In which Alison has two very big days, and manages to keep her cool by wrangling people.

Well, we've had an exceptionally busy weekend!

Saturday morning, bright and early, we all piled into the car and headed out for Imfluzi National Game Preserve. It's a national park that holds all of the "big five" (lions, elephant, cape bufflo, rhinos, and cheetahs). The road up to the park (which was about three hours away) was exceptionally well paved and fast. We were soon on the way (with the help of Gertrude) and out of the city. First, we passed through areas of suburbs that looked very much like where we were staying, then slowly the landscape became dryer and more arid. The houses, instead of being made of corrugated tin, were made of mud, and they were round shaped with thatched roofs. These are called Bosutos and are very common in Lestoto.

After driving for about three hours, we arrived at the park. The very first thing we saw as we pulled in the gate was a zebra standing by the lodge eating away. And then, from somewhere in the grass, a family of warthogs apeared and the little ones stated playing. There were six babies and one large, but very ugly, mother. We sang "Hakuna Matata" for her, but I' m not sure she appreciated it.

Our safari guides arrived with two huge, ten-seater open vehicles. This made me a little nervous, remember that at Lion Country Safari hands and arms were to remain inside at all times! but i figures the guides knew what they were doing. I got to sit next to Prof. Mallinson, who had shown up with his students from Swaziland. They were all traditionals, so we let them ride with Endera, Jill and Jenn and all of the adults came with us in our huge jeep. As we took off, we could see this huge expanse of African landscape spreading out before us. It was truly amazing, with hills in the background, acacia trees everywhere, and lots and lots of grass for animals to hide in. Along the four hour trip, we say some amazing things: an elephant that was eating right up next to the road, so that we could smell be sap fromt eh bark; a giraffe who was surprised by the appearance of the jeep and started running right along side us; a very far away view of a watering hole with impalas, zebras, elephants and cape buffalo. Lions who had just killed something and were lounging down by the river. The baby rhinos who were following their mother.

The driver told this great story about a obnoxious group of high school guys (rugby team) that he had in his van. They were so annoying that they threw a can of coke at a cape buffalo (the most dangerous animal in Africa, they don't stop attacking until they are sure that yo uare dead). He got so annoyed that he told them that was the end of the trip, and headed back for the gate. As they were nearly there, they ran acorss a pride of lions, resting right by the road. The guide took the keys out of the Jeep, tossed them among the lions and told the boy who had thrown the can to go get them. The boy was terrified, and crying, and then the guide stepped out of the Jeep, clapped his hands twice, and teh lions got up and trotted away. He said that we were much better than those kids.

We had to leave the park when teh sun was setting, and the light looked absolutly lovely on the landscape. It was dark when we got back on the main road, and about two hours into the trip we started to see lightling on the horizen. Then the wind started going wildly, and we were suddenly involved in a huge lighting storm. The only other storm I've ever seen like this was when I was at camp and we went on the trail ride. The sky was just a constant, moving picture of lightning going off, and we were sitting there transfixed. Bob got us through fine, and by the time we had gotten home it had died down, but it was still a scary experinece.

The next mroning, we all got up early and put on our Sunday best, because we were heading to mass at the Church on the Hospital grounds. When we arrived at the church, a line of white-dressed boys was heading in with insence. Singing was going up around them, and it was cear that there were too many people to go into the main door. We ran around to the first side, but that was full. Finally, we tried the last door and the usheress led us to seats right up front, with a wonderful view of the church. THe church was lovely, it and open with paintings of angels and two huge murals (one with the sacrafice of Isaac, one with the Last Supper). At the start of the service, the organ played a hymn and the whole church started singing. The voices had that slightly off kilter sound of African singing, and as they went on people started clapping and swaying from side to side. Through the whole service, whenever the music stopped a voice would cry out, either from the side or the back, nd the whole congregation would start sining again without accompaniment, even more joyfully than when the organ joined them. It was impossible not to sing along, even though I didn't know the words (a lifetime of following Hebrew has made me good at picking up the gist of sounds). I sang, and clapped, and amused the little girls in white dresses who were sitting directly across from us in the church (in the universal way of children, they were not paying much attention).

