January 15, 2015

The Pediatric Emergency Room
Photo Credit: Kirstie Geier 

Kirstie: Today was a truly memorable experience. We had the opportunity to provide care to patients in a level three hospital in the D.R. I was so excited because I had been placed in the Pediatric Emergency Department! I work as a Nursing Assistant in a Pediatric Emergency Department in the U.S. and was thrilled to have to chance to use my skills in another country! As soon as I arrived on the unit, I happily joined in with the chaos. I lent my hands wherever they were needed. The nurses, technicians, and doctors were extremely warm and welcoming and helped me with any questions I needed answered. I almost felt at home, as many of the children came in with the same issues that I see on my unit. For example, asthma exacerbation is a huge problem in the D.R. due to the low air quality and pollutants. Many children come to the unit I work on with asthma crises as well. I also witnessed many children with symptoms such as nausea, vomiting, and diarrhea where dehydration was a huge concern. This is also a common occurrence in the U.S. and I encounter this condition frequently on my unit. As a result, I was able to help in assessing and providing treatments to the children with issues in which I have handled in my career previously. Although there were some similarities that allowed me to dive right in and help, I  also struggled with some of their differing practices. The unit was one room that only had curtains to separate beds; therefore, a sense of privacy was absent, but reflected an intriguing variance between U.S. and Dominican culture. It was also interesting to see that the unit did not have many gloves available for use, nor hand sanitizer in every space possible. The healthcare providers did not use gloves for many processes we in the U.S. would use them for, such as giving an injection or starting an I.V. This was another reflection of how healthcare resources are seemingly endless in the U.S., but very scarce and difficult to obtain in the D.R. However, the people of the D.R. were able to provide adequate care for their patients with the little resources they had to utilize. These sights were hard for me to grasp and overcome at first because of how often we are told to use gloves in practice, as it is a concept that is drilled into our heads the first day of nursing school. I was mainly concerned with the spread of infection and possible negative health outcomes. However, I quickly put my antagonistic views aside and conformed to the Dominican way and provided care for patients. I was glad I was able move past my feelings, as this was an extremely rewarding experience that taught me many valuable lessons. I learned that the ways I have been taught may seem like the best, but in the U.S. we are blessed with ample resources, unlike many other places. As a result, functionality becomes the biggest factor of concern when resources are limited. In my eyes, the D.R.’s healthcare practices may have seemed “wrong,” but they were adaptable to what they had available and resulted in practical healthcare. Most importantly, I learned that my views or ways are not always the finest and it is important to be sensitive to the ways of others as a healthcare provider in order to provide the best care.

Crystal & Roalqui at the level three hospital
Photo Credit: Rose Kalala 

Crystal: Two days ago we were able to choose a specialty that we would be shadowing in. As soon as I heard that, I jumped at the opportunity to see that emergency surgery was all about. When we first arrived at about 9 a.m. the Surgical ER was already packed with patients waiting to be helped. Since there wasn’t much privacy we were allowed to look in at what was happening with any patient. Many patients came in with X-ray scans that wound need a cast for the broken bone, cast that needed to be removed and looked at, and many need sutures. Roalqui works in the specialty so we were able to work alongside him and help as he helped many patients. He gave Stephen and I lab coats just in case there was blood splatter. His first patient was a 5- year- old girl who needed sutures for a cut on her forehead. She must have hurt herself while playing at school, since she was still in her uniform. He performed the sutures while she was lying on a stretcher that did not raise up, which meant he had to bend over to perform the sutures. The room was also poorly lit so not only is he casting a shadow over the girl there is not proper lighting to make up for it. The thing that surprised me was when he asked for assistants before suturing the little girl none of the nurses agreed to assist. Stephen and I were left to assist and provide whatever Roalqui needed. He was able to successfully suture the girls cut, which she was unhappy about, but the job was done. The ER was not that sanitary and I never saw anyone wash their hands after handling a patient. In addition, I noticed there were spills of bodily fluids on the floor. It was eventually cleaned up, but the length of time it took to sanitize the floor of these spills seemed significantly longer than what is seen in the U.S. I learned a lot shadowing in the Surgical Emergency Room, it definitely made me grateful for what we have in the U.S.

Rose & Lily at the private hospital
Photo Credit: Crystal Croom 

Rose: Today was a day I will always remember. I volunteered on the gynecology unit with one of my classmates, Lily, and learned a lot about the specialty and about culture/healthcare system as a whole. Even though we were only there for a short period of time, we got to see a good glimpse of how a typical day on the GYN unit of a level three hospital unit goes. We arrived to find the small room equipped with the doctors desk in the corner on the left, three beds in a row next to the doctors desk, a bathroom in the back right corner of the room, and a small medicine/equipment cabinet on the back wall. My first impression of the room was that it was very small and easily crowded. There were two doctors, one nurse, two Dominican student nurses, and then me and Lily, plus any patients, family, and other medical personnel that would come in and out. It was overwhelming for us at times, especially since we did not necessarily know what to do or where to stand. When we came in there were two patients already in the room, both visibly pregnant. One of the patients spoke English so when the doctor asked her permission for us to look in on her assessment she nicely said yes and asked us how we were and where we were from. After the doctor assessed the patient’s abdomen for the source of her abdominal pain, she said that there was something abnormal about the placement. The doctor then determined that the patient’s pregnancy was ectopic. She announced the patient’s situation to me and the rest of the student nurses in the room, but loudly enough that anyone in the room, other patients included, were also all able to hear. Perhaps this was another way that the Dominican Republic functions as a collectivist society and the patient’s business was everyone’s business, but I could not help but feel bad for the patient’s lack of privacy and lack of comfort. What hurt me the most was watching the patient weep in the wheelchair waiting to be taken to surgery as a doctor and nurse laughed and joked (about something else) right over her. It did not sit well with me that she was never consoled in a way that I believe, and evidence proves, to be most rewarding. Besides a different approach to counseling, the doctor did have a lot of valuable information to share what us, but also had a lot of criticism about our short visit. She seemed to really appreciate our presence and expressed the need for more help and resources in order to make her facility better. It was hard to have to tell her that we would try to come back to help more in the future when we both were not sure if that was ever going to happen. The doctor gave us her contact information and asked us to let her know when we come back to the hospital. I do not know if I will ever go back to that hospital, but I hope the doctor and all the others that we interacted with today know how appreciative we were for the opportunity to shadow!

Rooftop view of Santo Domingo from the top of the private hospital
Photo Credit: Kirstie Geier 

The journey to obtain the beautiful photo above was quite enduring. This view was from the top of the private hospital, which was seven floors high. We attempted to squeeze over 12 adult-sized people in the elevator of the hospital to venture to the top. Our journey was not that easy.... Our elevator got stuck and we had to call for assistance! For many of us, this was our first time trapped in an elevator, especially in a foreign country. Fortunately, we were not shut in for long and eventually were set free. Needless to say, we still decided to make the trek to the top floor and the picture proves it was well worth it!

Everyone stuck in the elevator!
Photo Credit: Kirstie Geier