Road Trip!

"It's your turn to wake up the meaning of life.  Acknowledge your natural gifts and ways to fully express them! Create the world you dream of with every choice you make"  - A poster hanging in the library at Charles Roza School of Nursing in Linden

Today we took our "show" on the road to Linden at the Charles Roza School of Nursing.  We provided the same type of education to 11 tutors (and one CNO) about teaching strategies, designing an instructional guide, and clinical teaching.  The difference between this teaching and Georgetown was the level of enthusiasm we received.  Many of the tutors were prepared for teaching by taking courses in their BScN degree, and the dean, Mr. Christopher runs a tight ship.  The school was very well organized, clean, and the students were very respectful.  Just as all nurses are tested once in awhile on their ability to keep calm and keep going on in the face of crazy, Mina's skills were tested as we dealt with 2 major blackouts (these happen quite often in the interior) where she had to adapt to having no lights, no air-conditioning, and no computer/projector.  We did have one problem child (a continuously beeping surge protector), but like all problem children we made it sit out in the hall until it could behave :-)

                                                  Charles Roza School of Nursing

A drawing hanging in the library showing the work of a midwife

My favorite- old textbooks!  These are all texts about Neonatal/Infant care dating back to the 1950's, which is when NICUs were just gaining popularity in the states!

We learned a lot more about clinical instruction during this session.  We discovered that clinical hours are not regulated- the semester has a goal of x amount of hours between all the courses, but no set amount it relegated to any course.  Because of this, students may be in pediatric theory, but not get to the pediatric unit until after the course is complete, as they rotate students in any order they can.  This impacts what we have been discussing all week, which is the need to connect theory to clinical to foster critical thinking/clinical decision making skills.  While there are many problems that need to be solved at the level of the Ministry of Health (the schools have no ability to set or uphold their own standards of student behavior, for starters), the issue of there and when students are placed in clinical is a fixable one.  We also discussed the total amount of clinical hours.  The student may have 300 hours per semester (to give perspective, Capital U. required 210 hours for our senior students participating in a 1:1 preceptorship- the highest amount of hours in a single semester), but they have a high absentee rate, and the students are not given quality attention or supervision.  This leads to a high quantity of hours, but how many of those hours are quality?  Again, an issue to be discussed with Ministry/Nursing Council, but an important one if they want to improve their passage rates.

One other major discovery is that the Nursing Council does not share the criteria they use to evaluate students in practical portion of their national licensure exam.  So the tutors were saying that while they may teach a skill one way, the evaluator may want it done a different way, and would fail their students not because their technique wasn't correct, but it wasn't the exact way they wanted it done.  However, unlike most schools of nursing who give practical exams, the grading rubric is not disseminated, causing issues with passage rates.

It was interesting to get these more in-depth perspectives, which drastically impacts what Mina and I are teaching.  We thought passage rates were directly related to teaching strategies and curriculum, and while in many ways it may still be, there are other bigger issues that need addressed such as clinical hours, evaluation criteria, and the ability of the schools to set and uphold their own standards (rather than the ministry micromanaging).

Mina teaching

Mina facilitating the development of an instructional guide with some of the tutors

Philosophy of the School of Nursing

A 2 hour ride brought us back to Georgetown and to the home of Mina's Husband's family (cousins) for yet another amazing dinner of dahl with potato roti, okra, bora beans, and spinach.  They are quickly becoming my new Guyanese family, and I hope to get a cooking lesson during my next visit!


Another cousin drove us home with a tour of Georgetown first.  I discovered that Stabroek market has a very lively night market selling great produce and some cheap authentic dishes, such as cook up.  For future reference, there is also a great sports bar upstairs and a good restaurant at the corner.  Our drive also led to Kitty so that Mina could reminisce about her childhood then to two bars in the area (very close to project dawn)- G spot which had a great breezy patio and a laid back atmosphere and Steep's on station street which was a little younger and louder but with a great energy (just try to get a table outside!).  It's always great to get the local perspective- as I said tonight, I like to go places where there are no white people :-)

Early pickup tomorrow (7am!) so off to bed while listening to the driving rain...

