Pain is a great motivator. Towards making great decisions or dumb ones, or both. Therefore, when I willingly chose to leave the Renal Unit, it came as no surprise.
Huntly is a rural town in the middle of Aberdeenshire County in the City of Aberdeen, Scotland. There is United Kingdom weather and then there is Scotland. Scotland’s weather is so beautiful that it breaks my heart again and again. That is actually a joke.
It is wet in Summer and wet in Winter. Wet in Spring and it badly wants to be wet in Autumn. Even the sun here rains; too intimidated to shine.
I arrived in Huntly in late summer and I was fascinated by the long daylight hours. Sunset at 9pm was marvelously beautiful. My web of intrigues was to be woven further by the system I found myself in at work.
Having left a specialised unit, it was difficult to adjust to a carehome. This is a home for the elderly. United Kingdom gives a damn about her elderly citizens. The closest I had been to this was Bethany House in Sagana, Kenya. This was several decades ago when I was still young, fresh and juicy.
I was wowed. Several tens of residents all comfortable in what I’d call a retirement home. If this was explained to me at the interview stage, I conveniently forgot about it. All I remembered was someone saying nurses get paid more in a carehome as opposed to a hospital and money was a motivation. A jolly good one.
I settled gingerly. It is not easy being black in a sea of white. It is a tiny drop in an ocean which is constantly in motion. To many colleagues, I was the first black nurse they had ever seen. Worse, the first ever Overseas Nurse to ever be sent to their rustic carehome. To some of them (read most) , Africa is a tiny village and we all live in even tinier huts and we sing with monkeys and lions.
We also wear silky loin cloths and speak Zulu and Xhosa. Well, The gods Must Be Crazy is a famous film and it looks like that is all these my colleagues knew. Talk of excellent acting. However the ignorance tasted like fermented bitterness.
I marveled at the disproportion between technological advancements and the level of ignorance about the rest of the world. Fast and furiously came the questions. Did I train as a nurse in Africa? I kept correcting them to say Kenya, not Africa. It was futile. Did we have hospitals in Africa? Did we wear clothes in Africa? How did I speak such good English? How long have I spoken English?
Then came the nursing team. Am I really a registered Nurse? Do they have hospitals in Africa? ( Side note: Do we? Do we have hospitals when our leaders keep running them down and rush to London or India for treatment, do we?)
Would I know what I’m doing at the OSCE exam? And the cherry on the cake, am I REALLY a nurse? It was too hilarious as to be dumb.
I worked under the registered nurses but mostly as a health care assistant. That was before I passed my OSCE exam and joined the register of UKRNs. I shadowed nurses as they did hand over reports and shadowed carers as they helped residents with various activities of daily living.
It was a normal Tuesday morning when I listened to Tracy the night nurse complain about a resident’s urinary catheter that kept falling out. Tracy was as white as snow. True story. She spoke through her chiseled long nose. She gestured a lot too with her perfectly manicured hands. Her short cropped silky hair had a fringe which she kept pushing away from her face. A modern day Snow White–with a nursing uniform.
While she described the catheter problem, I counted the number of tattoos on her arms. There was a baby elephant that was blowing bubbles on her left wrist, those bubbles were being eaten by a tiny dragon that was three centimetres or so below her elbow. I was just getting to a match of an eagle and a lion tattoo when Juan, my mentor interrupted my fascination.
“Catherine I want you to observe as Amber inserts the catheter then you can join the carers in serving breakfast, ” she sweetly chimed.
Amber happened to be the most qualified nurse of the day. After gaining consent from Betty, the resident, Juan, another nurse whose name I can’t recall, Amber and I went into the resident’s bedroom.
Betty was a big girl. At 68 years she oozed folds of confidence and chunks of hope. She had divorced exercise many years before her car crash which injured the lower segment of her spinal cord. She was doubly incontinent. Betty adored her snacks and even as Amber explained the procedure, Betty munched on a delicious-looking piece of Maltese chocolate bar.
