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 3rd
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 2nd
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!
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