UConn Nursing in Cape Town Blog

December 3, 2008 (Wednesday)

Today I went to Themba Care to volunteer. Themba Care is a facility that treats children who are HIV positive. Themba care gives them a loving environment, a place of refuge while treating them with anti retro virals (ARVs). There is a normal routine at Themba Care. The sister (nurse) and staff start the day out with prayer. They pray for the children and pray that they will be able to give them the best care. Then, the children are bathed. After bath time, the children get their breakfast, which they pray over first. Each child had their temperature taken, which is what I did. I started with the older kids first because they go to school. One of the children was sick. He kept on coughing until he threw up and he had a fever, so he didn’t have to go to school. The doctor gave him Panado, which is for pain and fever.
After breakfast, all of the children are given their medications, their ARVs. The big kids go to school and the little ones stay, so we play with them. After playing inside for a little while, some of the volunteers decided to take the kids outside. I went outside to help. The kids love to play on the swing. Some of them also like to play on the see saw. There is one little girl who loves to come and play with me. She has such a little personality and the cutest little button face. Sometimes, all she wants is to be held, so that is what I do. I played with her, danced with her, sang to her, and played on the slide with her. We had a lot of fun. She got fussy and I think she was sleepy, so she fell asleep on my chest. I put her to bed. Once the kids finished playing outside, it was time for lunch. They prayed over their food. After lunch, it was naptime.
Whenever I leave Themba Care these last few weeks, I think about how much I will miss these little ones. It is sad to think that they may not find an adopted home as easily if they need one because they are HIV positive. One mother comes to visit her infant very often. I love to see how dedicated she is to her child and how much she cares for her child. The father of the baby came to visit too. It made me happy to see that. Some of the children’s parents visit, but not often. Some of the parents don’t visit at all. Some of the parents have died. Each child has a history and a story; most of them are sad and heart breaking. It makes me sad to think that they have to live with HIV their whole life, not because of anything they have done; it is just something that just happened to them. They have to take these ARVs the rest of their life, at a set time everyday. They may be stigmatized because their blood is infected with HIV, but they are all so precious. My hope for all of them is that they be taken care of by their family, but if their family can’t do it, I hope that someone who will really love them and care for them adopts them. They deserve all the love and care in the world, they are beautiful.

December 4, 2008 (Thursday)
Today I went to the beach with Iris. We went to a beach called Clifton. We took a minibus to Cape Town and then we took a minibus from Cape Town to the beach. It is getting easier to figure out our way on the minibus and I am feeling more and more comfortable on them. Clifton beach has four parts. When Iris and I got off of the minibus, we had to find our way down to the beach. We took the route where we had to pass construction that was being done. It was very interesting and dangerous at the same. I was concentrating on not falling down the stairs or tripping on a cord. When we got to the bottom, I looked up at the houses on the hilly slopes, and then I looked out at the bluish green waters and the rocks surrounding them. It was absolutely gorgeous. It was very peaceful, too. Iris and I walked through beaches one through three. We stopped to take pictures as we walked. Once we got to Clifton three, we decided to turn back and go to Clifton because it was quiet and not as crowded. We laid out our sheets and beach towels to lie down. It was a windy day, but a hot day at the same time. I decided to go in the water. I dipped my feet at first and then ran in. It was ice cold and the waves were fierce. It was fun though. I didn’t stay in too long because it was too cold, but I knew that I would be cool for a few more minutes. I decided to write some post cards to home and read my book, Iris decided to lie out and tan. We took more pictures of the beautiful scenery and of us enjoying the day in the sun. We also made videos on our cameras. The wind was picking up and sand kept coming up, so we decided to leave soon. It was a great day spent though, I definitely want to go to the beach again before I go home.

