I feel I have seriously neglected a subject which is a wonderful part of our daily life here. Namely, that of our nurses.
My official job here is “enfermera jefe.” I am the manager in charge of the nurses (and random other extraneous things such as linen, legal paperwork, and stocking the pharmacy). This has given me a wonderful chance to work directly with, and get to know all of our nurses.
We have 11 LVNs – two of whom have been here since my Grandparents time! Our nurses are amazing. They switch between the challenges of assisting in labor and delivery, surgery, trauma and daily to day hospital tasks without complaining (well, mostly without complaint).
It is a high achievement to finish 6th grade and be able to read here. In order to enter nursing school one must have finished 9th grade. Then there are two years of nursing school, and then one year of social service to the government. Truly an accomplishment. Right now we have 6 students serving their year of social service with us in Ahuas, along with our 11 experienced nurses.
Some of our nurses have gravitated towards certain specialties. Flor (who was called Florcita in my Grandparents’ days) learned how to use the autoclave from my Grandmother, and spent some time in the States training to be a surgical nurse. She is a wonderful scrub nurse. She scrubs into every routine surgery (she is scheduled Monday through Friday from 8am to 5pm) and then is always on call for emergency caesarians or traumas that come our way. She has become a particular friend of mine, telling me stories of the old days, giving me life advice, and teaching me about working in the OR. She knows where everything is in our sterile supply room (a somewhat daunting collection of new and resterilized materials, and ancient archaic machines that Dr. Rudy cannot bear to throw away) and is always good for a long talk while folding campos azules (surgical towels). Completing a generational circle, she taught me how to use the giant autoclave and sterilize materials for surgery.
Flor is the only nurse “on-call” for surgery, but several of our other nurses have trained to take and develop xrays and they too can be called in at any hour of the night or weekend. Last night a young boy was carried in after falling in front of a moving car. He had deep lacerations on his forehead with the skin peeled back to expose his scalp. His pelvic bone was broken and he had multiple abrasions down one side of his body. The shift nurse and nursing student helped as the doctor stitched up his head wound and then Jeny, one of the xray nurses, came in and we took multiple films to discern what all he had broken. Fortunately his skull was intact, but I was still very worried about internal bleeding and intracranial pressure. The family has no money for a flight to La Ceiba (where they have a CT scan, MRI, and more advanced surgical facilities) so we will have to watch and see how he does. The night nurse did neuro checks every two hours, as well as caring for her other nine patients and he looked better this morning. Vamos a ver.
Our nurses Brenda, Digna, Jeni, and Soila all take turns running the pharmacy and doing shift work. The farmacia nurse doles out medications and fills prescriptions, as well as running a thriving chatamusca (frozen coolaid) business whose proceeds go to a local Moravian church. Carmen runs the Preclinica and assists the doctors in the clinic. Monday through Saturday there is a nurse in Preclinica, a nurse in pharmacy, and then of course whoever is on shift in the hospital. We have one nurse on shift in the hospital (along with a nursing student right now) at all times. The A shift nurse is here from 7am to 2pm, the B shift nurse is here from 2pm to 9pm, and the C shift nurse spends the night from 9pm until 7 the next morning.
The patient load can range from 5 patients up to 20. We try and keep the acuity level to a manageable level, but at times there are gravely ill patients who simply cannot afford to fly out, so then the nurses care for them as well. It is all in a day’s work here to start an IV on an infant, do a vaginal check on a pregnant woman in labor, stitch up a wound, scrub into an emergency c-section, and get the local psychiatric patient to stop harassing people. Delroy – who does our monthly government paperwork, as well as being the best shift nurse on staff – was telling me how nervous he was when he first was hired. He had done his social service in Central Salud (the government clinic) giving vaccines and doing clinic work, so he was worried about not knowing how to check the cervix or help a laboring mother. Apparently he learned just fine, because I have seen him deliver two babies all by himself when the doctor could not get there in time. He is very patient with the students, can get an IV on the most difficult invisible vein, and is meticulous about charting. Plus he actually likes working C shifts, a task some of the other nurses do not prefer.
While I have been impressed for some time at the variety of skills possessed by our nurses here, and their ability to overcome challenges never conceived of in the States, I still am occasionally caught by surprise. Rafael, another wonderful shift nurse who also takes xrays, approached me asking for some extra time off one weekend. He explained that it was planting season and he needed to go tend to his “finca” (farm). I had no idea, but when I asked Dr. Rudy he said that most families need a small area of crops to survive. Whether it is just to grow food for themselves, or to sell the plantains, beans, coconuts, etc to others; having a farm or plantation is part of the daily existence. So Rafael has been tending to his bean plantation down river every day, while also working shifts in the hospital. Nurses get one month off a year, and Rafael asked for a month in spring so he could harvest his crop. Not what I think of when considering vacation.
Even for those nurses without farms daily life is hard. All cooking is done from scratch, including killing the cow to get the meat for dinner, separating the rocks from the harvested rice, soaking the beans for hours before cooking them, and hacking open coconuts with a machete. Laundry is done by hand, with water hauled up from the river, and then hung out to dry. Jenaine, a great shift nurse who also runs our prenatal care program, sorrowfully informed me one day that her favorite scrub top had been eaten off the clothes line by a passing cow. She found it mangled and masticated beyond repair in some nearby bushes.
One day in a particularly hectic surgery Dr. Norvelle asked me to do the first prep for the patient. I responded that I was happy to do it, but not quite sure of the process (having never done it before). Norvelle sniffed and made a comment about “what do they teach in nursing schools these days?” I don’t know what all they do teach in Honduran nursing school, but if these nurses are a good sample, I can tell you they are doing something right!