It’s always easier to share the positive things I’m experiencing on
this trip. Nothing I’ve posted on my social media has shown the things that
aren’t so beautiful, until now. I went from
working at the Shakhina clinic, the most peaceful place I’ve ever been, to the
Tamale Teaching Hospital where I had my hardest days yet. The three
days at the hospital were the most difficult shifts of my nursing degree.
However, it’s not all doom and gloom. The shining light in that place was a
tall, muscular, brilliant nurse named David. He often didn’t come in until 10:30, but that was the norm. In Ghana,
being on time has a completely different meaning then back home. The shifts
here are from 7:30am-1:30pm, 1:30pm-7:30pm, and overnight from 7:30pm-7:30am (Shorter day shifts
due to the heat). Here in Ghana, the staff come when they come and leave only
when the next nurse arrives, whatever time that may be. No one seems to be
bothered by it either.
In order to understand the traumas I saw, I need to share a little
bit about the people of Tamale. For them, going to a hospital is a last resort.
There are other options that are tried first, things like medicine men, juju
men, witch doctors, and bone setters. Western medicine isn’t always needed,
these traditional services can have some amazing results. I was talking to our
instructor Jeanette and she mentioned the research into bone setters was pretty
awesome. Another reason people wait to go to the hospital is money, without
insurance, everything must be paid for out of pocket and it’s expensive. I also
want you to consider the patients are not always treated well by the staff.
Back home, learning to communicate and build trusting relationships with
patients is just as important as learning the skills, but here that is not
always the case. They might be hushed when they call out in pain or scolded for
waiting so long to seek medical attention. Now that you have a bit of
background, I’ll tell you what it’s really like.
Day 1
I had been well prepared for this clinical placement. Told what to
expect and what I would see. I had made a worst case scenario in my head, but
never expected that is what I would be walking into. With our instructor
Maggie, Camille and I walked down to dark hall towards the unit. It smelled
like a combination of detol, the cleaning solution used here, and urine.
Stretchers lined the hallway, and every single bed was being used. There were
even people sprawled out on the hard floor of the trauma bay. There had been a
bus accident the night before.
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| It wouldn’t be uncommon for people to ride on the roof with the luggage. Traffic accidents are very common in Ghana. |
Back home this would be a code orange, this means extra staff and
protocols to control the chaos. Here, no one was yelling or running the
atmosphere was very laid back, which seemed to odd to me. I was so overwhelmed,
walking around wide eyed and not knowing where to start. I’m sure Maggie could
sense how I felt, she stayed.
David met us in the trauma bay and mid conversation his head turned
to the door and said “Oh Shit!” My back was towards the door and not going to
lie I was a little afraid to turn around. Once I did, I saw a young man covered
in blood. He was bleeding from the left side of his head. He was in a motor
cycle accident with no helmet. His head had collided with the person on the
other bike. We sat him down tried to remove his shirt but it was a struggle, the
blood had made it difficult. It was like trying to take off jeans after being
pushed in a pool. David put pressure on the wound and wrapped his head as
Camille and I tried to do an assessment. Maggie said “what does his heart and
lungs sound like?” I’d been so shocked I had forgotten to listen. When I pulled
out my stethoscope to listen I remember thinking that I’d never had blood on it
before. I’ve never had that much blood on me before come to think of it. Once
he was stable, Camille and I left the trauma bay and went to see where we could
be helpful.
A man had come in by ambulance, he was breathing and had a pulse but
was unresponsive and had no reaction to pain. His skin was so hot. It felt like
he could just burst into flames at any moment. He was triaged as red,
critical.
There isn’t much we could do for him. Even back home with all the
supplies at our fingertips. Here supplies were limited. Camille and I did our
assessment at supported the family while someone tried to find a bed and move
him to the “red zone” on the ward. I knew he wasn’t going to make it.
Another man in the red zone needed the dressing to his hand changed.
He had been in the bus accident and his hand was crushed and he was
unconscious. It looked like it had been through a meat grinder. I asked if we
could get him some pain medicine because I noticed his breathing and heart rate
had increased. The nurse said he didn’t need it. She pinched his arm and he had
no response. It was only once the antiseptic was poured on his hand and he
pulled his arm from her hand did she believe me that he was in pain. We stopped
and got an order for pain medicine, but the family couldn’t afford it and that
meant we had to keep going. Camille and I watched uncomfortably as she pulled
the clots out of the wounds and wrapped his hand in gauze that wasn’t
sterile.
