Work, a Wedding, and the Way Forward

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Our time in Rugazi has come to an end. In only two more sleeps and I will be in a crowded van on my way back to Mbarara…

The last week went well; I worked again in the inpatient ward, administering medications, performing IV starts, and scratching my head at some of the more troubling cases. There are really only a few courses of treatment provided here – antibiotics, malaria treatment, and fluid replacement. There were a couple of psychiatric cases the last couple weeks, and they receive an antipsychotic and/or mood stabilizer. The more time I spend at the clinic, the more I realize that a lot of what is done here is a crap shoot – different clinical officers prescribe different drugs and dosages for similar symptoms; antibiotics are used in abundance, I would say even in excess. In addition to the randomness of drug prescription, the system of drug administration seems helter skelter to me, especially in comparison to the careful methodology of home. More than once this week I have approached the nurses on duty with patients charts, asking “Is there a reason we didn’t give this drug??” to which the response is usually no, there is no reason other than it was forgotten, or the schedule was misinterpreted. The first time I transcribed orders, I wrote on the patients treatment page the exact times the drug should be give – 11:00am, 11:00pm, and 11:00am the following morning. Much to my chagrin and disappointment, the child who I had inserted the IV in the previous day had it removed when I came to work at 9:00 am the following morning, when his final dose wasn’t due for two more hours. The nurses on duty had assumed that since I had wrote the times, I had given the drugs. They cursed me out, and though I felt guilty for the child missing his doses, I wasn’t particularly in the mood to be over apologetic to the staff. With a little bit of critical thinking and communication, it should be clear that it’s impossible to administer drugs in the future – right?! With a little more organization and thoughtfulness they could work a lot more efficiently and effectively. It is frustrating sometimes, but I remind myself that I am a visitor here. Best to remain polite, help out where you can, and avoid being ethnocentric. It is easy and enjoyable to work when the nurses are collaborative and interested in my viewpoints, but some are so territorial and don’t like foreigners imposing themselves. Anyway, at the end of the day it should be about the patients, I remind myself when I become frustrated.

Working here really makes me appreciate the quality of my education, the passion of my professors, and the high standards of the nursing profession in North America. We are taught about the rights of patients, about treating people with respect and helping them to maintain their dignity. I recall one class where the guest lecturer said, “Any monkey can learn how to do skills and give needles! It’s how you treat people and how you make them feel that determines whether or not you are good at what you do.” I understand that so much working here. Ambrose tells me the students here are taught about patient rights, therapeutic communication, etc., but the practice-theory gap is so evident. Why? Is it part of the greater culture? Is it because they lack the diagnoses and treatment of home, and thus have less hope for their patients? Are they so accustomed to illness, hardship, and death that it seems frivolous to spend meaningful time with patients? Or, do I simply not understand? Likely, the latter; and although I struggle to understand the nursing paradigms of this place, I nonetheless sympathize with the enormous struggles they face. It is comforting to know that I have such an amazing country to come home to, where my personal philosophies align so nicely with the expectations of my professional body. Though it is nerve wracking to think of returning home, with that monstrous licensing exam looming over my head like a big dark cloud, and my terrifying first year of RN practice, I know that in time I will find my stride.

As far as community work goes, this week our focus was on developing education for the Village Health Teams and for the staff at the clinic. Unfortunately I will be returning to the city before we can commence with the staff training, but I will still enjoy working on handouts/mini training guides. It’s hard to say if the staff will take any of it seriously, but even if we can encourage one or two workers to greet, commend, and thank fathers for attending the clinic with their wives, that will be a job well done.

As good as the clinic and community work was last week, the real highlight was the Canada Day celebration we threw on Friday. Team A and Team B competed in a Canada Day Games on the lawn of our dorms; we held five events including a variation of botchi ball, flippy cup, Find the Beer (a game involving a blindfold and searching for the beer), pin-the-leaf on the flag, and a game of water balloon jackpot. In this game, the two teams fought over the water balloons chucked into the air to earn points - or lose points if they burst the balloon. The families of the patients in the wards emerged on the sidelines to observe the shenanigans; they laughed at our buffoonery and I can only imagine what they think. What kind of reputation are we leaving for Saskatchewanians, I keep wondering...

