Dashain and Tihar Festivals!
I am pleasantly surprised how the patients deal with the busy wards and staff here. Everybody waits without any complaints, those who speak English have told me, that they look around, and see that everyone else is also waiting and is just as sick. Inside the hospital they help and learn from each other. They have a lot less privacy but they make the best of it.
Everyone is so sweet and helpful, and I have been invited to so many dinner parties, that I have lost count. I spent most of Dashain and Dwali with my host family - everyone dressed up, and the food was amazing. Even the goat intestines tasted good – although maybe it was the atmosphere.
I have been lucky to see many different parts of Nepal in the festival days, but Diwali was definitely one of the best experiences.
My lovely boyfriend Peter came to Nepal to surprise me in The Garden of Dreams. He had planned it with Lucy, and she had told me we were going to a business meeting, so I just went a long without any question. It seemed like a strange place for a business meeting, but what do I know - it is Nepal. Suddenly I see a very blond person, but I did not think about it, then the person started to look like my boyfriend, I squeezed my eyes and realised it was my boyfriend, I look at Lucy and Peter again, and realize it was all planned!!! I am not a big fan of surprises, but looking back now, it was quite sweet! We had a week together and it was a nice break from NTR work.
We went out to eat a 22-course Nepali dinner in a very fancy restaurant. My stomach was not feeling great from the start, and all the food didn’t make it any better. You would think 22 courses would be small dishes, but no - normal size. I was ready to leave after the first 10 courses, but then he started to talk about a special present and I am the type of person who really likes presents so we stayed and I am glad we did.
You need to understand that my boyfriend is normally always well prepared or really good at hiding it, not nervous, love to talk and hold speeches, he travels in DR Congo, North Korea, and Iraq for fun!
This is the first time I ever have experienced him be visible nervous, and forgetting half the word he wanted to say, but he got down on his knees, and asked me to marry him, with the most gorgeous ring, with the finest quality diamond, white gold, and gold which he broad home from DR Congo two years ago. How romantic is that?!
We are both very happy and looking forward to get married next year!:) Now, back to reality….
REORGANISATION OF THE CHEMOTHERAPY PREPARATION ROOM:
As I mentioned in my last blog, I presented my recommendations for changes for the Nursing Director, Nursing Educator, Nursing Supervisor and the Preceptors. The following week I started in Medical Oncology to reorganize the whole chemotherapy room.
I do not think the Preceptors in the ward quite understood what I meant before we started. Once they got the hang of it, they were very interested and helped out with delegation of all the tasks, and I basically sat on a chair directing everybody what to do - an awkward feeling because I do not mind hard ward, but it seemed important for the Preceptors to maintain the hierarchy. Many different people were involved in the change, and it was definitely the entertainment of the day.
So what did we change?
The ward has only one room available for chemotherapy preparation, waste, storage and emergency equipment. In any developed country, chemotherapy is prepared in a separate room in a different ward often in the pharmacy, in a sterile environment. Chemotherapy is a health hazard, which basically means that if you are constantly being exposed without proper protection, there is a possibility you will experience anything from acute to long time side effects e.g. eye irritation, skin allergies, flu-like symptoms, sore throat, headaches, chronic cough, dizziness, fertility impairment, fetal loss, fetal abnormalities and/or cancers. Yes- this is serious.
I created a “Timeout chemotherapy preparation” poster a tool the nurses can use every time they are about to prepare chemotherapy. It is a tool, which is supposed to make them reflect, if they have remembered everything before they start preparing, so they don’t have to stop and start the preparation all the time.
We have also trained the staff to:
- Decontaminate drugs before and after preparation to protect staff and patient health
- Keep hands inside protective cabinet during preparation, and not take contaminated hands in and out to avoid spreading the chemotherapy to the work environment
- To take Personal protective equipment on/off correctly
- Identify the different between surgical mask and respirator
- Change gloves minimum every 30 min
- Talk about their work environment and how to protect themselves.
These simple changes in procedures will hopefully make the environment safer for the staff, families, patients etc. Right now this is the best that can be achieved with the resources they have available. Within two weeks I had showed the new procedures to the preceptors a couple of times. I believe the best start is they start to realize that chemotherapy is possibly very dangerous for them, and they need to change habits and procedures to create a more safe work environment.
Some of the nursing managers are really amazing. During the three days I had together with the preceptors in hematology and pediatrics, every single nurse was shown how to prepare chemotherapy in a way that was safer for themselves and the patients. The more time I spend here at the hospital. The more passionate I get about my and NTR’s work here. I really want to find a sustainable way to make the working environment safer for the staff, the patients and their families.
All the nurses are daily trying to save the life of their patients, and in the same time, they are slowly exposing themselves to hazardous materials.
It breaks my heart that the hospital would rather buy new complicated machines, that they don’t need yet, than provide their staff with proper personal protection. Hopefully because some of the doctors working here start to realize how serious it is, they will help to convince the management, government or whoever is responsible that they need to take safety seriously.
Next month I will make a survey about the staffs health, and if they have experienced any side effects which may have connection to exposure to hazardous drugs. I hope that we can get some valid data, and present to the hospital management etc. together with NTR's director Lucy.
I will meet up with the NTR team in Kathmandu, and four nurses will come down to Chitwan with me and I'm looking forward to having some company here in Chitwan.
We will have two teaching days in the second week in November. I will lecture about Emergencies in Oncology together with one of the preceptors from Medical Oncology and a lecture in Chemotherapy with two Preceptors.
Hopefully I will finish the Advanced Oncology log-book and continue working for a better work environment together with the preceptors.
I will let you know have it all goes in a couple of weeks.