Notes from the Surgical Ward

- So, in true Ugandan nursing fashion, I have been issued a little white outfit (very spiffy as you can imagine) to wear to the hospital everyday. Okay, so don’t take “little” literally…it’s just a figure of speech I guess…we’re not talking about a tight-fitting-mini-skirted white outfit like you’d find on a variety of skinny blondes at any given mainstream Halloween party in the States (since everyone knows that’s what nurses wear to work everyday afterall – so practical in cleaning up all kinds of bodily fluids and hauling people of all shapes and sizes up/down/around into different positions in their beds - since that’s clearly what nurses do all day…anyways I digress…). I was issued white tops and “trousers” since I’ve been told the Ugandan nurses “fear the trousers.” All of the “real” nurses wear the little white caps (which are more like crowns and seem to me to serve no purpose other than demarcating who is somewhat legit), and white uniform dresses. Well, the “trousers” I was issued are elastic waisted and about 5 sizes too big for me, so I had them altered back in Bundi before I came for good. Let’s just say that the altering was good, but you can only alter pants that are 5 sizes too big so much. So, one of the nurses and I were walking to where the hospital laundry is done (a couple buildings away from the Ward) and I was having to hike up my pants to keep them from falling down (which while wearing a long stiff shirt is no small task) and remarking to the nurse “these pants they gave me, they are too big.” And she looks at me with a surprised look and says matter of factly, “but you also are big.” Well, gee thanks. I acknowledged the truth in her statement but clarified that I may be big, but the pants are clearly big-er…it reminded me of the time I was on a boda going up the huge hill just past the health center in Nyahuka, and the motorcycle was put-putting away, struggling to get up the hill, and the driver turns his head slightly so I can hear him and says “you have too many kilo’s”…what else could I say other than, “sorry” (well, maybe, “your boda has too many years” would have worked).

- While we’re on the subject of “little white nurse outfits” I’d like to take the opportunity to point out that flirting with nurses is evidently a worldwide phenomenon. I’ve been out of adult care for about 6 years now and while it happens every once in a while with teenage boys (and girls for that matter with male nurses and staff) in childrens’ hospitals, it’s a whole different ball game in adult hospitals.

- The topic of male/female patient/nurse interactions brings me to another observation from this week. Generally speaking Ugandan culture is male dominant – men behave as if they were created to “rule over” women, men here rarely allow for vulnerability on their part to be made evident. Well, being on the Surgical Ward this week there are a few male burn patients with severe burns covering about 30% of their lower limbs. Their treatment involves daily dressing changes (which are, by the way, done at the bedside with no pain medication) done by the nurses. During these dressing changes, considering their thighs are the most affected part of their legs, these young men (about my age probably) have to put their legs in all kinds of positions to allow for the removal, wound cleaning and re-application of the daily dressing. With grimaces and gasps as their open flesh is poked and pried and scrubbed, these men are totally vulnerable. It’s a pretty unique situation anywhere in the world I think, for men to be put in such vulnerable positions (literally) apart from their own choice, especially here in Uganda. And these nurses, Ugandan women, handle the vulnerability with such care, I’ve come to really admire it. These women could choose to totally take advantage (not sexually, just even interpersonally) of these men and their vulnerability, but they don’t. They treat them with the utmost respect and dignity, trying to help them maintain as much privacy/dignity/honor in the process as possible. I have no idea what they’re saying of course, it’s all in Luganda usually, but I can tell that they speak kindly and gently and even humorously to these men as they do their job. And the men seem to recognize this and return the respect the nurses give them (only flirting with them every so often).

- Ugandan nurses have an obsession with trays (and “trolleys” or carts as we call them in the States). Each ward has a whole stack of trays and you don’t go in into a room to so much as hang a new bottle of IV fluids without one…even just carrying in that bottle of IV fluids, you had better carry it in on a tray. I’ve been scolded many a time now, which is not surprising since my SLCH coworkers will attest to my tendency to pile bed linens and gauze and suction catheters and medicine and IV set ups and bottles of sterile water and anything else I might need in a room in my arms to carry it to the bedside…usually dropping several things along the way and requiring their help in picking them up as I smile as to say “sorry! It’s me again!” (The funny thing is that I usually forget something anyways and stand in the doorway and look for Pammy as she ducks and dodges my glances begging for her help :)

- Redempta (“Reh-DEMPT-ah”) is currently my favorite name I’ve learned/found here in Uganda. It’s the second name of one of the theater assistant students on the ward. It seems such a true reminder of our status as “redeemed” – where we’ve been saved to as Christians and our complete lack of ability to accomplish that on our own.

- Yesterday I was so bored in the afternoon that I was reading the admission/discharge book where every patient is cataloged and diagnoses are recorded. Hands down, the funniest diagnosis I’ve ever heard is: Testicular Exploration. I mean really, surely they could have called it something else…I know I know, Heidi, get your mind out of the gutter. Runner up (which I found today in my afternoon boredom) is the diagnosis of “Fell off the building”….ouch. Spelling is also not a very highly respected skill in Uganda; the diagnosis “Gun shot wound” was not nearly as common as it wound be in an American surgical unit, but was also spelled “gun shit wound” (which pretty accurately describes my position on the “right to carry” policy disputes we often have in the States), “gun shoot wound,” and “gun shut wound” (which pretty accurately describes what the goal of the hospital stay for such a diagnosis would be).

- And on a totally unrelated note, a comment on the habits of boda drivers. There’s a boda stage at the next plot down the hill from where I stay. That means there’s a small plot of dirt by the side of the road where boda drivers congregate while they wait for their next fare. Well, they’ve picked up on the fact that there’s a muzungu living here at the Center, so when I walk out of the gate, if I walk down the hill on their side of the road and make eye contact with them as a group, within a couple steps they’ve all revved their engines and they peel out of their spots and try to be the first one up the hill to get my fare. I laughed out loud yesterday and said to the winner of the race “ you guys crack me up!” He responded, “you have to be the first, if you delay....” and shook his head with a smile.