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.

TIA (This Is Africa)

• The internet is still down because it was struck by lightening, so I'm currently writing this at an internet cafe. It could be fixed anytime between tomorrow and 3 months. It is likely to be longer because it has been raining and people tend to stay in when it rains making it less likely that the internet fixers will come sometime soon.
• There are these really weird spit bugs that live in a tree in the community. They form these giant frothing spitballs that drip from the tree making it feel like it is drizzling rain. The ground underneath the tree is wet from the spit. Pretty disgusting.
• You have to time your laundry correctly or it ends up rewashed by the rain and potentially soaking wet for days. I did my laundry hoping it would dry in the afternoon, but it started raining and rained off and on for the next several days so that they never dried. Luckily, a friend let me use her dryer and I now have clean clothes again.
• You quickly realize that the portion sizes in America are huge and that bottomless drinks may not be a good thing. I'm losing weight without trying, yay!!!

It's all politics

It has been strange to be here without television, radio, newspapers, and limited internet. I could have access to these things easily here in South Africa, but I have to admit it has been a nice change to not have a daily bombardment of political rhetoric, so I haven't been searching it out. It has begun to feel that the South Africans know more about what is happening than myself (which is probably true) as they have followed the election very closely. Being overseas has shown me the importance of what happens in the US to other countries. We have a lot of power and this power has great and grave consequences for the world.

I have to be honest that it would be difficult to be here and not be a Obama supporter. Everyone I have met was in support of Obama and it was much more comfortable for me to be able to say truthfully that I also supported Obama. One of the first questions many people have asked me when they learn that I am American is who I voted for and when I said Obama, there was often a nod of approval. An example was at the Zimbabwe border crossing. I'm always a bit nervous when I cross a border because there is always the fear that you will be declined from entering and going to Zimbabwe was no exception. The man took my passport and seeing that I was American, asked me who I was voting for. When I said Obama, he smiled and said "I will give you a cheaper price for your visa". I'm not sure the price he gave me was actually cheaper, but I did pay less than my Canadian and Brittish friends. There is the African pride of a black American president, but also there is the hope that he will care about Africa and several people have told me "He will do good things for Africa".

I hope so and I pray that he lives up to the hope that people have placed in him. I'm sure he will not be perfect and there will continue to be great problems, but I am hopeful for this is a huge step for America towards a new era.

On another note, I'm feeling really good about things here. I finally feel like I'm helping at the clinic and not a burden. I worked as the pharmacist tech for the past 2 weeks as there regular pharmacy tech was gone the past week so I was able to take over which felt great (they don't have a pharmacist at the clinic so the tech is essentially the pharmacist). I had to chuckle as I'm pretty sure a pharmacy at home wouldn't be able to let anyone begin dispensing medication. :->

Thanks for your prayers. My baptism was wonderful and the sun was shining and I felt very supported. I may be able to post pictures at a later date. My internet is a bit limited because it was struck by lightening so it is down. I'm currently writing this at a friend's place. Hopefully it will be up and running again soon.