Back at the beginning of March, four of us ladies made a trip to a more rural province. Each one of us has a goal of getting to a more isolated area to work, so we went on this survey trip to see how it may be. We had several goals. One was to see if that particular place was where we wanted to go. Two was to see what type of work was going on in that area. Three was to see..well, can we hack it?
All of us came away changed, but I will just tell my story. It was a more difficult place. We had an outdoor toilet, which would be fine except for the frequent diarrhea that is so common in Afghanistan. Trips out there at 4:30 in the morning aren't the best fun.
In Mazar, we are used to walking around anywhere and wearing a head covering that leaves our face bare (or naked as they say here). But, there we wore a hijab. (a veil that covers everything but your eyes). In this area, most of the foreign women have chosen to never walk alone, so we were somewhat of a disturbance to our guards. Every time we left, they would say, are you sure? I'll go with you. We finally convinced them that we would be ok.
So, F. and I went a walking one day, and as we came to an intersection, we saw a little Toyota truck full of police. We thought nothing of it, as it is such a common site. but suddenly we saw a riot of men following the police. Neither of us said a word, but both of us at the exact same time flipped around and started walking the other direction. We had no idea what was going on, but we knew it was something we didn't want to walk into. We found out later it was a demonstration in protest of Denmark, which had decided to republish some offensive cartoons regarding the prophet Mohammad. Glad we got the heck out of Dodge!
F.'s mother has cerebral palsy (CP), so her heart is drawn to children who have physical challenges. There is a CP clinic in the town we were in, so she and I worked in it for a few days. She had a lot of ideas, and had sent some toys and materials ahead that we could work with. The children were amazing, and the work that the clinic was doing was equally amazing. A physical therapist had come out and taught some local Afghan women how to stretch and exercise the children, and they had learned well. One little boy had even learned how to walk.
We have all seen some pretty horrific things here regarding how parents treat their children, and because of this, we were really worried about how they would treat a child who was less than physically perfect. We were very surprised. The mothers doted on these children. One mother even said that her husband was so good to their little girl with CP, that their other children didn't think he liked them at all!
I learned a lot about CP that week. I had thought it just happened at birth, but it can occur up to 2 years after as well. It can happen as a result of severe dehydration after a bought of diarrhea (which is a common cause of death here as well). It can happen after a high fever. (Also common here, because as soon as they see a runny nose, they start piling clothes and blankets onto a baby even in the severe summer heat thinking that they will prevent pneumonia. Instead, they cook their babies). I can't tell you the number of mothers who told me that their baby was fine until a bought of diarrhea, and suddenly they were limp or stiff. The same with the fever.
The saddest, though is that it can also be caused by shaken baby syndrome. Most kids here are severely abused. It is a part of life that they grow up with. The problem is that some of it is not meant at all as abuse. Kids are just thrown around like they are rag dolls when they are little. They have multiple siblings who pick them up and carry them, toss them around, and drop them (I have seen two year olds carrying around their 6 month old sibling who is almost the same size as they are). When a mom wants to put a baby to sleep, she puts it on her legs and rocks hard, it until it is completely rattled. They have no idea. Also, they shake them when they are choking. My heart freezes every time I visit friends with children, because I see danger at every turn!
While we were there, I evaluated a child new to the program, and I am fairly certain that she has shaken baby syndrome. Her head was huge indicating hydrocephalus (water on the brain), and she had gone blind. She also screamed a hideous scream, the kind you hear from crack babies. It was blood curdling and made you want to run away. It was so sad. She is scheduled soon to go to Kabul to have surgery to receive a shunt that will remove the water. So sad.
That was just the beginning of the trip...more to come...
Tuesday, April 22, 2008
Monday, April 21, 2008
beggars
What do you do with beggars in a country where it is a profession? According to the laws of Islam, you have to give to beggars to get to heaven. If that is true, then you have to have beggars to give to. I struggled for a long time about what to do with them. Some are truly poor and desperate, some are not. Some of the children aren't beggars at all, but see a foreign woman with a nice face, and act like a beggar to see if they can get anything from me.
In the past, I sort of picked and chose according to the moment. There are times in the bazaar that if I give to a beggar, tons of them will crowd around me, and it becomes a mob scene with women and children pulling my clothes off. I hate that.
Lately though, because of the wretched winter they had here and now the drought we are in, prices have doubled for staples like flour, oil, and rice, so I give to nearly everyone I see. When I shop, I ask for small change so I have something to give.
