Slumdog

Hundreds of people make their homes by the rail tracks, which still have trains that run on them.

I feel that no matter how elaborate or detailed I write, words cannot capture the complete essence of India.  Words cannot give justice to poverty.  The dense population of people, cattle, and autos that crowd the streets is almost incomprehensible.  No where else will you see a husband, wife, 2 children, and a baby all riding on one small motorcycle.

On my way to the hospital we pass a man pushing his fruit cart, and women carrying baskets on their heads filled with the day’s groceries.  School children dressed in their identical uniforms walk to school carrying their lunch in metal pails.

House in the slums

The slums are a different story though.  Children do not always get the privilege to go to school.  All too often it is too far away, and there is no public school bus to pick them up.  Or their parents cannot afford it.

Lack of water is a common problem, as they may only have water that is available for one hour a day.  Everyone in the community must hurry to get their share of water during that hour.  As you can imagine this could cause serious problems between the residents.

A mother feeding her child

We say in the USA that the poor keep getting poorer while the rich get richer.  It is even more true here.  Thanks to the caste system in India you are labeled and put in a specific caste when you are born, based on what your parents were.  No matter how hard you work, what job you get, or how much money you make you will always have that label.  You can never move up in society.  It makes me much more grateful for the things I have, and that in America you truly are what you make of yourself.

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Newsletter

With the whole Casey Anthony trial outcome I thought it only fitting that I would highlight what is going on in the news here in India…

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Small family = Happy family

“Cars for sterilization” drive – no, I am not making this up.  This was in the papers, no joke.  India does have a population of over 1.2 billion people, but come on.  They tried this in the 1970’s, and obviously it didn’t work.  If Indians undergo sterilization procedures they will be entered for a chance to win the world’s cheapest car!  Or a motorcycle.  Or a blender.  Yes, a blender.  Who wouldn’t want to be sterilized for that?

This picture to the right is a real poster that is in the AMG nursing school here in Vizag.  As is the one below, deciphering at what age you should get married at.  In a way, this is a good thing because this is a society where arranged marriages happen every day.  Underage marriages.

Guidelines for Marriage

The whole expectation for women to get married here is phenomenal.  I get asked all the time if I am married.  Why I am not married.  And at what age I will be married.  The whole concept of not having a plan and knowing at what age you will get married is somewhat foreign.  But I’m sure my parents just haven’t told me yet…they always said that arranged marriages were the way to go.  Funny how that opinion is not from personal experience…

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Nurse: Patient Advocate

Nursing students after clinical

The day started out with a normal hip replacement, which is a pretty big surgery for the hospital here.  After a while you get used to the way things are here.  At least some things.  I still think that you shouldn’t have to tie the blood pressure cuff onto someone’s arm with a piece of string.  There is no way that gives an accurate reading.

This patient was having continuous spinal anesthesia, which made me kind of nervous because our only monitoring system is a BP cuff and a pulse ox monitor.  It doesn’t help that the anesthesiologist likes to walk out of the room randomly, and be gone for periods of time to drink tea, or eat bananas.  I look at the monitor.  The BP is 175/123.  Surely the fact that the BP cuff is tied on cannot make that reading accurate.  The Dr. seems unphased.  He starts around drawing up medication and giving it without gloves or cleaning the IV port.  I’ve given up trying to explain about sterility without a translator because I always get the same blank expression, and I know they don’t understand what I’m saying.

The surgeons finally made the first incision and begin the long work.  The anesthesiologist isn’t to be seen.  I look at the monitor.  I step outside and find the him.  “Sir, the BP is 69/43.” He looks at me from where he’s sitting sipping tea.  “Ah, good.  Thank you” as he shakes his head back and forth, which leaves you wondering if he is saying yes, or no.  If you don’t have the privilege of knowing what I’m talking about just watch a Bollywood film.  Or better yet, Outsourced.

Avoid AIDS - yes, this is a real sign

The anesthesiologist goes back into the operating theatre.  Several more times throughout the surgery we have to go find him to notify him about severe changes in the BP or HR.  We as nurses are called to be patient advocates, but I didn’t realize that would mean I would have to make sure the doctor was doing his job.

