Good morning Blogger
I attended Queen Victoria Jubilee Hospital for the last day of my elective experience.........The Hospital is one of the largest Maternity and Gynae/Obstetric public Hospitals in J.A. The Hospital has 5 floors which make up the hospital. The Hospital accommodates 9-10,000 deliveries per year. The Head Sister informed me that at present they have 20-25 deliveries per day. (They have 6-7 staff on a good day on labour ward.)
A Midwifery School commenced in the 1980s at this hospital which came to a hault due to a shortage of staff. In 1997 the school was reinstated. The Midwifery school offers a 2 year direct entry midwifery program and a 1 year Midwifery program for Nurses.
In March 2010 a "Wellness Clinic" commenced. (It was revealed that staff and patients were in need of Professional staff to talk to and help them through any difficulties they were facing.) The Clinic has staff that comprise of Social workers and Psychologists.The clinic is on a Wednesday and commences at 9am.(Women who have experienced miscarriage or a loss of a baby are also referred to this service.)
Women are cared for by their own health clinic in their area......The Antenatal Ward is a high risk ward.
There is a Family Planning clinic on a Monday to Friday and also a Fertility control Clinic.
The Health Care is Free at this Hospital. (Just imagine how many patients and the difference in personality's that the staff would meet???It must be challenging at the least....)
The Uniform for everyone is white accompanied with a white hat....the difference between the nurse and the midwife is the nurse has a green stripe on her hat.....and the sisters of the Ward have a coloured belt on.
I was informed that I would not be allowed to take photographs of the hospital......
Mothers are advised that they must think of a name of their child before being admitted for delivery....as the babies are registered on the postnatal Ward before discharge.
The Antenatal ward has a capacity of 40 beds.....at present their are 50 patients....so they are housed in a ward opposite which is normally used as an isolation ward for infectious diseases like malaria, Tb etc. There are 3 Breastfeeding coordinators (UNICEF awarded this hospital as Breastfeeding friendly....they are in the process of reinstating the award).
The Postnatal ward has to wards......The Eastern side which caters for Abnormal postnatal women (women with problems postnatal whether it be post operative or gynae/obstetric related) and has 27 Beds....and the Western side which caters for Normal postnatal women and holds 63 beds.
The Labour ward has 5 beds and one room for examinations...(prior to admission). There is a High risk room with 10 beds, Induction room with 10 beds, and a or if they developwaiting room with 10 beds. There is a postpartum area with 17 beds split in two rooms. There are 2 operating theatres....1 Gynae and 1 obstetric.
The Hospital has a special care nursery which holds 35 cots but has 75 babies....you work that one out.....They have 7-8 staff and have 4 different rooms.......1st room is for babies on CPAP......2nd room is for the babies coming off CPAP...3rd room is the room for babies who need nursing and 4th room is for babies who need isolation.
There is an antenatal Clinic on the grounds.....on a Thursday it is solely for teenagers....They have an average of 80 teenagers per week attending.....A high under age pregnancy rate....youngest age is 12 years.......Women do not book at this hospital until they reach 32 weeks gestation or if they develop a problem before hand, in which case they have a Early pregnancy unit which is comprised of 14 beds for women of 20 weeks gestation and under.The antenatal Clinic have an average of 136 women attending per day....(not including the teenagers..)They have 6 qualified staff....but on occasion have only 3.
I did not get the opportunity to actually experience the staff at work.....as the staff could not facilitate this. The overall look of the hospital was very nice and big and clean. It was evident to see that they have an influx of patients but all are accomadated and no one is turned away.
Takecare Miss P
Friday 2 September 2011
Monday 29 August 2011
Postnatal Ward
Good morning Bloggers
I arrived on the Postnatal Ward today and was greeted by staff.....Its funny when you get introduced as the student from England.....you receive mixed emotions.....a range from.....MMMmmm why is she hear...(maybe to watch over us???)....to....WOOOowww.....she from England...(and the posh voice starts to take a roll....)...either way....once again received well and teaching proceeds...Fact!!!!I'm sure I've said it before.,...these women click into a teaching roll anytime your near them....'it's great'.
So the ward comprises of 24 beds with a staff average of 2-4 qualified staff. The day starts with handover then prayer.....which I am blending right in to....I wonder why no one has asked me to pray yet???Lol...
Tasks are delegated amongst the staff by the Senior sister. The first task was the baby bath....one baby is picked...(with the permission of the mother of course...) and taken to the end of the long ward ..where there is a table with all that is needed to facilitate this 'show bath'. (It reminded me of when I used to be a Health care assistant and had to carry out show baths....many moons ago...lol).
The women sit attentively and watch the guidance on how to bath their baby...(Olive oil and water...the baby's skin and hair, comes out looking gorgeous!!!)Then another member of staff at the same table gives the talk about the postnatal ward they are on.....she covers postnatal clinic appointments after discharge, illness after discharge (if there are any problems with the women or their baby after discharge up until 6 weeks, they return to this ward ), Care of Episiotomy/Lacerations...('Sitz Bath' which should be carried out twice daily....A small basin...large enough to sit in....enough water to cover the perinium...and as warm as the woman can tolerate....and 1 teaspoon of salt to 1 pint of water.....Fact!!!!Jamaican salt is like....quadruple strength to are salt......OOOUUUCCCHHHhhhh!!!!) , Bowel care....(Women are to avoid becoming constipated!!!), Sexual intercourse...(recommended none till after 6 weeks...), Family planning, exercises, Outpatient dressing clinic, Infant feeding, Diet, Rest, Hygiene, baby immunisation, Registering baby...(All babies must be registered before the mother leaves the hospital...a woman attends the ward Mon-Sun, the cost is $300), discussion about the Child health Passport...(equivalent to our red book..) and finally the Puerperal service is offered (care in community for those women in the attachment area. All women are given a leaflet on the above talk.
Then the general care for the women is carried out. The doctors progress with their round and postnatal care is given. The ward runs smoothly with every member of staff caring out their daily duties....the relationship between the staff and patients is good and almost comical to watch as they banter with each other whilst dealing with issues that arises....Fact!!!All women are referred to as 'Mommy or Mom'.
Thoroughly enjoyed my time there.
Blog later
Miss P xx
I arrived on the Postnatal Ward today and was greeted by staff.....Its funny when you get introduced as the student from England.....you receive mixed emotions.....a range from.....MMMmmm why is she hear...(maybe to watch over us???)....to....WOOOowww.....she from England...(and the posh voice starts to take a roll....)...either way....once again received well and teaching proceeds...Fact!!!!I'm sure I've said it before.,...these women click into a teaching roll anytime your near them....'it's great'.
So the ward comprises of 24 beds with a staff average of 2-4 qualified staff. The day starts with handover then prayer.....which I am blending right in to....I wonder why no one has asked me to pray yet???Lol...
Tasks are delegated amongst the staff by the Senior sister. The first task was the baby bath....one baby is picked...(with the permission of the mother of course...) and taken to the end of the long ward ..where there is a table with all that is needed to facilitate this 'show bath'. (It reminded me of when I used to be a Health care assistant and had to carry out show baths....many moons ago...lol).
The women sit attentively and watch the guidance on how to bath their baby...(Olive oil and water...the baby's skin and hair, comes out looking gorgeous!!!)Then another member of staff at the same table gives the talk about the postnatal ward they are on.....she covers postnatal clinic appointments after discharge, illness after discharge (if there are any problems with the women or their baby after discharge up until 6 weeks, they return to this ward ), Care of Episiotomy/Lacerations...('Sitz Bath' which should be carried out twice daily....A small basin...large enough to sit in....enough water to cover the perinium...and as warm as the woman can tolerate....and 1 teaspoon of salt to 1 pint of water.....Fact!!!!Jamaican salt is like....quadruple strength to are salt......OOOUUUCCCHHHhhhh!!!!) , Bowel care....(Women are to avoid becoming constipated!!!), Sexual intercourse...(recommended none till after 6 weeks...), Family planning, exercises, Outpatient dressing clinic, Infant feeding, Diet, Rest, Hygiene, baby immunisation, Registering baby...(All babies must be registered before the mother leaves the hospital...a woman attends the ward Mon-Sun, the cost is $300), discussion about the Child health Passport...(equivalent to our red book..) and finally the Puerperal service is offered (care in community for those women in the attachment area. All women are given a leaflet on the above talk.
Then the general care for the women is carried out. The doctors progress with their round and postnatal care is given. The ward runs smoothly with every member of staff caring out their daily duties....the relationship between the staff and patients is good and almost comical to watch as they banter with each other whilst dealing with issues that arises....Fact!!!All women are referred to as 'Mommy or Mom'.
Thoroughly enjoyed my time there.
Blog later
Miss P xx
Sunday 28 August 2011
Labour Ward in UHWI!!!!
Good Morning Bloggers
I've been struggling to stay awake to blog for the past few days....Hence the scarcity of the update.....I feel that the heat seems to absorb the energy.....as a result I have been drinking plenty of sugary drinks....I wonder if that is the reason the sugar intake on this island is so high???
Turned up Labour ward where I was greeted and took part in Handover.....Then prayer....Fact!!!!Just a little reminder....the whole island has a faith that surrounds the people.....They pray for the staff, the patients and the day....it is beautiful to be a part of.....it is like a family xx
Every Labouring woman has an IV administered and eventually administered a bag of fluids.....which at first I questioned in my head....then realised that....this is a tropical country....I need a bag of IV fluids attached to me and I am not in labour...lol
Once a woman is in established Labour, food and drink is not allowed, (the woman is allowed ice chips if needed) this is to avoid complications if an emergency arises i.e Emergency Caeserean section etc.
My mentor was RM/RN Williams also referred to as "Popcorn" .....She had a funny character and was very accommodating. The most noticeable fact that stands out, about all the staff in this hospital.....they all 'sing from the same hyme sheet' it's a teaching hospital and they all do exactly that.....
There is an "active labour" feel to what I observed....meaning that when a woman arrives in labour, she receives an enema (which I explained earlier....no obstruction of progress) bladder care is spot on every 3-4 hours (again no obstruction of progress) ....there was one issue that I found hard to take in.....all women laid on their back or side...... yes....I'm thinking....some delay in progress....and some women have their amniotic sac ruptured by amnio hook or Kocker forceps depending if the amnio hooks have run out.This is to eliminate any signs of meconium, I noticed this procedure was carried out quite often...but before doing so the women where checked thoroughly to ensure no blot able head/high head, no cord prolapse, no reason that would contraindicate this procedure.
The midwifes almost seemed like they were covering all aspects of the labouring woman to ensure that they would see if anything deviated from the 'norm' and in turn......put the appropriate action in place.....whether that meant contacting the appropriate Doctor/paediatrician or proceeding to an emergency procedure.
The midwives are very observant and depend mainly on their observation and experience with labour....for example......they continually observe their women...taking in to account the size of women, their shoe size, their partners size and put it together with the vaginal examination to determine whether a woman has an adequate pelvis size to deliver the child..........it's all very fascinating to watch.....one of the midwifes looked at a patent's abdomen without touching, and smiling she said 'you have a full bladder don't you ' the woman replied yes....experience as a midwife goes far!!!!
Fact!!!!Did I tell you that diluted savlon is used for everything????I used to love the smell of detol when I was young.....I wonder if it's because of my mothers culture......cleanliness is a big topic hear!!!!
Analgesia is given to the women in the form of Pethidine/Finnegan and the term used is 'sedation". All women are administered sedation at some point in their labour or postnatally after the baby is delivered to ensure the women have adequate rest.......sometimes it does result in babies being delivered 'flat'.....(poor agar's)....but a reversal of the drug is administered to baby and all is well.
There is one theatre on labour ward and one more that is accessible if needed.
Fact!!!!Did I tell you that I am known as 'Nelson' by everybody.....lol and on every ward and theatre....music is playing....I felt like dancing a lot of the time....he...he...
