Things are going well in Tamatave, Madagascar. I have found a good routine of working, enjoying free time and getting lots of rest.
My cabin has been great. I have a wonderful roommate, Mary, who has been really easy to live with. I was lucky enough to get into a cabin of two people and this has worked out well. Most people have at least 4 in their cabin, and as many as six. With everyone working all different shifts, it is difficult to sleep especially on night shift. I have been really blessed with Mary. We are very conscientious of each other, especially when it comes to sleep.
Work has been good. We are still doing plastic surgeries, but our plastic surgeons finish up next week and so we are winding down with the larger cases.
The surgeries being done are things like polydactaly and syndactaly cases. Polydactaly is when a person has extra fingers or toes. Sometimes they have bone in them, and sometimes not. If there is bone involved, it is a more difficult surgery. Syndactaly is when fingers or toes are fused together. The surgery to correct this is opening up the fusion and doing a skin graft to cover the uncovered skin. The skin graft is taken from the abdomen or the thigh. Since it is a small piece of skin, the graft heals well at both the donor and the recipient site. One of the children we had this week had syndactaly on both of her hands, and when her mom and baby sister came in, I noted that both the baby and the mother had the same. The mom had it on both hands and feet. We see this in the states, but I haven't seen it often. I don't know the cause, whether it's from poor nutrition, poor genetics or both.
We also are doing surgical resection of lipomas, which are fatty growths. We had a man who had these on his neck -- very large and he was dancing on his way to surgery yesterday.
I also took care of a 10 year old who had one on his hand.
More about the hospital teams on the ship.
Surgery-- we have 5 operating rooms - not all of them are being used right now. We need more surgeons. We have OR nurses from all over the world and their required length of service is only 2 weeks, so we see more of them come and go. We will soon start doing eye surgeries and when plastics finishes, we will be performing Vesico- vaginal fistulas. This is a very common problem here. I will tell you more about this surgery next time.
Wound care does all of our wound dressings. They have been specially trained to do the dressings and for the continuity of care, this is best.
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We also have a dietary team, physical therapy, hand therapy and day workers. And then there is chaplaincy. We have full time volunteers on the ship, but we have many day crew chaplains who come to worship and play music for the patients every day. They also visit with them throughout the day.
We have separate staff for admissions and outpatient discharge care. These are all RNs who provide care pre and post op.When the patients come back for dressing changes they go to a warehouse which is next to the ship. The ship is too small to accommodate these patients for follow up.
I have more information about our day crew-- from a friend's blog. We have many of them on the ship and they all work so hard and bring such joy to the ship. They work in many roles, from deck hands to patient care, to chaplaincy. I have been wondering how much they get paid, and I have learned from one of my fellow nurses this information. They get paid about 12,000 AriAri per day - this is the equivalent to about $5 U.S. per day. It's above the income average of $2 per day and they are very happy with their jobs. They are excellent patient care techs for us on the ship and invaluable in translating everything we need our patients to know.
I have learned a couple of Malagasy terms--
Chara bey-- OK
and Misotro-- thanks-- ( it sounds like Minnesota!)
and a few more. I have a list I keep in my pocket.
All of our charting is on paper- We have clinical pathways which we use as checklists and charting. Vital sign graft sheets and medicine sheets. things I haven't done in nursing on paper for at least 6-7 years. We reuse medicine cups. They get rinsed and put through a dishwasher. We don't reuse any syringes, or any thing which could convey any infection to a patient. We cut IV bags when done and tubing also. If we have a vial, we puncture it. We also put a slice into our Promod nutrition bottles. This is to prevent this being refilled and sold as "Mercy ship medicine" on the black market here. All patients get axillary temps and we save the thermometer probe covers in a place behind their beds. I though this was odd and when I asked why axillary temps I was told that many patients had never had their temperatures taken and when taken orally, they bite the probe. -- causing probe breakage, and then not able to take temps.
We have nice vital sign machines like on the divisions back at home, and pulse oximetry is done on everyone. I suspect all of these machines were donated by the companies.
Medicines for the patients consist of mainly pain medicines and nutritional supplements.
The patients get a lot of oral Morphine, Tylenol and Ibuprofen.
Nutritional supplements everyone gets are multivitamins, vitamin C, zinc. Adults get Juven-- a nutritional supplement to support healing and Promod- a concentrated liquid protein. Kids get Mana-- a peanut butter protein supplement packet to promote calories and healing.
Most of the patients are very small in stature and in size. I would guess probably due to poor continued nutrition. I asked about vaccinations for children. They are given vaccinations usually when a clinic or other group, like a Peace corp group come around. Therefore it is very sporadic for these kids. Which is why I had to be sure I had updates on all of my vaccines, so that I don't expose them to anything. A measles outbreak would be devastating here. Devastating.
I have become close to these patients, and am so enjoying this. I have a favorite -- his name is Andre and I always kid around with him. We played Uno yesterday and he and the others playing were having a blast. I have additional rules here! I lost badly! I love the kids, but I seem to have a bit more rapport with the adults than with the kids. The communication is a bit easier. I have reconnected with my Uno, coloring and Connect 4 playing skills. The down time is frequent and often, especially on evening shifts. Things I wish we had time to do at home.
As for fun-- I went to a place called the Palmerium last week. It was an ecotourism place, famous for its lemurs.I fed them, and had them all over me. It was great fun. I also saw the night lemurs, the Aye Aye lemurs who are pathetically scrawny and pretty ugly animals. It was all really great fun. To get there we took a 3 hour boat ride down a canal. About 20 of us went.
Well that's all for now--have a great week! Thank you all for your continued prayers for my patients-- and me too!
There is so much good being done here for these people. When I pray, I think of these words--
“Let no one ever come to you without leaving better and happier. Be the living expression of God's kindness: kindness in your face, kindness in your eyes, kindness in your smile.”
― Mother Teresa
The lemurs!!!
The canals-- Their boats are made from trees hollowed out.
