Guyana Nurse Training Program: Think horses, not Zebras

Our field trip today took us across two rivers to visit the NICU at Suddie. Our driver, Javid, took us across the Demarara harbor bridge to the stelling (boat dock) at Parika to catch a speed boat across the Essiquebo river to the stelling at Supranam to catch a taxi to Suddie. The speed boat was a modified fishing boat with a wood enclosure and open sides for optimal wind exposure. In low tide the water is fairly calm and easy to travel. In the afternoon at high tide, the waves are high and the water is rough, so Aruana booked us on the ferry, which is an extra 45 minute commute but definitely a much smoother ride.

After our long journey, we reached the hospital at Suddie where we met with the covering Regional Health officer (RHO, similar to a hospital medical director), Dr. Grey, who explained the needs at Suddie and discussed options for collaboration with physicians in Georgetown. We were also able to meet with Sister Bhowen, who is covering for the Matron of the maternity block, and ask about needs for the nursing staff regarding education and supplies. Similar to the other regional sites, they are severely lacking in physician and nurse leadership and consumable supplies. While the NICU was officially opened in August 2014, but due to lack of staffing and leadership it is not currently being used. They are using a smaller space just off the post-natal ward that can fit 1 RN and 2 incubators comfortably. The actual dedicated NICU is just a shell. It has a few isolettes, 2 monitors, a phototherapy lamp, a suction machine, and and IV pump, but has no cupboards or shelves for supplies or a crash cart. It's air conditioned but because of the lack of insolation in the walls, condensation builds up and drips down the walls. Again, suggesting a higher temperature will help reduce this. They also said that their isolette didn't work because it was making the baby too hot. It was a simple fix of providing education regarding how we have to set the temperature and adjust to the baby's temperature. Simple education which is not getting communicated.

The whole experience, and now that I've been to 3 different regional NICUs, brings to mind the old saying in medicine, "When you hear hoofbeats, think horses, not zebras", meaning that the simplest diagnosis or solution is usually the answer. We've spent so much time and resource getting advanced equipment to build a NICU but have neglected the basics like consumable supplies and cementing physician and nurse leadership. Having an actual timetable plan for implementation would have been helpful and kept us simple but effective. So now we have to circle back and go back to the horses.

To kill some time in the afternoon before our 4pm ferry departure, we hired a taxi driver to take us to Mainstay Lake Resort. It was fairly cheap for a day pass ($2 per person), and it had a nice lake with cabanas to eat lunch and lounge chairs to enjoy the sun and the breeze. While it reminded me of a rundown 50's style resort, it was a great place to relax after a long day of travel and meetings with hospital administration.

Our ferry ride home, while long, was just the right amount of scenery mixed with a beautiful sinking sun enjoying the wind in our hair. A great "second to last day" trip!