December 5, 2008 (Friday)
Today we went as a group to a few places. The first place we went to is called Fikelela and it is in Khayletisha. This is a facility that took care of children who need a place of refuge and children who are HIV+. I retrieved information from http://www.fikelela.org.za/about.asp. The mission statement is “Our vision and mission is to mobilise the Anglican community to make a sustained positive contribution to the reduction of new HIV infections and to drive HIV/AIDS education and care in partnership with others.”
As soon as the gate was opened, the kids were running towards us and wanting to be picked up. A little boy who is four years old came up to me. Before I picked him up, I was thinking that I was too small to lift him, but I didn’t have the heart to tell him no. So I picked him up and when it got too tiring, I gave him a piggyback ride. The secretary gave a tour of the facilities. She told us that there were two buildings, one for boys and one for girls. She told us that each building had their own health care workers. She told us that they try to get the children out to visit their families so that they get to know them and not only the caregivers.
We went outside next. Most of us decided to play with the kids outside. I took the little boy who was with me to the slide. I he looked so sad, so I figured it might cheer him up. We went down the slide together several times and he seemed to really like that. We also went on the monkey bars. I held his legs as he used his arms to swing across. After playing outside for a little while, we all went back to one of the buildings.
The children sang songs for us. They sang Christmas songs, such as “Jingle Bells” and “Silent Night”. They also sang a song in Xhosa that talked about God’s love being so big and man’s love being small in comparison. They did movements with this song. They were all so beautiful. They belted out the songs and sounded great. I got teary eyed as they sang. We sang for them next. We sang “Rudolph the Red Nose Reindeer” and “Santa Clause is Coming to Town.” Then it was time to go, and another group was coming in. It was nice to play with them and make them smile, but it was so temporary. It was sad to have to say goodbye to them so soon, I wish I knew about this place before so I could volunteer.
Next, we went to the Red Cross Hospital. We went to the ICU. We met a Doctor and a Sister. They were very friendly and very informative. We were brought to a conference room where they gave us information and answered any of our questions. The doctor told us that the ICU was a 20 bed unit. They did post-op care, general surgery, and all neonatal surgeries were done there. We got to do a tour of the unit in two different groups. I was in the first group. Some of the patients that we saw were here because of being severely burned, having pneumonia, patent ductus ateriosus, needing to be on CPAP and being HIV+ possibly, shock gastroenteritis, motor vehicle accident, and falling into a pool of water. While the next group went, we sat in the conference room. I saw a poster with the vision of the hospital and the nursing division and the mission of the hospital. The mission is “To provide holistic and comprehensive nursing care of the high standard to children in a nurturing and friendly environment.”
When the second group came back, the doctor gave us more information. He told us about ECMO (extra corporial membrane oxygenation), which is used when a patient is hypoxic because of a heart problem or a lung problem. He told us that is contains two big catheters, sends blood from the right atrium, the blood gets sucked out into circate to get oxygenated and goes to the aorta. He stated that this machine bypasses the lungs and heart and an external object circulates oxygenated blood to the system. There are complications with this machine and the major one is bleeding.
Someone asked if MRSA is a big concern here and the doctor said that they get a child with MRSA in the hospital every few months. He stated that it is not really seen in the child population that much, but it is seen in the adult population. We were all very shocked by this. He stated that the nosocomial infection they do see a lot is Acinetobacter Baumanii. The doctor also told us what some of the biggest health concerns they are faced with. These include gastroenteritis, pneumonia, and malnutrition. He told us that these are the biggest factors in death of children at the Red Cross. Someone asked why some parents would send their children to a private hospital instead of the public hospital like the Red Cross since the children receive much better care in public facilities. The doctor stated that for some surgeries such as tonsillectomies, the patient would be on the waiting list for a long time, but would be seen much quicker in a private facility. Also, some parents believe that the private facility will have better care because it is private, but that is not the case. Red Cross, which is public, had better equipment and updated technology compared to the private facilities we have seen. The doctor told us that the government supports the Red Cross, but the Red Cross has a trust fund that has money from donations and fundraising. They have a lot of money, so that is why they were able to build so many specialty units.
Next, we went to the NICU at Groote Schuur. There were so many small babies in the NICU. The sister told us that that there are 74 babies in total! The sister told us that there are not enough sisters to cover the amount of babies there are. Dr. Natasha came and spoke to us briefly. She told us that there was a shortage of 40, 000 midwives. She also talked about the fact that she has many ethical dilemmas to deal with. One of these issues is that a viable age for an infant is 28 weeks and 1000g. She stated that this was a problem when so many babies were below this weight. The smallest baby was 600g. She stated that a lot of the mothers have gestational protein hypertension, which causes the placenta to not get good blood flow. This causes the babies to be small. She told us that babies are no longer ventilated but put on CPAP instead. She said that only very sick babies are ventilated. After the doctor spoke with us, we got to tour around the NICU. We washed our hands and split up into smaller groups to tour the NICU. There was a high care and intensive care section. The babies were so small. One of the babies had an abnormal chromosome and ambiguous gentilia. The abnormal chromosome would cause a lot of severe health problems for the baby, so the baby would be taken off life support in the afternoon and given to the mother to die. We also went to another section where premature infants were receiving Kangaroo care from their mothers. These premature infants were gaining adequate weight and would go home once they have done so.
The next place we went to was the Heart of Cape Town museum, where the first heart transplant took place. Christiaan Barnard did the transplant. A young woman by the name of Denise Darvall, 24 years old, was walking across the street when a car struck her and her mother. Her mother died instantly. She had fractures and cerebral damage. Her father was asked if her heart could be donated and he agreed. Her heart was placed in 54 year old Louis Washkansky by Dr. Barnard. The surgery and transplant was a success. Unfortunately, Mr. Washkansky died 18 days later due to pneumonia. The museum had a lot of interesting sections. It began by telling how Dr. Barnard started out. There was a video about him and the success of the first heart transplant. There was a room with Ms. Darvall’s belongings. There was a room set up like Dr. Barnard’s office. There were letters congratulating Dr. Barnard on his success of doing the first heart transplant. There were also angry letters from people who disagreed with the surgery. They disagreed because Dr. Barnard used the idea that a person was considered dead when they were brain dead, but others believed that a person was dead when their heart stopped beating. Then we saw the actual theatre where the surgeries took place and a staged example of how things went that day. We saw newspapers about the first heart transplant, letters that children wrote to Dr. Barnard, and pictures they drew for him. We saw a room with information about Mr. Washkansky. We also saw the real hearts of the recipient and donor! It was very interesting.
That night all of us went out to dinner with Professor Engler and our RA Ben. We went to a restaurant called Addis in Cape in Downtown Cape Town. It is an Ethiopian restaurant. Everything was brightly colored and there were candles lit. We sat in low set chairs and sat around a table that was a woven basket. All of the food that was presented to us had to be eaten with our hands. We got pieces of bread rolled up like a scroll (at least I think it was bread). It was very spongy. We used these pieces to soak up the dip that was given to us. For the main course, we had more of the rolled up bread that we used to pick up the food. We had quite a variety: chicken, fish, veggies, potatoes, cabbage, and more. My favorite was the fish and cabbage. We also had dessert. It was a crusted pastry that was very sweet. It was served with ice cream and the ice cream had mint leafs on it. The plate was decorated with clove powder. One of the girls said it smelt like Christmas. The last thing we had was coffee. First the waitress had a tin of the coffee beans that filled the area with the aroma of the coffee beans. Ethiopia is considered the original source of coffee, so they do a coffee ceremony. We got our coffee in small little cups. It was very strong, too strong for me (I’m not really a coffee drinker).
I had a day well spent with lots of activities.