Another major noticeable factor.....There are plenty of ways that this particular hospital saves money.......Nearly everything is reused........Sterile gowns, Drapes,Suction tubing and CTG belts.....which are all washed...(sewn if needs be ) and sterilised.....Most of the staff buy their own scrubs and their own uniform......
One of the consultants greeted me and said....'Nelson......we do not clock watch' which made me laugh....(some of the people in J.a feel that us as the British culture...race around like mad people....I think we do sometimes lol)
Family Planning is situated next to the theatre and they carry out Laproscopys and Hysteroscopys using Pethidine and Dormincum (the diagnostic testing is carried out while the patient is awake???MMmmmm) another way of saving money.
The relationship between the labouring women and the midwife is one of complete trust......the midwifes are very supportive and encouraging to the women......and the women listen to what ever the midwife tells them.....it's like they surrender everything in the hospital and absorb everything they are being told...once again ...fascinating to observe......The culture is not reserved at all....when it comes to breastfeeding, etc...it's just excepted.....the norm....I'm sure they have less sick babies and the bonding is high!!!
Babies are bathed after delivery with olive oil and water.....and sometimes put in a little nursery while mother rests.
Take care Bloggers
Miss P
I've been struggling to stay awake to blog for the past few days....Hence the scarcity of the update.....I feel that the heat seems to absorb the energy.....as a result I have been drinking plenty of sugary drinks....I wonder if that is the reason the sugar intake on this island is so high???
Turned up Labour ward where I was greeted and took part in Handover.....Then prayer....Fact!!!!Just a little reminder....the whole island has a faith that surrounds the people.....They pray for the staff, the patients and the day....it is beautiful to be a part of.....it is like a family xx
Every Labouring woman has an IV administered and eventually administered a bag of fluids.....which at first I questioned in my head....then realised that....this is a tropical country....I need a bag of IV fluids attached to me and I am not in labour...lol
Once a woman is in established Labour, food and drink is not allowed, (the woman is allowed ice chips if needed) this is to avoid complications if an emergency arises i.e Emergency Caeserean section etc.
My mentor was RM/RN Williams also referred to as "Popcorn" .....She had a funny character and was very accommodating. The most noticeable fact that stands out, about all the staff in this hospital.....they all 'sing from the same hyme sheet' it's a teaching hospital and they all do exactly that.....
There is an "active labour" feel to what I observed....meaning that when a woman arrives in labour, she receives an enema (which I explained earlier....no obstruction of progress) bladder care is spot on every 3-4 hours (again no obstruction of progress) ....there was one issue that I found hard to take in.....all women laid on their back or side...... yes....I'm thinking....some delay in progress....and some women have their amniotic sac ruptured by amnio hook or Kocker forceps depending if the amnio hooks have run out.This is to eliminate any signs of meconium, I noticed this procedure was carried out quite often...but before doing so the women where checked thoroughly to ensure no blot able head/high head, no cord prolapse, no reason that would contraindicate this procedure.
The midwifes almost seemed like they were covering all aspects of the labouring woman to ensure that they would see if anything deviated from the 'norm' and in turn......put the appropriate action in place.....whether that meant contacting the appropriate Doctor/paediatrician or proceeding to an emergency procedure.
The midwives are very observant and depend mainly on their observation and experience with labour....for example......they continually observe their women...taking in to account the size of women, their shoe size, their partners size and put it together with the vaginal examination to determine whether a woman has an adequate pelvis size to deliver the child..........it's all very fascinating to watch.....one of the midwifes looked at a patent's abdomen without touching, and smiling she said 'you have a full bladder don't you ' the woman replied yes....experience as a midwife goes far!!!!
Fact!!!!Did I tell you that diluted savlon is used for everything????I used to love the smell of detol when I was young.....I wonder if it's because of my mothers culture......cleanliness is a big topic hear!!!!
Analgesia is given to the women in the form of Pethidine/Finnegan and the term used is 'sedation". All women are administered sedation at some point in their labour or postnatally after the baby is delivered to ensure the women have adequate rest.......sometimes it does result in babies being delivered 'flat'.....(poor agar's)....but a reversal of the drug is administered to baby and all is well.
There is one theatre on labour ward and one more that is accessible if needed.
Fact!!!!Did I tell you that I am known as 'Nelson' by everybody.....lol and on every ward and theatre....music is playing....I felt like dancing a lot of the time....he...he...
Another major noticeable factor.....There are plenty of ways that this particular hospital saves money.......Nearly everything is reused........Sterile gowns, Drapes,Suction tubing and CTG belts.....which are all washed...(sewn if needs be ) and sterilised.....Most of the staff buy their own scrubs and their own uniform......
One of the consultants greeted me and said....'Nelson......we do not clock watch' which made me laugh....(some of the people in J.a feel that us as the British culture...race around like mad people....I think we do sometimes lol)
Family Planning is situated next to the theatre and they carry out Laproscopys and Hysteroscopys using Pethidine and Dormincum (the diagnostic testing is carried out while the patient is awake???MMmmmm) another way of saving money.
The relationship between the labouring women and the midwife is one of complete trust......the midwifes are very supportive and encouraging to the women......and the women listen to what ever the midwife tells them.....it's like they surrender everything in the hospital and absorb everything they are being told...once again ...fascinating to observe......The culture is not reserved at all....when it comes to breastfeeding, etc...it's just excepted.....the norm....I'm sure they have less sick babies and the bonding is high!!!
Babies are bathed after delivery with olive oil and water.....and sometimes put in a little nursery while mother rests.
Take care Bloggers
Miss P
Wednesday 24 August 2011
Antenatal Ward!!!
Good night Bloggers
As you can see ....I am behind on my blogging.....due to unforeseen circumstances......THE HEAT!!!!! Gradually the heat seems to be draining me.....I find myself going to bed really early....and waking up tired due to the fact that in the night it is so hot that I am finding it hard to sleep......Now don't take this as me moaning.....because I'm loving the heat....but it makes me tired lol...I find myself slowly drinking more and more sugary drinks to get the sugar rush....that I desperately need to keep going.
So antenatal ward is comprised of 25 beds, and staffing is 3-4 qualified Nurse/Midwifes.Handover commenced at 7am followed by prayer for the day....which continues to make me smile. Women are accepted on this ward from 12 weeks gestation onwards. Further more the ward attends to miscarriages and inter uterine deaths. They have their own designated porter and a breastfeeding rep.
Pinards are constantly used on this ward and the women and staff relationship is close to the extent that I notice the women open up to the staff and seem very trusting towards the staff and there is a lot of humour that comes in to the care that is facilitated.
They care for women that develop problems during the antenatal period and the women that might be admitted in to hospital.
The staff were very welcoming and accommodating to me being there.
Unfortunately for me, the ward only had 6 patients....one of which was a 19 week miscarriage....and there were 7 students on shift so I did not have much to carry out. But the day in itself was productive.
Take care
Miss P xx
As you can see ....I am behind on my blogging.....due to unforeseen circumstances......THE HEAT!!!!! Gradually the heat seems to be draining me.....I find myself going to bed really early....and waking up tired due to the fact that in the night it is so hot that I am finding it hard to sleep......Now don't take this as me moaning.....because I'm loving the heat....but it makes me tired lol...I find myself slowly drinking more and more sugary drinks to get the sugar rush....that I desperately need to keep going.
So antenatal ward is comprised of 25 beds, and staffing is 3-4 qualified Nurse/Midwifes.Handover commenced at 7am followed by prayer for the day....which continues to make me smile. Women are accepted on this ward from 12 weeks gestation onwards. Further more the ward attends to miscarriages and inter uterine deaths. They have their own designated porter and a breastfeeding rep.
Pinards are constantly used on this ward and the women and staff relationship is close to the extent that I notice the women open up to the staff and seem very trusting towards the staff and there is a lot of humour that comes in to the care that is facilitated.
They care for women that develop problems during the antenatal period and the women that might be admitted in to hospital.
The staff were very welcoming and accommodating to me being there.
Unfortunately for me, the ward only had 6 patients....one of which was a 19 week miscarriage....and there were 7 students on shift so I did not have much to carry out. But the day in itself was productive.
Take care
Miss P xx
Tuesday 23 August 2011
Spanish Town Hospital!!!!!
Dear Bloggers.....Good morning.....
Apologies for the late feeds..........I have been starting work at 7am.....and finding it very hard to concentrate in the evenings due to tiredness......I feel its the heat....it seems very draining and soon as I stop to sit down.....my eyes just start to close......I'm thinking along with the fact that I am putting on weight from the good food......it would not be a good idea to stay here too long......believe me when I say .....you would not recognise me when I got back.......My food intake each morning has been a mixture of......green banana, ackee and salt fish, fried dumpling, corn beef and hard dough bread, breadfruit....should I go on????Yes it has been nice.....but....I think cereal would be a good thing for me right now!!!
So as you can see from the title.....I visited Spanish town Hospital.....which is in a different Parish....MMMmmmmm. My lovely mentor met me at reception, I passed through the gates.....which may I add, was guarded by security....Fact!!!!May I remind you about the dress code in the Antenatal clinic.....It applys here too...He...he......No sleeveless tops....No short skirts or "Bottom riders" (there is another term....but though inappropriate!)....Only down side is.....IT IS SOOOOO HOT!!!!!
I was taken to the supervisors.......It's amazing how you can feel like a child when you are out of familiar territory...........I was greeted by one member of staff and looked at by another.....(I figure that having a person from a new country can almost make a person change the way they would normally do things????for example.....one of the supervisors seemed sooooo...let me put this tactfully....extra!!!with the way she was being....I think....is that really how you would be on a daily basis???It made me smile inside because it was like watching a comic sketch.....She seemed to be moaning about everything but in a comical way.....(I'm sure if she had known I was smiling inside....well lets put it this way....I don't think she would have been so accommodating...lol) A little friend, let me in to a little saying which made complete sense......"Empty barrels make the most noise".....love her xx
So getting back to this hospital....outside appeared very nice and inside seemed like it had new decor. I was orientated round by a Sis Graham who was the Clinical Supervisor for Maternity. We walked to the Antenatal ward which was comprised of 28 beds......(not much you think.....I have not finished...remember this please.....) Please bare in mind that this hospital is free......The ward has a very old look to it.....and very clinical setting...the walls are a mint green with tiled bluey grey shiny flooring......the beds are very...very old.....it felt like I had reverted back in time together with the nurses who were dressed all in white with a doiley looking nurse hat on......my question is....how comes I...who turned up in my blue trousers and black shoes...managed to get mud all up the back of my trouser legs as I went in....and every nurse who crossed paths with me had prestige white clean uniform on?????Twilight zone I think....lol.
Touching back on the topic of 28 Antenatal beds.....(single beds might I add...) I was made aware that sometimes the ward can be so full of women that they have to "double up!!!!"......yes you heard right.....one person at the top....and one at the bottom.....strangers in a single bed...AAARRRGGGHHHhhhhh.......couldn't see me doing it.....but needs must...I guess......furthermore....only two qualified staff on the ward......Girls.....no more complaints from u please about understaffed situations....lol...
Now on to the Postnatal ward......Same setting as antenatal ward......but guess how many beds????72 beds......and maybe 3 qualified staff on a good day....tut...tut....included in a room next to the ward, our version of a home from home room....(for mothers who have unfortunately had a miscarriage or stillborn child) consisting of 3 beds near each other.
Fact!!!!No birthing partners are allowed whilst a woman is in labour.....and there is no skin to skin with mother and baby????Furthermore......All women deliver laying down.....and yes I will go in to this at a later point.
The orientation continued to the Labour ward....where we had to change in to scrubs before we entered and where introductions were made.The Labour ward was again very clinical looking.....the labouring beds were close together with a shower type curtain dividing each.....but the women could see each others head if they really wanted too. The Nurses station was in the middle of the room.
The staff seemed very abrupt with the way care was administered.......previously a woman explained to me that when she was in labour at this hospital, she was making noise from the pain she was feeling from the contractions.....the midwife that was caring for her told her that I quote " me know you weren't making that noise when you were laying down and conceiving this baby....so don't make any now!!!!"....harsh words.....but the woman listened.....It seems like some of the staff are so over worked....or the kind of women they care for....has tainted their love for the job????
