Week 4 at Chimala

It's hard to believe that four weeks at Chimala have come and gone. Time is such a strange thing! My time here has passed by so very quickly, yet I feel like I've been here my whole life. I wish I could explain how much this trip has grown and changed me, but I don't even think I know for myself. So much has been crammed into four weeks with not much time to process. Being a nurse requires the ability to still function even in the midst of grief, and I know I've learned a lot about the mix of taking time to grief losses yet still caring for the sick people that God has placed in front of me.

No class, team meeting, or story from previous years of this trip could have prepared me for the deep experiences I have lived here. While all of those things help and I am a believer in preparation for a trip like this, one can never fully prepare to hold a sick child's hand while they take their last breath. God has shown me so much grace in the way that He has provided His strength for me, day after day. He has given me the external and internal resources I've needed to keep going and I am grateful.

This week started on a very sad note. Monday I was on peds ward. Kaitlyn and I made rounds with Ms. Bingham and saw a very sick baby who had a huge, distended, tight abdomen and was retracting. He had come to the hospital the night before with diarrhea but his Mom said that he had been sick most of his life on and off. He was 8 months old but only weighed 5 kgs (11 pounds). We gave the baby a bolus of fluid and I got to drop my first nasogastric (NG) tube on him. We placed the NG tube to help release some of the pressure in his stomach. Kaitlyn and I took this little one under our wing and stayed with him and his Mom most of the day. Around 2 PM, he spiked a fever over 105 degrees F. His breathing got worse and we thought he was on his way out. We put him on oxygen, unwrapped him, and began tepid sponging him to decrease his fever. We did this for about 2 hours and got his fever under 100 degrees F, which is still not great but much better than it was previously. We sang to him about Jesus and prayed over him with his Mom before we left for the afternoon. We didn't want to leave, but we figured it would be better for his family to spend some time with him alone and we would come check on him later. We checked on him Monday night and his status was about the same- still on oxygen but his temperature was better and there was still some contents coming out of his NG tube, which was helping his abdominal distention. Before morning devo on Tuesday, Kaitlyn and I went to check on him and he looked about the same. We were hopeful that maybe he was going to get better because his condition had not gotten worse over night, especially after he scared us so badly on Monday afternoon.

Tuesday took a very different turn than I expected. Katy and I were assigned to be on male ward for the day, but I spent a total of 20 minutes there all day. It started off like any other day and we were ready to make rounds with Dr. Black. Dr. Black told us he was going to go check OB real quick to see if there were any possible c-sections because he was in charge of anesthesia for the day. We were waiting for him in male ward but got impatient so we decided to go check on a little premie baby in OB who had been born a few days before. We walked in to find the baby and noticed that another baby had just been born who was not crying or breathing. The nurse put the baby on oxygen but the baby had no stimulus to breathe. Katy and I hopped in, put our gloves on, and started resuscitating this baby. She didn't have a heartbeat when we listened, so I started compressions and Katy bagged her. After a few minutes she had a good, strong heartbeat but still wasn't breathing on her own, so we kept bagging her. We sent Melanie to go get Ms. Bingham to check  out the situation. We told her we had been bagging the baby for a little over 30 minutes and she said it was time to stop and see if the baby would breathe on her own. Her heartbeat remained strong, so Ms. Bingham continued working with her and after a little bit she began to breathe. While all of this was going on, Kayla found a different premie baby who was sitting in a little bassinet in the labor room. She picked up the baby and realized that the baby had a very low heart rate and was on the verge of death as well. Once Ms. Bingham took over the other baby Katy and I were working with, we picked up the baby we originally came to check on and found him cold and barely alive. We had three babies who all needed oxygen and resuscitation and we only had one concentrator. Katy and I began to resuscitate the baby and it helped but not for long. His heart rate increased and his color got better for a short time, but he was in need of help that we could not provide. He hung on for about 20 more minutes, which he spent in the arms of his Mama (previously he stayed in the warmer in the labor room to help regulate his temperature since he was so small). Lauren and I sat with the baby and his Mama, prayed with her, and held her hands while her child took his last breaths. Around that time, the baby Kayla found also died. We lost two in a matter of minutes. I went to check on the baby Ms. Bingham was working on and she was breathing on her own, but was having constant seizures due to the lack of oxygen she had at birth. We handed this baby over to her Mom so she could at least hold her before her baby passed away. We weren't sure how long she would make it. It was a very sad and quite traumatic morning.

