Just Keep Breathing

When we arrived at the IPU this morning, the nurses were trying to administer an IV into a man. It was the same man who was muttering nonsense yesterday as I held his hand. Today he was staring off into space, not blinking, not flinching or showing any signs of response as he was prodded over and over with needles into his collapsed veins. The nurses tried to get the needle into him for almost 45 minutes. They said, “He had already started to go cold”. He lay on his bed motionless, lifeless. His concave chest was exposed. His chest rose with each breath, then back down. I waited in anticipation for his chest to rise every time. There was about 5 seconds in between each gasping breath. Through out the day when I would look at him, I was always surprised when his chest would rise again with breath. All day he looked as if he was sleeping with his eyes open. They never got the needle into his veins.

Today Nurse Barnard taught us the precise way to make beds. I never knew there was such technique to it. He showed us exactly which sheets and blanekts must go in what order, and folded exactly which way. When putting the sheets on you must center the crease of the sheet, aligning it at the top first. You should try to fold the corners of a sheet like an envelope to tuck it into the bottom. There is a correct way to fold the sheets at the top. Nurse Barnard pays attention to every detail, as it will affect the patient. The sheets must be pulled tightly, with no creases, because bumps in the sheets can cause stress sores to the patients. Also, if a patient is tall, you shouldn’t tuck the bottom of the sheet into the bed, because it might stress the feet. Nurse Barnard amazes me. He is caring for the patients even when he is simply making their beds. So we made every bed in all the wards of the IPU. For the patients who are mobile, they took a break outside in the sun so that we could make their beds. During this time the patient Thabo cleaned his sneakers in anticipation of being discharged. Many of the patients are bed ridden. For some of them we just adjusted their linens with them in the beds. For others we managed to help them into a chair next to their bed so we could do a full change of bedding. Nurse Barnard was instructing us and helping us the whole way. I can’t get over how caring he is. He was so attentive to teaching us because he knows that we want to be nurses and doctors, and he believes that we will be better with our future patients because of this training. He even taught us to tie up the curtains with out any ties, so that it is aesthetically pleasing.

There was a new patient in the male ward today. He seemed in critical condition. I spoon-fed him his lunch. When I first took a spoon full of the egg salad and put it to his mouth he shook his head. So then I put the bowl in front of him and pointed at the different options in the bowl. He nodded his head when I pointed to the beans. He ate the entire serving of beans. He settled next on the beats. When he had enough he gave me a thumbs up. Noticing that Nurse Barnard wiped a patients mouth after feeding him, I cleaned up the man who I was feeding. I wet some gauze and tried to gently scrub the red beats from his lips, trying to be sensitive to the sores on his lips. Afterwards I held his hand for a bit. He didn’t talk all day.

In the late morning a woman in the female ward died. We summoned the courage to visit her. She looked a lot more peaceful than I expected. Her body was stiff, but looked as if she was just resting. Her face was the difficult part to look at. There were wet paper towels resting on her eyes to help them close. There was a bandage from the top of her head along her jaw. This was meant to help shut her mouth. Her mouth was not shut though. We watched Nurse Barnard as he kept pushing her mouth shut, but it would just keep opening. He put her pillow on her chest, with the edge against the bottom of her jaw. This seemed to help close her mouth better. Later she was taken away.

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.

Equipped to Serve: Crisis Counseling Course

This week I attended a three-day intensive crisis counseling course. The course is called “Equipped to Serve” and was created by an America. I was invited by the staff at Neo Birth. Maurie, the founder of Neo Birth, led the course. She told us that by the end of the three days we would be ready to counsel people in crisis. Maybe not. I have received a certificate for completing the course, however, I will take a test and if I pass I will be certified by the South African Course Qualification Accreditation (SACQA) to be a non-professional crisis counselor. Pretty cool right? Here’s the catch… it was a Christian counseling course. There were many positions discussed in the course that went against my own beliefs. We were taught how to counsel someone against the sin of a homosexual lifestyle. Wow. This section of the course was incredibly tough for me to get through, but I managed to sit still in my seat and keep my mouth shut. We learned theories, that as a non-Christian, I do not think I will ever be able to apply to the counseling I might do in the future. We learned that God gives us the authority to counsel. We learned that as counselors we must not be sinners. Instead we must have a strong and loving connection with God because it is impossible to love others, be genuine, or humble without God. We learned that a client will not be able to recover from a crisis if the client does not have a relationship with God. Maurie strongly believes that all counselors on a team must believe in the same God.

Despite having different views on some of the principles and theories of crisis counseling, I was able to appreciate many of the techniques. We learned very useful communication skills, the phases of a crisis, and obstacles of both the client and counselor. The most interesting thing that I learned was the Chinese definition of crisis: “opportunity riding on a dangerous wind”.