The games came down to a final tie breaking round of flippy cup in which Team B emerged triumphant. I was having too much fun (and just enough punch) to not even be miffed at losing.

After the games, the girls scrambled to prepare for the mock wedding we had planned for after the games. It all started because Team B put a play on at one of the schools to teach about HIV transmission - in the play, Dayna and Julius got married, but they didn’t act out the wedding. I was disappointed by this, and got it into my head that we should have a play wedding; this, along with the fact that Dayna’s mom told her she was not allowed to get married in Uganda, fueled the idea. By Tuesday we were gung ho on the idea; I don’t think the Ugandans believed us until the invite poster went up on Thursday. Hilariously, the Dean of Medicine made a visit to us the same day, but I think someone was able to hide the poster before he saw it…They definitely believed us when we started making bouquets, turned the dining room into a banquet hall, and got our dresses and make up on. DJ “Amb”(rose) set up his computer and speakers, ready with the play list I had him prepare. At 7:30 the ceremony began, beautifully conducted by Reverend Stevo, complete with a reading of Corinthians 13:4-7. After the brief but tasteful ceremony, we commenced with the reception; we heard speeches from the best man and maid of honor, followed by my speech welcoming Julius to the family, and finished with Maria welcoming Dayna. It was actually so nice, real tears were shed (by me). I played the picture slideshow I created on my computer. After a delicious meal of posho, matoke, and peas, the dance began. The blushing bride and handsome groom availed us with a first dance to “Amazed”, before we all joined in on the dance floor. DJ Amb had the house rocking until 11:00pm; at that point we had some people peeking in the doors and windows, reminding us we are, in fact, at a hospital. So, the wedding complete, we headed to the club for a few more hours of fun.

Although the wedding was fake, the celebration was very real, and a tribute to the friendships we have forged over the last month. It was so silly and so fun, and a perfect way to spend our last weekend together as a happy multi cultural family. And, I learned that if my career as a nurse doesn’t work out, I can probably make it as a make up artist or wedding planner!

Saturday, I spent most of the day in my room, only to emerge for meal times. I had a Lord of the Rings marathon (extended version, no less) – watching LOTR the day after Canada Day in Africa is becoming a tradition for me. Sunday I joined Group B for a community intervention at a school, where they provided testing and counseling on family planning. We got home at 7:30, just in time for chicken dinner. The cook works magic with her pot, producing the most delicious broth. It must be a combination of her seasoning and the freshness and quality of the chickens.

And now it is Monday; two of our Ugandan friends have left for the city for the week and so we had to say our goodbyes. They say they will be able to visit us in Mbarara when they leave return at the end of the month…another fake wedding, or perhaps a fake wedding anniversary (!), may be in order.

I write this now at the Baboon Safari Lodge, a 1500 shilling boda boda ride from the clinic (~50 Canadian cents). Dayna, Joline, Tenielle, and Julius frolic in the pool, I enjoy my nice, cold Nile Special and the spectacular view over the Queen Elizabeth park. There is a haze that seems to perpetually linger over the horizon; I can only imagine what it would look like on a clear day, with the blue skies of home. In five more weeks, our work will be done and we will begin our cross country safari that begins here, in this park. Though we’ve been in country for almost seven weeks, we’ve seen very little of the countryside. I am looking forward to this coming weekend, when we will get the chance to see some of the wilderness. When I write next, my words will be wrought with excitement after having spent the weekend at Lake Mburo, Bwindi Impenetrable Forest, and Lake Bunyoni, full of tales with intimate encounters with animals and nature as I’ve never seen her. I. Can’t. WAIT!!! This next weekend is the height of my anticipation in preparing for this trip. Five more sleeps until Carrie and the Silverbacks!

Thinking of everyone at home, I hope you all enjoyed your long weekend and celebrated our country with flair. She deserves nothing less.

Until next week,



Carrie Ann

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Photos

Carrie, Stevo, Ambrose
Just to prove it wasn't all fun and games this week!

Rehema
A rare candid shot of my dear friend