Limulunga

February 6

Hello world!

Today is a lovely day in Mongu. It rained buckets yesterday evening and you could still feel the cool air when we opened the door this morning. As the day progressed, the sun conquered all (it always does) and now it is hot with barely a cloud in the sky.

Rather than boarding the bus to Lewanika, Esther and I stayed back and enjoyed a later start to the day. We walked down to the road and within ten seconds we had flagged down a minibus heading toward Limulunga. A dozen kilometers later, we hopped out and walked toward the clinic.

The clinic is located behind a primary and secondary school. It's a very pretty area that is well looked after. The clinic itself is in a pretty magical looking place. Between all the buildings are ancient trees with roots lending themselves as steps. If you look to the horizon, you can see a clear view of the flood plains. Although they are not as flooded as they should be (they look like regular plains at the moment), they are nothing short of beautiful.

Upon arriving, we took a brief tour of the premises: male, female, and child wards (about four beds each, two useable each - the ones that have mattresses), OPD (out patient department, like emergency), maternity (one bed for delivery, four post-natal), a modest laboratory, pharmacy, ART (antiretroviral treatment for HIV), and probably a few more that I am missing, all spread out into about five or six buildings. No washrooms though (TIA, hahaha)

Esther and I were scheduled to work in the OPD today. I have to say, this is what I have been looking forward to most. It is the most like emergency except, here, nurses have a rather broad scope. Out of chance, Esther worked with the nurse attending to 'Under-Fives' and administered many vaccines.

I was very fortunate to work with a nurse that you would never guess was a new grad with just months of experience. In a small room, we sat at a table and received patients one by one (or more if the whole family was sick!). They would enter, sit on a chair, and would hand over a children's notebook. These notebooks act as a permanent record for each patient. Inside, we would write the date, chief complaint, symptoms, impression/diagnosis, and prescription (Yes! I was helping to diagnose and prescribe!).

This is exactly what I was talking about when I said that nurses here in Limulunga have broader scopes. Although they are Registered Nurses (three years of school and a diploma here), they are given massive responsibility. And just because the location is rural doesn't mean that they don't see variation. We saw everything from old-age aches and pain to toothaches to epilepsy to gastroenteritis. And for each of this ailments, we had to be able to identify them and select an appropriate medication to treat it. Rhinitis needs prometazine, a lung infection needs erythromycin, a 'threatening abortion' (due to possible placenta previa) needs salbutamol, and so on. It was fascinating! I can't remember a day in practice in Canada during which I had to use critical thinking quite this much!

That said, I was surprised to see that every visit ends with a prescription. I've been to the doctor back home with more symptoms than some of the patients today and have been sent home for bedrest. Here, there are prescriptions for runny noses, for coughs, and for aches from a day of too much work. Everybody receives a pill for their complaints. I can't help but wonder what this leads to. At home, a cold or the flu leads to staying home and perhaps eating soup. Here, it is paracetamol and prometazine and we'll see you tomorrow if you aren't better yet.

Also, there are quite a few antibiotics given out. In Canada, our nurse practitioners and doctors are learning to be more cautious with antibiotic use because of the increase of resistant organisms. I am not certain that caution is being taken yet here.

On another note, an interesting thing happened today with regard to relational practice. A young individual entered with a slip that indicating that they had just been tested positive for HIV. Before we had even had a chance to greet this person, a family burst in, struggling to carry a severely emaciating person. This person fell to the floor and the nurse and I helped to lift them onto the examination bed. Off the cuff, I would say that this new person was likely Stage III HIV and was reacting poorly to the ARV. We assessed the person, initiated an IV, and transfered them by hand to another ward. When we finally came back, the first individual was still sitting there waiting to be given instructions with regard to their new HIV status. I understand that nobody can be shielded from what HIV looks like here (it's seriously everywhere) but I couldn't help but wonder what they were thinking. "Is this going to be me in a few years? Will I not respond to therapy?" I wish that they hadn't seen everything that happened.

Before we knew it, it was already time to leave. We boarded a bus in town - these ones don't leave until they are about to burst with passengers - and headed back home. This ride felt like the real African deal. A woman boarded with what looked like three dead chickens and roosters. My stomach turned and I felt sick about the dead animals so close to me. Until they started squawking and nipping at the woman next to me. She shrieked, I laughed, she laughed, I got elbowed by her for laughing at her, and Esther clung to the bar on the side of the bus. Rinse and repeat for the long ride home.

Good times in Africa! Tomorrow, we are going to the feeding clinic (no idea what is in store!) and then we are joining Amanda at a school to talk about our experience in nursing and how it has changed our lives. I'm excited!