Gate outside the School of Nursing

On the drive out of Linden- Bauxite mines

Famous or Infamous?

Today Mina and I harvested the energy from yesterday to continue our workshop with the tutors. Today's topic related to test construction including item writing.  While many of the tutors shared that the information was "a good refresher", when looking at their test questions, many were in need of updating and clarifying so that they were upgraded to an application rather than knowledge level.  Also, most of the tutors were unaware that the blueprint for the national nursing council exam (the exam that licenses nurses in Guyana) was available to them.  In only 10 minutes of going through the blueprint, I discovered that they have both objective and essay style questions, that 60% cover clinical information and 40% cover functional (professional) questions, that over half of questions on both parts deal with interventions (second highest health promotion and communication), and that 70% are either the assessment or intervention steps of the nursing process.  I spent a little time explaining how they can create exams in the school that will most benefit their students on the council exam by mimicking these percentages on their own exams.  Interestingly, this is the very same issue that faculty around the US and Canada face very year- looking at the NCLEX blueprint and areas of greatest weakness in their students based on exit exams and NCLEX results and making sure that exams are truly preparing students for the licensing exams.  

Mina presenting certificates to the tutors

Workshop attendees

The end of the day brought the media (Minister  Dr. Bheri is very big on getting media involve with all programs benefitting the health care sector) with an interview of myself and Mina about our training and our experience with health care, nursing, and nursing education in Guyana.  The interview is supposed to run on the local news tonight, and pictures from the session along with the handing out of "certificates of attendance" for the workshop should appear in the papers tomorrow (I'll provide the link if we are!).  While I was a little excited, as this is the first time in my 2.5 years of working in Guyana that I would be featured or even mentioned in the press, it made me wonder how receptive people are to seeing foreigners in their papers.  We come, provide education, and leave without a backwards glance (most of the time...hopefully our efforts will be sustainable as we continue to work with the schools of nursing and the ministry).  Are we famous or infamous for our efforts?  

Most of our days consist of running to one meeting to the next, most of the time having to switch gears on the short car ride between.  After the faculty training, Mina and I met with Medex Benn (who I just realized is the brother of one of our NICU training graduates!) and Dr. Madan Rambaran who is the director of IHSE (Institute of  Health Science Education) at GPHC.  We were directed by Minister Bheri to meet with Dr. Rambaran about our proposal for accreditation of the neonatal nurse training program, specifically how we get a connection with University of Guyana.  He recommended having the program either, A. be a 1-year certificate program that is house with IHSE/GPHC and sponsored/accredited by UG or B. become a BScN specialty where the program would merge the bachelors of science in nursing with our specialty program and become a model for other nurse training programs to become specialty tracks within the BScN program (currently a 2 year program). He is going to set up a meeting for us on Thursday to meet with faculty from the school of nursing at UG to discuss next steps (we're making steps...preemie steps, but nonetheless...) 

Looking down the hospital grounds

View outside the A&E (accident & emergency) entrance

Sign outside of the pharmacy :-)

The last meeting of the day was with the ward supervisors/managers/nurses about clinical teaching.  It was a follow up to the meeting we had last week, and since it was a smaller group, we had more discussion regarding orientation to the wards, clinical objectives, and making connections between theory and clinical.  The consensus was that having 1 clinical orientation for the students before they begin on the ward would help to clarify objectives and give direction for the clinical session.  The ward nurses said that if they can get the schools of nursing to give them this 1 day/time, they could do the rest.  Yeah for collaboration!  Now to get the schools on board... :-)   Afterward, talking with brother John (the other assistant nurse matron alongside Sister Lalckecharran (who I met in March)- he is in charge of the medical wards and ICU and Sister is in charge of the maternity/NICU block), we discussed having a continued core group of nurses from the ward who want to precept students and commit to helping supervise and educate students in the clinical setting so that there is increased communication between the school and the nursing units as well as standardization of how theory and clinical merge. 

                       View of the entrance to the new pediatric unit next to our group meeting space

Ward supervisors (in green) with staff nurses (in white/blue scrubs) with Brother John

Mina told Brother John and Medex Benn to "act like you're discussing something important"- true to form Brother John is giving Medex Benn a look like he's crazy, a normal look when the two of them talk!

