Learning about TB-Mennigitis

Clinical has been going wonderful.  With the nurses supervision we are allowed to assist in doing full initial assessments and admitting our own patients.  Recently a little girl was admitted with suspected tuberula meningitis.  This is something we very rarely see in the united states so I was excited to have her as one of my patients.  She had a history of recurrent headaches, a history of TB and vision changes with eye pain.  Upon admission a full set of vitals were taken and a full body assessment was done.  There were no abnormal findings except for what the child reported.  We prepared her for a CT scan, chest X-ray and a lumbar puncture.  As the student nurse I was able to follow her to all of these procedures and provide therapeutic calming talk and encouragement.  She was so brave and did not cry once…not even during the lumbar puncture.  I had never seen any of these procedures done before so everything was a new learning experience for me.  No results were returned while I was in clinical that day, but the next morning everything was back and showed negative results for TBM.  This was thrilling to me because it’s a severe illness and this child was so young.  I continued care for the child who was alert oriented and quite pleasant to be around while the doctors tried to determine what the problem was.  Unfortunately nothing was determined during our shift in the hospital and by the time we returned the following week she was already discharged.  I probably won’t ever see TBM in the US so overall it was a great experience seeing how it would be diagnosed and the eventual treatment.

Boulder’s Beach and Table Mountain

This past weekend we went to Boulder’s Beach, which is well known for the penguins who live there.  It was neat to see all of the penguins so close to us.  On another day off, a few of us decided to get up early and hike up Table Mountain (some of us for the second time).  After about an hour and a half of hiking up what was the equivalent of stairs, we were so relieved to be at the top!  The view from the top of the mountain is breathtaking, as you can see the coast and the entire city of Cape Town.  We took a few pictures, and then decided to take the Cable Car down the mountain.  We have been very busy with pediatrics lately, as we try to fit the rest of our semester into the last three weeks.  I can’t believe we will be on our flight home so soon! It will be such a shock to be back home in the freezing weather of Connecticut!

Free Time = Hiking

I hiked Table Mountain today! The hike was tough and sweaty but it was all worth it. The weather was perfect and the scenery from the top was breathtaking. The other mountains and the water looked incredible from the top. It felt good to be on the top especially when the wind relaxed my body and cooled my tired feet.  I also enjoyed eating my snack at the little café on the top of Table Mountain. 

Hiking is something I really enjoy these days. Not only is it a good workout but it is also is a good way to de-stress after a long week. From hiking almost every weekend in South Africa, I have learned three points.  First, you can’t be influenced by what other say about the mountain you are going to hike. What one assumes to be easy may not necessarily be the case for you. You sort of have to choose for yourself and take responsibility of your own choices.  Second, when you start hiking, the mountaintop may seem closer than it really is but in reality, you have to go through many trails and hidden paths before you can make it to the top. The third point is that it is very important to respect your body as you are hiking. You can’t go too slowly or too fast but instead you have to listen to your body and breathe through every step you take. You should always encourage yourself, enjoy the landscape, and keep hiking. In life, making responsible choices, facing reality, and listening to your instincts can make many obstacles effortless.

 

Best Clinical Experiences

Allison Lampner

 One of the best experiences I have had here in South Africa was this week’s clinical at a local facility.  It was described to us as an AIDS orphanage, but in fact it is more of a holding center for HIV+ children with family concerns.  The staff (including nurses, social workers and occupational therapists) works with the families to try to stabilize the education and home environment so the children can go back with them.  However, in situations that it is not possible, the staff cares for the children and works to get them alternate long-term placement.  It’s pretty cool because as one of the medical staff told us, the organization started as a palliative care residence for children dying from the virus.  Nowadays with the improvements in treatment of positive children that kind of center is no longer needed and the staff can work to get the children poised for productive and long lives.  This involves a lot of familial support, which again isn’t always there.  Those cases are sad but the staff works to make a loving, supporting and encouraging environment for the children in the center. 

Brianna and I arrived at the orphanage and before we could get the gate closed behind us in the playroom, we each had a little child or two attached to our leg.  The children there are mostly babies and toddlers and they were some of the sweetest children I have ever encountered!  Our two days there this week were busy with playing, holding, changing, feeding and observing the children.  I’m too young to remember the effect of AIDS before there were effective drugs, but that connotation of sickly and dying children is still prevalent with the HIV+ image.  However, two seconds in the facility proved much of that preconception wrong.  They are just like any other children: playing with toys, wanting to explore and loving attention from the grownups.  There are of course complications with the disease but even with coughs or sniffly noses or even tracheotomies they are still regular little children enjoying their world. 

