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?