In Patient Unit

Today we shadowed Nurse Barnard in the in patient unit (IPU) at Tapologo. Barnard began working at the IPU as a care worker. He took a nursing course at Tapologo and now he works as a nurse. He did not receive any university education to be a nurse. I can’t imagine that happening in the US, but he is a great and sensitive nurse.

A typical day for a nurse at the IPU: When the shift begins at 7am the nurses take vitals of the patients, and changes the bedding of those needed. Then it is breakfast. Nurses assist patients who cannot eat by themselves. Afterwards, nurses attend to patients as needed (bathing, giving pain medication, talking to them). Lunch. Attending to patients’ needs. Take vital signs again at 4pm. Shift ends at 7pm. Yes, the nurses work 12 hour shifts. There is always a nurse on duty at night.

There are separate wards for the men and women. There were about 4 patients in each ward, and about 4 empty beds today. Barnard said that they usually never have to turn someone down to be admitted because there is usually room. There have only been 2 white patients at the IPU… ever. Almost all of the patients have HIV/AIDS. Some patients also have TB or cancer. There is another unit for TB patients. They keep them separate to avoid infecting the other patients. When we went into the TB ward we wore masks.

Today we met the male patients and TB patients. We spent a long time talking to the men. They seemed to really appreciate the company. Two of the four men spoke English. One of the English speaking men translated the non-English speaking man for me. One man only mumbled at me. I was told that he is very confused and speaks his own language. As he mumbled at me I just held his hand. I think he liked the attention. While I was talking to the other men he was staring at me, so I went over and kept him company for a bit. I learned about one of the men’s family and work. This man, Thabo, really wanted to leave so he could go back to work at the mine. Some of the other men said that they were very content at the IPU because they were supported, fed, and were getting stronger there. They are very bored at the IPU. The said their entertainment consisted of walking around and watching TV. I was then really glad to be providing conversation for them. We helped spoon feed lunch to one of the patients.

The TB ward: when we first went in there were 3 women. One of them, Pauline, was behind a curtain because she was in critical condition with TB, AIDS, and cancer. The other two women were happy to talk to us, but they seemed pretty miserable. They said they were aching to leave and go home. One of them showed us her stomach. At first I thought she was pregnant. She had a large swollen belly, while the rest of her body was skin and bones. We were told that last week she had 10 liters of fluid drained. She told me it was a side effect of the TB medicine. Later, Nurse Barnard said it was a result of not taking her ARVs. The women showed us their medicine and said they were responsible for taking it themselves. Ceasing treatment seems to be a major issue with TB and HIV/AIDS patients. While we were there, a TB patient named Regina was admitted to the IPU. She had been there before. Last time she was a patient she had regained strength at the IPU, and when she left she stopped taking her medication. Now she is again in critical condition.

At 11:45am today, Nurse Anna found Pauline dead. Nurse Barnard said that after a while they get more comfortable with death, but it never gets easier. When a patient dies a nurse lights a candle and allows time for people to reflect. We were present while Barnard called Pauline’s family. He said that it is always difficult to make this call. The woman on the other line cried during the conversation. An hour later a vehicle came to collect Pauline’s body, after her eyes and mouth had been closed, and she was changed into the clothes she arrived in.

Barnard said his job is very difficult but he is supported by the staff. He said that the staff is like one big family. They give each other support, comfort, and laughter. There is even a day care on site for the children and grandchildren of the staff. Barnard said he is also given strength to do his work from the patients. He makes it a point to get to know them and talk to them often. Having a strong relationship also allows the nurses to understand the patients’ life, and stressers, which can help the nurses communicate to the patients the importance of continuing treatment after being discharged from the IPU. Even the cleaning ladies have relationships with the patients. Some of them come into the wards often to chat or feed the patients even though it is not in their job description. I could really sense a genuine want to care for the patients by every staff member.