A few rough days, but finally some sunshine

Dr Costa set us up to do shifts in the ER all week, where we could get learn procedures and practice ones we already knew (such as suturing, I&D of abscesses, Lumbar punctures, and starting IVs.) The first day we mostly just watched and assisted the ER doctor. There were several lacerations from stepping on a broken bottle or something of similar nature. We watched her do a lumbar puncture and she walked us through the steps (which are fewer than in the US because they don't have access to tubing for measuring initial CSF pressure). We also were rebriefed on how to start IVs. The doctor told us it was a little slow while we were there, and the busiest time was around 7pm. So we decided that Tuesday we would work from 2-10pm. We were excited to put our skills to use and practice our technique!

Monday afternoon it started pouring the rain, which lasted into the night.When we woke Tuesday it was still pouring. The rain remained a steady downpour until Wednesday evening. Due to this, the ER was VERY slow. There were several asthma attacks and one little girl with a second degree burn from boiling water, but that was basically it. Needless to say, we were kind of disappointed because we sat around all night. We did make friends with a young doctor on call who spoke very good English. He taught us alot and quizzed us on things too. He was very helpful and our time with him seemed to make the night a little better.

The way the ER functions here is (obviously) somewhat different than in the states, but not necessarily in the ways you may think. We've noticed that often times, the doctor may leave the ER and be gone for an hour or so at a time. The nurses would continue work as usual, even doing sutures and I&D on their own. We noticed a young girl come in with a large cut on her face while the doctor was out. One nursing assistant immediately started prepping her for sutures. Emily asked if she could do it but he ignored her and did it himself. I cringed as I watched him suture her up. He was doing a very poor job and it really bothered me. For the size of the gash, I would have put at least two more stitches in than he did. But she was a trooper. She didn't cry and she barely flinched when he injected the numbing agent into the wound (which is the part that hurts the most). I have been carrying around Jolly Ranchers to snack on, and when we have had a kid come in for those procedures I usually give one to them when we finish. She definitely deserved one for being so good!

We left that night feeling a little frustrated but we were hopeful that Wednesday would bring somethings we could participate in. But the rain continued, and so it was still slow. When there were patients to see and things to do, the staff ignored us. This is when it got really frustrating. We tried to be more forward and remind them that we can do somethings, just let us know when you need us. We even tried to keep asking questions about patients, but the doctors were short with their answers. The way we were being treated made us feel like we were a nuisence, or completely invisible. One nurse in particular, that we will just call Bob, was really rude to us. He started on some sort of rant about keeping masks in our white coat pockets (which the doctors were doing as well) which then turned into some crazy lecture that made absolutely no sense. Part of it was saying "you Americans don't eat" and "if you don't eat, you will get TB. Thats why I'm 100kg." I was getting pretty aggitated with him as this point. After our lunch break, a boy came in with an abscess on his hand, where he was missing a few fingers. The doctor was still gone so Bob started prepping him for I&D, and Emily asked if we could to it. He said "No, I am doing it." She politely told him that we know how to do the procedure and he responded with "I will not allow you to do it." I was LIVID. It has been a very long time since I remember ever being so mad at someone. Luckily, just as he was about to start the procedure the doctor came back and stepped right in to do it while we watched. After he finished we tried to ask the doctor a few things about the boy (like what he would be prescribing) but again we were ignored. We were so angry that we just left. Yes, we walked out in the middle of our shift. Its not like anyone in the ER cared anyway.

We went over to the OPD in hopes to find our doctor friend from yesterday to spend a few hours with, but not a single doctor was there either. To our relief, we finally found Dr Costa with some patients and sat in with him for a little while. When he had finished seeing patients we gently informed him that we were being ignored and not allowed to do anything. So he said to meet him in the morning tomorrow and we'll work something out. In the morning he made a few calls and just reminded the doctors we were coming and want to practice doing procedures. He even called Bob directly and told him we need to do procedures. We went back to the ER where we found that a different doctor was working today and she was very receptive to us. Her name is Dr Sigwadti and she is from Zimbabwe (I've learned that there are alot of people here that are originally from Zimbabwe). Since the sun came back out, patients were coming in more frequently and we got to do them ourselves finally! We got to do at least 2 procedures each. The other doctor on duty was also nicer to us yesterday than he was in the past. We saw a 3 month old baby come in and he asked which one of us like kids. I said I did, but it turns out it was a bit of a trap. I got suckered into draining an abscess on this poor baby girl. It went well though, and I reminded myself she's probably too young to remember the trauma of this event.

The next procedure I got to do was suture a laceration on a 7 year old boy's ankle. This however, proved to be quite a task. He was a fighter!! It took four people to hold him down while I sutured and it was still difficult for them to hold him. One male nurse had to sit on him. I could hear the boy slapping, punching, and spitting at the others holding him down. Even after the numbing medicine had kicked in he still kept fighting strong. I think he was just mad at that point. Considering what I was up against, I feel I did a decent job closing the wound. It wasnt perfect, and I probably would have done the stitches a little closer, but it needed to get done fast. Once we finished the bandage we let him up and he chased the male nurse through the ER, still hitting him!! This sounds mean to say, but at that point it was actually kind of funny! Instead of giving the boy candy, I gave the nurse a piece for what he had to go through!

Dr. Sigwadti complemented us that we are actually quite good at the procedures. It was nice to finally feel helpful and appreciated. We were thankful to finally have a good experience in the ER. We are going to work evening shift tonight because we were told alot comes in on Friday nights. This is Rachel's last weekend with us :( It feels weird that she's leaving already, we've had such a great time with her! So tomorrow we are getting up very early and heading to South Africa to see the ocean and hang out at the beach! The hostel where we'll be staying doesn't have internet so after tonight, I probably wont be back on until Sunday evening. I feel like I should end this blog with a good picture since alot of the content has been negative. So here's a nice group shot of us:

From left to right: Emily, Zakhle, me, and Rachel. I'm laughing because the girl taking the picture said "I'm tired of "cheese', say BACON!!!"

Have a good weekend everyone!