In total, there was about ten of us attending the course. The other people were mostly OVC (orphan and vulnerable children) care workers in various Rustenburg communities, and volunteers from Neo Birth. My favorite part of the course was this morning when we each shared about our lives. I was very moved by many of the people’s genuineness to help hurting children. A couple people shared details about their lives that were clearly very hard to share. One woman was nearly in tears when she confessed that she had separated with her husband because he had become abusive. Other women shared that they had children outside of marriage. I finally felt that even though all of these women are Christian, they are human. I have met many of these women before while working in their communities, but I now feel that I have a real connection with many of them. After the woman who had separated with her husband because of abuse sat down next to me, I gave her a smile of appreciation, and she rubbed my leg. At the end of the day, one woman gave me a big hug and told me to come to her community and she will take me on home visits to her OVC homes.

This course really tested my patience at times (we prayed three times each day), however, I have learned incredibly practical counseling skills, and I have had the opportunity to better understand South Africans who want to make a difference and help their people.

Targeting Children for Medical Assessments

Tapologo offers free health assessment clinics for the orphan and vulnerable children (OVC) living in the squatter villages. However, many children do not attend these clinics. It is Tapologo’s goal to have a medical assessment of every child in these communities so that they can better understand the health situation in every community and also so Tapologo can give ARVs to the HIV positive children.

It was our task to find out which children have not been medically assessed in Freedom Park and Boitekong. We started by finding out which children have been assessed. We asked each care worker to tell us which of their children had been assessed. Each care worker could tell us off the top of their head which of their children had attended the health assessment clinic. I was very impressed by this. Each care worker looks after about 15-25 children. They did not even have to look at any files. It showed to me how close their relationship with their children is. Once we had the names of all the children who have already been assessed, we compared it to the master list of OV children to find out who still needs to be assessed. Tapologo will use this information to target these children and encourage them to attend the next health assessment clinic.

4/21 Training Session

Today’s training session was very informal. Angela, the counselor from Neo Birth, had no objective but to check in with each of the OVC care workers. I am very impressed by how dedicated Neo Birth is to having close relationships with each care worker. The counselors from Neo Birth meet the care workers weekly to give them training, and the care workers must report to the Neo Birth counselors. The Neo Birth counselors put themselves on an equal level as the care workers. Today Angela brought sweeties for the meeting. She was very vocal about her appreciation for the care workers. She acknowledged how important and hard the care worker’s work is. Angela asked each one of them how they are doing. She knows what is going on in most of their lives. She asked for feedback from each of them about how they are handling their work and personal lives. Neo Birth brings donations to the OVC program for the children in need, but Angela always makes sure she gets the care workers the clothes and supplies they need for themselves and their families. Many of the care workers themselves are sick and living in poverty, and on top of it their job is very stressful and they receive incredibly low pay. These care workers are battling HIV on the front lines by working daily with orphaned and vulnerable children. I think it is very important for them to feel support and appreciation. Neo Birth does a very good job of providing this.

Quote of the Day...

"On a lifelong search for the right balance of epic and solid."

Thanks Benny.

4/14 Training Session

Today we accompanied Maurie, from Neo Birth, while she lead training sessions for the OVC program child care workers at Boitekong and Freedom Park. The purpose of these weekly training sessions is to provide the child care workers with the skills to intervene, counsel, and empower the orphaned and vulnerable children they look after everyday. This month was the most accomplished the OVC program has ever been with 7,000 interventions collectively in Boitekong and Freedom Park this month. The childcare workers each work full time without a salary. The Impala Platinum Mine gives each childcare worker a 1,000 Rand stipend each month. That is equivalent to approximately 143 dollars.

The method of training that Neo Birth practices is called “equip to serve”. This is what was discussed at today’s training session:

The goal of counseling children is to “speak the truth in love”. Condoms are not 100% safe, so one must not teach the youth to use a condom. Instead, one must teach the youth the true way of staying safe—abstinence.

One must not manipulate when counseling. Instead, one must minister from the Holy Scriptures. Only God can change people

Children send out an “SOS”. S: scared. O: Overwhelming pressures (internal and external). S: Strengths (must help find each child’s strengths and use it to boost the child).

Quality care workers practice “HUGE”. H: humility. U: unconditional love (condemn sin, but always be there for them). G: genuineness. E: empathy.

The phases of a crisis is: denial, bargaining, anger, depression, forgiveness, accountability, and resolution. Childcare workers must help children through the phases.

The five counseling skills: “RIGHT”. R: reflective listening (content). I: interpretive listening (feelings). G: good questions (where, when, who, what; do not ask why because that is a judgment and only God must judge) H: helpful feedback (relate to the child through personal experiences). T: tender confrontation (must build relationship first).

The care workers build relationships with children through playing, helping with homework, and working together to do chores.

We ended each training session with prayer.