View from Main hospital gates- the security office is the blue hut

Our day finally over at 5:30, Mina and I retired to her hotel for drinks and dinner before I returned to El Dorado to prepare for our journey to Linden tomorrow.  While I was writing this blog, I noticed that in the desk drawer was a copy of "Guyana Inc.", a magazine for entrepreneurs.  On the cover, and in a  feature article was the head of the forestry sector for Guyana, who I felt looked familiar from my lunch at Rishi's grandparents the other day.  Turns out the "wood guy" as they liked to refer to him, who gave us a little rundown of the woods used in the home, is the same one featured in the article.  Again...famous or infamous?  :-)

Picture of "Avi" and his new wife, who we met Sunday

I do it for the love....

No one ever goes into teaching for the money.  Whether you work in K-12, college, or staff education, you will never get paid for the extra time you take with a student, or the hours you pour over lesson plans and activities to make sure your students have the best learning experience.  But we do it for the love- to help our students become successful people, professionals, and colleagues.  I can always feel this love and energy whenever I am in a room of educators, which is what I felt today when I attended a tutor (faculty) capacity building workshop.  Dr. Mina and I led discussions/lectures/workshops with faculty from the Georgetown school of Nursing, New Amsterdam School of Nursing, Ministry of Health/Health Sciences Education branch, and Georgetown Public Hospital.  In total we had 25 attendees who engaged in topics dealing with teaching strategies in the classroom, developing instructional guides, and clinical teaching.  You could feel the collective brainstorming happening in the room, along with the collective frustration from the lack of accreditation of the schools of nursing, which makes it difficult for them to have a standardized curriculum and evaluation.

Mina leading a class session

Helping the tutors develop instructional guides

An overview of the tutors working during the session

The afternoon led to a meeting about the accreditation of our Neonatal Intensive Care Nurse program.  The meeting held officials from the Ministry of Health, including the honorable Minister of Health Dr. Bheri Ramsaran, the Chief Medical Officer Dr. Sham Persaud, the Chief Nursing Officer Nurse Barker, and Medex Benn (title meaning "nurse practitioner") who is in charge of Health Sciences Education along with Heads of the National Accreditation Council for Nursing and the Permanent Secretary of the Public Service Ministry, Mr. Alli (they govern all of the nurses in hospitals beside the private sector/GPHC such as our nurses returning to Linden, Suddie, New Amsterdam, and West Demarara).  The goal for Guyana Help the Kids is to help transition our programs over to the government of Guyana by the end of our funding on December 31, 2016. One way to do this is to get our program accredited and recognized by the government as a nursing specialty and to find a home for the program so that the education of NICU nurses can continue.  We approached this subject when I was there in August, and we've had one follow up meeting at the end of August with major proposal and job description/definition written and sent.  Today was the follow up meeting with all the major players to see how best to approach this task.  What we left with was that the Nursing Council felt the best way was to approach the University of Guyana (UG) so the program would have a little more control, rigor, and ability to reach a wider audience (their hope is that nurses from all over the Caribbean would come to Guyana to enroll in the program).  I left with a meeting appointment with the Director of Health Sciences Education at UG for tomorrow afternoon, with Dr. Mina facilitating since I am scheduled to meet with the ward nurses to provide more clinical education around the same time.  I'm hoping we get a better response tomorrow than I did when I approached UG in March, where they wouldn't consider housing the program unless it was an additional certification after students completed their Bachelor's degree (another 2 years before they could even enroll in our program).  With the ministry on our side (Dr. Sham and Medex Benn are facilitating) and the call for the meeting coming from Dr. Bheri, I'm looking forward to a partnership with UG, which was always my goal from the beginning.  High hopes!!!

