By Diane E. Palmeri, R.N. (1982)
As I was contemplating the last months of my senior year at the College of Saint Teresa fifteen years ago, my mind often wandered to the future. I wondered where I would be ten or fifteen years later and if I’d have married, have children and still be practicing nursing. I hoped to nurse overseas in a developing country for at least a year and was quite open to doing such work long term, if only I could find a man willing to share in such a life. Pediatric nursing had been my favorite and I remember telling all my friends that I wanted twelve children. But if someone had told me that in fifteen years I’d be working in public health and nutrition, I’d have said it was impossible. I had really struggled through my nutrition courses and far preferred hospital nursing to public health.
However, a year at work at a hospital in the Central Highlands of Vietnam changed my mind about a lot of things. I had thought I would be working at the hospital all the time, but I ended up being assigned to train and then supervise village medics at their small clinics in half a dozen different villages. Somewhere along the line, I fell in love with public health. And back at the hospital, facing the challenges of nursing a handful of severely malnourished patients, some of whom were too far gone to be saved, gave me a new interest in nutrition. And of course I met and fell in love with my future husband, Tom.
Tom has written about how we got started on our work here in the Philippines . I’d like to share what that work means on a daily basis. Today was a fairly typical day. The chorus of crowing roosters, the neighbor’s radio and the babble from the kids finally got through to me about 6:30 . By the time I got out to the porch, where we eat breakfast, Paul, Chris, Jay-Jay and Reynaldo had all gone off to school. The rest of the kids were almost dressed and so I got out the tray of medicines and began giving them out. I started Monica on a decongestant since her nose had been running a couple of days and seemed to be turning into a bad cold. Her colds frequently develop into a draining ear and then I have to put her on an antibiotic, but sometimes the decongestant will prevent the ear infection. Renato got his last tablet of antiox for the worms he had again. He also got his isoniazid for primary complex TB. He will finish one year of the isoniazid in a couple of weeks. It’s hard to believe he’s been with us almost a year and even harder to believe how gravely malnourished he was at first when I look at his round smiling face and those sturdy arms and legs that never stop.
The only really sick one today is Juanita. She developed diarrhea two days ago and Tom found amoeba when he did the stool exam; so she has been on Kitnos. She still had diarrhea six times yesterday but was drinking well. But this morning she wouldn’t drink any tea and took only four ounces of Orasol (oral hydration solution). So I know I’ll have to keep a close eye on her.
After breakfast, I recorded the three stool exams that Sr. Gini did yesterday afternoon. All three had amoeba and so I computed the doses of their medicines and gave them to Joy to take to their mothers when she went down to supervise the feeding later in the morning. At 8:30 Monica, Renato and Erlinda headed across the street to their nursery school and I went over to our Day Care house where Sr. Gini was getting ready for our morning clinic. Roy arrived for his ear cleaning which Gine started. Then Sheilalin arrived for her dressing change. She had had an open sore on her leg for several weeks before her mother brought it to our attention. After five days of one ointment it really hadn’t improved, so I sent her to the doctor. Next came Daisey, who had been coughing and running fever for four days. Her chest sounded crackly with lots of wheezes, so she too went off to the doctor with a referral note. Next was Jennifer, who had been running fever just since yesterday and coughing. Her chest was clear and her lthroat was OK. But she did have swollen gums and so I told her mother she was probably just teething. I asked her to give her extra liquids and come back in two days if she was still running a fever. Galvin was next, with another boil. He has really had a terrible time with them the past few months. This one was already quite soft and ready to rupture, so I went ahead and did an incision with a scalpel blade and drained out the pus. Then I gave his mother the antibiotic and told her to come back tomorrow for a dressing change. Meanwhile, Sr. Gini had done several more ear cleanings and sent a couple of kids to the doctor with referral notes. Then she told me about a couple of sick children in the Day Care. We decided she should take Efrin to the doctor this afternoon since his ear drainage had gotten worse again. The couple of other sick ones seemed to have a touch of the flu, so we will just watch them for now.
The clinic finished up a bit early and I was glad to get back and check on Juanita. Tom had taken the little ones, back from nursery school, into the sea and I was also hoping to get my usual thirty minute swim in before lunch. That swim is my treat for the day. It makes me feel great physically and mentally, and it is the one thing I do during which no one can come and interrupt me with a problem. But today it was not to be. Juanita had had five watery stools and had refused anything more to drink. I sat down in the rocking chair with her to try giving her something myself, but she promptly vomited, and so I knew we would have to go to intravenous fluids. I called the doctor and she said to bring her over and she would start the IV and give me the medicine orders. I took Nening, one of our workers, along and we came back in a taxi with Nening holding Juanita and me holding the IV bottle up out of the open window. By the time I got Juanita settled back in her crib and told Nening how to time the IV rate, everyone else was just sitting down for lunch. After lunch, Juanita was sleeping peacefully and no longer looked dehydrated. I told Nening that she or one of the other helpers would have to stay with Juanita at all times and call me immediately if there was any problem. Then most of the rest of us settled down for a little siesta. After siesta, I was talking to Joy about the results of a stool exam Tom had done on Ronald while I had been at the hospoital. I told her to check with his mother and have her come see me so I could find out how bad the diarrhea was and decide which amoeba medicine to use this time. This baby has had amoeba monthly for six months, ever since he had the measles. He just doesn’t seem to have any resistance. Just as I finished telling Joy this, Christopher’s mother brought him to our outdoor kitchen. He had a deep cut on his leg. It was a clean cut that definitely needed stitches, probably about four. I thought of doing the suturing myself, but Sr. Gini was gone to the doctor with Efrin and Tom was teaching his Philosophy classes at the university, so I had no one to assist me. And I figured I had my hands full enough with keeping tabs on Juanita. So I sent the mother off to the government hospital, telling her that Christopher did not need any tetanus shot since we had just finished giving him his three doses about six months ago.
By this time it was 4:00 and the kids started arriving from school. They all wanted to see how Juanita was doing and she was glad for their attention. I sat with them and listened to how things had been at school. Some of them wanted some help with their homework so I helped them get started. There were a few interruptions as the mothers we had sent to the doctor this morning came back so we could mix and record their medicines. Our two volunteer pediatricians give the mothers sample medicines whenever they have them, but when they run out, the mothers come back with prescriptions, which we then fill.
Now as I finish this, the kids are having their dinner. Tom and I will eat later when he gets home from class. Juanita will sleep in our room tonight, so that we can keep a close eye on her. And I will need to set the alarm to get up during the night and check her IV. She will probably need the IV for only two or three days and then should be able to go back to oral liquids. Sometimes with amoeba you just have to give the stomach a rest for a couple of days.
It’s been a busy day and it isn’t over yet, but it’s been a satisfying day as well. Somewhere back in the States is a hospital where I am not working, but the patients there are cared for. If Family to Family were not here, I doubt that many of the people we saw today would have received any care at all. And I shudder to think of where the foster children might be. It’s a busy life, but it’s a kind of being busy that makes a difference. And that may just be all I’ve ever really wanted.