Operation Malawi: Part 3

In August/September I went on a 3 week mission trip to Malawi Africa, this is an account of my trip from week 3! 

Sunday, September 8:  Today we went on a safari drive, it was really fun.  We saw impala, water buck, hippos, crocodiles, elephants and other animals that I can’t remember what they were called. 

Monday, September 9:  Today was a good day.  I went in to the ICU to check on our patient that we had extubated on Friday to see how he was coming along.  He is looking amazing!  He is only requiring a couple of liters of oxygen now and he is talking, eating and smiling.  Dr. Priester is saying that tomorrow he should move out to the general ward.  She also asked me about some stuff for airway clearance.  I had brought a couple of Acapella's and Cornet's with me.  So I showed him how to use the Acapella device and instructed the nurses on how to do it with him as well.  I also told them how it worked and had them feel his chest as he did it so they could feel the vibration.  Another thing that happened with him today that was very encouraging is that the physio-therapist came by and got him up and walked the unit with him.  It was great to see him up and walking and to know that just last week he was so close to death.  Other than that, today I just attended the classes that the Loma Linda team was putting on.  There was a couple that was teaching BLS to the nursing staff and another couple that were teaching ACLS to the physicians.  I attended and chimed in and helped out where possible.  Then, tonight for dinner one of the surgeons invited everybody over to his place for dinner.  We all had a good time hanging around and fellowshipping.

Tuesday and Wednesday, September 10 and 11:  These past two days were pretty much carbon copies of each other.  Tuesday, yesterday, my friend that was in the ICU got moved out to the general ward.  He is looking great.  Every time I stop in to visit him and see how he is doing he credits me with saving his life.  I have to remind him that it wasn't me, that it was a team effort between the doctor, nurses and myself.  But I ultimately give the credit to God for saving his life; but since he is Hindu, I don't know how much of that he comprehends.  Other than checking on him, primarily just helped the Loma Linda team out with there classes.  I helped with the ACLS class most of the time, giving a non-physician perspective to running a code, teaching compressing and bagging technique as well as timing.  They really didn't need my help, they were doing a great job.  But it was something to do.  I also helped out another resident that was kinda on her own teaching BLS to the nurses.  I think she actually appreciated the help.  It is difficult to teach that stuff on your own while doing demonstrations and having them practice.  She is also a first year resident, so she has just learned this stuff herself, now having to teach it without having much experience with it.  I would feel slightly overwhelmed.  Later she told me that the most difficult part was that she realized that even though she was talking in generalities and simple terms for medicine, it was still over some of their heads.  She felt like she was building on nothing and didn't have time to go through and lay a foundation.  Though, she did the best she could, which was really very good.

Thursday, September 12: Today Dr. Stokes (the first year Loma Linda resident) and I went with Dr. Saunders to Malamulo Mission Hospital. Once a week either Dr. Saunders or Dr. Priester will go out to Malamulo and round on patients.  Malamulo only has a couple of physicians, it is mostly staffed by our equivalent to a physician assistant.  Though they frequently have residents come through for a rotation to help out and gain experience.  The staffing here is horrific by our standards, one nurse could have an entire ward of 60+ patients.  Though, they are doing a phenominal work taking care of these patients as best they can.  The reason for this, unfortunately, is because they serve a much poorer patient base.  They receive referrals from rural Malawi and Mozambique.  The grounds were very impressive and beautiful.  It looked like an old Spanish mission except it was made of brick.  My role there was to educate the nurses on oxygen therapy and airway clearance.  The nurse matron got all of the nurses together and I started my talk and five minutes later everyone was gone except the physio-therapist.  I can kinda understand their disappearing, though, because if its just them with a ton of patients, they need to get back to them.  The physio-therapist was a very pleasant young lady from Brazil and she was eager to learn.  So I went over with her the different oxygen delivery devices and when to use each one.  I also taught her proper technique for postural drainage and percussion (chest physio-therapy).  The hope was for her to be able to take her knowledge and pass it on the the nurses.  After that, she took me on a tour of the grounds and told me about everything that they do there and how the hospital is run.  After the tour she had to get back to work so I rejoined Dr. Saunders and Dr. Stokes as they were finishing up their rounds in the general ward.  After rounding the wife of one of the surgeons hosted us for lunch and we then went back to Blantyre for the rest of the day.  We took a detour on the way back, though, we went through one of the tea farms to view the tea fields.  It was very pretty.  When we got back I had to get ready to teach another class for the nursing staff, this one on trach care.  Our pediatric trach patient came in for me to demonstrate on, the only problem was that he was late...very late.  So I had to find ways to talk and fill in dead space without sounding like a broken record while waiting on him to arrive.  I ended up drawing on the white board and making lists.  This was the most interested I have seen them become in a topic during a training session, though, so that was good.  Finally he arrived and I got to demonstrate on him.  Overall, today was a good day.