I have been looking for other ways to give as well though. My roommate loads little draw string bags to give out. She packs it full of sample bottles of shampoos and soaps or first aid supplies and a 50 afghani note (one dollar...a lot for a beggar). I used to buy cookies when I went in to a shop to give to the children, but being the nurse that I am, I have wanted to do something a bit more nutritious. So, today, I walked home from "du sad bestar" (the hospital I am working in). It is about a three mile journey, so I usually run into a lot of beggars. Last week, I ran into about 5 in a 5 minute period, so I thought this week that I would be more prepared. So, I stopped at a little store and bought 4 little boxes of Mango juice, thinking it would add some vitamin C and beta carotenes to their diet. So I walked and walked, and no beggars. I couldn't believe it. There just weren't any out today! Perhaps they were hanging out at wedding halls, as it is wedding season. Or, perhaps the police came through and cleared them all out. That is possible. I saw a big truck full of Kalashnikov armed men drive by as I was leaving the hospital...who really knows?
I was a bit disappointed, as I was very tired from the day at the hospital, and I had loaded myself down with all these juices. But, as I got to the back side of the bazaar, where all of the used clothing is, I saw a little old woman bent completely in half shuffling along with her little bag of bread looking into a shop to see if the man would give her a bit of change. I looked to make sure she was a beggar (though I really didn't have a doubt). Then, I turned around and bent over to talk with her and gave her the juice and told her it would be good for her. At this point, usually the beggar will say "God bless you", because to give to beggars gains favor with God. I don't believe this. I give, because I know that God loves these poor distressed people. I said, "God bless you khAlla (auntie)". Then she grabbed me and hugged me around the waist because she couldn't stand strait, and burst into tears. I bent down to hug her back and cried with her.
What else could I do?
In the past, I sort of picked and chose according to the moment. There are times in the bazaar that if I give to a beggar, tons of them will crowd around me, and it becomes a mob scene with women and children pulling my clothes off. I hate that.
Lately though, because of the wretched winter they had here and now the drought we are in, prices have doubled for staples like flour, oil, and rice, so I give to nearly everyone I see. When I shop, I ask for small change so I have something to give.
I have been looking for other ways to give as well though. My roommate loads little draw string bags to give out. She packs it full of sample bottles of shampoos and soaps or first aid supplies and a 50 afghani note (one dollar...a lot for a beggar). I used to buy cookies when I went in to a shop to give to the children, but being the nurse that I am, I have wanted to do something a bit more nutritious. So, today, I walked home from "du sad bestar" (the hospital I am working in). It is about a three mile journey, so I usually run into a lot of beggars. Last week, I ran into about 5 in a 5 minute period, so I thought this week that I would be more prepared. So, I stopped at a little store and bought 4 little boxes of Mango juice, thinking it would add some vitamin C and beta carotenes to their diet. So I walked and walked, and no beggars. I couldn't believe it. There just weren't any out today! Perhaps they were hanging out at wedding halls, as it is wedding season. Or, perhaps the police came through and cleared them all out. That is possible. I saw a big truck full of Kalashnikov armed men drive by as I was leaving the hospital...who really knows?
I was a bit disappointed, as I was very tired from the day at the hospital, and I had loaded myself down with all these juices. But, as I got to the back side of the bazaar, where all of the used clothing is, I saw a little old woman bent completely in half shuffling along with her little bag of bread looking into a shop to see if the man would give her a bit of change. I looked to make sure she was a beggar (though I really didn't have a doubt). Then, I turned around and bent over to talk with her and gave her the juice and told her it would be good for her. At this point, usually the beggar will say "God bless you", because to give to beggars gains favor with God. I don't believe this. I give, because I know that God loves these poor distressed people. I said, "God bless you khAlla (auntie)". Then she grabbed me and hugged me around the waist because she couldn't stand strait, and burst into tears. I bent down to hug her back and cried with her.
What else could I do?
Wednesday, April 16, 2008
du sad bestar
Du Sad Bestar That is the name of the hospital that I am assigned to. It means 200 beds. I take that to mean that they can have two hundred patients. If you haven't been in Afghanistan for a long period of time, the first thing you may notice as you walk in the door is a guard with a Kalashnikov (old Russian type automatic machine gun) at his side. Not your every day occurrence in the USA. Though, I think we do have armed guards in most ERs nowadays. I have actually gotten used to seeing Kalashnikovs. I actually don't really notice them anymore unless I am trying to remember what it was like to be new here. I noticed this time, because I was wondering what in the world I would blog about. Life has gotten so "normal" for me here, that I forget what things are really NOT normal in the west.
