Nursing abroad stirs the soul

AORN Journal,  July, 2003  by Zarina Varma

• E-mail
• Print
• Link

[FIGURE 3 OMITTED]

The next morning, I checked in with the reporting center and told them about my experiences and what improvements were needed. I told them that I had put together a crash cart after trying to resuscitate a patient who arrested in the ER. We had to use an ambu bag connected to an oxygen tank without a stand. There were no monitors or defibrillators. We had equipment to intubate, however, and everybody was running all over the place to fetch things as I continued cardiopulmonary resuscitation on the patient. Staff members at the reporting center told me that a defibrillator had been ordered and should be arriving any day. I also requested a stand for the oxygen tank because the tank we used fell over while we were resuscitating the patient. They thanked me and promised to work on it.

The next day, I was driven to Singal, a small town with a main road running through it. In the middle of the town was a 20-bed hospital with ER and OR facilities. The nurses' quarters were 100 yds away from the hospital. I found substandard living conditions, including a bathroom with a squatting toilet. Next to the toilet was a water tap, a bucket with a plastic mug, and a footstool to sit on. To take a bath, you filled the bucket with water and used the mug to pour water over yourself. When it rained, this water was filled with mud, and late at night, the nurses would wait for the mud to settle and then bathe with the clear water on top. There were a lot of frogs all over town because of the small canals of water that were diverted from the river to water the fields. There were frogs hopping about my room and in the bathroom. There was a cow mooing outside my door, and I was covered with fleas and mosquito bites, so I made sure I took my malaria pills. The florescent light above my bed had a variety of insects flying around it, and some were crawling on my bed. Again, I told myself that I was camping and crawled into my bed, insects and all, and fell asleep.

WORKING IN SINGAL

The water source in Singal comes from glaciers, so it is crisply clean and cold (Figure 4). People in the town tended to get careless and drink it without boiling it first. Consequently, I saw many cases of malaria, tuberculosis, typhoid, cholera, and gastroenteritis, as well as worm-infested bowel obstructions, which we handled surgically. During one surgery for bowel obstruction, the surgeon pushed out a lot of worms, which was something I had never seen before, even in Africa. It made my stomach crawl.

[FIGURE 4 OMITTED]

There were no staples and only manual anastomosis. The sterile technique was relatively good, but few of the supplies were disposable. The hospital had sterilizers, and packs were wrapped in cloth. Needles and IV tubing were disposable, and the infection rate among patients was not as high as I expected because of their resistant immune systems. Antibiotics were prescribed often, however.

One day, we saw a patient who supposedly had fallen from a roof and landed on a sharp object that penetrated her abdomen and perforated her intestines. We performed surgery until 11 PM. After we recovered her, we walked to the dining room for a meal. I asked the physician what she fell on. He said that according to her husband, it was the edge of the fence. This story did not fit the circumstances, however, because the wound was clean cut and not lacerated. The next day, the physician called the husband and asked him to tell the truth. He started to sweat and then confessed that he stabbed his wife because she did not cook meat as she promised him and cooked vegetables instead. It was the grape season, and he got drunk and lost control. The physician then spoke to the wife, who confirmed this story. She also said that she had no intention of divorcing him, but she wanted him to swear in the name of Allah that he would never abuse her again. He agreed, but I hated to think what his wife's brothers were going to do to him.