Friday, September 13:  Last night around 2200 I got a call from Dr. Priester asking me to come into the hospital, they had just intubated someone.  Walking up to the hospital I see a huge crowd of people that I had to wade through to get inside.  When I finally make it to the ICU I talk to Dr. Priester and get the story behind this patient.  This one was a mother who was in her mid to late 30's with a history of uncontrolled hypertension.  They had to send her out for a CT scan earlier that day due to an acute change in mental status, turns out she had stroked.  After talking with Dr. Priester I go over and look at the ventilator, make a couple of adjustments and start talking to the Dr. Stokes and showing her some things on it,  then the patient's family physician comes in and starts asking me questions.  He was asking me my role, asking if I was a physician, what meds we had her on, why we were treating her the way we were.  I had to keep repeating to him that I didn't do that stuff, all I did was manage her ventilator and treat her lungs.  I was not a physician.  Then he started yelling at me because we had her on some sedation saying that it was contraindicated due to her stroke...well she was also having seizures and we had to treat that as well.  I finally said that I didn't know and instructed him to talk to somebody else.  Today when I went in she was hyperventilating and putting out fluid faster than we can put it back in her.  They had to put in a third I.V. and start pushing fluids through that one as well.  Through out the day she remained around three liters negative.  After pushing our twelfth liter, Shymol and I were brainstorming trying to think up anything that may help. The only think we could come up with was to ask Dr. Priester if we could switch to lactated ringers in hopes of putting something in that would help her retain some fluid.  She answered that we should have done that a while ago, but we didn't have an order for it.  So they made the switch.  Then I was asked to go do some asthma teaching in the Emergency department.  So I went over there and did some instruction with the nurses on emergency management of asthma, the hospital course of an asthmatic, the physiology, pathology and pharmacology of asthmatics.  I also showed them how to use a spacer.  They were very receptive to it and asked lots of questions, which was very encouraging.  The rest of the day I just sat in the ICU with the vent patient. 

Saturday, September 14:  Last night around 2100 I got another call from Dr. Priester asking me to go in a check on the patient.  She had just gotten a call that the patient wasn't maintaining her sats.  She just wanted me to go in and check to make sure it wasn't something simple that they weren't doing like suctioning while she was on her way in.  When got there her sats were in the 80's, her heart and respiratory rates were very fast.  I took a listen to her and she sounded good and her pressures on her vent were good as well.  So she didn't need suctioned, plus they had just suctioned her right before I got there.  So I turned her oxygen up a little bit and also bumped her PEEP up a little as well.  When Dr. Priester got there I informed her what was going on, what I did and that I felt it was all neurological.  She agreed and said that she was going to stay the night there since she knew that she was going to be getting called frequently.   I went in this morning to check on her and the ICU was locked up and dark.  She didn't make it through the night.  We figured that she wouldn't.  Now her husband is left alone with their child.  Her husband was the typical grieving spouse through all of this, I saw him going between anger and denial frequently, asking how, why and then blaming the hospital or her road trip for the CT scan.  It was very sad to witness, but Dr. Priester dealt with him very well and very professionally.

Anyways, today is the day I start my flight time!  After saying goodbye to my fellow housemate, Jewel, and her leaving for church, I sat and waited for a driver to come pick me up and take me to the airport.  It ended up being the same driver that picked me up from the airport three weeks ago, how funny is that!  On the flight to Addis Ababa I sat with two people from England, I couldn't make out what she did, but the man is a pediatric nurse and he was in Blantyre volunteering at the government hospital.  So we shared stories and experiences.  It was nice talking to them and sharing stories from our homes as well.  Ahh, I cannot wait to land in Ohio and see my wife and daughter.  It has been way to long...tomorrow!

Operation Malawi: Part 2

Operation Malawi part 2

Monday, September 2: 

