My internship at the Premature unit

This is the mother of my two favourite little patients past few weeks. The new born James and john. This are twin born who were born way to early. They are 2 kg today but have been in the hospital for the past month. With how many weeks they were born is not known, this happens a lot. I’ve seen many pregnant women who don’t know how long they’ve been pregnant. They come to the hospital when they think it’s time to give birth, the result of this is that some woman lay in the hospital for several weeks, going home is not an option because people come from far, far away, this is the cheapest hospital in Arusha and surroundings.

But, James and John. Especially John is a very strong boy, he gives a good kick and could go home last week, sadly he had to wait for his little brother john to be able to drink by himself. Today he did! Their mother gave him breastmilk and it all went very well. He had an effective suckle reflex as how you call this. So now it’s time for John and James to go home and grow very fast, meet their family and I wish them and their mom a really great time at home.

Their mother and I could get along very well, even though she didn't spoke English and I didn't speek Swahili. She did learn me a couple of words and I learned her some English ones.
In the beginning I didn't really know how to comfort her but I figured out that if I showed her the vital signs of her boys, if they were good or not, she knew what was going on and I saw that she liked that, to have centainty. So this I did everyday, tried to explain to her how her boys were doing and what we were going to do. At the end I was almost as relieved as she was about the fact that James and John could go home.

Sadly, not all babies are as strong and lucky as James and John. When we arrived this morning to take the vital signs from the premature babies one of them (she was born last night with a breech) already died… Nobody told us, the doctor didn’t knew, the mother wasn’t informed, we just saw a very pale feed and an oxygen machine that was turned off. At that moment we knew enough. One of us asked one of the mothers what was going on and she was the one who told us that the new born died... I’m very sorry for the child who definitely deserved better, and her mother, who carried her for almost 9 months and now has to bury her. This happened in the garden from the mother’s home instead of in a cemetery.

We told the doctor about the baby and when she was declared not live anymore it was 1 pm, when we found out at 9. In the meantime the baby lied in here bed next to the other premature. This is for us unacceptable and so frustrating but that’s the way things go around here. Dead is a completely different thing in Tanzania. For me this makes it not less terrible.

I also learned some great things today, the doctor and I worked together during the doctor’s ward rounds. A few months ago, they only had paper files, now they’re in kind of transition to an online system. In this system different disciplines can add their findings and interventions. The patient’s history and medicine are also added. I learned to admit patients, discharge them and add the findings and interventions from the doctor. Also the nurse and I made every morning health care plans from the premature babies. I found this very nice today because I’ve learned this in Holland and there it’s a very important part of being a nurse but also of the entire health care program. In a nursing care plan, we write the problem (diagnose), the goal you want to maintain and the way you are going to do it (the intervention). In holland this is a very expanded system. Here it is quite simple but as I said it is all very new, so I think it’s amazing they have this and I learned lot.

The doctor taught me the system but we figured it out together because she didn’t knew much of computers. It felt really great to mean something in the hospital and to help in the smallest way I could.