Week 7 (June 24-30)
Research Experience
I was only able to go to the hospital twice in my final week at Ocean Road. We spent the weekend in Zanzibar and only came back to Dar Monday evening. Jacob and I went to the hospital Tuesday morning, but we had to leave early because we had to move from one apartment to another. Megan stayed in Zanzibar for the week, so we went to ORCI alone. We also went to the hospital on Wednesday, but Thursday was a national holiday for Eid al-Adha, so we were told not to come. I caught a cold at some point and was sick Thursday and Friday, so Jacob went to the hospital alone on Friday. He was able to interview the palliative care nurse we'd been going on ward rounds with (thanks Jacob!) but other than that, we didn't conduct any interviews this week. Interviewing at ORCI was much more difficult than at Tossamaganga due to a variety of issues (lack of interpreters, busyness of workers and relatives, sickness of patients, etc.), so most of our data from this half of the project will come from observation.
During the time I spent at ORCI this week, the nurse I was with went to the ICU often and also met with a few patients and their relatives in her office. I wish I had had the chance to observe more of these meetings, because she collected a lot of interesting demographic, social, and psychological data using a detailed form (which she filled out in English as I looked over her shoulder).
Findings
A lot of observation and discussion this week was focused on hope, hopelessness, truth, and acceptance. Patients in the ICU often have very poor prognoses, and this can be very difficult for their relatives and for the patients themselves to accept. This means that nurses—especially palliative care nurses—spend a significant amount of time counseling patients and their families on their condition so that everyone feels as prepared as possible. At the same time, holding on to hope is important to some degree, and 'truth telling is sometimes very painful,' as a palliative care nurse told us after counseling the family of a man with inoperable cancer. Patients and families lean heavily on religion as a source of hope and support, and the nurses encourage that, particularly if they are able to 'accept the condition and leave it in the hand of God.'
Pain is to be avoided as much as possible, and hope, support, and food ('chakula ni dawa') seem to be the best painkillers, apart from the morphine itself. Patients and their families are encouraged to focus on improving quality of life and ensuring comfort, and to let go of concerns about productivity and responsibilities (such as fear of losing work or becoming a financial burden). It's unclear to me how effective this counseling ends up being, but the nurse I was shadowing clearly cared deeply, and that counts for something.