My mentor and I cared for a woman whilst she was in labour. The woman was very receptive to me as I talked to her and reassured her. There was a clear divide between the midwife and the patient here.....it was sad to experience.Once again could this be put down to a culture thing.....I don't think so!
Fact!!!!Diluted Savlon and Savlon....is used for almost every kind of cleaning in midwifery....i.e cleaning woman before a vaginal examination....cleaning equipment....etc.
Fact!!!!Once a woman becomes fully dilated, she is moved to the labour room.....where there is 2 beds. Once the woman delivers,her baby is put in a cot wrapped in a cover and placenta and membranes are completely delivered, the uterus is rubbed by the midwife to insure the uterus is well contacted, then the baby is taken and dressed. No skin to skin.
Good nite
Miss P xx
Apologies for the late feeds..........I have been starting work at 7am.....and finding it very hard to concentrate in the evenings due to tiredness......I feel its the heat....it seems very draining and soon as I stop to sit down.....my eyes just start to close......I'm thinking along with the fact that I am putting on weight from the good food......it would not be a good idea to stay here too long......believe me when I say .....you would not recognise me when I got back.......My food intake each morning has been a mixture of......green banana, ackee and salt fish, fried dumpling, corn beef and hard dough bread, breadfruit....should I go on????Yes it has been nice.....but....I think cereal would be a good thing for me right now!!!
So as you can see from the title.....I visited Spanish town Hospital.....which is in a different Parish....MMMmmmmm. My lovely mentor met me at reception, I passed through the gates.....which may I add, was guarded by security....Fact!!!!May I remind you about the dress code in the Antenatal clinic.....It applys here too...He...he......No sleeveless tops....No short skirts or "Bottom riders" (there is another term....but though inappropriate!)....Only down side is.....IT IS SOOOOO HOT!!!!!
I was taken to the supervisors.......It's amazing how you can feel like a child when you are out of familiar territory...........I was greeted by one member of staff and looked at by another.....(I figure that having a person from a new country can almost make a person change the way they would normally do things????for example.....one of the supervisors seemed sooooo...let me put this tactfully....extra!!!with the way she was being....I think....is that really how you would be on a daily basis???It made me smile inside because it was like watching a comic sketch.....She seemed to be moaning about everything but in a comical way.....(I'm sure if she had known I was smiling inside....well lets put it this way....I don't think she would have been so accommodating...lol) A little friend, let me in to a little saying which made complete sense......"Empty barrels make the most noise".....love her xx
So getting back to this hospital....outside appeared very nice and inside seemed like it had new decor. I was orientated round by a Sis Graham who was the Clinical Supervisor for Maternity. We walked to the Antenatal ward which was comprised of 28 beds......(not much you think.....I have not finished...remember this please.....) Please bare in mind that this hospital is free......The ward has a very old look to it.....and very clinical setting...the walls are a mint green with tiled bluey grey shiny flooring......the beds are very...very old.....it felt like I had reverted back in time together with the nurses who were dressed all in white with a doiley looking nurse hat on......my question is....how comes I...who turned up in my blue trousers and black shoes...managed to get mud all up the back of my trouser legs as I went in....and every nurse who crossed paths with me had prestige white clean uniform on?????Twilight zone I think....lol.
Touching back on the topic of 28 Antenatal beds.....(single beds might I add...) I was made aware that sometimes the ward can be so full of women that they have to "double up!!!!"......yes you heard right.....one person at the top....and one at the bottom.....strangers in a single bed...AAARRRGGGHHHhhhhh.......couldn't see me doing it.....but needs must...I guess......furthermore....only two qualified staff on the ward......Girls.....no more complaints from u please about understaffed situations....lol...
Now on to the Postnatal ward......Same setting as antenatal ward......but guess how many beds????72 beds......and maybe 3 qualified staff on a good day....tut...tut....included in a room next to the ward, our version of a home from home room....(for mothers who have unfortunately had a miscarriage or stillborn child) consisting of 3 beds near each other.
Fact!!!!No birthing partners are allowed whilst a woman is in labour.....and there is no skin to skin with mother and baby????Furthermore......All women deliver laying down.....and yes I will go in to this at a later point.
The orientation continued to the Labour ward....where we had to change in to scrubs before we entered and where introductions were made.The Labour ward was again very clinical looking.....the labouring beds were close together with a shower type curtain dividing each.....but the women could see each others head if they really wanted too. The Nurses station was in the middle of the room.
The staff seemed very abrupt with the way care was administered.......previously a woman explained to me that when she was in labour at this hospital, she was making noise from the pain she was feeling from the contractions.....the midwife that was caring for her told her that I quote " me know you weren't making that noise when you were laying down and conceiving this baby....so don't make any now!!!!"....harsh words.....but the woman listened.....It seems like some of the staff are so over worked....or the kind of women they care for....has tainted their love for the job????
My mentor and I cared for a woman whilst she was in labour. The woman was very receptive to me as I talked to her and reassured her. There was a clear divide between the midwife and the patient here.....it was sad to experience.Once again could this be put down to a culture thing.....I don't think so!
Fact!!!!Diluted Savlon and Savlon....is used for almost every kind of cleaning in midwifery....i.e cleaning woman before a vaginal examination....cleaning equipment....etc.
Fact!!!!Once a woman becomes fully dilated, she is moved to the labour room.....where there is 2 beds. Once the woman delivers,her baby is put in a cot wrapped in a cover and placenta and membranes are completely delivered, the uterus is rubbed by the midwife to insure the uterus is well contacted, then the baby is taken and dressed. No skin to skin.
Good nite
Miss P xx
Sunday 21 August 2011
Mothers with HIV!!!!!!!
Good nite Bloggers.....
Apologies for the loss of contact....Spent a day in a different hospital on the Friday 19th, so I stayed in Point Hill on the Thursday nite.....where there is no Internet of coarse....and have only just reached back.( I will fill you in on Friday's experience soon xx)
So the Sister in charge is HIV Specialist Jacynth Moore who once again to no surprise is a Midwife/Nurse. The service is called CHARES which stands for: Centre HIV AIDS RESEARCH EDUCATION SERVICE. Women and children travel across the island so they are not recognised by their community to be attending a HIV Clinic.Fact!!! They could travel up to 5 hours or more.There is still a stigma around the HIV virus amongst different community's. The Clinic caters for 0-24 year old and pregnant women. At the age of 21-22 years, the individual starts to get prepared by a counsellor for them to "go it alone" as they would term it. Fact!!!! Remember that there are individuals who have been attached to this clinic from birth and guided through the process of life...and safe practice of sexual intercourse, furthermore the clinic guides and sometimes facilitates the process of explaining to a child at the age of 8 onwards about the disease they have.....for example: Children who have the virus from birth, do not know that they have a disease, they just know that they visit a clinic often and it's a part of their life. Parents sometimes find it difficult to explain to their child, that they have the disease which they contracted from their parents, and some parents find it very difficult and struggle with letting their children know, and procrastinate for years......The counsellors feel that children cope better at a younger age learning they have HIV. The Staff are very sensitive to each individual and each case is dealt with in it's personal way.
The women who are diagnosed with an AIDS defining illness, TB, Hepatitis B or HIV Associated Nephropathy (HIVAN) are started on a treatment which is known by the name of HAART, which stands for Highly Active Anti Retroviral Therapy.
There are 3 types of therapy that are available....First line therapy, second line therapy and Salvage therapy (which I will comment on later...)
The medication prescribed is a combination of 3 drugs, which comprise of either Tenofovir and Emtricitabine or Zidovudine and Lamivudine (which are both Nucleoside Reverse Transcriptase Inhibitors, (NRTI), and then Efavirenz or Nevirapine ( which are both Non-Nucleoside Reverse Transcriptase Inhibitors, (NNRTI). This is the preferred option for patients (pregnant women ).
Follow up treatment is: a CD4 count at 3 months and 6 months, then once every 6 months. A Viral Load at 6months after commencing on the HAART and then at 12 month intervals.
Fact!!!!!.......CD4 tests measure the number of CD4 T-cells in the blood to gauge the strength of the immune system in the presence of HIV infection. It is also used to monitor the overall condition of the patient’s immune system. The test has two main limitations with regard to HIV management. First, there are many factors, other than HIV activity, that can affect the amount of CD4 T-cells present in the blood at any given time. So the doctor cannot be sure if the CD4 value is caused by HIV activity or other factors. Second, it can take up to 6 months for HIV activity to be reflected in the CD4 count. (Deep Breath....Exhale.....)
Fact!!!!The viral load test measures the number of virus particles in the blood directly. A low viral load indicates that HIV is not actively reproducing and that the immediate risk of disease progression is low. A high viral load means the virus is active and the infection will progress. The viral load test is a more reliable indicator of viral activity than the CD4 test and, as such, a more reliable indicator of disease progression. It is the most useful tool in determining whether or not antiretroviral drugs are working since treatment failure is first manifested by a rise in viral load. In virtually all cases, this rise in viral load occurs within a month or two of the cause of treatment failure. (You learn something new every day.....well I am!!!!)
Failure can only be assessed in patients who are over 95% adherent to the therapy....(for that reason patients are routinely quizzed about how they are taking their medication, when they take it, how they take it, if they are having any complications, what they are eating, how their diet is, how their well-being is....) taking all of the above in to account, if they still have:
The 3 x medication is Zidovudine and Lamivudine or Tenofovir and Emtricitabine (which again are both Nucleoside Reverse Transcriptase Inhibitors (NRTI), and Lopinavir and Ritonavir or Atazanavir and Ritonavir ( which are Protease Inhibitors (PI).
If the patients treatment fails the second regime....then the SALVAGE THERAPY begins.......I was advised that the reason for the name "salvage" is because that's exactly what is meant by the treatment.....and that by the time the patient is on this type of vigorous therapy......the probability does not look good....: (.....
Fact!!!!!Did you know that a PCR-(Polymerase Chain Reaction) can be detected as early as 4 weeks in a infant. This is carried out by a collection of Dried Blood Spots (DBS) It is carried out like our Guthrie's!!!!(Heel prick and 5 blood spots).
Last but least!!!!.l.......HIV is a reportable disease in Jamaica and the cases are sent to the Ministry Of Health and Surveillance Unit.
A lot to take in ....I KNOW......
Good nite Bloggers xx
Miss P
Apologies for the loss of contact....Spent a day in a different hospital on the Friday 19th, so I stayed in Point Hill on the Thursday nite.....where there is no Internet of coarse....and have only just reached back.( I will fill you in on Friday's experience soon xx)
So the Sister in charge is HIV Specialist Jacynth Moore who once again to no surprise is a Midwife/Nurse. The service is called CHARES which stands for: Centre HIV AIDS RESEARCH EDUCATION SERVICE. Women and children travel across the island so they are not recognised by their community to be attending a HIV Clinic.Fact!!! They could travel up to 5 hours or more.There is still a stigma around the HIV virus amongst different community's. The Clinic caters for 0-24 year old and pregnant women. At the age of 21-22 years, the individual starts to get prepared by a counsellor for them to "go it alone" as they would term it. Fact!!!! Remember that there are individuals who have been attached to this clinic from birth and guided through the process of life...and safe practice of sexual intercourse, furthermore the clinic guides and sometimes facilitates the process of explaining to a child at the age of 8 onwards about the disease they have.....for example: Children who have the virus from birth, do not know that they have a disease, they just know that they visit a clinic often and it's a part of their life. Parents sometimes find it difficult to explain to their child, that they have the disease which they contracted from their parents, and some parents find it very difficult and struggle with letting their children know, and procrastinate for years......The counsellors feel that children cope better at a younger age learning they have HIV. The Staff are very sensitive to each individual and each case is dealt with in it's personal way.
The women who are diagnosed with an AIDS defining illness, TB, Hepatitis B or HIV Associated Nephropathy (HIVAN) are started on a treatment which is known by the name of HAART, which stands for Highly Active Anti Retroviral Therapy.
