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Working among the poorest of the poor: a nursing lecturer and a nursing student--a mother and daughter--share their experiences of time spent last December and January doing volunteer work in Thailand and in India with the Missionaries of Charity, the religious order founded by Mother Teresa.

The Missionaries of Charity run a home for abandoned children with HIV/AIDS in a very poor rural village in north western Thailand. We worked there as volunteers with the sisters for three weeks, followed by four weeks in the Home for the Dying Destitute in Kolkata (Calcutta) India. This extraordinary journey provided us with an excellent opportunity to experience first hand, the nursing of children and adults with a range of serious illnesses such as HIV/AIDS, leprosy and tuberculosis. If it were not for the love and care the sisters and volunteers provide, these people would more than likely die alone and unwanted.

In this article Yvette shares the experience of nursing abandoned children, art of whose life expectancy is limited because of the ravages of HIV, poverty and stigma. The work of the sisters is nothing short of amazing. At the orphanage, we witnessed children "at death's door", who only a few weeks tater were eating well, laughing and learning to play despite the virus. Colette shares her experiences of nursing adults and young people who had arrived at the door of the Home for the Dying Destitute. Most of them lived like animals on the streets but they died like angels with dignity, gentle love and care. The opportunity to develop cultural, spiritual and physical nursing skills in a third world environment was inspiring.

The Missionaries of Charity work in more than 700 homes for the homeless, abandoned and unwanted throughout the world. These homes have become oases of love, joy and peace. In New Zealand, the sisters run a Women's Refuge in Auckland, and in Porirua, visit poor families and the elderly and teach children. Their mission is to care for the poorest of the poor.

Orphange in north western Thailand

The orphanage, Maryville, in Udon Thani, in north western Thailand, provided a home for children who were art HIV positive and had been abandoned by their parents, either because the parents were too sick to care for their children or they had died of AIDS. Poverty and stigma were also huge issues contributing to the abandonment of many children.

There were 18 children, 17 boys and one little girt, the youngest at 14 months. The oldest child was 11. All the children were very smart for their age. At least five of the children possibly had AIDS. The reason for the overwhelming number of boys was that in Thai culture girls are useful because they can perform housekeeping duties, which is unacceptable work for males. So the girls are able to stay at home, but the boys with HIV, especially if they are sick, are more likely to be abandoned. It was unclear as to how the children had acquired the virus, presumably through birth and/or breastfeeding. My day started at 8.30am when the children who were well left for a public school around the corner. Throughout the morning I played with the remaining six children. Three of the children were too young to attend school, one had serious communication difficulties as he had been severely abused, and the remaining two were unable to attend school because of the HIV-related lesions that covered their bodies. If the lesions didn't improve, these children would never be able to attend school.

The children were not without a variety of toys and books which the community had donated. I sang and danced with the children and it didn't matter that I didn't understand Thai. As Mother Teresa has said, there is a universal language in a smite and in touch.

Quality time

My goal for the morning was to spend as much quality one-on-one time with each child and this was manageable. The children absorbed cuddles like a sponge, many of them dropping off to steep on my hip. Colouring in, drawing and playing in the sand were favourite activities, just as they are for children anywhere. Breakfast, lunch and tea were often the same--rice and vegetables followed by fruit. The children's' favourite food was sticky rice and chicken nibbles. Many of the children had mouth ulcers or had respiratory problems and had varying appetites. All sat together at a large, low table. No highchairs were available, so the little ones sat on an adult's knee.

After lunch all the children slept--often where they dropped--for up to three hours. This was an opportunity for me to have a welcome siesta. However, each day at 2.30pm the resident elephant would blow his trumpet, which took some getting used to.

When the school children came home, they always had homework. I was able to assist the four older children who were teaming English. Thankfully the maths calculations were all in English. I tried to communicate with the odd Thai word and that made them all laugh. Between 4.30-5.30pm everyone was showered and dressed in clean pyjamas. All the children were encouraged to brush their teeth after meals. Many of the children had mouth ulcers and their baby teeth were broken or rotten. Years of neglect, as well as the HIV medication, were responsible for this.