Statue of "Cuffy" (also spelled Coffey or Kofi), a national hero of Guyana, who was a west-african who led a slave revolt in the Dutch colony of Berbice in 1763.  The statue can be seen from the waiting room at the Ministry of Health

As with all meetings with the ministry, a cold beer is always in order at the end, so Mina invited me to hang out with her family at their hotel where I was served leftovers from their family lunch at Rish's grandparents (roti with duck curry, cook up (rice, veggies, and black-eyed peas), fried snapper and roasted chicken).  As always, I practically licked the plate :)  They also had made friends with the  hotel owner, who cooked crab curry.  First time I used my teeth to crack open the shell, and again, the curry was amazing.   The party continued with another visit to the wedding house, where the family was celebrating the bride's return with lots of meat and alcohol.  I was greeted by hugs and a huge plate of food, again as if I'd know them my entire life.  I even earned a dinner invitation for later this week, with the man of the house saying how grateful he is that people come to his country, which he loves, to help his people, and because of this would do anything he can to help me feel welcome.  I, however, always feel that I am the lucky one, the blessed one, who has been welcomed into this community of people and allowed to share a little knowledge and hope. Like I say, I do it for the love...

Crab curry

Guyana Hospitality

Dr. Nar jokingly refers to the hospitality of this country as "Guyanese hostility" but today I witnessed the ultimate showing of how the Guyanese love to welcome people into their country with open bottles, open kitchens, and open arms.

I started my day with attending the 7th annual Guyana Medical Scientific Conference.  Even without an official registration, people allowed me to learn from the presenters, who were mostly residents in different specialty programs at GPHC.  Two of the pediatric residents, Dr. Areefa Aladdin and Dr. Winsome Scott presented their research, and the lab director, Pheona, whom Kate and I met with last week, also presented.  

There was also a presentation from one of the sponsors of the conference, JIPA Network, who are a group of physicians that deliver tele health/self-pay service who coordinate with many latin american and caribbean countries to give health care.  Most of their talk about about mobilizing healthcare and education to low to middle income countries using consultants throughout the U.S. and South America (mainly Columbia).  It was an interesting concept to me, and got my wheels turning about how I can turn my crazy obsession with delivering nursing education to a global audience into a real solution. Yes, I can hear all the voices of my past saying, "Don't get involved with yet another project" and "be happy where you are" and "just enjoy what you do, don't go looking for other things  to get involved in".  Hopefully most of you are helping me to tell those voices to shut up.  I know I should just enjoy having my NICU job and the Guyana Help the Kids position.  But I can' t help wanting to be an entrepreneur in the field of nursing education.  I can't help but want to figure out a way to help nursing faculty teach their nurses to the best of their ability so they can help change healthcare in their countries.  I can't help wanting to keep traveling, keep learning, keep experiencing everything my profession has to offer.  So, stay tuned for my crazy dreams of making a Khan Acadmemy/Coursera/JIPA-like virtual training program for nursing.  

Meanwhile, here are a couple of takeaway observations from the conference:  

1.  Physicians may have the data about a problem/solution, but nurses really bring the heart and reason to help solve a problem to light (One BScN nurse spoke from the heart about comforting a patient dealing with prostate cancer at the age of 45, which led to her wanting to explore attitudes and knowledge comprehension surrounding prevention, screening, and treatment of prostate cancer)

2. The medical community is always the first to blame nurses when there is a problem (One physician talked about his research with MRSA in patients on a burn unit.  Their first line was to test and "decontaminate" all of the nurses positive with MRSA- note- a good majority of even community people are positive for  this bacteria which is completely harmless to someone not immunocompromised.  They provided treatment to nurses and made them wear full protection gear when touching patients, yet never tested/treated physicians and never did a follow up to see if this intervention actually decreased their infection rates.  They just assumed nurses were the problem, and if they "fixed" it, the problem was solved)

3. Even physicians in low-income countries laugh/roll their eyes when talking about complementary/alternative medicine.  There was a video about "bush medicine" or alternative medicine practiced by people in outlying regions of the country, which mostly included use of herbs. The video ran through the most common herbs being used in the country along with side effects and drug interactions.  At the end of the video, it posed the question, "would you prescribe bush medicine for your patients?"  The physicians sitting in back of me starting laughing and answered with a "hell no!".  I found it interesting that while herbs have their side effects, physicians could be so short sided.  Even if you don't believe it using them, you have to understand that your patients may, and asking about additional drugs/herbs should be routine in all health questionnaires. They completely missed the point.

