Guyana Nurse Training Program: Randy (and Kate and Cait) get schooled

Finally, after 7 days on the unit, things are clicking into place. I feel like the episode of the TV show Scrubs where everything is falling in line for JD, IVs are done on the first try, you have a good rapport with the staff, and you generally know the flow of how things are done and where everything is located. I sometimes forget that I am not a permanent part of the saff...the doctors ask for a piece of equipment and we know the general vicinity of where to find it (there is no organization what so ever on the unit or in the store room...we're working on that!), orders are placed and we help implement them, heck, I even calculated an actual drip rate for the first time since nursing school (see...those labs weren't a complete waste of time even though we complained through the whole thing...thanks Prof. Diane Patterson for making us stick with it!). Despite all of this comfort, we are still learning a lot from the nurses, especially language, here's a couple of our favorites:

"Just now"- does not mean they are doing or going to do something immediately- means whenever they get around to it, or whenever there is time. I had a student ask me to explain something "just now' meaning whenever I had a moment.

"having wind"- gas

"Chesty"- meaning the patient sounds congested or lung sounds are crackly/wet- Randy thought the nurse ment that the patient had a huge chest or huge breasts- they had a good laugh at that. So Randy decided when the baby had a lot of nasal congestion that the baby was 'nosy'

"have a lime'- to hang out

There is also the random stringing together of words, which here they call 'creole'- such as if you wanted to tell someone you'll be back shortly, you would say, "Igocomebakman"- makes it a little difficult to understand what people are saying, as there is very little annunciation and they speak softly.

Also today, Randy and Kate got a lesson from sister Khirodhar, who is the most senior nurse in the NNU and a midwife. When we have come before, it seemed as if the sister reallly didn't want to change practice and didn't care about the improvements to the unit or really even care if the babies did well. They got the full story as sister opened up to them in the unit today, saying that due to staffing she didn't feel they could give their full attention to the sicker infants, and therefore had to concentrate on the infants they knew had a good shot at survival, such as the term breastfeeding, no IV fluids babies. She said that she wished they had better supplies because she feels terrible that she isn't able to give the best care. Hearing this broke my heart, but also filled it with hope, as I found that it isn't that the nurses don't care- they care very deeply for these babies and their outcomes. I hope that we can help to get them the resources and training needed to do the job they would like to do, along with the training to know how to do it.

Today was just your average day- Cait taught a lecture about problems with the GI system, along with some NRP training to the emergency medicine residents, Randy went about helping suction and position the CPAP babies (no more ventilated patients- we have 2 on CPAP!), Kate helped reinforce our schedules, developmental positioning, thermoregulation, and IVs (we had 2 more nurese today get their first IVs!), and Shaheen rounded with the residents reinforcing feeding and nutirition principles. Despite what we perceive to be routine, it is amazing to see how far this unit has come. The neurological baby that was ventilated when we first arrived last monday has since been weaned to CPAP, then to an 02 mask, and was discharged yesterday evening eating by breast and doing well. The nurses overnight set up the CPAP and tured a plugged ETT into an opportunity for extubation. The students are getting IVs started with great success. I even learned that they managed a baby with an omphalocele for about 3 months prior to our arrival, in which the infant is doing very well and was discharged home with just a little skin yet to grow over the site. While it is easy to concentrate on the frustrations, it is even better to see the small victories happening all around us. The unit may be taking preemie steps, but at least they are headed in the right direction.