Friday, November 12, 2010

Nothing is as it seems...

Placement is going well... To be honest, my first week was a bit more than frustrating. I came into this trip ascribing to the rule of “no expectations”. In my travels throughout the states I’ve learned that no advertisement, review, or anecdotal bit of info from friends could truly prepare me for my endeavors.

Rare is the trip that goes as planned; like the trip home from Chapel Hill NC that somehow turned into an 11 hour long fiasco, the camping grounds in Assateague a girlfriend told me were immaculate and lush (but looked more to me like an open litrene in a pile of dirt and sand, surrounded by a small patch of dogwoods), or on the brighter side…a “primitive” camping spot with pristine bathroom facilities, wheelbarrows for luggage, and an outside sink (complete with soap and sponges) for washing dishes. In light of this, I assumed it would be prudent to not take anything I heard about India, especially Delhi, as gospel.

Truly…No travel guide, blog, or bit of advice could have prepared me for the smell, sights or sounds of Delhi. Some amazing… some appalling.

But, for some reason, I had allowed myself to create an image of what I’d expected Mother Teresa’s to be. I’d expected to find the dying and destitute, yes… But I’d also expected to see modern, but maybe expired, medical supplies, actual nurses doing actual nursing care, and (most foolish of all) documentation on the residents at MTDD. After all, Mother Teresa’s homes are a “beacon of light”, providing not only shelter but wholesome food and medical care for all their residents (according to website details), right?

Well… yes and no. What I saw upon arrival was shocking to me, As one who has been fortunate enough to have worked in a variety of well managed care homes as well as one of the US’s top private psychiatric hospital, I was shocked by several things I saw upon my arrival: 90 residents to 1 nurse/Sister. Residents delivering medications from the Sister to other residents… sometimes correctly, but often incorrectly. Meds being given without water at times. No concern being given to med interactions or indications. For example the fact that the majority of residents are on meds that should not mix, or very high doses of medication, finding that many residents who should avoid direct sun due to med. interactions are lying on the concrete floor of the outside patio for several hours a day. Residents who are lower functioning, limbs contracted and sitting in their own urine, missing the noon meal because the other residents and workers missed that she had not received a plate of rice and dhal. Wound care that could hardly pass as clean, let alone sterile. Maggots in wounds (yes, I’ve overcome that aversion... after picking several out of a new admissions wound that was festering with what smelled like pseudomonas).

But apparently much better than most facilities for the elderly and indigent in the area. I have to remind myself I’m not in Maryland, where modern medical supplies are readily available, patient ratios (while ofter still absurd) or nowhere close to 1-to-90, and so on. Most reassuring of all is the way the sisters have slowly but surely warmed up to we strangers, and integrating some of our concerns in a revised version of their practice.

The residents on the women’s hall are mostly destitute psychiatric patients, women who have been abandoned following a divorce or serious medical illness, and a handful of young women who were placed at MT’s orphanages due to physical disabilities. Very few seem to be elderly, but they are certainly destitute. Some of the women heal from their illnesses, such as TB or acute mental breakdown, and become helpers to the less functional residents. There are sisters, on both the men’sand women’s wards who are trained nurses. They provide general supervision of the goings ons of the hall, oversee med administration, provide infusions and other medical treatments when needed, and (of course!) pray. A lot. This is important because someone’s gotta pray for all these folks. And pray they do. If you know me, you know I can be a bit critical of religious zealotry, and personally choose to seek out non-religiously affiliated charities to support with my money and time. At times I get irked that no Sister is on the hall to look after the residents…but I will also try very hard to respect the dedication it takes to become a nun, a nurse, and a caregiver of 90 patients, and understand that those meditative moments of prayer are just as important as anything else in their care routine.

Over the last few days, I must point out, you have to hand it to the Sisters and their helpers. They have heard our concerns for the most part, and are responding to them in their own good time. Extra care has been given to be sure that everyone gets a meal. Meds have been given with the oversight of one to three sisters at a time; with attention being given to make sure “pani” (water) is conveniently available with med administration. The wounds we dress are looking amazingly good now. That one wound I mentioned with the maggots and stinky infection? No longer rank, and no longer infested… but even better: the tissue is even granulating now and the wound edges are inching their way inward!

It’s not in my official duties at MTDD to complete assessments on the residents or report off to Sister if I see anything concerning. Instead I am to play with the residents, get them involved in physical activity, and encourage them to participate in group activities. That does not mean that I am not using my nursing skills during every minute of my day.

Take painting the ladies’ nails and applying lotion to their skin, a favorite activity of most everyone on the ward, for example. As I paint their nails I’m assessing the whole time: are the nail beds pale or pink, how’s capillary refill? Are they verbal or non verbal? If they are verbal: do they speak English or Hindi (or something else? In which case I ask to find out if those are real words or gibberish). How does their breath smell, how do their teeth and tongue look? If they don’t talk: are they social or withdrawn (or possibly not yet trusting of me)? How do their eyes look: are they red with irritation, clouded with cataracts, or bright and responsive? As I apply lotion to their scaly dry legs (which a lot of women have due to their chores of washing floors, laundry and subsequent naps in the blasting sun of the open yard): how’s skin turgor, hydration status, pedal and radial pulses? Are their limbs cool or warm? Do they have any sores? Are the limber or contracted? The list goes on and on and on...

I’m interacting with the residents, giving them much needed attention and affection, building deep bonds with those who require some extra special care, and using my nursing skills, AND LOVING IT… despite any cynicism I might have about religion or (quite specifically) charities of the catholic church.

This gives me a lot of hope for the rest of my five weeks.

I hope to see more wounds heal, and more names get crossed off of my wound clinic list. I hope to find more residents who had previously been left out at meals eating full plates. I hope to see more withdrawn residents come out of their shell…

And I hope to come home to the states a better nurse: more knowledgeable about wound care, more keen at assessment, and more tolerant and understanding of other faiths and cultures.



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