A Nurse's Worst Nightmare

By Savannah Swanner | Oct 01, 2012
After multiple shots and changing her bandage.  She was such a trooper!

God calls us to give thanks, and today my heart is full of thanks.  Thanks for those who helped me come here.  Thanks for my amazing God who is always loving me even when I mess up.  Thanks for my family who continually supports me.  Thanks for you who read my blog.  Thanks for my church family who I never realized were so important.  Thanks for the amazing love a small child can give.  Thanks for a world that is so beautiful.  I am so thankful.  How often I forget to remember the things, events, and people who God has provided.  I have only two weeks left with my angels at Angel House.  This morning I woke up from a dream distressed that the dream had been true and that I was back in the US without having said goodbye.  Just the thought has brought me to tears as I write this.  God has graciously reminded me that I am to always give thanks.  I am to give thanks for the time I have had and the time I still have.  I am to give thanks for the love I have been given and the love I have been able to share.  I am to simply give thanks.  So thank you God for constantly providing me with strength.  Thank you, Lord, for all you have done!  Thank you, Father, for Angel House!

The past week has been extremely eventful here in Tarime and at Angel House.  Last Saturday we had a church revival in the village, a group of Australian doctors, nurses, and paramedics came to Angel House, another missionary came for a few days, I had to take Bhoke, one of the Angel House girls to the hospital, and Angel Secondary School had its first graduation ceremony.

To start, the Saturday before last, Rachel and I ventured out to Angel House early in the morning to be able to greet a medical team from Australia who are here for four weeks working with the Tarime Good Will Foundation.  This team included doctors, nurses, and paramedics.  Since coming here, I have continually prayed for Matiko, the little boy with the burned hand.  I know several of you have also prayed.  Well, God is so amazing, and He constantly works far beyond my own imagination.  This team had heard about Matiko’s hand and part of the reason for them coming to Angel House was to look specifically at Matiko.  They wanted to take pictures and films to show the problems, hopefully devising a plan to help with the damage.  Dr. Julie informed me that if Matiko was to continue to use his hand in the future, then surgery would be necessary.  The scarring from the burns has caused contractures, and eventually if things continued the way they are he will lose the ability to use his hand.  She took pictures and films to show to their surgeon who might be able to suggest a plastic surgeon in Tanzania.  Although, this is quite disheartening, it is an answer.   We now know exactly what to pray for and have a direction to travel in.  I filtered kids into our small dispensary for several hours while the Australian team patiently cared for each child.  Because I am a new nurse, my experience and knowledge is limited.  Having the Australians there, I was able to ask questions and make sure we were providing the best care available to the Angel House kiddos.

During this time, Bhoke, a ten-year-old girl, came to the dispensary saying her finger “was sick.”  She said there had been a splinter under her nail, and she had pulled it out.  I looked down at her thumb.  There was no splinter, no blood, everything looked normal.  I told her there was nothing we could do about the pain and that it should feel better in the morning.  The next morning after church, Bhoke came back to me saying her whole finger was hurting.  I looked down and noticed a small, pus-colored streak through the middle of her nail.  She would barely let me even touch her finger.  I knew this was an infection and hoped her body would fight off the problem.  I gave her some pain medicine and knew to watch her closely over the next few days.  Monday morning rolled around and I went to Angle House to play with the kids.  I was immediately told Bhoke did not go to school because her arm was sick.  I went to check on her, finding her asleep on her bed.  Upon waking her up, she told me her whole arm was hurting.  Some basic assessments told me we needed to immediately go to the hospital.  Her whole demeanor had changed.  She was lethargic, her arm was hot, and her entire fingernail was now pus colored.  Auntie Teddy gave Bhoke a quick bath and then we were off to the hospital.  We waited in line for two hours before seeing the doctor.  The hospitals here are much different than hospitals at home.  During the day, only natural light is used.  The hallways have no windows, so they are dark and dank.  We sat down on wooden benches outside the exam rooms, waiting for the medical staff to tell us we could go in.  After briefly looking at Bhoke, the doctor told us that she needed to have the nail removed.  He wanted to keep her overnight and remove the nail today.  To my dismay and protest, he decided to use general anesthesia (put her completely to sleep) instead of just numbing her finger to remove the nail.  General anesthesia is a lot more dangerous (particularly in Africa) than simply numbing the thumb, hence why I protested.

