A visit to Motherwell Clinic — Elayne’s blog
Yesterday & today Janel & I went to Motherwell Clinic. This is a state run clinic (last week’s clinic experience was a municipal (city) run clinic, at least I think that is the way it goes.) Here they have all services and are open 24 hours to deliver babies, treat stabbings, shootings, asthma attacks, etc; much like our ERs. On regular clinic days they can treat upwards to 300 patients/day.
Each clinical visit brings a new experience. Here we teamed up with the 3rd yr NMMU students. The Matron for students (the clinical instructor) is a very pleasant, 70 YEAR OLD lady who has been doing nursing for as she says “I can’t remember how long.” She enjoys nursing and spreads her knowledge and enthusiasm to her students. I must say, though, that she loves her 10am tea break also. But, after seeing patients 2 at a time (so that each patient had 2 NMMU students and us as students) all morning, she needs a break by 10am.
We saw lots of HTN, DM, a patient with scabies (repeat episode because he did not use the medicated soap given him properly), diabetic ulcer that was I&D ed at the hospital, cough, etc., etc., etc. Lots of the same problems we see in our clinics, but the volume is overwhelming. I was totally blown away when I saw male & female patients being assessed in the same room. The patients don’t even blink an eye about this. If your problem is abd pain or breast discomfort, it doesn’t matter; they “whip it out”, no matter who is on the other side. But I guess if you are waiting 1/2 the day to be seen, or live with 10 people in 1 or 2 rooms privacy is not your top priority. Could you imagine this in the USA; we can’t even mention another patient’s name in the presence of a patient for fear that Mother HIPPA would slap us down !!!
I also have been seeing how hard it is to get a history from patients. (It has nothing to do with language). You have to know not only what questions to ask, but how to ask them. One girl came with c/o RLQ abd pain, she denied pregnancy, but had no menses x 4 mo. After questioning her for about 15 min she was then examined on the table in the back of the room only to find a protruding belly and pain that would not allow her to lay flat. The instructor asked her if she felt movement in her belly and she said YES. Guess what, you are pregnant with PID so off she was sent to the women’s clinic so they could prescribe safe medications for the infection.
Our second day at Motherwell I felt more at ease and I think the NMMU students did too. They would include us in the exams (lung assessments, breast exams, abd exams). They wanted to take pictures of them and us working & teaching patients and we had a good laugh taking pictures while we shared skills with each other. I asked questions about treating pain after surgery and explained our PCA and epidural approaches. Janel talked with them about pain management during infant delivery. Basically, I think, there are no epidural blocks for delivery in the public hospitals. The students were concerned about “does this affect the baby?”
I truly enjoyed tea time with Sister Mtisizi. She talked about her experience during the Apartheid and explained the peaceful transition. Up to this point I did not understand everything that happened, but to hear her express her feelings on the day of the change over and to watch her gestures was truly moving.
All and all I had a very good day. I think the shock of the poverty is over, now I am starting to see how one does what they can with what they have. It was a new and different experience for Janel & me to see how sharing hand sanitizer (we did a lot of this today), pens, and tote bags bring sincere excitement and gratitude. — Elayne