Medication time

The children received their medication at 7am and 7pm exactly. What amazed me was that they seemed to know exactly when to come. They would all line up and quietly take the potties with their names on them. Many of the medications were foul tasting and some of the pills were huge, but there was never any argument or questions--they would just make faces as they swallowed. I believe the children did this as they had seen their friends and parents die and it seemed as though they knew, even the younger ones, that if they didn't take their medication they would die too. Each child was on different medication, depending on the severity of their condition and if they had any other complications of HIM, eg tuberculosis and cytomegalovirus.

Around 7pm it was time for bed and more cuddles. For some reason I never worked out, there was an occasional power cut at this time and once we had a fire. Two of the children had brought matches home from school and set the statue of Our Lady on fire--something that definitely got my adrenaline pumping and certainly did not impress the sisters. This experience was great for crisis management training! All the children went to bed with their toys and not just soft toys. Often trucks filled with dirt were hidden under their pillows (the only way they could keep the toys for themselves).

What amazed me about these children was their energy. Before I left New Zealand, I imagined that the children I would be looking after would all be bed ridden. I had never worked with anyone with HIV or AIDS before and working with these children has certainly changed my understanding about working with people with HIV or AIDS.

Physical assessment

The children all visit the public hospital once a month to have a CD4 count check, as well as a physical assessment and medication evaluation. At this visit medications for the next month were given to the sisters. All medications were paid for by the Thai Government but unfortunately only three cycles of combination therapy were available for the children. Some of the older children were already on their third cycle. When drug resistance is apparent after the third cycle, there are no further treatment options and death quickly follows. This was something I chose not to think about.

I have always wanted to work with children and the chance to work at the orphanage was a great opportunity. I was asked if I would like to work with the sisters in Cambodia, working with severely malnourished children. I decided to wait until I had completed my nursing education and had gained some experience and confidence before working in Cambodia but I hope to work again with the sisters during my annual leave.

* Yvette sat her state final examinations last month. Pending the results, she begins work at the Royal Children's Hospital in Melbourne in mid-January.

Home for the dying and destitute

Kalighat is the name of the home for the dying destitute in Kolkatta, India. A "God-forsaken hole'" was my first impression of Kolkata. It was like stepping back into a time warp--even the cars look liked something from the 1950s. I expected poverty--after all that's why I came--but the poverty is invasive, all encompassing and very, very distressing. Filth is everywhere and people just step over and around it. There are beggars everywhere and they come right up to you, hold your arms, desperate. There are so many of them--if I ever gave to one, I would immediately be swamped by many others.

One morning outside my accommodation, the Salvation Army was running a mass feeding of the poor. The line of people was so long I couldn't see its end. The sisters fed 2500 people a day at the Mother House as well. There are always crowds at the ration office. Dogs, goats and cows share the roads/footpaths. The dogs are mangy, flea bitten and very unlikable, as are the stray cats.

I could not get used to seeing so many people searching for food through the rubbish piles in the streets, along with the birds, rats, flies and dogs. And there among all this are the sisters. My love and respect for the sisters has grown enormously since coming to Kolkata. I don't know how they do it. My dream of coming to do what I could felt like a nightmare at first. The volunteers--and there were hundreds of them--all said it gets better and the first week is the hardest. Many of them come year after year. They are from all over the world and are wonderful. They give of their skills and love, and say they receive more than they give.

I hit the floor running when I started at Kalighat. The first patient I had was dying. It was a privilege to sit with this man, an emaciated bag of bones, until he died. Next I had to do the most horrific dressings I had ever seen. Fortunately I had a plastic apron, gloves and a mask. When the street people get a wound, it very quickly becomes infected. The maggots then get control and literally eat the surrounding flesh. Betadine is poured on to such wounds, which is extremely painful, but all the maggots come to the surface and then we pick them out with forceps, before dressing the wounds. One dressing I did was on a woman who had leprosy, as do many of the patients. She had lost all her toes and the flesh on her remaining foot was rotten. The bone of her big toe was clearly visible. Another woman's wound was caused by rats. She was a street woman and had hurt her head somehow and over night, as she slept, the rats had gnawed at the wound, which was, of course, horribly infected.

High pain thresholds

The patients have the most incredibly high pain thresholds, which is just as well because there is no morphine. The men always make a lot more noise than the women--no surprises there! As a registered nurse I also gave out medications and gave injections, mainly of intramuscular antibiotics. The patients were of all ages and most had tuberculosis and other respiratory infections, nits and fungal skin infections. I was surprised at the excellent dressing supplies and medications.

