Learning small small.......

I LOVE roller coasters! I love the climb up the hill and then sudden drop and twirling around. The more time my stomach drops the better. Total exhilaration but feeling safe at the same time. (Besides the time my friend and I stopped at a sketchy carnival on the side of the freeway and I didn't even have my harness down before they started to go. I don't think "safety first" was their motto.)
Sometimes I feel like I'm on a bit of a roller coaster here. Things can just change SO fast. One second I feel like I'm ecstatic about a kiddo that got to go home or a good conversation I had and then the next second something makes me so sad or frustrated. Frustrating! :)

The other night I was at work and a kiddo came in who was pretty sick. He was really pale (I'm still learning what pale looks like here with their darker skin but even I could tell this kid was really pale!) His heart rate was 200(fast) and he was breathing 96 times a minute (really fast). I didn't hear anything in his lungs so I assumed that his respiratory stuff was happening because his hemoglobin was so low that he didn't have enough oxygen circulating in his blood. One of the things that malaria does is kill red blood cells (which carry oxygen). Since a lot of times moms will try everything else before bringing him to the hospital, they often come to us with hemoglobin's of 3 and 4. In my ICU in the US we'd start giving people blood transfusions when they dropped to about 8. Mine is probably 14. (Just so you have a sense....these kids come in REALLY low, often on deaths door).
So anyway, this kid came in looking pale and sick. We needed to check his hemoglobin and give him blood. We don't have a lab 24hrs a day but we have someone on call so we called him. His phone was off. So we tried his other phone. Also off. Finally, we sent someone down to his house to get him. He wasn't there and his wife had no idea where he was. Are you kidding me? I was on call all the time in the States. You never sleep very well because you're always waiting for your phone to go off because you know if they call you they really need you. I know the rules of being "on call." This guy is not playing by the rules!
Since we didn't know what else to do, we called the other lab guy who was not on call to see if he could come in. He told us he wasn't on call and said he'd try to call the other lab guy. We waited for awhile, sent someone to his house again with no response and finally called the second lab guy to see if he had any luck. He hadn't and said that he wasn't feeling well and wasn't going to come in. Ahhhhhh. Frustrating.
So we called the hospital manager and told him what was going on and he said we should try the on call guy's wife again. Ok. At this point I'm fuming. I keep thinking "if I was at home right now.....this, this and this would never happen, etc." I don't know what else to do. If I was able to do it myself I would have but I didn't have the keys to the lab and wouldn't have a clue how to go about doing the job.
At the end of my shift we still didn't have a resolution to the situation and I handed off report saying "here's the blood bag, tubing, everything you need. Keep trying to call the guy to see if you can get a hold of him." I woke up at 5am that morning and couldn't go back to sleep going over everything that had happened the night before and wondering if he would still be alive when I went down for rounds that morning. I was also feeling guilty because I wondered if there was more I should have done. What if it was my kiddo? If it was my kid, I probably would have gone down to the not on call lab guy and beat on his door until he came up to the hospital, I don't care HOW sick you feel. Should I have done that?

I've been wrestling with these kinds of questions lately. There are so many things I would change here "if I was in charge!!" No repercussions for people on call who don't show up would be one! Our ambulance driver lost his phone so we couldn't get a hold of him to drive the ambulance for 3 days. There's no way to mark when a chart has new orders and the nurses don't look at the chart so medications will be ordered and never given to patients. They sign of that they gave medications when every pill is still in the box so they obviously haven't and whenever you ask them if they gave it, the answer is always yes. The list goes on and on.

In the three weeks that I've been here I've had so many ideas for how to improve this place. Adding little flowsheets, better documentation sheets, etc. But then yesterday, I kind of had a "come to Jesus" moment if you will. I keep saying to myself "If I was in the States....." But the fact is, I'm not. I'm just not. I've chosen to come work here instead. And I've been here for exactly three weeks. A lot of these people have been here for years. They stayed here to take care of patients when all the missionaries left during the war. They stayed when it was occupied by the rebels and they knew they could be killed at any time.

We have a lot of ex-pats that come to this hospital for a few weeks, a few months. I'm sure they must feel the frustration that I do. I wonder how often they "suggest" things for improvement. I put myself in the Sierra Leoneans' place yesterday. A bunch of strangers come here every few months and tell them how to run their hospital. The hospital that they kept running for a decade by themselves during the war. I think if I was them I'd think "you know, we did just fine without you for years." I don't think I'd really care about the fancy education or experience in a big time medical center. It doesn't matter cause you'll be gone in a few months anyway.

So I've changed my train of thought. Or adjusted it. There are a lot of things that I would change. That for patient safety and better outcomes MUST change. But if I think I'm going to come in with some new charts and accountability and change that overnight, it's never going to happen. I'm accepting that. Slowly. :)

Then what do I do? Well, for now I've decided to be an observer. Learn how things work and why they work the way they do. Also, I want to be the best nurse that I can. Help as many patients physically, emotionally and spiritually as I can. And maybe, depending on how long the Lord leaves me here, help the nurses and nursing assistants see that there are other ways of doing things and why it might be good......but let them take the lead on what needs to change and why.
It feels freeing. I'm sure my frustration isn't going to go away but I've realized that I have to let it go. For my own sanity. I'm going to do what I came here to do which is become a better nurse, build relationships, and seek to love people the way Jesus does. If other things change, it's just icing on the cake. :) Anyway, just a few of my thoughts recently.

**Incidentally that little kiddo was still alive the next morning and is doing much better!! See? Roller coaster. Utter frustration to relief to extreme joy....in about 7 hours :)