The staff there is wonderful, they all truly care about the children and work in many ways to get them into the best situation they can.  I was most impressed in the charts about social work efforts.  No matter the duration of time a child spends in the facility (days, weeks, or months) it appears there is always hard work being done to procure the most positive discharge possible for each child.  All in all a fantastic experience overall and I wish I could spend more clinical hours there… the time went so fast!!

A Glimpse of Their World…

This week I had the opportunity to work at a HIV orphanages in Cape Town. For two days we were immersed in their clinic, we woke the kids up, fed them, played with them, and helped take care of them. It was such a bright atmosphere for a place that held a lot of sadness in it. I couldn’t help but think about how a lot of these children have parents with no intention of coming to get them, most of whom may end up in foster care or orphanages long term, but that seemed to be the last thing on everybody’s mind. All of the doctors, nurses, and social workers had a mission, to take care of these kids for the time being, and to show them all the love they can for the time that they are there. The future for these children is so indefinite, but the staff seems to have their mission straight. It is easy to get overwhelmed here by the poverty that is so present in this city, but one person can only do what one person can do. Each member of the staff was committed to doing the best for the kids that are there, and loving them the best they can, and that is what truly makes a difference in Cape Town. To have to opportunity to spend two days in their world, seeing what they see, and doing what they do, was an opportunity that not many people have, and it was a true privilege.

My favorite part of clinical…

I can’t believe that it’s already been three weeks since starting our Pediatric half of the semester. We’re not only placed in the hospitals that we were in for maternity but we are also placed one week in a clinic and one week in an aids orphanage (and I can’t wait for my turn to go).

My favorite part of clinical is just spending time and interacting with the children, especially the children that don’t have family with them. Last Wednesday, most of my morning was spent with the cutest little two-year old waiting for his family to visit. He was sitting so quietly with his little legs crossed watching television and everyone that walked past his room. I walked in to say hello and he wouldn’t talk to me until I was leaving out of his room. Just when I thought he didn’t understand me or just didn’t talk much he said. “No, come here.” He didn’t want to be alone so I stayed with him until it was time for him to get an IV line put in for the third time. His family was in by this time and I didn’t want to see him crying. He was in with respiratory distress and possible meningitis. The week before this I had to help restrain a four-year old girl getting an IV line put in for the fourth time. She also was in with respiratory distress (something we see a lot of in the hospital) and meningitis. The nurse informed me that she needed IV access for fourteen more days and that this probably wouldn’t be the last time trying to put and IV line in her. I felt horrible being the one to restrain her…I didn’t even want to be observing the procedure. I kept an outward appearance of calmness however, and tried to keep the patient focused on me as I soothingly talked to her and rubbed her back. I thought for sure she would hate me when the procedure was done but she only cared about getting back in her mother’s arms. I don’t know if my presence made a difference or not, I was just happy to see her smiling minutes later. ~Ashley

Safari

I went on safari at Aquilla last week with a guest and it was beautiful.

Our group has previously gone to Kwazula-Natal for a safari but I didn’t
see anything wrong with going on another one! So I got up early on a
Tuesday morning, early as in 4:30am. We traveled a couple hours with a
van packed full of people to the Aquilla park. We were greeted with
champagne and sparkling grape juice and led to a breakfast buffet. It
was amazing and it just so happened to be a beautiful, sunny, hot day.
We hopped on the safari truck that had higher seats in the back with a
top covering and were off into the park. The first animal we saw were
Hippos. The hippos are certainly one of the funniest animals I have seen
because they sit all day in the water with their bellies on the sand.
It’s their way of keeping cool. Although they are very cute, the safari
guide told us that hippos are responsible for a handful of deaths
because they are very territorial. The next animal we saw was Spring
Bucks. They were deer like animals and the pack we saw was a group of
bachelor males. There are many of the them on the reservation and are
one of the larger animals source of food. Next we saw a couple
elephants, which are my favorite! They are these large majestic animals
that move so gracefully. We also saw a group of Zebra and a lot of
pregnant Zebra actually. The female zebra that are pregnant just have
these significantly larger bellies than the rest of the pack. In
addition to the pack we saw a 5 day old zebra. The guide told us that
they can stand within minutes after birth and can run several hours
later. Amazing! We also saw giraffe, water buffalo, rhinos and several
dung beetles. There is another section of the park that is specifically
for lions but unfortunately we did not see them because it was such a
hot day. The guide told us that when it’s so hot out they usually lay in
the shadow of rocks towards the top of the mountains. After the safari
was over, we traveled across the street to a rehabilitation center for
animals. In the rehab facility was lions, a leopard and crocodile. We
got some fabulous pictures and were so lucky to see the big five in all
one day! The big five include lions, leopards, elephants, rhino and
water buffalos. They are called the big five because in the past they
have been the most hunted animals or the ones with most valued parts if
caught. Our safari came to an end after a buffet lunch and a couple hour
drive back to the hotel. We were so lucky to have such wonderful weather
and enjoyed seeing all the animals!

