VCU School of Nursing Blog

The VCU School of Nursing Heritage Room is currently displaying an inaugural exhibition of nursing artifacts and items from the history of the MCV, St. Philip and VCU Schools of Nursing. A committee is currently at work on the next exhibition, which will open in the spring of 2008. If you would like to be involved with the Heritage Room committee, please contact James Parrish, Director of Development and (804) 828-5172, or by e-mail at jtparrish@vcu.edu.

The Heritage Room is open from 8:30 am – 5 pm, Monday through Friday and during special events. Please come and visit!

Posted by at 5:38 PM | Permalink

One month ago I boarded a plane to South Africa. I was expecting to enter a world of people speaking other languages that I couldn’t understand, African dances that I wanted to learn, and a different culture filled with safaris and rituals. Most of all I wanted a better understanding of the South African health care system and the growing epidemic of HIV/AIDS.

Some of my findings reflected my expectations. I watched young children try to teach me to dance. I listened to them sing the South African anthem. I watched every single one of their eyes glow and their smiles would go from ear to ear when I would take their picture. They all were so happy. Amazingly enough I was the one that was sad. I watched these children play by themselves in piles of garbage with tattered clothes and dirty little bare feet. Behind their happy smiles, in the distance, I could see beautiful mountains and the bright sun. Somewhere there was something beyond the piles of garbage and dirty little feet running around. All I could think of were the times that I was frustrated that the cable was out, or my internet was working too slowly. All that time I never looked past for something better. I can’t say whether these children were told there was something better; something beyond the present. Maybe since they didn’t know any different, they were brought up to make use of all they had and appreciate it.

I was able to experience animals that I would never dare to see outside my car window. The lions were relaxing two feet away from our safari jeep, and elephants trotted past the van with their tusks dangerously close. I jotted down every fact I could remember that our tour guide would say with enthusiasm almost not realizing that I was standing next to these amazing creatures.

I spent many days before the trip wondering and thinking of ways to get across the repercussions of unprotected sex, the dangers in sharing needles, and the possibility of infecting the unborn child. I assumed a large portion of the population was just uninformed and we would go and help to spread our knowledge. After working within the South African hospital systems and multiple clinics, I realized that my original ideas to educate the population of South Africa were not feasible. Many of them are educated about HIV/AIDS. The clinics have hand outs, voluntary counseling and testing, free ARV medications, free contraceptives and still over one third of the population remains infected. When I wanted to know why, many of the nurses said it was ignorance. They spent countless hours educating and trying to get people tested. In turn, patients would giggle at the talk of contraception, not show up for clinic “appointments,” and not take their ARV medications. Patients would purposely stop taking their medications in order to have their CD4 count drop below 200 to be eligible for government assistance. That was the most baffling part to me. These people would run themselves down so much, and become so sick that they can’t do anything for themselves only to try to get government money. What will they do with that government money if they are too sick to use it?

At the clinics, pap smears were done with re-useable speculums and popsicle sticks. Patients would stand in a line every morning even before the sun came up to be able to get into the clinic. There is no privacy. TB patients would sit in the TB area, same with HIV/AIDS patients and the same with mothers and infants. Everyone knew your diagnosis. You sit in a room as a female and expose your breasts to the nurses, while two seats over a male patient is having a check up done by another nurse. There is no heat or air. Windows are left open for ventilation and flies swarm above patients. Fly paper dangling from the ceiling with dead flies garnishes the public hospitals. The smell of feces permeates through certain wards as well; all while the private hospital patients are allowed to order the seafood medley from the lunch menu. It seems there is no middle ground. Women only have funding to have one Pap smear every ten years and there is no funding for colonoscopies at all. Breast cancer is high as well as prostate cancer if you are lucky enough to live to the age where you are likely to see it occur in men.

My experience here has been one that I could never replicate. I have gained so much knowledge and wealth. I could never explain this experience in words. The magnificent views that I encountered while jumping off of the highest bungee bridge in the world, the exotic animals that I was so dangerously close to; these were things that were a once in a lifetime opportunity. I could never explain what it felt like to want to bring all of my belongings to Africa and leave them there. I could never take someone by the hand and walk them into the villages and townships and make them understand what poverty is, because we did that, and people still took things for granted. People still wanted to go home and still were not satisfied with what they had. I can only speak for myself where I say that before I complain, I will honestly remember that I am very fortunate. I am lucky to be alive and to have a healthy family and supportive friends in my life. Going to South Africa has truly been a rewarding and enriching experience. I feel very privileged that I get to be part of the first group of study abroad students to go there. I would do it again in a heartbeat; even if it means taking prophylactic aspirin before a 20 hour flight, wearing uncomfortable compression stockings, and being sprayed down with Malaria spray on return to the United States.

Posted by at 10:30 AM | Permalink | Comments (1)

I came, I saw, I left . . . but not unchanged. As we all have said, this trip to South Africa has been an opportunity of a life time. We have seen a coastline that is absolutely beautiful and wide open land that stretches for miles. There are forests and waterfalls/oceans and mountains, all providing tourists with endless opportunities for adventure and fun. Ziplining, bunjy jumping, walking with the elephants, playing with the lion cubs all in one place - awesome!

