Nuevo Laredo - Sue's Mission trip

[LATE POST - our apologies!]

Well, it's going on 3 weeks now and I haven't told you guys what's happening.  Sorry about that!

We've been slaving away (you might have seen the Tribute to Post It Notes) on the project proposal.  MSF Swiss is taking on the ED of the General Hospital (public hospital) in Nuevo Laredo. This is where people go who have the social insurance or none at all (about 50% of the population is at risk).  You would be astonished to see - there are 3 private hospitals with all the money in the world, look just like ERs in the US, TVs in the waiting rooms, marble floors and walls, polished spokespersons greeting you at the door ... And our hospital is the run down, doing their best with very little, dangerous part of town where all the traumas go.

The situation is that in Nuevo Laredo, over the past 13 years of the War on Drugs, two cartels have been fighting for control of this corridor - and civilians are caught in the crossfire.  Everything is locked up tight, few people on the streets, "no go" areas of the city.  400,000 residents living in fear.  This has caused the outlying public health clinics to limit services, hours, care and so everyone has become accustomed to coming to the ER for everything (sounds a bit familiar to our situation at home?).  The ER has now become overwhelmed with 50 patients per day, boarding for days (including TB patients boarding for a week in an non-ventilated "isolation" room in the middle of the ER), no in ER pharmacy system, doctors who are not ER trained, nurses who learn on the job ... AND the pre-hospital EMS/911 system doesn't work.  

What we've done so far is redesign the physical layout (working with the hospital architect), created the positions of Chief of Emergency Medicine and Nurse Manager of ED, created a new flow by having Triage and Fast Track, make lists for equipment, medications, training and systems that will help fix all of the above.  Sounds like a lot, eh?  Well, as we being to fix the ER, we will tackle the EMS system and fix that, plus repair the referral system to the clinics. 

We started with blank faces and blank walls.  The Mexican ER doctor had been here 3 weeks working and immersing himself in the ER, but had no idea how to go about creating a proposal to fix things.  So they brought me in.  My first task was to rearrange the office, put pieces of paper on the walls and  a pad of post its in each hand.  And began to brainstorm.  I can only imagine what was going through their heads - no one on the team had ever seen such a thing!  For 2 days we put ideas up on the wall, discussed, fine tuned and began to shape the ideas one by one and see how they could fit together.

Then came time to begin putting finger to keypad and bring it all together in a cohesive whole.  Each day we work on collecting more information, adjusting original ideas and trying to figure out what the project ought to look like.  The proposal will be sent to Geneva tomorrow and the discussions with the overseeing desk begins.  A week later, the fully polished version is presented to the President of MSF Switzerland for approval.  THEN the work really begins.

Our work day starts about 8:30 til 2, then 1 1/2 hrs for lunch and back to the office til 6ish.  My evenings are watching internet TV (The Daily Show and Colbert Report in order to keep up on the news :), chatting with Pete on Skype, reading, watching DVDs, etc.  Weekends so far have found me happy with internet sites to watch the Seahawks wins and Formula 1 races.  We've really not seen anything of the town - home to office by car, back again, to/from the hospital ... I walk a bit on weekends, but there's nowhere much to go that's safe.  Most of the city is "no go."

Hoping they will find and send the field team before I go so we will have some handover.  In the meanwhile, I'm going to be working on protocols, manuals, assessments and training and getting ready for the field team to implement what we've envisioned.  It's going to be an interesting 2 years for them and I'd love to see the results one day.

- Sue 

The Art of Nursing and the Science of Medicine - Sue Averill

From Sue-

Last month I traveled with other nurses and doctors to Port Au Prince, Haiti with Project Medishare, working at Bernard Mevs, the only neuro-surgical and trauma facility in the region.  Project Medishare’s goal is to train Haitian doctors and nurses and to establish sustainable programs so the facility can function independently beyond the departure of expats.

Among my role as ER and Triage nurse, I was anointed “The Hysteric Whisperer." Many teenage girls and young women came to the hospital via ambulance or private vehicle presenting in catatonic states, hyperventilating or as “post-ictal seizure” patients.  We soon learned, these were anxiety/panic attacks. One teenage girl was brought, ambulance lights blazing and sirens blaring for "seizures" – but made eye contact and was purposefully moving around in the gurney - not in a post-ictal state. The doctor approached the patient and shouted, "Prepare to intubate!"

Three minutes later, I held the girl’s hands and helped her off the gurney and onto a chair.  Intubation was certainly not necessary. With an astounded look on his face, the doctor asked “How did you do that?  That was magic!”  I replied, “Want to know the magic? I put my face down close to hers, spoke very slowly, softly and quietly into her ear, and told her  'It's OK' over and over and over.  I pet her cheek, made eye contact and suddenly big crocodile tears began to slide out."

The Haitian population has several factors working against them:  the traumatic events of the 2010 earthquake - the country is still piecing itself together.  The fact that Haiti is an impoverished developing country with limited resources.  Add to that frequent sexual violence against women, family issues, loss of not only loved ones but schools and homes and churches, plus the surging hormones of teenagers, it's no wonder these young female patients frequently present with anxiety and hysteria.

A nurse’s approach is humanistic. It's thoughtful.  It involves comfort, care, touch, words and warmth. It's holistic. Nursing approaches patient care - whether in a hospital, a clinic, or a tent in Africa – from another direction than medical doctors.  Our professions are intertwined yet quite different.

It's the art of nursing versus the science of medicine.

- Sue Averill, RN

August’s ONAAT Boarding Meeting

Another great board meeting this evening and it couldn't have been a nicer night!  The sunset was beautiful as it slowly dropped over the Olympic Mountains spilling its last sun-rays out across the sky, what a beautiful state we live in.

Since Staci has departed, it has taken me a while to get the hang of getting blog posts up on a regular basis, especially with two kids under the age of 3 and a part-time job – which seems to be more than part-time at times. So, my hope is to be a bit more regular and to give everyone an idea of what we are up too. J

Tonight we had an informal board meeting, mostly to have a face to face to meet our two newest additions to our One Nurse At A Time team. Our first addition is a fellow board member, Helen Jose. Helen Jose is a registered nurse serving her community in the southern part of Washington State. Helen comes to One Nurse At A Time with a lot of experience behind her. She has been in the nursing field since the 70’s and has tackled all sorts of nursing positions and departments. Right away, I think we all could tell that Helen will bring a lot of great experience and knowledge to the One Nurse At A Time table.

Our second addition to the ONAAT crew is Christine Van Horn. Christine is currently working for One Nurse At A Time in a paid position, our first! She is working on updating our directory, ensuring the organizations have all of the correct information posted on our site and assist ONAAT with coordination with our scholarship recipients.   Christine is currently employed at a local emergency department. She is definitely the go-to gal as she seems to have her hands in a little bit of everything – from data abstraction for Trauma and Stroke patients, filling in as the ED’s unit secretary when staff are sick, to capturing meeting minutes, creating dashboards, coordinating nurse managers and medical directors, and all while having a cheerful smile on her face.

We had a lot to discuss over dinner and drinks tonight. Most of our conversation surrounded our up and coming Jo’s Mission, marketing, goals, and discussion about our 5 year plan for One Nurse At A Time. It was good to get out, share our vision with one another and plan for future events and meetings. Here is just a little glimpse of what we were blessed with during our dinner tonight. Enjoy!