Working at the clinic

For most of the semester, we have been attending clinical at private hospitals. I had a great time at both hospitals I was assigned to, and I unquestionably learned a lot, but I was still excited to work in a public clinic, set much more in the community than a large hospital is. Two weeks ago, I got the opportunity to work at TC, and it was a great experience!

To begin with, I worked with a nurse who was put in charge of preliminary assessments of a long line of infants and toddlers.   There are so many waiting patients and so few staff, there really isn’t time for anything but working.  All of the families lived in the surround township, and they were all poor. Still, they were all doing the best they could to come in on time for their children’s immunizations and wellness check-ups.

I worked with the nurses on admission assessments for a few hours, and after lunch, I observed lengthier, private assessments in the back. This was a fantastic opportunity to observe the differences between South African and American culture. For the most part, every ailment I saw was treated with a bottle of amoxicillin or a nutrition powder (to be mixed with water to help underweight children gain weight more easily), and sometimes with both. The supply of drugs at the clinic was very limited, as was the amount of nutrition powder. The nurses told me that every child they saw was underweight, and therefore was qualified for the nutrition powder, but they often had the difficult task of denying one malnourished child the powder to save for a possibly worse-off child who could come in sometime in the future.

Overall, working at TC was completely eye-opening. I knew that it would be overcrowded and very hectic, but I wasn’t completely prepared for the massive amounts of patients who all needed the same basic healthcare treatments that we take for granted back home. Without a doubt, from this experience I have learned gratitude and appreciation for everything we have that we take for granted.

Community Clinic

My days at the community clinic have been a great experience. It’s a government-funded health clinic where mass amounts of children and adults with no medical aid flood the clinic from early in the morning hoping to be seen by the end of the day.

The nurses assess, and help triage beautiful young children who are often accompanied by their mothers or grandmothers, and I get to work closely with them.  The clinic has a particular assessment they follow depending on the issue. For example, if the child or mother complained of respiratory distress, we would take their temperature, count their respirations, document the findings and then send them to the back room to be further assessed, diagnosed, and treated by the ‘sisters’ or nurses and doctors.   If the child had a headache, we’d prick their finger and then assess their Hb count on the Hemoglobin meter to test for anemia. Many mothers bring their infants for neonatal checkups and immunizations and we’d document their weight and height on a flow chart to ensure proper growth. When we’d weigh the children, we’d write their weight in Kg on their mother’s hand. I noticed the children were nervous to step on the scale without their mothers support so I decided to try an alternative method.  In order to gain the child’s trust and enhance our nurse-patient relationship, I’d ask them if they could hold out their hand for me so I could write their weight on their own hand. I felt that asking for their hand and thanking him/her for letting me write on them gave each child a sense of independence and reward. The children seemed proud to have participated in their own care. Not only the children benefited from this experience, but I as a student nurse felt empowered. I made a connection with my patient’s and helped them feel more comfortable in my presence.

Robberg Peninsula

Our escape to Plettenberg Bay was a delight. It was a challenge to organize and plan, but it was well worth it. During the weekend on the Garden Route we pushed our limits. I bungee jumped 216 meters. And walked with an elephant. Not your typical Saturday afternoon events.

It was also a time to enjoy the beauty of South Africa; specifically, from a sea kayak. We started our kayak trip from the beach and headed out to Robberg Peninsula. From one side of the kayak we could see the cliff mansions. And on the other side we could see the never-ending Indian Ocean. Being out on the water gave me a chance to sit back and take everything in, especially the last two months that I’ve spent here in South Africa. I feel that I have seen and experienced so much while being here.

This was eventually interrupted when a seal jumped out of the water right next to my kayak. It was so full of life and continued to follow our group of kayaks all the way to Robberg Peninsula. As we approached the peninsula we could see small black objects on the rocks moving slowly. We soon figured out that the black moving objects were actually hundreds of seals! It was amazing to see so many creatures so close to me in their natural environment.   Only in Africa!