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| Protocol on how to triage incoming patients |
I noticed the doctor starting CPR on the man that was brought in and
Camille ran over to help. I was still helping splint the hand after the
dressing change and didn’t run over. Camille said the doctor did three
compressions and she offered to get the ambu-bag to help him breathe. Finding
things on the unit was not easy she asked for help and the nurse stopped to
chat with a friend instead of grabbing the bag. Needless to say, we were
frustrated. This man is dying and you’re stopping to talk! The doctor called
time of death. And then I remembered, this is what the nurses see almost
every day. This is their normal.
After that, we helped comfort the man from the motorcycle crash
while David stitched him up. (Emerg nurses here have a bigger scope of
practice, like rural nurses back home) He was sterile! It was nice to see such
good technique after what we had just witnessed.
Just then another man in the red zone started to choke on the oral
airway in his mouth. It was too small. I watched as David pulled out of the
patient’s mouth with pliers. I was the one to put the new one in, the correct
size is time, with Maggie by my side supporting me.
After this, Camille and I were done. That’s all we could handle for
one day. But we spoke too soon, as they needed us to do some teaching before we
left. We said okay, and I struggled with the language barrier, trying to
explain why it’s important to stay in the hospital with a bone sticking out of
a leg. We happened to be next to the family of the man who had just passed.
Camille’s eyes met theirs and I heard her say “I’m so sorry” and she had to
leave. I felt my heart sink. This was it. Now I was really done for the
day and it was only 12:30.
Day 2
I didn’t really want to come back. I didn’t feel helpful the first
day. Camille and I were on our own. We made a good team. I knew I could count
on her.
When we walked in today, there were empty beds! I was so relieved to
see that it was a slow morning. We took some vitals in the trauma bay for the
nurses. There was one critical blood pressure 220/120 (normal is 120/80). We
reported to the nurse and the patient got IV meds to lower his blood pressure
within a few minutes. After yesterday, I was impressed with how fast that
happened.
Camille and I found David and went to assess a young boy who had
fallen out of a mango tree. He had broken his neck and was paralyzed from the
neck down. David found him a neck brace, his neck hadn’t been properly
supported until now. Using my finger, I traced a line from his neck to foot to
see when he could no longer feel my touch. He could feel everything! This was a
great sign Camille and I helped wash him up with the help of two other nursing
students. This process took over an hour. Between finding linen, a basin,
towels, and all the turning. I noticed that then number one priority around
here seems to be keeping the patients clean.
Just when I thought all was well, in came a man in respiratory
distress. He was working so hard to breath. Camille and I jumped into action
getting oxygen and doing assessments. The nurse interrupted us and said, “he
needs to rest, stop asking questions.” We didn’t stop. He doctors came and
ordered a steroid to reduce the inflammation and help him breath. The family
member had to run across the street to buy the medicine while he struggled for
every breath.
Just then, a woman was wheeled in also struggling to breath. She
looked worse, yet all the doctors stayed with the young man. Camille and I
desperately searched for another oxygen mask. We found one, but it had been
used so many times the seal was not good. The good mask was being used on the
young man. One of the residents came over eventually, we had taken vitals. They
were critical. Her oxygen saturation was 64% (it should be above 95% in a
healthy individual). We got her a nebulizer to open her airway and a steroid.
It didn’t help moments later she stopped breathing and collapsed in Camille’s
arms. Her heart stopped Camille started CPR immediately. I had brought over an
ambu-bag earlier and I started breathing for her. She started vomiting. The
resident hooked up suction and I put in an oral airway. All that was going
through my mind was, “Thank God I put one of these in for the first time
yesterday. So at least I know what to do.” I was so impressed by Camille, she
was running this code. The resident looked petrified. He was learning too and
didn’t have support. I don’t think she stopped doing CPR the whole time. We did
everything we could with the limited supplies we had, but the resident called
time of death. Within ten minutes of being wheeled in she had passed. Camille
and I cleaned her up. Camille told the resident he had to talk to the family
now. I was proud of her. Usually the doctors do paperwork first but, she made
sure this was a priority. This was it. All we could handle for another
day.
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| All of the equipment we had in the ER |
Camille and I left out the main entrance and we’re stopped by the
daughter. She hadn’t been with the family when they were told. Camille, without
hesitation, told her everything we did and finished with your mom had passed
away. She collapsed into our arms. Screaming. Crying. This is not news a nurse
would ever have to give in Canada. We held her until a friend came to get
her.
We walked into the parking lot, tears streaming down our faces in
silence. I hoped that no one else would notice around us. It was 40 degrees.
Maybe I could pass my tears off as beads of sweat.
Day 3
After a rough couple of days, Camille and I were given the option of
not going today. We both felt like we had to be there.