I couldn't say anything about the content of the service, which is too bad because the priest was clearly very passionate. His style of preaching was more what we would associate with a baptists or other kind of clergy than a catholic priest. One woman even "caught the spirit" while he was preaching, which the catholics among us said wasn't usually for their churches. Otherwise, things proceeded in a way that I am told is fairly typical for mass. At the end, the congregation sang "Hark! The Harold Angels sing" and "Oh, come all ye faithful" in Zulu, but I sang along happily in English which made the lady across from me smile. All in all, it was a great experience.

After Church, we headed into Durban to do brunch at a art gallery there. The brunch was lovely, and the shopping was amazing. Everything was produced by local artists, and we spend many a happy rand (and hour) there getting gifts to take back. After our shopping, we wanted to head to the beach. The best beach is Durban is found near the Suncoast Casino, which was a glitzy place which wouldn't have looked out of place anywhere in America. We headed in, and I noticed immediately that the vast majority of people inside were Indian. This was interesting, since we hadn't seen many Indian people, but I guess that this is where they hang out. The beach was great, warm water with big waves. I didn't swim, but I waded in and had a great time. Then we all sat on the beach just enjoying the fresh air and the sense of peace. We had dinner overlooking the water at a restuarant in the casino, and then headed home.

In which Alison takes care of patients with strokes, delierium, and chexia but is still pretty much ok.

For those who don't want to read beyond the "spoiler bar" just know that I am totally fine and having a better time that I thought I was yesterday. Those who dare, read on.



WARNING: THIS AND THE REST OF MY ENTRIES MIGHT NOT BE FOR THE FAINT OF STOMACH.



I was in the medical unit today, which is mostly long-temrm or paliative care for peple with HIV. I say mostly, and for the duration of this trip I think you should assume that patients have HIV less I say otherwise, it's so common in the hostpial. Endera was working wtih me, through somewhat reluctatnly. She had been working on this unit the day before, and had lost several patients during the day. We started the day just looking over the unit. There were only two nurses for the unit, which consisted of two rooms: one for women and one for men. The staff don't wear TB masks, though we do, which is a bone of contention between us (but I'm not going without it, even thorugh the windows are open). The rooms each ahve ten beds in them, and the men's side was full though the women had only three patianets. Of those three, only one was fully conscious. In the men's side, the look of the patient's was striking. At least five of the patient's were nothing but skin and bones (from AIDS related wasting or chexia), one was unconsious, one was both, and the man in the far corner was...well, he looked from a distance like he was completetly grey colored. When we got over to him, we saw that what we had thorugh was skin coloring was coming from the fact that every surface on his body was peeling. His entire body was sloughing off, and it was on the bed sheets and floor around him. One patient was delious to the point of having halluincations of pills that he mimed putting in a drawer, and thinking he was in a hotel and wanted to leave.


We started with one of the unconsious women, a patient that Endera had taken care of the day befoere. She had had a stroke while they were with her. Her pupils were unresponcive, and her NG tube was draining "coffee grounds" which indicates taht she had a bleed in ther GI tract, and Dr. Schivone was worried that her stroke was really a bleed into her brain. We talked to the DR about it and they also seemed slightly concerned. They said that they wanted to talk to the family to get a more complete history, and the nurse on the ward stated that "there is no family". The dr moved on after ordering an x-ray, and we were going to move on two when a man and a woman walked onto the unit. "Are you relatives of this woman?" Dr. schivone asked. Turns out it was her sister and brother, and they said that she had come to the hostpial several times for severe headaches. She'd been taking lots of pain medicine, and I wondered outloud if it might be an asprin type substance that she was taking. Dr. schivone as very proud that I had asked, but we didn't fine out (though we had the South African name of the drug, so we can look it up).

