Umphumulo, South Africa

Friday, March 4, 2011

Close Your Eyes, See With Your Heart

Have you ever been so prepared for something that you wake up in the morning and you couldn’t get that nice cup of freshly brewed coffee, but you don’t care? Then, you feel so overwhelmed with confidence that those you come into contact with just want to know what’s going on, why you’re smiling for no reason, or they even want to be with you or near you to catch this contagious ora of optimism that seeps our of your skin like the sweat dripping off your face after a nice long run. Have you ever been this prepared before? Well, imagine being like this and then once you get to where you’re going… have it all taken away with a sudden change that’s not in your control. All of your hard work, research, and organization down the drain, and only to find that you’ve now to do things on the top of your mind, maybe with a bit of anxiety and not with the full effort and dedication that you’d like. This, my friends, is what it is like at the Umphumulo Public Hospital… and I think now is the time to reflect on the 5 to 6 months that I’ve been shadowing, learning, and most definitely growing from what being a doctor in the rural hospital of Umphumulo is like.

I wake up every Tuesday and Thursday mornings at a quarter til 6 to take a nice walk or jog around Umphumulo (of course when it’s not raining heavily too), get ready for the day, head to chapel for morning prayer at 8, and then around 8:30 I take my nice little stroll towards the hospital. At the beginning, getting to the hospital was a bit awkward; as I walked through the entrance gate with stares of ‘what are you doing here?,’ but I walked in with my head up, my eyes observant, and my unconscious smile still intact… tell myself that the road I’m about to embark will turn out nice and smooth, in due time! Today, as I walk through the entrance gate, I greet everyone with such cheer and whole hearted excitement that everyone from the security guards to the sisters (nurses) to the doctors to the patients see me, greet me, and the awkwardness that was once there has dissipated into the midst of the past. It’s going to be a good day no matter where I end up observing and I’m going to learn something new no matter where I ‘plan’ to be. So far, I’ve had the opportunity to experience being in the HIV&AIDS Counseling and Testing Center (CTC), Outpatient Department (OPD), Maternity Ward, Theatre (Surgery), Casualty (Emergency Room), Pediatric Ward, and Female Ward. I’ve also been blessed to have a few of the doctors take me under their wing in which I am consistently and intriguingly observing different procedures, listening to how and why they make diagnoses, and asking all sorts of questions; it’s the questions part that the doctors are so captivated by as they don’t really know where my questions keep coming form because I have now been going to the hospital for some time now. With that in mind, let me explain some of the things that I’ve grown from while being here.

One of the first things that come to mind when you thing of South Africa, or maybe even Africa, is HIV&AIDS. Yes, there is an ongoing epidemic of HIV&AIDS within this country, but as far as education, becoming aware, and getting tested is concerned… it IS there! Most people know their status, more people are aware of how it’s contracted (this begins as early as primary school), and proactive advertisements, information pamphlets, organizations (like the Diakonia Aids Ministry connected within ELCSA), and even newsletters of all kinds are being made so that people can have easy accessibility to the hows and whys for preventing and treating HIV. Amazingly, one thing that I have learned since being here is that you can still have children while being HIV positive too! Of course there is a regimen that is to be done before, during, and after birth, but the treatments that are given and the medications taken have really decreased the risk of the child contracting HIV too. As far as the CTC is concerned, every day there are people lining up to be counseled and tested and then counseled again if one’s results turn out HIV+, and every day there are people coming in to get their medications to keep a strong, healthy, and long life. The sisters working in the CTC at the Umphumulo Hospital are really one of a kind, are sincere helpers, and are strongly educated in what they are doing too; as I’m sure this is how it is like all over the country whether in hospitals, clinics, or surgeries (private practices). Even though this epidemic causes a significant amount of deaths every day… the fight against it is ever growing each day too.

