Lions & Tigers & Cheetahs--oh my! (And Universitas Day 1)

Wow! I haven't posted in what feels like forever! And a lot has happened!! 


On Friday morning, we were taken to a soup kitchen in downtown Bloem and given a tour of the facility. As interesting as it was, we really didn't get the opportunity to help anyone in need because they weren't serving food at the time we were there, the day care was not in session, and all of the social workers were at a meeting. So...it was really only a way to get us out of our dorm rooms on a COLD and rainy Friday morning. 


Luckily, Friday afternoon was SO much better! We went to the Cheetah Experience, a non profit organization aimed to promote and fund the conservation of the cheetah and other endangered species through captive breeding, behavioral research and public awareness. This means that we actually got to play with little baby "big cats" and it was A BLAST! 

Me petting a REAL baby cheetah!

 We were able to go inside of the enclosure and pet the babies and love on them until we were more than content. During all of our fun, we also managed to learn about each of the animals that lives at the Cheetah experience and were even able to hear able different volunteer opportunities that they offer (some of us are heavily considering them!) For more information about what we did, you can go to http://www.cheetahexperience.com/ and see for yourself. 

For all of you Lion King fans--baby Simba and baby Nala. 

Friday evening, we were scheduled to leave for Lesotho, the mountain kingdom of the world. Unfortunately, there was A LOT of miscommunication and we weren't able to leave until very early on Saturday morning. We left for the taxi rink (in South Africa, a "cab" is what we would think of as a taxi...small car...usually only fits 4-5 people. A "taxi" is a 22 passenger van) at 5:30 in the morning anticipating a 6:00 departure time for Lesotho. However, we didn't board the taxi until 7:00 and since they refuse to leave until the entire taxi is filled, we didn't leave until 8:00. Because it is free to take luggage on the taxi, they wait until each seat is filled with a person and then add all of the luggage in to the aisles...not very safe if you ask anyone sitting in the back of the taxi (aka...us!). Once we finally had everyone and everything loaded, we started to leave Bloemfontein...but not before it took 20 minutes to fill up with gas (now...couldn't this have been done before you even pulled in to the taxi rink?!)! Finally after all of these minor hiccups, we were on our way! 

What if there's an emergency?! 

The taxi takes you as far as the South African border and then you walk across to Lesotho. So we first had to "check-out" of South Africa and then "check-in" to Lesotho before the real adventure could begin! We all successfully passed inspection and made it in to the Kingdom of Lesotho and were starving (remember, we've been up since 5 am and were anticipating being in Lesotho at 8...it is now 10:15ish) so we quickly went to the cab rink and set out for breakfast. Now remember when I explained the difference between cabs and taxis? Well there were 7 of us...so you do the math...we couldn't fit in one cab. So we gave the drivers explicit instructions to not lose one another because our South African phones would not work and we had no other way of contacting each other if we were to be separated. Now here's where our stories start to split. 


Aubrey, Brittany, Ryland, and Lesotho Man (we don't think we ever learned his name):
We arrive at the mall first, thinking that the second cab was right behind us. But was it? No...of course it wasn't. So we started looking in the mall, thinking that maybe they had come in a different entrance. And after 45 minutes of painstakingly looking in every shop and restaurant (the mall wasn't that big), we still could not find our friends! So we caught another cab back to the border to asking the cab marshal where he had sent them and we were NOT happy about it! As soon as we got back to the border, the cab marshal snidely informed us that our friends were waiting for us at the mall. Still not happy. 


Kalie, Christina, and Kage:
Their stupid cab driver decided to take a different route. Why? Because he was an idiot. Needless to say, they didn't see us at the mall because our stupid cab driver had taken us to the back entrance. So they returned to the border trying to find out where we had been taken. They returned to the mall...still no finding us and on their way back to the border a SECOND time, their cab ran out of GAS!!! So they had to catch another cab back to the border and then again were sent to the mall where they stayed waiting for our arrival. 


All of us: 
Never before have I been more excited to see someone in my life. As soon as she saw us, Kalie flew out of the mall and gave the three of us the biggest hug in the world. We had just spent an hour frantically searching for our friends in a foreign country where we had no cell phone reception and no other way of communicating with each other. Needless to say, we were more than excited to sit down and finally eat lunch at 11:30. 


