april fools!

Problems with the internet again...sorry this is late.

In honor of April Fools Day, I was going to write out 3 scenarios and have you guess which one really happened today (I’d already started one about staring in Matt Damon's movie, meeting the love of my life, and signing a contract to stay here indefinitely), but then I got worried that some people wouldn’t get it and would be spreading stories about things that didn’t really happen. I didn’t want to be the cause of confusion, so I used my better judgment and will just stick to the facts today. ☺

Wednesdays are usually the crazy days, but we had far fewer kids on the ward, so it was much more manageable. We have tea after ward rounds every Wednesday. Someone brings in chips, cakes, juice and tea. Today we even had fat cakes - basically fried bread - awesome! We all meet in the OT room and hang out before continuing on with the rest of the day. (This isn’t the only tea time – it seems like some people take about 10 teas a day, but who knows. ☺) They even have a little teacart set up outside the OR, so the doctors can step out and have a cup of tea between cases. That’s one cultural phenomenon I’m yet to wrap my mind around.

Anyway… one of the nurses was retiring who had been there for about 30 years, so we celebrated with her. Prof was asking her about her time here. She mentioned the stress of the treatment room and how the kids just fight against the sisters. She discussed how it was just too much in too little time for too few people to do. Prof asked what could make that better and she said she didn’t know. I was like – I know! ☺ Hopefully we’ll be able to use that discussion as a jumping off point for future recommendations. It does benefit the nurses as well as the kids when there is a supportive environment and I think framing it that way for the nurses will help them to be more receptive to those ideas. Prof also discussed the difficulty in making those treatments better, as there are such limited resources as far as manpower and anesthesia, etc. He mentioned how he wished the kids could be sedated for these treatments, but they just don’t have the staff available for those types of sedations, nor the budget for those medications. I felt so humbled in the moment he said that. I often find myself thinking…well in the US we do it this way. Why can’t these kids have the same treatment? Well – the answer is there just aren’t the resources available here. The staff is doing the best they can with the resources they have available. Don’t get me wrong; there are always areas where the care of patients can be improved. That’s why Child Life is such a great asset here. There is so much we can do to improve the experiences of the patients at this hospital with minimal cost!

Today I tried to work with Othathali again in mastering her fear of theatre. I gathered together a number of medical play supplies and a baby doll and spread them out for us to play. Othathali eagerly joined me, but as soon as she saw the oxygen mask she turned and walked out of the room. She would not return to play until I had removed the mask. I put it back in the prep box and invited her to play. She engaged in a great medical play session for quite some time. When we were done play, she helped me gather up our supplies. However, she refused to even carry the box which held the oxygen mask. Later that day, some of the other kids decided to play with the medical equipment. One of the little girls was using the oxygen mask. Othathali left the room and would not return until the mask was gone. The moral of the story is…we seem to be getting nowhere in mastering this fear. ☺ I was able to talk to Othathali about her surgery for Friday, though. She doesn’t speak of it with as much anxiety as she did the day before. I told her what a great job she had done in theatre the day before and praised her for being so brave. She agreed that she had done a great job and commented that all she had to do was sleep. I asked her where her fear came from. Again, she mentioned the lights – no mention of the mask. I reminded her how the lights had been pushed away before her surgery and she said that helped. I asked her what else would help her not be so frightened for surgery. She stated that the lights were her biggest concern. She confirmed that if we took care of them again, she would probably be less scared in theatre this time. I’m not really sure if that will be the case or not - she seems to be centering all her fears on this one object, but I am glad that we were able to discuss her anxieties a bit.

Missy smiled really big today! Her hands are splinted, so she looks like she has two giant paddles for hands – making it difficult to participating in some activities. Her hands were very sore today, so she did not want to move them at all. The music therapist addressed that issue by putting jingle bells on Missy’s feet. I’m not sure if it was the thrill of being able to participate or what, but she laughed and smiled. It’s so good to see that emotion, because it is rarely revealed with her. Unfortunately the play session had to end and Missy returned to her sad state, crying when we left. I’m hopeful that we can continue to find ways to help her express her emotions and cope with the stress of being alone in the hospital.

One of my biggest challenges today seemed to be setting boundaries with the kids for some of the supplies. It’s really hard to introduce toys here because families and patients often misunderstand that they need to be returned before we leave for the day. Many of the orphaned kids don’t have any person possessions, so they hoard the supplies (often hiding them in drawers, etc). It makes it very difficult to promote sharing and often turns me in to the bad guy when it’s time to go. Kids bargain with me all the time, telling me things like – “You can take one toy, but you must leave the other with me until tomorrow.” When I explain that we have to gather all the toys for the night, they become very cross. I know it’s good for kids to have boundaries, but it’s so difficult to explain to kids who don’t have anything why you can’t just give them the bubbles around your neck. I mean really – but our resources are limited and it is important to maintain them for the future kids to come.

Caroline has been gathering feedback from the staff about our presence here to include in the program evaluation. The staff has been so amazing and supportive – from doctors to nurses to physios. One of the doctors today went on and on about the important role we play here. He mentioned how there are so many patients he only has time to focus on the physical needs and we have been able to remind them that there is more to healing a child than their physical needs. He appreciates the consistent, supportive presence we have been able to provide for the kids. It’s so great to hear that feedback. We are constantly reminded how life is so much different since we’ve come and how they can’t see any other way than for the hospital to allow us to stay on. Hopefully the trust feels the same way!

Tonight we went to the free jazz concert at Greenmarket Square. It kicks off the huge international jazz festival that is held in Cape Town every year. It was a fun evening and the one group we listened to was very good. But now I’m really tired and not even sure what I’ve said in the blog, so I hope it’s coherent.

Our new addition to the Child Life team comes tonight, so we are all so excited to meet her and welcome her to our team. So, welcome Jamie! We’re so glad you’re here! ☺

Goodnight from South Africa!