 I need to begin this by starting with last night.  Last night around 2200 I got a call from Shymol stating that there was a vent in the ICU now, asking if I would come in.  So I said sure, I’ll be there as soon as I can.  So I go in and take a look at the ventilator and all the settings were good (Dr. Saunders and I had already discussed initial vent setting and such).  I talked to him about the plan and the history (patient had been drinking a little too much, vomited, and developed aspiration pneumonia) of the pt and everything looked good for now, so I went back to where I was staying.  This morning I went in and the pt was doing OK at best.  Oxygenation was good.  But we were still suctioning out a lot of secretions.  He was also sounding very tight and wheezy, I would have sworn that he smoked but family kept denying that he smoked.  We got a gas and it showed metabolic acidosis with partial respiratory compensation.  So Dr. Saunders and I talked and decided to start him on Salbutomol and Methylprednisolone.   The question was how were we going to give the Salbutomol?  I couldn't find any t-piece adaptors for a nebulizer.  I did, however find an in-line spacer.  So I taught them how to give an MDI in-line with the ventilator.  I also got to go more in depth in the ventilator education with the nursing staff.  Now they could see the ventilator working on a patient and put together the settings with what they mean.  Now they could see how they affect the patient.  I was able to see a lot of light bulbs turning on and that was AWESOME.  I also worked with them on suctioning technique (bizzing the patient to loosen up secretions) and started teaching them breath sounds and how to properly listen to the patient.  I stressed to them the importance of securing the ETT when repositioning the patient and suctioning.  Though something that did drive me nuts, and I didn't say anything to them about it because there really isn't anything that they can do about it, is that they don't practice sterile suctioning and they re-use the same catheters.  The reason for this is due to cost and to preserve equipment.  So I didn't even bother trying to fight that fight.

Tuesday and Wednesday, September 3-4:  

These three days were pretty much spent all doing the same thing.  I was sitting in the ICU helping to take care of the ventilator patient.  I kept going over with the nursing staff about listening the breath sounds, taught them how to do ventilator checks on a flow-sheet that goes in the chart (they actually already had one, they were just inconsistent with it because they didn’t know what it was for and what they were writing down), suctioning and care of and minding the ETT.  It was amazing seeing the information click in their heads.  I also had them teach each other, every time a new shift would come in I had the old shift teach them.  It was awesome seeing the info click and seeing them share it with their co-workers.  I also spent this time teaching the nursing staff about non-invasive ventilation.  The ventilators that they have actually have non-invasive mode on it, and I was asked to try and figure out how to use it and teach them how to use it.  They had been having problems with patient comfort and synchrony.  So I figured that out for them and taught the nursing staff how to use it and how to care for a patient on non-invasive ventilation.  I even made them all put the mask on and discover how it feels to be placed on non-invasive so that they could understand how the patient feels and why they may fight it.  The only issue I was having is that for some reason the machine kept cycling itself when it shouldn’t have been.  I will have to work on that some more to figure out what was going on there.  On Wednesday, September 4, a team from Loma Linda University Medical Center’s Emergency Department arrived, though nobody got the meet them till Thursday.

Thursday, September 5:  

Today, the morning went pretty much like the rest of the week did.  Went to the ICU to and helped to take care of the vent patient.  He is coming along very well and I am having a blast taking care of him and teaching the nursing staff to take better care of him.  I also got to meet the team from Loma Linda, they seem very nice.  Anyways, this morning when I went in the patient was on CPAP, Dr. Saunders just wanted to see how well he would do.  He seemed to do pretty good and we kept him on it most of the morning.  In the afternoon I was asked to do another CPD class.  This one was on trach care.  They had asked the trach patient to come in special just for this class so that I could teach the nursing staff how to do trach care and what special precautions are needed when taking care of a patient with a trach.  The issue here was that my demo patient was late in arriving so I had to kill time talking and trying to get them to ask questions.  I even resorted drawing a neck on the white board and demonstrating trach care on the white board.  But my patient finally arrived and we got it done.  It was awesome being able to see things click with them.  Right before the CPD, though, Shymol and I were called to the ED to help take care of a critical patient that had arrived from an outside clinic.  We arrived to a patient that was unresponsive doing Biot’s respirations.  He was just responsive enough to take the oral airway out and occasionally pulling on the NRB mask.  They kept trying to put the oral airway back in, finally I was able to convince them not to.  It was obvious that he still had a patent airway and didn’t need it, plus if he kept pulling it out that means that he may still have a gag reflex.  So I ran to get a nasal trumpet and put it in to make everyone feel better.  He was so clamped down, though, that we couldn’t get a SpO2 reading on him anywhere and it was very difficult to get a peripheral pulse and blood pressure on him.  When I got done with the CPD we went back to the ICU and the stroke patient was in there with the Loma Linda team working on him.  I was talking to Dr. Saunders and he told me that normally in this case they would just provide palliative care and let the patient pass.  There was really nothing they could do for him, didn’t have the right supplies/equipment or the knowledge to take care of his condition.  The CT scanner was down so they couldn’t do a scan to find out if it was hemorrhagic or a clot.  Plus the patient was HIV+, not that it makes a difference, but that means that the patient likely had other issues going on as well.  Though they were letting the residents from Loma Linda do what they could for him just for the experience and so they could say they tried to save him.  Anyways, they were trying to put a central line in him.  It took them a long time, but they did finally get one in him.  The entire time, every time they would get it, it would immediately clot off.  It was no wonder he stroked out. 

