Monday, July 25, 2011

Final Thoughts

Well, it’s over. Five weeks have passed faster than I ever imagined, especially in this final week. It’s been a struggle to come up with words for a final post, because many of the feelings I have are indescribable. I will try my best to compile some of my final thoughts.
            This last week has included working in the parish clinic operating room. We had the task of operating on inguinal hernias, and with a team of surgeons, anesthesiologists, and nurses, we successfully finished 36 patients. I was able to place IVs and care for patients in their pre and post-operative states. We were all thrilled to be able to maintain a nurse-patient relationship all the way through surgery.
            For two days of the week, I was able to be interpreter for American family practice doctors in the village open clinics. It was similar to a triage setting, where the patient comes in with their chief complaint, is seen by the doctor, is prescribed medications, and given them in a matter of an hour. It’s marvelous to see the amount of difference a medical team can make in a population group that is ridden with parasites, urinary tract infections, rashes, and flu. It’s been a challenge to come up with simple ways to explain a medical issue, and in Spanish. However, the people are understanding and patient. The week ended with a feeling of accomplishment for everyone on the team.
            It’s still surreal to me that I’m here, let alone leaving this afternoon. Course evaluations were due to Dr. Belknap today, and I laughed a little at the thought that this was for a grade and credit. That thought hasn’t crossed my mind once while here. Nevertheless, I was happy to fill out the evaluation. One of the questions was: name one thing you have learned while on this trip. Of course, I could’ve written a million different things.
            Simplistically, there is much to learn here, and none of it comes from a textbook or a professor. My lessons have resulted from the culmination of thousands of conversations I’ve had and relationships with people I’ve met here. I have identified three specific lessons that exemplify this trip: empathy, humility, and vulnerability.
            Empathy is simply part of the Peruvian culture. It is defined as “the intellectual identfication with or vicarious experiencing of the feelings, thoughts, or attitudes of another”. Basically, feeling what another person feels. Most Peruvians have the same struggles from day to day, and they are each other’s support system in a poverty-stricken life with limited education and health care. I have experienced this through almost everyone I have met, especially patients. Although I cannot even wrap my head around the pain some of them may be experiencing, it is always helpful for them to have someone present through their times of hardship. It is fascinating to me that the Spanish phrase for “I’m sorry”, lo siento, directly translates to “I feel it”. I feel for you. While this may not be literal, it is a personal, empathetic connection with someone that may be more meaningful than just saying sorry.
            I think that the feelings of empathy and vulnerability go hand in hand, because these people are some of the most vulnerable in the world, and they connect to each other through this hardship. There were times on this trip where I have never felt so vulnerable in my life, such as standing on the top of a mountain overlooking a world wonder, realizing that the world is so much bigger than I ever imagined. Or, in the hospice, helping a son prepare to bury his beloved father. It was these times that my feelings of vulnerability allowed me to truly feel for that person in need, and to know that sometimes, simply being with someone is the best comfort for sadness. To quote our professor, Dr Belknap, you can’t connect with a person who is suffering unless you become vulnerable yourself.
            Lastly, humility was present everywhere I went here, with every person I met. I found it to be especially there on home visits, where simply washing someone’s feet welcomed a wave of gratitude. It’s also humbling to witness those at the hospice go through painful, daily wound dressing changes and still have the ability to smile. It’s a beautiful thing, and ironic that such poverty and hardship can create this sense of humility. As Mother Teresa of Calcutta said, “The poor give us much more than we give them. They’re such strong people, living day to day with no food. And they never curse, never complain. We don’t have to give them pity or sympathy. We have so much to learn from them”. From what I’ve seen in Peru, they accept their daily struggles with grace, perseverance, and of course, humility. I’ve only been back in the US a few hours, and seeing the cultural differences is a shock. While this is hard, I know that I will always look back at this trip and think of the wonderful people who make so much out of so little. Thank you to everyone for reading and I hope the rest of the summer goes well!

