Week 5 (June 10-16)
Research Experience
We made it to Dar es Salaam on Saturday evening (11 hour drive from Iringa) and started working at our new hospital research site this week. On Monday we met with the hospital's academic and research director. She was welcoming but also informed us that our plans for interpreters would not be possible (non-hospital employees need special permission to work in the hospital or something) and so we are trying to figure that out. This week we were planning on just being with Megan (the post-doc) anyway, so it didn't change much for now. We shadowed doctors, nurses, and residents on ward rounds and also conducted 6 interviews—5 with health professionals and 1 with a patient. We were also able to attend a morning meeting at which residents present on specific cancers and example patient cases. It was interesting to learn more about the medical side of things and also to observe medical training in action.
Patients here are much sicker, as we are in the palliative care unit of the biggest (only?) cancer hospital in the country, so our interviewing process will have to look much different for patients and relatives than it was at our previous research site. The patient that we were able to interview is not an in-patient, but a survivor who is now getting chemo again. She is a volunteer at the hospital who spends all day informing others about cancer, so she was willing and interested in talking to us. Most interviews were just conducted by Megan in Swahili or in a mix of Swahili and English.
Findings
There have not been super significant findings this week as we were mostly just getting adjusted to the new research environment. One notable difference, though, is that at this hospital we are working with the palliative care team. The main focus of palliative care is pain reduction, and so most of the daily activities for nurses revolve around pain: asking patients and relatives about pain, getting doctors to prescribe pain medication, administering pain medication, counseling patients and relatives about the medication, reevaluating the dosage, etc. The main pain medication given to patients on palliative care here is liquid oral morphine, which is called dawa ya maji in Swahili (translates to water medicine).
Pain assessment is also slightly different in the palliative care here. Along with the methods I've observed previously (patient communication, facial expressions, vital signs, etc.), practitioners here also use a 1-5 scale that corresponds to the fingers on a hand, with each finger representing a different level of pain. This seems to help determine proper morphine dosage (the options are weak morphine or strong morphine) and is used in combination with the practitioner's observation and expertise.
