Reflecting in Rugazi


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Africa » Uganda » Western Region
June 27th 2016
Published: June 27th 2016
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Another week down - oh, the tricks of time, weeks pass in the blink of an eye, but there are times when a half hour can feel so long…

I have decided to remain on in Rugazi for the extra ten days. It was not an easy choice, but as I flipped through the pages of my journal seeking my answer, I remembered how excited I was when we were originally granted permission to stay the extra week and a half in the rural community instead of returning to the city. I decided I wouldn’t let my emotions or temper get in the way of that. Although it is difficult to work within the group and cultural differences sometimes, I decided that if I can get through working with this one man, then I should be able to work with anybody in the future. It is an exercise in patience and self control – I cannot allow one individual to influence my decision. Especially since I so enjoy the work here, and the next ten days will involve training/education with the community health workers and staff at the clinic, if all goes accordingly. It is not work I wish too miss, so I decided to stay. Additionally, said individual left last Monday, to return on Saturday (yesterday) – which in Ugandan time could mean anytime after next Wednesday. So really, we only have one week in which to butt heads with one another. I can surely endure that…

The week has been rather slow; I woke up Monday with a sore throat, body aches and a runny nose. When I visited the orphanage yesterday (Saturday) their runny noses and coughs confirmed my suspicion that I had picked it up from them. I took one day off from the clinic, but was less active in the afternoons then I have been previously, lacking the energy and not wishing to spend too much time with the others for fear of spreading the sick, though I think I managed to do so anyway.

I was back on the Inpatient ward this week, mostly full of children with malaria or sickle cell crises. We had plenty of IV starts and needles to administer; their veins are so difficult to find under their dark skin, and they fight and scream enough to make my blood curdle. I am growing more adjusted to their cries, but it still troubles me. Yet what troubles me more than their fright and anxiety is the treatment doled out by the staff. I try my best not to judge, but their way of nursing is sometimes so different from what I have been taught and the role I have formed for myself in my mind. Witnessing some of their techniques this last week has resulted in a deep reflection on my role and personal understanding of what my responsibility and duty as a professional nurse is. Quite simply, I believe it is my job to look after people, as best I can with what I have available to me. I look after not just their bodies, but their minds, and I would even go so far as to say their spirits. I nurse these with my brain and my heart, which in turn guides my hands and my words. All these together work to complete the physical tasks – measuring, drawing up, and administering chemicals into the bloodstream; feeling and listening for the bodies’ warning signs; performing the ritual of washing the major organ that defends them from microbes, the skin, to keep it healthy and intact, a task that becomes so much more than an obligatory duty. A nurse should be conscious of their touch and assume a gentle voice in every attempt to help the patient feel soothed, so they can enjoy the feeling of soap and water against their body without feeling shame for having to be subject to the care of another for such a basic need. Finding the right balance between utilizing heart and brain is dependent on each individual patient, and the particular situation; the better I learn and understand this balance, the better my nursing ability will be. It's striking this harmony that elevates the physical tasks to something more...

The rough handling of patients I sometimes witness here leads me to believe that my theory of brain-and-heart nursing doesn’t really resound with all nurses. It’s more of a brain-brute-heart style. I have no doubt they feel compassion, as who can work in this field and not, but their techniques make my head swarm and stomach turn. The children generally fear us when we approach with them anything that gleams, and is thus capable of puncturing their tough, dirty skin. They almost always require a restraint of one or two people in order to keep the arm immobilized long enough to insert our intravenous cannulas, but some children become so hysterical it often requires more. One child, Mackeline, a six-year-old girl in a sickle cell crises and diagnoses of malaria (a rare combination), sticks out particularly in my mind. These sickle cell crises send the unfortunate individual into bouts of pain, and even a gentle touch can cause them to cry out in agony. Mackeline, little fighter that she is, removed her IV twice, and on this day we had to insert yet another cannula in order to finish her drug therapy. I bore witness to the second insertion the day previously, and was not looking forward to this third attempt. The girl’s mother was sick in the next ward over, and so her grandmother was the one there to care for her. Unfortunately, Grandma’s approach with Mackeline when she became disturbed at the sight of the needle was in line with the nurses on duty that day - that is - threats to slap and beat the child if she did not stop crying or fighting. Naturally, this has very little affect on frightened children, other than to send them into further hysterics; the point of rational reasoning is long gone for them when they are that distraught. With two nurses restraining her, she managed to break free twice, bolting for the door of the treatment room before being snatched and brought back. The staff howled with laughter at this, which was the part that really hurt me. It took six of them to make the insertion – one person per limb, one to hold her torso, and one to do the poke. Her screams wracked her body; I crossed my fingers and said my prayers that the nurse would hit the vein on the first shot to end the ordeal as soon as possible. She did, and the child was released.