But, there is more; we have seen poverty that is just incomprehensible until you stand in the middle of the wooden shanties; free clinics that are overcrowded (250-300 patients per day), and public hospitals that function with equipment dating back to the 1940's & 50's in many areas. Healthcare access for specific needs (patients needing orthopedics were referred to Livingstone, psychiatric patients were treated only at Dora Nginza) could be an all-day experience and that's if one had the money for transportation or the strength to walk. Nursing has the same approach to health problems as in the U.S, namely history taking, examining, and planning. Patient education, however, is different. Educating about medication purpose, timing, and completing the dose is routine; however, how do you tell a patient not to eat salt, sugar, fried foods; or to eat green veggies, citrus fruits, etc. when the only thing your patient gets to eat all day may be a cup of soup and bread provided by community organizations. When babies are born at home in shanties, the community wheelbarrel serves to carry water from the community tap and doubles as a way to get ailing patients to hospitals, and people are waiting for a "real house with plumbing and electricity what do you do, how do you help? What do you work on first to decrease the poverty, the AIDS, the TB? We as nursing students (American and South African) are taught to educate our patients; how can anyone focus on learning when they are cold, hungry, and tired?
While I was in South Africa I would say, "America has the same problems of homelessness, poor access to healthcare, and poverty; it's just that South Africa has a bigger volume". Now, as I sit in my home with all my creature comforts, I have to say the poverty and homelessness abroad is overwhelming! With unemployment at 60%, HIV/AIDS at 34%, and medical equipment outdated, where do you start? Janel is correct in writing that one cannot look at the whole picture. The needs are so great and the government is so new. America has had 100+ years to work on healthcare issues and we still say there are pockets of poor access, poverty, etc. South Africa's new government has had only about 14 years to sort things out. People keep asking what was it like over there? With the problems so great, hope so aboundant, and cultural beliefs so strong I can only reply, "God Bless the leaders with knowledge, leadership, understanding, and perserverance." As the nurses at the clinics say, "We do what we can and then we go home only to return tomorrow and try again to help."

Posted by at 1:10 PM | Permalink | Comments (2)

My nursing experience in South Africa was worth the trip to me. Since I
have so little experience as a nursing student in the US, everything we
did and saw there was beneficial to me. Their whole health care system
works differently then ours.

It is much more stressed, busy, and
desperate. There were many diseases and health issues that I have only
read about in text books, but never seen. To be totally submerged in
that world helped my nursing ability tremendously and made me personally
a better person.
The nurses have to make use of the little equipment they have. They have
very little paper towels to wash their hands, primitive equipment to
assess a patient, and almost no access to a doctor. I will never take
these things for granted again. They also don't have enough nurses for
their patient population. Patients line up outside the clinic starting
at 2am hoping to be seen sometime during the day. One newspaper reported
that a local hospital had one nurse for every 90 patients!
I never realized how lucky we were and how much we really do have.
Becca

Posted by at 7:30 PM | Permalink

It's hard to believe that our time in Africa has come to an end. Being back home, in familiar surroundings has really allowed for the experience to sink in and has given me a lot of perspective. The things I saw are images that will forever be burned into my mind. Some good - some bad. Here is a brief synopsis.

What I have learned about the South African health care system is that it is a major work in progress, much like every other faction of the political/economic infrastructure of the country. I think the health care providers do an adequate job of providing services, given the context of the conditions they must work under. But there is so much room for growth and improvement. I was constantly forced to remind myself that while the Republic of South Africa has been existence for many years, the apartheid government's demise is not even two decades removed. The country is still in its infancy, and so the problems people are encountering are somewhat to be expected.

South Africa is a nation of diversity. Diverse geography - with rugged mountains, sparse deserts and miles upon miles of coastline. Diverse people - from the black South Africans; the coloured Indian, Malay, and Asian populations and the white Afrikaans. And diverse problems - the poverty and disease epidemics are overwhelming. With over 60% of the country unemployed, it is hard to know where to begin to rectify the crisis of HIV/AIDS, malnutrition, tuberculosis, substance abuse, etc. I quickly learned that one cannot focus on the big picture or you will become completely overwhelmed. Rather you must take it one day at a time, or better yet - one individual at a time.

This trip was indeed an opportunity of a lifetime. To have gone into the townships and seen the unfathomable poverty is something I will never, ever forget. To see the love an unwavering faith the people have, despite living in the most horrific of conditions is something that will resonate within me forever. A woman on the flight back to the states asked why I had traveled to South Africa and after listening said "Janel, you are blessed for having gone there. Don't ever forget that." And while I'm not the most religious of people, I truly believe she is right. My spirit has been enriched in ways I can't sum up in words and know I will be a better clinician and (more importantly) human being for having been a part of the South African experience.

Posted by at 2:24 PM | Permalink

Hello hello! Sorry I have not had the chance to email much this week...it's been a busy one. But I am leaving to come home in less than one hour!!! So, to update you on my week...

Monday I was at Greenacres hospital, a private hospital, and I spend the morning in the ICU working with a patient with adult respiratory distress syndrome (ARDS). On Tuesday I went to Chatty clinic and worked in the well baby/sick baby/immunizations area. That was a lot of fun because I got to give Vitamin A supplementation and took some pics of babies being immunized. On Wednesday we went to do home care. This was a very touching event. The family I was assigned to consisted of a blind man and his wife with TB. They had 5 kids and 11 grandkids. We gave them some food, blankets, and seeds for their garden. On Thursday we visited the squatter camps and this was very very sad. I have some pictures to show you because words can not even describe the poverty we saw there. The uplifting thing is that the people were so friendly and pretty hopeful despite their living conditions.

My last week in SA was pretty intense. I have learned so much and seen so much. I will be doing a summary when I return home to the states that I'll share with all of you. I don't have many more internet minutes here. Can't wait to see you -- Mica

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The healthcare system here in SA is unique, the nurses here have more autonomy and authority than in the US, but they also can have up to 90 pts on a night shift. This recently made headlines, a nurse had 90 patients on a night shift at a state hospital, Dora Nginza. There is also a major difference between state and private hospitals here. A private hospital is comparable to all of our hospitals. The state hospitals, well, let's just say, I wouldn't seek healthcare from there. Nursing assessment and care is done the same way here that we do on the US, we do however, have much more modern equipment, I have seen metal bedpans and emesis basins in use here and that is standard. There is really not a thing here like a nurse practitioner, the nurses can go on in schooling to receive special certificates in child birth, OR, prescribing meds, etc, but there is no official specialty for a nurse practitioner. It has been an enlightening experience here in SA, I hope to return again soon.