Then there’s the OPD and Theatre. These departments are where I spend most of my time as Dr. Pukana, Dr. Kabeya, Dr. A. Rajaram, and Dr. E. Rajaram are always requesting my presence; hence I am under their wings the most which doesn’t bother me one bit! In OPD I observe all sorts of healthcare aspects… from triaging patients to seeing results of all kinds (X-rays, blood serums, sugar levels, etc) to diagnosing. One of the things that I really feel different about is my quality of patient care. When I first walked into the entrance of the Umphumulo Hospital no one (patient wise) looked a bit thrilled to see me walking by or sitting next to the doctor in OPD as they took the seat in front of us. Well two reasons immediately came to mind: 1) they’re not feeling well hence their visit to see us, and 2) I’m the only light skinned person in this entire facility that walks around the buildings and doesn’t look like a doctor! As the days became weeks and I become more familiar with how things are done at the hospital I was getting a bit ‘flustered’ with being seen by just my appearance. So, as I walked into OPD and began helping the nurses with triaging one morning, instead of staying on my chair… I sat next to the patient and became eye level with them as I began with the “what brings you in today?,” kind of questions. This automatically let them know that I am no better than they are, there is no need to feel intimidated by me at all, I will help them to the best of my ability, and that their concern was really my concern too. I’ve learned that in this Zulu culture I am in, because I look different I will be treated as a guest… all the time; I can’t change this as it is their culture and what respect is. It’s this beautiful presence of Ubuntu and the Zulus practice it daily, but now that I am here and the ‘honey-moon phase’ has been long gone I can only hope that others, especially in the hospital, will see me and not just thing, “what is she doing here?,” but I want them to think and maybe even express, “Thank you for just being here because it made me feel more comfortable when I was scared and didn’t know what was going on.” I know how doctors have their ‘what the heck does that mean’ lingo, but I want the people coming in and out of the hospital to feel that they are going to receive the best healthcare that can be offered here and just because they don’t know what this or that means, doesn’t mean they are not going to get help or even have to feel intimidated for coming to the hospital at all. But as each day is never the same in OPD and the cases are always random, I just walk in, smile, follow, listen, and learn. With doing that, I have learned more about myself and the passion I have for being in healthcare, and the patients are feeling better too!

In the Theatre, most procedures that are done at the Umphumulo Hospital are Cesarean Sections (C-Sections), Tubal Ligations, Circumcisions, and Abortions. Most of the time, I am observing the “Cesars,” or what I’m used to calling C-Sections, but I have been to at least one of each procedure. Most of the procedures actually take longer than what they are supposed to as there becomes a shortage of supplies. So, going the long way tends to be the most efficient way, but both Dr. Pukana and Dr. Kabeya explain everything to me as far as what is being done and how it would be different if they had a certain material. As far as C-Sections go, I have shadowed Dr. Pukana (what takes the role of the Anesthesiologist) give the Epidural, keep track of the patients vitals, and most importantly as the patient how she’s doing throughout the entire procedure. I have shadowed Dr. Kabeya (who takes on the role of the Suregion) scrub in, deliver the new born, and then suture the openings that were made for the delivery. And I have shadowed the Pediatric Caretaker who is the sister or sir that assesses the newborn as soon as he or she has been delivered. They clean the newborn, check reflexes, give a routine injection, and then wrap the baby up to be seen by the mother and then the newborn is taken to the maternity ward. The only one I have not shadowed is the assistant surgeon (usually done by the matron or head nurse), but my time will come soon! My favorite part about being in the theatre during C-Sections, hands down, is being a primary witness to life. No one can take away the feeling of seeing a newborn and then hearing a newborn cry. Also, getting to scrub in and witness how learning never ends because no matter how many procedures I have been in, there is something else that I missed. Learning is not always about already knowing too, and I’m discovering that saying I need help (not just while I’m at the hospital too) really defines a person. So, when I take my little stroll back to the church center, I find myself with this little light inside that never fades away because of several reasons: 1) questions that I ask, 2) new people that I have met, and 3) patients that I have served alongside—it may be small to the sisters or doctors, but big to the patients… and even me!

Just recently, I have also spent lots of mornings in the Maternity Ward too. Here, Dr. Kabeya makes his daily rounds of the soon to be mothers or patients who were admitted and are having some kind of unknown complications. Most of the time, the patients that Dr. Kabeya and I see are in their third trimester, but we also see patients who have found they are pregnant and want to abort. The Umphumulo Hospital takes these patients very seriously and therefore, there are steps that are done to ensure the patient is aborting for the correct reason. Counseling is done pre and post procedure. The maternity ward is nice to be in as well, as I’m not just learning from the doctor, but the sisters who work there too. Plus, my hand holding skills are becoming quite popular amongst the mothers too! =D

I have only been to the Pediatric Ward once out of the time that I have been going to the hospital. My one day shadowing Dr. Kodagiri, I have found that maybe I can’t work with children, especially in the rural aspect. The doctor there, however, is quite knowledgeable about what to do for any child that is ill; as that day we say children suffering from epileptic spasms, respiratory illnesses, Tuberculosis (TB), and HIV. As the Umphumulo Hospital is rural, sometimes not all of the supplies or equipment that is needed can be offered or provided to the child. As I asked questions, some of the responses I was given was, “Well we should, but we don’t have that equipment or another machine to offer.” So, I have found that following the doctor in the Pediatric Ward was a bit too disheartening for me, especially knowing that there could only be so much done for the children. In the mean time, when I pass by I never hesitate to say hello and offer a smile to the children and sisters, but I prefer not to know their cases.