After a mediocre lunch, we braved the snow (yes...it was SNOWING) to do a little touring and shopping. All-in-all, it turned out to be a pretty fun day, despite the extremely hectic morning. And if nothing else we can chalk it up to a cultural experience!

We survived Lesotho! 

Finally, on Sunday, we went on a game drive...and it was the coolest thing ever. We basically were on a mini safari through a game reserve just outside of Bloemfontein. We went at 4:00 in the afternoon and were able to see all of the animals as they were eating dinner. We were even close enough to touch a rhino because it decided to try to eat the Jeep. At the end of the game drive, we were given the opportunity to climb up a small hill and watch the sunset while we munched on a little snack and had some hot tea (because it actually gets quite cold here at night!). It was without a doubt one of the most beautiful things that I've ever seen and I'm so happy that we were able to see it. 

Bye-bye rhinos--thanks for not eating me!

All in all, I'd say that it was a great way to end the week before I started my hardest internship week. 

Universitas Hospital (Bloemfontein, South Africa)

Today was my first day at the University Hospital (one of Bloemfontein's tertiary government hospitals) and it certainly started out as quite an adventure. The dietetics department is hidden in the back of the hospital and through a gate (which you need a card or chip to get through...which I don't have) and so I got lost before I even started making rounds with the senior dieticians. Luckily, after I finagled my way to their offices, the rest of the day was very interesting and educational. 

I began the day in the neurological ICU where patients are normally admitted with head trauma (due to fighting when under the influence of alcohol or car accidents) or brain aneurysms. Those patients with brain aneurysms typically also have hypertension, which is often times a contributing factor to the aneurysm. The dietician told me that one of the biggest problems in the ICU is infections. Patients on a ventilator are at a higher risk of contracting an infection than those who are not ventilated, and so those who are eventually able to be taken off ventilation have a better chance of survival. 

Patients in the neurological ICU at Universitas feed for 18 hours a day and rest for the remaining 6 and are fed within the first 24 hours of admittance to the hospital. However, diabetic patients are fed 24 hours a day. It is important the the dieticians indicate the method of food consumption (i.e. via the mouth, a feeding tube, intravenously  etc) and that all formulas prescribed come from the same company. Dieticians do not restrict energy (caloric) intake for overweight and obese patients in this work and it is important that they look at the patient's urine for diagnostic purposes. The color of the urine helps the dieticians to assess if there is an infection in the kidneys or if medication is causing the discoloration. 

I was quite surprised to see that even though this was an ICU, there were empty beds lining/blocking the hallways and the so called "isolation" rooms weren't exactly completely isolated. For example, one of the patients was isolated from the remainder of the ward, but the door between his room and the hallway (which was filled with nurses, doctors, stray beds, etc) was wide open the entire time we were making rounds. The nurses who cared for him we careful to wear smocks (not them I'm entirely sure that did anything for them), but did not utilize gloves or a face mask. 

After visiting the neurological ICU, we moved forward to the neurology and neuro-surgical wards. The majority of the patients admitted in to this ward arrive malnourished and have poor dental hygiene, which causes them to struggle with eating solid foods. Therefore, they are given what are known as sip feeds, which is simply the oral intake of a liquid dietary supplement. The only restriction we discussed in this ward was the restriction of protein when a patient is in a coma or is severely disoriented. 

It is also quite common for these patients to have co-morbidities and sometimes even auto-immune diseases. They are sometimes fastened to their beds (i.e. hands tied to the bed rails) so that they can not pull out their tubes. 

Next was the high-care ward. High-care is a level of care between ICU and general wards. The nurse to patient ratio is 1:1 in high-care and these patients are too healthy for ICU and too sick for general wards. They are typically given pureed foods because it decreases the risk of asphyxiation. 

The last thing I did today at Universitas was sit in on a couple of nutrition consultations and learn a little about the nutrition care process. Nutrition consultations are given when requested by a doctor for a patient that is struggling to eat the food being given to them or for those patients who will be discharged soon. They are typically done to help with a supplementation regimen or to help develop an at-home diet plan. If a patient is not being discharged immediately, then they require daily follow-up consultations. There are set menus for diabetic patients. Each plate will look exactly the same, but portion sizes are dependent on caloric restriction and intake levels. Otherwise, dieticians will work with the patients to help develop a diet plan that is right for them. 

The Nutritional Care Process