Staff Nurse Gascoynes story

Hammocks, helicopters and howler monkeys…Staff Nurse Gascoyne is out of the office.

Very recently, I have been fortunate enough to be awarded the Dorothy Holland Educational Grant for Continuing Professional Development. With the funds I have undertaken an Advanced Trauma Life Support (ATLS) course and some Domestic Violence training. I wanted to share my reasons for choosing to complete these studies and to offer an insight into my journey of personal and professional development. I have been inspired by my experiences and hope they might inspire others too.

Friday 26^th April 2002

Somewhere over the Black Sea…

…Sitting here, looking down at the water and clouds it doesn’t seem possible that this time yesterday we were drinking champagne on the South Bank to celebrate having finished our nursing finals. Even more surreal still, is the fact that I’m on my way to India.

The past two and a half years have gone so quickly, and yet, it seems to have taken forever to get here. I wonder what the next five weeks will hold.

The above is an extract taken from a journal that I kept while on my elective placement toward the end of my paediatric nurse training at Kings’ College London and Guys Hospital.

An old friend had given me his copy of the Dalai Lama’s autobiography a year or so before and reading it had inspired me to undertake my elective in a Tibetan refugee children’s village in Northern India, instead of in a big intensive care unit, which was the original area in which I wanted to specialise. In fact, I had applied to do my nurse training solely because I wanted to nurse in children’s intensive care. Little did I know that reading this book would be the catalyst for my intended life to change beyond anything I could have imagined.

My nursing career to date has followed a path that has introduced me to some amazing cultures, stunning places, a massively diverse and mind blowing range of experiences and education, some of my best and most cherished friends, and my husband, to name but a few. Through hard work and dedication, the unconditional support (and fabulous food parcels) of my family and friends, a natural sense of adventure and inquisitiveness, the willingness to face my fear of large spiders head-on, being fortunate enough to have been awarded a number of grants and bursaries, and destiny perhaps, the above has been made possible.

I spent most of the five weeks I was in India fading away with amoebic dysentery and in equal portions loving and hating the whole experience. I found India a land of contradictions: the poverty stifling and the lack of sanitation almost unbearable, but at the same time I felt really excited that I had found something different to do with my nursing career. I hadn’t travelled at all when I was younger and was 25 when I began my nurse training and suddenly felt more inspired than I had ever been in my life.

In brief, since then, my nursing career has involved the following: Acute medicine, high dependency, trauma and orthopaedic surgery at the Royal London Hospital, Whitechapel; volunteering at the EMERGENCY surgical centre for civilian war casualties in Battambang, Cambodia; a Diploma in Tropical Nursing at LSHTM; working as an expedition nurse for Trekforce, a youth development and conservation charity in Belize and Guatemala (on three different occasions, for ten months, over three years. I loved it so much I kept going back for more, despite finding a tarantula up my t-shirt and my hammock collapsing into a clutter of wolf spiders); Infectious diseases and immunology at GOSH, London; working as a medic for the filming of ‘Ben Fogle’s Extreme Dreams’ in Papua New Guinea and now working in Intensive Care at Sick Kids, Edinburgh where I have been for the past two years.

This is, however, all about to change. My husband has just graduated from the University of Edinburgh with a Masters Degree in International Development and the Environment and has accepted a job with one of the best respected conservation organisations on the planet, and so it happens that we are about to emigrate to Papua New Guinea. With this change imminent, I have focused on building on my existing knowledge and enhancing my skills for practice in the developing world.

Trauma is a massive cause of mortality and morbidity in the developing world and I lack recent experience in this area, so I applied to be a nurse observer on an Advanced Trauma Life Support (ATLS) course. Although, I must say that observer should be used in the loosest of terms. I most definitely wasn’t an observer when it came to learning to read trauma x-rays (I was very pleased that I managed to diagnose a broken neck!), putting a chest drain in a sheep (thankfully not a live one, which may well have been more traumatic, both for the sheep and me) and performing an emergency tracheostomy (again on that poor sheep). Papua New Guinea (PNG) also has a problem with gender based violence and my work has never exposed me to this area of practice, which led to my decision to undertake this specific training.

