Emmanuel

Emmanuel assessing the patient

     Yesterday was my second full day on the unit. Thank goodness Emmanuel was there. Wednesday was my first "full-time" day at the hospital and I went into panic mode a little. I was suppose to meet with Nasson, my director of nursing, but then he got pulled into an all day meeting. The next thing I knew I was left alone in the ICU, with staff who had never met me, some who don't speak English, and I floundered quite a bit. For the first few weeks we are suppose to observe in order to really understand why things are they way they are and to get to know the staff and for them to know me. The last thing in the world I want to do is come waltzing in and step on toes. But, yesterday was rough.

     Alarms constantly going off, the central monitor was not on, no running water in the building, unstable vital signs, and nurses and students sitting during all of this. It is very different and very disturbing coming from the US. I was rescued by Steph, the neonatal/pediatric nurse from Maryland who gave me a complete tour of the hospital and also gave me the ins and outs of everything. She is so fantastic. I am sad that she is going home for a month! I'll be very happy for her safe return here to Butare with goodies from home though (hopefully Berger cookies are included in this)!

      Emmanuel, switched his schedule so that he could be here with me. He is absolutely amazing. He wants to improve not just his nursing skills, but the unit, and really the healthcare system here in Rwanda. The first thing after nursing report is to give bed baths... not assess your patients, but to clean them. Similar to Haiti, nurses are not taught to critically think here and that is largely what we are trying to change. Culturally, stethoscopes are for doctors only. My predecessor, Jessie, worked very hard to change this and even gifted the unit six stethoscopes, one for each ICU bed for the nurses to use. However, it's still challenging to change the unit culture. Emmanuel gave probably the most thorough bed bath and oral care that I have ever witnessed and then informed me it was time to assess. It was almost 10 am at this point. I can imagine my good friend Karen (and fellow MPH/ICU nurse) having a slight heart attack reading this... if her patients weren't done being assessed by 8:15 am something was wrong. But this is Africa and things move slower here and are completely different. So Emmanuel told me that he wanted to make sure the student nurses could do a proper head to toe assessment. We had about six or seven nursing students who are part of te E-learning system. Essentially, these are US equivalent diploma or associate degree nurses who are "upgrading" to a bachelors degree. Emmanuel rounded up four or five of them and started to teach away. He asked for my input on occasion and all of a sudden I found myself demonstrating the differences between decerebrate and decorticate posturing and the students were peppering me with questions. What English they didn't understand Emmanuel was able to explain in Kinyarwanda. We make a good team. It was slow going, but went well and I'm excited to see how the students do next week.

     Thank God for Emmanuel. I am so lucky to be paired with him.

Emmanuel helping the students.



Lesson Learned: It's ok to have a bad day