Same Stuff, Different Day

I don't know why it took me so long to realize (or perhaps just remember) that the ingredients for exciting opportunity are the same as the ingredients for overwhelming insanity. Solomon was right, there is nothing new under the sun! All of life problems boil down to the same few themes and no matter were you go here on earth, you'll be met with the same kinds of challenges. Yep, it really is same stuff, different day!
A friend of mine told me she hated it when I would say that, apparently it sounded depressing? I for one, am happy that if there's nothing new, at least it's a different day. I am happy that each day is a NEW day and new opportunity to put my trust in my Maker that He will bake those ingredients into the most grand and exciting adventure of them all!

Still Here With 10 Months to ABD!

No, I didn't fall off the face of the planet. I've been adjusting to my new job at Evergreen and working on my PhD stuff. The job is a little crazy right now as we are preparing for a JCAHO visit and we have a year's worth of competencies to catch up on.
School is as busy as ever, I'm just doing my best to keep up. I'm counting down the ten months (if all goes well) until I'll officially be ABD (all but dissertation). So until then, I'll just keep plugging away.

New Adventures

This week marks the start of my new job as clinical nurse educator at Evergreen. So far it's been full days of sitting through orientation. Yesterday I finally got my email sign on, when I checked my email, I had 3 weeks worth of messages in there. Apparently there has been scrambling to get my office ready? I was cc'ed on a bunch of emails regarding it's condition and dump like qualities since it has been vacant for so long. So, thank you to the environmental services person who spent hours making it sparkle. If only I could take you home with me!
For everyone who's been asking about how I like my new job or what I'm doing, I don't really know yet as I've only been sitting in orientation. Next week I'll be working with some of the people in education department, so I should have more of an idea of what's going on then.

Que Hubole?

Starting at Cruz Roja

After a nice relaxing weekend,we will begin our time working at Cruz Roja today. The group will be split between two clinics, I'll be at Zona Norte which is in a poorer neighborhood. The plan is to rotate the students between the two sites so they can see a little of everything. The students are excited, we'll see how they feel tonight. So far so good.
We're having some great times of fellowship with our host families. It looks like our social calander is booked up for the weekend with dinners in people's houses and parties with pinatas. Good times, God times...

In Mexico City

Hello to anybody who still reads this blog. I'm currently in Mexico City with 8 nursing students. We have been out in the mountains in Oaxaca for the last few days doing free medical clinics. We've finally made it back into Mexico City tonight and are hoping to get some sleep before we hit the ground running tomorrow.
I'm hoping to be able to post some pictures soon and to share more specifics about the trip but I have very limited internet at the moment. More to come...

Lorazepam

During the first few nights in Rwanda I was suffering from jet lag and was unable to sleep. Lisa so kindly offered me her ipad so I could listen to her "sleepy time" play list to see if some soothing music might help. As I scrolled through the playlists on her ipad I cam across one title "Lorazepam." For all you non medical folks, lorazepam is a sedative and is also used to treat anxiety. Of course I found the very idea of a lorazepam playlist quite amusing so I took a listen. It didn't take long before I was hooked, it really worked! The power of music is pretty amazing. When I got home I made my own "alprazolam" playlist.
I love this idea and I think I might suggest it for some of the new grad nurses I'm mentoring when they work their first year in practice. Here is one of my songs from Lisa's lorazepam list: http://www.youtube.com/watch?v=yXywFuTf65I&feature=related

The Finished Product

One of the main reasons for my most recent trip to Rwanda (although, who needs an excuse)was to deliver the complete and final version of the trauma curriculum. It only took me four years to do it, but I finally finished the entirety of basic trauma curriculum that I wrote specifically for the resources available at Kibogora Hospital. The lectures are all recorded on video complete with skills demonstrations. Each module has a case study, assignments and a unit exam. It felt pretty good to hand the whole thing over to Sheila. I even took a photo as proof!
Now maybe I can start concentrating on that dissertation...

