Hospital Placement Week 3

Day 17 - 20

We’ve finished our final week in Muhimbili National Hopsital and what an eventful three weeks it’s been! It’s been challenging both physically and mentally, we’ve battled with our emotions and at times had to walk away from difficult situations. However, we’re so grateful and feel privileged to have been welcomed into the hospital and experienced working in a different clinical, as well as cultural environment.

Our third week has probably been the hardest one. Our week started having to use our BLS resuscitation skills, we visited the paediatric burns ward and saw a multitude of very poorly patients including a septic wound which had developed over 7 years (don’t worry there won’t be anymore detail on that!).

Just a little warning the following text may cause upset, but we’ve tried to keep it readable for all...

We arrived for our shift Tuesday morning and Laura chose Resus Bay 4 to start the day. Prior to our arrival, a 75 year old gentleman had presented in ED with difficulty breathing (suspected pneumonia) and the ED team had intubated him. Mid morning the team decided his vital signs had improved and they made the decision to extubate him. The patient was barely stable for less than an hour and Laura noticed his oxygen sats began to drop considerably to around 55% and initiated to the team that the patient needed assisted breathing ASAP using a BVM and oxygen. Laura managed the patient airway while the team decided on a plan of action for the patient. At which point I (Jennie) had come to check in with Laura as we both frequently did if we were in different Resus Bay’s during the day. The look on Laura’s face said it all, so we took it in turns to manage the airway, check patient vital signs and try offer our suggestions to the ED team. A doctor arrived and took control of the situation as the patient was deteriorating rapidly. The patient had gone into respiratory arrest and we were both prepared for this patient to end up in cardiac arrest. The doctor asked what we were comfortable doing if this were to be the case and we said we’d take it in turns to do CPR to free up other members of the hospital team to manage the airway and deal with Resus drugs. A pulse check was taken and his pulse was absent. We started CPR and insisted again that they get the defib machine up and running. The first machine was out of battery / broken so it took some time before we had proper monitoring on the patient. The room was quickly filling up with people and it had become very disorganised. We just stayed as focussed as we could on giving good quality CPR and communicating with each other with regards to our responsibilities. We believe the patient was given adrenaline 3 times and they were trying to re intubate but there was so much going on and language barrier made it much more difficult to keep track. After 40 minutes of trying to save the patient and eventually having ECG monitoring on showing asystole, the doctor pronounced time of death. We were commended by the doctor for our efforts and support, which made the situation a little more easier to digest knowing that we helped as much as we physically could in the environment we found ourselves in. Needless to say, we left sweaty, drained, confused and in need of a whiskey or two (and we don’t even drink whiskey!), but instead we diced with death ourselves and got a tuk tuk back to the house for lunch.

As part of our placement we requested to spend some time in the paediatric department, so on Wednesday we visited the paediatric burns and maxfax ward. This was by far one of the hardest and most upsetting experiences of the trip, due to the vast numbers of children with life threatening burns and the mechanisms in which they received them. We assisted the doctor with the morning ward rounds and then provided comfort and compassion to a little boy who was having his dressings changed with no pain relief. Due to the varying audience reading this blog, we don’t think it’s appropriate to go into too much detail but all we will say is the resilience of these children is astonishing. One of the hardest things for us to digest is that these types of burns could be prevented, but due to cultural differences and the lack of health and safety awareness, they are so so common.

On a lighter note, we managed to put smiles on some of the patients and their siblings faces, playing football in the corridor, letting them use our stethoscopes to listen to each others heart sounds and trying our best to communicate with them in our broken Swahili.

We apologise if this post has been heavy reading but we want to be honest about our experiences. It’s been tough going at times but this trip has broadened our life skills and built resilience and confidence for our EMT/EMT2 year with Yorkshire Ambulance Service (YAS).

Also it’s not been all bad, there’s been some good days too. Clinically we may not of learnt a lot, as our education and placement experience at Bradford University and with YAS is second to none. But we’ve gained some leadership experience, working closely with the medical students on the wards, offering suggestions and advice that may help them in their career moving forward, helping them work the through differential diagnosis and basic analysis of ECG’s. We’re by no means experts, nor have years of experience behind us but it has made us realise we do know more than we think and it’s nice to offer what we do know to others.

We’ve also shown real care, empathy and compassion for patients when they need it most. Patients are often ignored by staff in the ED, sometimes not even informed when procedures are going to take place or if something will hurt. So we took it upon ourselves as part of our role to hold a patients hand or reassure them (even if they often couldn’t understand a word we were saying)!

We have so much to reflect on and we probably don’t even realise yet to what extent this trip has impacted and benefitted us both in our career to come and we were only there 3 weeks! We will be writing reflection pieces once we’re home which we’ll post on here for you all to read.

Anyway we’re in Zanzibar at the moment and travelling back to Dar es Salaam for our final few days! There’s a few more posts to come, so don’t tune out just yet…

Jennie & Laura x