Memoir of a Girl

The stories of my life

No Comment August 20, 2010

Or in other words, more. culture. shock.

A few weeks ago I did my first rotation in a surgical ward at a government hospital. When I say ward, I mean what we typical Americans think of if someone said, “you know, like the hospitals in the 1950′s,” or at least, for those of us who never experienced it, what we see on TV.

There is one large room with let’s say, maybe 30 beds. Not the hospital beds we know with buttons and heads/feet that go up and down. No, more like dorm room beds, with hard vinyl mattresses, a hospital sheet that is as thin as paper and doesn’t stay on, and you have to bring a pillow from home. There might be a large electric fan on the other side of the room, but you should bring one from home because there is no such luxury as air conditioning in this room. There is one bathroom. I’m not sure, but maybe it has three toilets in it, and everyone in the ward, including the “watchers” share it.

There are actually rooms like this, one for the men, and one for the women. Have I said enough?

While I was on this rotation, I did a lot of preparing of medications. Lucky for me my patients, math has always been a strong subject for me; I’ve never had trouble doing math for medication dosages. I was preparing a simple medication; let’s say the patient needed 100 mg of this med, and it came in a 2 ml ampule labeled 50 mg/ml. I quickly determined that I need to give the patient 2 ml in order for him to get the correct dose of 100 mg.

My clinical instructor looked at me and couldn’t figure out how I could get that amount in my head, but just went with it.

The following week, the clinical instructor gave us a quiz. On the quiz were things like the 10 rights of giving medication, the color coding for the medication cards, and some IV flow rates/dosage problems.

We went over the answers after finishing and turning the quizzes in, but I wasn’t paying much attention because I didn’t remember what I wrote for all of the dosages. Until. Someone asked him to explain further, because they got a different answer than the instructor, and wanted to know how he came up with the dose.

To make a long story short, the clinical instructor indicated that the correct answer was really double the amount of the correct dosage. We went over and over and round and round, and finally he understood where the problem was. Later in the week I asked another instructor to complete the same problem, and he also answered with double the correct amount. He suggested that I talk to the dean, because the instructors learned this formula they were using for figuring meds, and as I had already concluded, this is a serious problem.

I followed his advice and spoke to the dean who immediately understood the problem, however… The reaction was not quite what I was expecting. I was expecting to hear something to the effect of  ‘we really need to address this with the person who is teaching medication dosages, and be sure that all of the clinical instructors in the hospital are aware of this’. What I heard was something more to the tune of how they use a standard formula here [in the Philippines]; the pharmacists, the doctors, and the nurses, and how this, that, and the other agency and person need to have this brought to their attention. There was also a comment about speaking to the doctors, who are ultimately responsible for this…(?). Say whaaaa…?

In another class, I received handouts about nursing as a profession, patient’s rights, and nurse’s rights. The bottom line is that nursing is a profession. Nurses are professionals. Nurses have the right to be respected and trusted, not only by patients, but also by colleagues. I think doctors count as colleagues. Here, they don’t agree.

Here, doctors are Gods, and if you question an order, you might “hurt their ego.” Yes. You understood that correctly. If you are a nurse in this country, you follow the doctors orders even if they are questionable; even if you know there are additional things that should be done for the patient (let’s say a daily weight/abdominal girth on an ascites patient), you do not take the initiative and do these things if the doctor forgot to write it in the orders. You do not ask the doctor if these things should be done. Apparently, here, the doctor’s ego is more important than quality care, or possibly life.

I’m having a hard time right now, as I have more and more hours of duty logged in. I’m being exposed to more and more eye openers every time I have a new rotation. I am trying to find some kind of balance, a way that I can somehow ask questions without getting into trouble while I am representing my school. I’m trying to ask questions more in an ‘I’m just wondering kind of way’, hoping that I am bringing something that needs to be addressed  to someone’s attention. Something that needs to be changed, desperately.

I’m trying to be the change I want to see.

How can I be that change and culturally sensitive at the same time?