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Last Wednesday we changed townships and visited with another group of volunteer workers. We were introduced to a volunteer named Stumpy, a 3 ½ foot dwarfed lady who carries the weight of this community on her shoulders. Cheerful, lively, and hopeful she explains that she is a volunteer that has had special training to help people in the Kleinschool Township. Unlike the Emanuel Volunteers who help with only HIV/AIDS victims, this lady helps all her neighbors whether they have HIV, HTN, alcoholism, etc. Everyone comes to Stumpy. In fact last month she delivered a baby (not the usual occurrence, the women just appeared at her door in late stages of labor).

I don’t remember how many people Stumpy said live in this area, but the unemployment rate is running about 60%. There are formal government issued houses (concrete, 40 m sq buildings with plumbing and electric wiring) and informal shacks with no plumbing, electricity, or toilet. Many families have to get their water at the community tap and the homes without a toilet use “the rubber pail”. Many of the homes survive on disability or old age income checks from the government only ($820; divide by 7 for US dollars) for the month. Planting gardens is a way for families to have fresh veggies; seeds may be obtained from the Health Dept (I think that’s where they come from).
Stumpy explained she frequently tries to help families to apply for disability or some kind of government aid, but this is a long process because many of the people don’t have a birth certificate or ID card. I was shocked when she explained that if a woman has a baby in the hospital or at home it is the family’s responsibility to register that birth and get a certificate. The hospitals do not do this. Since the place to register births is down in the city, which is 2 taxi rides up and 2 taxi rides back, many times it is not done. If you can’t afford supper, why would you care about registering your new child. One would think this would get caught at the school level when the child goes to enter school because they have to be vaccinated, but if the child never goes to school no one catches the omission. So at the time when someone is sick or injured and is trying to get aid the lack of birth registration is finally discovered. I wonder what happens if one doesn’t remember their birthdate.
We were taken to families in this township to ask questions about health & living situations. I talked with a family that consisted of a women, her husband, and a non-family elderly woman who was >60yrs old. The younger woman has kidney problems, her husband has HTN, and the elderly lady is basically healthy and is the sole income to this household (she receives $820/mo for being 60+). The house is a formal dwelling which is divided into 4 rooms, a toilet, and a tin roof. This is one of the luck homes, there is plumbing, electricity, an inside toilet along with the luxuries of a refrigerator and electric stove. There are no children in this home, but the women has 3 children from a previous marriage. When she married again it was decided to leave the children with the family of the previous marriage because they could get foster-care money. Apparently the husband can decide if he is going to take the children in his home or not; if he cannot afford the care for the children they usually stay with the first family.

I asked this lady what would be her number one wish and she said she wants seeds to plant in her garden. So along the some food items, I will try to find seeds for planting.

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On Monday 8/6 I was at Greenacres hospital for the morning. This is a private hospital and as such is a lot nicer than the public hospitals. It actually reminded me a lot of the hospitals we have back home. It reminds me a lot of St. Mary's. I was assigned to a sister (S.A. nurse) for the morning and observed her typical day at work. I was also able to remove sutures and change sterile dressings for a patient as well as give discharge instructions for a patient.

On Tuesday 8/7 I was visiting Motherwell Clinic. There were so many students there that I was only able to observe assessments but I was able to talk with the students and instructor about various aspects of primary care. Our mentor, Devona, was with me on this trip and I had the opportunity to ask her a lot of questions and learn more about the type of care people expect and the culture of health care in these primary clinics. On Wednesday 8/8 we did home visits and I was really happy with how these went. I was paired with 2 other students and we went into a home to see a man and his family. The man was diagnosed with bladder cancer and had been undergoing radiation therapy. He lived with his wife and 2 of his children and 1 of his grandchildren. He had 9 kids and 11 grandchildren. We were able to ask about the availability of resources (food, water, electricity, etc), employment/disability, and various other aspects of day to day life. I found it to be a very enriching experience and the family was really friendly. That night we had dinner with the nursing faculty from NMMU. We had a good time wining and dining with them. Beginning Thursday (8/9) until Sunday (8/12) was the holiday weekend. We did a lot of shopping (last minute gift buying...get excited!) and caught up on some sleep. On Wednesday night a few of us went to karioke and then on Thursday night we played trivia again. This time we won...woohoo!!! Friday some of us did whale watching which was awesome and Saturday we went to Addo National Elephant Park and Schotia Game Reserves. That was an awesome day with a braai at the end (a braai is a S. African bar-b-que type thing). Delicious!!!

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So Wednesday (August 1) I went back to the clinic Kwazakhele and it was not any easier as I had anticipated. My first patient had a blood sugar of 20.1, which is really high as the normal is 5.5-10 or something like that. We measure blood glucose different in the states...confusing to explain. Anyway, so she had to be put on a drip but they used a normal saline drip and not an insulin drip. When I asked the nurse why, she said because they reserve the insulin for true emergencies since they don't have much of it.

My second and third patients came in for a checkup and a refill for medications which I was allowed to write up. The nursing write up and medical record charting here is very different. Then on Thursday (August 2) we were supposed to go on home visits and perform home care. We went to two different homes but didn't really perform any care. We learned some about their situations, the government grants they get for not being employed, and how they survive on a day to day basis. It is really a very sad situation they have in some places in this country. So many people are HIV infected and TB spreads because of the close quarters. Pneumonia and flu are rampant because so many people live without heat and electricity and it does get very very cold here (30s-40s some nights). Another very prevalent issue is that they throw antibiotics around like candy. They give everyone amoxil or another that I can't remember the name of and Brufen which is a pain medication, opioid of some sort.

That night we went out with some of the NMMU nursing students to play trivia. We came in second place...beginner's luck? On Friday (August 3) we were supposed to go on a Frontier Tour but that did not work out. We did a tour of an African musical instrument factory and sat in on a great jam session. We got close to our destination for dinner and lodging and the road had been bull dozed. Our vehicle was not equipped for off-roading and we had to turn around and come back to P.E. We tried to make the best of a 12 hour day in a microbus. On Saturday and Sunday (August 4 and 5) we were supposed to be on the tour and since that did not work out, we had the weekend free for shopping, sightseeing, fine dining, and some movie watching since we have worked so hard doing nursing here is S. Africa.

