More random thoughts and some student pics.....

Random thoughts again and from clinic…

            We use the ambulance for home visits. People here could care less of emergency vehicles and despite beeps and honks they don’t move or barely slow down for us to pass.

            Flu vaccine is for private clinics only. They rarely have issues with it though so most don’t get, even health care workers.  Pneumococcal vaccine only for small children with high risk and elderly with high risk, like immuno-compromised, but not diabetics.

            Biggest problem they have is chikungunya fever, similar to Dengue Fever or breakbone fever, from mosquitos. They can treat it with NSAIDS and rest but Dengue fever they only use rest and fluids and monitor, no NSAIDS and use only Tylenol instead. Both have high fevers that last about 2-7 days and can be life-threatening if patient does not properly hydrate, which in this area of the world can be problematic when one is healthy, let alone ill and sweating more from fever. Chikungunya can cause joint pain that can last months to years after the disease is gone. Dengue can become hemorrhagic after blood vessels are “leaky” and one can get pleural effusions, ascites or CHF and needs to be watched closely to see if gums bleed or other orifices and for easy bruising…..Obviously tends to be worse in small children and elderly. There is sadly no vaccine for either, but I have not seen either since being here yet! The trick, avoid mosquitos, lol. Not easy to do here! It is why I have mosquito netting in my bedrooms I suppose.

Had school health for 2 days and was great working with the kids. I think I will remember them most from this trip! They are all adorable. Most are shy with us but the parents say they are very chatty at home. A few were scared of immunization shots and would cry when it came time for exams but overall most were good and loved getting stickers for being “good patients”.

The rainy season here starts in June but has been coming a bit early this year. Most days it rains a few minutes but today it has been pouring almost all day.

Having a girls sleep over Wednesday night at Sister Glynn, my preceptor’s house, so she can show us how a traditional house is here, but the apartments kinda are already. She has a motive because her husband works nights and she doesn’t like being alone. She picked a night he is working lol so Stephanie and I can stay there with her.

Sister Glynn and her husband, Fordy, surprised us with a picnic and beach day. They cooked steamed tuna filets, rice with veggies, salad, pumpkin, sweet potatoes and black beans. It was very delicious and the usual foods they eat here. The day was a bit overcast but still got a little color. Working on a nice tan while here J. We did not get to walk the volcano due to some logistic problems, but heard that most days if it is cloudy you can’t see the craters anyway. Most days have been cloudy and we would have been sad to spend an entire day of hiking, a lot of money and travel 70 min one way for MAYBE seeing craters.

The pics are of a few of the nursing students here. They are dressed way better than us in the states in RN school! There is a yarned bottle holder my preceptor made for my birthday. LOVE it! Then saw a Steel Drum Band while out with a local we met on the plane from NYC. He has lived in states for 35 years but was born here and comes back each year for Easter to see family. 

The others include our picnic lunch, the walkway around the cove from one beach to another and a sunset. 

Random thoughts and more pics, plus SCUBA!

Apr 11
SCUBA!! Got certified to SCUBA dive and excited to do next dives. Got in 4 over last 2 days :). Stephanie got some great underwater shots with her camera and I will post when she posts up and I can save/tag them to me. We are planning a dive Monday 27th when my husband arrives for all three of us so she can get another dive in too. It is so serene and calm and very cool to be underwater with aquatic life Dave has been the best instructor and if your every here use Indigo Dive for sure! Got to play with a Crab that looks like a spider and see a trumpet fish and rock fish.

Apr 12th

Went to the Pirates of the Caribbean movie set. It was kinda depressing as the government took down most of anything that you would recognize. Their was a bar owner who has been here for years and he was quite upset about it as his bar was one of the sites the crew used as a spot to chill and have meetings. His bar is covered in pictures and he wishes that more people could enjoy it. We took Asquith as a tour guide with us and he showed us a small waterfall in the mountain. It was a bit chilly but was refreshing on a hot day. We just sat and chilled out and read the paper at the local restaurant there and took in the numerous lizards. We also ate real coco beans. They are white and very sweet. They are mixed with milk and pulverized into powder.

Apr 13th & 14th

2 days in clinic with not much to note except a pt with a BP of 220/180. Yes you read that right! After ORAL meds and rest he was 200/160. He had a slight headache and was up walking around. The NP and MD and I were like we have NEVER seen a diastolic that high on a conscious pt!! I have only seen 160 but they were in the CCU on a drip! The patient stayed at the ED for 36hrs and rested and was given 3 oral meds every 4-6 hours. He was DC'd home with a pressure of 151/120. He came back the next day for a check of BP and labs to see why he is so high. He did fine and it crazy that his pressure was soo high with so little complications. He made urine, which means his body has probably compensated so much...