As Endera worked with this patient, Dr. Schivone and I moved to the other unconscious patient, who was having some drool issues. As I cleaned her up, DR. Schvone (hereby known as Deb, it's too hard to type her whole name), told me about her case (HepB, fluid in her abdomen, she'd be unconscious all day the day before). She ahd me paplate her abdomen to find her liver, but as I did so the woman's arms started mvoing down to protect her belly. Dr. schivone tried to keep them out of the way, but she got more and more agetated and finally openned her eyes. W tried to reassure her (and I stopped poking her) but it was actually kind of a good thing since she hadn't been awake for a while and now was speaking, even if we didn't understand her.

As we were telling the nurse about that patient, the nurse mentioned that she had found a pressure ulcer on the men's side, and asked if we would like to dress it. We were really excited, since this was a chance to do a proceedure that we'd be prepared for for a while, and headed over. The patient, David, had some paralysis and wasn't able ot help us move himself much (his ulcer was on the left side) when we got ready to move him, we saw that the sheets were soiled. Deb ran to get more, and endera and I talked to him a bit. We asked his name, his age, and I checked that he had uninated (and it wasn't drainage or stoll as well). He said yes, and that he was sorry. WE both told him not to be osrry, he was in hostpial, and I guess he was getting to like us because he started saying "it hurts" and showed us a penile ucler that looked painful. Just as Enera and I were showing that we had no idea what to do with that, Deb came and we told her about it. We cleaned him up, and rolled him over to the ulcer (it was stage three, and the skin was sheering off arund it where hte nurses would pull the sheet to mve him). WE told David that we would be back, moved him off that side, and took our info to the nurse. The nurse (a guy we didn't like very much) said that David never says when he needs his sheets changed, he just sits there without complaining. I wondered how ambarassed he must be that he needs that kind of help. They didn't know about the penile sore (he'd never shared it with them). I felt like, even in a short time, we'd made a different with this one patietn. Endera put a dressing on it, and he seemed more comfortable while we were there.

The last patient that I really took care of was the man with no skin. WE went over to check on him and found him shaking like a leaf, enough so his whole bedframe was moving. I got a termometer (glass) and put it under his arm, while the nurse covered him in blankets. His temp was 38.4 C, which is high, and we went to the nurse to get him a a\tylanol. As DR. shivone wehn to get it, I talked with him a little. I can't imagine how scary that must be, even DR. Shcivone ddn't know for sure what was going on. His chart stated that he had come in for an URI, and absolutly no mention was made in the nursing notes to the fact that all of his skin was falling off. It was abserd, the fact that this huge thing was happening to him and as far as the chart was concerned he was "bathed and comfortable". Finally, we got him some drugs, and he stopped shaking, but two hours later his temperature was still 38.8. We were leaving at that point, so I just reported off to the nurse. This was during visiting hours, so a woman was sitting with him. Several of the pts had felame visiters, and I looked at these womn and wondred if they were sisters, girlfriends, or wifes, and if when they looked at these men they saw where they wouldbe in some small amount of time.

My last adventure invovled taking a patient downt o x-ray. Th trip itself wasn't that exicing, except being able to talk ato the male nurse, and Benny (a priest in traiing who ehlps out in the wards) who are nice guys, and the x-ray tech, who was "so impressed' that i'd been able to say "hello" Zulu, but the patient when we moved him was nothing but skin and bone. It was so strange, like moving a man made of paper mache. I was afriad that his bones would come through his skin every time I touched him.

At the end of this long day, I had spent half of it "holding up the walls" as magie would ahve aid and the other half changing beds and doing other little things. I felt a little like I had been too hestitant, again, to interact with the patients, but Deb cought me on the way out and said that I ad done and good job and jumped right in. It was a great feeling to hear her say that, and made me excited to go back next week.

TOmorrow: SAFARI!

In which Alson makes two mistakes that she can remember, but still feels pretty good about her day.