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Hey everyone,

I will be home soon and get to show you all pictures! Get excited! Just think hours and hours with me and pictures...what else could you think of that you would like to be doing?

So these past two days have been amazing. Saturday 6 of us went whale watching. I told everyone I could call the whales and Elayne didn't believe me, but here was my chance to prove it. When I was little my parents let me adopt one of those "Free willy" whales. I learned how to make those noises from her. So right when we spotted a few in the distance I started making my noises and they put up their tales and their heads and whatever else whales have. They were Southern Right whales just in case you want to look up pictures before I get back.

After I got some blowhole spray on my face we took off again to St Croix. It's a island off the coast of South Africa that holds the largest amount of African penguins in the world. It was very neat to see all the little guys swimming in the water and then ducking when the boat came. Apparently their biggest predator is a an Arctic Skua bird. The reason is that they eat the penguin eggs and the penguin chicks. They are pretty aggressive suckers that are black with a bit of white on the tips of their wings. One tried to dive bomb the boat. Apparently I have not been too lucky with the birds this trip. We also saw oyster catchers while we were by the island. They are endangered black birds with amazing red beaks and red feet. They are strictly costal and indigenous to south africa. I have a picture of them as well. Get excited that you get to see endangered species.

OK so I was disappointed that i didn't see dolphins or great whites, however it was pretty good anyway. I am happy with the blowhole spray I had on my face and our skipper George was awesome.

Next amazing adventure...Addo Elephant park!!! Yesterday we woke up early and got into our most amazing van the entire trip. The seats reclined further than the ones on the South African Airways flight! Seriously...It was amazing. Our guide for the day was Peter. He is one of the most brilliant people I have met here so far. I have pages of information on the animals that we saw today. He also gave us some information on the constellations and such. Very brilliant, courteous and so funny he had me speechless at times. I know you are all thinking..."I have to meet this man." How do we make Cortney shut up?

Anyway, we saw so many elephants I have pictures galore. Stacey...This is the perfect wedding day present for you. Elephants on your wedding day. Can it get any better? Babies and Big ones, drinking and playing...you will be ecstatic.

Peter taught us that the Eles. produce about 175 Kg of Dung/day to make up for the 200L of H2O they drink and the 200-300 Kg of food/day they eat. Amazing huh? Beats any of you boys...even a night after drinking. I will also give you one guess as to how many muscles are in the trunk of a regular size ele.....give up??? approx 60,000 and they can do everything with them except tie them in a knot. Seriously! They have a total of 50 L of blood circulating through their bodies and 12 of it is located behind their ears alone, so when they are hot they flap their ears...you didn't think they flapped their ears to fly did you? (don't tell anyone, but I did until peter told me I was dumb)...haha. They only process 40% of what they eat and one of the biggest reasons they die is due to malnutrition...not old age. What a horrible way to die?! However, it is actually congruent with the population in the townships of ZA as well (along with sickness). There are no such thing as ele. graveyards either. However, when they die the "car"/family of elephants will mourn the death for a very long time and even pick up bones with their trunks.

The Eles. breastfeed until they are about 4 years old, however they can eat vegetation long before that point. They give birth standing up and actually back up over the calf to help the birthing process (not quite sure exactly how this works). They are also the ones who encourage the calf to stand up. We humans are the only predators.

After that we went and watched them all gather at the watering hole for a bit and play and eat/drink. Then it was our turn for lunch. We filled our bellies and headed to our "real" safari. Peter loaded us up into a 4x4 real safari wagon. I sat up front so I could be the guide. If anyone knows what an awesome passenger I am...you would understand why Peter wanted me up there...haha.

I would like to remind you that in these 4x4s there are no windows and just in case a lion wants to eat us...they can. We got amazingly close to all of the animals. I will tell you some neat details about some of them just in case you ever want to go on jeopardy and give me half of your winnings....or just in case you want to play trivial pursuit.

We saw tons of warthogs...Pumbas if you will. They are supercute even though they are ugly. The males have 4 warts on their face and the females have 2. Bushpigs are similar to Warthogs however they are carnivores and warthogs eat vegetation/grass. They eat this vegetation and grass while kneeling on their front two legs by the way. No two wildebeasts are the same, they all have different blue, striped type markings that make them different; like how our fingerprints make us different. Impalas...which I have already told you about are awesome. They are like Mormons in a way (the old school way)...one man and many females. Another interesting fact about them...they can hold back their pregnancy for up to 3 weeks if they need to. This is due to food sources/scarcity issues. Impalas have scent glands on the back of their legs that are used to help other impalas track them if they are in danger. These scent glands do not develop until a while after birth (exact time I don't know...so don't ask...haha). They can also climb trees! Only up to 20% of their body weight though. Just in case you can't tell an Impala either...they have a McDonalds sign on their butt.

Blesbok...these are antelope type animals that have a big white face. They are named this because in Afrikanns (one of the official languages) it means white/pale face (exact terminology...once again...don't know). You can tell the difference between the males and females because the males have thicker horns.

Giraffe...The only double toothed ( split hoofed) mammel that is born with horns. The horns are born laying down and cartilageonous. They become hard and bony as they get older. The males have fuzz on the top of their horns and the females don't (this is an easy way to tell the difference between the obvious girl/boy). They are also the only mammel that walk same sided feet except the camel. Pretty neat huh? They eat on a tree/bush called Cashakaroo (sp?). They can only eat on this for 2-5 minutes before it produces tenin(sp?). It starts to taste bitter after that. If tenin is produced then that tenin will let off phermones to close by Cashakaroo and it will also produce phermones. This could cause problems for the giraffes and feeding time if they aren't careful.

