Cancer Sucks Still

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There is a cancer center across the street from the hospital. The doctor who spearheaded the project is in town and gave me and one of the residents a tour. My specialty has not played a part in this whole trip so I was so interested to go see this facility. It sounds like Dr. Degenarro (from Miami)  has been spending most of the last 3 years starting this treatment center and getting clinical trials started in Haiti. There aren't as many rules to follow in Haiti as in the US. Weird. 

The infusion room. Four chairs, no pumps, no pillows. The chairs are lined up against those back 2 windows.  

The infusion room. Four chairs, no pumps, no pillows. The chairs are lined up against those back 2 windows.  

This cancer treatment center focuses on breast and OBGYN cancers but sees and treats whatever walks through the door. When Dr. Degenarro gave us the tour, he jabbered on in French to several patients. We met a woman with breast cancer who needed fluid drained from her lungs. He wanted the resident with me to do it. She was getting a Cisplatin infusion through a peripheral IV. Then we met an older man with lymphoma who had been getting the CHOP regime and now has cardiac problems. As we walked into another part of the building, patients stopped him to ask questions and show him paperwork and he willingly stopped and spent several minutes jabbering on with them. One of the women looked 10 months pregnant but since she was a bit older, I'm guessing she had ascites (fluid on the belly). 

Ultrasound machine  

Ultrasound machine  

Dr. Degenarro works with an OBGYN oncologist who is Haitian. He explained that mammograms usually show that there is indeed a mass and the next step is to ultrasound and biopsy it. Since they do not have mammography, they skip straight to ultrasound and even showed us the biopsy needle...there is one and they just sterilize it. This Haitian doc does the ultrasounds in this room in the picture above. 

Oncology infusion is my normal daytime job so it's fascinating to see how one does it in another country!  I know my infusion nurse friends will appreciate this! 

Today was my last work day in Haiti! I know more stories and experiences will eek themselves out of me in time. Thanks for tuning in!  

 

Third day with this gal. She's a trooper. I love her pouty lips and sassafras toddler personality.  

Third day with this gal. She's a trooper. I love her pouty lips and sassafras toddler personality.  

No HIPAA in Haiti

My patient for the last two days. She has a spinal cord injury and has paralysis in her left arm and both legs. She cries all the time because she can't poop. She calmed down this afternoon and let me hold her!

My patient for the last two days. She has a spinal cord injury and has paralysis in her left arm and both legs. She cries all the time because she can't poop. She calmed down this afternoon and let me hold her!

One thing I noticed immediately at this Haitian hospital is there is absolutely NO PRIVACY. Everything is everyones business. We don't need curtains or gowns or consult rooms. We certainly don't need individual patient rooms.  Oh no. When the neurosurgeons were rounding yesterday, they float from crib to crib in Pediatrics openly talking about each baby (not even TO the parents). Family members of other patients gather and listen. It kind of made me laugh that they are so interested. And the surgeon was mostly speaking English, so they probably don't understand a lot of it anyway! 

The neurosurgeons will do shunt placements on hopefully 3 out of 5 of our hydrocephalus babies tomorrow. One of the moms found out that her baby would not be getting the surgery. She cried and cried. Since there is no privacy for that either, the other moms gather around her and jabber in Creole. I wish I could know what they are saying! How do they comfort each other?? This is the second time one of the moms has had a meltdown and it facinates me that the other moms in your living-room-space come around her and console her. 

The community of developing countries truly is fascinating. In Peds, these families come from all over the country! They don't know each other, but looking at them all in Peds, they seem like family. They bring each other food, give each other money to pay for procedures, and are ALWAYS talking and watching kids for each other. It's beautiful the way they mesh in a scary, painful environment. 

Cuddles. His mom dressed him so cute. My coworker said "looks like he's late for work" because he gets so dressed up in grown up hats. He is about to be discharged in this picture but mom had to pay the bill before they could leave.  

Cuddles. His mom dressed him so cute. My coworker said "looks like he's late for work" because he gets so dressed up in grown up hats. He is about to be discharged in this picture but mom had to pay the bill before they could leave.  

A note about the above picture: I am sweating BULLETS. That Peds unit is the hottest, sweatiest place on earth. There is AC but I doubt it's fully working and there is no ventilation. So having a hot sweaty child lay on me for 30 min really was a sacrifice. But I loved every second of it. 

This is the CT scanner I talked about before. The backside of it is pretty much up against a wall and THATS the entrance side of it.  

This is the CT scanner I talked about before. The backside of it is pretty much up against a wall and THATS the entrance side of it.  

Taken from the entrance of the hospital looking at the back wall. The units are off to both sides.  

Taken from the entrance of the hospital looking at the back wall. The units are off to both sides.  

It's taken 5 days, but today I had those twinges of "I can't go back to real life!" Settling in here was HARD, but now that that's done, the hospital staff and my team mates are starting to feel like family and home...all in different, very strange ways. More to come on that....Zzzzzzz.... 

The Little People

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The strange world of sick little people in a developing country. Peds is a whole new world for me. The unit is the size of your living room, crammed with 12 cribs, and 1-2 parents, grandparents, sisters, friends, cousins, whoever. PLUS doctors, nurses, interns, externs, attendings, residents. So. Many. People. In. Your. Living. Room.