Saturday, July 16, 2011

The Home Stretch

After our Aggregate Presentation

No class, book, or professor in Nursing School could have prepared us for this week. Day after day, we faced new challenges with people whose hardships are bigger than ours will ever be. In the nursing home, we spent our last day with the women giving hand massages and teaching chair exercises. This place was always a challenge, because there is one nun and her assistant to look after about fifteen patients. Sadly, the people who inhabit this wing are women with extreme cases of dementia. Many of them sit in chairs for hours, a blank stare occupying their faces. It was certainly humbling to be feed them, give them a massage, or simply be present with them.
After the nursing home, we came to our last time with our women’s group, Vaso De Leche. Over the past three weeks, we have been working on our aggregate assessment presentation, to be done for them this week. Our presentation focuses on three nursing diagnoses that fit in with what the women can do to fully reach their potential. They already do so much, mentoring for their communities and feeding the village children breakfast on a regular basis. In these women, we saw strong, confident people with a loud message. However, their voices are unfortunately muffled by a society that condemns women to the home, left without the opportunity to grow. Many of them had their education cut short by fathers who believe that women have no place in the professional world. But, this group goes against the grain.
 They are a voice for education, mentorship, confidence, and teamwork. We diagnosed them with stress, readiness to learn, and a lack of structure within their programs. In the weeks that we have been here, we have given them our knowledge. But no measure of education can be equivalent to what these women have taught us in return. Their perseverance and grace in their daily struggles has given us inspiration to become stronger women; advocates for our peers and our community. We have been so inspired by their inquiry and curiosity, and we only hope that our suggestions and outreach will be taken to heart, from women to women. As relieving as it is to have this presentation and the twenty two-page paper done, we are anxious to see if Vaso De Leche will expand and grow like we hoped it would. Only time will tell.
Finally, it was time today to say goodbye to the hospice. We spent the most time here, bonding with people whose strength has no measure. We worked with Hermelinda, the woman whose leg is consumed by a deadly cancer. She persevered through every painstaking dressing change, even helping us on occasion. Unfortunately, her time here is limited, as doctors have given her a prognosis of four months. Given that she is uneducated, sick, and a woman, no one, including the nurses at the hospice, have told her about her cancer. Due to cultural humility, we have shut our mouths at this Peruvian show of silence, simply hoping that it will change in the future and that she will stay strong through her time left.
A few times on this trip, certain things about Piura have rocked me to the core. None of them were like today. This morning, we lost a patient in the hospice. David, who suffered from complications from prostate cancer and pneumonia, passed away during the night shift. Over the past two weeks, we noticed physiological signs of impending death, such as fluid overload in his hands and feet. But none of us expected to walk into his room during our time here, only to see a white sheet over his body. David was the hospice’s first patient, coming in three years ago, fully able to walk and talk. The hospice nurses, Daisy and Coco, watched him deteriorate to the point of feeding tubes and a complete loss of speech. Today, these nurses graciously dealt with his death, saying that he was a father to them and a dear friend to the other patients. Here in Peru, people do not hire morticians or funeral homes to deal with the body. It is the family, and if present, nurses. So, accompanied by David’s son and the hospice nurses, we changed him into clean clothes and helped lift him into his casket. With Luis, another patient, we watched the car containing David drive away. Luis nodded toward the car, one last goodbye to his friend.
After a few moments, Coco brought us back into the moment. She said, “We are so sad to see him go. But here, there are other patients who need our help, and we will go into their rooms with a smile. Our day starts now.” Her words could not be more true, since we still were scheduled to tend to Oswaldo’s bed sores. Oswaldo is always difficult, because his wounds are deep and his mood is usually depressed. Today was the same, but when we finished, Oswaldo smiled. Somehow, through the daily dressing changes and paraplegia, he still manages to smile. I will always remember that smile as one of the most beautiful things I have ever seen.
Our upcoming final week here will consist of bittersweet goodbyes and work with a group of surgeons. We are to help with intakes in the villages for hernia surgeries, some of us also assisting a pediatric dentist with translating. We are sad to end regular clinical, but also excited about the change of pace. One week left of Marquette Nurses in Piura, and we are hoping to go out with a bang. 

