Despite the stringent rules and terms of service, I signed the contract and started working immediately.

After a month of tiring and stressful day shifts, I got allocated for a week long night shift. The first night was tiring and stressful. I couldn’t wait to get home to get the much needed sleep. As I walked home that morning, I questioned my ability to get through the week. Amidst the fear and anxiety, I got consolation in the knowledge that I had received the best training.

I reported to work later on that evening at around six pm. The nursing officer informed me that I would be taking up the duties of the night shift  clinical officer who had tendered in his resignation letter earlier on in the day. I just couldn’t comprehend how one nurse aid and I were expected to flawless and competently handle the busy outpatient department, the inpatient that had a little over twenty patients, a maternity unit , and an operating theater. I figured it was a normal practice and readied for the tough night ahead of me.

We somehow managed to get some work done, with me handling the outpatient clients and the nurse aid taking up the inpatient nursing duties.  At around 3am, the nurse aid and I sat down for a cup of tea as we took stock of that night’s happenings,then the dreaded emergency call came from the security guard on the ground floor. I nearly broke a foot running down the stairs to the reception area, it is then that I encountered the client who in a few days would cost me my job. A 3 year old, breathless, wheezy little girl straddled across her father’s lap.

I did not ask for the consultation fee as was required, before any consultation. I I knew how uncomfortable and frightening an acute asthmatic attack could be since I had had quite a few of them myself. I calmly but purposely put the girl on oxygen as I reconstituted and withdrew the required doses of aminophylline, hydrocortisone and adrenaline injections. I made small talks with the little girl’s father as I administered the injections. An hour later the little girl was stable enough to go home.

The little girl’s father needed to pay up around Ksh 700 for the consultation, injections and to take at home medications. He said he didn’t have any money on him and assured me that he would bring it very early in the morning. He offered to leave his motorolla phone(it was the weirdly christened coffin make)   as collateral for the owed payment. I thought it would be an injustice to hold on to his phone, since he might have needed to call for help, incase his little girl got another asthmatic attack and requested for his identity card instead. I wrote his phone number down and as I let them leave, I was confident that the man would be coming in the morning to pay up.

Three days later, the man had not showed up and  was not picking any of my calls. The hospital administrator, kept reminding  me that the only way I was going to receive the previous month’s salary was by paying up what ‘I owed ‘ the hospital. It was impossible to to save up from the daily Ksh 50 I received from my dad. Two weeks later, I was surmoned by the administrator. He informed me that I risked losing my job if I didn’t come up with the money I was supposed to pay “for being too careless” with undeserving patients. I seeked to understand how any sane person would demand payment before attending to any obviously dyspnoic and suffering patient. He dismissed me from his office and told me to go home as he tried to come up with a reason why each and every patient had to pay before receiving care.

Two days later no call had come through from my employer. I decided to go to my work place and find out what was happening. The proprietor, who was an enrolled nurse was in a consultative meeting with the administrator, the lab technician, who doubled up as the ward in charge and the nursing officer in charge. I waited as they deliberated on things I thought  were of no concern to me. Later on I was ushered into the office and faced the four man ‘disciplinary committee’  as it was dubbed. To date I cannot tell how I managed to sit through the tirade of accusations that were tabled on that single sitting. I had was being dismissed from my job, for allegedly conspiring to defraud the hospital. I was also accused of being too proud and reckless enough to bring the hospital unnecessary loses.I received part of my salary, the rest was deducted to cater for the loses I had subjected the hospital to.

These are some of the challenges a nursing school will never prepare anyone for. There is no knowing when a penniless and in need of emergency care, person will present at the nursing desk. The Kenyan constitution provides for the right to emergency medical care at any health facility with or without payment… It however does not define the consequences for situations where an employee is required to pay for emergency services rendered to patients who are unable to pay. It is unfortunate that the public is ignorant of the fact that, the nurse in that outpatient department, the ICU or any other department  has no say in any financial decision making.

I am not sorry for what I did for the sick little girl, I would do the exact same thing in a similar situation. I am however smart enough not to take an identity card for collateral. I would instead  hold on to a mobile phone,  and maybe  sell it to pay off any money, should the patient become elusive. 

NURSING CARDEX. The journey to now.