Friday, September 6:  

Today I arrived in the ICU to see that our stroke patient had passed in the night.  It was expected.  The vent patient that we had been taking care of all week was on CPAP/PS again, and doing amazingly.  I started experimenting with the vent and looking at how it did respiratory mechanics to get weaning parameters.  This vent is able to do the RSBI, VC and NIF.  Though it had a little quirk that the only way it would calculate the RSBI was to turn off the pressure support and leave the patient on CPAP without any pressure support.  I didn’t really care for that, but I did it just to see how well he would do.  He actually tolerated it for a while.  Then he started to putter out and started to breathe fast and shallow.  So I put the pressure support back on.  That helped a little bit, but not enough.  So we started to suction, and he was rather difficult to bag and we weren’t able to pass the suction catheter.  We had to bizz (they were still having a difficult time grasping that concept) and he ended up hacking a big ole mucous plug into the bag.  It was AWESOME!  After that we suctioned him out a little bit more then let him rest for a few more hours.  At this point in time I was getting nervous, and I think Shymol was getting nervous as well.  I was getting nervous because I felt that my credibility with the nursing staff and physicians was on the line.  Shymol was nervous because her reputation and the reputation of the hospital was on the line with the community that this patient was a part of (they don’t trust the hospital and the care provided, even though it is the best hospital in the country.  Being from India, they were used to first world care).  Later that afternoon we decided to risk it and extubate him.  Turns out there was a huge dried mucous plug at the bend of the tube that causing him his problems.  Shymol was getting on the nurses pointing it out to them saying that this was why they needed to suction and why suctioning was important.  Placed the patient on a mask initially and quickly weaned him down to a cannula.  I don’t know much about what the Loma Linda team was doing today, other than teaching BLS classes to the nursing staff.  I was able to attend a little bit of one of the classes.  They were doing a good job.

Sabbath, September 7:  

Went to church today.  But after church there was a huge gathering at one of the physician’s houses.  The pediatrician, Dr. Varona, invited a lot of people, new people old people, birthday people, pretty much everybody, over to her house for Sabbath Potluck.  Also today Dr. Priester returned from South Africa where she was attending at continuing ed conference the past week and a half.  It was fun eating good food (not hospital food) and fellow-shipping with everyone. 

Week Recap:  This week was much better.  I felt like I was finally doing what I was there to do: teach and help take care of patients.  I had fun this week doing what I love to do.  I really do need to thank and God for helping me get through the slump I was feeling during the first week and Jewel for putting up with me and helping me through that first week.  I also need to thank Shymol for helping me into this week and helping to instill confidence into her nursing staff so that would trust me.

Operation Malawi: Part 1

First I want to apologize for taking so long on getting these up.  Please hang in there with me as I try to find time to go through these and get them posted.  Thanks!

Following are my daily thoughts on the first week I spent in Malawi.  As you will tell, it was kind of an emotional roller coaster of a week.  This was due to several reasons, culture shock, missing my family, lack of confidence in myself and lack of faith in God, uncertainty and hitting the "wall."

Monday, August 26: I just arrived in Blantyre, Malawi.  Going through customs was easier than I thought it would be.  They just asked me what I was here for, where I was going and if I had anything to declare.  That was pretty much it.  Fortunately there was a driver waiting for me in front of the airport.  So we hop in the truck and he drives me to the hospital.  I knew to expect it, but I was a little thrown off by them driving on the “wrong” side of the road, and they really don’t pay that much attention to traffic laws, if there are any at all.  So I arrive at the hospital and from there I am handed over to a young American lady named Jewel.  She has been one of my e-mail contacts.  Fortunately from there they just let me rest and relax and get cleaned up from the long trip over.

Tuesday, August 27:  Today was kind of the orientation day. Went to morning worship and was introduced during the announcement section.  Fortunately they didn’t ask me to make any big speech, like I was warned that they might.  Then from there I was shown around the hospital and the outpatient department.  The general floor is comprised of just a bunch of wards.  There is a pediatric ward, labor and delivery ward, maternity ward, post natal ward, a nursery (comprised of two isolettes, one radiant warmer and I saw what I thought one old bubble cpap machine, turns out it was just a blow-by for humidified oxygen), then a few med/surge wards.  There is also an ICU, which looks much more advanced than the rest of the hospital.  One of the doctors, a pediatrician, didn’t waste any time taking advantage of my presence.  She immediately called me in to talk about an asthmatic, she wanted to me to do a water bottle “spacer” instruction with this boy and his family (turned out they already had one).  She then wanted to go over another child with me that presented like CF, but everything kept coming back negative and she asked me to do pulmonary toilette training with the mother.  Then I start getting a list of everything that they want me to teach the nursing staff and physicians while I am here.  Now I am starting to feel very overwhelmed and worry that I am not going to be able to meet their expectations.  I still have that fear, another fear that I have is that they don’t have the proper equipment do what they want me to teach.  For instance they want me to teach NICU stuff, I am not a NICU therapist, yet, so I don’t have that skill.  How am I supposed to teach something that I don’t know?  Then I look at the equipment and it is so archaic that I don’t even know how to use it.  Then in the ICU looking at their equipment drawers, they don’t even know what they have and if it can be used.  But they make do with what they have.  So needless to say, I am very nervous and am wondering what I got myself into here.  I just hope and pray that the Lord will bless and use me.  Because I know that I can’t do this without Him.  I am really missing my family right now…Happy anniversary deary!

