Divide and Conquer

Our morning started promptly at 6am by roosters crowing and Nat coming into our room saying "wakey wakey eggs and bakey!!" We had to make sure to be at the clinic on time because today was a big day...it was presentation day. Our schedule consisted of Nat and Cari presenting to nurses at the hospital for 3 hours on what is chemo and what is cancer, followed by a 2 hour presentation to the nursing students on the same topic. Brittany and I had prepared a short talk to present to the clinic staff on how to use all of the IV tubing that the clinic had donated to them.

Brittany and I had a good presentation that ended with the nurses excitedly practicing with the IV tubing. We then sat in with Furaha (the oncologist) while he saw patients in the clinic. The day started with Furaha reviewing the charts of the patients he would be seeing this morning. 

He beckoned us to sit with him as the nurses one by one brought patients back. We saw 4 patients with him. We saw a white woman with breast cancer who had come in to get her sixth cycle of chemotherapy. She spoke English very well, and when we chatted with her we found out she was born and raised in Tanzania and her parents immigrated to Africa before she was born. She has spent her whole life in Tanzania. She was the first white person we had seen that wasn't a "westerner/muzungu." She was an interesting patient because she originally got her first treatments in Nairobi, Kenya. She was on vacation to England for 2 weeks to visit her son, and had a PET scan while she was there. Her 2 week trip turned into 6 months while she received her treatment. While in England, she had a port placed. This provided to be a problem for the nurses in the clinic because no one had really worked with them before! Thankfully- this is what we know!!! She actually had brought a port needle with her and we were able to walk the nurses through on how to access it. Just to give you an idea of "africa time"...here is how her day went..

8am- arrived at clinic

8:15am- decided to leave the clinic because she saw a lot of people in the waiting room. She headed to the lab which is about a 5 min drive from the cancer clinic. Most patients get their labs done at the hospital (?) (we think?) but she chooses to pay out of pocket at a private lab- to get her results ASAP. She was out of there and back to the clinic by 8:45

9am- called back to meet with Furaha- reviewed her chart and what type of treatment she was going to receive

9:30- She was sent to the infusion center to get her treatment

11:00- she left to get lunch- hadn't received her chemo yet at this point

12:15- We assisted in accessing her port, explaining to the nurses what to do. They were able to verbalize back our teaching and were excited to now know how to access ports! They will get more practice when she returns in 3 weeks. 

She got her infusions and was out the door around 6pm. She had brought a book, a computer, and other things to keep her busy. When we were sitting with her, waiting to do the port, she said, "you get used to waiting here!" She had a long day!

After her visit, we saw a man who was in his 80s. He had advanced prostate cancer and the first line of treatment did not work. Furaha explained to him that the next line of treatment would be to do the second line of chemotherapy, but it would be very very expensive. Another option would be palliative radiation, but he would have to travel to Dar Es Salaam which is about 9 hours away by bus. He was in excruciating pain (at least an 8/10) but there was just no possible way for him to do either the chemo or the palliative radiation in Dar. It was a humbling experience to realize that this patient truly had no other option except pain control and symptom management. Palliative care is a really important topic here and they truly can benefit from it. Anyone who knows me knows that it's a topic I am very interested in, so this was extremely eye opening to me. Already, the wheels were turning in my head about the future and how we can streamline the process to make care available to everyone. 

Brittany and I hung around the infusion center for the rest of the afternoon, breaking to go to lunch (at home). We were able to observe the nurses with their process, reviewing our IV tubing (they were using it all correctly!), drip rates, and reviewing neutropenia and leukopenia. We made a list of things to do to help improve their workflow. By the end of the day, there were 5 patients actively getting chemo. It was so cool to see how good they are at putting in peripheral IV's and how the nurses are so ready to learn from us.

We hit a bump in the road when the nurses were to give 190mg of Methotrexate (20cc) over 5 min as an IV push. The only concentration we could find of the Methotrexate was 10mg/4ml. We quickly did the math and realized that we would have well over 70cc of the medication, which was not the original 20cc intended by the oncologist. (For all the non-oncology nurses, people can react to Methotrexate, and so it is sometimes given first as a smaller dose in an IV push/bolus. If the patient can tolerate that, we go ahead with the larger dose). The doctor came over and made a couple phone calls, and it was determined that we would pick it up tomorrow and try to find the medication at the right concentration. If we were to give the concentration we had on hand, we would wipe out their whole supply- and they use that particular drug for the pediatric patients as well. There are just so many differences and it is eye opening to see the hurdles that are faced that we otherwise take for granted.

While Brittany and I spent time with the nurses in the infusion center, Cari and Nat were cranking out their presentations. They spent 3 hours reviewing topics such as  "What is Cancer?" and "What is Chemotherapy" to a group of nurses- 1 or 2 representatives from each ward. After a few hiccups (a table falling on Cari's foot is actually the hiccup I am talking about.... go figure!) It was hands on and interactive, and the nurses were very receptive. Cari and Nat reviewed safe chemo handling and what to do if there was a chemo spill. The nurses all wanted copies of the power point presentation for their reference, so they collected email addresses at the end. They then headed to the nursing school, where they did a condensed version of the presentation they just did. Although it was pretty warm in the classroom (we are not doing too hot with this heat.....lol, no pun intended), they were able to present the material and the nursing students learned about what cancer was and the very basics on how to treat it!

We found out this afternoon that we had run out of data on our "wifi stick" (we have a little vodacom hotspot that we can carry with us to give us wifi). I guess all the blogging, picture uploading, and face timing eats up some data, who knew ;)  Nat and Cari headed to the little shops that are in front of KCMC after their presentations at the school, and tried to figure out how to reload it. We paid approximately 12,000 shillings ($5) to load it up and it should hopefully last us another week. 

Around 6pm we finally started to head home, totally exhausted! Fatuma had some yummy pancakes, mango, and bananas prepared for us for dinner. We ate, showered and prepared our slides and presentations for tomorrow. 

In case you were wondering what ~$150 USD in TZS looks like....

We are all struggling with our own little first world problems while we are here...

1. I got a cold in the middle of a dry african summer.... Who knew that was possible??!

2. Having a table accidentally dropped on Cari's foot in TZ is not a good idea.. especially when you have a 15 min walk one way to the clinic 

3. Brittany is feeling like Nagini from Harry Potter--because of her cruise she just went on she is peeling on her arms and legs..The people here don't know what to think!!

4. Nat fell in the shower yesterday out of nowhere.......and cut her foot. Someone give her a yellow fall risk band!

Until next time...

Kari