Tuesday, 11 November 2008

The HIV/Aids Outpatient clinic

I started at the clinic today, full of trepidation, unsure how I will cope in this new area of work. Well, I did, 40 patients later, and with a great sense of achievement at the end.

There are 3 clinical nurse specialists working there. They provide the primary and secondary care to the newly diagnosed and the returnees. They provide counselling and information as and when required.There appeared to be a lot of duplicating information being collected in various formats .One for HIV testing , another for CD4 blood count, and another for dispensing the tablets . So it goes on ...

The nurses work 6 hours shift x 6 days, sunday to friday. Saturday is their weekly holiday.They work similar hours to UK nurses except that we do ours in 5 days, with an hour less. Their shifts are 8/9am to2/3pm.I am less clear now about the shift pattern in UK

The background to the huge rise in HIV patients are mainly through sexual transmision .And the drug addiction to a lesser extent.Nepali men needs to go abroad to seek better paid jobs in order to support their families. Majority of men tended to go to India across the border to find their fortune. Nepal is surrounded by India on 3 sides and China ,on the other. Many Nepali young girls (10 years onwards ) have been kidnapped and sold into prostitution along the border to service the men .By the time the girls/young women showed signs and symptoms of the conditon, they were discarded back to Nepal . Their families are ashamed of them and shunned them .In the same token, the Nepali men became infected through their many years away from their wives. Majority of the patients are males from19 -40 years of age They in turn infected their wives on their glorious return from India

I booked 7 chidren in for CD4 blood test today. They ranged from 4 years to 10 years, from an orphanage. They all seemed happy enough in the corridor. I was thrown in the deep end .I had to find out their names and address in English because all notes were written in Nepali language.
The Nepalis have their own calendar for the year , month and day.It is like the chinese with our own lunar calendar. According to the Nepali calendar, today is 2065/7/26 and not 2008/11/11. To confuse the matter further, the Nepali 1 2 3 4 and so on do not resemble anything like the Roman 1 2 3 4 as we know it. I have to do a crash course to recognise the 1 2 3 4 in Nepali. it was fun and games.

I thought I was doing ok , all things considered when the nurses asked if I could dispense the tablets to the patients as well. Bearing in mind the notes were written in nepali, this was one occasion when I started to sweat. Talked about being put under the pressure. I said smilingly to the nurse that I am in no position to help her out there, because I can't read the notes. Admittedly UKCC Codes of Professioal Conduct did flash through my mind, much good that did me.In the event, the patient dispensed the tablets for himself and one other patient while I look on , bemused. Talk about accountability! However,I did managed to get their signatures in the dispensing book. That I thought was pretty good , under the circumstances.

Dr Pandey came along sometime in the morning. Apparently he stood and watched what I was doing for a considerable time. I was so snowed under, surrounded by 4/5 patients at any one time that I didn't look up until he came close to the booking desk. He then told me thatI am to stay in this clinic for the rest of the week. I have to say I am very happy to do that

All in all, a very satisfying day .This is the first time since arriving in Nepal that I feel I have done something useful. I feel really good walking home through the dust and chaos when I finish my shift. I look forward to going again tomorrow

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