Wednesday, August 28:  Today, so far, has been a mixed day.  This morning I was sent to the ICU, which doesn’t have any patients right now, with no instructions.  So I took it upon myself to start organizing some of their respiratory equipment.  One of the problems that they are having is also a blessing.  They rely primarily on donations for equipment.  They had a lot of equipment that they can’t even use.  So we (the ICU nurse manager came in and helped also) went through and took out what they couldn’t use and organized what they could.  Yesterday I was able to figure out a way to make their ventilator (Respironics Esprit) work as a CPAP/BiPAP as well.  So that helped to weed out the types of circuits that they could and couldn't use.  Then I was called to meet a pediatric patient that had come in for an outpatient visit.  He was trached (I was rather surprised to hear that they had a living trach patient here) and was feeling very self conscious and his family was worried that it was permanent.  Being that I was used to be trached they thought that it would be a good idea for me to meet him and give his family hope.  They also wanted me to go over trach care with the family.  The family was so grateful to see that I was trached and am now without the trach and doing very well.  Grandma (primary care giver) stated that I gave her hope. The plan was to do an surgery on this boys airway to remove some polyps that grew rapidly in it, then from there start weaning his trach to decannulate him. 

From there I just kind of wondered around exploring the grounds, trying to figure out how to get to certain places, trying to keep from getting bored.  When I finally found the ICU nurse manager again I asked her if there was anything else I could do for her.  She called in her staff that was working today and had me give a brief in-service on ventilator management and care of the ventilated patient.  That was fun and I really enjoyed it.  Tomorrow they want me to teach oxygen therapy and trach care.  They say that they have blocked out 2.5 hours for this, I don’t know if I can take up that much time, but we shall see.  Maybe they’ll ask a bunch of questions.  Still missing my family, A LOT.  Wishing I hadn’t taken so much time.  I believe I could have crammed in what they want in a much smaller amount of time.  Oh well, God will bless.  I’m praying that he will guide me to be the most service to these people.

Thursday, August 29:  Today seemed to go better.  Right after morning worship, the ICU nurse manager and I went to the ED to do some BLS instruction (Loma Linda is sending an ED team to go over ACLS in detail next week).  That actually took up about two hours, I think.  We went over how to do proper compressions, bagging and defibrillator use.  We touched a little on ACLS as well since we also included the advanced airway and the defibrillator was not an AED.  We had a manikin that they could bag, but they couldn’t practice compressions on him as it was designed for airway training.  So we had them practice compressions on a pillow with a backboard under it.  Then in the afternoon we had a CPD (don’t know what it stands for, but it is essentially an in-service, or continuing ed class).  There was a lady there that taught an EKG class.  She basically went over the parts and meanings of the different parts of the EKG’s.  Then they had me give a talk on oxygen therapy.  So I went over the different oxygen delivery devices that they had (nasal cannula, simple mask, non-rebreather mask and they had just gotten some venturi masks as well).  I also told them how to use them properly and how to titrate up and down.

From there I went grocery shopping.  That was definitely an experience.  The store really wasn’t all that different from a grocery store in the States, it was the prices.  It was difficult to judge how much money I needed.  Thankfully the store was able to take Visa.  Over all, today was a very good and productive day.

Friday August 30:  Today I found out that the ICU nurse manager (from here on out I am going to use her name, Shymol) had today off.  So I was a little nervous, as she was the one that has been taking the responsibility to organize and get times for me to educate the nursing staff.  But the ED charge nurse (Tina) stated that we were going to just do another BLS teach with the ED nurses and OPD (Out Patient Department) nurses.  So we went over the same thing we did yesterday with another group of nurses.  It was still fun.  This time I decided to also go over how to insert an oral airway.  I decided after thinking about yesterday’s session that it would be important for them to learn as well.  It is really quite interesting.  Some of their equipment is very nice, such as their laryngoscopes and blades, and their ventilators are decent, but other equipment is extremely archaic, like their defibrillators and infant bubble CPAP machine.  I guess that’s what you have to do in a third world country, you work with what is being donated to you.  Anyways, after that I asked Tina if there were any other nurses or education she wanted me to do.  She said no, that they only work a half day on Friday and that I was pretty much done the rest of the day.