She gave me one look and winked. Oh sweet soul! Trying to make me feel at home. I immediately took a liking to her. Amber confidently aimed the tip of the catheter into Betty’s private parts. I looked on as Juan and the other nurse kept me company.
That is when it struck me that Amber was not inserting the urinary catheter into the urethra. Juan and her pal were dutifully observing and encouraging her as I stood there flabbergasted. My mouth took over my mind.
“Nurse Amber please remove that catheter and insert a new one. Here,” I said as I suddenly took a new silicone catheter from the lower shelf of her working trolley and opened it for her. ” I will use my phone’s flashlight to give you more lighting. That is not the urethra. “
Uh-oh. I forgot the rules of engagement. I was to watch not talk. I was to be seen and not heard. All I wanted was the catheter in the urinary bladder. We weren’t going to achieve that if we inserted the catheter into the vagina. No wonder the nursing team was complaining about the catheter falling out. It definitely would fall out if what we were targeting was an opening bigger than a female urethra.
Amber silently allowed me to use my light to help her maneuver through Betty’s folds to locate the urethra. The female urethra is one canal that confuses many a healthcare workers if not the public themselves.
Located just below the clitoral fold and atop the vaginal orifice, it is easy to miss. Many may be forgiven to think urine is expelled through the birth canal. It is not. It is expelled through the urethra. It is what leads up to the urinary bladder,where urine is stored.
A urinary catheter is a tube used to access the urinary bladder so as to remove urine. Many reasons make the use of a catheter vital. Betty had had an injury which had severed the nerves that tell the bladder to release urine. The nerves that tell the brain that it is time to pee.
After leaving that room and washing hands, the atmosphere was ripe with palpable tension. Like slimy okra the team was unsure what to do with me. To love or hate? They decided to make independent decisions to be indifferent. How exhausting.
Betty was so appreciative and she would later joke with me about me being the first black nurse she was seeing. She however was to ask me if I trained in Africa as a nurse. If Africa had catheters. Ah, here we go again…
Juan my mentor didn’t chide me for talking during the procedure and she did not acknowledge my helping save the day. It was like nothing had happened. However, the nursing team gave me a wide berth. The hours I would shadow a nurse were greatly reduced. I was also not allowed to attend the handing over reports until I qualified as a UKRN. Amber also stopped talking to me.
It would later therefore come as no shock when I was on shift with her when a resident called me a few racist terms and Amber was silent about it. It happened twice. And twice in her presence, she didn’t intervene.
That was the straw that broke the camel’s back and I was the camel. I wrote to the powers that be and gave an ultimatum that if I wasn’t transferred from that carehome, either of the following two things would happen. A) I would lose my mind or B) I would book my next flight to Nairobi. Where skyscrapers and cars do exist,to everyone’s surprise.
Nursing in a carehome is different because it demands autonomy. The hospital will always have a team of fellow nurses but more often than not, carehomes are run by a single nurse on each unit. Every decision is made by that nurse and therefore accountability starts and stops with the nurse.
That experience horned my leadership skills and increased my problem solving capabilities. Geriatric Nursing is a broad area and I was able to integrate my theory into practice.
I consider myself very lucky to have begun in a carehome and as a care assistant. It helped me learn different things I only saw in textbooks. For instance mobility assistive devices. Take a Zimmer Frame for example, I had never used one or seen a patient use one. I know they are there in Kenya but for the chosen few. Money talks, doesn’t it?
I learnt the basics of moving and handling residents and patients. I appreciated how utterly incapacitating old age, frailty and dementia are.
I remember calling my best friend and sharing how one day I’d run a carehome in Kenya. That our elderly parents and grandparents have been left to fend for themselves in the rural areas while we could do with a formal system of care for their needs.
There is a desperate need for such as well as home based nursing care services in Kenya. The gap between hospital admissions and rehabilitation in the community for the elderly and terminally ill is valley-wide. A dry expanse of nothingness. It smells of loneliness, memories and anxiety for our grandparents and the terminally ill.
Perhaps this pool of silence on how we take care of our elderly needs to be poked. Maybe then it will cough into life.