Nursing perspective

A nursing perspective from Sarah Martin

Hello from Tanzania. We have each been encouraged to blog about our experience at least once (seems pretty reasonable until I remember that Internet can be a challenge here in Ilula... They have satellite to power their internet). I have been waiting for a day where I feel like I can actually contribute to the blog in a meaningful way and decided I should just note some of my impressions from my first couple days on the general ward in the hospital here. 

Maybe others have mentioned the differences between the hospital here and at home (they seem particularly stark for me coming from an academic medical center working as a nurse), but here are mine: 

when I think about nursing care, I think about the daily maintenance of each patient in my charge. I may do dressing changes, administer oral, subQ or IM and IV medications and education about each one, assist in personal cares, change and roll incontinent or bed bound patients, get vitals and watch trends, maintain drains, tubes, lines, etc. in addition to lots of other things. I work with my team and patients to take care of all their needs. Here the patient's families provide their own food for the patients and assist in the personal cares as necessary. There is one shared bathroom for the 50+ patients we saw and no private rooms, you are lucky if you get a room with only 3 or 4 other people in it. Infection prevention like we do in the states is non existent... MRSA precautions? Yea right... You are lucky if proper hand hygiene is done between patients. As a nurse, this is just such a simple part of my practice and Krista (another nurse who is with me on this journey - thank goodness) have been encouraged to continue to do education with staff here about washing hands and using hand sanitizer, etc. It was a major culture shock for me when such ingrained infection prevention techniques are not routinely followed. Some techniques such as IV set ups and other daily routines of the nurse seem actually pretty similar here minus a few infection prevention techniques we utilize in the States. The nurses here speak some English but not as well as the physicians. One nurse was able to tell me that they have 3-4 nurses on during the day for those 50 some kids, women and men on the general ward. For those that aren't familiar with nursing ratios, this is incredibly high. We have 3-5 patients in our care usually on a medicine floor where I work at home. The nurses here are not assigned to patients as far as I can understand, instead they work as a group to carry out the physicians orders and ordered medications. Daily vitals are only sometimes done to all of our consternation (no q4hr or q8 vitals). And I have yet to see a nurse do a head to toe assessment on a patient. They have very few drains, lines, Etc here. I have seen one NG tube and two Foleys total. One patient on oxygen. Such a difference from back home. 

It has been a true learning experience for me to see the difference in the role of the nurse here in Tanzania. There are certainly similarities in the roles such as the nurses give and document their medications (albeit with less technology than we do at home) but lots of differences too because the nurses do not take much initiative here and are not very independent. They get their orders from the physicians and that seems to be it. I have gained some perspective when it comes to my own practice and our complaints about feeling overworked, or feeling like I don't have the resources I need. Watching the nurses here has been eye opening and a good reminder that maybe our issues at home aren't as big a deal as I sometimes think they are (although that doesn't mean they don't matter of course). Our ability to just send lots of tests out to diagnosis a patient or our ability to call specialists is almost non existent here and such a gift. No ICU at the hospital here so the staff do the best that they can. The nurses seem to be constantly busy (although I would say most nurses at home are too) but yet they don't spend much time with their patients and don't seem to be taking note of issues or things that need to be addressed. Kinda frustrating for me as a nurse that thinks healthcare is a team sport to see a rather hierarchical structure and very little nurse initiative. 

The staff here have been very kind to us. The language barrier makes care from "mzungu" (white person) challenging; very few patients speak any English. The people here are pretty sick. Lots of malaria, injuries and diarrhea issues in addition to some other interesting cases. Learning lots and so happy to be a part of a group that is so fun, smart, kind and passionate about medicine. I continue to look forward to getting to know the nurses here and getting a better understanding of their role and how the nurse functions here.