(November 3 - November 23)
Well, I am a nurse again! About time! I have not practiced in six months! But it is just like riding a bike, right?
During the first two weeks in Madagascar, the nurses, including me, were busy cleaning and setting up the hospital. Every day, all day, for two weeks, we unpacked, scrubbed, and organized the entire hospital. Every cabinet, wall, floor, ceiling, light fixture, bin, binder, bed, mattress, pillow…EVERYTHING…was scrubbed with a hospital-grade cleaner…twice!
I work in A Ward. A is the General and overflow ward. We will see a lot of hernias and lipomas. We will also take the less acute overflow patients from other wards. B Ward is Orthopedics ("Ortho"). D Ward is Maxillofacial ("Max Fax") which is where Dr. Gary Parker's cleft lips and palates and facial tumors will be. D also has an attached ICU with five beds - two of those are in separate isolation rooms. Max Fax patients tend to be less routine and have higher chances of complications.
We also set up the Outpatient Center in C Ward. Patients return to the ship at some point after their surgery, though the varying time lengths depends on the type of surgery. We follow up with each patient. There is also the Eye Clinic and Patient Treatment Room (which is mainly used by Rehabilitation for casting purposes). We washed every scrap of linen and uniform. We sterilized the patient equipment. It was a long, involved process to make the hospital first-world worthy.
However, before we admit a patient to the hospital, he goes through a rigorous screening process:
1. Pre-screening
2. Off site screening (same location as pre-screening)
3. Dockside screening
4. (not for every patient) Return visit for test results
5. Admission
There is a lot of waiting involved.
I spent one day at the screening site - the first day, November 3. We used the deserted wing of a local hospital.
The first day was the busiest day. About 20 crew members from all departments volunteered to help with crowd control onsite, in addition to the ship's security officers, screening team, chaplaincy, and translators already present. About 3,000 people waited in line, though no more than half of them were potential patients as nearly every person waiting had at least one family member accompanying them. The line started outside the hospital gate and continued down the road before turning down a side street.
The line then extended the whole length of the side street until it reached the T-intersection before
turning down a narrow alley. You can just see me in an orange vest in the middle of the picture with another crowd control volunteer.
The crowd control volunteers spoke with the crowds and entertained the children. In other countries, the crowds at screening could be unruly. Desperation could make some people riotous. However, despite there being more people waiting than anticipated, the crowds were very calm and polite. It was a joy to meet so many Malagasy people.
One little girl was not seen by the pre-screeners the first day and returned on the second:
At the gate, pre-screeners sifted through the waiting potentials. Those who we could possibly help were given tickets to pass through to the screening site. There are types of surgeries we definitely do not perform - such as orthopedic surgeries on patients older than 15 years. I will explain more about why - and Ortho in general - in a separate blog. If an individual meets the very basic requirements, he is given a numbered ticket and allowed inside the hospital gates. On this first day, only 200 potential patients passed through pre-screening at the front gate to see the screening team inside.
If the screening team decides that we may be able to help the person, he is given a coveted yellow patient ID card and a date to come to the dockside screening center for further evaluation. They arrive by the car-full.
After spending time in the "waiting room," the patient sees a physician or surgeon. At this time, we will also perform any needed CAT scans onboard, though not many patients require the test.
If no CAT scan is needed, the physician and surgeon decide whether the surgery can be safely performed. If so, the patient receives a surgery date written on the back of their yellow patient card. If a scan is needed, the patient returns at a later date to get the results of the CAT scan before a final determination is made for surgery.
On the morning before the day of surgery, patients come to the dockside admissions center. Any pre-op blood work is drawn and files made. Patients are then escorted into the ward in the afternoon.
I have worked as a nurse these past two weeks. I have cared for pediatric and adult patients. I have taken care of those with hernia repairs, lipoma removals, and even some Max Fax patients. I have learned an incredible amount in a short period of time. I have done a lot teaching. I have started IVs. I have changed dressings. Even something as double-checking medication dosages is exciting right now!
When possible, I will share about specific patients. This is Vololonirina. She was a patient on my ward this past week:
Her surgery took over five hours. She is doing well. Although my ward is the General Ward, the first few Max Fax patients, including Vololonirina, stayed on our ward. Due to the low patient load, we combined wards A and D for this week.
DISCLAIMER: Only the Communications Team takes photos of patients (or potential patients). The team does get permission to share photos before making them available to the general crew.