Today I was in the Labor and Delivery ward that was run my midwives the midwife obstetrcis unit (or MOU for short). I went with the idea that I was just going to be obnoxious and follow people around, make them let me help, and basically just make a nusence of myself. Unlike in India, mifiery here is a three year degreee and they can (and do) deliver low-risk babys alone. The unit has six beds, and women in early labor sit in the waiting room until they are deemed ready to move to a bed. Mother's deliver and then are moved to the recovery room (with ten beds) for six hours. Then, assuming they and the baby are ok, they go home.

I started by learning all of the midwives names. They talked to me a little about their work, my schooling, and how I would have to go to school for six years to be midwife (the whole accelerated thing is hard to get their heads around...its easier to just say that I'm finishing my four-year degree). They were shocked. But, their two year "general" nursing has no rotations through clinical areas like peds and mentla health, just basic medical/surgical nursing. They then started going into the room of a woman who was moaning really loudly, and I noticied that she was laboring hard and her contractions were close togetehr. I let Cathine and Courtney (who were with me) know that she was close and we went in and hugged the wall while she gave birht. They don't do epidurals (or any pain meds) so it was a pretty nerve-rakcing things to watch. The nurse stuck her fingers into the vagina, and then positioned the scissors for a episotomy (the baby wasn't crowning yet) and cut very, very, slowly. The mother seemed almost out of it, but was able to push. The nurses kept telling her to push, even thorugh the strong contactions that she had been feeling seemed to ahve decreased. Finally, she pushed out a little girl, who was slightly blue but crying. The baby was taken away, and the mother layted back while her cut was stiched up.

At this moment, Dr. schivone came in. She a nice lady (a mental health nurse) and she is very good with patient's but some of the things she does make me alittle uncofortable. She went right in, stood next to the patient, and started speaking to her in very bight, happy English about the little girl that she ahd had, and what was she going to call her. The woman clearly didn't undertstand everythign that she was saying, and i couldn't help thinking about how I would feel if I had ust given birth with no meds and someone started speaking perky Frnech to me (it would not be pretty). I was probably jsut feeling very akward, and afraid of doing the wrong thing, which never seems to run arcoss her mind.

Dr. Schivone then went into the waiting room, sat right down next to a woman and started teaching about labor breathing. She looked at me and said "this woman needs a labor coach" so I sat down and chatted with her a little. The language barrier may not be as extereme as it is in Inida, but it was enought ot make conversation, strained to say the least. I was glad that Lunch came quickly.

After lunch at the cafeteria, we rutenred to find that a bus had dropped off four mothers, two who were in active labor and one who was screaming her head off. I took a gulp and went in with ehr, said hello and my name and started holding her hand and tlaking to her (luckily she spoke fairly good Englush). She alreaay had a daughter and was having a son, and was HIV postiive (50% of mothers are). I stayed wiht her off and on for the aftnoon, holding her hand, helping her get comofrable and sit up, and trying to support her (all mothers labor alone here, just like in Inida but with even less nurse support) Iwas told to leave her alone because she just wanted attention, but she semeed to be really scared. Her first child had been born at home, and she ahd never been to a hostpial before.

At one point, she said that she needed to use the bathroom, and I told the nurse, who told me to put in catheter. She came in, dumped some supplied on the table, and left. Putting in a catheter is a sterile proceedure, and in the uS everything comes in one kit that you open at the bedside. This colelction of gear on the table was unsettling, but I started to put things where I thought it would make sense and be sterile. I was doing well until I actually had to put it in, but I didn't aim correctly and unsterilized the whole thing. I knew I had to start over, and knew that I wasn't up for this. The woman was crying, and I felt awful. LIke a failure because i had not been able to put the catherer in, and like a I had failer her. I got the nurse, who put it in with reasonable sterile technique in about five seconds.

Just as I had managed to talk myself down from that one (I didn't know, it was so fidderent from the US, I didn't even have any lubriactation, ect) and realize that asking for help is somethime she best thing that you can do for a patient, I managed to make another mistake. The paitnet said that she wanted to sit up, so I got her up and held her there (she was really unsteady and tippy). She starteed trying to turn around (bad idea!) and said that she wanted her bag. Iwas afraid to leave her on the table, so I helped her down as I ran for the bag. She directed me to take out a white plastic bag, with some pills in it. I was looking at her as she popped on and started to take in, and I stopped her and told ehr that I had to check with the nurse. They were in her bag, so I assumed that they were pain pills or some other OTC medication, and I didn't want her to take anyhting that wasn't ok. I brugh tthem to the nurse who said "Oh, yes, she can take these, she's due" I asked what the pills were, and the nurse said "AZT".

