Some of you may have read my previous post about the difference in nursing here in Ilula and most of what I previously noted is still true but I would like to add a few notes and tidbits I have picked up in my last couple weeks here.
There is a major shortage of well educated medical staff here - be it nurses or physicians. From what I can understand, this shortage is nationwide in Tanzania. According to the head of nursing, Ilula hospital has approximately 21 nurses and if they were staffed to provide appropriate ratios (about 6 patients per nurse) they would require 52 nurses. Essentially they have half the nurses they should have for safe patient care. This helps to give me some perspective when I start to get frustrated by the practices I see. There are what seems to be the equivalent of what we call medical or nursing assistants in the states. These staff have one year of training and from what we gather, are trained to do personal cares and vitals but are not medicine administration or assessment trained. Due to the shortage, and I think also in part to cultural practices here, these staff reconstitute, draw up, and administer medications (oral, IM, and IV). Krista and I have been frustrated at times to watch the trained nurses sit around while the assistants do tasks that seem to be outside of their scope and training. I do have hope that as the nursing school here in Ilula opens and more trained staff are available, that these practices may change but as most things around here, I understand it will take lots of time.
Nurses here do not regularly assess patients, even the very sick patients that would likely be in ICU or intermediate care at home. The highly acute patients get the same level of care as those that aren't so sick. Situations that would be medical emergencies at home are taken with an air of lightness around here such as a child seizing for long periods of time or an arm presentation (requiring immediate C-section at home). This has lead to what I perceive as anger and frustration from many members of our american group because some babies/kids have died while we have been here due to what some have thought is lack of monitoring and lack of thorough frequent assessment. This is a hard pill to swallow for me because potentially preventable death of babies and children due to what seems to be a lack of nursing responsibility and care seems... Innately wrong. But yet this is not my country, my hospital or even my place to simply insert myself or my practice. We have a partnership with the staff here and have been careful to not pass much judgement or blame on our friends here. As nurses in the US we take responsibility for the care of each patient and care deeply about the impact and outcomes of our care - that does not seem to necessarily be true here. I am curious to know whether their teamwork style of caring for patients - for example where one nurse does admissions, one nurse places IVs, and the other passes medications - leads to lack of personal responsibility when it comes to patient deaths or poor outcomes. On the other hand, perhaps the staff have blocked out the pain of losing patients and kids because it happens so much here and would break you eventually if you didn't become resigned to it. Certainly lots of food for thought.
HIPPA does not exist here. You are trying to give out paper files (charts) to patients in a room of 8 people plus families? Just yell each name out to find out who is who. The first day I saw this practice, I just watched in awe.
The nursing staff here have been very kind to us and let us invade their space and watch them work. It has been quite the experience. We have seen some very sick kids that we thought would not make it, recover and even be discharged from the hospital. It has been a joy to watch some of these hard cases be so successful.
The last part of our dwindling group (we now have 10 of us total) will be returning to the states a week from today. I think people are most excited for warm showers and a change in food (the talk of a big salad upon arrival has been spoken by many - lots of starch and carbs here with very little protein or veggies). All in all though, I don't think any of us are ready to be back in the snow and cold most of you are experiencing. So much love sent from Tanzania to all of our loved ones back home!
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