Posted in Hospital, Vizag | 12 Comments

American Cousins

Last weekend the entire family that I’m staying with took a trip up to Delhi and Agra since some American cousins were flying in.  I was able to tag along.  I was pretty excited.  My second trip to India and I finally get to see the Taj Mahal!

Taj Mahal, Agra

We arrived in Delhi.  Four American college students, including myself.  All from different states, and on three separate trips.  Somehow we all meet at this family reunion, where only one of us is actually related.  You can’t say life is predictable, that’s for sure.

The Taj Mahal was majestic.  The experience was only dimmed by the enormous crowds and unbearable heat that India is famous for.

The Taj Mahal - in majestic splendor

I was completely thrilled to meet the other Americans, Chris, Justin, and Aneesa.  The past two weeks had been very trying since very few people at the hospital speak English.  Imagine my surprise when Chris and Justin came back to Vizag with me for a few days!

Unfortunately, our brief encounter had to end.  They left yesterday to travel to other cities to work in slums, bringing hope, and showing the love of Christ to those who need it most.  Saying goodbye was like saying goodbye to two old friends, unsure if you would ever meet again.  But that is what traveling is about, right?  Sharing experiences, laughter, and memories.  You’ll never get those moments back, but they stay with you for the rest of your life.

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A documentation nightmare…or dream…

Documentation Nightmare

If HIPAA were to do an inspection here in India they would have a heyday.  The standard guidelines and protocols simply don’t exist.  Yet anyway.  The whole concept of patient confidentiality is just beginning to surface here, but has yet to actually materialize.

During procedures in the OR there is no ongoing documentation.  And computerized charting is unheard of.  After procedures their documentation will look something like this:

  • Patient name, and name of surgeon, anesthesiologist, and scrub nurse(s)
  • Type of procedure, and approximate time in OR
  • What “medicines” were used – this list does not usually include dosages, routes, and times that medications were given and what the response was.  It instead includes how many pairs of gloves, IV sets, foley catheters, gauze pieces and bandages, ect.
  • Outcome of the procedure charted main hospital computer as “operation successful”

Medicine Supply Cabinet in OR

As surprising as it may seem, this is probably the most amount of documentation that I have seen since my stay here at the Ruch Deichmann hospital in Vizag.  The floor nurses do even less charting, which simply includes vital signs, any medications given, intake/output, and if a dressing change was done.  There is no assessment.  No planning, or implementation.  No evaluation.  Nurses are told what to do.  They are not taught to think or to question for themselves if what they are doing is truly the best thing for the patient.

Naomi and Padma - BSN and General Nurse

Education in India is quite a change from the USA as well.  BSN students take most of the same classes as students in the USA, but here it is considered more specialized.  Upon graduation BSN’s are allowed to teach in nursing schools.  General nursing programs are similar to LPN schools.  But the big difference is that at the end of your education there is no NCLEX, no licensing exam, nothing.  You graduate and are able to get a job and practice.  They also only have exams about once a year.  Let me repeat that for all you nursing students.  They have exams once a year.  That is a stark difference from the 20 grueling nursing exams I took this spring semester alone!

You can also become a doctor in only 4 1/2 years since it is a Bachelor’s degree.  Despite the fact that nurses and doctors receive the same amount of training, doctors exert complete control over patient care.  Nursing autonomy is not respected, and to some degree not allowed.  I have had to fight the doctors to change the way they take care of wounds here.  To actually take the time to pack a wound properly.  Not just carelessly and haphazardly stuffing gauze in there.  Or worse, stuffing cotton inside it.

Basic principles such as sterility somehow are lost.  I’m having to teach about keeping the wound bed clean, to not contaminate it by cleaning the edges and then going inside.  To use difference gauze pieces to clean each wound.  That way you are not carrying bacteria from an infected wound to a non-infected one.

There is room for a lot of growth.  The hospital does a great service, to a great many people, but there is always room for improvement.  Education, I believe, is just one small part.

Posted in Hospital, Vizag | 4 Comments

Valley of Love

Leprosy.  The word itself is embedded with history, evoking unspeakable emotions.  Fear.  Uncertainty.  Uncleanliness.  The stigma attached to it almost unbreakable.  Or so we may think.