We had a young man come in from the railway station where he lived. He was no more than 20. Apparently he had originally had a mosquito bite, which had become infected and he had just his big toe and two flaps, which were the last two toes. Two toes had gone completely. We spent two hours picking the maggots out with forceps and we stopped counting them when we reached 1000! I was working with a Swiss doctor, also a volunteer. Neither of us had seen anything like it. The poor chap was in agony, but we saved his life.

Surgery without anaesthetic

Later that same day we performed surgery without anaesthetic (there isn't any) on a young man, to remove the mangled fingers on his left hand. They wouldn't accept him at the local hospital because he had no money. We had to shave the crushed bone with a razor blade so the bones were smooth before stitching. The hardiness of these people is remarkable. Next day when I saw him, he was sitting up in bed, eating voraciously and smiling happily.

We also cared for woman with an intellectual disability, who was about six months pregnant. I taught the novice sisters how to check the baby's heart rate and they were delighted, especially when they could feet the baby kick. This woman's extensive burn wound would not heal for at least another three months. I couldn't help but worry about the baby, as maggots occasionally crawled out of the woman's vagina. The volunteers, who come from all over the world, are a special breed. They are mainly young men and women of all faiths and cultures, united in the desire to give of their love and skills to the poorest of the poor.

There are hostels for the volunteers everywhere. I paid $11 a night for a basic room, which I shared with three others. Occasionally we had hot running water and a good breakfast was always provided, plus we all got on famously. Transport is very cheap. We paid four rupees (about 15 cents) for a bus ride to Kalighat. Work started at 8am and continued until noon. Volunteers were free until 3pm and they then worked until 5.30pm. Between noon and 3pm most of the volunteers met for lunch and hung out together. Without the support and encouragement from home and from other volunteers, this work would be impossible. Thursday was the volunteers' day off. However, each week some of us went to help out at the Leper Colony run by the Missionary Brothers of Charity.

Despite the filth, I was very safe and never got sick, but I was very careful Bottled water is everywhere and cheap at 10 rupees or 30 cents a litre. I went in the Indian winter (December/ January/February) and the temperature remained stable at a very pleasant 20-25 degrees. I first heard of Mother Teresa when I was 10 and have been inspired by her ever since. I have done volunteer work with the Missionaries of Charity for the last six years. In the health sector we hear a great deal about the ambulance at the top of the cliff and of empowering people to take control of their health. But Mother Teresa said there had to be somebody at the bottom of the cliff and it appeals to me to be there. It is not glamorous work but it is the hardest work I have ever done. It has been a life-changing experience for me. I no longer take anything for granted and tend to get a little impatient with what I see as trivial worries. As New Zealanders, we are so lucky. If I ever hear anyone complain about taxes, the cost of food/houses/petrol etc, they get a very animated and lengthy lecture from me.

I [Colette] really, really look forward to my volunteer work at the end of the academic year--it is like the light at the end of the tunnel for me. Next year I am going to work with the sisters in Katherine, in Australia's Northern Territory, where they have a community for Aborigines. I will be teaching Aboriginal women parenting skills and a colleague, who has been inspired by my stories of the work, is coming with me and will be teaching the women sewing, knitting and other crafts.

No specific skills are needed to be a volunteer, although a strong constitution and a heart of love help. It is a gift and a privilege to be able to do this work.

* If interested in this volunteer work, please contact Colette Blockely at coletteb@tekotago.oc.nz. We wish to acknowledge the moral support of our families and,friends, as well as the financial support from the Ngaio Fulton Nurses" Trust and Otago Polytechnic Education and Development Trust.

Colette Blockley, RN, MA, is a senior lecturer and year-two co-ordinator at the School of Nursing, Otago Polytechnic, Dunedin.

Yvette Moore, RN, BN, was a third-year nursing student at Otago Polytechnic when she wrote this article. She begins works as a staff nurse at the Royal Children's Hospital in Melbourne in mid-January.
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Title Annotation:NURSING OVERSEAS; servicing at missionaries
Author:Moore, Yvette
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:Dec 1, 2006
Words:2777
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