We saw hippos and a rhino. Peter let me name the hippos Thelma and Louise. The Rhino's name is JB. Rhinos cannot swim because they cannot lift their head above their shoulders hence their really thick necks. They also eat from the middle to whatever side their foot is out to. Ex...left foot out front...the head goes middle of the grass to the left foot. Pretty neat...and you never have to cut grass. Ingenious. I am getting one.

I saw a yellow mongoose. Cutest little things ever...and because I saw them...I felt safe there were no Cobras around. End of Story.

Now my most favorite story...the lions. So we pull up to one huge lion. He just lays there...kind of like Scout does on the couch. He just was laying there tired and wanted us to go away...no great shots. A little bit later we found 3 more. The male lion started biting the one female lion's butt. There you have it people...there is your birds and the bees lesson. However, the flashes of the camera must have embarrassed them because that's all that happened. Dirty people wanting to see more than that. Go watch animal planet. Haha. They were really beautiful. It was getting late so Peter used some lighting for us to get really great pictures with. I promise you that we were so close...almost even closer than that one that was sleeping in my bed that first week. It was crazy.

We eventually started to get cold so we went back to the camp for a braai. There was really great food and dessert and wine. Pretty much the best ending to an amazing day. To get back we had to ride in the safari jeep one more time and let me tell you that I got to see some little animal that hopped around (i can't remember it's name) and a few more that i just wanted to pick up and squeeze.

Anyway that was the end of the day. Yesterday we went to a jazz show at a restaurant and that was pretty fun. Rachel, Les and I danced for a bit. I have got the Afrikanns moves down so I will teach you all when I get back;)

I miss you all. Pray that I am not getting sick again. because my throat is killing me again!!!! I will be flying back on friday. I love you...take care.

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I don't have a lot of time to write this message so i'll just give you the basics.
On monday night we went out to dinner and i had kudu, escargot, and creme brule.
On tuesday we went to the clinics and i went on a tour of the clinic and then worked in the VCT which is where they test patients for HIV and give them counseling for it. That night we went to a faculty member’s house for dinner and we mingled with all the teachers of NMMU. They served some really good soups.

On wednesday we went on a home visit and my patient had TB and wasn't taking her medication because she was using the money to buy alcohol so there was some heated conversations going on between her and her family so it was a good learning experience. That night we all went to the Kareoke bar and we had the most fun i think i have ever had!!

On thursday it was women's day so we had the whole day off. we went to the craft market and had mcdonalds (it was heavenly) and then that night we went back to the bar that we went to last week where they play trivia. and team america won 1st place!!! It was pretty cool, but they asked a lot of american questions. Then we went back to the kareoke bar and had some more fun!

On friday we were supposed to go whale watching in the morning but the boat was being used to transport sick people off some island so we went to the mall instead. I bought a cute clutch and a nice shirt for the kareoke bar this thursday! Then that afternoon we were able to go whale watching and we had a lot of fun on the boat ride.

On saturday we went to the elephant park and on another safari and this one was really nice. They had this huge lunch and dinner for us and our tour guide was a lot of fun. We also got to get right next to the lions and get some great pictures. We also went on a night safari to see the nocturnal animals.

Today is another free day and we are going to the craft market for the last of our gifts. Then tonight we are going to a live jazz club and that should be good. On wednesday we have been offered an opportunity to work on the labor and delivery ward for the night shift and catch babies all day. I'm not sure if it's going to work out but i hope it does because i'm excited to deliver babies. Becca

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Chatty Clinic, another government sponsored clinic that deals with primary care, mother infant, vaccinations, etc (no birthing, no suturing, emergencies are referred ASAP). This clinic sees 200+ patients/day on a busy day. Today was a little slower because it was cold and raining this a.m.

Did get to see a patient with low back pain. It was a little tricky assessing for "numbness & tingling", ROM of the spine, and trying to understand how long that soft movable lump had been in the middle of his back (T10-11region). Used lots of "can you do this" (getting the patient to cross his left foot to his right thigh was definitely something, felt like I was playing charades. The NMMU student was great translating my instructions. Did have a problem for all students, American & NMMU alike, with the inguinal pain patient that did not speak English, Afrikaans, or Xhosa. Even the Mentor had to get an interpreter. Turns out the patient needed an RPR test and treatment for STI. No interpreter phones here so I hope all patient education made it through the barrier. You know it must be frustrating for nurses here at times, especially when the patients are given the best information (like the use of condoms are important) and the patient has the right to refuse. Makes me want to say, "It will fall off" or "You will go blind if you don't...." Don't think I would be very patient with some of these people. Like the lady that came to clinic last week with 3.5+ tonsils, fever, pus on the tonsils, & could not talk or swallow food for a week. I just want to say "how could you stand this for so long? After all, the clinics are free. But I guess this is why I came here, to see how illness is perceived and handled.
I liked this Clinic the best so far (still have another one to go to). The students and mentor were most helpful and easy to talk with, and they were good at making sure my questions were answered. Not all experiences have been this comfortable --Elayne

Posted by at 11:37 PM | Permalink

So on thursday night we went out with the south african students to a local bar and we had a blast. they had trivia night and we all divided into teams, and there were nine teams total (we were team america!) We ended up in third place which was pretty good because there were a lot of south african questions that we didn't know!!

On friday we got up early and got on the bus to go to our farm visit. We stopped in a small town in the mountains to visit a music factory which was actually cool because they played some traditional south african music for us! Then we headed out to the farm and we were still three hours away from it. We had to travel on a dirt road for literally an hour that weaved and rose high and deep into these remote mountains with nothing around!! There were no houses to be seen and no signs of civilization. Then we were about 5 miles away from the farmers and the road was out. Apparently they had bulldozed it that day. The road was impassible and we ended up denting a rim on the van we were in. We had no cell phone service, no one around, and the sun was setting. So we made the safe decision and decided to turn around and drive the 5 hours back to port elizabeth!! So we never made it to the frontier land.

On saturday we caught up on some much needed sleep and never left our rooms. It was nice to lie in bed all day and watch TV and read my harry potter book (i'm almost done by the way i only have three chapters left!!)

