Saturday, November 22, 2008
Christina
This is Christina, a 12-year-old girl with osteosarcoma who is a patient receiving Hospice Jinja services. We visited her on last Friday's outreach in her community. In May, she fell out of a tree and because her bones were so brittle she broke her leg. Her left leg was amputated in June, and as you can see the surgical site hasn't healed yet (5 months). As is common in polygamous families here, Christina's step-mother has nothing to do with her. The only time someone interacts with Christina is when her father comes home from work in the evenings and helps her with bathing, toileting, eating, etc. She stays in a little 4-foot wide hut on a mat on the floor, away from the family home where her father, step-mother and step-siblings live. We were able to offer her comfort, support and the love of Jesus during our 15-minute visit...It was hard for me to leave her when it was time to go.
Nursing Care Successes and Frustrations
As I near the end of three months in Uganda, I hardly have time to reflect on how busy I've been in the nursing realm. I never expected to be this insanely busy - But it is a true joy to know that the things I'm doing are not just "busy things" but apparently things that really are important in the various areas I'm involved. (I really dislike being busy for busyness' sake.)
Upon meeting other muzungus in Jinja ("muzungu" = foreigner white person) sometimes I am asked the classic question, "So what are you doing in Jinja?" I take a deep breath and say...
"My husband Gabriel and I are here with Engineering Ministries International which is assisting the ministry Arise Africa in the Jinja area. He is an engineer working on their baby home construction project in Bukaleba. I am a nurse currently working with Hospice Jinja and the Jinja Regional Referral Hospital Palliative Care Office. Also, I've been working with Northern Lights Ministries and I've been Amani Baby Cottage's temporary nurse."
I started my time in September doing some health record keeping work with Northern Lights Ministries project in the village/slum of Budumbule and also getting a feel for the work that Hospice Jinja does in the area. As I got more and more involved with the vision of Hospice Jinja, I realized the needs at the associate Jinja Regional Referral Hospital (JIRRHO) Palliative Care Office for support. Due to a mix-up in communication between my contacts in Houston, the people in Uganda, and myself, at the same time I was being drawn to be more involved with the JIRRHO Palliative Office I realized this was the project that my contact in Houston was desiring me to be more involved with anyway. As I saw the work being accomplished at JIRRHO under harsh circumstances, I began an assessment of sorts and started problem-solving some ways for patients to benefit more from the services available at JIRRHO and at Hospice Jinja through collaboration.
In the middle of October, I was called by a new friend of mine who moved to Jinja during the summer and is the administrator at Amani Baby Cottage. Surprise, surprise -- Judy is a Hope College alumni and is from Kalamazoo! It was like finding a little bit of home here in Jinja, and we've continued to be friends here ever since. When Judy called the second week of October, she said there was an unexpected 2-week gap between the baby home's temporary and permanent resident nurse. They had one child on IV antibiotics, and wondered if I could stop by each day to give him his medicine. I thought, "Sure...No big deal...Would be fun to see kids for a change!" Little did I know what I was getting into! The second day I was there to "drop by" to give medicine, I ended up staying for 6 hours involving two children needing IVs in their heads, other sick children needing medicine, and a lot of drug handbook usage as I checked and double-checked my pediatric dosage calculations. I definitely counted down the days until the full-time nurse, Siouxanne, would be returning from furlough! :) I really hate to see kids hurt and having them see me as the one to blame.
In October/November, at the request of Dr. Namyuga Mirioce from JIRRHO, I initiated a small research study entitled, "Oral Liquid Morphine Administration to Palliative Care Inpatients At Jinja Regional Referral Hospital." Currently, there is no palliative ward at the hospital - All palliative patients are spread amongst seven wards according to diagnosis. As a result of this and many other contributing factors, the ball is dropped on quality palliative-specific nursing care. With this study, I interviewed ward nurses, patients, and patient carers about their experiences using Oral Liquid Morphine (carers are family members who stay 24/7 at the bedside to essentially do the nurses' work). The government of Uganda provides Oral Liquid Morphine for free to be used by palliative patients and people in severe pain, and it must be prescribed by a doctor or by a palliative-trained nurse. By looking specifically at the use of morphine on the wards at JIRRHO, I've been able to see where the strengths are and where there is room for improvement in regards to the delivery of palliative care to inpatients. (A note to my fellow Hope nursing friends: I never thought I'd kick myself for not packing my Nursing Research book to take to Uganda...But I am disappointed in myself. Would have come in handy many times.)
Along the way, I have found myself adding the rold of "mediator" to my nursing experience. There is a great need for policy establishment between Hospice Jinja (home-based care support) and JIRRHO Palliative Care (inpatient). There is currently no clear referral system between the two organizations, and I've found a few hurt feelings amongst both staff groups and many disadvantaged patients along the way. I see this as perhaps the most vital and most beneficial work I've been involved with yet...Definitely. Because of some wounded feelings and some mutual blaming, neither side seems willing to approach the other organization to arrive at a solution for the referral problem. The whole time, patients are suffering because they are discharged from the hospital with no follow-up palliative resources known to them. I have spent a great deal of time in the past two weeks meeting with both parties, sharing my ideas with them and drawing up many drafts of a referral form for them to discuss. I get frustrated with how extremely complex it is just to get a referral system established - It isn't even this difficult in America! Numerous approvals, reviews, choicy wording, etc... I pray every day that I don't get completely frustrated and jaded.
