Hospice Nurse in Ethiopia

Emily Sorman just returned from Ethiopia where she worked as a hospice nurse.  Here is her story.

I was working with an organization that provides home visit for hospice patients with HIV and Cancer. In total, they serve 25 patients, but I was not able to see all of them while I was their.  I worked with three local nurses, as well as two missionary nurses who are spending a year there working with the program.

One of the things I enjoyed most was seeing patients who live in one room with no running water and who cook food over fire was really eye-opening for me. They were all so kind despite their difficult circumstances. Every patient I saw was HIV positive, and most of their children were too. Hearing their stories and being able to provide them care was extremely rewarding.

One of the hardest things to see was that pretty much all of the patients were hungry and did not have enough money to buy food. They are provided food once a month, but it is not enough to feed their families. Another volunteer and I bought food for as many patients as we could, but knowing that once we are gone they would go hungry again was heart breaking.

I was surprised to discover that these patients had very little medical records. The nurses communicated their history verbally, and documentation was incomplete. I was able to write sample care plans, and in collaboration with the missionary nurses, we taught the local nurses how to write their own care plans and use them to improve the health of the patients. I thought that I would be just doing hands-on care with the patients, but I was actually able to use my nursing knowledge to improve their health delivery system, which will hopefully improve the outcomes of all of their patients in the future.

I never considered myself a materialistic person, and always thought I could be happy with very little. Once I was faced with hardly ever having running water or the food I am used to having, I realized how fortunate I am to have these simple luxuries at home. Many of our patients have to walk long distances to fill up heavy jugs with water to bring it back to their homes. This is a way of life for them, and they never complain. I feel very humbled to have met such wonderful people.

Ethiopians are very warm and like to greet each other with hugs and kisses. People talk to strangers as if they are friends. Many people yelled "forengi" at me walking in the street, which means foreigner. It is not meant to be offensive, they are usually fascinated with seeing someone from an outside place.

One of our patients had a two month old baby who was malnourished. The mother's breast milk had dried up, and she had to use formula which they could not afford. Some of the volunteers were able to buy formula, but the baby's respiratory status was compromised. She seemed to us to be in respiratory distress. We finally got her to a doctor, who said she simply had small nasal passages and will grow out of it. In the United States, she would at least have some sort of diagnostic test performed to determine the cause, but the care provided there is not what we are used to.

Another memorable experience was a visit to an elderly woman who was not even our patient. She asked us for food as we were walking by, so we went and bought her food and hygiene supplies. She invited us in her home. We made her lunch and drank coffee together, which is an important tradition for Ethiopians. She was alone and had very little of her basic needs yet, but she was cheerful. She sang us songs and thanked God everything she has.

This mission has made me more culturally aware, more grateful, more patient, and all around a better nurse. If I see a system that is not working, I know I can use my skills and knowledge to help change it.

One Nurse at a Time has supported me in both my mission to Peru last year and, along with the funding from Barco's Nightingales Foundation, this year's trip to Ethiopia. Without One Nurse, I probably wouldn't have made the leap to do international volunteer nursing. They have not only helped me financially, but Sue was able help give me advice on how to help patients while I was there.Being able to talk to someone with so much experience in this field is invaluable. My goal is to do one trip every year. I believe I've been able to touch many lives already, and I am hopeful I can continue to do so in the future.

Nurses for Edna: A Medical Mission to Hargesia, Somaliland

In August 2013, Wanda Chestnut, Kim Law and Kerra Plesko, three members of the Nurses for Edna team, left for Hargesia, Somaliland.  Due to a death in the family the last nurse, Sarah David, joined them two weeks later.

 Each member of the team had expressed a passion to improve women’s health around the world. For almost a year they had planned and worked.  They held fund raisers to augment the already generous grant awarded by Barco’s Nightingale Foundation for this mission. They sought free medical equipment and found ways to cover shipping costs and logistics. They sent out hundreds of appeals to friends and family to raise awareness of the plight of the Somaliland women. They did all this in an effort to make a difference in a country still struggling to recover from years of civil war. They traveled with little personal luggage so they might fill their baggage allowances with donations of medical equipment.  The trip took more than 24 hours; they arrived exhausted, but eager to begin work.

The Hospital director, Edna Adan requested they teach a First Aid course while they were in Hargesia. What they didn’t realize was how large the group would be – over 150 nurses, lab techs and public health students. Nor did they realize that some of their teaching would need to be done using pantomime and interpreters! 

Although each member of the team expressed that the teaching experience was both frustrating and somewhat overwhelming, they also expressed that one of the best things about the trip was the positive feedback that they got from their students. They can feel proud that they were instrumental in teaching more than 150 students the necessary skills needed to provide basic First Aid Care for the people of Somaliland.

“My happiest moment is a culmination of positive feedback from my students and from the university. Both have expressed gratitude for and positivity towards my teaching and indicated they would happily  have me teach again. Having never taught in a classroom setting before, and having experienced numerous frustrations throughout the course, the end response was very gratifying,” Kim Law.

Besides teaching and working at the Edna Adan Maternity Hospital the nurses also worked and taught in the

community at the Abdi Idan MCH Clinic. This free, government funded clinic provides multiple services including antenatal and postpartum care, low risk deliveries, a nutrition clinic, a pediatric health and immunization clinic, and lab services in one of the poorest neighborhoods in Hargesia.

While they were not able to spend as much time as they had hoped providing women’s health clinical care at the hospital, the nurses did both work, and provide supervision to student nurses, on the wards. Three of the nurses identified their biggest challenge, and saddest moments, came while resuscitating a newborn infant with no doctor to guide them.

