Archive for January 18, 2012

Hospital–Maternity Floor

Many of our team members were very interested in spending some time on the maternity floor, so we had people rotate in and out during our day in the hospital.  It ended up that we were supposed to meet back at 7:00pm to change out of our scrubs and head home, but when we all made our way back up to maternity, a patient with whom the student had been working was fully dilated and of course we wanted to stay to see her give birth.  The patient was Haitian, as were a number of other patients on the floor.  She did not speak Spanish, and the nurses only spoke a few words of Creole.  We saw the importance of communication and how patient care is in some ways very dependent on this ability to communicate.

We understood that the patient was “happy” to have us all with her in the room for the delivery.  We all crowded around the delivery table in the small, dimly lit, hot, humid room.  One student noted how different the sounds were in the delivery room compared with those in hospitals in the US.  The window was open, so we could hear cars passing, music playing, people talking outside.  There were no sounds of the fetal heart monitor beeping telling us the baby’s heart rate was accelerating as it should.  The woman, though it was her first birth, made barely a sound.  The auxilary nurse who has much experience, yet little formal nursing education, delivered the baby, and this was not because the OB doctor or even resident didn’t make it there in time,  it was because in the DR normal births are performed by the nurses.   After the birth, the nurse stitched up the small tear by the light of one small lamp, and our students performed the newborn assessments with the guidance of Dr. Foster.  There was much excitement in the room; for some of us this was the first birth we had seen, while others on our team are planning to continue to study midwifery.

It had been a busy day on the Maternity floor; they had so many women deliver, that they actually had some women sharing beds in the post-partem ward.  Before we barely had time to wipe down the table, another woman, also Haitian, was wheeled into the room ready to deliver.  We were excited to see another birth and once again everyone crowded around to watch the nurse deliver the baby.  However, as she delivered the excitement in the room quickly dampened as the baby was stillborn.  Later it was decided that the baby had probably been dead for about 10 days, and the causes were congenital.  It was hard for us to watch the events that ensued; it is difficult to imagine what these nurses experience when the deliver sometimes multiple births such as this every day.  After a woman delivers in the DR it is not customary to show the woman the child, and this is especially the case after a stillborn birth.  Dr. Foster and other students wanted the woman to be able to see her baby, as we were not sure that she even understood that she knew that her baby was dead.  The nurse had put the baby on the floor and was waiting for another nurse to bring her a cardboard box which is where they put stillborn babies.  Dr. Foster though was able to convince the nurse to let the mother hold her baby as studies have shown that this helps the mother to cope and decreases post-partem depression.  We are not sure whether the woman actually understood what had happend until that moment since she also only spoke Creole.  She just laid there for a couple minutes with her baby on her chest looking sad and confused.  We later found out that a resident had performed an ultrasound on her and had done an assessment earlier that day and had charted that everything was fine.

As there were more women ready to deliver, we helped the woman off the table into a wheelchair and accompanied her into the post-partem ward with at least 10 other happy mothers and their babies who had delivered that day.  At first our team members felt very upset that this woman who had just lost her baby had to be in such a room, without even any family with her.  However, as we sat with her in the room trying to comfort her, another woman in the ward, a sister of another patient walked over took her hand and shared a glass of juice with her.  Then slowly others approached her, held her hand, and told us they would take care of her.  We asked one woman if she was a friend or family member, and she replied “Today we are all family”

Hospital San Vicente

On Tuesday we had our first day in the hospital. We divided up into little groups to work on different floors. Many members of our team are very interested in Maternity, so they worked with Jenny our faculty leader to the maternity department. Jenny has worked on various research projects in the hospital, so when we arrived on the floor everyone greeted her with hugs and kisses! Others from our group worked on the pediatric floor, ICU, and the clinic where people received vaccines. Karen and I observed in the emergency room. We actually even saw two codes performed. As I just finished my first semester of clinicals and don’t have any experience int he emergency department, so Karen who has years of experience in the ER was explaining the similarities and the many differences between running a code in the US and running one in the Dominican Republicchong qi zhang peng! It was interesting to observe the hierarchy in the personnel in the emergency department among the nurses, pre-interns, interns, residents, and attendings. Karen said that although things are so different, some of their interactions were so similar to those in the US. It was really interesting also to see the contrast in the care provided by the community health nurse and that provided in the hospital. In my opinion it makes a big difference if people are working in their own community, because there is a sense of patient care when working with family, friends, neighbors, that I think sometimes gets lost when you move farther from the community.

