Goodbye Mango

I’ve worked my last shift. I’ve packed up my things and left my white nursing scrub tops and stethoscope behind in Mango. I hugged my friends goodbye, hopped in a vehicle early in the morning and arrived in the capital, 295 miles away from a place that became home.

Right now I’m traveling for a short time with my sister before heading back to Australia. So far we have visited two of her Compassion sponsor children (one in Togo and one in Ghana) and have been very impressed by Compassion’s work in the lives of the two children and the children in each project.

In between visiting kids and being a tourist, I have been trying to process and debrief what happened in my life over the last two months.
I don’t really know where to begin. Before working in Mango at the Hospital of Hope I had never worked in a place where I felt so consistently stretched and stressed that my patients were going to die. Sometimes in other places I’ve worked, after a busy shift we joke that everyone is alive so that’s our nursing job done, but in Mango so often you can’t even say that. Instead we joke that if everyone survived our shift it was a good day. Of course there are good and bad moments of every shift but with so little staff, such high patient to nurse numbers and high acuity (very sick patients), it really takes nursing to a new level of stress.

One shift I had an admission of a boy who was writhing around on his bed, gasping for air, dripping saliva. It was during the afternoon when we take our mandatory (by Togolese government) 2 hour lunch break (the only break we get from 0700-1930). During this time we take over one other nurse's patient load which end up being half the hospital (your patients plus theirs). So, not only did I have a boy who was the definition of a hot mess (an American term which I have wholeheartedly embraced), but I had a bunch of other sick and unconscious kids too.

Before I let the other nurse go on break, I went to assess this kid and give him some medications. He was doing circles in his bed. The leads from the cardiac monitor was pulled off and stuck to his stomach, his IV line was pulled tight across the bed, the non-rebreather oxygen mask was around his neck and not on his face. What a mess! It wasn't simply a matter of reorganizing the wires and tubes, because this kid just simply couldn't stay still, but to make matter worse, it sounded as though he was choking to death. I went out to find a doctor but couldn't find her. I found the other nurse and she said that he sounded like that previously but she would help me try to settle him. I walked around trying to find the doctor while inside I was panicking thinking that any moment he would have a respiratory arrest and I would have to do CPR and we would lose another child. My stress response is crying, which is super unhelpful. So I choked back tears, clenched my teeth and did what I could.

Eventually I got him calmed down and when I saw him touch his mama tenderly on the face, I repented of my frustration towards him, realising that it wasn't him, but his sickness that was making him so hard to care for.

When I handed over to the nurse that evening, I was fairly certain that he wouldn't last her shift. After she assessed him, she didn't think he would either.

What I have come to realise is that I just don't know what God is doing and why some children survive and others don't, but this child managed to pull through. Several days later when he was much more healthy, I asked his papa if I could take a photo so that I could remember that despite the situation looking hopeless, he is alive and well.

 

On my last day of work I had a premie baby have 3 apneas and a young boy (cared for by another nurse but in the same room as my patients) drop his pulse too low several times, requiring a long sternal rub (it causes a pain response) to increase his heart rate and a baby have no urine output and an increasing heart rate all before 11:00. Thankfully we had an extra nurse that day because the previous day I had all the kids (the regular paeds ward and paeds ICU) and I couldn’t keep up and then throw in a baby who is very sick and I wondered how on earth I would keep them all alive. The crazy thing is, we have nurse aids that do all the vital signs. Nurse friends- you know how much time recording and paper charting vitals take, remove that from the equation and I’m giving meds, fluids, feeds, doing assessments and trying to keep up with charting everything (which is way less than a western hospital). Often at work in Australia I feel like all I ever do it vitals, hand out food, showers, make beds, fill out paperwork and a few meds. You could not find two nursing jobs more different.

Aside from the work in the hospital, I met some really amazing people who became friends and it’s hard and sad to walk away from it all. Also knowing I can’t be there to shoulder any of the heavy workload for them. The best I can do is pray.
 

I walk away having very mixed emotions. On one hand I’m excited to see my family and friends in Australia and somewhat relieved that my stress level is dramatically reduced by returning to a job that has equipment and drugs to keep children who are dangerously unwell alive and treated (for the most part).
One the other hand I have left behind friends with whom I now share experience of deep emotion. I have left a town of Togolese that I have shared precious moments of life with; the beginning for some and the ending for others.
I’m also afraid that when I return to work in Australia I’ll be frustrated and bored. I know there’s no fix for this and I do realise I’ve just written about how stressed I was, but there has to be a happy medium!? I don’t know what that looks like.

So, friends who are welcoming me home, be patient with me. Don’t be afraid to ask me questions, even if it feels like it could be a sensitive topic. I know I’ll feel sad and want to cry. It’s not personal. It’s not because you are not enough.

I sent a message to one of my nurse friends I left behind in Mango asking how one of the babies I looked after was going since I’d been gone. She replied saying that he passed away.  He was 8 months old. His mother had died at his birth and his grandma was caring for him. He was severely malnourished and had other things going on that we couldn’t test for or figure out treatment to cure him. I believe he’s now held by Jesus, but that doesn’t stop me from feeling sad.

I don’t know how to wrap this up and I don’t know what my next step is, but I’m on a journey like you, taking each day at a time and asking God to direct my path.