Guyana Nurse Training Program: Somewhere over the rainbow...

It is said that rainbows bring the promise that the troubles of the day will pass, and that if you hold strong in your faith and vision the rainbow will bring fresh beginnings and prosperity (hence the pot of gold). With it being so easy to have cloudiness while trying to see your vision come to light here in Guyana, it was fitting that we witnessed a large rainbow while on our way into the hospital. The majestic rainbow always has a way of lifting my spirits, which was highly needed today, especially since within 5 minutes of getting in the door to Aruna’s office were called because of a code on the unit (no time for our pump up moves today!). One of the babies had plugged off their endotracheal tube overnight which led to respiratory distress and needing re-intubation. Regardless of the countless lectures and reminders to all of the nursing classes about care of the patient on the ventilator, and how important it is to suction the breathing tube every 3 hours, we still have a large amount of babies with this problem. This is definitely the issue with giving equipment before education- they need to understand the basics of neonatal care before they can use advanced equipment. But, seeing as we’re already down that rabbit hole, all we can do is continue to emphasize how important suction and humidification are to helping babies survive ventilation.

After our rousing start, I fulfilled my “feeding rounds” mission by attending rounds and being a feeding advocate. Again, many of the babies transferred to the NICU overnight from post-natal (we got 4 that were supposed meconium aspiration with respiratory distress that were rooting and acting like normal infants) were allowed to start breastfeeding. We increased the feeding volumes of several of the infants, and started one of the ventilated infants on trophic feeds (1ml every 12 hours) with the hope of advancement over the next week. Feedings make happy babies (and nurses, as the unit is a lot quieter!).

Kate’s favorite moment of the day was being able to syringe feed (also called pipette feeding) an infant for the first time. Her little friend from yesterday, the 38 week corrected gestational age infant who looks more like a 28-29 week infant because of her severe malnutrition, was getting only 4ml via syringe and the rest down her feeding tube. Kate held the infant for a few minutes and watched as the little girl sucked down the 4mls in a matter of seconds. She was able to advocate for the infant to take as much by mouth as she wanted, and giving the rest down the feeding tube. Another feeding success! (syringe feeding helps develop the oral motor muscles needed for eating and speaking).

Randy fulfilled his mission (ok, I voluntold him his mission) of getting a ballard/closed-suction system set up on every ventilated baby and giving in-services to all of the nursing staff caring for those babies. He also created his own mission by venturing out to buy another vibrator since the old one was “worn out”- this time a small little pink bullet (if you’re wondering what I’m talking about, revisit the blog post titled “good vibrations” from April 2014)! Halarious!

My favorite moment of the day was talking to and encouraging the mothers to bond with their infants. Family centered care is still a major struggle here. While they are making some slow progress (there is now a sign outside the NICU stating that the doctor will be available on Tuesday and Thursday from 10-11am to discuss their baby’s progress), it’s still far from where it needs to be in terms of getting parents involved in the care of their baby early and often. There is also a very hierarchal, almost patronizing tone that the staff take with the mothers, which is very disheartening. So, I try my best to talk with the mothers, encouraging them to hold or touch and talk or sing to their babies as much as possible. One of the babies (picture below of infant looking at mother) was one that I pushed to get breastfeeding yesterday-she’s doing great! The other baby finally got a loving touch from his mother for the first time, on day of life 4 (picture of mother looking at son in incubator). As I’ve said in other blog posts, I love watching the love between a mother and her child (and child with their mother!).

I hope the rainbow continues to bless us with a decreased supply of troubles and an increase in prosperity and freshness as we continue working with the NICU staff over the next several weeks.