Well Tuesday was once of the busiest since I arrived. It felt good to be occupied for the whole day as the past week and a half have been very quiet. I was beginning to wonder whether there were actually any patients for me to see!
We had arranged to go back and see our man who I had seen last week. I had packed up stronger pain killers to take in anticipation that he would need more. I was keen to get to know the family a bit more and to start to build a relationship with them. We had also not really started to talk about how they felt about the patient dying. As we let ourselves in through the gate into the courtyard of their house, Sylvie (our translator) pulled us back. 'I think something has happened' she said. Several family members and friends were sitting around. 'People only sit in large groups like this if someone has died' she said. The custom is not to immediately give condolences for the death, but to make small talk first before asking. Eventually we found out that he had died on Sunday. The family insinuated that they knew he was going to die when we visited last week even though they did not say anything. It is so difficult in this culture to know when to broach challenging topics. The advice that we were given from the ship was to hold back until relationships had been formed however we could have possibly talked further last week. Its a minefield! The family seemed so grateful for us coming to see him, even though we had not really started to help them and to get his pain under control. As a result, he died in pain. As a nurse it is so difficult for me to not be able to meet the needs of the patient and give them a good and comfortable death. I felt that the gratitude that the family showed us was so undeserved on our part. But afterwards I realised that just us being there and showing some love and support was more than they would ever get. We left having been invited to the funeral, which is going to be a cultural experience and a half!
In the afternoon Alex and I had been asked to talk to a group of local church pastors about caring for the palliative care patients in their communities. It started well with me talking a bit about palliative care and touching briefly on what cancer is and its causes. Alex then went on to explain the Biblical theory behind caring for the dying. At this point I then made the mistake of encouraging questions. They had picked up on what I had said but couldn't understand that the causes of cancer I mentioned were only risks, and did not cause cancer in everyone. Then followed a 45 minute barrage of questions the best being, 'My Aunt did not wash out her cooking pot and kept reusing it. There was debris left at the bottom and she then got breast cancer - could this have caused it?!'. I am just beginning to realise what a problem cancer is here and how little services there are for early diagnosis and treatment, let alone palliative care. There is very little education or knowledge about cancer despite it being very prevalent. I am finding that my patients do not have an understanding of what cancer is. I am putting together a teaching aid to simply explain cancer to people as it is proving to be a huge challenge to make people grasp an understanding of their condition. There is also widespread thought that if a person has a visible tumour, then they are cursed or have sinned. We are trying to re educate people that this is not the case. Despite all of this, people are very open to talking about their faith and being prayed for which means that we are able to give our patients hope and peace through their suffering and grief. We also have weekly team and hospital devotionals which means that we can talk and pray through any issues. My line manager is also wonderful and very supportive. I know that if I am having a tough time there is always someone to debrief with and pray with which is the amazing thing about working in a Christian environment.
Yesterday I got the ok to drive the ship Land Rovers. It feels a little bit like driving a tank and is a lot wider than what I am used to. I haven't been out on the roads yet, but I am slightly apprehensive. As you can imagine the roads are chaos especially the erratic behaviour of people on motorbikes. The craziest part of the roads is the roundabouts - the rule is that the people coming in to the roundabout have right of way so you have to give way once you are on the roundabout. Who ever thought that that was a good idea?!
Physically my stomach has settled now. I have been so blessed by all the words of encouragement from all my friends at home. God has really been answering my prayers this week and, especially when it comes to seeing patients, has given me a peace and love for what I am doing that I had not thought I would get so soon. I feel like this is the right place for me to be and despite a lot of things being quite tough still, I am beginning to feel more settled. Thank you all for your love and support, it means so much to me.
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