The Sound of Grief

Let me first apologize for the delay in posting. The last 13 days have been challenging; the last 5 especially challenging. I knew coming here there would be tough days. This is true any time I leave my comfort zone. As much as I hate to admit it, I really like having routine in my life. That's one of the reasons I do what I do: to force myself out my comfort zone--to be challenged. And challenged I have been.

As I sit here trying to write, I am at a loss on how to start. One of the main tasks I was supposed to be accomplishing was holding nursing conferences (lectures & training sessions). I have been here close to one month now, and none of the sessions have been held. I have been delayed for the last 3 weeks for a variety of reasons--some valid, some not so much. I am prayerful that it will actually happen this week.

Prior to my coming, I was under the impression that most people here understood that lack of quality nursing care was a major contributor to patient morbidity and mortality. I still think the administrators, physicians, and some of the nurses understand this. However, there are so many complex factors at play here, training is often the first thing swept aside. It seems training is quick to be postponed, but special meetings are held to "redistribute" staff almost weekly. But all of this is really just a minor annoyance. One of those reported complications of working internationally, and not what has really been weighing me down.

After being here for some time, I began to realize that it wasn't if a patient would die while I was here, but when. "When" has arrived. . . twice in 36hours. Certainly, death is something I deal on a somewhat regular basis in my line of work. And, since I have been doing this type of mission work, I have yet to leave the country without someone dying. The situations have all been vastly different, but death is the end result. I would take it personally, except I know I don't have control of this.

We've probably all heard about people in "other" countries dying because they couldn't get the help and treatment they needed. It's one thing to know this and quite another to be smacked in the face by it. On last Wednesday, I realized that one of the patients (a gentleman) needed a general surgery consult to investigate a GI bleed. The cardiac surgeon agreed and the request was made. The gentleman died on Saturday morning still waiting to be seen by the general surgeon. To say the least I was horrified and heartbroken. He'd had a stroke following his heart surgery at the beginning of June. I held his hand during painful procedures, while he was bathed him, and when he cried out in pain. I was right there. Everyone knew what needed to be done. The resources are available in Suly, it just didn't get done. And he died because of it.

I'm sorry this post is such a downer. The bedside teaching is going pretty well. Many of the nurses have started asking me questions about patients and care; :that is encouraging. Even if the lectures never happen, some of them have taken initiative and seeking out the information. As I write this, the question of proper translation for tomorrow's conference loombs. Please be in prayer for this.

I want to end this post on a high note. So, here is an adorable child I met the other evening while I was waiting for my driver. Isn't he so cute?!

Picture Pages, Picture Pages

Bethany & I washing the knives so we could cut vegetables for our picnic. Washing in the stream and then rinsing with filtered water (from my Nalgene). This was before the hike.

These are the falls! Aren't they just beautiful?! Ahmed Awa! I made just be geographically challenged, but I had no idea part of Iraq looked like this. I assumed it was desert, desert; loved this oasis. Actually, I found out that Suly is a common vacation destination for Arabs escaping the Baghdad heat. It's a balmy 122 there, whereas Suly is a cool 110-115 this time of year.

These were the "stairs" to get to the top of the falls. Without the "small stairs" one came up mid-thigh on me. I really felt as though I should have had climbing gear on. That's Bethany climbing; she and her husband are two of my new friends. (Miss you guys!)

Again, repelling gear to come down.

This was on the way to the top. I didn't alter this camera angle at all!

Beautiful view from the top!

The ridge I'm pointing to in the distance--behind that is Iran. Don't worry, this really is the closest I got. As hiking goes it's probably a 2-3 day trek to get there. Again, no plans to go there. I enjoy my Suly freedoms!

Hope you enjoyed the pictures!

Picnics & Policies

Today I started my second official workweek. (If I didn't mention it before, the workweek starts on Sunday here.) This week I will begin my "lecture series." It sounds much fancier that it is. That being said I have been working on this curriculum for a little over a month. The process of developing, implementing, and evaluating the curriculum will hopefully eventually become the basis for my MPH thesis. My first lesson is on vital signs (how to take them, when to take them, why take them?) It seems basic, but basics are necessary. I have been in the ICU and hospital for 4 full days. I have seen quite a bit; some parts okay, other, not so much. I am trying really hard to not swoop in and fix everything. ICU nurses tend to be pretty Type A--controllers. Of all the ICU nurses I know, I am among the more laid-back variety. However, I am who I am, and watching patients be under unnecessary risk is nearly impossible for me.

