we love you nutella :)

May 12, 2010

A lot has happened since we last wrote…seems like we've been her for a long time already! We had our first night shift which went well. The first patient was a 17 year old girl who was supposed to be an ASD repair only but ended up also having TAPVR. Luckily, the surgeons noticed this and repaired both issues! The second patient was a 3 month old baby girl that received a complete TET Repair and she was only 5 kg!! We were actually impressed by the skill level of the nursing staff with these post-ops in some regards. However, we did notice that nursing here seems to be very task oriented with not much critical thinking involved. But, both nurses were very nice about letting us make suggestions and help to take care of the patients. We were very honored during shift change when one of our MDs translated that the night nurse told the day shift nurse coming on how well we did/nice we were :) Nice to have a verbal confirmation that you are not completely annoying someone after trying to speak a language they don't understand to them constantly haha. We are supposed to be helping the nursing staff learn so it was hard for us not to dive in and do everything. It is also really hard to communicate here, especially during the night shift because we don't have a translator. Luckily the intensivist that was on, Eugene, who is from Minsk speaks Russian and English. Like we said earlier the hospital is very outdated and is lacking a lot of supplies but, after a night of witnessing the resourcefulness necessary to complete pretty much every task it became even more obvious how different our health care is from theirs. In our world it is not clean/safe/policy to reuse almost anything but in their world if you don't re-use you won't have it. Also you should see their setups for oxygen and suction, I would never be able to figure them out!! Both patients did very well throughout the night only requiring a handful of blood/fluid boluses and other medication adjustments. The TET came back from the OR in JET and we struggled throughout the night trying to get her back in Normal Sinus Rhythm. Still no success by the morning but assessment wise she looked much better. These patients will be moved out of the ICU much quicker than we are use to in our unit. We also got to get a glimpse of ICU care for adults here. There is a woman who looks to be in her 50s or 60s in the corner of the ICU that we are not really supposed to help with but we tried to here and there because it was difficult to see someone looking so hopeless. Long story short this poor woman is in a coma after having a cardiac arrest initially due to pericarditis that remains unexplained. This woman has been in their ICU ward for 2 weeks and most likely has been laying in the same position besides what appears to be a one time a day linen change. This woman does not have a depends on and is having liquid stools. We helped change her bed in the morning and could not believe the condition of her skin and that she was simply lying in her own feces. Very sad. However, hard to judge because the bed is so small with no side rails or much possibility for position change. Also, the nurses manage several patients by themselves and she requires a few hands to even provide simple care. We discussed mouth care after noting her condition and it appears that is not practiced here….we are going to try to convince them to start performing mouth care on her but again it's not like they have the convenient swabs or safe suctioning that we do. She would be likely to bite down on any make-shift swab and potentially do more harm than good. Again very sad not to have supplies necessary to provide routine care. It was a mix of being impressed with what they could do with not much and being shocked at the simple care problems they had due to lack of supplies & knowledge. We are going to teach more about infection control and simple infection prevention methods before we leave. On a lighter note, while all the patients were being good we were able to learn a couple words in Russian from a nurse named Alex. We are pretty pathetic at pronunciation but they are very excited when you try. BTW Alex has been a nurse for almost 2 years and is only 18! Pretty crazy! Alex also spoke some english so we could communicate a little that way but of course I (katie) use a little too much "flowery" language as the nurse from London puts it haha.

Besides our shift at the hospital and sleeping to prepare for it we made a quick trip to a nearby "botanical garden." There weren't any flowers haha but there is a natural spring. The locals bring water jugs to fill! Super cool! Also, there are a couple small pool-like areas where people dunk themselves in the chilly water. Mostly old men in speedos but we did see one woman in a 2 piece so we feel like it would be safe for us to give it a whirl. We plan on getting our dunk on if weather and time permit :) I had my suit on and everything today to go but it was raining again :( Another important part of our day besides sight seeing is diving into the cuisine! Pretty much my favorite part! So far everything has been really tasty, especially the salads that are made with some of the freshest vegetables I've ever tasted! There is a super market right next to us and everything is very cheap so we stock up on snacks and such for night shift…nutella is our new fav!