A Humble Dignity

We may often forget that it was not their choice.  No one wants to be an outcast.

Sitting with people from the ward

But here, at AMG’s Valley of Love, people with leprosy are accepted.  They are given jobs according to their profession and ability, giving them back their dignity.  Their children are educated, giving them a hope for the future.

Small tasks are given to the people throughout the day, according to their ability and profession.

For those that the disease has taken away so much of their life and body that they cannot perform day to day activities, they are placed in a dormitory.  Food is provided, along with medical care.  They are given small jobs for an hour or so, such as sweeping the floors, so that all may contribute to the community.

Rice and Dal, family style

While the stigma against leprosy is slowly changing, there is so much more education and research that needs to be done on this disease.

Valley of Love office and medical clinic

Change is possible.  The number of leprosy cases is slowly declining.  People are becoming more aware about it.  The children of parents with leprosy are now allowed to get out into other communities and go to schools, colleges, and even hold jobs.

I will always be changed after this.  I hope you are too.

“As you go, proclaim this message: ‘The kingdom of heaven is near.’  Heal the sick, raise the dead, cleanse those who have leprosy, drive out demons.  Freely you have received; freely give.”  Matthew 10:7-8

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God Speaks Telugu

On Sunday I attended my first church service here.  I can honestly say that it was unlike anything I have experienced before.  We all sat on the floor for one thing.  Men on one side and women on the other.  The entire service was in Telugu, which is the language of Andhra Pradesh.  Which essentially means that I have no idea what the minister talked about.

Afterwards I went with Sheba, who is an 18 year old who’s family’s house I am staying at, to stop by a friend’s Hindu wedding reception.  While here she introduced me to several of her friends.  It is at this point that I met Santhosh.  A first year general nursing student (equivalent to LPN) here in Vizag.

Within moments of our encounter together she asked me, “Do you know Jesus?”.  Her eyes were full of questions.  But underneath that there was pain.  A great sadness that overshadowed her frail figure.  “Yes, I do know Him.” I answered.  “I want to know Jesus…but can not” she answered.  I tried explaining that she only had to ask Jesus.  Tell Him that you want to know Him and He will answer that request.  But she did not speak English well, and my Telugu is almost nonexistent save for being able to remember “thank you” and “come”.

She shook her head.  “My parents…will die.  I…cannot.”  She couldn’t defy her parents.  It was like she didn’t have a choice.  My heart was breaking.  My spirit was crying out to God to fill my mouth with His words, and that she would understand the love that He has for this woman.  “You speak to God?” she asked.  “Yes.”  Her eyes filled with tears.  I felt lost.  I felt ashamed that I couldn’t communicate with this woman who so desperately was searching for the Lord, and had questions that she needed answered.

I left wishing that there had been more I could have done.  I will pray, and continue to do so.  It was only after we had departed that I came to the realization that even though I may not speak Telugu, God does.  He knows.

“In my distress I called upon the Lord, Yes, I cried to my God; And from His temple He heard my voice.  And my cry for help came into His ears.” 2 Samuel 22:7

Posted in Religion, Vizag | 14 Comments

Back to Our Roots

I felt a little closer to our nursing roots today, by experiencing something that I thought was long outdated.  I helped cut, fold, and roll our own bandages today with scissors that Florence herself probably used.  After this somewhat aggravating experience, because gauze does not like to be cut evenly it seems, I have a new appreciation for those pre-cut 2×2’s and 4×4’s that we take for granted.  Not to mention never having to question if they really are sterile or not.

You ask me why I do not write something…. I think one’s feelings waste themselves in words, they ought all to be distilled into actions and into actions which bring results.  – Florence Nightingale

So in honor, I shall oblige for tonight.

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The Miracle of Life

Even better than being forced to watch the video (which, being home schooled I didn’t have that, let’s say, privilege), I actually got to witness this today.  It was a C-section, but still incredible.  After doing an epidural, and scrubbing the abdomen down , the surgeon started making the incisions, cauterizing the blood vessels as she went.  As she made the final incision I realized that the round, hairy object I was looking at was actually the child’s head!