Day 4 in Eleuthera, Bahamas

For our fourth day on Eleuthera, we had the opportunity for some sight-seeing and touring across the island. Our first stop was to the new Centre for the Arts that is being built in Tarpum Bay, an area that will soon hold an outdoor amphitheatre and stage. In fact, this very stage will hold a concert for Earth Day this coming year with a variety of well-known American artists. While construction is being completed on this new addition to the area, we were also able to see where time has stood still on another part of the island. Part of our tour included visiting the abandoned VentaClub, an Italian resort/club that was abandoned decades ago due to lack of sustainability. As we walked through the remains of the resort, we saw a once beautiful property with direct access to the soft sands of the Atlantic Ocean. Unfortunately, the lot was deserted, and is now only minimally maintained by one sole caretaker. VentaClub is not the only abandoned resort on the island; farther down, there is also a deserted and overgrown Club Med that was once a popular, elegant place for tourists.  However, neither of the resorts was properly built for sustainability on the island, and eventually both were simply left as empty buildings.

Despite seeing these beautiful shells of a wealthy time once past, we also saw that many people on the island are busy working hard towards promoting sustainability and sustainable projects on the island. In addition to the new Arts Centre being built in Tarpum Bay, we also visited the Leon Levy Native Plant Preserve. This area is a 25 acre stretch of land that was renovated through a donation by Mr. Leon Levy to be a preserve to a large variety of native plants, and even some animal species. During the tour, we saw numerous plants that are used for natural bush medicine in Eleuthera, such as certain leaves that one would make into a tonic or tea in order to cure different problems like colds or the flu. In addition to the growth that we were able to see at the Native Plant Preserve, we were also able to see the work the community has done for their own volunteer fire station, which also houses the area’s ambulance. Shaun Ingraham, one of the top community leaders, and the contact from Island Journeys that sets up the Bahamas alternative winter break trips for Emory, even took the student nurses on a special trip on top of the fire truck. Shaun has been incredibly helpful to us the entire time we’ve been here, and has let some of the students stay in his childhood home throughout the trip. Although, I think he may have a special place for Emory in his heart, as he is a master’s graduate of Emory University’s Candler School of Theology.

After the excitement of taking our first ride on a fire truck, we traveled farther up north to a unique, historical spot known as “Preacher’s Cave”. The specifics behind Preacher’s Cave vary, but the general story is that it is the original founding spot of the Bahamas. There were missionaries traveling throughout the Atlantic Ocean who wrecked their ship on a dangerous spot near Eleuthera called “Devil’s Backbone.” When they survived the shipwreck, they took cover in a nearby cave that came to be known as “Preacher’s Cave.” This is the spot considered to be the founding place of the Bahamas.

Finally, we were allowed a very special treat to attend the Eleuthera Rotary Club’s meeting, where some of the strongest and most progressive leaders in the community meet monthly to discuss community needs and goals. Dr. Thomas has been working with a variety of the Rotary Club members for a number of years now, and they were very excited to meet another group of her nursing students. We all loved the warm, good-humored atmosphere that the members kept even while discussing important events on the island. It was refreshing to see so many people coming together with honest, sincere interest in bettering the island of Eleuthera. And, as we have noticed is custom on Eleuthera, we were made to feel right at home amongst all of the most important members of the community, and like they truly appreciated our work here. I think all of us felt proud of not only ourselves as Emory nurses, but also of the Bahamian nurses that we have learned so much from throughout this journey.