I really would like to continue to tell you about the corruption in government hospitals, the unique challenges to palliative care here, and some of the patient stories I hear every day. I think these issues will be covered in a reflective essay I'll be writing once I get back to Michigan. To give you a clue, at Jinja Hospital I've seen people die of asthma right before my eyes because the hospital was out of oxygen, people left in filth for days (weeks?) because they had no caregiver and the nurses did not see that as part of their job description, and a 10lb. one-year-old baby be given adult doses of IV Quinine when she didn't even have malaria, along with adult doses of IV Ceftriaxone antibiotics. So much more - So much pain. I find myself thinking this is normal at times...In my experiences here, the sad reality is that this really is normal in Uganda.
Upon meeting other muzungus in Jinja ("muzungu" = foreigner white person) sometimes I am asked the classic question, "So what are you doing in Jinja?" I take a deep breath and say...
"My husband Gabriel and I are here with Engineering Ministries International which is assisting the ministry Arise Africa in the Jinja area. He is an engineer working on their baby home construction project in Bukaleba. I am a nurse currently working with Hospice Jinja and the Jinja Regional Referral Hospital Palliative Care Office. Also, I've been working with Northern Lights Ministries and I've been Amani Baby Cottage's temporary nurse."
I started my time in September doing some health record keeping work with Northern Lights Ministries project in the village/slum of Budumbule and also getting a feel for the work that Hospice Jinja does in the area. As I got more and more involved with the vision of Hospice Jinja, I realized the needs at the associate Jinja Regional Referral Hospital (JIRRHO) Palliative Care Office for support. Due to a mix-up in communication between my contacts in Houston, the people in Uganda, and myself, at the same time I was being drawn to be more involved with the JIRRHO Palliative Office I realized this was the project that my contact in Houston was desiring me to be more involved with anyway. As I saw the work being accomplished at JIRRHO under harsh circumstances, I began an assessment of sorts and started problem-solving some ways for patients to benefit more from the services available at JIRRHO and at Hospice Jinja through collaboration.
In the middle of October, I was called by a new friend of mine who moved to Jinja during the summer and is the administrator at Amani Baby Cottage. Surprise, surprise -- Judy is a Hope College alumni and is from Kalamazoo! It was like finding a little bit of home here in Jinja, and we've continued to be friends here ever since. When Judy called the second week of October, she said there was an unexpected 2-week gap between the baby home's temporary and permanent resident nurse. They had one child on IV antibiotics, and wondered if I could stop by each day to give him his medicine. I thought, "Sure...No big deal...Would be fun to see kids for a change!" Little did I know what I was getting into! The second day I was there to "drop by" to give medicine, I ended up staying for 6 hours involving two children needing IVs in their heads, other sick children needing medicine, and a lot of drug handbook usage as I checked and double-checked my pediatric dosage calculations. I definitely counted down the days until the full-time nurse, Siouxanne, would be returning from furlough! :) I really hate to see kids hurt and having them see me as the one to blame.
In October/November, at the request of Dr. Namyuga Mirioce from JIRRHO, I initiated a small research study entitled, "Oral Liquid Morphine Administration to Palliative Care Inpatients At Jinja Regional Referral Hospital." Currently, there is no palliative ward at the hospital - All palliative patients are spread amongst seven wards according to diagnosis. As a result of this and many other contributing factors, the ball is dropped on quality palliative-specific nursing care. With this study, I interviewed ward nurses, patients, and patient carers about their experiences using Oral Liquid Morphine (carers are family members who stay 24/7 at the bedside to essentially do the nurses' work). The government of Uganda provides Oral Liquid Morphine for free to be used by palliative patients and people in severe pain, and it must be prescribed by a doctor or by a palliative-trained nurse. By looking specifically at the use of morphine on the wards at JIRRHO, I've been able to see where the strengths are and where there is room for improvement in regards to the delivery of palliative care to inpatients. (A note to my fellow Hope nursing friends: I never thought I'd kick myself for not packing my Nursing Research book to take to Uganda...But I am disappointed in myself. Would have come in handy many times.)
Along the way, I have found myself adding the rold of "mediator" to my nursing experience. There is a great need for policy establishment between Hospice Jinja (home-based care support) and JIRRHO Palliative Care (inpatient). There is currently no clear referral system between the two organizations, and I've found a few hurt feelings amongst both staff groups and many disadvantaged patients along the way. I see this as perhaps the most vital and most beneficial work I've been involved with yet...Definitely. Because of some wounded feelings and some mutual blaming, neither side seems willing to approach the other organization to arrive at a solution for the referral problem. The whole time, patients are suffering because they are discharged from the hospital with no follow-up palliative resources known to them. I have spent a great deal of time in the past two weeks meeting with both parties, sharing my ideas with them and drawing up many drafts of a referral form for them to discuss. I get frustrated with how extremely complex it is just to get a referral system established - It isn't even this difficult in America! Numerous approvals, reviews, choicy wording, etc... I pray every day that I don't get completely frustrated and jaded.
I really would like to continue to tell you about the corruption in government hospitals, the unique challenges to palliative care here, and some of the patient stories I hear every day. I think these issues will be covered in a reflective essay I'll be writing once I get back to Michigan. To give you a clue, at Jinja Hospital I've seen people die of asthma right before my eyes because the hospital was out of oxygen, people left in filth for days (weeks?) because they had no caregiver and the nurses did not see that as part of their job description, and a 10lb. one-year-old baby be given adult doses of IV Quinine when she didn't even have malaria, along with adult doses of IV Ceftriaxone antibiotics. So much more - So much pain. I find myself thinking this is normal at times...In my experiences here, the sad reality is that this really is normal in Uganda.
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