Session 5 (September 2013) ~ Lisa Roessel, NP.


Clinic Day #1:

It is the first day of clinic and there is a buzz in the air as everyone gets ready for the day. Excitement, anticipation, perhaps a little bit of nervousness. Mental questions: “Which scrubs should I wear today?” , “Do I have my stethoscope? My blood pressure cuff? My notes? My watch?”, “Do we have all the meds?” 

But mostly ….“Am I ready for this?”

The team gathers upstairs for one of many meals that will be taken here over the next week. Over breakfast, last minute preparations are made. “I’d like to review blood pressures again!”, “Am I shadowing or working the pharmacy?”

I am enjoying this opportunity to work with students again as so often, in healthcare, we get jaded. When I began my career in nursing, I was smiling, naïve, squeaky cheeked and determined to save the world, one patient at a time. However sadly, over time, the squeaky cheeks become tarnished, the smile fades and the brows begin to furrow. Cynicism breeds cynicism and therefore becomes an infection that spreads across a hospital unit like wildfire. I freely admit that over time, I began to lose my passion and my compassion. 2 essential qualities when caring for patients.

But today, I am thrilled to see the enthusiasm in the students. They’re excited. They’re compassionate. They’re passionate. They want to do a good job. They are varying degrees of skill and experience, some with significant medical backgrounds, some with none. However, the quality that they all share is that they genuinely care about this process and the impact they want to make both here and in the world. 

And as a bonus….they all get along and treat each other with respect. 

They are the future of health care and that leaves me hopeful. 

We load up the bus and head to Pachacutec. Pachacutec is a village not far from our compound and we set up clinic on a hillside which by some measure could be considered prime real estate. Below, there is a view of the ocean and if you look closely, you can see large ships and barges in the distance. 

The clinic will be set up in an area used as a soccer (or more accurately futbol) field made of dirt. There are fishnets set up around the perimeter, held up by long poles and I imagine that the fishnets are there to keep the soccer balls in. 

3 blue tents are set up emblazoned with the V4P logo on the side and inside each tent is an exam table and several chairs. There will be 2 physicians from Peru along with myself seeing patients. 

The pharmacy is a table taped off with areas that say “Antibiotics”, “Vitamins”, etc. and our lab is a table under a tent.

In a separate area, there is a set of tables for taking vital signs and another set for taking medical histories. At each table, there are 3 chairs. One for the patient, one for the medical provider and one for the ever important translator (THANK YOU TRANSLATORS!).

Already, there are patients lined up in the waiting area!

We get set up and then the gun fires (Ok, not literally, but figuratively) and we are off!

The clinic is bustling as everyone works hard to get the patients through their respective stations in an efficient manner. 

We are asked to see a patient in the waiting area who feels she is going to faint. In checking her blood pressure it is 220/110 in the RUE and 210/100 in the LUE. Holy hell! We need to get her to the hospital! She is complaining of blurred vision (I bet!) and dizziness (I bet!). She says she feels like her heart is going to explode (I can imagine!). We beg her to go to the hospital (we can take her!), but she refuses. She has not had a good experience with the hospital in the past (“All they do is give me pain medication!”). So, we opt to do our best to treat her here. 

What have we got? Captopril. Ok then… let’s roll with it. Over the hour that she is with us, she tells Emily and me all about her daughters, her grandchildren and her history. She is adorable and I feel a sense of privilege to be a even a small part of her life. 

We continue to recheck her B/P (thank the Lord it is coming down) and her blood sugar is normal. On discharge, her B/P is 140/90 and she sits up and says she feels ready to go. She cries tears of joy and cannot stop hugging Emily nor me (nor anyone who will let her for that matter!). She wants to adopt us (which I seriously consider taking her up on!) and asks when we will be back. She promises to pray for us every night at 10pm. Her hugs are so tight that you feel consumed. In a good way. 

And I am pleasantly reminded why I got into healthcare in the first place.