SuperNurses and Community

Being here in Eleuthera has been truly amazing. Physically interacting with the people in the clinics and schools has changed our perspectives of community. The people of Eleuthera have been welcoming and pleasant!

Following our experiences in the schools, actually talking with the students and hearing feedback from the teachers, I was proud, knowing I was able to make a difference. After a young, teenage girl asked if there was a way for her to keep in contact with me following our STD Presentation, I was ecstatic! I hope the knowledge we shared will save lives and encourage the students to make responsible decisions. They can now use and share the knowledge they learned with others. Hopefully, our efforts can assist with slowing the spread of STD’s, especially herpes. According to an Eleuthera nurse, it is currently on the rise on the island. It was truly an experience I value and wish to continue in schools and other “at risk” populations.
I definitely honor volunteering and sharing knowledge. When I think over my goals of serving the underserved, I definitely see the possibilities here. These amazing people of Eleuthera deal with what they have, hope for the better, but the are not greedy or wasteful. They don’t fret over what they do not have available, they simply value their blessings.
Everyone knows everyone and they all help and share with each other. I have still been unable to digest how amazing the nurses are in Eleuthera. They are literally “Superwomen!” They have to work autonomously as they are sometimes the only healthcare personnel available. They can do everything except major surgeries, trust me, they do! The main focus for Eleuthera nurses is preventive health and hypertension and diabetes surveillance, although they respond to all patient concerns. Under the Eleuthera’s Government and the Department of Health, the healthcare workers attend to school aged children, in at least grades 1, 5, and 10. It is mandatory for them to do health screenings for the students at the schools. I remember a similar process when I was in elementary school, so assisting with the screenings, brought back memories. The nurses do general screenings of height, weight, blood pressure, vision with Snellen charts, immunizations, and sometimes hemoglobin tests. The doctor then follows up with “at risk children,” or children with abnormal values.

The Eleuthera nurses definitely have encouraged me to go far, embrace nursing and my explore my capabilities to heal and impact the lives of my patients.

Day 3 in Eleuthera, Bahamas

Today was our third day on Eleuthera, Bahamas. During the morning, my group was sent to Tarpum Bay to work with the nurses in the clinic there. The majority of the clinics in Eleuthera serve a variety of different patients, and they attend to numerous ailments. Each day, they typically have one type of service offered (such as a well-baby clinic day, a day for general ailments, and a day to see the doctor). Wednesday is their well-baby clinic day, so we were able to work with many different children coming in for general check-ups and vaccinations, although some sick children also came in. Once again, the nurses here had to do the initial intake of the patient, assess the child, and then either provide a treatment in the office, or prescribe the appropriate medication to go home with the child. I am continually amazed by the amount of work that they have to do, and the knowledge they must to possess in order to do that work effectively.

After we finished our nursing work during the well-baby clinic (where we made friends with many adorable, tiny patients), we went with the nurses to do two home visits. These home visits are done approximately once a month for patients who are unable to come into the clinic for whatever reason. The nurses go to their houses, perform a general assessment, and determine what the patient’s plan is for the upcoming weeks. One of the aspects of these visits that I found most special is how much the nurses know about the patient’s social history and family history. As one nurse put it, “everyone knows everyone on Eleuthera. Well, almost.” Both patients seemed especially appreciative and happy to see the nurses as they came in to care for them. I was impressed by the way the nurses incorporated their knowledge of the patient’s family history (such as their brother, father, or grandfather having hypertension, diabetes, cancer, etc) into the planning for the patient. The community of Eleuthera is so tightly knit together, and it seems to truly pay off not only through increased social interaction, but also healthcare planning.