There are 3 types of therapy that are available....First line therapy, second line therapy and Salvage therapy (which I will comment on later...)
The medication prescribed is a combination of 3 drugs, which comprise of either Tenofovir and Emtricitabine or Zidovudine and Lamivudine (which are both Nucleoside Reverse Transcriptase Inhibitors, (NRTI), and then Efavirenz or Nevirapine ( which are both Non-Nucleoside Reverse Transcriptase Inhibitors, (NNRTI). This is the preferred option for patients (pregnant women ).
Follow up treatment is: a CD4 count at 3 months and 6 months, then once every 6 months. A Viral Load at 6months after commencing on the HAART and then at 12 month intervals.
Fact!!!!!.......CD4 tests measure the number of CD4 T-cells in the blood to gauge the strength of the immune system in the presence of HIV infection. It is also used to monitor the overall condition of the patient’s immune system. The test has two main limitations with regard to HIV management. First, there are many factors, other than HIV activity, that can affect the amount of CD4 T-cells present in the blood at any given time. So the doctor cannot be sure if the CD4 value is caused by HIV activity or other factors. Second, it can take up to 6 months for HIV activity to be reflected in the CD4 count. (Deep Breath....Exhale.....)
Fact!!!!The viral load test measures the number of virus particles in the blood directly. A low viral load indicates that HIV is not actively reproducing and that the immediate risk of disease progression is low. A high viral load means the virus is active and the infection will progress. The viral load test is a more reliable indicator of viral activity than the CD4 test and, as such, a more reliable indicator of disease progression. It is the most useful tool in determining whether or not antiretroviral drugs are working since treatment failure is first manifested by a rise in viral load. In virtually all cases, this rise in viral load occurs within a month or two of the cause of treatment failure. (You learn something new every day.....well I am!!!!)
Failure can only be assessed in patients who are over 95% adherent to the therapy....(for that reason patients are routinely quizzed about how they are taking their medication, when they take it, how they take it, if they are having any complications, what they are eating, how their diet is, how their well-being is....) taking all of the above in to account, if they still have:
- A confirmed viral load greater than 400 copies/ml in a patient on HAART for more than 6 months and a previously undetectable viral load
- Falling CD4 Count of more than 30% decline in 6 months
- Clinical progression or development of new or recurrent Opportunistic Infections despite being compliant with medications for at least 6 months
The 3 x medication is Zidovudine and Lamivudine or Tenofovir and Emtricitabine (which again are both Nucleoside Reverse Transcriptase Inhibitors (NRTI), and Lopinavir and Ritonavir or Atazanavir and Ritonavir ( which are Protease Inhibitors (PI).
If the patients treatment fails the second regime....then the SALVAGE THERAPY begins.......I was advised that the reason for the name "salvage" is because that's exactly what is meant by the treatment.....and that by the time the patient is on this type of vigorous therapy......the probability does not look good....: (.....
Fact!!!!!Did you know that a PCR-(Polymerase Chain Reaction) can be detected as early as 4 weeks in a infant. This is carried out by a collection of Dried Blood Spots (DBS) It is carried out like our Guthrie's!!!!(Heel prick and 5 blood spots).
Last but least!!!!.l.......HIV is a reportable disease in Jamaica and the cases are sent to the Ministry Of Health and Surveillance Unit.
A lot to take in ....I KNOW......
Good nite Bloggers xx
Miss P
Wednesday 17 August 2011
Adolescent HIV Clinic
Good nite Bloggers
Today I spent my time in Adolescent HIV clinic.......It was very interesting and very informative and stirred a lot of feelings inside me.
When a HIV diagnosed mother gives birth to a neonate, there is a care bundle that is put in place to try and prevent mother to child transmission of HIV.....Prevention of mother to child transmission of HIV (PMTCT) :- follow up care of HIV exposed infants!!
The check ups were every 3-4months for patients to check how they were coping with medication...to check their weight and viral load. There is counseling put in place for advice on sexual intercourse, relationships...the patients understanding of the disease they have and general discloser of whatever the patient feels to disclose.
When the senior Nurse addressed the adolescents...she spoke to them on a level.....and involved them in conversations and asked them the questions as well as the family member that might of arrived with them. Today was an eye opener to the realisation of diversity in health, and how much we take for granted.....
Blog later
Miss P xx
Today I spent my time in Adolescent HIV clinic.......It was very interesting and very informative and stirred a lot of feelings inside me.
When a HIV diagnosed mother gives birth to a neonate, there is a care bundle that is put in place to try and prevent mother to child transmission of HIV.....Prevention of mother to child transmission of HIV (PMTCT) :- follow up care of HIV exposed infants!!
- All HIV-exposed infants receive standard doses of Zidovudine and Nevirapine z,ov 4mg/kg (0.4ml/kg) P.O every 12 hours for 4 weeks and a single dose of 2mg/kg of Nevirapine suspension immediately at birth
- All Infants will have a blood test at 6 weeks and 3 months for PCR testing to determine HIV status.
- All infants that have a positive PCR at 3 months, are referred for a viral load test, they should also have an ELISA (HIV Antibody) test at 18months.
- HIV exposed infants with 2 negative HIV tests can be considered HIV negative....however the child will have a ELISA test at 18 months to confirm the negative status.
The check ups were every 3-4months for patients to check how they were coping with medication...to check their weight and viral load. There is counseling put in place for advice on sexual intercourse, relationships...the patients understanding of the disease they have and general discloser of whatever the patient feels to disclose.
When the senior Nurse addressed the adolescents...she spoke to them on a level.....and involved them in conversations and asked them the questions as well as the family member that might of arrived with them. Today was an eye opener to the realisation of diversity in health, and how much we take for granted.....
Blog later
Miss P xx
Classroom
Good nite Bloggers.....
Today class commenced at 8am.........starting surprisingly with singing a chorus.....(which for those who know me well.....made me smile....and for those who do not know me so well....I am a christian who loves worship....singing to God ; ).......Fact!!!The majority of J.A residents are either Christian's or have another religious belief. Then a passage of scripture was read.....by this time I feel right at home....and then prayer.....(please don't wake me up......I'm at peace....he...he...).
As I look over at the wall....I see a sign that states...."We swim or sink Together!!!!"....what a profound statement....it sums up exactly what i have personally seen with my own eyes...this culture that I am experiencing are very close in aspects.....the students are almost like family with one another and the mentors are like mothers almost???It's fascinating to watch and be a part of....and to be received in that way.
Diverting from the classroom for a second.....I recall being out in community and conversing with one of the nurses/midwifes that was sitting in the back of the car with me. I could see the fascination of the way I spoke in her face and she warmed to me straight away. We discussed what it was like in England and compared it to J.a.........20 minutes in to our discussion I found her hand on my wrist as she showed me different areas that we passed......Now.....I thought I was a friendly person until I experienced how uncomfortable I felt with this persons hand on me for an extended amount of time.......as she was talking....I could not help concentrating on the fact that her hand was still on me (Like a person holding a child's wrist to cross the road).....The nurse/midwife was not aware how uncomfortable I felt....but I was, it was as if i wanted my wrist to drop off lol.....we as British people, have a very reserved culture....me thinks......I found myself trying to retrain my mind to get past the idea of feeling uncomfortable......I realised that she was not the only person that done this.......it was a cultural thing.....over here people are very touchy feely when they get to know you.......I would like you to know....that i am fine with the whole touchy feely thing.....but it did take a little getting use to.
Getting back to the class setting......So today was student presentations in class, the topics were Anaemia, Antepartum Haemorrhage, Minor Disorders of pregnancy, Stages 1-3 of Labour, and Diabetes Mellitus in Pregnancy.
The first presentation was carried out by a Lady called Nervalin Mendez......she covered the topic Anaemia.....and boy did she cover it!!!!She decided to role play by herself.....It was amazing to watch as she acted out her role as anaemia itself......It was one of those moments where you had to be there to experience it.......her acting was comical but yet very informative at the least.....Fact!!!The Caribbean culture is very expressive with words and body language....I find myself zoning out of the verbal communication and memorised by the non-verbal communication that is used.....very fascinating.
She shared the four classifications of anaemia.....Mild anaemia Haemoglobin (Hb) level 9-11, Moderate Hb 7-9, Severe Hb 4-7 and Very severe Hb below 4. We also learnt about the causes of anaemia and the affects . Fact!!!!Anaemia causes a deviation in normal respiration, it reduces the number of red blood cells and it reduces the oxygen- carrying capacity of the blood. In order to overcome this hypoxia the respiration rate increases to supply the body with extra oxygen.MMMMmmm no wonder why women get out of breath when they are anaemic.....
There were other topics discussed by various different student, in various different presentation, we covered Antepartum Haemorrhage, Minor disorders of pregnancy, stages 1-3 of Labour and Diabetes mellitus in pregnancy. The presentations were very thorough and the mentor was there to correct or ask more questions where needed. It was a very informative class discussion. When discussing each condition,,,,,it was broken down into the most simplest form....and then put together so methodically that even if you did not understand what the discussion was about....it would be revealed to you by the end of each discussion.....everybody took part.Furthermore the students were interested in how we as a British culture delivered health care in comparison.
It is funny...reflecting on how when I was first introduced to all the students, they were very reserved....almost skeptical of me......and I'm most positive I was of them........but today was different.....they accepted me fully into their class...even made jokes....which meant so much. Now it could be that....I have let my guard down and in response they have let their guard down....but either way.....it's refreshing in every aspect.....Fact!!!!Acceptance plays a significant role in life.......I feel no matter who you are.....it is needed in order to have that sense of well-being... ; )
Blog later
Miss P xxx
Today class commenced at 8am.........starting surprisingly with singing a chorus.....(which for those who know me well.....made me smile....and for those who do not know me so well....I am a christian who loves worship....singing to God ; ).......Fact!!!The majority of J.A residents are either Christian's or have another religious belief. Then a passage of scripture was read.....by this time I feel right at home....and then prayer.....(please don't wake me up......I'm at peace....he...he...).
As I look over at the wall....I see a sign that states...."We swim or sink Together!!!!"....what a profound statement....it sums up exactly what i have personally seen with my own eyes...this culture that I am experiencing are very close in aspects.....the students are almost like family with one another and the mentors are like mothers almost???It's fascinating to watch and be a part of....and to be received in that way.
Diverting from the classroom for a second.....I recall being out in community and conversing with one of the nurses/midwifes that was sitting in the back of the car with me. I could see the fascination of the way I spoke in her face and she warmed to me straight away. We discussed what it was like in England and compared it to J.a.........20 minutes in to our discussion I found her hand on my wrist as she showed me different areas that we passed......Now.....I thought I was a friendly person until I experienced how uncomfortable I felt with this persons hand on me for an extended amount of time.......as she was talking....I could not help concentrating on the fact that her hand was still on me (Like a person holding a child's wrist to cross the road).....The nurse/midwife was not aware how uncomfortable I felt....but I was, it was as if i wanted my wrist to drop off lol.....we as British people, have a very reserved culture....me thinks......I found myself trying to retrain my mind to get past the idea of feeling uncomfortable......I realised that she was not the only person that done this.......it was a cultural thing.....over here people are very touchy feely when they get to know you.......I would like you to know....that i am fine with the whole touchy feely thing.....but it did take a little getting use to.
Getting back to the class setting......So today was student presentations in class, the topics were Anaemia, Antepartum Haemorrhage, Minor Disorders of pregnancy, Stages 1-3 of Labour, and Diabetes Mellitus in Pregnancy.
The first presentation was carried out by a Lady called Nervalin Mendez......she covered the topic Anaemia.....and boy did she cover it!!!!She decided to role play by herself.....It was amazing to watch as she acted out her role as anaemia itself......It was one of those moments where you had to be there to experience it.......her acting was comical but yet very informative at the least.....Fact!!!The Caribbean culture is very expressive with words and body language....I find myself zoning out of the verbal communication and memorised by the non-verbal communication that is used.....very fascinating.