After lunch I went to check on male ward and the nurses said there wasn't much to do, so Katy and I went to peds ward to check on my baby from the day before. His fever started rising again and his breathing got worse. He began to gasp for air and then he would wait about 5 seconds before taking the next breath. The break between breaths got longer and longer and he died around 3:30 PM Tuesday afternoon. Kaitlyn and I were both there, along with his Mom, Katy, Lauren, and Kate. He had his little fingers wrapped around mine until the very end.  Watching him die was so hard, but it was an honor to be with him as he transitioned from this earth to the Lord. It is frustrating to know that at home, this baby would have a complete work up with countless tests, medications, and surgeries, yet here we ran out of options. As Ms. Bingham says, "where you live determines whether you live." Unfortunately, this baby was a perfect example of that statement. We were not quite sure what his problem was, but we did all we could with the resources we had and gave that baby the best chance at life. It was really easy to feel defeated after Tuesday, but God reminded me once again that he holds the keys of life and death and that he was he one now holding the three children that had passed away. It was not ever my job to heal them, only to show them Jesus by the care they received from my hands. I believe that was done and I rejoice in the fact that Jesus has overcome death and it has no hold on us or those sweet babies. They are perfect in every way and with Jesus forever! Praise God for His promises.

On Wednesday, Kaitlin and I went on a mobile clinic to a Masii village. It was one of the neatest experiences and we felt like public health warriors! The ride to the village was an adventure in itself. Kaitlyn and I rode in the back of this truck that was covered in a tarp. We thought the tarp would protect us from the dust but boy were we wrong! When we got to the village, Margaret, one of the nurses who came with us, came to the back of the truck to help us out and just said "pole sana" (I am so sorry!). I'm pretty sure we looked a few shades darker due to the layers of dust that was caked on our faces and extremities. Mamas and babies began to show up from out of the woodwork when we arrived around 11:30 AM. The Masii women all have a distinct look to them. They are all very tall and thin and all wear similar dresses. Once we had about 70 children there, we began to weigh the babies. We brought a scale and hung it on the roof of the building and each Mama had a little sac they would put their baby in. They took the handles and hung the baby on the scale. It was the cutest sight ever! So many babies with their little cheeks pushed together! I couldn't handle it. Kaitlyn and I recorded all of  the weights on each child's card. After, we helped Margaret with the prenatal checks for the pregnant women who came to the clinic. We looked for anemia (paleness in the conjunctiva of the eyes), edema in the legs, fundal height, presentation of the baby, and the fetal heart tones with this little wooden funnel thing (sorry, that is the best description I can come up with). Margaret was so much fun to work with and was a great teacher. Next we gave immunizations to the children. We gave oral polio, oral rotavirus, and injections of PENTA (tdap) and PCV (pneumococcal). We made some babies not very happy but it is so important for these children to have protection from diseases that are preventable. Wednesday was such a needed break from the hospital. It was so good to see happy, healthy babies that were chunky and growing! I was reminded about the advantage of simplicity and the importance of relationships when I saw the village members sitting together under a tree, sharing food for lunch. They live in community and help their neighbors. It really is a beautiful way to live. We had a wonderful time with them!

Thursday and Friday were slower days at the hospital, but they were good for tying up loose ends before we left on Saturday. Katy and I helped deliver one baby girl on Thursday morning. She was healthy and beautiful! I absolutely love getting to hand over a healthy baby to the Mama and say to her, "hungara, Mama!" (Congrats, Mama!) Thursday afternoon I helped move some supplies we still had at the house to the storeroom at the hospital (which they call the stoo). We went around and visited with some of the staff at the hospital like the x-ray technicians, the lab technicians, and some of the nurses. It's been so neat to see the way that the staff has brought us in and worked so well with us. While our training may be much different than theirs, we have worked together to accomplish a common goal. I've really grown to love and appreciate the work that the doctors, nurses, and other staff do to manage the cases at the hospital. Without them, we would not have the opportunity to come and have this experience. We come to help for one month, but 12 months a year these people are working hard to give the best care they know. The language barrier has been a problem at times and has caused some confusion, but I love seeing the way that relationships were still formed.