Other random things different between US and here. Mammograms are every 5 years unless a fam history, Colonoscopies are not done unless you have a GI problem. PAPs are still done yearly despite new guidelines stating they are only needed every 3 years. Labs are done every 2 weeks because the hospital is closed for renovations. The MD draws them and they are sent via ferry on the 0930 boat. The moringa tree here is thought of as a "miracle tree" People believe it cures cancer, diabetes, HTN and everything ailment. While it does have some medicinal properties, it cures cancer as much as the South Sap fruit down here does :). The bark does have a toxin in it and causes paralysis so, only use the leaves!

The ULP is the party of government here for last 14 years and the elections are coming up so there was a party the first weekend we came in like a fundraiser. There is no Cath Lab here and no ECHO machine. Any heart diagnostic tests are done in Trinidad and Tabago and requires a plane ride. We scheduled a Doppler for a man having cramps in his legs and while the labs will be back in a few days, the soonest they can do his Dopplers is July!!! What if he had a DVT, he would be dead or loose a limb before he got the test, but it is the best they have :(. He was told to bring his own towel too, We think that was to wipe down sweat as he must ride a ferry to get there and wait for a while in the waiting room but I'm unsure...

One day 2 men came in for water. The public pipe was turned off so they had no way to get water. The gas station was out as well so they came to the hospital with 2 giant jugs. It is sad the things we take for granted. I have had hot water about 40% of the time due to some electrical issues with the apt owners water tank. I have been OK with it, but I will never take for granted again the ability to have hot water every second, to have water I don't have to boil to drink or to have think about what I am buying at store cause I must walk up 2 steep hills and carry myself in 2 hands. I wonder how strange it will be to drive again in traffic!

Beaches, birthdays and boys...

Apr 3^rd 

Sister Glyyn my preceptor and her husband took us to the turtle sanctuary on the other side of the island. It was awesome seeing the hard work one guy has put into saving the sea turtles here! They have babies from a few months up to a 17yr old guy names Old Hegg. Steph and I then hung out at the beach and relaxed. I got to read a book that was not nursing related for first time in 6 months! We met one of the crew of a Regatta boat called Zulu and the guy Triney was really nice. He introduced to several of the crew and owners from Nantucket. His personality reminds me of a friend at home so I called him Black John Kelly, lol. 

Apr 4^th

We went did schoolwork in the AM…boo but gotta do some! We did reward our hard work with some drinking and met up with our crew guy from the Zulu Triney again. He brought along another crew his brother Nolan and we went to a local bar to eat some pulled pork. Well Stephanie didn’t eat it! Lol. They actually chop their pork, not pull but it was very tasty. Then we went to play dominos at another local car. He got into the spirit and Steph and I won the first 3 games!! They get into the game and slam the dominos down hard. I got Steph revved up with my competiveness and she slammed so hard on the table her last 2 wins she knocked dominos off the table! We hit up the big Easter Dance party at the hard court, which is basketball and enjoyed dancing to 90s hip-hop. Apparently remixes of dance songs from our youth is popular here! They even have a giant bubble machine and we just had to jump in! Was a great night!

Apr 5^th

Rest day and beach time, which was much needed! Steph and I did find that Coconuts are our favorite new thing. As we took a “scenic” short cut route home from the market and harbor and turned out it was a long cut up to the top of the world, err I mean mountain. We definitely got in a workout!! If not for the coconuts, which can stain your clothes if the outside touches them when they are immature, we would have died on the mountain top road lol. Home safe though and a bit wiser on taking seeming “short cuts”.

Apr 6^th

We made it into town for the Easter holiday but missed the crying contest and laughing contest. The local winner the last few years, who I heard won again, is sooo god she has gotten her son upset from her crying and has had to stop! I met up with our crew friend Triney again and hung out a bit while the Regatta awards were given out. Their boat the Zulu won a lot! They won 2- 1^st places in the Cruising II Class, which the largest, 1 2^nd place and they won the overall in the class. Some of the other categories were cool and a 15-year-old kid won the solo class for the day and overall and they prize was a trophy and a bottle of rum, but they couldn’t give him the rum L.

Apr 7^th.

Another DM/HTN clinic day and a few people with BP’s >170s which seems to be commonplace and BS >400-500. They treat very strange here. They will page MD despite a DM protocol. The protocol is very similar to what we have in US, but the MD over rides and will give insulin 70/30, have then drink water and wait for a hr. to recheck. The sugar is of course still high and then he gives regular insulin and follows the protocol… The NP’s here have ability to change meds but I have yet to see them do it yet. They don’t like to override MD or do without pt. seeing them first. They were surprised that we can do this ourselves at home.

