Clinical experiences in Chami

The Chami group rocks!

So now as our third week here is coming to a close I have many reflections about my time in our village health clinic.  Everything is soooooooooooo different here!  First off lets start off with the clinic.  They hand wash the laundry for the sheets and stuff in the procedure room which means that every patient shares the same sheet for that day because they only do the wash once a day.  Do you know how many pap smears were done on that sheet in one day?!  Also, the clinic is laid out so that it has an open courtyard in the middle and there are no front or back doors it is just open.  Which means you are exposed to weather and that random village dogs just wander in and out as they please.  Also, everything is pretty antiquated as you can imagine, there is no technology like there is in the states.  Half of the time there isn't even running water.  It makes providing health care a completely different experience.

umm, what does this Spanish questionnaire say?

Then you have the patients.  They come from all kinds of distances just to get here which means that they walk for hours upon hours in all sorts of weather to get seen.  Hardly anyone here has a car unlike in the states.  And it is not exactly flat like it is in Florida so the fact that these people walk up and down these slippery muddy trails through these steep mountains when they are sick is impressive.  Then you have the staff which come and live in a little house behind the clinic during the week because the village of Chami is 2 hours away from the nearest decent sized city and some of the staff come from farther than that so it is a trek.  That is dedication.  Also, it is a relatively small staff which means everyone has more responsibility.  Most of the time there is only one doctor present, one nurse, and about three techs, and two maintenance staff.  Another difference is that there is no pharmacist here.  The prescriptions are filled by one of the techs.  I got to help out in the pharmacy room for a little bit one day reading the Spanish prescriptions the doctor wrote and pulling the proper amountof each medication to fill it.  It was really neat too because I would never be able to do that in the states, EVER.  The other super cool experience that I had here that I would never have been allowed to do as a nursing student is put sutures in a kids head.  It was so incredibly awesome! 

Nurses are responsible for so much more here especially because they have to be able to do anything if the doctor is not there.  The nurse's role and scope of practice is much larger and more encompassing than in the states; they basically can do everything.  Their roles include being a leader, a case finder, a community mobilizer, an educator, a role model, a caregiver, a counselor, and a referral source.  Especially because of how long it takes people to get to the clinic and that they might not come often the nurses (and doctors too) tend to address everything they can while the individual is there.  So, they educate them on whatever is applicable like when we had a lady in with infected dermatitis and I taught her how to apply her skin cream properly and then had her demonstrate for me.  She had apparently had the cream given to her before but didn't keep using it so the nurse explained how it works and that it takes time and to stick with it to get results and what signs of infection to watch for in case it gets worse.  The nurses also frequently go out into the community either walking through the villages door to door to give check ups and vaccines or go to the schools to give vaccines.

Out in the community giving vaccines

One observation that has been hard to witness is the fact that as a whole the people here are so much more healthy than we are in the states and they have access to so much less.  Most of the things that are big health issues here are preventable like respiratory diseases, diarrhea, and malnutrition.  The people here seem more motivated to take care of themselves and if they had the same access to care as we did in the states you would be looking at a much different situation.  Then you have the states where people have easy access to clean water, health care, healthy food and they choose to not take care of themselves and take what they have for granted and our big problems are mostly self inflicted like smoking, obesity, diabetes etc.  It is frustrating to see that.

Walking with my new friends from school

Overall, it has been an amazing experience, one that I will treasure forever.  The indigenous people here in Chami are a beautiful people, the staff is kind and welcoming and has been so great with us, and this area's scenery is stunning.