Monday, July 11, 2011

Teaching Project: Done!

           Teaching seems to be this week’s theme. Three of us are to complete our teaching projects over the course of the next five days and we are all to complete our aggregate project on Friday. Today, I taught about women’s nutrition and blood pressure to Vaso de Leche, our beloved women’s group. This is a topic in which they requested information, and I was happy to provide what knowledge I could.
            I decided to conduct my presentation entirely in Spanish. I figured I would be able to say more without having to deal with a translator, and also relate to my audience better. There were about thirty women there today to listen and learn. I split my project up into a few sections that I thought most relevant to what the women wanted to learn. First and foremost, I talked about the basics of nutrition, and why it is important to eat well. Simplistically, people must eat well to feel good. 

            Secondly, I thought it would be important for the these women to learn about the FDA's nutrition programs that we have in the United States. For those of you who don't know, the MyPyramid program has recently changed into Choose My Plate, a demonstration of color-coded portion control. I gave the women hand-outs in Spanish describing the new nutrition guide. 
New FDA Program
       I explained which foods were in each food group and described healthy options. Next, I focused on women's nutrition specifically. When a woman is pregnant, she must consume certain vitamins, such as folic acid and calcium, and I described each and gave food examples. I showed why it is important for women to receive prenatal care and what to eat while pregnant and breastfeeding. 
      My next topic circulated around adolescent girls, and how older women should approach them and their eating habits. When I conferenced with Cecilia, the clinic's gynecological doctor, she told me that eating disorders are actually quite prevalent in the area. Unfortunately, due to shame and embarrassment, girls do not talk about it and the problem is usually left unaddressed. I told the women that it's okay to chat with young girls about their eating habits, and that prevention of eating disorders is important for their future growth and fertility. 
      My focus shifted next to blood pressure and how to control it. The women wanted education on this topic, so I was sure to include the basics of what blood pressure exactly is. The fundamentals of this can be confusing, so I did my best to describe it in a way that wasn't ridden with medical jargon. There's high blood pressure and low, and to keep it in control, diet and exercise must be improved. Unfortunately, stress runs rampant here in Peru, and this is one of the main causes of hypertension. I taught a brief relaxation and breathing exercise for the women to do daily in order to decrease their stress. To conclude, I, along with the rest of the MU nurses, took blood pressures of the group. Many of them wanted to know if their numbers were high or low and had questions about stress management. We were happy to provide answers. 
         In the past, I've normally gotten pre-presentation nerves. However, it's a whole different situation when the speech is in a different language. Luckily, with the help of Cecilia and an online translator, I was able to complete my powerpoint presentation and deliver it smoothly. I'm thankful that I had such great help and that my accidental stuttering over words was kept to a minimum. Overall, I am pleased that the women will take this information back to the villages and share it with others. 