Oh. I felt bad again, that she might be embarassed or anxious that she wouldn't get her medicaiton. I brought ti back with an I'm sorry, and a cup of water, and reazlied taht I wasn't totally off the mark. Never would a patient be able to take a medication in hostpial without the nurse checking on it first. I had done the right thing, given what I knew.

When time came for us to go, we all gathered by the van an reazlied that we had all had rough days. For Endera, two patient's had died in the medical unit. Jenn had done CPR for a baby that died in the NICU. And when we got back and were able to check internet I had bad news waiting for me. We allagreed that she didn't feel ike dinner out, and so had pata at the B and B and went to bed early.

More about Today Tomorrow.

In which Alison is NOT in India, but in South Africa

Well. This is different.



I'm in South Africa now for a program with my school, and promised that I would try to keep u p with blog stuff if possilbe. Now taht the internet is fixed, Ill get down to it. Same rules apply: no making fun of spelling mistakes, and this is as much for me as you so I tell it as I see it.

We arrived on Tuesday night, and walked into the Druban airport. That's where I met the Traditional stduents who are coming with us for the first time, Jill, Jenn and Endera. Jill had come from Rome (her family had spent x-mas there) and had sat in the airport for ten hours waiting for us. I can't belive she didn't do anyhting, but then again, she didn't really know anything about the area. They are all very nice. Jill is my roommate, and is bright and bubbly. She reminds me fo Kyla VEry much. Jenn is the model of the group (like Abeje) and is planning to work on neonatal intensive care. Indira was in one of my classes, but she was a little quiet but really sweet.

We all got into the huge white van, and Bob Norton (our teacher DR. Notron's husband) took off. The van was standard shift, and even through we had a GPS device we were soon lost. Dr. Notron had the GPS (Gertrude) in her hand, and was not able to turnon the sound. Finally, I got a hold of it and turned n her voice (all my expertice with E mily is paying off) and read the directions so we got easily...back to the airport! The GPS was trying to go home! We reset her and made it ot the hotel, while is unfortunatly on a hill on which the van stalle dout, but we got it going again. I can tell that Bob already hates the van.

We split up into rooms (I ended up begin the odd-second degree student out) and couldn't belive our luck. The rooms are lovely, with huge white fluffy beds, nice showers, lovely decour, and huge windows onto the garden. There's a pool and a lounge, and breakfast was going to be 7 the next morning. We were asleep right away.

The next morning we got up and had a wonderful breakfast, cooked by Emma our hostess. Eggs and tomato and mushrooms and all knids of good thigns. We went ot eh ospital, were we met with the cheif docotr and the nurse manaager who assigned up all exactly where we wanted to be. I will be working in the midwife labor unit and HIV treatment unit. I also volunteered to go out the first day on the mobile clinic. I was looking forward to seeing the counrtryside.

Yesterday, we got up saying that we neeeded to be at the hospital for the mobile clinic at 8:00am, so of course we didn't leave until 7:45 and were running in the gate at 8:05. Catherine and I ran to the front desk, where the lovely lady looked us up and down as I said, "wearegeorgetownstudentssupposedtogoontheMobileclinic" Her responce? "Yeeeees....they left you."

Well, shoot.


