Monday, April 15, 2013

Student Highlight - Michelle McCowin: Working with the Belizean Community Healthcare

Michelle McCowin

There were two nursing students in our group, Megan and I, and we were blessed with the amazing opportunity to spend one of the Easter Camp days shadowing a Belizean rural community health nurse. Megan went on Monday, and I went on Wednesday, the last day of Easter Camp. Megan didn’t tell me much about her experience because she “didn’t want to spoil the surprise of it all,” so I really had no idea what to expect.
Dawned in my BSU scrubs uniform, I  met with Professor Dunnagan (Shawn) and Dr. Breitkreuz (Karen) 6 am Wednesday morning, to meet our driver at the Corozal Community Hospital. When the driver arrived, Karen went off to do her thing with the head nurse of the area, while Shawn and I got in our driver’s surprisingly nice, new-looking, and air-conditioned truck. We had no idea where we were being taken to. The driver told us we were picking up one of the nurses and then heading to the clinic at the village of Concepcion. We ended up driving around for over an hour, as there was apparently a few things he needed to drop off, which was fine because the scenery was awesome. We got to see sugar cane fields, orchards with papaya and coconut trees, and the old abandoned sugar cane processing factory, so were happy.
When we finally arrived in Concepcion, my first impressions were “Wow, this clinic is small!” and “Wow, these women are really nice!” The 3 women at the clinic were “community health workers,” (CHW) which are similar to certified assistive personnel (CAP), with some special community health training. They have a focus on health promotion and teaching, where a CAP would not.
There were already a few women and their babies waiting to be seen when we arrived. One of the CHW’s had just gone through a  mini-training course on health promotion for pregnant women and new mothers, so she set up some visual aids and began presenting (in Spanish) a lecture on breastfeeding and transitioning an infant from milk to solid foods. Just a few weeks prior, we’d discussed breastfeeding in-depth in my Maternal/Pediatric nursing class, and I was happy to see that everything she was teaching was spot-on. (I could translate only part of what she was actually saying, but all of the information was on the posters, in English.)
After she was done presenting, I asked why the women were still waiting. Apparently, we were waiting for Nurse Terry to arrive, who had all of the supplies, as this is a “mobile clinic.” Nurse Terry is not an RN (registered nurse), but has been a nurse for 30 years, and says when they’re short-staffed, they aren’t going to tell her not to give someone stitches who needs it, because it’s “out of her scope of practice.” Nurse Terry sets up the mobile clinic once per month to do “well-baby exams,” which include filling certain prescriptions (including nebulizer treatments for breathing disorders), giving vaccines, weighing and measuring the children and babies. She also does prenatal exams, which include breast exams, a pelvic exam including a pap-smear, and recording the fetal heart rate.

Nurse Terry and Michelle

 The CHW’s open the clinic once per week when Terry is not present, to offer blood sugar testing for the many diabetic patients in the area. They want to offer blood pressure testing as well, but they do not have access a sphygomanometer, the instrument that reads blood pressure. For the mobile clinic days, they measure height, weight, and blood sugars, as well as work on health promotion with the patients, while Terry does everything else.
My first impression of Terry is that she was a little bit intimidating, but there was a warmth about her, which radiated from her big smile. She was very “straight-to-the point,” but had a sense of humor at the same time, and very open to teaching me anything I wanted to know. She asked me what level I was at in school, and I told her my experience and what skills I’d practiced so far in the clinical setting. The first patient we saw needed a nebulizer treatment, and she asked if I’d ever given one. When I said “no,” she replied, “Well, today you will.” I gave a startled “Oh! Well, ok then! I mean, are you sure that’s ok?” I was not expecting to have the opportunity to participate in the care, I was expecting only to be observing, so it caught me a little off guard. She must have sensed my feeling of terror, because she calmly said, “Well you have to learn at some point, don’t you? Come one, I’ll show you how.” So she walked me through it, which was super awkward for many reasons,  my hands were shaking like crazy, I could hardly read the prescription from the doctor (that “doctors have horrible hand writing” stereotype rings true in the states, and in Belize, apparently), and all of the tools and packages and syringes looked just slightly different than what I was used to, so it was a little nerve-wracking.