As the doctor held the baby, the anesthesiologist pushed on the mother’s abdomen to help push the child out, while the nurse suctioned the blood and amniotic fluid.  Finally she was out!  It was a girl!  A beautiful girl with a complete head full of hair.  Still attached to the mother through the umbilical cord she was laid between the mother’s legs.  In my mind a terrifying moment passed and the baby did not move.  The moment did pass, thankfully, as she coughed and let out a big cry.  The umbilical cord was clamped, she was suctioned, and placed in a lined tray and taken out to be cleaned and placed under a heating light while the mother was sutured up.

After being dried off, we put a feeding tube down the baby’s nostrils to suction out any amniotic fluid that she might have swallowed.  Upon ensuring that we were aspirating stomach contents, we proceeded to flush with normal saline and aspirate it back out.  She of course did not like this, and continued to scream, quite loudly I may add.

This experience was really quite incredible, and will always be a moment that I remember.  I am so thankful that God gave me this opportunity to be there today.  I hate to say this, but I almost cried when the baby was finally out and started wailing.  This has definitely given me a new outlook on my upcoming OB class this next semester.

Posted in Hospital, Vizag | 4 Comments

Operation Theatre

“So you want to study theatre?”  Those words used to have a very different meaning to me, but here they just mean the operating theatre, AKA, the OR.  Talk about a different experience.

Here are just a few of the differences that might stand out:

  • Shoes are considered dirty in India.  So, in the pre-op area everyone is barefoot.  No shoes allowed.  They have separate flip-flops for you to wear when you go into the OR.  Yes, I wore flip-flops while watching surgery, and yes, it was amazing.
  • My surgical scrubs/attire was actually a dress.
  • They have a sterilization room, with an autoclave, where they sterilize almost everything.  There is very little that gets thrown away.  I’m pretty sure that even the sterile gloves that they use in surgery get cleaned and passed down to the floor nurses for dressing changes.
  • They rarely use general anesthesia.  More often than not they do spinal anesthesia, and the patient is still awake.  The inguinal hernia repair, the skin grafting, and the appendectomy were all awake.  We covered their eyes, of course.
  • The monitoring system during surgery? A pulse ox.  Occasionally we would use the BP cuff, except it is only available in an adult size…  So the pediatric tonsillectomy went without BP monitoring.

Watching surgery here is so completely different from in the USA.  But despite all of these differences, it works.  Their goal here is to help as many people, the best they can, while making it free or low-cost for the patient, and I think it works.

For those of you medical maniacs, and trauma junkies, here is a more detailed description of what I have done and seen so far.

Warning: if you are allergic to reading, hearing, or generally thinking about blood, or any type of bodily fluids, do not continue.  I take no responsibility for any nausea, general discomfort, or other illness that comes from reading this posting.

Skin grafting: an adult had suffered some bad burns on the major anterior part of his right foot stretching from the top of the ankle to the base of the toes, and a smaller burn on his left.  We harvested a rather large portion of skin from his left thigh, which we immediately placed in a container of normal saline (NS) so it wouldn’t dry out.  This harvested skin was then stretched over the burned skin and trimmed so the edges lined up.  Stitches were then placed along the edges to keep the graft in place.  The entire time the newly grafted skin had to be kept moist with NS.

Appendectomy: acute appendicitis.  Spinal anesthesia was used.  A small incision was made in the right lower quadrant.  Only really interesting thing about this was when the surgeon went to remove the appendix, this purulent pus shot out everywhere.  Needless to say I jumped backwards so I wouldn’t get hit.  He then had to go in and make sure that he got all of the pus out so it wouldn’t cause peritonitis.

Wound care: this was a teenage boy who had blown up his hand using fireworks.  He had lost one finger and half of another. The skin on his palm was quite mangled, and swollen.  A chunk of his hand was missing between his index and thumb.  There were probably 20 stitches on the back of his hand where they had to go in and fix the bone structure.  We washed the wound with iodine solution, hydrogen peroxide, and NS.  Then placed iodine soaked gauze on the wound and then wrapped it up. These people don’t usually get a lot of pain medications either…

Posted in Hospital, Vizag | 2 Comments