So from there I went around twiddling my thumbs until my roomy, Jewel, asked if I would be willing to go to their their NICU/Peds respiratory equipment.  So I jumped on the opportunity for something to do.  So I went through all their equipment, attempted to organize it and weed out some stuff that would be useless.  I also went through their emergency (Code) boxes and made sure that the right respiratory equipment was in those.  That was fun and took up some time.  From there I just went out to the nurses desk and talked to Jewel, some.  She told me about a miracle that had happened with a micro preemie that was born there and by the grace of God survived and is still alive to this day.  The baby was born at 28 weeks was taken care of at that hospital and was released to go home six weeks later.  That is virtually unheard of!  The baby is still doing well and thriving today.  PRAISE GOD! 

Sabbath, August 31:  Today was a true blessing.  I love the Sabbath!  I got to sleep in (hurrah!) and then got up to go to church.  Though, I was slightly disappointed in the church service.  I was kind of expecting it to be different, but it was pretty much the same type of service that we would have back in the States.  Oh well.  After the church service I was invited for Sabbath lunch to a couple that were in Africa as Maranatha (if you get a chance check out www.maranatha.org) workers.  They go around with teams and build one day churches, schools, hospitals, and drill wells for water.  It was amazing to hear their stories and how God is working through them to spread the message of the gospel around Africa.  They cannot keep up with the demand for churches!  It was truly uplifting and encouraging to hear them talk.  If God has in His plan for me to come back to Africa to work, I would like to do it with Maranatha, if it is in His will.  Thank you Lord for such an uplifting and encouraging Sabbath!

If you missed my intro post on my trip to Malawi Africa, you can read it here. 

Operation Malawi: Preface

(Photo from timcooke.com)

As I am typing this out, I am sitting at a table in a guest house in Malawi.  What am I doing in Malawi?  Well I have volunteered to come over and work in a hospital for three weeks.  First I will give you some background information.

For a long time now I have been looking for an opportunity to utilize my skills as a Respiratory Care Professional in the mission field.  Most mission agencies are only looking for physicians or nurses, figuring the respiratory issues can be handled by those two groups.  I happened to come across an agency within my church (Adventist Health International) and sent them an e-mail asking if I would be of use to them.  They said that I could and that they have a hospital in Malawi that could use my skills and was looking for a Respiratory Therapist.  So I started e-mailing back and forth with them, and so, here I am. 

It was definitely a God thing that I was even able to get out here.  When I initially put in for the time off from my employer, the director called me into her office and stating that she didn’t want to discourage me from doing activities like this, but that she didn’t believe I would have the PTO time to take off for such a long trip (I am a newer employee and was also taking a week off in June for vacation).  I did the math and was accruing a little bit more PTO per pay period than she thought I was and I would have just enough to take the three weeks off for this tip, even with the week vacation in June!  I was very excited to inform her of that and she stated that since I have the hours, they would be willing to work with me!  PTL!!!

The way I figured that this would probably work best would to post once a week and each post divided into daily sections, or reflections on each day.  That way you won’t get bombarded by posts.  Though just for an FYI, these posts are delayed for when I get back (mainly just for the protection of my family).

Stats about Malawi

Here are just a few statistics about Malawi that I had heard when I got out here:  Malawi is the ninth poorest nation in the world.  Malawians have the SLOWEST walking pace in the world.  This one is definitely true.  Malawians have no sense of urgency at all.  They move at their own time and pace.  Malawi has the most expensive cell phone plans in the world.

The Flight

Needless to say the flight was a very LOOOOONNNNNNGGGGG one.  But I already saw God working while flying out here.  I flew from my home airport to Washington D.C. then to Addis Ababa, Ethiopia, then on to Blantyre, Malawi, through Lilongwe, Malawi.  The flight from D.C. to Addis Ababa was a long 13 hours, but God was good.  It was a Boeing 777 and I had a window seat, there was an older lady that had some mobility difficulties in the aisle seat.  Naturally on a flight that long my biggest concern is developing a DVT, and if she’s not able to get up much, I’m not going to be able to get up and walk around.  We were blessed, however, that there was nobody sitting in the middle seat between us so I was able to stretch out my legs and do heal pumps, kicks and other things to try and keep the blood flowing.  And, of course, whenever she got up to use the restroom, I got up as well.  So it all worked out and I was able to get to Malawi safely.

Day Shift vs. Night Shift

Working in healthcare there are many discussions as to which shift people would prefer to work.  There is a significant percentage of healthcare workers that only have two choices as to the shift they get to work: day shift or night shift.  These are 12 hour shifts and they only have to work three of them a week, and if scheduled correctly one could end up with six day weekends.  Now this takes us to which shift is better, night shift or day shift.

