Emory Report
June 22, 2009
Volume 61, Number 33

See photos from Flores’ nursing work
in South Africa


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June 22, 2009
Nurse finds more than ocean between Midtown, Africa

D. Dennis Flores is a 71-ICU nurse at Emory University Hospital Midtown and president-elect of the Association of Nurses in AIDS Care Atlanta Chapter.

To be ‘floated,’ in hospital vernacular, is when a nurse gets assigned to an area other than his or her regular unit. As an ICU nurse from Emory University Hospital Midtown, it is expected that once in a while we may have to work in unfamiliar areas due to low patient census or a higher need for nurses elsewhere.

Not even in my wildest Florence Nightingale moment did I think that would include international travel. As the tiny dot on the in-flight navigator showed our protracted descent over Botswana toward our destination, South Africa, I had to contemplate how in the world of bedside nursing I missed reading the Clinical Protocol on Flying Over Bots-awesome-wana?

As part of a rotating group of health care personnel from the Association of Nurses in AIDS Care, our motley group of three RNs was deployed to Durban, South Africa, to mentor nurses, to assist in the transfer of knowledge and help in capacity building. Funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the three-week stint included visiting multiple sites, which ranged from blink-and-you-miss-it community centers to sophisticated hospitals and nursing schools.

But it wasn’t until we toured Hlengisizwe that I could finally hear the drumbeats of the great diaspora. In that satellite facility in the heart of Zululand, amidst informal settlements, overcrowded waiting rooms and curious children, it hit me that this nurse was not in Midtown anymore.

To say that the clinic was understaffed would be putting it mildly. The RNs in the clinic were essentially an endangered species and the lone doctor who braved coming in every day, despite not having a command of the dialect, might as well be the Broadway version of Mufasa. Patients trickle in before daybreak and, while it may seem chaotic at times, everyone is seen before the day is over. In an era where stateside health care is about accreditation and space-age technology, it is interesting how the tiny clinic accomplishes its work with such aplomb.

It is true that I was horrified that consistent hand-washing was seen more as a personality quirk than standard operating procedure, and I was stumped by the non-contact physical assessments that seemed to be the norm. However, the undeniable fact remained that several hundred people were seen every day by the fledgling staff. Without appointments — with everyone carefully observing the implied laws of queuing.

HIV and AIDS have altered the world’s social landscape, but even more so for countries in sub-Saharan Africa. Where children should be going to school they instead are forced to care for their parents who are expiring before their very eyes. Where grandparents should be enjoying their twilight years we see them instead go through another round of child-rearing their children’s children. Condolences for those who have died of AIDS is a sentiment sparingly doled out.

As an outsider, it was initially baffling to think that stigma could not be overcome in a place where almost a third of the population is infected with HIV. With such a modern-day plague ostensibly in their midst, one would assume that the tipping point against discrimination would have been reached years ago. But it has not.

The reality for the people in KwaZulu Natal is that due to the extreme poverty in their quarters, a cycle of mistrust is seemingly endemic. Hence, this nurse gets to hear the agony a college girl goes through at the hands of her schoolmates who hurl stones at her as she passes by due to her flat backside, a classic sign of clinical AIDS-related wasting and proof undeniable of her infection.

An ocean away from Peachtree Street, this nurse sees how mothers go to painstaking lengths to camouflage the bulky tin cans of government-issued baby formula from the local clinic rather than risk being spotted carrying them home by their neighbors — the specific brand synonymous with nutrition for babies who cannot be exposed to their mother’s tainted breast milk. In the overcrowded clinic of Hlengisizwe, it is easy to see that while a lot are infected, the community is inescapably fully affected.

Pathology of choice is a disease process that nurses gravitate to. It is the inevitable cause whose walkathons, fun runs and bake sales they support. It is our way of staying grounded, our reminder of why we have chosen our profession. As a nurse of two years, this trip allowed me to do the kind of work I would be indulging in if bills, credit scores, 403bs and other grown-up concerns were non-issues.

PEPFAR ‘floated’ this Midtown nurse to mentor his African peers and to possibly buy a couple of “I heart Africa” T-shirts along the way. It nevertheless became an immersion experience that underscored how much more can be achieved with far fewer resources. Loaded with a Mac and an arsenal of snazzy PowerPoints, he was supposed to teach South African nurses about the American way.

Instead, he came back educated with how much more he and his stateside coworkers can actually accomplish.