To Hell and Back

It was the weekend before Easter Sunday and I was scheduled to work at the hospital for a 12 hour shift. The assignment I got was a single patient, a woman with stage four cancer and aspiration pneumonia on a ventilator. She didn't sound too terribly complex in comparison to some patients I have had, but I would soon find out why she was singled.
As I walked into her room that morning the first thing I noticed was the number 666 tattooed on her forehead. Though she was on a fair dose of IV sedatives, she was still quite agitated and thrashing about in the bed. As I proceeded with my routine assessment I noticed two other satanic tattoos on each of her arms, additionally I found one that said "Property of ______" (fill in the blank with a name).
Upon the neurological assessment I found her to be able to respond to yes and no questions by nodding her head, she was also able to follow basic commands.
As I was charting I felt God prompt me to approach her and ask "Do you know there is a God who loves you?" When I asked her this, she began to cry. I spoke with her about it a little more and asked if I could pray for her. She nodded (or maybe she was just getting restless) so I did.
Because she was so restless and thrashed about, I couldn't leave the room as she ran the risk of extubating herself and pulling out all of her IVs. In between medications, dressings and charting I did my best to find out the story behind this woman's tattoos.
Long story short, her mother had died shortly after she was born. She was hospitalized with a head injury at age 4 which resulted in her being labeled as developmentally delayed and having almost weekly seizures. She was molested as a school aged girl and homeless by high school. She showed up in a different state several years later as homeless with a drug and alcohol problem. She had a history of multiple suicide attempts.
Later I looked up the name written on her arm and found that he was a convicted sex offender who had been imprisoned for kidnapping young girls and prostituting them at truck stops around the country. I saw a photo of the man who was also, ironically, covered with satanic tattoos.
When I got home from work, I continued to think about this women and the interaction that we had. What was it like for her to find herself restrained to a hospital bed with people hovering around her giving her interventions that she likely didn't want and probably couldn't understand? My stuggles can't even begin to compare with many of the things she has gone though. Did anything I had to say to her mean anything?
As I prayed and pondered these questions that evening this scripture came to mind: Isaiah 55:11 "So will My word be which goes forth from My mouth; It will not return to Me empty, Without accomplishing what I desire, And without succeeding in the matter for which I sent it."
If the words I said truly came from God, then they are His words and He gives them meaning and purpose. He then reminded that aside from being God, He had been to hell and back for her and for me. What a wonderful reminder of the redeeming power of God, I am humbled.

Muzungu Moments '11-4

Sorry I've been a little slow with my updates. It's been a busy week with a lot of things to do so I'll just give a short recap.
Yesterday Dorothy and Melba went to visit the Batwah Pygmie village with the hospital chaplian. Apparently it was quite the amazing experience but I have yet to see their pictures as yesterday afternoon and last night were so full.
Lisa and I finally got the 12 lead EKG machine working properly. The radiology tech is the one who does the EKGs here so we spent some time with Xavier showing him how to use the new machine. It will be interesting to do some follow up and see how often it is used and what kinds of patients are getting EKGs ordered.
I also had the opportunity to go out with the ambulance. We went to a nearby health center to pick a woman in labor with possible fetal distress. I don't really know much about OB so I couldn't really offer much in that department, but I was able to learn more about the actual ambulance, it's equipment and the transport system.
In the afternoon, my class did some ambulance drills. I think it's safe to say that everyone had a lot of fun. Our assigned pretent patients did a great job acting sick or injured and there was a lot of laughter involved. We drew quite the crowd!
It's now time to start heading out to Kigali where we will visit the Bourbon (Rwanda's Starbucks with the most wonderful Rwandan coffee ever!) and perhaps visit the genocide museum. We fly out to Kenya tomorrow afternoon. It's hard to believe that the trip is almost over.

Muzungu Moments '11-3 Ambulances in Africa

This morning after I finished my class I went down to the ER just to see what was going on. Communication is starting to get a bit better and I managed to get the point across that I needed to look at/in the ambulances. When I went out to the first ambulance I was pleasantly surprised to find a nearly full oxygen cylander, a working portable suction unit and a fully functional transport monitor complete with EKG cable and and SPO2 monitor, score!!!
Nobody seemed to know what the oxygen tank was or what to do with it so I'm assuming that is how it remains full. I found a few electrodes for the EKG monitor and we tested it out on John, the driver, who had never before seen an EKG. It was like Christmas for all of us! We couldn't stop smiling and laughing all over a simple EKG tracing. I must have spent about an hour in the back of just one of the rigs showing John and Dr. Bora how to turn off and on the O2 tank and what to do with all of the other exciting finds of the day.
The next time the rig goes out when I'm not teaching, I'm supposed to tag along. I guess I'm teaching an ambulance class at the end of the week.
Melba is having a good time with her quality improvement group and Lisa taught a clas about heart failure to the doctors today. Dorothy's got the backboard strap situation almost completely covered. We've been keeping busy here, I just wish there more hours to the day.

