Facing African realities - in the profession of nursing

by Krista

Taken from: 

http://www.nationalnursesunited.org/issues/entry/ratios

A couple months ago, one of my friends from nursing school in Chicago shared a link on Facebook to a National Campaign for Safe RN-to-Patient Staffing Ratios in the US. The proposed safe ratio for Pediatrics was 1 nurse to 3 patients. And, in the States, I actually whole-heartedly agree with that proposition. But, then here- I had just finished shadowing a nurse at Kibuye Hospital on the Pediatrics service, and her nurse to patient ratio that day was 1 nurse to 34 patients. Quite the contrast!

One of my life-long dreams has been to practice nursing in Africa, and it was one of the reasons we joined this team here in Burundi. In the last two years since we moved here, I have spent most of my time at home with our young boys, only occasionally making it up to the hospital for Grand Rounds or special occasions.

But then - this year, a team of our doctors started a program (actually, the first in Burundi) to treat Retinoblastoma (“RB” - eye cancer) with chemotherapy in pediatric patients. When they first asked if I could help out with the program, I was terrified. I hadn’t spent much time at the hospital yet, but I had been there enough to know that chemotherapy in this setting scared me: most of the kids in the program would be malnourished, overcrowding and poor sanitation in our hospital is a constant challenge, and nursing and medical supplies are limited. I was used to pristine, sterile hospitals (well, hem/onc floors at least) around Chicago, with the best of the best supplies at my fingertips. But, before long, I found myself working 12-16hr shifts during chemo weeks with a group of incredible RB kids. And now, I’m so glad our docs here had the guts to say, “Let’s do this!”

My Staff ID badge for Hopital Espoir de Kibuye

Living my dream working as a nurse in Africa

Drawing up chemotherapy medications

Our first round of chemo, we started with mattresses on the floor in the cleanest room we could create and only 4 patients

However, the transition hasn't been easy for me. I miss monitors. I miss pharmacists. I miss ports and central lines. I miss J-tips. I miss EMRs that remind me when a med is due or an order is outstanding. I miss IV pumps (Yes- I had to reteach myself how to calculate drip rates!). I miss saline flushes. I miss oxygen piped through the walls. I miss wall suction. I miss Child Life Specialists. I miss Respiratory Therapists. I miss Rapid Response Teams. I miss a lot of things about working in the States. But these kids, though… Totally make it worth it.

12 kids in the chemo program during the latest round of chemo

Using the iPad for some distraction for the kids

Our youngest child in the program- only 8 months old

These two patients were the best of buddies, but unfortunately the one on the left passed away last month

These two patients are good friends too- sharing a meal together. God, please keep them healthy!

During our second round of chemo, one of the new patients developed a fever and was vomiting. Oral Tylenol wasn’t an option, but we didn’t have any suppositories. We waited almost an hour before one of the nurses from Pediatrics had time to come hang IV Tylenol. I had never hung IV Tylenol in the States. I didn’t know how to set it up or where to get it from in our hospital here. I was the only nurse working in the RB program at that time, and I realized that I really needed to spend some time with the nurses on other services to see how things work here from a nursing perspective.

So, I’ve started shadowing whenever I can. And wow, have I been amazed. My first day, I worked in Pediatrics with an incredible nurse, Joyeuse. There were 117 patients on the peds service that day and only 4 nurses. Here, they don’t assign patients to nurses - they assign whole rooms full of patients. She had three rooms with about 10+ patients each in them. Overnight, there is usually only 1 nurse, maybe 2, per service.

But, I don’t want to communicate that working in the US was “easier” than it is working here. I have never been more stressed as a nurse than I was working nights on a busy adult med-surg floor in Chicago. It’s just different- some things are easier, some things are harder- it’s just…different. Yes, there were more resources there, but there were also more expectations on the nurse. In a hospital in the States, you have almost any resource you can think of to help prolong someone’s life. Of course, they don’t always work, but there is a big responsibility on the nurse and the patient-care team, to try absolutely everything. But here- along with a lack of resources, comes a sort of fatalistic mentality. If you don’t have access to the supplies needed to save a life- then they die. Whether it’s wrong or right, there isn’t the same amount of pressure here as in the States to keep people alive. I imagine that will change as our hospital grows and more and more interventions become available. But, right now… it’s just different.

Here, each patient is required to have a caregiver (usually a family member) at the bedside at all times- to help feed, bathe, assist them to the bathroom, etc. In the States, that was all my responsibility. Here, if you work night shift as a nurse, you actually have a bed in an on-call room and you often sleep from the last med pass at 10pm until the next med pass at 6am (unless you are working maternity or surgery- Labor and traumas can't wait!) The nurses here couldn’t believe that in the States, I worked from 7pm to 7am as a night-shift nurse on peds and didn’t get a bed, and certainly never slept during my shift!

Room with 10 beds in it for those working night shift here

There are some similarities though. One of my favorite things about working in the States was the awesome team of nurses I worked with. We helped each other out. Yesterday, I worked with Divine (one of the Peds nurses) in the NICU – she had 18 patients… 18 NICU patients- by herself!!! So, Joyeuse came to help her out, placing lines, inserting NG tubes, and administering medications. They were totally there for each other. I love that.

The full NICU

Nurse Divine checking on one of the NICU babies

NICU babies sharing a bed- can you find the two babies?

Divine and Joyeuse inserting an NG tube into a baby who only weighs 950g

Divine and Joyeuse starting an IV on one of the NICU patients

We hope to hire a Burundian nurse in the RB program soon, but for several different reasons, we have not yet been able to. Right now, volunteers are key. The first few rounds, our awesome doctors functioned as nurses, helping administer the chemo and monitor patients at the bedside. My sister-in-law, Heather, has been helping out as our “pharmacist”, drawing up meds while we administer them. And in September, we had some new team members join our group. Among them were the Sund’s (Stephanie is a nurse and Greg is an anesthesiologist) who have been such a huge blessing to the RB program.

Working with an awesome team - Dr. Logan, Dr. Parfait, Heather (my sister-in-law) and Stephanie (the other nurse)

Heather helping us out by drawing up meds on chemo days

 A fantastic hem/onc nurse, Becky Cook, came from Kijabe Hospital in Kenya with a wealth of information which helped us to get our program up and running

And she brought Stephanie Cox, an audiologist who performed baseline hearing tests on all of our RB kids

So, even though there are a lot of differences between practicing here as a nurse and practicing in the US, a couple of the most important things remain the same in both places:

1)   Teamwork.

2)   And a heart for the people we are caring for.

The wonderful team of nurses on the Pediatric service

Some of the incredible kids in our RB program