Work...

I don't know why I feel so reluctant to write about work.  I have so little and yet so much to say.  I don't know anything yet.  I have no idea what I am doing, what I shall be able to do, what is needed or wanted of me.  I have a million ideas and no ideas.  I mostly work on Ward 12 of the General Hospital.  It is over 100 years old and the psych. unit was adapted supposedly to accommodate psych patients.  I think I described it in another blog entry.  It is out of the dark ages. It is clean though.  A cleaning team is there daily washing and dusting and completely cleaning one time week.  They also do the gardening.  The thing that is interesting to me, coming from another culture, is that the patients don't seem bothered by the age or lack of accommodation .  Women and men are used to bathing with others and doing their own laundry by hand on the cement.  It is noted if patients are not washing or doing their laundry as a symptom.  It is just expected they will do their washing.  Patients seem very well behaved compared to American patients and demand nothing.  Manic behavior is like a mild temper tantrum.  It is just not done here I guess.  That is one of the many cultural things I need to learn more about, the behavior of people, on the street, in the hospital, at home, toward parents.  I am baffled by how much ECT they do here, almost everyone, no matter their diagnosis, get's ECT and is put on antipsychotic meds.  They use our newer antipsychotics but not our newer antidepressants.
The staff has been amazingly welcoming to me.  The nurses, there are 8 of them altogether, notice my presence or absence, what I am wearing, the fact that I went to the dedication of the hospital.  The attendants (also about 8 of them)  also are attentive but less so.  It has been very hard to set up a meeting time with the nursing staff where we can talk about what they need, want or are interested in.  As of now, one is scheduled for Thursday at 10AM.  That is a holiday but the best day for the most of them to be together.  There are 2 Social Workers plus Ancy who I am finally meeting late tonight or tomorrow.  One of the Social Workers is outstanding and works wonderfully with patients and their families.  There is an Occupational Therapist who has only been employed there for a month and a half and is young, eager and speaks good English!  Then there are the Medical Officers, 4 of them, with some Mental Health training and the Consulting Psychiatrist who is eager to bring Psychiatry into the 21 century.  When I arrived, Dr. K. the psychiatrist, sat with me and some of the staff and confronted me with what I felt I could bring to improve things.  I made a few observations which he didn't seem to think much of and then proceeded to list all the things he felt I could accomplish in the next 11/2 to 2 years.  Some of it would not be in my knowledge base and some of it scared and overwhelmed me and some was exciting. The point was though that it was enough to fill 10 years of work!  I went home that day and read over my notes (which I take constantly) and felt I was out of my league, got kind of glum, frightened I suppose.  Dr. K. had asked me to summarize my career for the staff and I think I said to much because if I heard about that person, I would think she was capable of doing anything including writing workshops and proposals and all sorts of things I've never done.  Anyway, the other part of this is that I really have nothing to do yet.  We were told to basically, hang out, observe, watch, let the staff get to know us for a month or 2 and don't expect too much.  I am having a hard time with this also because I don't know where to be, where to put myself, I want to be active and feel funny not being.  I really have no boss, no one watching what time I arrive or leave or what I do in between.  So here I am feeling weird about sort of just floating around, listening, hanging out with the patients, going over to the clinic, hanging out there, talking to staff, asking a million questions but generally aimless and at the same time I am feeling overwhelmed that too much will be expected and I won't know what to do.  Anyway, it took me about a day to talk myself out of my gloomy feelings.  I keep thinking of more to know and ask.  I question a lot about patients and was asked to consult on a teen age boy who I didn't understand being there.  There is really no psychotherapy here.  There is no time to explore people's lives and social situations.  The stories are horrible, lot's of alcoholism,  spousal abuse, many things that people don't talk about like homosexuality in one member of a heterosexual couple, some people don't seem but momentarily psychotic to deal with issues no one is talking about.  I am not judging this, I don't think it is that different at home, just handled differently.  Anyway, Dr. K. seems thrilled with my big mouth and has encouraged me to see as many patients as I choose to help  the team better understand a patient.  The problem of course is the language.  I have to work thru one of the staff who speak English and they of course are giving me their interpretation of what the patient is saying and of course don't translate everything.  I love the patients though, I just smile and hold hands or put an arm around and it's good.
A big problem for me though is language.  Part of it is cultural I am sure.  I am not told a lot.  Even if I have made it plain that I would like to know something, I won't be told;  or I'll be told a piece of something.  I sort of accidentally have to learn things like if a meeting is happening or the consultant isn't coming.
The thing that is most disturbing to me and this may also be cultural is that there is absolutely no privacy at almost any time.  4 MO's interview patients at the same time, in the same room, before one patient leaves the next one is coming in and the MO's are talking about the patients.  Patients sit and wait until spoken to even if the staff member is having a conversation about the weather!  I think people are just very respectful of authority here and just accept the way it is. Did I mention this is the same room ECT is done in!  During ECT which people line up for and carry their own sheets for, staff walk in and out having all sorts of conversations. Hopefully we shall be moving into a brand new just being built building in 3 months.  I went to see the space and see that all the men and all the women are still all in one room.   There is indoor plumbing.  What is not there right now which is the other thing that I feel disturbed about for the patients is a room for meetings and therapies, OT, RT etc.  The patients do nothing all day.  They hang out all day.  The amazing thing is that patients sort of take care of each other, they are kind to each other, especially the women.  They really have their own Therapeutic Community, a milieu created by them that is soothing to each other.
The equipment is very, very old, the ECT table has rips in it.  The Blood Pressure monitor and cuff are what we got rid of in the 60's.  We are so outrageous in the west and so fortunate.  This is definitely third world in terms of availability of goods.  The social worker told me his family does not eat pineapples because they are too expensive.  I eat one every other day, they are 80 cents!  Despite this, the Sri Lankan, including patients and staff, are always trying to  share food.  People share lunch and breakfast with each other, it is a communal kind of thing, so wonderful, no one would not ask me to join them to eat if they have food.
So to go back to what Dr. K wants.  He wants all staff to have knowledge, skills and the right attitude toward patients.  He wants it to be patient centered. He wants people to have better counseling skills.   It is a bureaucracy , a hierarchy and very paternalistic and he wants a multidisciplinary team of professionals pulling together for the patient because right now the patient is at the bottom of the hierarchy.   He wants trainings and lectures and rehabilitation and a Day Center and  non professional local  community teams trained to work with the Mental Health population in the communities all over the district.  This is some of what he wants.  I shall know more about nursing and attendant staff after I meet with them.  Did I explain the system here.  NOBODY, NOBODY chooses were they want to work.  MO, RN, Aide, get assigned when applying or graduating to were the need is.  The only exception is if you have had special training in a field you were interested in after graduation.  On top of that, once assigned a unit, you stay there and can't request a change for 2 years.  So, I can try to teach an attendant not to shove or yell at a patient.  Will I be effective, who knows.