Needles Anyone??

After a few days in Freetown doing some administrative stuff for WMT, I'm back in my little village town. Honestly, I was so drained....emotionally and physically when I left last week that I wasn't sure if I'd want to come back. But as soon as I walked into the little Peds ward I realized how much I'd missed my little kiddos and was glad to be back!

I've learned something about doing rounds on the ward. The first thing I look at is the kid....do they look sick or not? The second thing I look at is the date of admission. I've found that our routine kids with malaria associated anemia can usually be in and out in about 3 days. So if the date of admission is more than 3 days, I know I'm going to have to think harder about what's going on. There were 22 kids in the ward and my first 8 or so were easy! Mostly new admissions who had received blood and were waiting for their post transfusion hemoglobin to be drawn that morning. Then I got to P9. Admitted July 29. Rats. I looked at the girl and she looked sick. She's older than most of our kids-probably around 7 or so. And she was skin and bones--clearly malnourished. Mom's complaint was that she didn't want to eat and that she was still vomiting up everything she ate. She'd been diagnosed with malaria, transfused and her post-hemoglobin was 8.....which is pretty good for these kids. Her malaria medicine was finished but since she'd been vomiting, I decided to give her something for nausea, start her on a different malaria medicine, and recheck her hemoglobin.

I got the results a couple hours later and her hemoglobin had dropped from 8 to 6. I kind of hate it when kids have a hemoglobin in the 6's because it's kind of boarderline as to whether or not we should transfuse. Since I have now seen one adult and one kiddo who did NOT do well after a transfusion, I am always a little nervous. But with this kid, it was an obvious choice because she looked sick and since she was so malnourished she was going to need all the help she could get. I sent her down to the lab to get her blood.

No donor. The kiddo was A+ and mom was B+. This happens sometimes and we may have a small supply in stock but we transfused so many kids today that we didn't have any extra blood. Never fear! I am A+. Woo hoo! I've been trying to donate since I got here but they kept telling me to keep it and they'll call me when they need it. Score!
I haven't been able to donate blood in America for years because I've been coming to Sierra Leone every year. Because it is endemic with malaria, they make you wait a year after you're back before they'll let you give. I remember the time I found that out. I'd been waiting for an hour or so and had filled out the questionnaire when they sent me back to the lady who checks your iron and clarifies any of the "bad" answers on the questionnaire. It's all sectioned off so it's very confidential. When she saw that I'd been to Sierra Leone she told me that I couldn't give. I had to do the walk of shame back to the door without giving and wanted to shout to the waiting room "Just in case any of you are curious, NO! I did not use IV drugs or trade sex for money! It's just......Africa!!!" But I didn't. Social filter. I'm learning.

Anyway, I digress! Again. I told them that I wanted to give some blood for this kiddo. It's not good enough in America but in Africa I think it's prime real estate because it's malaria free!! We don't check for malaria so I know sometimes we infuse kids with blood that has even more malaria. You win some.....

I went to the lab and told them I wanted to give this kid some blood. Lab Man said we should go to the OR. That's weird. They always do it in the lab. I always get nervous when I have to poke someone I know so I thought, maybe he's just a little nervous and wants to make sure he gets it right in. I'm ok with that! I've been told I don't have great veins but I've never been stuck more than once so....shouldn't be a problem. Well, small problem. Fourth time was the charm. At one point I was feeling around myself and felt what I thought was a pretty decent one. I tried to think if there was any way I could poke myself. That would have been tricky.
As soon as he got it in I started worrying. They always do a screening for HIV, hepatitis and maybe a couple other things. They hadn't done that with me. As far as I know I don't have any of those diseases but I've stuck myself with dirty needles a couple times and I'm always playing in blood over here so....well, you never know. I definitely didn't want this kiddo getting sick but felt kind of weird saying "Hey, by the way....can you check me for HIV?" But that's pretty much what I did. No problem, they checked me when they checked my blood type. Good.

After I was finished I called the little girl into the OR room to start her IV and give her....my blood. I've been giving blood for years and it was kind of weird to see the blood hanging up, knowing that 5 minutes earlier it had been in my body.....pumping through my heart, lungs, etc. Weird.

After she went back to the ward I looked outside and had a line of kiddos waiting to get blood. The IV's are usually put in by the OR staff but Wed. and Sat's are half days so they leave at 12. It was just me and a couple other nursing assistants who don't put IV's in very often. Crap. It wouldn't be a big deal if I could use catheters and put them in the arms....but those are in such short supply that I knew I needed to at least try the scalp first. Dangit. I hate those things. And I really stink at putting them in. 0 for 5 so far. I can always hit the vein but then I blow them. BUT!!! Today was my lucky day!! I put in my first successful scalp IV!!! And may or may not have done a little dance in the OR. I've been trying for weeks!!! It's the little things, you know?

So all in all, it was a good day! Got to give blood, got to successfully put a needle into a child's head........I was made for this! :)