The night nurse had waited for us to get there to do vitals in the
trauma bay again. We didn’t mind. There were also two nursing students from
Belgium on the ward today. Yay, I thought, some backup. Camille and I checked
on some of the patients we saw yesterday then took a break. On our break
we felt that the day was different, it was calm. We even sent a message to our
group chat saying………
After choking down another granola bar, Camille looked at me and
said “We need to go to the trauma bay.” I asked if her nurse sense was tingling
and she said it was. I still don’t know how she knew, but two traumas had just
come in. We split up. She went to the head trauma and I went to man struggling
to breath. The resident asked a student to bring over a screen to do an
assessment. Not again. After three days here I was feeling ballsy! I broke protocol, I told the doctor we’re going to the ward
and he can do an assessment there. He needs oxygen, now! While I had to hunt
down a mask, clean it, and hook it up, the resident put in a Foley catheter.
Ugh! Interesting choice. The basics are the CABs: circulation, airway,
breathing. Not urination.  |
| resuscitation is number ten on the to do list here |
Now that the oxygen had helped him breath better, it was time to
focus on his blood pressure. It was 65/40(normal is 120/80). This is a critical
low. He was bleeding from a peptic ulcer in his stomach. He was in shock.
Camille was back now. We took turns sealing the mask to his face, but the
doctors had a plan: “Fluids and lots of them. Then to the operating room to
stop the bleed.” His brother came by crying and I gave him a hug and let
him know what we were doing. This man was young maybe a little older than me.
The fluids were taking too long, Camille ran to the pharmacy herself and make
them give her bags of normal saline. She put her name down to be billed later.
We kept him breathing and running fluids for a couple hours before Maggie,
Jeanette, and Vida walked in. They had been saying the official goodbyes and
all the other students had left the hospital for the day. Their nurse senses
were tingling too and they felt like they needed to check on us. At this point
I was in over my head. His oxygen tank had emptied and it had taken 5 long
minutes to switch it over to a new one, all while I watched his oxygen levels
drop. Hour three, still waiting for the OR. Maggie tagged in holding the mask
and decided to stay. I’m so grateful she did. Camille and I were so frustrated
at this point. Camille had run to the pharmacy again for fluids and I had paid
5 cidis out of my own pocket for a glucose test strip.
All of the fluid hadn’t increased his blood pressure. His abdomen
was becoming more and more distended. The resident got an NG tube into his
stomach to try and suction out the blood. It wasn’t working. It had been too
long. David was by our side now. The man’s lungs started to fill. His heart
stopped. Maggie instinctively jumped on the bed she straddled him and started
compressions. Camille had the ambu-bag and started breathing for him. I grabbed
an airway and David put it in. He yelled at Maggie, “Too many compressions!
Take a break!” David, Maggie, Camille, and I took turns doing CPR. This was the
first time I’ve ever done CPR. The first time I pressed down on his chest, it
was such an awful feeling. I wasn’t pressing nearly hard enough. I heard Maggie
yell “Deeper!” so I did, I pressed harder. It felt like each rib had broken off
from his sternum and I could feel the bones grind with every compression. David
yelled for epinepherine. One of the Belgian nursing students started to walk to
the pharmacy. Maggie screamed “RUN!!!!” After the epinepherine, we got a pulse
back. I was ecstatic. I was the one on the mask. With his heart beating I gave
him a breath every 5 seconds. This didn’t last long his pulse faded away and it
was back to CPR. The blood oozed from his nostrils, mouth and out of the tube
that had been placed. We had an audience. In the quiet ward here were
three white women yelling and barking orders at people. I’m not usually one to
yell but when one of the other students attempted CPR it looked like she was
just slapping him in the chest. Maggie tried to coach her, but it wasn’t
working. Every second counts now. I shouted “NO” and shooed her out of the way.
It had been thirty-five minutes, decision time. Maggie asked for a decision and
the resident called it.
When I saw the brother after he was smiling. I thought it was the
weirdest reaction. He shook my hand and kept saying thank you. Maybe he had
watched how hard we tried. No way to be sure. This time when I said we did
everything we could. I meant it.
Witnessing death every day was awful. I don’t know how the nurses do
it. It’s nurses like David that I’m in awe of. He works so hard every day, with
limited supplies and hustles in an environment when it’s acceptable not to. I
learned a lot about myself. I know more then I think I do. I loved seeing how
creative they are with the things they do have. I’m so thankful for Maggie and
Camille. I couldn’t have asked for better teammates.
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| Rachel, David, Albert [head nurse and awesome too], and Danielle |
Tamale Teaching Hospital was where Camille and I tried our best to
save a life, and we did the best that we could with what we had.
***Don’t worry Mom and Dad we are coping well and heading to Mole to
rest and recover!
Written by Krista Koenig, UBCO 4th year BSN student