Our last stop for the day was at the primary school near the Tarpum Bay clinic to watch the students practice their dance routines for the upcoming Junkanoo Festival. Junkanoo is a masquerade/parade type of street festival common throughout the Bahamas during the month of January. The adults have their own version, and the younger kids celebrate a Junior Junkanoo, where they make elaborate costumes and masks and dance in a street parade with songs and drums. All of the students were busy practicing their dances when we stopped by to see them perform. Even though the dance seemed fairly exhausting under the warm Bahamian sun, the students truly seemed to enjoy themselves and to want to work together on their dance. I thought this was an especially fun way for them to get exercise, given the concern with obesity and diets on the island. One of our own faculty members here with us, Dr. Tami Thomas, had suggested this to the students as a great form of exercise on one of her previous trips to Eleuthera. As Dr. Thomas said, “the people of the island have such a great culture and such great resources here…someone just needs to tap into that, and many of their problems could be solved.”

Finally, at the end of the day, we were surprised by a special visit at our house by some of the local neighborhood children. They came up to our door twice and gave us various little “presents”, such as flowers, berries, and a bracelet. Their kindness and generosity shocked us, and I know it touched my heart. We didn’t have much to offer them in return, but they really weren’t even expecting anything of value from us… They seemed excited when we were able to give them some of our stickers from our previous days of teaching in the schools. We were once again shown how caring this island is, especially in our community of Tarpum Bay. The Bahamians on this island truly have a way of making everyone feel at home, and like we’re part of their family.

Snap Snap!

Day 2 in Eleuthera, Bahamas

Today was our second day in Eleuthera, where we are volunteering in clinics and schools across the island. My group was sent south on this very long, skinny, beautiful stretch of land to Rock Sound primary clinic and Rock Sound primary school. While at the clinic, we did intake reports on a variety of patients and were able to see some of the common ailments that day: rashes, influenza, back pain, etc. All of the patients seemed incredibly welcoming, receptive, and trusting of us, despite the fact that some of our group are still in the undergraduate nursing program. We were given as much respect as the other healthcare staff (doctors and nurses) in the clinic. During the second day, we were able to spot the continuing theme of autonomy among the nurses of Eleuthera. We were surprised to realize that they function in a variety of rolls, ranging from general nurse, to a sort of nurse practitioner, to pharmacist, to social worker, to friend to all of the patients… (not to mention that the majority of them are also mothers, and sometimes grandmothers, with their very own families to care of as well). I have so much respect for these women and what they are able to accomplish every single day; they never seem to have a minute to spare, and they never waste a minute either. I plan to keep them in my memory when I’m feeling bogged down by finals, clinicals, and work. There are nurses here doing so much more than I could ever have imagined with the limited supplies that they have.

In addition to our wonderful clinic experiences, we also have gone to a couple of different schools from different parts of the island. In one school, we assisted with health screenings of different classes. At the Rock Sound primary school, we gave a presentation on healthy eating and healthy diets to follow. Eleuthera has recently had some issues with a high rate of obesity, as their main food staples are heavy in grains and meat. However, we found out very quickly that these young children (ranging from ages 6-12) are quite well-informed about healthy diets; the issue seems to lie more in access to more fruits and vegetables, and the costs of these items. Another theme we’ve noticed across the island is that of the warm, caring, respectful, good-hearted nature of all the children. While many of us have worked with children previously, and are fond of their sweet ways, we were shocked not only by how respectful and polite these children of Eleuthera were, but also how loving they were. We were given so many hugs and compliments by them, and they were very interested and engaged in all of the work or teaching we did. Almost everyone wanted to listen to their heart or their friend’s heartbeat. They were also interested in taking lots of pictures with us and their friends. Each day that we left, they asked us with huge smiles on their face, “are you coming back tomorrow to see us?” It made me a little sad to let them know that no, I personally wouldn’t be coming, but that some of my friends would for the rest of the week. Some of the older students even asked to be FaceBook friends with us, as opposed to pen pals. It must be a sign of the times and our generation, no matter where you are in the world!