Then on sunday we got up early and went to the local craft market that is held every sunday and it was awesome. I bought a ton of gifts for everyone and tried a lot of good traditional food. It is almost like a fair only with all shopping and food and no entertainment. We then went shopping some more along the board walk and had a late afternoon snack. We spent the rest of the day showing each other our gifts and relaxing.

Today we went back to the hospitals and i was at livingstone hospital. When our driver took us inside to be dropped off for the day, there were no other nursing students in the hospital and no one knew we were coming so we had to leave. We did come back a little later and got a 30 min walking tour but that was it.

Tomorrow we go back to clinics and on wednesday we are going to a soup kitchen for an orphanage. Then the rest of the week is off because its a national holiday here for Women's day. -- Becca

Posted by at 11:35 PM | Permalink

I would first like to tell you that I last left you with the dun dun dun...I am going bungee jumping...will I return. Obviously I did. It was the tallest bridge in the world and I did it. It was amazing. I have a DVD and everyone will watch it. You will have no excuses not to. I almost died. I felt my poor lifeless body slipping away and then snatch a rescue man came down and got me and pulled me up by my little cord all while I was taking in the breathe taking views of the mountains and rivers and oceans below me. It was pretty traumatic and you will all experience it.

After that we were exposed to some dreadful olive loaf and butter sandwiches. Maybe they were dreadful because I just almost died and wanted lobster...or maybe it was just because they were gross..who knows. We also ganked some oranges and hid them in our bags until Martha told us that the elephants that we would later be hanging out with get a little excited about oranges....those came out of the bags immediately.

So now I have a little diddy about my time at Monkey Land. It goes a little something like this...
Ring tailed lemurs have 26 stripes unless they fight
Always 13 rings of black and 13 of white
To clean eachother they like to lick
Unlike other monkeys who like to pick
Squirrel monkeys are little but definitely the most mean
Atlas walked on his hands so his arms were lean
The tour guide was also very intellectual
So me being Cortney, I found him quite sexual
So this whole day of monkey land came to an end
With a whole new adventure around the bend.....

(PS...I would like to tell everyone that a monkey grabbed Janel's leg and she screamed like a girl and lemurs like to meditate for real in the sun.)


ENTER...BIRDS OF EDEN...Now I will take you on a visit to the place where we were dive bombed by birds and almost eaten alive (rachel definitely got her foot bitten by an african parrot). However, on the upside I met Toucan Sam so the day was good.

As the day ended we went and had a brai at the lodge we were staying at. It is like a big cookout, however since it was 3 degrees we did it inside. Zack the dog liked to eat our leftovers. I would like to paint a quick picture of my night just to show you I can "rough it" in case anyone had their doubts....#1 there were arachnoids in my bed #2 I have a cold and sore throat #3 I just ate an Atkin's dieters dream #4 Dr Moon took us stargazing until I finally could see the southern cross #5 Jessica and I definitely tried to call cows by mooing at them #6 I wore the same clothes two whole days in a row!!! I am the picture of a true woodsman now.

OK so trying to write faster the next day we went zip-lining. That was pretty awesome too. I got to see a bunch of cool sites below us. Our tour guide named us all different names. Mine was Shakira. Of Course...

OK so this week we went on our first day of hospital tours. I got to be on a pre/post type surgical floor. I can honestly say they do take longer discharging patients there. They also reconcile all meds so that they don't charge the patient for all of the meds they didn't use while in the hospital. I am very use to us just grabbing the meds from the draw and sending them to pharmacy. I also don't know if I already said this...however everyday between 10 and 10:30 there is a tea-break. If you are dying...and it's tea break...too bad for you. Seriously. It's like the world stops. It's very confusing to me, but it's not my culture so there's one difference I won't get.

OK then we have the clinics...Margaret and I got to be with the women's and kids on Tuesday. The little kids are so cute. We did a lot of immunizations and one really big difference in theirs compared to ours is they give Vitamin A shots and Deworming shots as part of their regular immunizations. Obviously this is because of the region that they live in and what they are exposed to. Also there is a nation wide polio vaccine campaign to make sure that polio doesn't spread since it is so prevalent here. Margaret did a pap test and I am sure that in her blog she will explain the room, however I will note that there were no stirrups and I had to hand her wooden tongue depressor type things to actually scrape the cervical cells with. It was less than sterile. We also were witnesses to a young pregnant woman getting a rapid HIV test. The nurse made her read the results herself and for a few moments she thought it was positive and in a way...it almost seemed as if she "knew" that that was her destiny one day. Thankfully it wasn't positive, but she didn't smile. She was still very quiet. And it is sad, because when you talk to people here a lot of times they feel like it is their destiny.

Yesterday Margaret and I were in the AIDS/HIV clinic working with ARV drugs. It was very educational. We got a book to bring back with us that tells us a lot about not only the virus, but the drugs the lifestyle you should lead to remain healthy with the virus and all the side effects from the drugs. It was really sad to see 16 year olds come in to the clinic. We also saw a girl with a horrible case of shingles. It is an opportunistic infections that attacks the body usually in the 3rd and 4th stages of the disease. She was in horrible pain and needed help putting her shirt back on and the worst part was is that most of the patients were not much older than us.

OK I have to go..we are going to trivia night with some of the SA nursing students and I am going to be on a team with Margaret and Janel..We are going to win so I have to brush up on my knowledgeable facts about who britney is dating now and how many days nicole ritchie will be in jail without stilletos. -- Cortney

Posted by at 10:50 AM | Permalink | Comments (1)

Posted by at 10:44 AM | Permalink

Everyday is jammed pack with things for us to do and we get up so early everyday to do these things that when we are done in the evening we just want to go to bed. So i left off on Saturday when we went to Tsitsikamma. It was absolutely beautiful!! It was in mountains of trees and canyons! The first thing we did was go

bungee jumping ....obviously i did not go bungee jumping but 4 girls from the group did! It was fun to sit at the lookout point and watch them go over the ledge especially since we had binoculars! Then we went to monkeyland which was actually a lot of fun. It was a caged in forest so that the monkeys could not escape but we were able to walk around inside with a tour guide. The monkeys were running free and they would run up to us and cross our path so we got a lot of really cool photos. The tour guide was also really funny so that made it good too. Then we went to birds of eden which was just like monkeyland only the top of the forest was enclosed as well. We saw some really beautiful birds there too! Then we went back to the hotel and i ended up rooming with elayne since it was only two to a room. Then the people who ran the hotel gave us a bunch of raw meat and some potato salad and we had to cook the meat on an open stone grill thing. It was a lot of fun just laughing and sitting around. It was very cold though.

