Guyana Nurse Training Program: Let's get ready to rumble......

Every morning, our team gets to the hospital around 7:45-8am, and we head to Aruna's office to drop off our bags, get our day organized, and catch up on the happenings around the unit/regions. For me, it also affords a 30 minute window where the caffeine has a little more time to work it's magic before heading into a typically busy unit. This morning, leaning towards the 45 minute mark and knowing we needed to finally step foot on the unit, Aruna noticed that Kate and I were a little sluggish- knowing what was awaiting us behind the double pink door. She gets it- the frustration of trying to change attitudes and practices that are set in their ways while working in a resource poor environment that averages around 80 degrees Fahrenheit. So Kate decided that we needed a little "get out the door dance"- her's was a cute little made up number, mine resembled the 90's favorite , "let's get ready to rumble"from the Jock Jams CD. Either way it afforded us a laugh and a way to get pumped for the day ahead.

Today's activities focused on suctioning of the endotracheal tube (breathing tube). We brought multiple bags of in-line, closed suction catheters which help to decrease risk of infection and make it easier for the caregiver to suction. We attached one to a baby on a ventilator, and Randy went around to all of the nurses (our goal is to educate everyone, not just our students) to show them how to use it properly and explain why it will make their job easier. I gave a small inservice to the physicians who were very excited to have this resource.

My other goal as I mentioned yesterday was to start "feeding rounds" to ensure that every baby had a feeding plan for the day to help increase the early use of breastmilk to reduce infection. I went around with the physician group, and with the help of Dr. Scott, a 3rd year resident, we had a plan for every baby on the unit. We still had 2 that were not being fed, but for a better reason that just "waiting to see if the baby becomes septic". One of the babies that Kate was holding yesterday was able to eat for the first time- baby and mommy were so pleased! Most of the babies do not have good nutrition due to waiting to initiate first feedings and not having TPN (total parenteral nutrition). They also don't routinely use vitamins for the feeding infants. I encouraged the physicians to have the moms continue their prenatal vitamins during breastfeeding to increase nutrition.

Our afternoons are typically spent in what we call our "research time"- we are either looking up diagnoses we are seeing on the unit, researching policies to implement, creating a procedure manual with pictures and step by step instructions (Kate), and creating lectures needed for both nurses and physicians. Today I used my research time to organize the three stock shelves on the unit. Three out of the four rooms have large white shelves where supplies are kept for easy access. My plan was to place things in labeled bins and then keep the supply room as the "central supply" where the PCAs could restock from. It took me the better part of the afternoon, but it was completed!

Dinner tonight was at Grand Costal for Guyanese buffet night. We had goat curry, rice with dahl, sautéed breadfruit, okra, spicy trout, and other curries with rice pudding for dessert (it tasted like christmas!). Soooo good! And of course Kate could get her American food, which is always a plus.

As I put this blog to bed, the three of us have taken over the balcony- enjoying the breeze and some music while we prepare for another full day.

Randy and Kate explaining how to use an In-line suction catheter for endotracheal tubes

Rajan explaining Cricket to Randy

Newly organized shelf in room #4

Pretty sunset on our way into Project Dawn after work

Aruna and Cait during their morning chat

Cait demonstrating how to wrap the abdomen with gauze and plastic

(the infant had a malrotation of the gut, had a surgery but then dehiscence of the wound- so his entire bowel was out leaving him susceptible to tissue trauma, infection, and hypothermia- the plastic wrap will help with many of these issues until surgery can decide on a plan)