Apr 8^th

School and immunization day! We had several school age kids getting their last Pre-K immunizations of OPV/MMR/Dtap. Since school has been out the last 2 weeks and she has not office with the hospital down, she pulled a few of the kids into a room and did their assessment for school clearance. It was really cool to participate in this. While I am not doing FNP and will not have children as patients, it was great to work with these adorable kids. Some were shy and some were very excited to have a white person at their attention! I one girl who waved like a princess at you and when you asked for a high five, she fist bumped you with her thumb up and giggled. It was the cutest thing ever! ALMOST makes me want one, lol. Finding mornings are crazy as everyone comes early to get things done and then slows down after lunchtime. Staying busy thankfully due to ER being the clinic as well. After Easter it should pick up though. Also mainland had a project for the head nurse to get their meds inventoried every week and monthly so they can order more efficiently and not run out, which has been happening. I volunteered to help her get the spreadsheet set-up and met with the guy who orders the meds and saw the boat manifests he works off to set-up up the sheet. The head nurse was busy with 2 traumas. One boy had a stone dropped on his foot and it cut a 2in deep gash all the way down his foot. He was likely to need surgery. He had several broken toes too. He was 10 and barely cried while there. The next was a man who was pretending to be in a movie and a stuntman and was punching through a glass window. Well he did not do it quite as well as in Hollywood and had a hole the size of a fist in his forearm to elbow! The MD came in for both and had to do NS washing, cleaning and suturing. The arm guy was then sent to the mainland to the hospital once he was stable. Oh and I almost forgot, I woman came in having mild labor contractions so she was sent on the ferry with a RN and an emergency bag in case… Lucky for her she made it to the hospital and did not deliver on the ferry!

Apr 9^th

MY BIRTHDAY! I slept in, had a pedicure and manicure at London Beauty Supply which was a great placeJ. She took her time and pampered me for 2 hrs, gave me 2 hookups in case I wanted to hike and the other is a surprise for Brian so I can’t mention yet! Then ate a wonderful steak dinner after the beach at the Black Pearl. The chef was outside and since I was only patron at the time he came over asked me what I wanted cooked and offered a special and made it order. When he found out it was my birthday, he made me a lava cake and put  candle in it. He at the end of my meal had friends from France where he was from come in and it was one of their birthdays too. She was watching me get my cake later and made the staff come sing to me as she said everyone should have that lol. I then met up with my crew friend Triney again for a few birthday drinks.

Apr 10^th

Got the rest of my confined water dives done and then met up with Steph at her place. We went out for some local brews in area in SVG called Quetellaes. We met several great characters, one who wouldn’t leave her alone to where she had to pretend to be with another local and he still would stop staring. Ziggy was a young 21 gentleman who was nice enough to keep the guy away from her. He later passed out and the female bar owner took the pool chalk and rubbed all over his face to get him back for messing with us ladies! Girl power. Oh and I almost ran pool table on a regular, Steph got down to last ball and we saw a local girl beat up on 2 guys. We met Asquith, who has the small dreads and I'll discuss more on next blog, and a farmer Marcus or “Melody” cause he sings. Then there was a Calypso singer “Rankin” who is suppose to be famous and was popular in Germany in the 80-90s. Steph and I are looking for nicknames as everyone has one. White and Tall girl are NOT options lol. That catches me up mostly and will post more in a few days! Tomorrow we hit up waterfall and Pirates of Caribbean movie set……