Muzungu Moments '11-2

Lightening is Striking Again...
Last night after my class session I went down to the emergency room to track down Lisa and to see what was going on. As I was walking down the hill, two ambulances went speeding past me. As I got down to the ER entry there was a lot of commotion. All of the ER beds were full and there were crying babies, and people moaning on stretchers all over. I couldn’t find anyone in the ER who spoke English and Lisa was nowhere to be found so I ran back up to house to see if I could find her and we could all go to the ER to help.
As it turns out,5 people who had just been stricken by lightening had been brought in from a village clinic; two little boys and three women. One of the women had a baby strapped to her back at the time of the strike and had been thrown to the ground baby and all. We examined all the patients for signs of arrhythmias and burns, looking for entries and exits of electricity. One of the boys had burns on his neck while another women was found to have burns on her back and yet another with burns on her legs. The infant was assessed for potential injuries from the mother’s fall but checked out as normal.
All of the patients were admitted for observation overnight. Lisa was able to do a little education about rhabdomyolysis and the importance of administering fluids and assessing labs. This morning when we went to round on the patients, no labs were available. We also had difficulty even finding the patients as nobody seemed to know where they got transferred to. Fortunately, when we found them, all of the patients appeared stable but the overall experience of watching how this situation was handled was quite interesting. The doctor we were working with had never seen lightening strike victims before and I had only seen one under very different circumstances. What an interesting day!

Muzungu Moments '11:1

I taught the trauma assessment class yesterday and used Melba as my patient for demonstration. Everyone thought she was my mom! Things went fairly well and in the afternoon session we had opportunity to practice, which is always fun to watch. It was the lone midwife in our class who seemed to pick up things the most quickly, a sharp woman she is!
Lisa and I were able to round with one of the doctors in internal medicine. We are seeing quite a few respiratory infections, cases of ascites and case of heart failure.
It would appear that our next assignment is to fix (figure out how it works) an EKG machine, teach basic EKG interpretation and prepare a basic curriculum on heart failure. This wouldn’t be a problem accept for the fact that poor Lisa is only given 2 hours to present 5 subjects! We shall see…
Dorothy is having a great time working with the malnutrition program. She may even get to go to a village to see the community nutrition programs! We have also charged her with the task of designing some backboard straps for the two new backboards that have been made here a Kibogora since I was here in 2008. (See blog posts of May 2008 to truly understand the excitement of this). Lisa also had the brilliant idea of making pinwheels for the patients to blow on (because there are no incentive spirometers) for pulmonary hygiene; another great way to put Dorothy’s creativity to work!

Hats off to Kibogora

We've made it to Kibogora with 323 crocheted or knitted hats! The hats were made by various women (including my mom, my sister, my old high school Spanish teacher and Julie's mom) around the state of Washington to be given out to children being treated for malnutrition at the hospital program. Before we left, people just kept loading us up with hats. We were able to vacuum pack them and take every hat we were given. When we got here, Dorothy counted 323 hats for Kibogora!

Mediwe From Rwanda!

Mediwe from Rwanda! Melba, Lisa, Dorothy and I made it safely to Kibogora last night. We have now had a good night's sleep and are being filled on the happenings around the hospital. This afternoon's assignment is to fix EKG machines! It looks like I'll be teaching the nurses the trauma curriculum in the mornings with practicum in the afternoons. I will also be working in the ER and with the ambulances. Apparently there is a need for some training regarding patient triage and transport in the ambulances, sounds like a fun project to me!
Lisa and I will be working together fairly closely on the teaching projects and we might just whip something up about cardiology also. Melba will be working with the nurse managers on quality improvement issues and she will also be working with Lisa and I in developing a disaster plan. Dorothy is already happily working away in the supply department and later she will be working with the child malnutrition program. She might also get to go to the villages to work with a community nutrition program as well. All in all we are doing well and are excited to get started working on things. The projects however, just seem to be getting bigger. I guess that just means that we'll have to come back again to continue them!
The internet here is a little scetchy so I don't know how often I'll be able to update this, but I hope to do it frequently. Thanks for reading and thinking of us on our journey!