The babes are adorable.  But if you want to know what's wrong with them, you have to decipher the chart, as it is in French. One of the biggest problems I've seen is hydrocephalus. It means fluid is on the brain. 

Example of hydrocephalus  

Example of hydrocephalus  

We have about 4-5 babies in Peds with this illness. You don't see this in the developing world because it is diagnosed very early and a shunt is placed that drains the fluid from the brain to the abdomen. A team (from Europe) came in today to the hospital to perform this very surgery. They came into the unit, examined babies and measures heads. I don't know how many they will be able to do before they leave. There was a whole line in the parking lot, full of parents with hydrocephalus kids, waiting to be se by the surgeon.  

How medication arrives at the beginning of a shift. Better doubl check! The patients do not wear any sort of identifiers. This system is fraught with mediation errors.  

How medication arrives at the beginning of a shift. Better doubl check! The patients do not wear any sort of identifiers. This system is fraught with mediation errors.  

I spent most of the day figuring out how to give three antibiotics with the minimum usage of saline. This was the best idea I had. 

I spent most of the day figuring out how to give three antibiotics with the minimum usage of saline. This was the best idea I had. 

I had a patient, 10 year old girl, who fell out of a tree and broke her radius (forearm). She never got it set and it eventually became so infected that she came into the hospital for multiple surgeries and debridement. The stigma for an amputee in Haiti is worse than a useless limb so they will try to save it as much as possible. I watched the local wound nurse do her dressing change today and almost vomited. There is only one layer of skin and bone left of her forearm. She is one tough chick. 

This guy. So adorable. He sat in my lap during down time for almost half an hour! He loves to fist bump.  

This guy. So adorable. He sat in my lap during down time for almost half an hour! He loves to fist bump.  

By the end of my day, I was thinking "OHHH MAAA GAAAA STOP CRYING!" Peds is truly a different world than adult nursing. Such a wonderful day of challenges and new experiences and stories!  

Day off blues

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We got a lovely day off today at Hotel Visa Lodge. The organization coordinator decided it was safe for us to leave in a group and the hotel is a 4 min drive from the hospital. Lots of pool time, beer, and naps! My mother will be happy to know I did 3 rounds of SPF 70. :) Unfortunately, they dyed the pool green and now we have green hair and suits. 

View of Port-au-Prince from the pool. The airport is pretty close out there.  

View of Port-au-Prince from the pool. The airport is pretty close out there.  

My new friend Meredith who met me in the Miami airport. This is her 3rd trip here to work at the hospital.  

My new friend Meredith who met me in the Miami airport. This is her 3rd trip here to work at the hospital.  

Team members relaxing. There are a total of 17 of us volunteering for the week. Mixture of 1 Doctor, 3 residents, many nurses, 2 EMTs, and 1 speech therapist. 

Team members relaxing. There are a total of 17 of us volunteering for the week. Mixture of 1 Doctor, 3 residents, many nurses, 2 EMTs, and 1 speech therapist. 

All the women from the team in the van, driving back to the hospital.  

All the women from the team in the van, driving back to the hospital.  

This little guy can see into our kitchen area of the residence hall. He keeps motioning us to come over so I did...with my camera.  

This little guy can see into our kitchen area of the residence hall. He keeps motioning us to come over so I did...with my camera.  

Back to the grind tomorrow!  

Just Do It

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Well today (day 2) was really something. I was the primary nurse for an ICU patient who didn't have a lot going on. During my slow morning, I discover that a neighboring ICU patient has a central line! *oncology nurse perks up* I didn't expect to find any central lines, but my sweet patient in Portland donated a lot of extra central line dressing kits to me last week and I had the chance to use it! The hospital is mega short on biopatches and I had brought tons! The charge nurse graciously let me change the dressing, possibly the one nursing task in which I am truly experienced. 

Cue the afternoon excitement. I was informed that I was getting an admission from the ED (which totally terrified me! I don't know what to do!). So I just walked over to ED and started pitching in on his care right away by running to the pharmacy for meds. He had a gun shot wound to the head and had lost consciousness and was now intubated and very agitated. He needed a CT scan. I wish I had a video of the colossal process it is to GET the patient to the CT scanner. It took 4 of us to roll the rickety stretcher over to the scanner's location, then LIFT the stretcher onto this motorized lift that takes you to the level of the scanner, then maneuver past trash cans and chairs to the table. Get patient on the table, all while manually ventilating patient and keep him from thrashing off the stretcher and giving sedating medications I've never given before. Once that is done, the power goes out. It comes back on but the scanner is not working. No CT scan. All that work for nothing. Meanwhile the patient is aspirating his copious secretions and still thrashing. Now to get him back DOWN from the scanner. This all makes sense when you can see what we are dealing with here. 

We do a similar process to get an X-ray and discover that the bullet is lodged far back in his brain with fragments scattered throughout. His prognosis is not good. He is 21. The doctor (Dave) brought his dad in to see him after he is back in ICU. After he explains everything, Dave says "Are you okay," and puts his arm over his shoulders. The dad says in French, "no, but I will try to be." 

Today was crazy. I think I did my best jumping into a completely new, uncomfortable situation. I was definitely challenged! I wish I had more pictures to show. I'm not allowed to take photos of patients without consent so I have to be careful who is in my photos. 

I'm learning that if I can't get someone to understand me, I'll say the English word in a French accent and SOMETIMES it's better understood! I call this a victory.