That said, I have had some wonderful teaching moments the last couple of days, which I have truly appreciated. I am starting to figure out what some of the barriers to learning and teaching are here. I am sure I'll learn more on Thursday when I actually try to teach.

Tomorrow, I will go into the hospital for the afternoon. Hopefully, I'll get there before the patient comes back from the operating room. I learn a great deal about colleague relations and communication styles during that relative high stress time.

In the morning, I am going to the immigration office to apply for residency. It's a requirement for anyone here longer than 10 days. I tried to go last week, but the office was apparently in the process of moving to another location. There were probably a hundred people or so milling around trying to get all their signatures and blood work when the lights went out & registration stopped. It was very confusing for this white girl. The Samaritian's Purse lawyer said, "Ok, it's not open anymore, maybe next week." I love it. We'll just keep trying.

A great Kurdish tradition is picnicking. Yesterday, Nawzad and Omar (2 Samaritian's Purse staffers) took the other 4 non-Kurds (John, Brian, Bethany & I) to Ahmed Awa for a picnic. Ahmed Awa is in the East of country. It was amazing. We were driving through the desert for a couple of hours until we entered this lush oasis. The stream was rushing past us as we ate. After lunch we went for a quick hike up to the main waterfall. It was beautiful! It reminded me of Yosemite; except that at Yosemite you can feel the falls coming, because the air gets so thick with moisture. Here they just came out of no where. The falls themsleves came from within the mountain. I had been told it was beautiful, but it really was surprising how stunning it all was.

I'd love to show you pictures as evidence but I am having trouble loading pictures onto this post. Any suggestions? I'll take them. By the way, it's now Tuesday, and I am not sure if the lecture will happen this weekend. Each day this week I have heard a different reason why. Today it was, "We must talk to the Head Nurse of the hospital and get an order to have conference." This was news to me. No one told me I had to get outside permission to teach. Oh the joys of finding your way through red tape!

Hope your week is going well! God bless!

Safely Ensconced in Northern Iraq

This title may seem to be a bit of an oxymoron, but I truly am. After leaving the States on June 1 and overnighting in Amman, Jordan, I arrived in Sulaymaniyah (Suly) on the 3rd. I spent the first couple of days getting settled into my apartment and hanging out with some of the wonderful Samaritan's Purse staff here. I actually got to see Iron Man 2 my second night here! (Fun movie) I feel totally safe here. I have been shown (on a map) were the conflict areas are, and don't worry, I have no plans to go there. It's mostly cities you've heard of. Mosul & Kirkuk are the closest conflict cities, and they are not that close. Plus, you have to try to get to them. Again, I have no plans to try. Rest assured, all my worriers!

On Sunday I started work. I will spend the next 2-ish months working with the ICU nurses at the heart hospital enhancing their skills, teaching some advanced care concepts, and helping them put it all into practice. The heart hospital has been open for 2 months and treats mainly adults, but also some children. Fortunately, over the last 2 days we performed surgery on two 8-year-old girls (who are both doing well). If it's not obvious, I say 'fortunately' because I'm more comfortable working with kids than I am with adults. Adults tend to be so much bigger than I: scary!

Dr. Jaafar is the cardiothoracic surgeon here. Through a complicated network of networking, he requested that I come. Well, not me specifically, that would be weird, but someone with my kind of background to come and train the nurses here. And since I am in school, had a 'free' summer (thanks, CHOA, for my leave of absence), & in need of a project for my public health thesis (not to mention that I am actually interested in this kind of work), I'm here. He has basically given me free rein to do whatever I want, however I want, as long as it gets done.

There are definately barriers and obstacles to overcome, but with patience and a teachable spirit (on everyone's part, especially mine), I believe this is do-able. More about this later, I'm sure.

Okay, enough about that. The countryside here is beautiful! I have a lovely view of the mountains from my 3rd floor balcony; althougth there is a dust storm today, so I can't actually see them. It's hot, very hot, and getting hotter (like 120+ degrees). Thank God for AC. Ironically, today I have AC, but no running water in my apartment. The super is working on it. I'm sure it'll be back on soon. No shower for me this morning; it's okay, it would have been cold anyway. Cold showers are almost as good as coffee, almost. If anyone is wondering what to get me for my birthday, my french press broke leaving me no other option but instant coffee. Not a great option, let me tell you; however, anything is drinkable given enough milk & sugar. But for future refence Nescafe (the brand of instant coffee here) will now be referred to as Nes-crappe.

Thanks for checking in on me! And for those who have, thank you so much for committing to praying for me. I truly covet your prayers and God has made his presence known to me more than once in exciting ways. God bless!