If you ask anybody that has been set on a particular shift for a majority of their career, they would likely tell you that they wouldn't touch the other shift with a ten foot pole; there isn't any way that you would get them to switch.  I have worked both shifts over the past few years and have identified pros and cons of each and will attempt to lay them out for you here:

Day Shift

First lets start with most people's first choice as they come out of school.

Pros:  This one seems fairly obvious.  If a person works day shift they get a lead a relatively normal life outside of work.  When they get a day off work they can devote that day to whatever activity they wish, whether recreational, working around they're place of residence, a second job or simply spending time with their friends and/or family.  They also have the opportunity to have a somewhat normal sleep pattern.

Cons:  The downside to working day shift is that management is there and watching you.  If something is done that they don't approve of, even if it wasn't on your shift you are likely to catch heat for it.  You also have to deal with the physicians questioning and arguing with you as well as your fellow stressed out healthcare workers.  Then any therapies that you have to complete that day have to be worked around meal trays, testing and visitors.  Then you have an angry patient/family if you interrupt meal or visitor time.  Needless to say all of this together or even by itself can be very stressful.

Night Shift

Pros: Night shift offers many positives as well.  One of the positives is that there is no management breathing down your neck, however it can be very frightening if you do see management there during any part of your shift.  Physicians typically aren't present during night shift unless you work at a teaching hospital which has residents present during all hours of the day; otherwise the only physicians present are in the ED and the hospitalist admitting from the ED.  Night shift is also much more relaxed due to the before mentioned reasons.  You can usually have more fun on night shift and the patients usually can sense that you are more relaxed and appreciate it.  Also on night shift you don't have to fight meal trays, testing or visitors to get your therapies done.  Another bonus to working night shift is financial.  There is a night shift differential that varies from employer to employer.  Some are a set dollar amount, others may be a percentage of your base pay.

Cons:  The cons to night shift are fairly significant.  There are many health hazards to working night shift including increased risk for obesity, cardiovascular disease, sleep disorders, gastrointestinal problems and problems with diabetes.  There is also an increased risk for domestic problems including divorce as well as an increased risk for involvement in motor vehicle accidents.  When you have a night off, it is difficult to get things done due to everything being closed.  It is also difficult with family and friends, because unless they have worked night shift it is very difficult for them to understand what you are feeling or what you have to do.    They may not understand that on a day off that you need to sleep.  When you work nights, you lose your days, because you are sleeping to either prepare for your night shift or sleeping to recover from working night shift.  Remember, most of the rest of the world is on day shift, including your family.

Another factor to consider that is neither a pro nor a con to night shift is that since there are no physicians, or there are physicians that lack experience that they, as well as other healthcare providers, will lean on you more to be knowledgeable and know what to do in critical situations.  So you have to be on your "A" game and know what you are talking about and know what you are doing.  That kind of responsibility can be very frightening to some people.

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As I stated above, I have worked both day shift and night shift and currently work night shift.  Currently I work night shift out of financial necessity (shift diff mentioned above).  I hope to eventually go back to day shift just for the family aspect of it.  It is very difficult for me juggling night shift work with a day shift family life.  I feel like I have been sleeping away most of my little girl's life.  Fortunately God has blessed me a wonderful wife that understands the necessity of it and I thank God for her every day.

When I went to night shift I worked someplace else and the change was due to work related issues and it was to escape stress being caused by management.  And as soon as I went to night shift I could just feel the tension go away and felt much less stressed.  I had eliminated that emotional and psychological stressor, however I traded it for physical stressors and now another emotional and psychological stressor.

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To summarize there are many pros and cons to both shifts.  You just have to figure out which one is right for you.  For most new grads, the most available shift is night shift.  That is usually the entry position.  If you are single or have a spouse/significant other that is also night shift it may be great for you.  However if you have a family it may be much more difficult for you.

Now your turn:  What are you thoughts on medical shift work?  What is your preferred shift and why?

Shiftwork - health effects

Benefits of Fresh Air

I know it's the winter and we've all been cooped up inside.  You might be starting to feel kind of depressed, or irritated.  You might even be starting to feel like you are going crazy from boredom and not being able to get outside. Then I come along and post an article on the benefits of getting fresh air just to rub a little salt in that wound of cabin fever.

Actually this post is coming up because my wife is doing a series on her blog over at Golden Reflections on a healthier lifestyle.  Her series is called 31 Days to a Healthier New Year and in it she is going through and discussing the different parts of the NEW START (nutrition, exercise, water, sunshine, temperance, air, rest, trust in divine power) program.  So when she got to the part of planning the post about air, she looked at me and asked me to do a guest post for her.  And being the loving husband that I am, agreed to do it for her.