Friday morning I was on female ward, and surprisingly enough, it was pretty quiet which is really abnormal for that ward. Katy and I got to spend some time giving extra care to an older women in traction due to a broken hip. Our group has started calling her bebe (which means grandma in Kiswahili). She was admitted before we came so we got to see her smiling face each day at the hospital. Katy and I noticed that she had some dry skin around her cast so we ran up to the house and grabbed some lotion and we got to give her a "spa day" African style! Patients at the hospital never get shown care like that because family members are responsible for bathing and cleaning their loved ones. I think it meant a lot to her that we noticed and did something to help her. I had also set a goal for myself to start one more IV before I left, and there was a new admit to female ward right before lunch so  I got to start an IV on her. It was a great way to end my time at the hospital! (Before this trip I was terrified to stick anyone. This trip has been a great way for me to gain confidence in my ability to perform nursing skills.)

Friday afternoon the staff at the hospital threw our team a going away sherehe (party).  Dr. Mehengie (the head doctor), Emani (the head nurse), Cheryl (the missionary in charge of the hospital), Chad (another missionary at Chimala), Bernard (the head administrator at the hospital), Dr. Black, and Ms. Bingham all spoke. They served food and sodas to us and then gifted us each with a new kitenge. Dr. Mehengie called each of our names, one at a time, and we came up and were met by a Tanzanian staff member from the hospital. They tied the kitenge on us while everyone else in the room sang a Tanzanian song. I loved looking around at all of these faces who were once strangers and were now good friends. At the end of the party, they had us all line up and each staff member came through the line to tell us goodbye. We took lots of pictures and called it a day. It doesn't seem real that our time at the hospital has come and gone so quickly. It has been four weeks crammed full of loving, learning, and adapting to situations that I found myself in. I loved the creativity I was forced to find within myself to make procedures work with little supplies. I loved having the time to sit at a patient's bedside to be a listening presence. I know when I am a real nurse, there will be little time to provide that type of care due to high patient loads and constant charting that must be done in America. I pray that when I'm a real nurse in America and abroad, wherever The Lord leads me, that I will implement the lessons I've learned here. I want to be a nurse that cares for the whole person, not just the physical part of someone. I've learned how to do that here, even in the midst of a big language barrier. I am so thankful for this experience and the lessons that I hope to continue learning from this time I've spent at Chimala. There is so much processing that still needs to be done, but I know that God will guide my transition home. It's so comforting to know that He is the same in Tanzania as He is in America, and He promises to be the same yesterday, today, and tomorrow.

We left Chimala on Saturday morning to drive to Dar Es Salaam. We drove from western Tanzania to the eastern coast, which was a beautiful drive! I loved seeing all of the different landscapes that are present in this country! We saw flat land, mountains all the way in the clouds, desert places, and green, lush trees and shrubs. I'm surprised by the number of Palm trees here! We stopped half way on Saturday at a hotel and went on a half day safari this morning (Sunday). I loved the way that the park was surrounded by mountains. We saw giraffes, monkeys, elephants, impalas, hippos, a variety of beautiful birds, crocs, and even a lion!! It was a great way to decompress and enjoy the beautiful creation that God made.

Tomorrow and Tuesday we are hanging out in Dar Es Salaam. We are visiting the beach (Indian Ocean, holla!) and doing some souvenir shopping. We start our journey home on Wednesday and I am set to arrive in Houston on Thursday afternoon. Please be praying for a safe journey home.

Thank you for keeping up with my experience in Tanzania. I have received so much encouragement and am thankful for you. Whether you supported me financially, through prayer, or both, I have felt so loved and you have shown me the face of God by your support and partnership. Thank you, thank you, thank you and may God bless you today and in the days to come.