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
Monday, 29 August 2011
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
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