Appreciate your doctor

I feel a bit overwhelmed today by the responsibilities of being a nurse. I feel like there is so much to know and even if you have the book knowledge, you still have to have some experience of what you are looking for or at in a patient. Because of the lack of doctors in South Africa, nurses have become the key people in primary health care and many people may never see a doctor because the nurse handles all of their concerns. I have been assisting the nurses at the clinic doing sick visits and I am learning loads! I feel so incompetent at times as they will ask me if I have ever done something and when I say no, they look at me a little stunned. So, I have now done 4 pap smears (may not be very exciting to most of you, but very exciting to me because nurses at home can't do these and I've never learned how), am learning to diagnose ear infections, taking out sutures (haven't yet learned to put them in, but that will be coming I am sure), and becoming much better at my exams.

At home, unless you are a nurse practioner, you are not allowed to diagnose and prescribe so I know how to do a basic head to toe exam, but leave it to the doctors to do the diagnostic work. Not here, the nurses must diagnose and prescribe. I don't think this is a good thing because they have less schooling and have not been trained like a doctor, but it is a necesary thing because without nurses here many many people would not be treated. I have never wanted to be a doctor because of the responsibility and because quite honestly, I am not smart enough and don't retain information that well, but I am definitely learning a lot more being here. It is a bit of trial and error, I will say what I think is going on with the patient and they often correct me. At least, I am not on my own. The nurses do pick things up and refer to the hospital for anything that can't do themselves, but I do fear that quite a lot goes unnoticed because they are simply not trained like doctors. They only spend a small amount of time with each patient (they are too busy) mostly weighing, measuring, and giving vaccines unless the parent has specific questions (which is rare, they mostly keep quiet). I think of the children that visited the doctors I worked for at home who spend 20 minutes discussing everything from development to nutrition. Definitely a luxury of the developed world.

Because of people knowing that I am a nurse, I have been asked many questions by friends, church members, and people I know in the community. I do my best, but ultimately I refer a lot of people to the clinic because I am not able to prescribe anyway. Today, I arrived at the creche (daycare/preschool) to try to talk to a mom about her baby which seems chronically ill that I am concerned about. Instead, I found a sick 6 month old that was wheezing and breathing badly. Based on how she was breathing, I thought she needed to be seen today and the clinic was closing in an hour or so. We tried calling the mother but she was an hour away by public transport. She gave us permission to take the baby to the clinic. As we drove to the clinic, me holding the baby (not a lot of car seats here), she seemed improved a bit. She was playful and alert, but her breathing sounded terrible. At the clinic, they diagnosed her with pneumonia and we were able to get medication and take her back to the creche to wait for her Mom. I realized she wasn't as ill as I initially thought, but it was good to get her on medication and now the Mother doesn't have to take her to the clinic tomorrow. A lot of decision making with a lot of responsibility attached, I'm not sure I like it. :-> Decisions such as should we tell the mother to take her tomorrow or take her now? What if she worsens overnight? Will the Mom be upset if we take her now? Will I get to the clinic and look foolish because maybe she isn't that bad? Where's Dr. Armsby when I need him? (The pediatrician I worked for at home is Dr. Armsby and he is fantastic).

Sometimes, I wish I was back at The Children's Clinic where I was comfortable and confident. I was limited in what I could do and there was always someone with more knowledge to take over. But I know that it takes getting out of your comfort zone to really grow and learn.