The next day we started out going zip lining which i was terrified of at first but after the first few lines i was ok. The waterfalls were really pretty and i even got some video of it. Then we went to tsitsikamma national park to eat lunch and it had a beautiful view of the Indian ocean. the waves here are as tall as i am!!! That’s why south africa is the surfing capital of the world!! Then we went to the elephant sanctuary to play with the elephants. I got to walk with one while he wrapped his trunk around my hand and i got to hug his trunk for a picture and play with his ears and all sorts of cool things. I even got the trainer to open up his mouth and had courtney take a picture while i brushed his teeth!! I am definitely going to win my dentist’s competition!!!! It was the perfect ending to the trip!

On Monday we went to the hospitals here for the first time. All the equipment in there is from the 1960s!! it's really sad the equipment that they have to deal with. I met this really cool nursing student named Hanli who offered to give us a tour of the hospital. We got to see the OR, the ICU, the ER, and the oncology unit. The oncology unit is known as the florence nightengale ward becuase it's literally that old and you can tell from the way it is set up that its from world war one!! Of course in the middle of the tour, the clock struck 10am which is tea time here and everyone stopped what they were doing and went to have tea!! Tea time is a half an hour here so it's a nice luxury that we americans are not used to but we have to bring it back with us!!! we all laugh at them and they don't understand why we don't have tea time!! Hanli also offered to hang out with us one night and show us what the students at NMMU like to do so that should be fun!! after that we took our hour lunch break at 12pm which is also very nice and then went back to the room to sleep!

The next day we went to more clinics to observe how it works. I got to do a few assessments and listen to lungs but nothing too exciting. There are not TB masks much less any negative pressure rooms to put the patients with TB so we have all come into contact with it by now. I just hope that that gives you some idea of how far behind these people are in the health care system and how desperate they are!

On Wednesday we went back to the same clinics and we did the same thing as before. We had patients come into one exam room two at a time to speed up the lines of people out the door!! The nursing students from NMMU that we were working with took us to a local cafe during their half an hour tea break (i just can't get over that. they literally kick patients out the door when it’s tea time!!) and we tried some samoosas which is a traditional dish here. I also tried something that the other student had brought and i don't know what it was but it made my eyes water and my nose run!! When we were finished at the clinic we hung around with the nursing students for an hour and asked them a lot of questions about their culture and they asked a lot about ours. For example they asked me if i had a fake ID since i am under age to drink because they said in the movies everyone has a fake ID in america!!! We learned a lot of interesting things. When we were talking about the different racial groups in south africa they told us that the joke among them is this: The perfect life is to marry an Indian women, make american dollars, drive a german car, eat chinese food, and live in south africa. Then they said that the worst life is to: marry an american women, make indian dollars, drive a chinese car, and eat german food!! It was really funny. They think american women are very strong and independent but that we spend a lot of money!!! After that the weather was so nice and hot that we all went down to the beach for the afternoon!! It's like all of a sudden its hot here which is a nice change from the cold!!!

Today we went to go and do home based care. We only went to two homes because we spent two hours driving around trying to find the homes but it was ok. Then we had tea at one of the ladies house and we had cook sisters (which are kind of like doughnuts with coconut on them) and curry bunnies (which are biscuits that are studded with curry, onions, and beef). They were all really good. For the rest of the day we plan on napping (because we are all soooooo tired) and then Hanli and a few other nursing students are coming to pick us up and take us to a local bar. It should be a lot of fun. Tommorrow we leave for the farm that we are staying on for the weekend. Two weeks down and two to go!!! --Becca

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Posted by at 3:15 PM | Permalink

Yesterday & today Janel & I went to Motherwell Clinic. This is a state run clinic (last week's clinic experience was a municipal (city) run clinic, at least I think that is the way it goes.) Here they have all services and are open 24 hours to deliver babies, treat stabbings, shootings, asthma attacks, etc; much like our ERs. On regular clinic days they can treat upwards to 300 patients/day.