Finally, at the end of the day, we got an hour or so for some relaxation time to take a walk on this beautiful Caribbean beach. As we walked up and down the sand, we were greeted with a friendly “hello, how are you?” or a polite “good evening” by almost everyone we passed. At first, it seemed a little ‘off’ to me…almost a little unnerving for someone to be that friendly without wanting something else from a passerby. Then, I thought that I was probably the one that was a little ‘off’ or out of touch with my people in my own home. I think it’s very easy to take for granted politeness and friendliness in a big city in America; it seems that honking horns, avoiding formalities, and sometimes even rude remarks are the norm there. Here, the people are just truly friendly, caring people. They’re honestly interested in how you’re doing, and they want to make sure you’re enjoying your stay on their small little island, that’s so full of culture and life. As we watched the sun set over this Bahamian island in the Caribbean Sea, I think all of us felt a little more connected with the earth, each other, and everyone on this island. Living in a place like this, I can see why so many people have smiles on their faces all day. I can’t wait to see what excitement, adventures, and interactions tomorrow will bring!

Day #1–Home Visits

Getting to know our hosts and community workers Sunday at the beach helped us to feel more comfortable today when we out in the community to do home visits for our first day of work.  Ramona, one of the community health nurses, was our guide for the day.  Since we have Dr. Pullen, a physical therapist from the school of medicine, with us, we concentrated on visiting patients who had a disability, were homebound, or in need of physical therapy.  Ramona had previously identified the people with disabilities in just one sector of town.  As Dr. Foster says, we feel like we are just hitting the tip of the iceberg, as there are over 380,000 people who live in the town.  Just imagine how many other people are in need of physical therapy.  As the day went on, more and more people called out to Ramona as we walked by their houses to ask Ramona if the “doctors” could see them, if we had medicine for high blood pressure, or telling us of a neighbor or family member who had been injured.

We were all amazed by the extent of the injuries we saw, most of them being the result of motor vehicle accidents.  As the day continued and we saw more and more of these injuries; we started to look behind us and be much more aware of our surroundings walking down the street, looking out for cars and scooters.  As we waited outside houses and walked down the street, the public health nurses in our group helped us to see the public health issues in the community and how some of these injuries and other health problems could possibly be prevented.

The quality of care these patients were receiving from their families in their homes had a big impact on us.  Some of the patients had received surgeries, but many of them never had.  Many had been referred to physical therapists, but since there aren’t any in the town, this was not a realistic option.  Patients were so well taken care of by their families; they were very clean, well dressed, their family members took them out, helped them get out of bed, turned them, we did not even see a single pressure ulcer.  The patients looked much better than many of the patients we have seen in the hospitals in the US.  After seeing the hard work that these caregivers provide, we started to not only assess the patient, but also the caregiver, and were able to work with them on proper body mechanics and provide them exercises they could do to prevent injuring Britain
themselves.

On one visit, we worked with a 12 year old boy who had cerebral palsy.  His mother had abandoned him as a baby and his grandparents were his primary caregivers.  His grandmother had been in an accident and the family did not have the money to amputate her foot, so she had been living with an ulcer on this leg off and on for 8 years.  She could barely walk on this leg, and since her husband worked during the day, her other grandson who is 13 years old provides much of the care for his brother.  Although it was somewhat hard to think about a 13 year old boy (who in our opinion should be out playing with his friends) stuck inside caring for his brother, it was really beautiful to see the connection between the two brothers and to see the younger brother with a big smile watching his older brother performing his exercises.  We learned so much today from these home visits, about the kinds of injuries people in this area suffer from, the care that is available, and the important role families play in the care of these patients.

 

Only the Beginning…

At 5:30 am, the roosters begin to crow! We are awakened but struggle to enjoy the final two hours of sleep left before it was actually time to get dressed and head out for our busy first service day. We all met promptly at 8:15am ready to divide into our groups of three for our daily assignments. Before departing, we were fortunate enough to meet Mr. Shaun Ingraham. He shared with us the efforts of One Eleuthera, including strengthening Eleuthera’s economy and healthcare system. Most notably, Eleuthera will be hosting the first “Earth Day” benefit concert here on the island on April 22nd which I found to be very exciting news!
We all then went our separate ways into Elethera’s primary and high schools, and also the clinics for an exciting day of learning, teaching, and healing!