Saturday, July 9, 2011

Concluding Thoughts from Week Two

Our professor, Dr. Ruth Ann Belknap, posed a question for our journals this week: Where have you seen cultural humility this week? None of us were too familiar with this phrase, because it used to be termed “cultural competence”. She explained that when a difference in cultures is recognized, humility and modesty is needed to step back and respect the other culture. Having been in Peru for three weeks now, there have been several examples of this. Peruvians are friendly people, greeting everyone with a hug and a kiss. They are significantly more open about breastfeeding, something kept relatively private in the States. But this week, I started to think of this term on a much larger scale.
Quite frequently, we hear unbelievable things about the healthcare system here. In interviewing the women’s group, we heard some shocking stories. One woman’s husband had been in a work accident and had shards of glass stuck in his back. Of course, insurance covered nothing, a typical situation for many people here in Peru. Initially when they visited the ER, they took out what was visible and rushed him out of the ER. They wanted him to go home as quickly as possible because doctors here simply do not want to be responsible for anything that might go wrong. Ten years later, this man still has shards of glass in his back because there is no care or money to fix it. This is the reason that people here turn to natural medicines and methods. They will avoid the healthcare at all costs.
It’s hard to be silent when a story like that creates so much anger. However, my biggest challenge this week was in the hospice. I always had difficulty with the pressure ulcers; those kinds of wounds would shock even the most experienced nurse. But yesterday, a new patient was admitted, a 31-year-old woman with terminal sarcoma. What lies under her bandages rocked me to my core. We don’t know what happened when she tried treatment down in Lima, but it appears that they tried to scoop the tumor out of her leg. She has an open wound that is the size of my face on the outer side of her thigh. Her skin is completely gone, and she bleeds ceaselessly. She has full visibility of not only this wound, but also the three baseball sized tumors that jut out of her groin. The worst part about this is not the grotesque appearance of her leg or the amount of time it took to stop her bleeding and clean the wound. It’s that the doctors and nurses here refuse to tell her she has terminal cancer.
It’s so hard to not question this, especially when the woman is already in the hospice and clearly has a serious ailment. But, I suppose this is where humility falls into place. There is a time to step back, respect the culture, and just administer the best care possible for this woman’s remaining time. Many Peruvians are very quiet about their own illnesses and the illnesses of others, and this part of the culture has been frustrating for our group. We come from a place where we want to know everything that’s wrong at all times, so we can treat it.
I’m slightly put at ease by the amount of educating we are doing during our time here in Piura. If we teach, then there is more widespread awareness of illness and the ways to prevent it. As the old proverb states, “Give a man a fish; you have fed him for today. Teach a man to fish; and you have fed him for a lifetime”. This rings true in places like this. On Monday, I will teach about nutrition and I am looking forward to contributing to illness prevention efforts. I’ll post more details about my teaching project soon!

Wednesday, July 6, 2011

Trauma: Life in the (Peruvian) ER

      Today, I was happy with the fact that I waste hours watching Discovery Health’s Trauma: Life in the ER. Although, it’s a different experience in the safety of my own home than it is in the actual emergency room. When you throw in the language barrier, it’s a whole different world. I found myself thrown into the procedure room with Meg, neither of us knowing what our purpose was. We soon found out when the doctor started rattling off medical jargon in Spanish. Thank goodness for cognates, because I would’ve been clueless. Soon, after donning gloves, I was given suture scissors to assist in stitching our first patient up.
            Now, it’s slightly overwhelming to see someone’s toe practically falling off, but I had to fight through the temporary lightheadedness in order to maintain my scissor job. I left the ER feeling accomplished, having done something for a change and not just shadowed. The rest of the day was spent with Vaso De Leche, our beloved woman’s group. Marianne and Rachael taught about first aid, something these women desperately wanted to learn about. Taking care of cuts and scrapes is different here in Peru. When asked about what to do to a bleeding gash, one of the women suggested finding a spider web to curtail the bleeding. It’s interesting what people do here with no resources.
            We finished the day with our first interview with the group. They were started in 1993 in response to the bad rains that year. The villages needed help, and these women were there to respond. They began a program that gave the village children a breakfast everyday. Now, the program has grown into something educational for the community. The women get together weekly to learn and to grow. They bring information back to the communities with them, somewhat acting as mentors for the villages. We are thrilled to have three of our teaching projects with them, because they are so excited to learn. Many of them take notes during our presentations. On Monday, I will teach about women’s nutrition and blood pressure. It is so nice to teach people who actually want to learn and are so grateful for your presence. 