In Casualty I get to see almost everything and anything with Dr. Pukana or Dr. A. Rajaram, who ever is working at the time. From motor vehicle (MV) accidents to major lacerations to broken bones to snake bites… this hospital sees it all. When I first walked into this hospital, because of its placement I didn’t really thing they saw these kinds of cases, but then you shouldn’t ever judge a book by its cover! So what has happened to me over the months that I’ve been here is that I’m beginning to feel comfortable at NOT being so good on my toes. When there isn’t much going on in Casualty, however, this department tends to help with the overflow of patients that are coming into OPD. The busiest times in this department are usually around pay days and weekends, but other than that they do get the occasional cardiovascular, low glucose, MV, ect. patients that need to be seen urgently. Being a rural hospital, I sometimes feel like I’m in a show on the Discovery Health channel; as everything can be an organized chaos. However, it just goes to show you that people in this area are also getting the urgent care that they need too, and the doctors that I’ve worked alongside really know their stuff. As far as I’m concerned, they always like my questions as it keeps them on their toes too!

I have just recently (like late January) begun observing in the Female Ward. Here I follow the NEW doctor, Dr. E. Rajaram, with her daily rounds and get to experience what a doctor would probably see on a Medical floor of a hospital. At the Umphumulo Hospital the males and females are separated if they must be admitted into the hospital. So there is a Male Ward too, but unfortunately I am not allowed to volunteer there because most patients have an infectious disease and the doctors preferred that I just observe in the Female Ward. Following the doctor here has been a great experience because I am able to read charts, see X-rays, observe minor procedures that the doctor might need to do to determine the prognosis of the patients, etc. It is a bit like being in OPD, but more inclusive because we can actually sit down and see patients for more than 10 minutes or so… that’s what I enjoy the most. It’s also nice when a patient comes back to the ward for a follow-up visit after they have been discharged. Getting to see a new, healthy, and vibrant looking person compared to before is one of those feelings that take your breath away, and all you can really do is smile! It has also been nice to get to talk with a female doctor… as the female doctors at the Umphumulo Hospital are only 2 of 11. I’m sure being a female doctor in the Female Ward also puts the woman at ease when she makes her rounds… so this also makes my learning experience more ‘comfortable’ for me too.

One of the most interesting things I have learned from the doctors here at the Umphumulo Hospital is that every doctor is not specifically specialized in any one field; all the doctors routinely switch wards every three months or so. This is because in order to work in a rural hospital the doctor must be knowledgeable in everything that is offered, like a General Practice Physician, due to a shortage of staff. Being a rural hospital, it sometimes amazes me at the distances that several of the patients travel to receive medial attention too. I have heard stories that have changed my life, observed procedures that have changed my life, witnessed the reality of this rural hospital that has changed my life, and been alongside all kinds of individuals that have changed my life too. It is always a humbling experience for me to be here and it has allowed me to literally close my eyes and see with my heart. And even after all of this, I have found that this is who I am and where I want to be… because I am NOT filled with apprehensiveness, but with power, love, and self-control that His Spirit has given me like stated in 2 Timothy 1:6-7. and finally, knowing that I have a strong interest with healthcare, I will continue to use this gift God has blessed me with because Romans 12:6-8 guides me to do so.

I hope you all discern, listen, and discover the gifts God has blessed each and every one of you with, as each person has their own. When you find it, don’t turn away from it no matter what anyone (even your own family) may tell you. It’s kind of like SEEING the wind for the first time, no one can really pin point and articulate this feeling of your own, but it has some kind of effect to feeling in awe, with understanding, and heartfelt satisfaction. And that’s exactly what’s been slowly, but surely happening to me. Until next time… hamba kahle (go well).

1 comment:

heiditorgerson said...

What an awesome description of your day-to-day life in the hospital, Valerie. Thank you for sharing this. Also, my colleague Twila just stopped by my desk to tell me what a deep impression you left on her when she had the chance to visit you. I wasn't surprised to hear that, of course! :-) I'm so proud of all that you are offering and experiencing. Sending you a big hug from Chicago!