I know that this is just one of many stories from the day (I’d love it if you have other stories from the day to add in the comments below! )

After a full day of a busy clinic, we load back on the bus and back to Casa Emmanuel where we recap the day. The buzz in the air is a bit different now. Excited, relieved, cheery. Overall, it has been a good day! First day jitters are over and now we can just relax. 

Tomorrow will be clinic at the stadium and I think good things are ahead!

Read more here 

Session 5 (September, 2013) - L.R., Nurse Practitioner

Let's get acquainted, shall we?

Today is the first day that we all wake up at the compound together like one big happy family. 

We all load on the bus back to Miraflores where some of us take (what I later hear was a fantastic) tour of historic Lima. I opt out of the bike tour in favor of Starbucks and free wifi (I know, I am weak....so weak). This however, gives me an opportunity to bond with some of the "Adultos" (as we will later be titled), so I do not consider it a missed opportunity. This Starbucks does not have my usual Veranda blend so I am forced to drink a vanilla latte (and for those of you who know me, this is a big compromise. I am now officially, "roughing it"). And, since I am in a different zip code, I'm pretty sure that means that calories don't count so I order a cookie. With chocolate chips. Two different kinds. Haha!

When the group is finished, we join together for a tour of the local hospital, Salud Hospital General Maria Auxiliadora.

This is a humbling experience for me. 

As we walk the hallways, the nurses and doctors smile and greet us with open arms. "Anything you need, you let me know", one doctor says. They are eager to explain how the individual units work and the nature of the patients for whom they treat.

In the US, we often complain about the state of our health care, what we deserve and what we think we are owed. We are issued surveys that ask "Did your doctor listen to your concerns?' or "How was the food on a scale from 1-10". We have the luxury of worrying about whether the food was delicious or if the hospital had Cable TV. 

As we begin our tour, I note that there are patients in gurneys lining the hallways. There are small pieces of paper with a number and their name taped above their beds. I am told that some of these patients have been there for 6 months. 6 months! 6 months without even a room, let alone a private one. 

My heart breaks.

As we walk through the halls, we pass by rooms that host approximately 6 patients each, tucked in small white metal beds. These patients greet us with smiles as we walk by. I notice the stark contrast from my rooms in the US, where every patient gets a private room and will often greet you with the "Watchu lookin' at?" stare if you peek in there. 

What I instantly notice is the lack of high tech equipment. There are no monitors at the bedside. No machines that whir or click. There is no familiar beeping of IV pumps or pagers. This is instead, replaced with a simple IV bag on a pole, and drips are calculated the "old fashioned way".

I notice a particularly peculiar piece of equipment on the windowsill. This is a wooden board with a vial of potassium taped to it sideways. What is it? Is it for emergencies? Like a crash cart? We are told that no, this is a level, to be used for placing CVC catheters. Aha! These nurses are not only hardworking, but clever as well! It suddenly makes me wonder why I've paid $20 at Home Depot for the one that I have at home.

We also notice what can only be described as a Pyxis. This is fashioned out of an old desk and the medications are in the drawer. No fingerprint nor bar code required. 

We then head to the pediatric ward. It is here that my heart melts and breaks at the same time. 
It is here that I fall in love and I have to tell my husband that he is now #2 in my life, as I've lost my heart to a 32 day old boy named Sebastian. Sebastian has been abandoned and is destined for the orphanage in a week. I instantly begin devising a plan for Kelly to create a diversion so that I can slip him into my backpack (It could work, right?). His 30 day old roommate, Bella, is destined for the same fate, tomorrow. 
It is here that we meet a child with cerebal palsy who essentially lives at the hospital and a baby girl with hydrocephalus with a beaming mother, proud to show off her daughter to our team.

As we leave the hospital, I note that I am filled with conflicting emotions. I note that on one hand, I feel pity that these patients do not have the same health care that we do. At the same time, I feel shame at my ethnocentrism in thinking that is somehow better. And I feel just a little ashamed at the sense of entitlement that often plagues me as a citizen of the US. 

My eyes are open. 

I am now, more than ever, ready to roll up my sleeves and get to work. 

Bring on clinic day #1!