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!