She shared the four classifications of anaemia.....Mild anaemia Haemoglobin (Hb) level 9-11, Moderate Hb 7-9, Severe Hb 4-7 and Very severe Hb below 4. We also learnt about the causes of anaemia and the affects . Fact!!!!Anaemia causes a deviation in normal respiration, it reduces the number of red blood cells and it reduces the oxygen- carrying capacity of the blood. In order to overcome this hypoxia the respiration rate increases to supply the body with extra oxygen.MMMMmmm no wonder why women get out of breath when they are anaemic.....
There were other topics discussed by various different student, in various different presentation, we covered Antepartum Haemorrhage, Minor disorders of pregnancy, stages 1-3 of Labour and Diabetes mellitus in pregnancy. The presentations were very thorough and the mentor was there to correct or ask more questions where needed. It was a very informative class discussion. When discussing each condition,,,,,it was broken down into the most simplest form....and then put together so methodically that even if you did not understand what the discussion was about....it would be revealed to you by the end of each discussion.....everybody took part.Furthermore the students were interested in how we as a British culture delivered health care in comparison.
It is funny...reflecting on how when I was first introduced to all the students, they were very reserved....almost skeptical of me......and I'm most positive I was of them........but today was different.....they accepted me fully into their class...even made jokes....which meant so much. Now it could be that....I have let my guard down and in response they have let their guard down....but either way.....it's refreshing in every aspect.....Fact!!!!Acceptance plays a significant role in life.......I feel no matter who you are.....it is needed in order to have that sense of well-being... ; )
Blog later
Miss P xxx
Tuesday 16 August 2011
Special Care Nursey and Neonatal Intensive Care Unit!!!
Good Morning Bloggers
Today I spent the day in Special Care and Neonatal Intensive care unit. Lets start with the Philosophy of this unit....The Baby (neonate) is an individual, with individual needs, and is also a member of a family and a society....Let me ask a question.....Do you feel sometimes that there are certain members of staff that actually forget why they chose the profession they are in and that we are dealing with patients that could be our Mother, Sister ect???we need a philosophy statement to remind us sometimes why we are doing our job!!!!I think....
The aim of Neonatal nursing is to provide for, and meet the needs of the baby, and to encourage, and teach the parents, until such a time as they can provide for and meet the needs of their baby (i.e take baby home ).
On admission the baby's oxygenation and circulation is assessed, Fact!!!Babies who are nursed in oxygen have regular arterial blood gases taken to assess the accuracy of the monitors and to assess baby's progress.
All babies who are on the unit are given their mothers expressed milk (EBM) All mothers are encouraged to express their milk.Fact!!!Most women in J.A breastfeed, they all are aware of the nutritional value and the benefits to baby.....I'm presuming that it's considered the only option if it is well established and the mother is able to breastfeed or express. Cheap too....lol.
All babies that are born less than 32-34 weeks gestation are given a nasogastric tube which is changed every 5 days until baby establishes breast or cup feeding. Babies greater than 32 weeks gestation may have breast or cup feeds. All babies less than 34 weeks gestation are given vitamin supplements from day 14 onwards.
All babies have their blood glucose checked for Hypoglycemia and if it reports to be less than 2mmol/1, it is repoted to the doctor. All babies have vital signs checked daily in accompaniment with skin care and hygiene. All babies are bathed once per day depending on their condition...and they are bathed in olive oil and water.Babies are all weighed every other day to reassess feeds and calculations.
The other very noticeble fact...was that this hospital used Manual CPAP....(A bottle with water and tubing attached with measurements.......it was fascinating to observe.)
Their is efficient hand washing through out the staff. The staff are aware that there is a need for care and belonging of each child, so they facilitate this by making sure an early photograph of the baby is taken and given to parents, Early visits by parents are encouraged, all parents are encouraged to touch, hold and participate in the care of their baby no matter how small the baby is. It is the nurses duty to know the family by name and involve the family with the decisions and planning of baby's care. The only babies that have minimal touch...are the ventilated babies.
All babies that are discharged from this unit are followed up at 6weeks, then 4, 8, 12, 18 and 24 months.
Question.....Have you ever worked along side a work colleague who you feel does not like you???Well I met that very said person today......(smiling inside as I share)....The ward was secured by locked doors, I pressed the buzzer and was buzzed in. I walked on the ward and was greeted by a nurse/midwife who told me to join in the handover. As I walked over to where the handing over was taking place, I noticed a nurse/midwife at the corner of my eye....so naturally....me being me...(for those who know me) I smiled......and smiled...and smiled....(hoping that my smile would crack the stern faced person who was staring straight at me)......and of coarse ...it did not...Gulp....this particular lady was not impressed with me at all....Now I feel I am a pretty good judge of character.......so I figured....give me long enough....and I will get at least a change of facial expression from this lady......(if only she new how hard I actually tried....lol)....to no avail of course. The rest of the staff were very accommodating with the exchange of smiles.
After hand over, I was greeted by my mentor for the day, who explained that she would delegate the task of orientating me around the ward to one of her nurses......And guess who the lovely nurse was.......Yes.....my lovely....sterned face friend.....who still had no expression when she was asked??? Now surely......this nurse would smile with me.....wrong again.....I was orientated round...(Very well...baring in mind) and do you think that this nurse smiled once???or even made eye contact with me...come to think of it.....but.....I knew my surroundings which was nice....Later when sharing this little bit of information with a mentor of mine....she explained that some people when working have a set agenda....and if you are not on that agenda...then you don't exist in that persons eyes.....that makes perfect sense......I might try that same tactic when I want certain individuals to vanish out of my world....Don't take offence guys...YOUR NOT ON MY AGENDA!!!!LOL
It was truly amazing to watch the staff at work.....even though the facilities they had were different to what we have and more dated apparatus were being used.....the knowledge of the staff was tremendous....and the quality of care was second to none....and the observations that were carried out were finely tuned as they do not have the machines that we rely on.......Question.......Do we rely to much on machines to do are jobs......I'm thinking yes....what do you think???
Blog later
Miss P xxx
Today I spent the day in Special Care and Neonatal Intensive care unit. Lets start with the Philosophy of this unit....The Baby (neonate) is an individual, with individual needs, and is also a member of a family and a society....Let me ask a question.....Do you feel sometimes that there are certain members of staff that actually forget why they chose the profession they are in and that we are dealing with patients that could be our Mother, Sister ect???we need a philosophy statement to remind us sometimes why we are doing our job!!!!I think....
The aim of Neonatal nursing is to provide for, and meet the needs of the baby, and to encourage, and teach the parents, until such a time as they can provide for and meet the needs of their baby (i.e take baby home ).
On admission the baby's oxygenation and circulation is assessed, Fact!!!Babies who are nursed in oxygen have regular arterial blood gases taken to assess the accuracy of the monitors and to assess baby's progress.
All babies who are on the unit are given their mothers expressed milk (EBM) All mothers are encouraged to express their milk.Fact!!!Most women in J.A breastfeed, they all are aware of the nutritional value and the benefits to baby.....I'm presuming that it's considered the only option if it is well established and the mother is able to breastfeed or express. Cheap too....lol.
All babies that are born less than 32-34 weeks gestation are given a nasogastric tube which is changed every 5 days until baby establishes breast or cup feeding. Babies greater than 32 weeks gestation may have breast or cup feeds. All babies less than 34 weeks gestation are given vitamin supplements from day 14 onwards.
All babies have their blood glucose checked for Hypoglycemia and if it reports to be less than 2mmol/1, it is repoted to the doctor. All babies have vital signs checked daily in accompaniment with skin care and hygiene. All babies are bathed once per day depending on their condition...and they are bathed in olive oil and water.Babies are all weighed every other day to reassess feeds and calculations.
The other very noticeble fact...was that this hospital used Manual CPAP....(A bottle with water and tubing attached with measurements.......it was fascinating to observe.)
Their is efficient hand washing through out the staff. The staff are aware that there is a need for care and belonging of each child, so they facilitate this by making sure an early photograph of the baby is taken and given to parents, Early visits by parents are encouraged, all parents are encouraged to touch, hold and participate in the care of their baby no matter how small the baby is. It is the nurses duty to know the family by name and involve the family with the decisions and planning of baby's care. The only babies that have minimal touch...are the ventilated babies.
All babies that are discharged from this unit are followed up at 6weeks, then 4, 8, 12, 18 and 24 months.
Question.....Have you ever worked along side a work colleague who you feel does not like you???Well I met that very said person today......(smiling inside as I share)....The ward was secured by locked doors, I pressed the buzzer and was buzzed in. I walked on the ward and was greeted by a nurse/midwife who told me to join in the handover. As I walked over to where the handing over was taking place, I noticed a nurse/midwife at the corner of my eye....so naturally....me being me...(for those who know me) I smiled......and smiled...and smiled....(hoping that my smile would crack the stern faced person who was staring straight at me)......and of coarse ...it did not...Gulp....this particular lady was not impressed with me at all....Now I feel I am a pretty good judge of character.......so I figured....give me long enough....and I will get at least a change of facial expression from this lady......(if only she new how hard I actually tried....lol)....to no avail of course. The rest of the staff were very accommodating with the exchange of smiles.
After hand over, I was greeted by my mentor for the day, who explained that she would delegate the task of orientating me around the ward to one of her nurses......And guess who the lovely nurse was.......Yes.....my lovely....sterned face friend.....who still had no expression when she was asked??? Now surely......this nurse would smile with me.....wrong again.....I was orientated round...(Very well...baring in mind) and do you think that this nurse smiled once???or even made eye contact with me...come to think of it.....but.....I knew my surroundings which was nice....Later when sharing this little bit of information with a mentor of mine....she explained that some people when working have a set agenda....and if you are not on that agenda...then you don't exist in that persons eyes.....that makes perfect sense......I might try that same tactic when I want certain individuals to vanish out of my world....Don't take offence guys...YOUR NOT ON MY AGENDA!!!!LOL
It was truly amazing to watch the staff at work.....even though the facilities they had were different to what we have and more dated apparatus were being used.....the knowledge of the staff was tremendous....and the quality of care was second to none....and the observations that were carried out were finely tuned as they do not have the machines that we rely on.......Question.......Do we rely to much on machines to do are jobs......I'm thinking yes....what do you think???
Blog later
Miss P xxx
Monday 15 August 2011
Antenatal Clinic......
Good nite...fellow bloggers...Lol
I do apologise for not updating on Friday evening, I returned to a parish called Point hill in St Catherine's (which is in the country) were there is no Internet, But I am back in Kingston now and can make contact xx
So just to update you about Friday....I spent the day in Antenatal Clinic with a Mentor called Sis Mills who's job description is of course "nurse/midwife and public health practitioner".
So where do I start....Antenatal clinic has the same function as we know it.....to facilitate care to women antenataly and to detect any deviations from the norm and refer where appropriate.
Fact!!!!Did I mention that this particular hospital had a screening process that women went through to assess whether they were able to receive care from conception to birth of baby???Let me start with a little background on how the system works....
In Jamaica it has recently been confirmed that residents will no longer have to pay for health care.......I will go into more depth about this topic at a later date. UHWI is the one hospital that facilitates a private health care and a public health care at a cost.......In order for a pregnant woman to receive care from this hospital it will cost her $24,500 (That is providing she has a normal delivery with no complications....) She would have to pay an extra $60,000 if she had to have a caeserean section....
The breakdown of costs are as follows: Clinic visits $10,000, Normal Delivery $10,000, Lab Fees $3000, HIV, VDRL screening $1000.....furthermore if a woman is Reh - then she would require an Anti D injection (Rhogan) which would cost $24,000....and for the women with financial constraints.....MMMmmmm. I posed the question "what if a woman arrives in Labour and has no means of payment???" I was advised that woman do arrive in labour and they are delivered at this hospital with no antenatal care throughout pregnancy.......there are ways and means of getting round the system and some women know this.