Afterwards, she congratulated me on a good job, and told me I didn’t need to be scared, because “Everyone has to learn, someone had to teach me, too, so I understand. You’re learning, don’t be afraid about making mistakes.” I remember feeling so lucky at that point that we’d been set up with her, because she seemed to be the most supportive nurse I’d ever worked with, and was so open to teaching. When the next patient needed a vaccine, she asked if I’d ever done one. I told her yes, but not to any children, and she said again, “Today, you will.” I was beaming! I had Shawn phone Dr. Breitkreuz (the only nursing faculty on the trip) to see if it was ok, and when she gave us the green light, I was giving immunizations left and right! By the end of the day, I couldn’t even count how many I’d given. I also got to spend some time with the CHW’s measuring heights and weights of the children and babies. This opportunity was so incredible for me, because for our pediatric/maternal nursing course where we’re in the hospital, we mostly just observe our nurses, because we are switching units every week. I may not have gotten an opportunity to practice any nursing skills on children at all before graduation, if not for this day. It was quite a special day.
Things started slowing down, as the transition between the child and baby appointments and the prenatal appointments began. There wasn’t as much that I could do for the prenatal exams, since pap smears are out of my “scope of practice,” so I was doing more observing for these patients. At one point, as a patient was changing out of her clothes for the pelvic exam, Terry handed me a bag of fresh chili-lime seasoned mango, and asked me to try it. I was pretty grossed out, since we were in the examination room, but I didn’t want to be rude, so I washed my hands and tried it out. She then sent me away to go have shawn try some, and I took this as a hint that she wanted me to check out what they were doing for a while. Shawn had been hanging out with the CHW who was seeing the diabetic patients and taking their blood sugars. This is Shawn’s specialty area, so she was having a ball learning about the dynamic of diabetes in the area. I sat down with them and talked about what she’d learned so far, and learned that the diabetes rate was an alarming nearly 50% in the village. We asked why they think it is so high, and found out it was much of the same reasons as we have in the U.S.: mainly diet and lack of exercise. Their diet consists of large portions of rice and many sugary drinks, and they expressed that people are eating less and less vegetables as people are losing interest in having home and school gardens. This made me feel good about the fact that we are building sustainable vegetable gardens for a couple of the schools. I hope our gardens will make a difference in the kids’ diets and health.
No patients had been coming in for about half an hour, so the CHW offered to take us on a walk and show us around the neighborhood. Though I saw the first legitimate “shack” houses, some of these houses kept the most neatly groomed yards with beautiful flowers and trees and bountiful vegetable gardens. She showed us the cemetery, which, though littered with trash (that’s a whole other issue I could get into), was absolutely beautiful with the raised graves and bright flowers adornments.
By the time we made it back, it was about time to leave. Shawn wanted to get back to the community fair before it ended, and I didn’t blame her for wanting to leave a little bit early, because she didn’t get to do any hands-on stuff like I did, and was probably a little bit tired of sitting around there. So, we bid our farewells, and as I was thanking Terry, she said something along the lines of “Oh, you’ll forget all about me and Belize.” I smiled and said “No, Terry. I don’t think you realize what this day has meant to me. I seriously will never forget today, and I will never forget you for giving me this amazing opportunity,” and I meant it.  She just looked at me and grabbed my hand and looked like she was about to cry and said “God bless you. You are welcome back any time you want.” I gave her a big hug, and we said our goodbyes.
As I was walking to the car, the magnitude of what I just experienced hit me. Seeing so many beautiful children and smiling mothers who trusted me with their children’s care, working with such a great woman who was such a patient and warm teacher to me and gave me reassurance that I was okay and the confidence that I would be a great nurse, seeing the beautiful neighborhood and cemetery and asking the women all sorts of questions I’d had about all the little details of life in Belize, being terrified at my first immunization to feeling like a pro by the 5th, these things stirred up so much emotion and so much thought within me, these are the experiences life is about. I knew in that moment, that this day had changed me, and I would never be quite the same as before I came. As that beautiful thought was running through my head, I suddenly had this strange burning sensation in my eyes and sinuses. I had a moment of gratitude for my sunglasses, so I could shamelessly and slyly let a couple of tears run free and be able to raise my eyes up to have one last look at this life-changing place, to keep it in my memories forever. 

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