Everything in Africa moves very slowly, so when the doctor told us he wanted to remove the fingernail I thought we would have several hours of waiting before anything happened.  This was not the case.  Bhoke and I left the doctor’s office and were directed to a large room at the end of the hall.  Above the door read “Injection Room” in large black letters.  Inside we both sat down on another wooden bench.  Bhoke was hysterically crying at this point and there was not much I could do to comfort her other than protectively wrap my arms around her.  I soon realized that this big room was actually their surgery room.  In the middle of the room was a multipurpose table.  It looked as if it was used for surgeries and for birthing babies.  Hanging on some hooks beside the table were two plastic, reusable aprons.  Both were splattered with dried blood.  The nurse brought in a huge one-liter glass bottle of antiseptic along with some other supplies.  At this point, one of the Australian paramedics showed up to say hello.  I think she could obviously see the distressed look on my face and the hysterical child I was trying to calm.  She knew what was happening and asked me if we would like to wait until their (the Australians) surgeon came to remove the nail.  Thanking God, I said yes, we would wait as long as necessary so that the Australian surgeon could perform the removal.  At the point, this man showed up and began grabbing Bhoke’s arm to look at the nail.  She immediately screamed, yet he continued to poke and squeeze her hurting arm.  I began to pull her back closer to me, hoping he would understand that he needed to stop hurting her.  Remember, there is a language barrier here.  Although the doctors and nurses speak some English it is not enough to completely understand one another.  Gill, the Australian paramedic, told the man she was going to call their surgeon to come and do the removal.  The man said okay and left the room.  Gill went to call and inform her team of the happenings as the nurse began moving about the surgery room.  The nurse picked up the bottle of antiseptic solution and immediately glass shattered on the floor.  Part of the bottle had cracked and broken, sending glass and solution flying to the floor.  In America, the glass jar and antiseptic would be immediately thrown away because tiny shards of broken glass could easily have fallen into the solution.  Well, not in Tanzania.  The nurse poured some solution into a nearby tray and then placed the bottle and remaining solution on the counter.  At this point, the man from earlier came back in with needles and ketamine.  He tells me to get Bhoke on the table.  I asked him what he was doing and that we wanted to wait, but his response was, “I’ll tell you what I’m doing when I am doing it.”  Initially, I thought that he was going to start an IV.  At home, anyone with general anesthesia has an IV in which to administer the drugs.  But everything was happening so fast.  The next thing I knew he was placing the needle into her arm, pushing medicine rapidly into her vein.  He did not wash his hands before the procedure.  He did not clean the injection site before inserting the needle.  He did not wear gloves.  He did not use a bandage to stop the blood after removing the needle.  He used his bare, unwashed hands to cover the injected site.  (My nursing instructors would have definitely failed him had he been in my class.)  I then looked at Bhoke and realize she is unconscious.  The medicine he had given her was the anesthesia medicine.  Her body was lying limply on the table with her legs draping over the edge and her head awkwardly placed to one side.  This man then went to her hurt thumb, used a scalpel to cut, then took pliers and jerked her nail off.  The nurse, also not wearing gloves, wrapped Bhoke’s finger with some gauze and tape, handed me the nail, and then both the man and nurse left.  At some point, during the middle of this, Gill walked back in.  I thank God, because if she had not been there I would have probably started crying.  Once the nurse and man left, Gill and I began counting Bhoke’s respirations and pulse.  We tried to turn her to her side to provide a better airway since she was drooling profusely.  The man came back in at this point, yelled at us for turning her over, and then pick her up.  Cradling her in his arms with her hands and feet dangling and her head limply hanging backwards he started walking down the hall.  Gill and I rushed after him.  He placed her in a bed in one of the wards, told us not to move her, and then left.  Gill and I quickly positioned her so that she would not drown on her own saliva and waited.  At this point, Rachel, my fellow missionary, arrived from Angel House with money and emotional support.  Gill left to check on other patients and Rachel and I watched Bhoke.  After about an hour, Bhoke began to wake up.  She began screaming for me.  All the other patients and families in the ward stared strangely at these two white girls and this small screaming child.  The amazing thing is that Bhoke spoke only in English.  I was worried that without someone there to comfort her in Swahili she might become more distressed, but that was not the case.  Instead, the one time the nurse came to check on her because she was screaming so much, Bhoke seemed confused that the lady was speaking in Swahili.  It took about three hours for her to wake up enough to understand what was going on.  I told the nurse I wanted to take her home, so that she did not have to sleep in the ward over night.  We called for the car and took Bhoke home.  With Rachel’s support, I was successful in giving my first penicillin injections throughout the night and morning.  Bhoke was such a trooper.  She has now become my little partner at Angel House.  Always hanging out with me and giving me amazing smiles!  Her finger, despite me efforts is infected again.  The Australian team is coming back to the house, so between their knowledge and God’s healing I am sure Bhoke will continue to heal.  This experience was truly eye opening, but I pray never again will our kids have to go through such a horrifying time.  The realities here are hard to stomach.  We continually complain about medical care in the States, the rules, the costs, the problems, but thank God we have medical care.  The care I saw provided felt as if I was placed back in the early 1900s.  I hope we can all remember how truly blessed we are!

 

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