The doctors are on strike in Tanzania. I'm not kidding. Patients are dying while the doctors are arguing with the government about salary. It started about 3 weeks ago and just made its way to Haydom today. Fortunately at Haydom there are a number of western doctors here to provide care. Here's some more information: http://allafrica.com/stories/201202070756.html

I've been in the ICU for the past 2 days and it continues to be a challenge. I introduced one of my Norwegian friends to the phrase "fish out of water" and I cannot think of a better phrase to describe how I feel. The ICU is utter chaos. There are approximately 10 Tanzanian nursing students, 4 Norwegian nursing students, and 2 nurses working at any given time a small 2 room unit. There are 12 possible patient beds and patients are constantly coming and going. Patients range in age from 8 days old to 95 years old (talk about spectrum of care!). They practice team nursing. Team nursing is the practice of working together as nurses to get tasks done without a primary nurse. My friends that I've worked with in the past, I've loved it. It means a teamwork atmosphere and improved patient care because if one nurse is tied up, another can help. What this means here is that no nurse takes responsibility for the patients. I have literally stepped in to intervene in patients that need assistance and apparently this meant that I assumed care of the patient.

Karen and I taught our first lesson on the respiratory system today. One area that needs improvement is basic assessment. The nurses do not routinely assess their patients. This is one thing that we would like to see improve. I do not believe that the nurses are to blame but rather the system of education. There is a great lapse in education.

The day starts with breakfast at 7 and is followed by sala at 8. Sala is a short chapel service. I first attended sala yesterday and was greeted by the melodious sound of the Tanzanian nursing students singing a hymn. Their voices are amazing. After a hymn one of the Tanzanians reads a passage of scripture. That is followed by introducing newcomers and announcing those departing. After a short prayer, everyone is dismissed to start the day.

There are lots of donations that must be sorted. Unfortunately, a lot of it does not come with manual or all of the parts. At one point yesterday there was a Norwegian nurse and this American nurse trying to figure out a German monitor on a Tanzanian patient. Today we tried to put together a ventilator. I gained a new appreciation for respiratory therapists. Eventually, Karen was successful after I admitted defeat and started an IV, something I can do. The lack of resources is unbelievable. At one point yesterday we ran out of gloves in the ICU. Oh, yes, and there are 2 oxygen compressors that can be shared between 2 patients each. That means that no more than 4 patients in the ICU can receive oxygen at any given time. The picture I've included (sorry for the poor quality) is Karen and Morten attempting to figure out he ventilator and remove a bug from the tubing.

It is easy to identify areas that need improvement. It is not so easy to think logistically about how to facilitate change. I feel 100% inadequate. However, the head nurse today discussed wanting to develop the emergency room...something I know! The emergency room is currently called "casualty room" and is more like a receiving area prior to admission. I have not ascertained if interventions actually occur there. We are supposed to meet soon to discuss what he wants.