Guyana Nurse Training Program: First Steps in the NICU

I was actually nervous to walk into the NICU today. Not having set foot yesterday, wanting to spend the time with the students in the classroom, I wasn't sure what I would find. I was nervous that everything would be different, and even worse, the complete same. I was afraid to find that even after three years of training and education we would have made absolutely no progress. In some areas I was pleasantly surprised, in some others my fears were validated. My first steps in the NICU today were full of insight either way.

We started out the day surveying the unit- the equipment, the layout, the staff and patients. One of the biggest changes was that all 4 rooms of the NICU were being used to house patients- room #3 last year held dirty equipment, rooms #1 & #2 had patients, and room #4 was isolation. We found that the equipment had been moved to allow more movement between the rooms as well as prevent the spread of infection. Each room was labeled and named after one of the founding physicians- the preterm infant section in room #1 was named after Dr. Leif Nelin, our chief neonatologist at Children's who has been involved with the program since it's beginning in 2012. We also noticed how organized most of the shelving was in the unit- most things were in bins and labeled, which is a change from the complete lack of organization in the past (Kate was also glad to see that someone had kept her organization of the storage room she started last March!). We were also glad to see that the nurses were divided up amongst the rooms, creating actual assignments (when we started, all the nurses would wander around and just carry out orders without regards to knowing the patient).

While we were excited to see these positive changes, it was still heartbreaking to find so many of the babies with low temperatures. For as much as we've tried to reinforce thermoregulation, it's still not being done. I will consider this a positive trip if I can get every baby to be warm 100% of the time (without having to remind the nurses to do so!). Nutrition is another issue that we have yet to resolve. Most of this has to do with resources- they don't currently have Total Parenteral Nutrition (TPN, or "IV Gatorade" for lay persons)- but it also has to do with education about starting feedings early, which has been shown to help reduce infection rates. Infection rates continue to be high, but by keeping babies warm and fed, I truly believe we can help reduce these as well.

The comfort level with resuscitation by the entire staff is very positive. There was one full resuscitation in the NICU where there was pretty good collaboration and communication between the nurses and physicians. While the outcome for the patient was not good, I was encouraged to see how far the staff have come in their resuscitation skills and ability to work together as a team (something that was NOT observed when I assisted in a resuscitation in the delivery room- but definitely something that will be discussed with the OB team during our visit this month). Overall, it was a good day full of insight into how things are going in the NICU.

We made some plantain and cassava chips for dinner along with grilled cheese, pineapple, and mango...delicious! We got to try a new fruit, called cookrit, which tastes similar to a not-ripe pawpaw (not that great, but I always like trying new things). Looking forward to another busy day tomorrow!