 
 

Culture. Shock August 4, 2010

Filed under: Adventures,Mabuhay Philippines,Savoir faire — krisedja @ 12:13 am
Tags: , ,

Where I am here, on the other side of the earth, things are different. I was expecting different when I got here, and I think I adjusted well, but there is still something weekly, if not daily, that just shocks me for at least a second. This last week it was more than one, and it was day after day after day.

First, a friend/neighbor was sick and had to be admitted to the hospital. Since there was nobody else volunteering to go, or even one that said yes when asked directly, I was the ‘watcher’ as they call them here. That means that I was at the hospital for a great amount of time during the admission, running here and there to get food and more supplies from home. This is in addition to having duty, and although the hospital I had duty at happened to be the same as friend was admitted to, said hospital is about 1-1.5 hours away from where I live, depending on how I am traveling.

Now, this was all good, and I am not complaining, but I just have to say that what bothered me has bothered me before. It is times like these that we see who people really are. Who is really a friend, and who really gots-your-back. Lots of people knew this friend was sick. Lots of people knew I slept not a wink in over 24 hours and have 3 littles I would love to see for at least a minute in the craziness that can be my life, and lots of people knew that I was traveling back and forth sometimes twice a day between duty and keeping this friend company. But do you think that anyone offered to trade places with me? Even for just the afternoon? Enough said, I just needed to vent and now I can move on.

The next thing that got me is the difference between what a private room and the ward patients experience. I have put many an hour into the medical ward at this hospital, and I’ll just say that it is not a place I would like to be in when needing any kind of medical care.

Ward equals up to six beds in one room with noises, lots of people in and out, and could be lights on for 24 hours… mostly student nurses attending to your needs, which typically equals a visit every two hours for vital signs depending on what the good doctor ordered. The CR (or bathroom as we like to call it in the west) is shared by everyone, might not have a shower, typically has not been cleaned since Moses was breathing, and has only a hole where there may have at one time been a door knob. Sheets and gowns are not typically changed during the entire hospital stay, and you may have an additional fee if they are.

Private room equals two sheets on the bed, two pillows, a TV, a fridge, and a private CR with a shower. They get better food for meals, better dishes, and they even get a snack. The sheets were changed while we were there without any request being made. There were three staff nurses for no more than 10 patients, while in the ward they could have three nurses with as many as 60 patients.

Big.difference.

On a general note, I have to say that I was shocked, but not really, when I noticed that the stretcher in the ER that my friend was placed on had a sheet that had not been changed since the last patient, or who knows how much longer. How do I know that you ask? There was a little blood stain that I noticed. My observant self also noticed some blood stains on the floor that had not been cleaned up.

That was Friday. Fast forward to Monday, 3 pm -11 pm shift duty. To make a long story short, I observed a male patient with feces draining from an abdominal wound that had dehisced, a colostomy bag made out of what appeared to be a tube normally used for suctioning and a rubber glove, and a decubitus ulcer. I haven’t been impressed with the care I have generally observed since I have been here, but this one just made my jaw drop.

Fast forward again to Tuesday 3 pm – 11 pm shift, different hospital. I got my patient assignment, which was nothing too terribly toxic. Went to take the vital signs, and my classmate is waving at me and speaking lip. I went out to the hall and asked her what she was trying to tell me, and the answer was, “you might want to put a mask on because there is a patient in there who has PTB.” Enough. said. I asked to be reassigned because I am not really sure if my reaction from the BCG vaccine was really positive, and The Baby has now had two doses that were definitely not reactive. My choice was a patient in the other ward room, but there was another PTB patient in there as well. Aren’t these patients supposed to be in isolation? Why weren’t they at least sharing a room while the other non PTB patients shared another room? I’ll never know the answer to that one, that’s just the way they roll here.

So. Really. All I wanted to do here was make a note so that I would never forget this past week, and be reminded of how little we really have to complain about living in such a rich, developed country.

By the way, another thing that has been nagging at me… Um… if you live in the U.S. and you are not a Native American Indian (or whatever the politically correct term that we are using these days is), you my dear are really an immigrant too… Maybe not directly, but somewhere along the line one of your family members traveled to the U.S. from another country. Stop bitching about immigrants. Please.