I actually haven't blogged in a while, because I was over a half a month without electricity, and my computer battery is so bad now, that by the time I used it for a 45 minute exercise routine, it was finished. I guess our frequent, long lasting power outages are also not "normal".
There are two of us "foreign" nurses who are to be supervising the clinical instructors. Clinicals are on Monday and Tuesday, though the original schedule had them on Tuesday and Wednesdays...ok, how can I begin to explain why we had to completely change the 18 week schedule that had been set for months....March 21 was the Afghan New Year. It is celebrated by people from all over Afghanistan making a pilgrimage to Mazar (my town) to the blue mosque/shrine of Ali (you can Google that one...it may be under Shi'ite traditions). Then, every Wednesday, for 40 days (which equals like 5 Wednesdays or so), the women of the city gather at the shrine for a picnic lunch. Police guard the perimeter so that men can't get in, and women dress up in their finest shiny dresses and it becomes the social event of the year. We had to change our schedule that had been set for months, so that the female instructors could go on a picnic.
We also have a short meeting on Sunday to go over what the instructors are to be teaching during the clinicals. The plan was that we would rotate around all of the clinical sites to see how the teachers were doing. Unfortunately, the teacher at du sad bester has a habit of not showing up for clinicals. So, I am there on a permanent basis. All of the other instructors go to the school to sign in that they are present, then they go to the clinical site, then back to the school at the end of the day to sign out. This particular teacher was told to not even go to the school, but just show up at the clinical site, because otherwise, he would sign in, then disappear and reappear to sign out at the end of the day, having never stepped foot in the hospital. Sigh...
Our first week was technically last week. We started at the nursing school on Monday with a meeting for the students to explain the rules to them. Mostly "normal" stuff... you must have a uniform, your ID badge, a watch with a second hand, stethoscope...Boy did they ever balk at that! One guy got up and said, "you can't lay your American rules on us. We are poor Afghans!" We actually didn't make any rules. We just read to them the rules that the nursing school has always had, and told them that they would be enforced.
So, the next day was practice day. They were to show up at their clinical site, in uniform, on time. That was all. we had 7 of 10 show up. All were late. One didn't have his uniform, several, a couple didn't have ID cards, a couple didn't have a pen or paper. None had stethoscopes. On the bright side, the instructor showed up on time.
We finally got started this week. Only three students showed up the first day. My coworker, K, made this great plan to build up their knowledge every week. So, this week they were to take a history and get vital signs. Next week, they will do the same, but also do a head to toe assessment, the next week, we add procedures like IV starts, etc... We let them go into a ward to choose their patients, get their history and take the vital signs. Here I must put in another aside. A ward is not like a ward in the States. It is a room full of beds. Also, in the States behind hospital beds is equipment, like oxygen, suction, ambu bags (the bags used in respiratory resuscitation) . There is no such thing here. Just beds.
About 15 minutes later we went to check on them, and take the vital signs ourselves, so that we could see if the students were right or not. It turns out they hadn't really done anything. So I observed. It was obvious that they had never done that before. So, I gathered them together and took them to an empty room and taught them how to take a temperature, blood pressure, pulse and respirations, and then made them practice on each other until I knew that they could at least put the cuff on right side up.
Another thing we did was buy bags of supplies for each of the clinical sites. We included things like a BP cuff, alcohol swabs, thermometers (you would be hard pressed to find a thermometer in a hospital here. the nurses just touch your forehead and make a guess as to what the temperature is.) My big contribution was a bottle of alcohol so that the students can wash their hands between patients. They thought I was obsessed, as I followed them around with this bottle. Everytime I got near one of them, I was pouring alcohol on them! Yet another aside. They don't have isopropyl alcohol here. That is the rubbing alcohol that we use in the States. They have ethanol. It smells like a bottle of rum, and I have to confess, the past two days of clinicals have tempted me to upend that bottle into my mouth!
So this particular clinical group, which I will have for several weeks is all boys, so all of the patients are male. As this is Afghanistan, before I can touch a patient who is a man, I must ask his permission. So far, I haven't had anyone refuse, though I have had some very smiley men, who really creeped me out.