                                     The conference center (which has routinely showed up in the background of many of my pictures from project dawn.  Notice that I am one of the first persons in the auditorium- The program was supposed to start 2 minutes after I snapped this picture.  Guyanese time is very loose- I think we started about 20 minutes after the program said it would, which isn't too bad, considering many things start 30min-1hour later than advertised)

                     The lab director, Pheona, presenting her research on the testing for sickle cell traits

The conference program and schedule of events

Mina and I ditched the conference at lunchtime to attend a wedding of her future son-in-law's (Rish) cousin. We first went to lunch at Rish's grandparents house where we also met his mother, cousins, uncles, and his father Robin who Kate and I met earlier in the week (Nar's brother).  They all welcomed me in with open arms to share in their lunchtime feast of Indo-Guyanese dishes like mutton curry, baked chicken, potato salad, and rice with dahl.  We marveled at their beautiful garden (Rish's grandmother brings back plants from the US and Canada when she visits...) and their traditional outdoor cookstove which is made out of clay and seen in Indian cooking.

Clay/mud stove used to cook traditional Indian dishes

Grandma's Orchids

View from the entry way to Rish's grandparent's home

After lunch we went to the "yard wedding" held at the bride's home.  Apparently the actual ceremony was held earlier in the day, in which the groom traveled from his home across the river to attend, then afterwards he takes his new wife back to his house for a celebration while the bride's family celebrates separately- this celebration is meant to be more strict as there is no meat served, and no alcohol is allowed in  the house. Tomorrow the groom and bride will return to her house for another celebration with all of these things.  When we turned onto the block, I could hear the party before I could see it as the Hindi music was rockin.  Again we were welcomed in with open arms, and I don't believe I had stepped 2 feet out of the car before I was handed my first beer and introduced to every cousin there.  Mina and her daughter explained the rituals and took me into the house to teach me how to dance as well as taste (with only my fingers) all the delicacies, all of which was cooked by 2 of the elder men. Rice, Dahl, roti, potato curry, 7-vegetable curry, pumpkin curry, spinach and eggplant were piled onto my leaf (it was a lilly-pad looking leaf which is commonly used in these celebrations), and it was all delicious!  The drinks kept flowing (I never had a beer out of my hand more than 5 seconds before another was placed there) and the introductions, dance lessons, and sharing of culture kept on through dusk.  It was a great experience, one that made me feel like I really had a Guyanese family.  

Outside view of the party house

Indoor wedding chapel

Beware...white girl dancing

Family time

The cooking spot

View of the feast table and one of the cooks

Yum.......

Mina's husband shows off the "plate"

It's beginning to look a lot like Christmas...

Kate and I enjoyed a little R&R in the sunshine today by sitting at the pool at the Pegasus hotel.  After a long week, some sun and suds were greatly appreciated.  It's hard to realize that Christmas is only about a month away when you have palm trees surrounding you, but everyone is decorated and the christmas music is playing :-)

 "The only ice here is my ice cold beer" My Facebook post today, in honor of all the Ohio people dealing with the ice today

View from the Pegasus pool

           

                                    Christmas with sun and palm trees- this Ohio girl doesn't know how to react!

View from the front of Pegasus hotel

Tonight we attended the awards banquet for the 7th annual medical conference.  Our 16 nurse training program graduate all received their certificates.  We also gave out 4 awards- best academic to Michelle, best clinical to Janelle, most caring to Rachel, and best overall to Terrance.  The students all looked great and we had a lot of fun taking pictures.  The students also gave Nationwide Children's a trophy from their class as a thank you for sponsoring the program. Guyana Help the Kids was also honored with an award for it's continual dedication to medical and nursing education.

Guyana nurse educator, Cenise and me

Guyana Help the Kids' award

Dr. Nar receiving an award from Michelle on behalf of Dr. Nelin and Nationwide Children's Hospital

Cenise receiving an award from Michelle for her dedication to the class

Kate, myself, and Aruna (our program coordinator)

Some of the students with 2 of the residents

Christmas Tree Selfie at Pegasus after the awards ceremony