Author: Blair Bryan
Its 06:45 and I have just arrived for my first shift of the weekend. My charge nurse assigns 3 to 4 patients to me depending on their acuity. One patient is in need of total care due to a stroke, one has a stage 4 diabetic pressure ulcer, one is on a Cardizem drip due to hypertensive crisis, and my fourth patient is in a negative air pressure isolation room with airborne precautions for tuberculosis with shortness of breath and pulmonary edema.
I get report from the night shift nurse and get started taking my patients’ vital signs, read over their charts with orders from the doctor who rounded yesterday, pass medications if need be, and make sure my patients remain stable until the doctor has their rounds for the day.
I have gone to the supply closet and stocked my pockets with alcohol swabs, saline flushes, sterile gauze, and I don’t even think about gloves because each room has one box of small gloves, one of medium, and one large. When those run out, I’ll simply walk to the Central Supply and grab a new box.
While I check vital signs, one of my patient’s blood pressure cuffs breaks, so I retrieve a new one. Each patient is given a blood pressure cuff when they are admitted and that cuff stays with him until he is discharged, at which time the cuff is thrown away.
My TB patient has to wear a mask and every time I (or anyone for that matter) enter the room, I must don the appropriate mask, gloves, and gown to protect against spreading the highly contagious infectious disease of tuberculosis.
The diabetic ulcer must have its dressing changed every day with sterile gloves, betadine, and packing gauze until the wound is debrided in four days. Bottom line is that I have all the supplies to properly care for my patients and I have the means to disinfect any supplies that are multi-use with Sani Wipes.
I always wash my hands when I leave a patient’s room, and I always sanitize with the sanitizer provided on the inside of each room door as I enter. There is privacy; only one patient in triage at a time.
If a urine sample is needed, it is collected in a specimen cup that has a lid and is handled with the use of gloves. This is what nursing and the medical field is like in my hometown. So you may understand why I was quite taken back when I ventured into Zulu communities in South Africa.
There is one major clinic that services the three villages. Monday through Thursday is for chronic and acute patients; Friday through Sunday are for acute patients only. The clinic is staffed by overworked nurses, with a doctor who may come once a month.
As a volunteer, I help give the nurses a break and check the patient’s vital signs as they come in. this takes place in a small room where weight, height, blood pressure, blood sugar, and heart rate is checked. There are two desks, several chairs, one BP machine, a scale to measure weight and height, and a baby scale.
Multiple patients are in the room at a time and the BP machine is constantly in use. It is never lent between patients because there is no time and nothing with which it can be cleaned.
There is one thermometer that doesn’t function properly and to clean it, alcohol is sprayed on a cotton ball and that same cotton ball is used multiple times.
The scale for the babies has not been cleaned between babies, sick and well. Everyone is piled into the waiting area together.
A patient comes into the vitals room, I get his BP, pulse, weight and height, and then he tells me that he has been waiting for the supplies to get a sputum sample to test if he has tuberculosis. He has not been wearing a mask, there are no precautions, and he has been breathing on everyone.
For blood glucose checks, there are no retractable lancets. The patient’s finger is not cleaned with alcohol before the stick, so any bacteria is now inside the tiny prick.
When a woman comes in and needs a pregnancy test or to give a urine sample, she takes a tiny bedpan to the toilet, uses it, then carries the urine back into the vitals room completely exposed. By that time there is at least one other patient in the room and the opportunity for spilled urine is great. There are no extra supplies, there is no hand sanitizer or soap in the sink. No one wears gloves when handling urine or blood. There’s no infection control.
We go into the communities to provide home care and it is an entirely new ballgame. There is one medical bag which contains some mild pain killers, wound care supplies, antiseptic sprays and ointments, and a handful of gloves.
The patient lies on the bed to let us get a look at the wound, but we’re inside and there’s no light, no flashlight or penlight, so it is very difficult to see the true nature of the wound. I open the medical bag and pray that there are gloves inside. There’s a limited supply of what I need to care for this wound so I am acutely aware of how much gauze and ointment I use. When I finish cleaning the wound, I remove my gloves, but there’s no trash can to properly dispose of the soiled products.
There’s no running water so I’m unable to wash my hands. We search the medical bag for hand sanitizer and there’s none to be found. Thankfully there’s a small bottle of it in the car. The patient is so grateful we came to see her. We communicate with her how to care for her wound and leave a small quantity of materials to clean the wound and change the dressing. These communities are special.
They want to learn how to care for themselves. The nurses on duty at the clinic will not waste resources because they know how valuable they are for helping the next person. The women in the support group ask how they might make their lives better, by learning English or a skill like healthcare and teaching. There has been so much oppression and the people I have come across in these communities have so much resilience and love for life in the face of adversity.
Family members are willing to change dressings and practice physical therapy exercises with loved ones. Gogos (or grandmothers) will take in all of their children, grandchildren, great grandchildren, as well as other’s children. One Gogo still cares for family and cannot even walk, but she will do anything she is able to, to support her family.
Support is needed and supplies are needed. Actual physicians are needed. Regardless of the ‘things’ that are lacking from these communities, the members of these communities have hope. They’re willing to learn and want to learn. And no matter what, that hope remains.