Slumber Party in Kenya!

I just bought 4 tickets to Rwanda! Unfortunately we have an 11 hour layover in Kenya but I anticipate that we will all be so tired that at that point we'll be at the "everything is funny" stage. Looks like we'll be having a slumber party in Kenya!
So it appears that I will be returning to Kibogora,Rwanda with a wonderful team of health care professionals. The team consists of a family medicine doctor, a fellow nursing professor and a nutritionist. I will be delivering the completed trauma curriculum. My friend Lisa (the doctor) and I will be developing some teaching materials on basic cardiology for the hospital staff as they just recently got their first EKG machine.
Melba,the other nursing professor, will be working with the nurse managers on quality improvement strategies and Dorothy (the nutritionist) will be working with the child survival program. I also plan to do a little networking and note taking for possible future work on my dissertation. Stay tuned for another round of "Muzungu Moments."

They Should Put a Warning Label on These Things

I think there should be a warning label on graduate education, esp. doctoral education. I've heard that doctoral education is less about learning certain things and more about becoming a certain kind of person. It's true... Doctoral education is an experience that will change the way you see the world, think about the world and communicate with the world forever. I can't say that's a bad thing but it's not an entirely good thing either. There is danger of becoming indecisive; instead of becoming more concrete, many things become more ambigous. The people who make up degree programs and decide prerequisits, objectives and requirements; the people who accredit these same programs are people no different than you and me. This a scarey thought in my mind. Embarking on this process also has potential to affect the way you are able to relate (or perhaps more likely, not relate) to others. How do you make your new paradigm compatible with function in the world you live in? It would be interesting to do a study on students persuing a PhD to examine the life changes they experience during and immediately after PhD journey. Did they experience any major changes in their relationships with family, friends and collegues? Did they change jobs? What would they put warning labels on?
I asked one student what she would put a warning label on and we ended up having a really interesting conversation. What life experiences would you put a warning label on and why?

I Love It When a Plan Comes Together

The other day a student came to my office with questions about clinical paperwork. Somehow the conversation went from paperwork to prayer and ended up lasting and hour and a half. We talked about the things we were learning about prayer and the things we didn't understand about it. We talked about how prayer "changes things" but more importantly how prayer changes us.
At the end of our conversation, I mentioned how I felt God was calling us as a campus community to prayer. She said that she had been thinking similar things. Long story short, for post clinical conference we ended up back at the school at 10pm doing a prayer walk through the building. When we made it to the offices, each student stood outside a faculty members office and prayed. Turns out that God had been stirring each one of their hearts to the same thing. I'm excited to see what God is doing.

Friends and Fortune Cookies

A couple of weeks ago I was eating Chinese food with my sister. Of course there were fortune cookies involved. Truth be told, I actually think fortune cookies taste pretty awful, kind of like those waffle cones that fancy ice cream is served in. I can't waste food, so I ate it anyway. The "fortune" inside said, "You will be visited by a dear friend from afar." Conveniently, it just so happened to be the Christmas season. The chances of friends visiting "from afar" had just increased exponentially.
As I reflect on my last several weeks, I am blessed to have such wonderful friends from both near and far.

Carlos and Carrie, friends and missionaries from Mexico City, came to visit us in Seattle for two weeks in December. We had a great time full of exploring the Pacific Northwest, fellowship and of course food. We were able to have a reunion of previous "Mexico Goers" which proved to be a wonderful time. It was pretty amazing to see how our work with Carlos and Carrie in Mexico City has grown and how it has positively impacted so many people. Yay for "sappy teacher moments!"

Olie's Graduation

I've been feeling a little guilty because I haven't posted anything for a while. I had a mental list of blog worthy topics but for some reason, they escape me at the moment. I took a look at my phone and caught a glimpse of Olie's graduation photo. I haven't written about that yet.
Olie and I signed up for an 8 week session of puppy classes. Most of the time he went wild and barked a lot, but did manage to learn a few things. He sits, lays down, shakes, comes and occasionally walks on leash without pulling. Go Olie!