This handling of children is really rather horrendous to me. At home we are blessed with sedatives and local anesthetics to make the process more tolerable, for children and staff alike. But even without, I couldn’t imagine threatening to slap them, or to laugh at their distress. Not just that we would lose our license, but it’s simply not a part of our culture. We don’t expect such stoicism of our little ones as they do here.

Watching events like this makes me feel ashamed – ashamed of these individuals who bear the title “nurse”, a title I hold in high honor. These goings on sully the name of the profession I hold so high in my idealistic young mind. I feel ashamed of myself also that I can’t do more to interfere with this way of treatment. As much as I long to tell them to be more conscientious, if not compassionate, they would never listen and would look at me in disbelief and even disdain. It is often hard enough functioning as a “mzungu” in their territory, and I would stand to lose their help, which is imperative to function in a foreign environment. No, I do not interfere, and stand cowardly in the corner and bear witness. I remind myself of my professor’s words from last year in Tanzania, when I experienced similar feelings. She told me there are good and bad nurses everywhere, and to use these experiences to decide what kind of nurse I will be. Yes, I have so, so much to learn yet, but the one thing I know with certainty is that as a nurse
Side Angle for our Spectators Side Angle for our Spectators Side Angle for our Spectators

Our daily yoga attracts many onlookers
I wield a power, and it is my vow to use it responsibly. To act with intelligence, compassion, empathy and understanding. These incidents I experience here burn into my memory, so that I will never forget which kind of nurse I am. And the second I lose that is the day it is time to find a new career…

On a lighter note, our group went out on Friday night as a celebration to say goodbye to the three girls who returned to Mbarara on Saturday. We went to the club in town, which was an impressive open outdoor stone amphitheater sort of venue, tucked behind the walls of a dirty shop and hidden from street view. They played great music, and I danced for four hours straight. It didn’t help my cold, but my lower body sure got a good work out. Some of the local girls there helped us to dance, guiding our hips with their hands, encouraging us to gyrate along with them. You could tell they were happy to dance with foreigners and delighted in our incompetence. I simply was not built to move that way, but it’s fun to try. I told Rehema that I think one of the major differences is our body types – their endowments give them an extra half beat to every move they make, a half beat that no matter how fast I attempt to shake I will never achieve! We stayed until 1:00am; around that time the dance floor was packed. Being white, we are a novelty and we found ourselves getting swarmed with people wanting to dance. We tried to be nice and give everyone “turns”, but eventually it all became a bit too much and we asked the boys to walk us home. As Ambrose put it - “Many of them have never danced with a mzungo, so they become veeeedy excited when they see you”. We had a lot of fun, though I set my nose to running for an extra day or two by way of retribution.

Now that my roommate, Brooklyn, has returned to the city my room feels somewhat lonely. Brooklyn and I became roommates by default, and though we are an odd pairing, we somehow worked out well together. She is incredibly pious, I would drop dead if a curse ever crossed her lips, and she studies her bible whereas I drink and smoke and make vulgar jokes. She stayed out with us on Friday, and on the walk home she said, “Oh my, I haven’t stayed out so late since New Years!” Totally serious. We are a sharp contrast and have become unlikely friends - another one of the joys of travelling. I look forward to seeing her again in ten days; I know the time will fly by and soon it will be my turn to say goodbye to Rugazi and my sweet Ugandan friends. The week will be busy with clinic and community work, to be capped off this weekend with an elaborate Canada Day celebration. We are excited for the event - it’s going to be a good one.

That is all I have for this week!



Love to everyone,





Carrie Ann


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28th June 2016

best nurse ever
So proud of your spirit and soul Carrie!
4th July 2016

Thank you Auntie Karen, I love you :-)
4th July 2016

Thumbs up
Awesome again Carrie. Enjoy all of it. Nice Father's Day gift to give the children, their dads and their family.
4th July 2016

Thanks Mama!! It makes me so happy you and Dad are reading and enjoying my words :-)

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