Dog Days of Clinic

So my first day of clinic was spent observing and learning about how the clinic and system run here versus in the US. They have free healthcare for all, children <18 and elders >60 pay nothing for meds and others pay $5 for all meds in generic which is all they have. If you go to college you can still get free meds until you graduate. You can also pay for private insurance and healthcare. Most who do have more money or are ones with STI’s so they don’t have the stigma of their disease known. Must be nice! Nurses here are also given a free education!!! They travel in the Caribbean for their education and then they will find you a job when you graduate. Their levels are a bit different. The have male and female attendants which are similar to Techs and they have CNA’s which are more than ours, but not quite an LPN. They tend to do a lot of wound care in the clinic and getting the patient’s vitals and weights. The MD is on call 24/7 with Wednesday as a day “off”. His house is next to the clinic so he is super close. He is the only MD on the island so when he takes a vacation they send a MD from the main land, i.e. SVG. He has clinic days at Bequia Mon and Thurs 9-1pm. Then he has a private practice next to his house. He has clinic on the other side of the island at Paget Farm Tues and Friday 9-1pm and then back for private practice. He still can see 50-60 pts. a day, which is amazing, compared to at home and the fact that there is only 5,000 people on the island. There are student nurses at the clinic working on their community projects. They were all blue with plastic hats. The Community Health RN wears a yellow dress, the FNP’s wear gray suits (pants or skirts), the Staff RN wears white suits (pants or skirt) with the Senior ones with pleats on their top. The Charge RN wears a black belt, the Staff RN on the ward wears a blue one. They work with 1 attendant, 2 RN’s, 1-2CNA’s, CH RN and FNP most days. They are currently renovating the hospital next door so they are acting as the island hospital until it reopens in May. They are open 24/7 to allow for an “ED” or casualty walk-ins. They have 2 RN’s each month working night shift then they rotate the RN”S. 1 RN works 2 nights on then 2 nights off while the other is on nights. They have 2 beds where they also do deliveries. The midwives deliver most of the babies here and they still have OB/GYN’s for pre-natal and women’s health. There are males CNAs and RN’s but few. They had 100 students last year and 5 were males, 1 went back to CAN, 1 terminated and 3 graduated. They have RN’s quartiles for students who come from other islands to learn but they are being used now for hospital beds. If they have someone who needs just an overnight stay they don’t send on ferry to mainland hospital they keep in the apt and the night RN takes care of them. They have 1 male and 1 female bed this way. Shifts run 7a-1p, 1p-7p and 7p-7a for all staff except Pharmacy who is 830ish to 4pmish M-F and FNP and CH RN who are M-F 8-4.

            Everything here is a hot commodity from medications they get from a Trust from SVG to crutches. They charge for them $50 EC dollars or about $17 US for loan and the person gets their money back when they return them. They said they still loose several because people just keep them. They do this more wheelchairs and other item too. Cotton balls are handmade from a ream of cotton they sterilize then the CAN picks the ream apart and rolls the balls. Since they have no alcohol wipes they soak the cotton balls in alcohol for their wipes for BS checks, wound care and cleaning skin for sticks so they use a lot of cotton balls. Labs can take 2-10 days to come back and they call the patients at home for abnormal to come to clinic to see the MD. Many children here test anemic and their UA’s for Pre-K show high Oxalates meaning they drink too much juice and need to drink more water. Luckily they have a sorda of WIC program. They give mothers during pregnancy up until the baby is 24 months, 5 staples including rice, powdered milk, flour, split peas and something else I can’t remember. They just come every 3 months and pick it up at the clinic in bags and are signed up at clinic. The main land brings it over based on whom the clinic registers. They do have computers but 1 in each room and 1 at station but all staff RN’s have password to enter charting and health stats. They don’t have access to the Wifi and only front computer does. The Pharmicist has one for ordering meds. They get them once a month and she can order more from main land if she needs to. The Charge RN also can order supplies if running short.  The charting is just adding a blank sheet to the chart and the ED record is a running ledger book with name, address, date, time, problem and treatment.

The clinic itself has an on-site pharmacist and the waiting area is outside on a porch. There is no AC and only 1 fan for the nurse’s station. Lucky the weather stays a consistent 75-85 here mostly year round but the humidity is pretty bad. I did wound care and child wellness exams today. The wound care is a bit different in the CNA does it M-W-F here and it is walk-in. They use gloves to remove the old dressing but due to money they then use 2 hemostats with no gloves to soak and drain cotton balls in either NS or iodine depending on the wound. They use a 3^rd one for cleaning the wound. It takes a good amount of skill to move fast for 10 cotton balls for each wound. You typically clean with 2, soak with 2 and then cover with gauze 4 x4 also soaked. It took me some practice but by the 2^nd patient I had it down. My fat fingers were hard to work with the hemostats for twisting the cotton balls to drain them! They then tape it and off they go. I did a few legs today J. Many diabetic and hypertensive patients so wound care clinic is always busy. I then helped with child wellness, which is 0-5 years on growth and development, nutrition, measurements for stats and Z-score charting, immunizations and overall health before they go to school. The kids were stinking cute! One girl who was 12 months waved like a queen when she came in and she loved to give a thumbs up and fist pump you with the thumb up and giggle. I could have taken her home! It is nice to work with healthy kids sometimes, although watching the 2 mo. old scream after his first vaccination in the thigh was sad and I changed my mind on doing Family NP lol. Talking with patients has been the biggest challenge, as they have strong Creole accents with broken English. Some even when talking fast throw in a few non-English words but after a few days I am getting the hang of it!

Well that is enough for now. I’ write more about the type of patients they see on next one. This is really make me appreciate what I have. I spend time just boiling water to have to drink the next day and it makes me think ahead or I’d be dehydrated and still probably am. Drinking 100+ oz a day and peeing 1 cup out so far. The rest I am sweating out or with some ankle edema slightly holding onto!  Until next time!