The day started out with Kate and I making morning rounds with the students and checking on all the babies. Two of the infants needed IVs so Kate and I were able to work with 2 of the students directly to insert. Next came Cait's first field trip of the day, which was to observe a meconium stained fluid c-section. I was impressed that the delivery room staff had everything they needed and that the radiant warmer was on and functioning when the resident and I arrived. Baby came out a little unresponsive, and the one midwife knew not to stimulate him, but didn't know how to hook up and use the meconium aspirator with the ETT. It was great to be able to teach/ show them how to effectively use this device, as it is a common problem here. The baby did well, we transferred him to the NICU for further monitoring, but was breathing better by the end of our day today. The one thing of note was that there was no timer to assess the APGAR score, and at the end of the resuscitation, the resident had to use her best judgement as to what the scores were. I'm hoping to talk with Ruth ( the OB resident coordinator) about my observations and to plan an NRP class with the midwives next week.
Kate's field trip was next. She was able to travel to the lab to talk with the physician in charge about their equipment and how we can best obtain lab tests on our babies. They both agreed that point of care testing would be the best, as currently their machines are unable to process small volumes of blood like in the U.S. Kate is going to solicit advice from NCH laboratory staff about feesability of POC testing upon our return.
Finally a field trip for Randy, Mike, and Cait while Kate stayed back to teach the students about nurse to nurse handoff reports had how to structure the work day to best care for infants based on our scheduling system for NPO vs. patients that are eating. Our field trip was to the hospital in West Demerrara, which is a site that Guyana Help the Kids wants to equip with physical resources and nurses for a NNU ( neonatal unit). Having an offsite in this location would be a significant help, as babies that require minimal care, such as preemie grower/ feeders, babies needing phototherapy or antibiotics, or babies transitioning would've have to make the trip to GPHC. The unit was still under "construction" as they were putting in electrical outlets and oxygen hook ups, but it was a nice space that is directly in the post-natal unit where the NNU nurses could have direct observation and early identification of infants who need additional monitoring. The unit is almost complete, so now we just need nurses who are willing to sign the contract with the hospital and enroll in our program. We met Dr. George, the medical director, who said that a shorter orientation program (4-6 months) would help recruit nurses as many of them said that a year training was too long for them to commit. Now that I have heard this from several sources, that will be a priority upon my return.
Driving back to GPHC, we stopped at a roadside stand for fresh coconut milk and to pick up some lunch at one of Aruna's favorite drive ups ( excellent BBQ chicken and fried rice!).
Out week rounded out nicely as the students practiced giving a finally report on their patients while Dr. Mike discussed/practiced NRP with the pediatric/ neonatal residents. We were able to leave the unit happy with our progress this week and with Hope for a quiet weekend.
Tonight we are all headed to a Brazilian restaurant with our flat mates from the UK, then to gravity bar (a rooftop bar) for a drink overlooking the city.
Kate and nurse Trudell
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