I was assigned to Tarpum Bay clinic, just blocks away from where we are staying. As we arrived to the pink building, home of the post office, police station, and clinic, I grew more eager to get inside. My group members, Lauren Settle and Brette Winston and I met Nurse Ingraham, Nurse Rolle, Mrs. Kayla and Sabrina Clark, the Tarpum Bay Clinic staff, who welcomed us in and put us to work right away after a grand tour and information session. I did patient intake, signing patients in, weighing them, and directing them to the “Nurse’s Office/ exam rooms.” I also did blood pressure checks for a few patients. Both Brette and Lauren did patient interviewing and patient assessments.
What stood out to me the most was the autonomy of the nurses and the courage within them. Despite their limited medical supply, lack of informational resources, and growing number of clients waiting to be seen, the nurses operated smoothly with content embrace for each patient. They were so pleasant and extremely helpful, sharing their expertise with us and encouraging us in our efforts.Angels Camp

I learned more details of Eleuthera’s healthcare disparities and the government funded insurance that assists people over the age of 65 and people with diabetes or asthma. Children, students under 18, and patients requiring family planning services or antenatal care are seen free of charge, Some of the major health concerns here on the island include chronic illnesses such as diabetes, hypertension, asthma and in terms of sexually transmitted diseases, the Herpes Simplex virus.
According to a Tarpum Bay staff member and a male patient, more emphasis should be on “role changing behavior.” Nurse Rolle stated, “People here just will not eat better foods when they know it is not good for them, they love to eat what tastes good.”

My group members and I were prepared to share lesson plans covering healthy lifestyles and preventing obesity, but it was elected that we discuss STD’s by the young Nurse Cadets, five high school females desiring to become nurses. With them, we played a candy trading game to simulate the spread of STD’s and led a discussion session covering abstinence, the Human Papillomavirus and vaccine, and Herpes and allowed the girls to ask questions. We got exceptional feedback following our presentation which made us very happy to know we had shared valuable knowledge.
Around 4:30pm, my group and I returned to our houses, where we reflected on the day and gave each other our analyses and ideas. Some of us then completed our day with a relaxing, inspiring walk around the beautiful island before dinner. I was not entirely surprised, but amazed by the strength of the people here. Today was only the beginning of this journey that opened our eyes to an island dedicated to community and faith.

Vamos por la playa!

Today was our first official day in the Dominican Republic. We arrived yesterday to our hosts and Dr. Foster waiting with “banderas” the Domincan Flags in hand ready to take our first picture! We loaded our suitcases full of supplies and medicines into our bus with the help of Leo our bus driver and our new friends from the community, and we took off for our 2 hour bus ride to San Francisco Macoris. To our surprise we arrived to a delicious meal of chicken, beans, rice, veggies, and passion fruit juice awaiting us at Rosa’s house. A little exhausted from the trip, after an hour long wait for the cold shower we were ready for bed, but our neighbors had another plan… a celebration for Three Kings Day including loud, loud music luckily some of us had our ear plugs.

We awoke this morning to cockadoodledoo from those same neighbors roosters… and we headed for the beach! We had a few detours along the way, and after 2 hours we arrived at the beach! Only to find the beach was not as beautiful this morning because of all the rain the previous night. So we walked back to the road through the mud… waited for our bus that went to pickup lunch from Margarita’s house (who woke up at 4am to make us our delicious fish lunch!). Then we drove another hour to another beach… Las Terrenas, where we had lunch and got to know our hosts who we will be working with this week.inflatable bouncer

Tonight we had a little debrief and here are a couple things we observed today…
The colors
The language
The driving
The culture
The feeling of being home (some of our team members are from other countries)
The welcoming personalities
And how much fun we are all having!