ok now its Linda writing.
today was another busy day! I woke up to the sun rising and the sound of patients and families starting to move about. ( we are sleeping in an area that I guess is best described as a loft that is right above the med/surg patients. ) At 630 we rounded with the ortho doc then at 730 the Sabbath was celebrated ( Adventist = sabbath on saturday) and we went to the english church service and I actually got roped into being a part of the song group. (not excited about that)
Anyways, we had a lot of difficult dressing changes today like gurpreet said. The humidity doesn't make it any better. THe whole process of changing dressing seems to take so much longer here due to lack of available supplies being readily available - we are often running back and forth to the central supply station downstairs just to grab things like a sterile q-tip or chucks. Not to mention that just putting on a glove takes about five minutes because our hands are drenched in sweat. One patient's wounds were so bad that we had to recruit the CRNA (that just arrived today) to provide conscious sedation during the change (another story). Another wound vac change literally took over an hour- luckily there was a fan in that room and we had live music going from the creole/french church service going on downstairs.
The goal of this week is to have the Haitian nurse start to take over the wound care. Our team will be leaving soon and so they will be responsible for these dressing changes and a LOT of teaching needs to be done. I had one Nurse who decided to watch me change one of my patients dressing - when I asked her to get involved she said "no no just watch." So I explained to her what I was doing and tried to walk her through it, but everything was via translator so Im not sure which pieces got through and which ones might of been lost in translation. Another nurse approached me and said he wanted me to watch him change this dressing on a wound. I really couldnt watch for too long without having to speak up- and it felt kind of awkward trying to tell him that he was doing everything wrong, and not just minor things.. Things like blatant breaks in sterility and even when he tried to be helpful it was in the wrong way. SO we have our work cut out for us in terms of education. We plan on holding an inservices for them every night while we are here.
Otherwise, I am having a great time getting to know the Haitian people. One of my patients is teaching me how to say the days of the week in creole. Everytime I pass her in the hallway she quizzes me. Now I keep a cheat sheet in my fanny pack and study it really fast before I go out and see her, I can almost remember all the days: Dimanche (sun), Ledi, Medi, Merkedi, Jedi, _____, Samdi. I do have my own translator, Claudene, with me during the dressing changes but the patients seem to appreciate it so much more when they see you trying to understand the language. Claudene is also helping me a few phrases like "how are you?" "are u having pain?" etc. As he was teaching me to speak creole in the hallway of the hopital and a few people stopped by to hear me fumble with the creole phrases. I guess they think its a pretty funny thing to watch.
another story or two to reiterate the lack of adequate supplies here:
1. had to do a dressing change on a patient who had severe wounds due to being electricuted by a electrical wire. VERY painful. needed morphine. asked nurse for morphine - 10 minutes later she hands me a syringe filled with 3cc, the bottle thats taped on it says that its morphine 10mg/ml in 1 ml bottle- well we couldnt figure out what consisted of the other 2 cc's so went to go grab our own only to discover that there really isnt ANY morphine to be found
2. I was eating dinner when a translator ran in to get someone to help the pediatrician - apparently he needed a pulse ox and couldnt find one. THe only people he knew with one was a midwife who had left the grounds to eat dinner. I asked around and came up with one that I ran down there only to find that it wouldnt work because it was too big for this 3 year old baby who was working really hard to breathe. Finally 15 minutes later I had found another pulse ox but I had to rummage through the nurses cardboard box of supplies to find it and then only to realize that the batteries were dead, well then i had to find someone who had AA batteries, that was David the PT who was in the shower.. luckily he didnt take too long and as soon as I found him and replaced the batteries I ran the pulse ox down to the ED and slapped it on the poor girl - luckily the 02 sat's were in the high 90's but she was definetly using all of her accesory muscles to breathe.
so I am finding there to be a lot of problems/inefficiences and areas that need work but most of them cannot be fixed due to lack of money. period.
After work we went to the universitie that was just outside of the hospital grounds. As we entered the universitie grounds we realized that it had become a huge tent city. The little kids came running up to us smiling and waving. This one cute little girl just started holding my hand and walking with me speakingin creole and smiling at me. SHe got really excited when I snapped her picture and wanted me to keep taking more and more! Another little boy taught me some more things to say in Creole. they were all so adorable. but we had to leave almost as soon as we got there because it began to rain.
right now I have three small fans pointed at me and im still sweating.
did I mention that I forgot to pack the rods to our tent and so we cant use it? so we are currently sleeping on cots under mosquito nets that have holes in it.
more to come later but its after midnight here and i have get some sleep! -- will post more pics later !!!
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