The clinic is divided in to 4 "firms" as it would be termed in J.A. Firm A is on a Tuesday where normal pregnant woman are provided with health care. Firm B, which is held on a Thursday will provide health care to women who have had multiple miscarriages, diabetic women, teenagers, women who are over 35years old, woman who have a parity of 4+ and woman who have High BP. Firm C is on a Wednesday for the women who are in between firm A and B, so they are not completely normal in pregnancy with no complications but they are not as serious as the problems in firm B.Firm D is held on a Tuesday and the antenatal women have high risk pregnancy's because of their conditions i.e sickle cell and cardiac problems, or multiple pregnancy ect.
Women are seen at 12, 20, 28, 32, 36, 38 and 40 weeks....(more if needed)
Fact!!!!All teenage pregnancies under 16yrs old are reported to the social services were a thorough investigation is carried out, and where necessary the authorities will be involved. It is the Midwifes/Nurses duty to report each case, and if they fail to do so they will be charged $250,000.......so I have feeling that no one forgets!!!
Getting back to the subject of the screening process of being accepted under the care of UHWI, .....all the pregnant women who request health care to be given to them by UHWI go through an Interview process for acceptance. At 7 am in the morning the women (about 40-50 of them )wait patiently out side the antenatal clinic building....some accompanied with a friend, partner or by themselves. At approx 7.15 the women are let in to a room filled with chairs. A spokes person addresses the women as a whole.....explaining the procedure and process of the day and what it will entail, also covering what is required of each individual who is accepted for care for example the dress code.....No shorts, No mini skirts, No hair in rollers, No cleavage, and to dress modestly...and no revealing of the bump with half tops......Now I would like us to adopt the dress code....He...He...imagines telling our woman that they had to dress a certain way before attending clinic????Do you think we would have any women left????NOPE!!!No one questioned this and they were happy to go along with what was said. Woman were also advised if accepted to bring hand towels to each appointment and soap would be provided.....I am loving the money saving techniques.....I feel we should try some of them!!
The women are then given sheets to fill out requesting data about previous pregnancy....Gynae and obstetric history...where they last delivered, where they live ect. All the papers are collected and the information is given to the senior Sister in charge, and it is her job to read through each persons individual status and decide whether to accept or decline the individual. Women get declined for a numerous amount of reasons...one being if they are not between 8-16 weeks (i.e their gestation is greater than 16 weeks), or they live outside the attachment area, or they delivered at a different hospital previously.
Fact!!!!Did you know that abortions are illegal in J.A?????(They are only meant to be carried out for medical reasons....although women have been known to pay doctors illegally to carry out abortions by themselves!!!)
Once the documentation is collected and the screening process has been carried out, the women are then addressed again as one....It is explained to them what they must expect, and why certain screening needs to be carried out....i.e...screening for sexually transmitted diseases...a discussion is held where women can ask questions and questions are asked to the women....it reminded me of our antenatal classes...very informative to the women...Then the women are asked to Que and pay their fees (whilst each woman pays their fee they are taken into a side bay and booking commences........(the same way we book our ladies with a full extensive history taken.) Only difference is the women are palpated and a pap smear is carried out.....(Our version of a swab...)
Fact!!!!Metal Speculum's are still used, the Midwife is expected at the end of each clinic to wash them and autoclave them...accompanied with the instruments that are used......Can you imagine midwifes.....having to wash our instrument's after use and then having to put them through the autoclave????Nope...neither can I......I keep telling you ...these Midwifes are multi-talented!!!!
Good night Bloggers
Miss P
I do apologise for not updating on Friday evening, I returned to a parish called Point hill in St Catherine's (which is in the country) were there is no Internet, But I am back in Kingston now and can make contact xx
So just to update you about Friday....I spent the day in Antenatal Clinic with a Mentor called Sis Mills who's job description is of course "nurse/midwife and public health practitioner".
So where do I start....Antenatal clinic has the same function as we know it.....to facilitate care to women antenataly and to detect any deviations from the norm and refer where appropriate.
Fact!!!!Did I mention that this particular hospital had a screening process that women went through to assess whether they were able to receive care from conception to birth of baby???Let me start with a little background on how the system works....
In Jamaica it has recently been confirmed that residents will no longer have to pay for health care.......I will go into more depth about this topic at a later date. UHWI is the one hospital that facilitates a private health care and a public health care at a cost.......In order for a pregnant woman to receive care from this hospital it will cost her $24,500 (That is providing she has a normal delivery with no complications....) She would have to pay an extra $60,000 if she had to have a caeserean section....
The breakdown of costs are as follows: Clinic visits $10,000, Normal Delivery $10,000, Lab Fees $3000, HIV, VDRL screening $1000.....furthermore if a woman is Reh - then she would require an Anti D injection (Rhogan) which would cost $24,000....and for the women with financial constraints.....MMMmmmm. I posed the question "what if a woman arrives in Labour and has no means of payment???" I was advised that woman do arrive in labour and they are delivered at this hospital with no antenatal care throughout pregnancy.......there are ways and means of getting round the system and some women know this.
The clinic is divided in to 4 "firms" as it would be termed in J.A. Firm A is on a Tuesday where normal pregnant woman are provided with health care. Firm B, which is held on a Thursday will provide health care to women who have had multiple miscarriages, diabetic women, teenagers, women who are over 35years old, woman who have a parity of 4+ and woman who have High BP. Firm C is on a Wednesday for the women who are in between firm A and B, so they are not completely normal in pregnancy with no complications but they are not as serious as the problems in firm B.Firm D is held on a Tuesday and the antenatal women have high risk pregnancy's because of their conditions i.e sickle cell and cardiac problems, or multiple pregnancy ect.
Women are seen at 12, 20, 28, 32, 36, 38 and 40 weeks....(more if needed)
Fact!!!!All teenage pregnancies under 16yrs old are reported to the social services were a thorough investigation is carried out, and where necessary the authorities will be involved. It is the Midwifes/Nurses duty to report each case, and if they fail to do so they will be charged $250,000.......so I have feeling that no one forgets!!!
Getting back to the subject of the screening process of being accepted under the care of UHWI, .....all the pregnant women who request health care to be given to them by UHWI go through an Interview process for acceptance. At 7 am in the morning the women (about 40-50 of them )wait patiently out side the antenatal clinic building....some accompanied with a friend, partner or by themselves. At approx 7.15 the women are let in to a room filled with chairs. A spokes person addresses the women as a whole.....explaining the procedure and process of the day and what it will entail, also covering what is required of each individual who is accepted for care for example the dress code.....No shorts, No mini skirts, No hair in rollers, No cleavage, and to dress modestly...and no revealing of the bump with half tops......Now I would like us to adopt the dress code....He...He...imagines telling our woman that they had to dress a certain way before attending clinic????Do you think we would have any women left????NOPE!!!No one questioned this and they were happy to go along with what was said. Woman were also advised if accepted to bring hand towels to each appointment and soap would be provided.....I am loving the money saving techniques.....I feel we should try some of them!!
The women are then given sheets to fill out requesting data about previous pregnancy....Gynae and obstetric history...where they last delivered, where they live ect. All the papers are collected and the information is given to the senior Sister in charge, and it is her job to read through each persons individual status and decide whether to accept or decline the individual. Women get declined for a numerous amount of reasons...one being if they are not between 8-16 weeks (i.e their gestation is greater than 16 weeks), or they live outside the attachment area, or they delivered at a different hospital previously.
Fact!!!!Did you know that abortions are illegal in J.A?????(They are only meant to be carried out for medical reasons....although women have been known to pay doctors illegally to carry out abortions by themselves!!!)
Once the documentation is collected and the screening process has been carried out, the women are then addressed again as one....It is explained to them what they must expect, and why certain screening needs to be carried out....i.e...screening for sexually transmitted diseases...a discussion is held where women can ask questions and questions are asked to the women....it reminded me of our antenatal classes...very informative to the women...Then the women are asked to Que and pay their fees (whilst each woman pays their fee they are taken into a side bay and booking commences........(the same way we book our ladies with a full extensive history taken.) Only difference is the women are palpated and a pap smear is carried out.....(Our version of a swab...)
Fact!!!!Metal Speculum's are still used, the Midwife is expected at the end of each clinic to wash them and autoclave them...accompanied with the instruments that are used......Can you imagine midwifes.....having to wash our instrument's after use and then having to put them through the autoclave????Nope...neither can I......I keep telling you ...these Midwifes are multi-talented!!!!
Good night Bloggers
Miss P
Thursday 11 August 2011
Domicilary/Puerperal Service...(Community !!!!)
Goodnite....(Good afternoon....)
If you are not aware already.....I am slowly integrating the terms that are used in Jamaica....."Good nite " is a term that is used instead of our 'Good evening"...I actually prefer it...lol...
Focusing back to my day in community....I shall start from the background....
Puerperal....The period from child birth to 6-8 weeks to complete involution of the uterus and healing of pelvic structure (as quoted in the hand book that was handed to me at 7am )
Aim of Puerperal Service (PS)....to prevent maternal and infant morbidity and mortality . To promote breastfeeding and healthy living for the mother and her family.
Admission to P S......Once the woman and baby have been discharged from the postnatal ward, they are given an option to take up the PS (which is free of charge).
Visits are made on the 2nd, 3rd, 5th and 7th day and then weekly for up to 6 weeks (8 if there is a problem).
Visits...At each visit the woman is assessed for coping mechanism in the home environment, furthermore...breasts, fundus, perineum, Lochia, Blood pressure, Temperature, pulse and respiration's on mother are checked.
The women are advised prior to visit to have the area cleaned for visit, to have a newspaper to hand or the back of a calender (every house hold has an A5 cardboard calender in their house?????), cotton wool and cotton buds, and to have either liquid hand wash or a bar of soap that is not opened ready for the midwife's visit. Fact!!! Midwifes visit in twos and are chauffeur driven to each destination(this promotes safety..).
Each Baby has a head to toe assessment, documenting their nutritional status, weight, skin colour, turgor(dehydration pinch), Integrity(if skin is broken) and umbilicus(once the cord and clamp have dropped off, the umbilicus is thoroughly cleaned daily with a cotton bud dipped in 70% white alcohol.....OUCH!!!
The baby's immunisation is also checked and referred to child health clinic.Fact!!!!Breastfeeding is the norm in this country.....every woman engages in it ....and it facilitated anywhere...and every where ; )
Talks are also given to reinforce self care, nutrition,rest,home breastfeeding using various positions and how to express and store expressed milk....family education r.e: medication,vitamins and minerals (up until recently the mothers were told to sun in the baby,,,,where the baby was left in the sun for 20minutes, but an incident happened where a child was left too long....and.....I won't go down that road with you...but the hospital got sued!!)
My mentor for the day was Sis Bonnick, who was happy to share that she had qualified in England as a nurse and went on to qualify as a Midwife...surprise surprise. She explained to me that Midwifery was an acquired skill that had to be learnt over years of experience......she later confirmed her experience and skill!!!
Between 7 and 9 the PS was opened for hospital visits (there is an area that is circled on the Jamaica map....in comparison to our London waiting area..), and women who are outside the area have to come in to the hospital for their SP visit as some of the areas are to risky and difficult to get to via car.
The woman that attend all seem to know the procedure of what to do when they arrive....they enter the room, put their baby in to an empty cot that is on a table , then walk behind a divider curtain and take their bottom clothing off to be examined...they are also quizzed about the care they have been given to their baby and how they are feeding, what they are washing their baby with and how many nappies are changed a day, it is quite amusing to watch the banter between the midwife and the patient. The mother then takes both breasts out so they can be examined by the midwife, and then she has to prove that she can breastfeed and express....It is comical to watch!!!
Then the home visits commence.I'm sure you were wondering what the newspaper/calender was needed for....well....it is used to put the equipment on whilst in the house. Whilst in the house you are not allowed to sit down or except drinks...(reduce cross infection???) furthermore baby's could be in anything from a cot to a box'container' made up like a little bed. Every woman who has had perennial stitches have to have an inspection to eliminate infection ect, and every woman has a thorough breast check to eliminate unusual lumps.