I always wanted to be a doctor,  at the age of 12,  I didn’t know that nursing and medicine were different careers. Miss Mary… My nursery school teacher had repeatedly told us that “N is for nurse” and to drive her point home insisted that my floor mate point out the nurse on the alphabet chart. My floor mate (we sat on the floor with our legs crossed),  pointed out a white clad beautiful young woman on the chart and countered “This is a nurse. ”

I joined an average performing secondary school after acing my kcpe examinations and my dream to the medical cannan begun to take shape. I enjoyed and performed well in the science subjects but for some reason I just couldn’t get the relationship between bodmas, navigation and the reproductive system. I was scared of mathematics and no amount of counseling or threatening was going to mend the broken relationship between ‘that subject’ and I.

I unfortunately didn’t make grades that would have secured me a place in any local medical school. I spent a better part of the year 2004 going through the local dailies in search of a suitable occupation. I thought of seeking admission in the Nairobi school of law but my dad told me there was no room in his household for dishonest and unscrupulous beings. After much soul searching I settled for nursing school and made an application for March 2005 intake. I was admitted to the school a week after the stipulated admission date.I didn’t know what to expect and even though I had relatives who were nurses, I had never taken interest in what they did at their work places.

My father and I were ushered into the principal’s office and sat on the offered seats. As my father and the principal engaged in financial matters, I indulged in memories of my childhood. I knew the reason why I had finally accepted to give nursing a chance and knew I would enjoy every bit of it.

That Friday had started like any other, the lesson had been enjoyable and the break that was upcoming, eagerly awaited. I didn’t like playing because the dust and physical activity triggered unexplained chest pains. I decided to go back to class and as I went through my school bag, I came across a little, empty, plastic, bottle. It must have been an eye drops bottles, I had no idea how it had found its way into my bag. I felt adventurous and punctured the plastic cap with a pin that I had taken from one of my revision papers. I then filled the plastic bottle with tap water, recapped the bottle with a pinned cap. I fiddled with my hand made syringe as I waited for the commencement of after break classes. When everyone was finally settled in class, I slipped the syringe into my bag. To date,  I cannot explain how muthoni njehu got into my bag and stole my syringe. Maybe it was because she was very good at hide and seek. Her mama was a changaa brewer and the cat and mouse games with the police were the family’s specialty. Muthoni was so good at ‘seeking’ answers from her deskmate during exams,  despite the fiti moja between desks during exams rule. When I heard my deskmate Sam scream, gripping his ‘matter_core’, I knew trouble had finally found me. Muthoni had sneaked behind my deskmate and darted his butt with my syringe. She had done it so cruelly that Sam’s hand was bloodied when he pulled it out of his shorts. The crazy girl had decided to rid Sam of his abnoxious after githeri tear gassing behavior. That is how muthoni and I earned ourselves a week’s suspension. We were directed to inform our parents of the suspension and present a letter asking our parents to accompany us to school after a week.

A week later, dad and I sat silently in the head master’s office as we waited for the prouncement of suitable punishment. I couldn’t explain why I had made that syringe. I had experienced my father’s fury but at that moment, sitting in that office, I got  to discover a totally different man. He volunteered to punish me in the head master’s office, remembering the intensity of the beatings I had already received at home, I braced myself for more pain. What he did next was totally unexpected… You see my father had his own explanation on why girls should not be whipped on the buttocks. For some strange reason he believed that the ovaries were close to the butt and any cruelty on them would render one infertile.  I was very surprised when he ordered me to lie on the floor face down. I will never forget how my ovaries hurt that day. I was only convinced of my fertility when I got pregnant many years later. Muthoni njehu came back month later.

I knew I had made the right career choice, that day, sitted in the principal’s office at the Thika kmtc campus. After the not so beautiful recollection of events from my past, I knew I was meant to be a nurse. I didn’t know how tough the job would be. I knew that I would be doing a lot of darting people’s butts with a satisfied ‘ syringe’,without worrying about the integrity of my already traumatized ovaries. I knew the ride was going to be bumpy but I was going to enjoy it nonetheless. I enjoy what I do, sometimes it gets so frustrating but I still push on. Nothing is as satisfying as helping bring a life forth, or stop a bleeding, or carry out the numerous nursing duties. It doesn’t matter how I got here, I am just glad I did. It is always a privilege and pleasure darting butts.