I will continue this blog tomorrow, as I am now exhausted just recalling the past two days!
I actually haven't blogged in a while, because I was over a half a month without electricity, and my computer battery is so bad now, that by the time I used it for a 45 minute exercise routine, it was finished. I guess our frequent, long lasting power outages are also not "normal".
There are two of us "foreign" nurses who are to be supervising the clinical instructors. Clinicals are on Monday and Tuesday, though the original schedule had them on Tuesday and Wednesdays...ok, how can I begin to explain why we had to completely change the 18 week schedule that had been set for months....March 21 was the Afghan New Year. It is celebrated by people from all over Afghanistan making a pilgrimage to Mazar (my town) to the blue mosque/shrine of Ali (you can Google that one...it may be under Shi'ite traditions). Then, every Wednesday, for 40 days (which equals like 5 Wednesdays or so), the women of the city gather at the shrine for a picnic lunch. Police guard the perimeter so that men can't get in, and women dress up in their finest shiny dresses and it becomes the social event of the year. We had to change our schedule that had been set for months, so that the female instructors could go on a picnic.
We also have a short meeting on Sunday to go over what the instructors are to be teaching during the clinicals. The plan was that we would rotate around all of the clinical sites to see how the teachers were doing. Unfortunately, the teacher at du sad bester has a habit of not showing up for clinicals. So, I am there on a permanent basis. All of the other instructors go to the school to sign in that they are present, then they go to the clinical site, then back to the school at the end of the day to sign out. This particular teacher was told to not even go to the school, but just show up at the clinical site, because otherwise, he would sign in, then disappear and reappear to sign out at the end of the day, having never stepped foot in the hospital. Sigh...
Our first week was technically last week. We started at the nursing school on Monday with a meeting for the students to explain the rules to them. Mostly "normal" stuff... you must have a uniform, your ID badge, a watch with a second hand, stethoscope...Boy did they ever balk at that! One guy got up and said, "you can't lay your American rules on us. We are poor Afghans!" We actually didn't make any rules. We just read to them the rules that the nursing school has always had, and told them that they would be enforced.
So, the next day was practice day. They were to show up at their clinical site, in uniform, on time. That was all. we had 7 of 10 show up. All were late. One didn't have his uniform, several, a couple didn't have ID cards, a couple didn't have a pen or paper. None had stethoscopes. On the bright side, the instructor showed up on time.
We finally got started this week. Only three students showed up the first day. My coworker, K, made this great plan to build up their knowledge every week. So, this week they were to take a history and get vital signs. Next week, they will do the same, but also do a head to toe assessment, the next week, we add procedures like IV starts, etc... We let them go into a ward to choose their patients, get their history and take the vital signs. Here I must put in another aside. A ward is not like a ward in the States. It is a room full of beds. Also, in the States behind hospital beds is equipment, like oxygen, suction, ambu bags (the bags used in respiratory resuscitation) . There is no such thing here. Just beds.
About 15 minutes later we went to check on them, and take the vital signs ourselves, so that we could see if the students were right or not. It turns out they hadn't really done anything. So I observed. It was obvious that they had never done that before. So, I gathered them together and took them to an empty room and taught them how to take a temperature, blood pressure, pulse and respirations, and then made them practice on each other until I knew that they could at least put the cuff on right side up.
Another thing we did was buy bags of supplies for each of the clinical sites. We included things like a BP cuff, alcohol swabs, thermometers (you would be hard pressed to find a thermometer in a hospital here. the nurses just touch your forehead and make a guess as to what the temperature is.) My big contribution was a bottle of alcohol so that the students can wash their hands between patients. They thought I was obsessed, as I followed them around with this bottle. Everytime I got near one of them, I was pouring alcohol on them! Yet another aside. They don't have isopropyl alcohol here. That is the rubbing alcohol that we use in the States. They have ethanol. It smells like a bottle of rum, and I have to confess, the past two days of clinicals have tempted me to upend that bottle into my mouth!
So this particular clinical group, which I will have for several weeks is all boys, so all of the patients are male. As this is Afghanistan, before I can touch a patient who is a man, I must ask his permission. So far, I haven't had anyone refuse, though I have had some very smiley men, who really creeped me out.
I will continue this blog tomorrow, as I am now exhausted just recalling the past two days!
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