But, luckily, she took pity on us, finding a driver, Dennis (the menece) and have him drive us to where they were working. The drive was near the hostpial, up into the hills. We passed a "town" though I histate to call it taht since it had no center, nothing but a taxi stand (were people could catch the cab to Druban and Pinehill) and a meat shop made out of siding. We drove a little farther, and pulled into a clinic, in which the mobile unit was parked in the parking lot. Turns out the mobile clinic is less mobile than I would ahve throught, just going to local community clinics to do testing for HIV and CD4 counts. We were taken under the wing of Sister Doris (it's a little strange being around so many nuns) who runs the clinic. She sat us down in her office, and started seeing patients. It reminded me very much of Inida, except Sister Doris stopped in the midst of every patient to let us know what was happening, what was being said, and what she was going to tell the patient. This was really ehlpful, becuase so many of their stories had very little to do with why they were here.

A few patients stood out for their injuies: a woman with vaginal discharge (gross), a child with infected foot sores (really gross), a woman whose arm had been burned in a parafin cooking fire. But three stood out because of their stories. One man, who came in with penile discharge, was sent to the van for ain HIV test. He said that he had had a girlfriend who refused to use condoms, and had run off recently. I think there might have been more to this story (we talking in our HIV class about how common it is for men to have multiple partner ehre, and how NOT using a condom is a sign of trust and indicates that you are the "main" woman, so some women don't want to sue comdoms so they move up in the pecking oder. I ahve no idea if that was at play here, but it was an interesting thought). but he had a really nice demenor, just really friendly and jokey about his past, even in front of the strange white girls. It made us feel like "all verterns together" as if he expected us to be on his side. But, after he went to the van, one of the workers from the testing came back saying taht he had just tested postiive. He said that it was "just good to know", but I couldn't imagine the impact of this on his life. Another patient already knew that she was postive, but her husband didn't know. She didn't want to go out of the van to get her CD4 test done, so we had to do it in the office, and then she was terrified that her husband would know that she'd had something done because of the pin-prick. She started pumping her arm fast, probably to get rid of the mark, but that just made blood gush from the puncture. The last patient was a seven year old (who looked more like she was 5 years old0 who had a vaginal dicharge and Sister suspected that she had been abused. She denied it, but it was still such an upsetting thought. She was so tiny, and with erh fine features and short hair she looked just like an elf.

The clinic closed up early because of the holiday (New Years Eve) and we headed back to the clinic for the afternoon. We stopped at the cafeteria for lunch (the caf is great, a huge plate of hot, homemade food for less than two dollars) and chatted with Dr. Nortons husband, who was also at loose ends. After we finished our lunch, I wanted to go for a walk around the compound (I was feeling a little claustrophbic) but Catherine (who is a muhc better person than I) said..."Oh, what can we do? We'll stock stock-rooms!" Luckily, Dr. Schivone asked us to come with her to Peds. It was a rather frustrating experience, but it a good, growing way. I just felt so...not sure what to do with myself. At first, Dr. Schivone handed me a stack of papers and told me to file them in the patient's charts (which are at teh ends of their beds, old school style). I though, ok, I can do this. UNfortunatly, three of the patient's we'rent there anymore and one was mis=labeled. Having failed to complete that task (though I did as much as I could) I was set losose in the main room with children in it. While Dr. Schivone always had something to do, I was unsure of how to start. The kids were of all ages, from infants to ten year-olds. Some had HIV complications, some had burns, some were there for other things. Finally, I helped Mustafa play the hand-clap game wiht the kids, and then set them up coloring. We finally left just as I was learning words for animals in Zulu. I can now say "Hello", "I'm fine", "whats your name?", "fish", "dog" and "I'm ALison".

After we finished at the hostpial, we headed back for our new-years party. We showered, got dressed up, and went down to Caitlin and Catherine's room for a little champange. Then, we all piled into the van (with Gertrude the GPS device) and went into the city for dinner. The restaruant we went to was right on the Indian ocean, and there was a drumming group and fire-works over the water. We had our first South African wine, and had a wonderful time. Dr. Norton's husband (Bob) told the story of how they met on New Years Eve when they were in High School (they had each taken other blind dates to a party) and it was very sweet.

After dinner, we came back and watch the countdown on TV. The tradtiional students wanted to watch a concert, and it made all of us feel very, very old to keep saying "Who;s that singer?".

I went to bed shortly aftermidnight. More about today, tomorrow!