I am also in the process of applying to James Cook University, Cairns to do a Masters Degree in Public Health by distance learning, basing my research in PNG and am very much hoping that my good fortune in securing funding holds out for this too! The visa conditions for me prevent me from getting a paid job (at least to begin with) but I have already had an amazing email from a gentleman who has lived out in PNG for the past 46 years and has started a small charity working with marginalised women and children. He asked whether I might like to help him out in establishing some basic healthcare for the groups he works with. My answer? A resounding yes. I couldn’t think of anything more perfect. This does really feel like my destiny.

I will leave you with a few more extracts from my journals written from far flung corners of the world… and, if you’re interested in reading more, or wish to follow my future adventures then you might like to read my blog at: http://halfadayaway.wordpress.com/

Tuesday 30^th April 2002, Mussoorie, India

…Back at the hospital we sat outside preparing the dressing packs for tomorrows’ clinic-cutting out squares of newspaper, whittling long twigs and winding cotton onto them, folding it all into a sealed pack and then lining them up in a tray ready to go into the autoclave for sterilising. Having just written an assignment about the barriers to inter-professional collaboration, it’s very inspiring to see everyone happy to lend a hand. The dentist, pharmacist, x-ray technician and one of the foster home Palas all came to help. Much to everyone’s amusement I wasn’t very good at folding and sealing the origami style packs and I am the subject of some shy teasing. One of the nurses tells me that during the monsoon season so many of the children are sick that they have to top-and-tail at least three to each bed! But, this is the quietest time at the hospital and I’m feeling like a bit of a spare part. The nurses rarely accept my offers of help and even more rarely ask me to do anything. I’m so conscious of not wanting to make a bad impression, both personally and professionally.

Desperately in need of cheering up I wandered into town. The hot, dusty streets were thronging with people; shops, stalls and shacks selling an eclectic array of goods; chai stands, rickshaws, horses, dogs and monkeys. Once-grand colonial hotels have fallen into disrepair and now house many families, satellite dishes and rows of washing line the balconies; dragon flies zoom past, groups of elders from all religions sit together in the late afternoon sun catching up on news, and gossip, a Sadhu sitting in the back of a Land Rover catches my eye and offers a namaste, all to the backdrop of the breathtaking snow-capped peaks of the Himalaya…it’s a mind-blowing place and I adore it!

Monday 19^th January 2004…Battambang, Cambodia

A day of mixed emotions…

The intensive care unit are having their weekly deep clean…which, I have to say makes ours look more than a little un-enthusiastic! All of the patients were moved outside into the open corridors and garden, and all of the trolleys, cupboards, instruments and medication with them. The cleaners sluiced and scrubbed the walls, floors and bed frames while the nurses cleaned out the cupboards and their contents whilst still doing hourly obs on their post-op patients!

In this intensive care unit, there are no monitors, pumps or ventilators, no sophisticated equipment at all. If a patient needs ventilation and inotropes then three nurses are allocated to them: one to hand ventilate with a bag, valve, mask, one to recalculate the drips/drops per minute of the inotropes every 15 minutes and to take the blood pressure with a sphyg and their fingers to feel for a pulse, and then one to do all of the other things.

Back in the unit and a 21 year old patient has just died. He was in a car accident last week and has been in a coma since. Today, his heart finally stopped working. His sister has been staying with him (each patient has a relative staying with them to attend to basic nursing care and they will normally sleep on a reed mat on the floor under the patients’ bed). They are a stunningly beautiful family. Not only has his sister been helping to care for him but also for most of the other ITU patients-emptying catheter bags, feeding, helping with turns and transfers.

