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Michigan Nurse


From Hospital to Mission Field by Teresa Miller, RN

07.02.2012

By Teresa Miller, RN

During a recent mission trip to Nicaragua, I saw how quickly the basic nursing skills I have after years of assessing patients is all that is needed when modern machines are not available.  To get to our destination, we spent five hours in a microbus, a 1.5 hour ride down the river in a small ponga (boat) and then traveled another 1.5 hours in a  Toyota pick-up on rocky, bumpy, and washed out roads.  The flat bridges we crossed were also a challenge; you could hear the boards bouncing around under the truck and they had no side rails.  The next day we held our first clinic and saw about 125 people, giving them pain medicines, vitamins, parasite treatment and antibiotics as needed.

Family members carry an ill
patient on a stretcher made
of logs to the free clinic.
The next clinic day we had just gotten started when a family came in carrying a stretcher they had made from small trees tied together.  We learned they had walked for five hours, leaving before the sun was up, to get to Las Marvellous to see us.

We quickly moved the woman to a wooden bench. She was in a great deal of pain and was holding her head trying not to move it.  I wondered how we could get her to a hospital; I really didn’t think she could survive the trip we had done a few days earlier.  I then noticed that she had two large (3cm) fluid filled sacs, a rash from her ear across her face, and peeling skin around her nose.

Theresa Miller assesses her patient.

We did not have a thermometer, but a quick touch let me know she was febrile.  I grabbed a gram of Tylenol, then a Zpack was started.  I did an I&D (incision & drainage) on the fluid filled cyst, and taught her husband how to apply triple antibiotic cream twice a day.  Our Nicaraguan doctor, Dr. Mirtilla wanted to see her for a day or so to make sure she was getting better.  She felt that the infection had started in her ear, and was spreading through out her head.  They did not know anyone in town, so the local pastor said she could stay in their home.  I gave him a few dollars for some food and by noon that day she was feeling better and walked next door to the pastor’s home.

The next day she came into the clinic and looked like a new women. She was moving normally, was pain free, and a febrile.  Her husband attended the Community Based Healthcare class and received tools and information to take home to be a healthcare worker in their little village. The following day, they began their 5-hour walk home. 
 
Every trip I make to Nicaragua there is someone that needs our help.  Once there was a two-week-old baby who would not nurse due to an infection.  We dropped antibiotics into the baby’s mouth as it could not suck. A month later we received a picture of a fat sassy baby.  Our basic skills can make a big difference for people with such basic needs.  I am thankful for the skills that I’ve developed over my 32 years of nursing, and that I can take them into underserved areas.
 
For Jeanette Hokett, RN, (at left in van) a BSN completion student at U-M Flint and Adolescent Psych nurse at U-M, going to Kenya in May 2012 was an eye-opening experience. “I went as part of a service learning class,” Jeanette said. “Our goal was to study how other countries deal with mental health. But I experienced so much more than just that goal.”
 
In Kenya, Jeanette explained, there is no middle class. The people are literally divided into the haves and the have-nots. “You’ll see cell phones, Internet cafes in little shacks, BMWs. But then you’ll see homes with pit latrines and no running water, where the family is collecting rainwater for cooking and bathing.”
 
For Jeanette, the two week trip was a medley of sound bites and experiences. The nurse who explained that if a patient has TB, the health care professionals will position their chairs to match the wind blowing away from the patient. The absence of masks – anytime. The natal monitoring system that is nothing more than a pulse/oxygen machine. The oxygen delivery machine for children that is built out of a 5 foot oxygen tank, a bottle and numerous tubes for children needing oxygen to hook up to for 2-3 hours a day.
 
“And yet,” says Jeanette, “The Kenyans are satisfied with what they have. They are not caught up in what they don’t have. They are incredibly inventive and make things work medically that we would not even consider.”
 

You don’t have time to sweat the small stuff when you’re worried about where your next meal is coming from.

 
 The students were tickled to be called “doctors.” In Kenya, only physicians do assessments so they are the only health care professionals who wear stethoscopes. Nurses are called “Sisters” and must wear uniforms; in fact, to not wear a uniform can result in being suspended by the national nurse board for six months. The nurses follow the British model of wards and pass meds; but nurses deliver all babies as a rule and there are no midwives. Well-baby cases are the exception to the physician-only assessment rule.
 
“The health care is done by clinics,” Jeanette explained. “There are no emergency departments. The doctors sit in one room and the patients come in to see them. If labs are needed, the patient is given a slip. They must then go pay for the lab work, and return to the doctor with the results. The patients are responsible for making sure the actual delivery of care happens.”
 
“It’s certainly not free health care. Payment must happen at every point. A patient won’t be discharged until the bill is paid. Families of a patient who has died must pay the bill or the body is not released. Sometimes you’ll see families begging or selling something in order to get money to pay a health care bill. It’s like their education system – they value education but there’s a fee for everything.”
 
The only exception is that the government will pay for AIDS drugs.
 
 “I would go back to Kenya in a heartbeat,” Jeanette said. “The people are pleasant to work with and appreciated help. The experience made me look hard at my possessions and even the things I use on a daily basis in health care, like gloves, in a new way. It’s not a place where you can visit for a few weeks and insist that everything change to the American style of medical care. There were times where I had to keep from gasping at some of the ways procedures were handled. The heartbeat of the Kenyan people, however, is their resiliency and desire to do what it takes to provide care for their people. It may seem crude to us at times, but they make it work, and quite often, successfully.”