So following is the post that I did for her.  If you get a chance please go check out her blog and her series!  I believe you will find it very beneficial for you!  She posts on a variety of different topics, something is sure to appeal to your interests!

Fresh air.  We hear all kinds of talk on the importance of fresh air.  But why is it so important?  Why is it that when we have been cooped up inside all day that when we step out and take that big deep breath of fresh air that we suddenly feel rejuvenated?  Why is it that when the weather has been horrible that when we get that first chance at a nice day one of the first things we do is open up our windows to "air" out our houses?  It's because inherently we know that fresh air is important, but why?

First reason is that fresh air is vital for life.  Air is made up of many different gases, the two most abundant gases are nitrogen (79%) and oxygen (20.9%), the rest are all trace gases.  The body needs oxygen to function.  When you take that big deep breath of fresh air, your blood takes that oxygen from your lungs and transports it to all the cells in your body.  Your cells use that oxygen metabolize and create energy, the by-product of that metabolism is then transported back to your lungs and exhaled as waste gases (most of which is carbon dioxide).  Fresh air helps this process out because it has fewer pollutants and toxins in it than city or indoor air (sometimes referred to as stale air).

When you are indoors for long periods of time (such as in an office, school or house) you end up rebreathing the same old air.  As you and everyone around your rebreathes that same old air the quality of that air begins to decrease.  When the quality of the air decreases, you begin to feel fatigued and you may not think as clearly.  This is because your cells and your brain aren't getting the quality of oxygen, or air, they require to perform at peak performance.

But the benefits to fresh are are not just limited to cognitive benefits.  There are many others:

When you get fresh air every day you will find that you will not only feel more energized, but that you will also sleep better at night.

You will also find that you will breathe better.  Fresh air helps your airways to open more so that you can breathe more efficiently, thus exhaling more toxins out of your body.

Fresh air helps you digest your food more effectively and efficiently.  It is a good idea to take a walk outside in the fresh air after you eat.  This will help those of you that are trying to lose weight (and who isn't after the holidays).

Fresh air is also great for lowering your heart rate and blood pressure.  It also will help you to feel more relaxed and happier.  A general mood lifter.

It will also help to boost your immune system and make it easier for your body to fight disease.

Following are some tips to help you get some fresh air everyday.  These tips are taken from www.natural-health-restored.com.  These pretty much sum up what I would suggest, so I don't see a need to change them:

• While on your breaks at work, step outside and take some slow, deep breaths. This will banish that tired, sluggish feeling and will leave you feeling more energized and focused.
• Open your windows regularly and air out your house as often as you can. If there happens to be a smog warning in effect, wait until later on at night or very early in the morning when the air is a lot cleaner.
• If you can, sleep with your bedroom window open. You can also leave your bedroom door open to increase the transfer of air
• Do not smoke in your home and do not allow other family members or guests to smoke in your home either. Even second hand smoke contains hundreds of harmful chemicals.
• Avoid breathing in car exhaust. Do not allow cars to idle near your windows or in the garage attached to your house
• Try not to stay in stuffy rooms for long periods of time.
• Make sure that your clothes dryers, gas cooking ranges, heaters, and fireplaces are properly vented to the outdoors.
• Be sure to maintain your heating and air-conditioning units on a regular basis.
• Get your air ducts and furnace filters cleaned regularly.
• Do some deep breathing exercises every day. Work them into your regular routine.
• Get some exercise on a daily basis. When you can, try to exercise outside. Exercise gets your circulation going and floods your body with oxygen.
• Don't forget about your posture. Always try to sit up straight and stand tall to allow your lungs to expand. That will help you take in enough oxygen.
• Wear loose, comfortable clothing that allows you to breathe deeply and freely without being restricted. Try not to wear clothes that are tight around your chest or abdomen.
• Avoid using air fresheners, and other artificial fragrances in your home. Use natural alternatives instead. Pure essential oils are a great choice. Or you can put some cinnamon and cloves in a pot with water and let it simmer for a few minutes.
• Keep plants in your home and work environment to help improve the air quality. Plants produce oxygen and absorb carbon dioxide from the air. Some plants can even remove toxic pollutants from the air.

As you can see, getting fresh air really isn't that hard.  Yet, somehow we have lost sight of the importance of it.  We have somehow become a sedentary and sluggish society content with sitting on the couch playing video games, surfing the net or watching the tube.  Then wondering why we have so many health problems, in particular cardiac and pulmonary problems.  So please, for your health and the health of your family, go out and get some fresh air.  You will be amazed with the benefits!  

Sources:

http://www.natural-health-restored.com/fresh-air.html

http://goodrelaxation.com/2012/01/health-benefits-of-fresh-air/

Other links of interest:

http://www.livestrong.com/article/436651-the-effects-of-sunlight-fresh-air-on-the-body/

http://www.newstart.com