I was with her brother when he died, she was feeding another patient. None of the little Khmer I speak was adequate enough, so I just went over, silently took her hand and led her back to him. Later, before she left I heard a quiet voice say ‘Samantha’. I turned around to find her standing next to me, with her hands in prayer, tips of her fingers touching her forehead, head bowed. ‘Aw kohn’ (thank you).

It always leaves me feeling a little bewildered that life should go on as normal all around after someone has died. Cycling home, I spotted a pagoda and decided that this would be a good place to collect my thoughts. Not so. The monks wanted to talk…I had a guided tour and was then invited to give an English lesson…good job I had postcards and photos from home with me!

3^rd February 2005, Gallon Jug, Belize.

As daylight fades, the jungle is coming to life, it’s awesome. The frog chorus is almost deafening. Our camp is next to a river and last night, lying in our hammocks we could hear two troupes of howler monkeys calling to each other across the river, it genuinely sounded as though there were dinosaurs out there. Peering out from the safety of my mosquito net the wolf spiders’ eyes shine blue in the light of my head torch-I’m surrounded and am really hoping that I don’t need to get up in the night to go to the loo…which incidentally is a pit latrine on the far side of our jungle training camp. Yes, that’s right, jungle training. I’ve never even been camping in England before and yet, here I am in the depths of the Belizean rain forest at the beginning of five months as an expedition nurse…but first I have to learn how to live here safely.

Casualty evacuation practice, Belize

Fire lighting, water collection, safe use of machetes, setting traps, building shelters, navigation (is that tree really different to the others and which way up does this compass go again?), river crossings, jungle observation, search and rescue, locating and clearing helicopter landing sites…my head is about to burst and I still have to write my own lesson plans for the volunteers (first aid and basic life support, casualty evacuation, base camp health and hygiene), pack up my medical kit and organise all of my individual health checks…oh, and I have been picked to be one of the two medics on what is generally considered to be the toughest expedition out of the six groups…

8^th February 2005, Edwards Central camp, Maya mountains, Belize

The past two days have been two of the most physically demanding days of my entire life. Yesterday we trekked for eight hours in the rain, through knee deep clay with 25kg rucksacks on our backs, today we have spent the day ferrying food for the first 3 weeks to our initial base camp from the drop off point on the logging road. Three trips, two hours each, rucksacks full of med kit, tins and packets, hands full of chainsaws, petrol, pots, pans and all of the other things that I never knew you needed for an expedition. We’re only here for five days before we move on…

I had a wash with a mess tin in a stream tonight. A hummingbird was dancing around in the trees overhead.

14^th February 2005, Edwards’ Central

We cleared the trail to and past Sapodilla camp today, there were lots of snakes around, mainly Fer de Lance which is more than a little terrifying as they’re really poisonous and the stretcher carry to the HLS (helicopter landing site) should someone be bitten would be epic…

6^th March, Ceibo Chico camp

Today we walked 30km, it took ten hours…it hurt. One of the volunteers has acute abdominal pain; we are literally miles from anywhere.

11^th March, Natural Arch camp

Bad, bad news…one of the volunteers has conjunctivitis again and despite 24 hours of treatment it appears to be getting worse and she is losing the vision in her left eye. She will be evacuated tomorrow at first light, which is a massive downer for the rest of the group and really disappointing for the medical and leadership team as we’ve managed to keep everyone relatively healthy up until now. No mean feat given the rigors of our project.

19^th March, Soda Real camp

Only four days left until the jungle phase of the expedition ends and what an amazing journey it has been. Sitting here as dusk falls, the lush green forest is full of vines and palms. Mountain streams flow over rocks between each rise and fall of the beautiful but sometimes punishing peaks of the Maya mountains. As daylight fades the creatures of the night compete for the loudest song. A month living by a lake in Guatemala beckons while the volunteers learn Spanish. I seem to have somehow volunteered to look after ninety of them, a bit of an increase on the fourteen I’ve been caring for for the past two months! Bring it on!

Written by Samantha Leggett (nee Gascoyne)

RN (KCL 1999)