Today was a very busy and productive Tuesday at the hospital. I spent the morning working in the AMPATH paediatric clinic with the children in for visits today. It was very busy with children constantly coming and going. It was an awesome experience and one that I would not have the chance to participate in at home (along with many other things I have been doing here). Working in such a fast-paced, outpatient environment provided me with a lot of opportunity to exercise my skills.
With children constantly being summoned to leave the play/waiting area to meet with the doctors or nurses and returning only a short period of time after, the group dynamic was constantly changing. I presented the group with a few activities including Easter egg maracas and beaded jewellery. It was clear that activities in the AMPATH play area needed to be short, sweet, and to the point, as children were constantly shuffling. Intricate crafts with multiple steps and high concentration and difficulty are not ideal in this setting. So, what can we do that will keep kids of all ages and abilities entertained, educated, and distracted? Lot’s of things! I have been given the task of coming up with simplistic, but fun ideas to incorporate into the AMPATH program. Just add it to my list!
I spent the afternoon observing some procedural prep in the surgery ward. This was the most interesting and thought-provoking part of my day. The child life specialist I was working with was speaking ~98% Swahili to patients and their families. FYI I don’t speak Swahili (minus the few words and phrases I’ve picked up since I’ve been here). This didn’t matter. In fact, I almost liked not having to worry about listening to the exact words that were being used…it provided me with a chance to focus on facial expressions, intonations, reactions, and body language. As an intern, I want to learn as much as I can, and if she were speaking english, I would have been focusing more on the words she was saying rather than the way she was saying them and the way in which the patient was receiving them. While I was able to pick up on some select words – dawa (medicine), doctare (doctor), maji (water) – knowing word for word what was being said proved to be less important. The CLS had a prep binder on general “what to expect” items that she was going through with each patient – this book was in English, so I understood what she was trying to explain but by being able to focus more on other aspects of the interaction, I feel as though I absorbed a lot.
…the first patient was a young boy (9, I think). He was withdrawn, had sad eyes, didn’t smile, and leaned closely to his mother, who sat beside him with her arm around his waist. His mother spoke some english to me (greetings and introductions) but all other interactions between the child life specialist and patient/mother were in Swahili. I was briefly concerned as to how I was going to learn about procedural preparation if I didn’t know what she was saying, but I stopped and thought…’I do know what she’s saying’. Without knowing the diagnosis-specific information, I knew the general words and phrases she would be using to calm this child. I could tell by the tone and intonation in her voice when she was asking a question, and although this patient was fearful, he always responded with a nod or head shake. At the end of the conversation he laid back down on his bed. I flashed him a smile and held out my hand for a high five…he smiled back and reached his hand out to mine. In spite of the fact that there was minimal verbal interaction between the two of us, you could tell that he felt more relaxed after the surgery process was discussed with him.
This same thing happened with nearly all of the patients we visited, but none of them had the same demeanour as one another. Some were very distracted and not paying attention, some were very little so the prep was more for the parents’ sake, some were upset, and some were very happy and ready to soak in all of the information. Families were often eager to participate and ask questions and encourage responses from their child.
I was able to get this and so much more information from my time there all without being able to verbally communicate thoroughly with these patients and families. It was an awesome learning experience but could have gone very differently. I think that often times we close ourselves off if we cannot communicate with someone or understand them (or vice versa) but that is not what we should be doing. If you aren’t there to communicate, observe the things that don’t require verbal language and learn from that. If you do need to communicate, you can do so without communicating verbally! Of course, encouraging words or a soft and happy voice, regardless of the language, can increase feelings of positivity, but you can find ways of connecting with patients without being able to speaking to them.
In between prep sessions, I snuck around to other kids in the room (remember this is a public hospital with anywhere from 5-10 beds in a room – no curtains), and tried to soothe, distract, or calm anyone that needed to be soothed, distracted, or calmed. I happened to have a glitter wand in my pant pocket (shoutout to Fay for making me carry it!) – score! I passed this on to the kids who were in pain and needed something to draw their attention away. I helped several kids stop crying…some even smiled..a couple giggled. From raging tears to smiling faces…and I didn’t say anything more than “jambo“.