“We tried to get one of the nursing students to go find a doctor, but she didn’t understand what we wanted. Finally, the nurse anesthetist came in and we were able to partially stabilize the baby and get it breathing. But, it was just a situation where no one in the room knew what to do and we couldn’t find anyone to help us, Kerra Plesko.

It was during incidents like this one, and other long neonatal resuscitations that the nurses felt pummeled with a moral and ethical dilemma.

 “My absolute worst experience here is the ethical dilemma I am now constantly thinking about. We've done a few, long neonatal resuscitations, and have been able to revive the babies, only to have them die a few days later. If they had lived they would have been severely disabled. Is it ethically responsible to do long resuscitations in resource poor countries where the risk for long term disability is high?” Kim Law

However, the nurses also expressed being positively impacted by their time in Somaliland, They came home with a greater appreciation for everything available to them at work and at home: medications, supplies and equipment.

“I now really appreciate being prepared at every delivery, having the necessary equipment ready, or

even having it at all, and having qualified trained people who know the importance of quick resuscitation and being efficient with what we are doing.  I appreciated it before, but I had never seen babies die from the lack of those things. I know we live in a rush- rush society and I do believe that we need time for slowdowns often, but I also value responding to a task quickly, and Africa has shown me how valuable that can be,” Kerra Plesko

They also came home with a greater appreciation for their knowledgeable, supportive team members at their respective work places.  Larger still, they returned with a sense of respect for the people of Somaliland and a reminder of the importance of humility.

“The people of Hargesia are so poor and despite being poor they are humble people. This experience reminded me to remain humble in all situations and circumstances,” Wanda Chestnut.

The nursing team also described moments of happiness along a difficult medical mission. Moments of showing support for each other; of early morning work -out sessions on the roof to decrease their stress; and spontaneous dancing in their rooms after working all day to the point of exhaustion. But, the most gratifying memories they report are of times they saw their hard work actually bringing change in the nursing practice at the Edna Adan Maternity Hospital:

“My happiest moment was when I went downstairs one morning after breakfast and saw the nurses and midwives put two babies in the Embrace warmers! It was a proud moment. Not only did they do it correctly, but they actually remembered to use them! It’s hard to tell when you get through to some of the nurses, but at that moment, I knew that our in-services and teachings had some sort of impact because the neonates were in Embrace,”  Sarah David

The  nurses report feeling proud of some of the small, yet significant, changes they brought to the Edna Edan Maternity Hospital such as putting together an emergency resuscitation kit for the med/surg ward. They are particularly proud of the part they played  in the prevention of neonatal hyperthermia.

“When we first arrived at the hospital, neonatal resuscitation were being done on an old cart with a heating pad. The babies would get extremely cold (like 34 C cold). They had two radiant warmers shoved into corners so we decided to check them out. One of them didn't work but the other one was in beautiful shape. It took several weeks to get everyone to leave the warmer on and plugged in at all times. But eventually, with perseverance and a little duct tape, we made it happen.”Kim Law.

Although the mission to Hargesia was challenging, each nurse expressed how very grateful they are to have had this experience. Each feels this experience both gave them a fuller appreciation of their nursing careers at home, as well as helped to prepare them for future medical missions. Each member of the Nurses for Edna team: Sarah David, Wanda Chestnut, Kim Law, and Kerra Plesko plan to continue to volunteer in the global arena. One nurse at a time they will change the world!

 The nurses of the Nurses for Edna team want to thank One Nurse At A Time as well as the Barcos Nightingale’s Foundation for their generous support of this medical mission.

Sue Pharney's trip to Kenya

Thank you to One Nurse At A Time, and Barcos' Nightingales,  for helping support me on my medical mission to Kenya. Below is a brief account of my trip, and a few photos.

The team from Project Helping Hands, twenty six of us, all met together and assembled in Nairobi Kenya. We than drove seven hours to Oyugis where we hold medical clinics for the next 8 days. Oyugis is one of the areas in Kenya that has been hit the hardest by HIV and thus has hundreds of orphaned children and thousands of people in need of medical assistance. Everyday the team would walk three miles through the country side to get to the medical clinic site and would be greeted by a couple hundred people waiting in line to be seen. In total the team saw over two thousand people on this medical mission.

The team was able to help patients get HIV and TB testing and treat several for malaria and dengue fever. My personal nursing knowledge was greatly enhanced on this trip. I was able to help treat and diagnosis diseases I had learned about in nursing school but never seen. We also tried to provide as much health education as possible and make sure the medical treatments we were prescribing were sustainable after we left Kenya. I personally was reminded of the importance of health education and preventive care. One of the saddest cases I saw was a seven month baby seen for severe malnutrition and acute diarrhea. The baby weighed less than five kilograms and was severely dehydrated and lethargic. We paid for the baby to be admitted at the local hospital where she was treated for rota virus. When we left the baby was still hospitalized and was being tested for HIV as the mother was HIV positive and had breast fed the baby. Preventative care in the form of immunizations and nutrition good have prevented this from happening. Education on oral rehydration with diarrhea and not breast feeding when HIV positive could have also prevented the baby from becoming so sick. This case showed me how blessed we are in the states with our medical system even at a time when our medical system is under much scrutiny.

One of my favorite memories of my time in Kenya was our daily walk home. Everyday

around five o'clock after clinic was finished we would walk the three miles back to our hotel. Without fail we would be greeted by a hundred "jambo" and smiling faces and cheering children. It was not uncommon for little kids to come running up to us grab our hands and walk us home. I was touched by the Kenyan spirit and by the love and appreciation they had for us. I was over whelmed by the thanks they gave and the gratitude they had for a simple toothbrush or even just holding the hand of a "mzungu".

Thank you again to everyone who helped support me and make my medical mission to Kenya possible.

Sincerely,

Susie Pharney