We set up three wards that look nearly identical…Ward A, Ward B, and Ward D. A and B have twenty beds. D has fifteen. This is Ward B. You should see that all the beds are on risers. This makes room for a mattress to be placed beneath a patient bed for a caregiver.
I work in A Ward. A is the General and overflow ward. We will see a lot of hernias and lipomas. We will also take the less acute overflow patients from other wards. B Ward is Orthopedics ("Ortho"). D Ward is Maxillofacial ("Max Fax") which is where Dr. Gary Parker's cleft lips and palates and facial tumors will be. D also has an attached ICU with five beds - two of those are in separate isolation rooms. Max Fax patients tend to be less routine and have higher chances of complications.
We also set up the Outpatient Center in C Ward. Patients return to the ship at some point after their surgery, though the varying time lengths depends on the type of surgery. We follow up with each patient. There is also the Eye Clinic and Patient Treatment Room (which is mainly used by Rehabilitation for casting purposes). We washed every scrap of linen and uniform. We sterilized the patient equipment. It was a long, involved process to make the hospital first-world worthy.
However, before we admit a patient to the hospital, he goes through a rigorous screening process:
1. Pre-screening
2. Off site screening (same location as pre-screening)
3. Dockside screening
4. (not for every patient) Return visit for test results
5. Admission
There is a lot of waiting involved.
I spent one day at the screening site - the first day, November 3. We used the deserted wing of a local hospital.
The first day was the busiest day. About 20 crew members from all departments volunteered to help with crowd control onsite, in addition to the ship's security officers, screening team, chaplaincy, and translators already present. About 3,000 people waited in line, though no more than half of them were potential patients as nearly every person waiting had at least one family member accompanying them. The line started outside the hospital gate and continued down the road before turning down a side street.
The line then extended the whole length of the side street until it reached the T-intersection before
turning down a narrow alley. You can just see me in an orange vest in the middle of the picture with another crowd control volunteer.
The crowd control volunteers spoke with the crowds and entertained the children. In other countries, the crowds at screening could be unruly. Desperation could make some people riotous. However, despite there being more people waiting than anticipated, the crowds were very calm and polite. It was a joy to meet so many Malagasy people.
One little girl was not seen by the pre-screeners the first day and returned on the second:
At the gate, pre-screeners sifted through the waiting potentials. Those who we could possibly help were given tickets to pass through to the screening site. There are types of surgeries we definitely do not perform - such as orthopedic surgeries on patients older than 15 years. I will explain more about why - and Ortho in general - in a separate blog. If an individual meets the very basic requirements, he is given a numbered ticket and allowed inside the hospital gates. On this first day, only 200 potential patients passed through pre-screening at the front gate to see the screening team inside.
Once inside, after more waiting, a medical team collects the necessary information (such as medical history), performs a quick non-evasive examination, and takes photos for the medical files. There are not as many volunteers inside, though we still try to keep the children entertained.
If the screening team decides that we may be able to help the person, he is given a coveted yellow patient ID card and a date to come to the dockside screening center for further evaluation. They arrive by the car-full.
After spending time in the "waiting room," the patient sees a physician or surgeon. At this time, we will also perform any needed CAT scans onboard, though not many patients require the test.
If no CAT scan is needed, the physician and surgeon decide whether the surgery can be safely performed. If so, the patient receives a surgery date written on the back of their yellow patient card. If a scan is needed, the patient returns at a later date to get the results of the CAT scan before a final determination is made for surgery.
On the morning before the day of surgery, patients come to the dockside admissions center. Any pre-op blood work is drawn and files made. Patients are then escorted into the ward in the afternoon.
I have worked as a nurse these past two weeks. I have cared for pediatric and adult patients. I have taken care of those with hernia repairs, lipoma removals, and even some Max Fax patients. I have learned an incredible amount in a short period of time. I have done a lot teaching. I have started IVs. I have changed dressings. Even something as double-checking medication dosages is exciting right now!
When possible, I will share about specific patients. This is Vololonirina. She was a patient on my ward this past week:
Her surgery took over five hours. She is doing well. Although my ward is the General Ward, the first few Max Fax patients, including Vololonirina, stayed on our ward. Due to the low patient load, we combined wards A and D for this week.
DISCLAIMER: Only the Communications Team takes photos of patients (or potential patients). The team does get permission to share photos before making them available to the general crew.
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