I am really tired and the heat is making me drowsy...so...goodnight and share soon.
Miss p xx
If you are not aware already.....I am slowly integrating the terms that are used in Jamaica....."Good nite " is a term that is used instead of our 'Good evening"...I actually prefer it...lol...
Focusing back to my day in community....I shall start from the background....
Puerperal....The period from child birth to 6-8 weeks to complete involution of the uterus and healing of pelvic structure (as quoted in the hand book that was handed to me at 7am )
Aim of Puerperal Service (PS)....to prevent maternal and infant morbidity and mortality . To promote breastfeeding and healthy living for the mother and her family.
Admission to P S......Once the woman and baby have been discharged from the postnatal ward, they are given an option to take up the PS (which is free of charge).
Visits are made on the 2nd, 3rd, 5th and 7th day and then weekly for up to 6 weeks (8 if there is a problem).
Visits...At each visit the woman is assessed for coping mechanism in the home environment, furthermore...breasts, fundus, perineum, Lochia, Blood pressure, Temperature, pulse and respiration's on mother are checked.
The women are advised prior to visit to have the area cleaned for visit, to have a newspaper to hand or the back of a calender (every house hold has an A5 cardboard calender in their house?????), cotton wool and cotton buds, and to have either liquid hand wash or a bar of soap that is not opened ready for the midwife's visit. Fact!!! Midwifes visit in twos and are chauffeur driven to each destination(this promotes safety..).
Each Baby has a head to toe assessment, documenting their nutritional status, weight, skin colour, turgor(dehydration pinch), Integrity(if skin is broken) and umbilicus(once the cord and clamp have dropped off, the umbilicus is thoroughly cleaned daily with a cotton bud dipped in 70% white alcohol.....OUCH!!!
The baby's immunisation is also checked and referred to child health clinic.Fact!!!!Breastfeeding is the norm in this country.....every woman engages in it ....and it facilitated anywhere...and every where ; )
Talks are also given to reinforce self care, nutrition,rest,home breastfeeding using various positions and how to express and store expressed milk....family education r.e: medication,vitamins and minerals (up until recently the mothers were told to sun in the baby,,,,where the baby was left in the sun for 20minutes, but an incident happened where a child was left too long....and.....I won't go down that road with you...but the hospital got sued!!)
My mentor for the day was Sis Bonnick, who was happy to share that she had qualified in England as a nurse and went on to qualify as a Midwife...surprise surprise. She explained to me that Midwifery was an acquired skill that had to be learnt over years of experience......she later confirmed her experience and skill!!!
Between 7 and 9 the PS was opened for hospital visits (there is an area that is circled on the Jamaica map....in comparison to our London waiting area..), and women who are outside the area have to come in to the hospital for their SP visit as some of the areas are to risky and difficult to get to via car.
The woman that attend all seem to know the procedure of what to do when they arrive....they enter the room, put their baby in to an empty cot that is on a table , then walk behind a divider curtain and take their bottom clothing off to be examined...they are also quizzed about the care they have been given to their baby and how they are feeding, what they are washing their baby with and how many nappies are changed a day, it is quite amusing to watch the banter between the midwife and the patient. The mother then takes both breasts out so they can be examined by the midwife, and then she has to prove that she can breastfeed and express....It is comical to watch!!!
Then the home visits commence.I'm sure you were wondering what the newspaper/calender was needed for....well....it is used to put the equipment on whilst in the house. Whilst in the house you are not allowed to sit down or except drinks...(reduce cross infection???) furthermore baby's could be in anything from a cot to a box'container' made up like a little bed. Every woman who has had perennial stitches have to have an inspection to eliminate infection ect, and every woman has a thorough breast check to eliminate unusual lumps.
I am really tired and the heat is making me drowsy...so...goodnight and share soon.
Miss p xx
Child Health Clinic....."USH"
Morning Readers…..
What an Interesting day I experienced today……Started work at 8am…..and I was in the “Child Health Clinic” known also as the Infant Welfare Clinic.
I was greeted by a Sis Farr…(did I mention that all the senior nurses were to be addressed as sis and their second name…..and nurse’s were to be addressed by nurse and their second name???) Well I apologise if I did not inform you….but it is so.
I will continue…..Sis Farr was my Mentor and her qualifications are ….Midwife, Nurse and Public health Nurse(Health visitor)..MMmmmm, why so many qualifications…you wonder???Well…in Jamiaca……All midwives have to be nurses first, and the midwives roll is to look after the newborn baby from 0-17 years…. ‘cough…cough’…that’s right I said it….and there are no health visitors….just Midwifes….they are every where……Lol and they are multi talented…he…he….
So…where was I….Oh yes, Ms Farr….she introduced me to the rest of the team in the clinic which comprised of, 2 public health Nurses (who were of coarse midwives), A midwife, a community health aid (Health care assistant) and a patient care assistant.
In the clinic from day to day they cover immunizations (for children and adults??), general health and welfare of children and postnatal mothers and sexual health…..(cough…cough..) yes you heard right.
I notice the Jamaican culture is a very joyful and happy one were you get enough jokes through the day…even at the sad times. FACT!!!!A woman shared with me that she had a still born child at term due to gestational diabetes…..her Doctor advised her that there was no time to grieve…there were eggs waiting to be fertilized…and she must try again… “now..now..now..” she explained that she conceived immediately and received intensive follow up care and gave birth to a beautiful boy….and not one mention of the grieving for her lost child…...culture is a major part of how we react…Mmmmm
In the morning we immunized 5 children….it was fascinating to watch the interaction between the Nurse and the patients……at times there was laughter and at other times there was seriousness…..the nurse referred to each mother as “Mommy”….and each boy child as “Boss” and each Baby as “Dumplin”…….But when an injection was being administered, the nurse was very stern with the child by saying “ Do not move and do not contaminate my area”…..not even I moved!!! and each mother sympathised with their child by squeezing them tight and responding "Me afi bare de pain too" meaning...I'm feeling the pain with you....The other noticeable action …was the amount of respect the women had for the Nurses….attentive listening and gracious answering…”yes mam” to every piece of advice that was given…..Another word that was referred to often from both mother and Nurse was…..(USH….)….the word was used so much that even I was using it….It came after any type of pain or mishap deliberate or not……example….baby has injection administered… “ush!!”….baby cries… “ush”….i get bitten by a mosquito… “ush”…..you be surprised how many times the word is used lol.
Fact!!!Most woman do not shave their legs……MMMMmmmm weird for me but normal for them….cultural!!!!Difference….It would save me a whole lot of bother....but could I refrain????
So.....back to the day, every child from the age of 0 to 17 is issued with a Child Health Passport (equivalent to our red book) it is referred to as a "docket", and each child has a right to be immunised under the 'child care and protection Act"...in other words...(every child has to be immunised!!!)If the mother refuses to take the responsibility to get the child immunised...then she will receive a fine from the Ministry of health....women take immunisation very seriously....
Fact!!!Record keeping is all paper work...the only information that is kept on computer is where a person is registered....for example...which health centre they attend (that's it!!) Every thing else is paper work...reports ect......imagine not having to put birth notifications through computer...MMmmmmm
So the immunisation schedule child for each baby is....birth - 6weeks...BCG, OPV/IPV(Polio), Hep B and Hib......at 3 months ...OPV(Polio),and DPT(Diphtheria,Pertussis,Tetanus), Hep B and Hib......6 months...OPV(Polio), DPT, Hep B and Hib.....12 months...MMR.....18 months OPV and DPT and DT(p)boosters......4-6 years...OPV,MMR and DPT and DT(p) booster........IN ORDER FOR A CHILD TO ENTER PRIMARY SCHOOL.....ALL THE ABOVE VACCINES ARE NECESSARY!!!!
Fact!!!There is a particular vaccine called the PENTAVALENT (Easy Five)....which is one vaccine that immunises against 5 diseases......Diphtheria,Tetanus (Lock-jaw), Pertussis(Whooping Cough), Hepatitis B,Hib (Haemophilis influenza (Type B)).........Wow!!!
The mothers are also given advise on the child's diet and all are advised of the importance of porridge and eating it right the way through to adulthood!!!!!Believe me when I advise the porridge is lush!!! Furthermore the mothers are advised to be careful of letting the baby use the bottle whilst asleep or just to suck for comfort....Fact!!!The sugar in take is high in Jamaica...and baby's have sugary drinks in a bottle.....some children develop baby bottle syndrome(where the baby's teeth start to decay from leaving the baby sucking the bottle for long periods of time whilst asleep or for comfort)..... all mothers are also asked "does the child eat from the family pot??" meaning does the child eat home cooked food.....this will determine whether the child's diet is good...MMmmmm
Anyway......tomorrow is dominicary/Puerperal Service (community/home visits)....lol
Blog later xxxxx
Tuesday 9 August 2011
Pharmacology!!!!(DRUGS!!!!!)
Good afternoon Friends.....
As you can see the topic of today is Pharmacology......yes if you've guessed it all about pharmaceuticals.
I attended a class today based solely on this topic. The students were very warming to me, although they made me stand up and introduce myself...then proceeded to bombard me with questions (and telling me I spoke to fast, so I REPEATED MYSELF A LOT...LEARNING MY COMMUNICATION SKILLS...ALL OVER AGAIN...; )...)
As I sat down and the class proceeded in a room that was like one of those rooms that you would see in an old movie that was almost empty looking but actually was not...with glass slabs as window and chairs that were attached to little wooden side tables, and an old black board and white chalk.....(I found my self day dreaming as I looked around and absorbed the heat) Then reality slapped me across my face when the question "What do you think" was fired at me... MMmmm....What do I think of what I thought....and the class laughed at my expense....for some reason it did not feel unusual....
I was given a sheet with different pharmaceuticals which were under different sub-headings.....Analgesia & Narcotics, Antibiotic's, Anaesthetics and supporting agents, Antidotes, Anticoagulants, and Anticonvulsant, Anti platelets, Hypoglycemic Agents,Diuretic,Immune Globulin, Anti emetics, Malarial Agent, Anti fungal, Prostaglandins, Antihaemorrhagic Agent, Oxytocic Agent, Anti hypertensive, Supplements, Anti retro viral , Hormones, Nervous System, Tocolytic Agents, Cardiovascular agents, Gastrointestinal agent, Tocolytic Agents, Steroids ,Gonadotropin Releasing Hormone analog and Psychotropic Agents...These girls really know their stuff!!!!!
They told me the classification, the Availability, the action, the therapeutic effects, the uses, contraindication's, route, dosage, adverse effects, interactions, pharmacokinetics, obstetric significance and midwives responsibilities for each drug....and there were 98 different Pharmaceuticals in all......THESE GIRLS ARE GOOD AT THEIR KNOWLEDGE!!!! I was able to in put into some of the topics but others went way over my head.
FACT!!!Some of the medicines used on women...were only used because they were cheaper....i.e Heparin instead of clexane...MMMmmm....will expand at a later date.
Fact!!!!Just because a country choose to use there money different to another country...does that mean they are less advantaged????Nope.....Does it mean they are less knowledgeable???Nope....
Saving money tactics.....watch this space ; ).....
Tomorrow I'm in the child health clinic....7am start.....
Blog later xx
As you can see the topic of today is Pharmacology......yes if you've guessed it all about pharmaceuticals.
I attended a class today based solely on this topic. The students were very warming to me, although they made me stand up and introduce myself...then proceeded to bombard me with questions (and telling me I spoke to fast, so I REPEATED MYSELF A LOT...LEARNING MY COMMUNICATION SKILLS...ALL OVER AGAIN...; )...)
As I sat down and the class proceeded in a room that was like one of those rooms that you would see in an old movie that was almost empty looking but actually was not...with glass slabs as window and chairs that were attached to little wooden side tables, and an old black board and white chalk.....(I found my self day dreaming as I looked around and absorbed the heat) Then reality slapped me across my face when the question "What do you think" was fired at me... MMmmm....What do I think of what I thought....and the class laughed at my expense....for some reason it did not feel unusual....