Each clinical visit brings a new experience. Here we teamed up with the 3rd yr NMMU students. The Matron for students (the clinical instructor) is a very pleasant, 70 YEAR OLD lady who has been doing nursing for as she says "I can't remember how long." She enjoys nursing and spreads her knowledge and enthusiasm to her students. I must say, though, that she loves her 10am tea break also. But, after seeing patients 2 at a time (so that each patient had 2 NMMU students and us as students) all morning, she needs a break by 10am.
We saw lots of HTN, DM, a patient with scabies (repeat episode because he did not use the medicated soap given him properly), diabetic ulcer that was I&D ed at the hospital, cough, etc., etc., etc. Lots of the same problems we see in our clinics, but the volume is overwhelming. I was totally blown away when I saw male & female patients being assessed in the same room. The patients don't even blink an eye about this. If your problem is abd pain or breast discomfort, it doesn't matter; they "whip it out", no matter who is on the other side. But I guess if you are waiting 1/2 the day to be seen, or live with 10 people in 1 or 2 rooms privacy is not your top priority. Could you imagine this in the USA; we can't even mention another patient's name in the presence of a patient for fear that Mother HIPPA would slap us down !!!
I also have been seeing how hard it is to get a history from patients. (It has nothing to do with language). You have to know not only what questions to ask, but how to ask them. One girl came with c/o RLQ abd pain, she denied pregnancy, but had no menses x 4 mo. After questioning her for about 15 min she was then examined on the table in the back of the room only to find a protruding belly and pain that would not allow her to lay flat. The instructor asked her if she felt movement in her belly and she said YES. Guess what, you are pregnant with PID so off she was sent to the women's clinic so they could prescribe safe medications for the infection.
Our second day at Motherwell I felt more at ease and I think the NMMU students did too. They would include us in the exams (lung assessments, breast exams, abd exams). They wanted to take pictures of them and us working & teaching patients and we had a good laugh taking pictures while we shared skills with each other. I asked questions about treating pain after surgery and explained our PCA and epidural approaches. Janel talked with them about pain management during infant delivery. Basically, I think, there are no epidural blocks for delivery in the public hospitals. The students were concerned about "does this affect the baby?"
I truly enjoyed tea time with Sister Mtisizi. She talked about her experience during the Apartheid and explained the peaceful transition. Up to this point I did not understand everything that happened, but to hear her express her feelings on the day of the change over and to watch her gestures was truly moving.
All and all I had a very good day. I think the shock of the poverty is over, now I am starting to see how one does what they can with what they have. It was a new and different experience for Janel & me to see how sharing hand sanitizer (we did a lot of this today), pens, and tote bags bring sincere excitement and gratitude. -- Elayne

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Posted by at 3:06 PM | Permalink

It's been a while since my last update but here is what has been happening. On Thursday we went to Sapphire Primary School and visited with the children. I have lots of pictures and some video of them singing their national anthem. They wanted us to sing for them and the only thing we all knew the words to was our national anthem. Surprisingly enough they really loved it. After we left the school we went for a home visit and talked with a man who is HIV positive.

We talked about his circumstances and his living situation and what it has been like for him living with HIV. They have this interesting set up where they pre-pay for electricity via this swipe card box in their house and the government rations out a certain allowance per month to each home that qualifies. Outside of that ration, they pay for what they can afford. It seems to be difficult living conditions and since it is winter here, it gets pretty cold at night.

Then on Friday we went to see a traditional African healer. So here I am thinking of that really old Alvin and the Chipmunks movie where they see the witch doctor and he has cauldrons of potions and herbs brewing and he lives in a hut with shrunken heads hanging around the outside. Well, this guy was nothing like that. He treats people in the privacy of his home and even refers people to the clinics for TB and HIV testing and treatment when necessary. The traditional healers are on a mission to get recognition from the government in the ability to refer patients and have offices, etc. He described their endeavor and talked with us about his work.

On Saturday we traveled to Tsitsikamma Waterfall Park where we stayed for the weekend. And OMG I bungee jumped!!! Off the tallest commercial bridge bungee jump to a crazy 216 meters. For those of you who are conversion challenged that is somewhere between 600-650 feet. It was insane! The scariest thing I have ever done in my life! You know that dream where you are falling and you wake up scared, sweating, and trembling???...well, that's exactly what it felt like. They had to push me because I could not hurl myself off that bridge...and I have a DVD of it so there is no telling what I was saying before they pushed me off. I guess we'll find out when we watch it when I get back. After that adrenaline rush we went to Monkeyland and Birds of Eden where I took lots of pictures. Both parks had beautiful animals and the tour guide in Monkeyland was pretty funny with his cheesy jokes. Then we slept at the Tsitsikamma Lodge where we had a South African braii. We cooked 5 pieces of mystery meat over hot coals seasoned with Bar-b-q seasoning. For mystery meat, lukewarm potato salad, and onion and tomato salad, it was not too bad. We slept there over night after warming by the fire...it was sooo cold. Half of the group had a cold after that. Sunday morning we did a zip line tour of the Tsitsikamma waterfall park where I took some really cute pictures of all of us harnessed in with helmets. Then we went to Storm Mouth River which is this really turbulent area where the river drains into the ocean. The waves were huge and the sea spray was nice. The last thing for that day was the elephant sanctuary where we walked with the elephants and fed them. I have never touched an elephant before...they are hairy, rough skin, slimy trunks, and they are sort of timid.

Now for the nursing stuff - On Monday, I had the unique experience of going to Livingstone Hospital. This is a state hospital that stays pretty much at full capacity with patients. They are short staffed of doctors and nurses and the students hate going there. I was on a medical ward with all male patients. Many were HIV positive, many had TB (don't worry, I'll get tested 3 weeks after I get back to the states per recommendation from the nurse at student health), and many had psychological issues. This is not really my area considering my psych clinical instructor told me to never go into psych nursing (I'm not so good at it!). I saw some pretty horrible things...this ward was really dirty, they did not give the patients clean linens unless they were overtly soiled, and the patients would just use the bathroom in their bed or one guy got up, squatted as if he was on the toilet and had a bowel movement all over the floor. A nurse took a trash bag and covered it up saying that they did not have time or a mop and would clean it up later if they got to it. Some of the patients had not had their vitals taken in days...not a blood pressure, temperature, nothing. Some of these men were shivering with cold and the nurses are either burnt out or overworked. They must not only provide nursing care but they clean, give out meals, reception, paperwork, diagnose etc. It was a good learning experience and I worked really hard that day but it was really very sad.

So, today (Tuesday), Jessica and I were at Kwazakhele clinic. This is a comprehensive clinic that tests and treats TB, has VCT (voluntary counseling and treatment for HIV), well-baby visits, and adult primary health care. I was able to take a history and do a focused assessment on one patient. She spoke Xhosa so the exam took a lot longer bouncing back and forth between languages and trying to figure out what was wrong with her. I had to present her to the doctor and he said she had bacterial cystitis (bladder infection) but her urine was negative for everything the past two visits. When I told him that observation he got mad, said she needed a vaginal exam, and told me to leave. Oh well...doctors will be doctors. Tomorrow I get to go back to that clinic...maybe I'll get an easier patient.

Posted by at 4:43 AM | Permalink