Tuesday, July 5, 2011

Week Two Beginnings

      It’s been a strong start for week two in Piura. On Sunday, we visited Madre Del Redentor, the girl’s orphanage. The compound is surrounded by dirt roads and heaps of garbage, but inside, it is a home. The minute we exit the truck, girls are by our sides, grabbing our hands. I am led to the garden, where the girls place a red flower behind my ear, a welcome gesture. We were simply enchanted with the performances the girls prepared for us, traditional dances hailing from the jungles of Peru. Our new friends were so generous and kind, and we hope to return here soon.
With Juliana and Elise

            We began our aggregate assignment yesterday, a large project focusing on one population group. We chose Vaso De Leche, the women’s group, and we are enthusiastic about our plans. We must collect data about the group and then produce nursing diagnoses. We are to write a 20 page paper on this and present to the entire aggregate and parish staff. It’s going to be a lot of work, and it is certainly an adjustment having schoolwork along with daily clinicals. It looks like we have our work cut out for us!
            Today, I got my first experience with working in the hospice. The other girls in the group were able to work here last week while I visited homes, so this was very new. It’s difficult to come up with words to describe the work we do here, because each day and patient is different.
An Average Hospice Room

Today was a concentration on wound care. Some patients here are quad and paraplegics, and have developed severe pressure ulcers. For those in the medical field, they range from stage 3 to unstageable. Unfortunately, this means that they may never heal. One particular patient, Oswaldo, has seven bedsores, three completely covering his backside. We try as hard as we can to care for his wounds and change the dressings quickly, because he has to have this done everyday. It is heart wrenching to see him in this situation, but one of our jobs as nurses is to put on a smile and act empathetically.
            For the rest of the week, we will be rotating in the hospice, ER, and village homes. It’s time to get to work on our project this week, and hopefully the finished product will be successful. 

Friday, July 1, 2011

First Week Conclusion

I’ve always associated flies with things that are dead. They swarm over roadkill, port-o-potties, or even a plate of food that’s been sitting out. Basically, things no one ever wants to touch. Here in Peru, they are everywhere. Of course, the people pay no mind to the flies that inconspicuously land on their furniture, their food, and their bodies. To a foreigner like myself, the flies are more than noticeable, and I swat them away instinctively. Although I’m getting used to it, they are still the enemy.
            To the elderly gentleman sitting in front of his house in his wheelchair, the more than 40 flies swarming around him are merely part of the scenery. The “home visit team”, which consists of Daisy the nurse, Meg, and myself, arrive at this man’s home to do the routine: recording vital signs, a haircut, a shave, and a wash. However, after about five minutes in front of his home, I realize that nothing about this visit is routine. Up until today, all of our clients have been relatively happy, and if sad, consolable. This man sobs whenever we talk to him, and he is barely understandable with his lack of teeth. After a struggle, we understand that he is sad about his inability to walk and the pain in his knees. We try as hard as we can to console him before we begin our work, but it is without gain.
            I’ve never cut anyone’s hair before, let alone someone of the opposite sex. I’ve also never imagined haircutting as a nursing skill, but it is one here out in the community. While Meg washes his feet and hands, I begin snipping away at his salt and pepper hair. I am successful, though I feel like a fool swatting away at the flies that surround us. He continues to carry his sad expression, though smiling once when we tell him he looks “guapo”, or handsome. I carry on, beginning to shave and wash his face. Again, I’ve never shaved anyone’s face before. However, he trusted me, a stranger. I wipe the shaving cream off his face and begin to uncover the lines and wrinkles that have presumably resulted from the stresses of life. I’ve heard people say: stress kills. Here in Peru, this certainly rings true.
            Yesterday, I took a woman’s blood pressure, and it measured up to 170/110. This is extremely high, for those who don’t know blood pressures. Hypertension (high BP) usually results from eating a ton of salty foods, and in America, this is typically the case. In Peru, the hypertensive people I have come across have all been victims of extreme acute stress. This particular woman was so worried about her sick daughter that she became sick herself. This is when my English-Spanish medical dictionary comes in handy, because we need to look up how to say: “You’re stressed out and you need to relax. Just breathe”. It’s stressful when a child is sick. It’s even more stressful when a child is sick and there is no money to cover the medical charges.

            The home visit team and I take these cases as they come. The people here are so willing to listen and learn, and it is amazing to teach. Next week, I will most likely be working in the hospice, and I am ready for the new experience. We will work through new battles and old ones, including the fight with the flies. No matter the temporary struggle, I am always enthralled to work with a culture based on love.