I was given a sheet with different pharmaceuticals which were under different sub-headings.....Analgesia & Narcotics, Antibiotic's, Anaesthetics and supporting agents, Antidotes, Anticoagulants, and Anticonvulsant, Anti platelets, Hypoglycemic Agents,Diuretic,Immune Globulin, Anti emetics, Malarial Agent, Anti fungal, Prostaglandins, Antihaemorrhagic Agent, Oxytocic Agent, Anti hypertensive, Supplements, Anti retro viral , Hormones, Nervous System, Tocolytic Agents, Cardiovascular agents, Gastrointestinal agent, Tocolytic Agents, Steroids ,Gonadotropin Releasing Hormone analog and Psychotropic Agents...These girls really know their stuff!!!!!
They told me the classification, the Availability, the action, the therapeutic effects, the uses, contraindication's, route, dosage, adverse effects, interactions, pharmacokinetics, obstetric significance and midwives responsibilities for each drug....and there were 98 different Pharmaceuticals in all......THESE GIRLS ARE GOOD AT THEIR KNOWLEDGE!!!! I was able to in put into some of the topics but others went way over my head.
FACT!!!Some of the medicines used on women...were only used because they were cheaper....i.e Heparin instead of clexane...MMMmmm....will expand at a later date.
Fact!!!!Just because a country choose to use there money different to another country...does that mean they are less advantaged????Nope.....Does it mean they are less knowledgeable???Nope....
Saving money tactics.....watch this space ; ).....
Tomorrow I'm in the child health clinic....7am start.....
Blog later xx
Monday 8 August 2011
First day at work!!!
Dear Readers
Attended the University Hospital of the West Indies (UHWI) at 08.30 this morning. I waited at the Nursing administration office for approximately 2 hours (did I inform you that there is no rush in J.a?????) while members of staff organised themselves to organise who would be facilitating my program??? Then finally I was asked to step in to a room...(very nerve racking) to be greeted by two members of the Nursing and Midwifery Council. They went through the paper work thoroughly whilst asking me questions, then pointed out that there was a technical hitch........the letter from my University had not been signed.....consequence being they could not let me start my elective until it was signed. But not to worry as orientation would be the agenda for today (which was very interesting at the least)....
So where do I start.....
Mission statement/Vision statement me thinks...
The University Hospital of the West Indies envisions itself as a dynamic, environmentally safe, adequately equipped organization with trained and highly motivated staff dedicated to promoting teaching, research and the delivery of the highest quality health care to meet the needs of the region. (That's the Vision statement)
The (UHWI) is committed to teaching, research and the provision of quality health care for the region. In striving for excellence, we maintain an environment conducive to an efficient, cost effective and responsive health care promotion and delivery system, by incorporating the participation of all categories of staff and students, patients, their families and the wider community. (The Mission Statement)
What do you think so far???? It will become clearer as we venture on.
This particular teaching hospital facilitates nursing students on a post basic midwifery programme for 1 year, which is broken down into clear precise objectives for the students to carry out (I will return to this topic at a later date ).
A bit about the actual hospital....
UHWI facilitates 514 beds distributed within 21 wards and a private wing consisting of 30 beds. It is Type A referral, acute care hospital providing both inpatient and out patient health care services. It has different clinical specialities including HIV/AIDS Research, a Detoxification Unit and In vitro fertilisation. ( I was shown 10 labouring beds and two delivery beds in the delivery suite as we would call it......) , and was told all women deliver laying down!!!!MMMmmmmm. (Once again I will get back to this particular subject later on in our journey.
Fact!!......Did you know that in J.a.....all early labouring women get given an ENEMA????? I'm sure you would like me to explain....Now we all know what an Enema is...right??......Well the J.a enema is a cleansing procedure for the bowel...yes u got it in one!!!Now for the details.....and I will only write this once!!
A mixture of warm soapy water (with a bar of soap) inserted in to an Enema Bag (about 1000mls).....and then inserted into the woman (via a tube in to her back passage) for a thorough cleans out.MMMmmm what do you think students???plus side no mess, no obstruction...down side???please tell me lol.
Visual thoughts...The hospital has a clinical look and feel to it. The furnishings are old....and some of the procedures are dated....i.e still using metal speculum's. There is a lot more to share but I will let you take a day to soak in and gather thoughts....I plan to add photos of the buildings and equipment, but still waiting for approval.
Will blog soon...
Take care xx
Attended the University Hospital of the West Indies (UHWI) at 08.30 this morning. I waited at the Nursing administration office for approximately 2 hours (did I inform you that there is no rush in J.a?????) while members of staff organised themselves to organise who would be facilitating my program??? Then finally I was asked to step in to a room...(very nerve racking) to be greeted by two members of the Nursing and Midwifery Council. They went through the paper work thoroughly whilst asking me questions, then pointed out that there was a technical hitch........the letter from my University had not been signed.....consequence being they could not let me start my elective until it was signed. But not to worry as orientation would be the agenda for today (which was very interesting at the least)....
So where do I start.....
Mission statement/Vision statement me thinks...
The University Hospital of the West Indies envisions itself as a dynamic, environmentally safe, adequately equipped organization with trained and highly motivated staff dedicated to promoting teaching, research and the delivery of the highest quality health care to meet the needs of the region. (That's the Vision statement)
The (UHWI) is committed to teaching, research and the provision of quality health care for the region. In striving for excellence, we maintain an environment conducive to an efficient, cost effective and responsive health care promotion and delivery system, by incorporating the participation of all categories of staff and students, patients, their families and the wider community. (The Mission Statement)
What do you think so far???? It will become clearer as we venture on.
This particular teaching hospital facilitates nursing students on a post basic midwifery programme for 1 year, which is broken down into clear precise objectives for the students to carry out (I will return to this topic at a later date ).
A bit about the actual hospital....
UHWI facilitates 514 beds distributed within 21 wards and a private wing consisting of 30 beds. It is Type A referral, acute care hospital providing both inpatient and out patient health care services. It has different clinical specialities including HIV/AIDS Research, a Detoxification Unit and In vitro fertilisation. ( I was shown 10 labouring beds and two delivery beds in the delivery suite as we would call it......) , and was told all women deliver laying down!!!!MMMmmmmm. (Once again I will get back to this particular subject later on in our journey.
Fact!!......Did you know that in J.a.....all early labouring women get given an ENEMA????? I'm sure you would like me to explain....Now we all know what an Enema is...right??......Well the J.a enema is a cleansing procedure for the bowel...yes u got it in one!!!Now for the details.....and I will only write this once!!
A mixture of warm soapy water (with a bar of soap) inserted in to an Enema Bag (about 1000mls).....and then inserted into the woman (via a tube in to her back passage) for a thorough cleans out.MMMmmm what do you think students???plus side no mess, no obstruction...down side???please tell me lol.
Visual thoughts...The hospital has a clinical look and feel to it. The furnishings are old....and some of the procedures are dated....i.e still using metal speculum's. There is a lot more to share but I will let you take a day to soak in and gather thoughts....I plan to add photos of the buildings and equipment, but still waiting for approval.
Will blog soon...
Take care xx
What have I been doin??
Dear friends
I reached Jamaica an hour late on the 4th August 2011, and was greeted by thunderstorms, lightning and torrential rain....MMMmmmm, welcome to hurricane season!!!
I have been residing in St Catherine's point hill, for those of you who would like to google map and see exactly where I was. Unfortunately there was no Internet access...(people refer to this area as country!!!) ...meaning...loads of bushes...beautiful scenery....massive potholes....grasshoppers that make the most amazing noises....spiders...lizards...you name it and they have it....lol....Oh and I have been washing my clothes....(BY HAND)......furthermore....bathing outside with cold water....Definitely invigorating!!!
The community (or Parish as it is termed here) is a nice small community were everybody knows each other....and yes ...I stick out like a sore thumb....because...as they would use the term......"I'm "British".....which is hilarious as I don't have to say a word and they know....and as for my name being..."Paulette".....who's that???....I get greeted by..." Morning British"....he...he....but it's nice.
Both my parents were born in Jamaica, so fortunately I will always have a place to stay. I was staying with my Gran, who is 81years old and can carry my suitcase on her head.......I feel weak compared to her....lol....The people are very strong over here, I put it down to the fresh food...i.e...yam, banana, okra, ackee and salt fish, fresh meat, avocado pear, fresh fruits.....all of the above which I plan on tasting through out my stay...MMmmm. Furthermore they live longer over here.
I am now in Kingston, and I am preparing for my first day at work....and yes I'm nervous. I am staying with a lovely couple called Carol and Ruben.
I will keep you updated this evening with my first day.
Blog soon xx
I reached Jamaica an hour late on the 4th August 2011, and was greeted by thunderstorms, lightning and torrential rain....MMMmmmm, welcome to hurricane season!!!
I have been residing in St Catherine's point hill, for those of you who would like to google map and see exactly where I was. Unfortunately there was no Internet access...(people refer to this area as country!!!) ...meaning...loads of bushes...beautiful scenery....massive potholes....grasshoppers that make the most amazing noises....spiders...lizards...you name it and they have it....lol....Oh and I have been washing my clothes....(BY HAND)......furthermore....bathing outside with cold water....Definitely invigorating!!!
The community (or Parish as it is termed here) is a nice small community were everybody knows each other....and yes ...I stick out like a sore thumb....because...as they would use the term......"I'm "British".....which is hilarious as I don't have to say a word and they know....and as for my name being..."Paulette".....who's that???....I get greeted by..." Morning British"....he...he....but it's nice.
Both my parents were born in Jamaica, so fortunately I will always have a place to stay. I was staying with my Gran, who is 81years old and can carry my suitcase on her head.......I feel weak compared to her....lol....The people are very strong over here, I put it down to the fresh food...i.e...yam, banana, okra, ackee and salt fish, fresh meat, avocado pear, fresh fruits.....all of the above which I plan on tasting through out my stay...MMmmm. Furthermore they live longer over here.
I am now in Kingston, and I am preparing for my first day at work....and yes I'm nervous. I am staying with a lovely couple called Carol and Ruben.
I will keep you updated this evening with my first day.
Blog soon xx
Wednesday 3 August 2011
Greetings.......
Hello Everyone!!
I would just like to welcome you to my "Jamaican midwifery experience" Blog, I would like to explain firstly........that this is my first ever blog....so please bare with me.....oh....and I would like to apologise for my spelling before hand....as it is not one of my strengths.
It is 1.54am on the 4th August and I have had a brain storm......I figure if I stay up through the nite and then proceed to sleep on the flight in the day.....the 6 hour time difference of Jamaica (j.a) (6 hours behind that is....) would tally up in my head and I would be able to adapt immediately???What do you think??Even though my eyes seem slowly to be closing...MMMmmm
So...a little background......I am due to commence my placement at the Kingston University Hospital on the 8th August 2011 at approximately 8am. Yes I am nervous....if anyone was curious...and I have no idea of my placement schedule....so watch this space....and I'm sure when I know....you will know. Feel free to ask me questions at any time and I will find out the answer if I do not know it....
Speak soon Miss P xx
I would just like to welcome you to my "Jamaican midwifery experience" Blog, I would like to explain firstly........that this is my first ever blog....so please bare with me.....oh....and I would like to apologise for my spelling before hand....as it is not one of my strengths.
It is 1.54am on the 4th August and I have had a brain storm......I figure if I stay up through the nite and then proceed to sleep on the flight in the day.....the 6 hour time difference of Jamaica (j.a) (6 hours behind that is....) would tally up in my head and I would be able to adapt immediately???What do you think??Even though my eyes seem slowly to be closing...MMMmmm
So...a little background......I am due to commence my placement at the Kingston University Hospital on the 8th August 2011 at approximately 8am. Yes I am nervous....if anyone was curious...and I have no idea of my placement schedule....so watch this space....and I'm sure when I know....you will know. Feel free to ask me questions at any time and I will find out the answer if I do not know it....
Speak soon Miss P xx
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