Guyana Nurse Training Program: Who turned the lights out?

In much of the developing world, power outages are the norm. Supply often surpasses demand, resources for generating power are limited, and theft is rampant (up to 25% can be lost in distribution in some countries...the U.S. loses around 6%). Put together with a government that is corrupt, inefficient, or both, power outages lasting anywhere from a couple of minutes to several days can occur throughout a country. Guyana is not a stranger to power outages. Many places, from personal residences to businesses and hotels to hospitals often have their own generator power, so the loss is minimized. The downside, however, comes when you have an NICU in a developing country. We have lots of equipment that runs on electricity- IV pumps, Incubators, Monitors, Ventilators- they all depend on the generator to kick on within it's 20 second window to supply power to our critical patients. On Thursday, that didn't happen. I was sitting in my "office" around 4:30pm working on a lecture for Friday's session with the residents when the power went out. No problem, I thought, as I waited for the sound of the generator and my fan to turn back on. Twenty seconds passed. Then 45, then a full minute. I walked over to Aruna's office next door and asked if she had power. She didn't. I immediately rushed into the NICU to assist with our ventilated patient, not knowing if anyone recognized that the baby needed to be handbagged. The doctors were on it, but our oxygen supply also went out. The nurses went to get our portable oxygen tank, and that was empty. With no oxygen available, we had to do the best we could and bag with 21% oxygen aka room air, what you and I breathe all the time (we usually bag with 100%, 60-80% for a preemie). Luckily, oxygen came back before the lights, but because of the time delay in handbagging the patient, and only bagging with a minimal amount of oxygen, the patient went into a full-on code. Using the light of the windows, the nurses drew up medications, physicians did compressions and bagged. The only help of no lighting was that we were able to transilluminate (place a light up against the chest wall to see if there is a glow, which indicates that air is present outside the lung) easily to see that the baby had a pneumothorax (accumulation of air in the space between the lung and chest wall). The electricity came back on within about 5 minutes, but it almost cost the baby his life.

While resource issues continue to be a huge problem, lack of responsibility is the biggest challenge we face in brining the NICU up to a safe functioning level. We didn't have any oxygen in our portable oxygen tank because the person in charge never came to switch out the empty one with a full one. While the charge RN called to have the tank refilled, they never followed up to see if it had been done (the call was placed the day before). Follow through and critical thinking do not exist in most people here, for whatever reason and I'm sure there are many. Take my hand gel issue that I've been ranting about for the last 3 weeks. I had to follow up every day for 2.5 weeks to get 12 bottles of hand gel. Someone needs to talk to someone else who relays the message to the person who fills the bottles, yet no one follows up to make sure it got done (except me- I'm sure they're counting down the days til I'm gone..haha). When a piece of equipment isn't functioning exactly how it should, no one takes a minute to do a quick trouble shoot. One of the nurses stopped me as I was walking out the door Friday, bag and empty coffee mug in hand, to say the suction machine wasn't working. I asked her what she had done to try and remedy the situation. She looked at me like I had two heads. So I put down my bag, got down on the ground and taught her how to start one end of the machine and test each section individually to see where the leak was. Turns out, a piece of plastic was stuck between the lid and the canister of the suction chamber, which caused pressure to leak out and not reach the suction catheter. Took me about a minute to figure it out. Simple mechanics. Another found me earlier in the day to say that the IV pump wasn't working (props to her for coming to me- most of the RNs don't trust the pumps, or the monitors for that matter, and therefore as soon as they alarm just shut them off and put them in a corner to sit there until I return again)- it was reading "Air in line". So I took her to the pump and asked what she thought was wrong with the pump. She had no idea. I asked her to read the error message, then together we opened the door and looked at the tubing, which had multiple air bubbles in it. We ran out the bubbles, put the tubing back in the pump, restarted the pump and it was working perfectly. Really? Can you not read? I pick on our nurses but it goes for all levels of staff in the hospital. My bosses are constantly telling me I need to teach them how to trouble shoot the equipment. I'm starting to realize that this could be a full time job.

Our little guy who suffered during the power outage is doing OK. He got a chest tube placed, went back on the ventilator, and we were able to wean his settings on Friday as the pneumo had resolved. It was a great teaching opportunity for all of the staff, and a chance for me to gain more insight into the ever vexing problems of maintaining and NICU in a developing country.

A light map showing the heaviest uses of electricity around the globe. The more light, the more development, which equals better economies which provide better health outcomes. As you can see, Guyana is almost all in the dark.

Randy performing surgery at 7am on suction tubing to help fix our suction machines

Baby on a ventilator with chest tube

Inadvertent family centered rounds- Dr. Winsome Scott presents a patient to physicians and nurses during rounds. The mother happened to be there feeding her baby and therefore was able to listen to the plan of care.

Stepper's! A rasafarian restaurant next to the hospital- All vegetarian, no added sugar or salt- yet incredibly delicious! Pictured here is blackeye peas with potato, eddo leaf curry, and cook-up rice