Flood Day!

Karma...she's wicked!  Just as Kate and I were mocking all of our Ohio friends with our pictures of sun, we got hit with 8+ hours of hard rain overnight and into the early morning, causing a massive flood in the center of Georgetown.  Because of this, schools were shut down, roads were closed, and the hospital was almost impossible to get to unless you had high boots on.  Our program director, who lives on the West Bank, across the Demerara river, was unable to get to the hospital because of the massive flood state, so Kate and I stayed at project dawn to look up information for the unit and catch up on laundry and sleep.  

A little perspective on the flooding in Georgetown.  First, the  city is about 2 feet below sea level- hence the large sea wall the lines the northern coast of Georgetown.  Second, there are 2 major rivers- the Demarara and the Esquibo- with an island of the "west bank" in the middle.  These rivers drain into the ocean, on the coast of the city, so all the water is influenced by the tide waters.  Third, there are canals located throughout the city that help drain water to the rivers, but they are only effective when the tide is out.  So, this left much of the city in a flood state until 3pm today, when the water was finally able to recede.  One interesting political topic right now is the construction of a new canal, called Hope Canal, which was commissioned in 2011 and was supposed to be completed in 2 years.  It was pushed back to June 2014 for  completion, and just today, they announced that the project may be completed by the end of the year.  I love talking to our driver, Munir, about the politics of the country while I am here.  In August, we talked about how the people were unhappy about how the taxpayer money was being spent, so they were going to hold an election in November. So, on this trip, I asked the result of the election, and he said that the Prime Minister decided to suspend parliament in October  for the next 6 months because he was being investigated for fraud, and elections were not held.  The people are upset not because of the projects being funded, as most of the projects will help the country and are for the people, but because the ministry uses a lot of their friends to complete projects, many of which do not really have the necessary skills or background to do the job right, and who charge a lot of money to complete them.  So in the long run, while the project may be worthwhile, it is done poorly for 5 times the cost, and never on schedule.  The Hope Canal is one of these projects, and it's clear that the project is costing much more than initially planned, and taking an extra year to complete.  Seems that the use of taxpayer funds is an issue for everyone, not just in the U.S. :-)

                                              The cows came home....

                                              Flooding at project dawn

                                             Flooding of the canal outside the entrance to project dawn

                             newspaper photo of the flooding in downtown georgetown, outside the post office

        The afternoon brought a few moments of sun, and the horses enjoying the extra watering hole

Aerial shot of where the Hope Canal will be- you can see it doesn't reach the ocean yet as proposed (taken from Keiteur News)

Today's task for me was to look at the disinfectant that the unit is using for everything from cleaning umbilical cords, preping for procedures, and cleaning equipment.  When I was on the unit Wednesday, I was helping Cenise and Tamacia insert a foley catheter.  Cenise said we needed to clean with Savlon, but since I wasn't familiar with the solution (which i thought was just a hand soap), I explained that we needed to use betadine, which I know has been studied in the research to be the most effective at disinfecting the skin for procedures (better than alcohol).  I told them that I would look into Savlon as a disinfectant, but until then I wanted only betadine used for all IVs, blood draws, and foley insertions.  What I found today was that Savlon is a disinfectant from the U.K that is a mixture of Chlorhexidine, Cetrimide, and Isopropyl Alcohol.  It comes as a topical cream and solution, and can be used for everything form minor cuts and burns (kind of like neosporin in the states) to surgical site care to disinfecting instruments and equipment.  However, there are different grades of the solution, and the hospital grade one has a different concentration of the 3 components than the over the counter solutions/creams.  Also, in order to disinfect, it needs to be mixed with water (which isn't clean here) and needs to be mixed in different concentrations depending on what is being cleaned.  I still can't find information about whether it is safe to use on infants, and being that betadine is known to be effective, I will probably still recommend betadine for procedural prep, I am confident that we can use it to clean the equipment, if mixed with filtered water and in the right proportion.  I commented to Kate that I never imagined in nursing school that I would be sitting around on a rainy day looking up information on disinfectants.  Maybe I should have paid more attention in microbiology :)

Also, an addendum to yesterday (which I was more focused on the unit than the afternoon session), a highlight was that I teamed up with Dr. Mina Singh, a professor from York University in Toronto. Mina is a member of the Guyana Help the Kids board and is on sabbatical this year- we met in August because she wanted to use her year to help with the nurse training program, but in the process got roped in by the ministry of health to help improve the nursing board passing rates.  Because of my love of nursing education, and my want to get a PhD to be able to teach master's students in the field of nursing education, I teamed up with Mina to help provide education to nursing faculty at the schools of nursing in Guyana.  So, yesterday was day 1 of this training.  We started with a 2 hour class with the nursing managers/supervisors at Georgetown Public Hospital who are often in charge of helping to educate nursing students.  The clinical instructor from the school usually have 20-30 students on the unit at one time, so they rely on the nurses to help teach.  Most of the nurses are open to this task, but they have no direction, no orientation, and no formal training on how to teach.  Therefore, many of the nursing students are not performing up to the standard in the clinical setting, and therefore are failing their nursing exams.  So I put together a presentation on clinical teaching for 18 nurses under the direction of Medex Winston Benn, the director of Health Sciences Education in Guyana.  The presentation was met with a lot of enthusiasm, and as I was talking about the use of reflection as a teaching strategy and as an evaluation method, Mina had all of them pause and complete a  1 minute reflection about what they learned today.  Then she had all of them share what they will take from the presentation to use with the students.  Their answers varied, but I was grateful that they all learned something practical to use that will hopefully help assist the students in their learning.  

Tonight Kate and I picked up some groceries from the market and made dinner with the rest of our housemates. Not as glamorous a meal as when Randy or the UK boys were cooking, but still a nice night in and enjoying each other's company.  

Kristen, an Emergency Room attending from Vanderbuilt, showing a few housemates pictures of interesting patients from her travels (there were lots of maggots and necrosis- awesome!)