Scattered thoughts through deciphering my notes throughout the past months...
Peru:
Note on how the clinic I worked in was different from my norm
1. morning rounds with the entire team, at the bedside. Although it wasn't much talking to the patient and more talking over the patient, it was refreshing to see the entire team together and reviewing the cases with everyone involved
2. all paper charting... holy nightmare
3. Knowing or simple introductions to the patient and family was absent
4. answering personal phone at the bedside is acceptable, woah... weird concept for me.
5. lack of sterile technique used... reusing most supplies for lack of ability to get new one, including gloves
6. hand washing and "foam in foam out" non existent, no soap in the bathrooms even
7. patient rooms ALWAYS had accommodations for family members... so awesome
8. no interpreters available for non-spanish speaking patients, which is hard since the clinic gets a lot of foreign travelers
9. clinics here are more like mini hospitals rather than the typical outpatient clinics that the US is used to
10. ergonomics non existent... beds were old school and didn't change height/position... rough on the old back.
11. medications are for each patient are all kept in the drawer next to the patient bedside... didn't realize how uncomfortable I was with that and how little faith/trust I had in patients
12. For each procedure that needed to be done, staff would go out and buy the supplies needed, nothing was stocked as to not waste money on expired or unused supplies, worried for me emergent situations
13. tips for nurses was highly encouraged, lol
Peruvian food:
Mote: large corn kernels
Choclo: large corn
Cuy: guinea pig, cusco delicacy
Lomo saltado
Frutillada: corn beer with fruit
Matasca: rice with stew
Creama de espinaca: green soup
Locro de zapallo: rice with italian pumpkin, potatoes, vegetables, cheese
Revuelto de fideo: noodles of different colors, meat, vegetables
Arroz Tapado: rice on bottom, top with meat, raisins, nuts, vegetables in middle
Alfajorcito de maizena: dessert
Restaurants:
Cicciolina: expensive place with courtney near plaza
Cusquenita: place where we ate cut
Morena: place with awesome pizza with Julia and lindsay before puno, flowers on food
Paddys
Jacks
Cappuccino: in plaza, great coffee, overlooks the plaza
Papachos: burgers, near paddys
La Bondiet: pastry shop with awesome chocolate cake
Ulrikes: place in pisac, ate at when we were really hungover
Peruvian music:
Mala Juntera: tu eres para mi
Juanes
Hill song music spanish
Fiel su presencia
Viva estas
HA-ASH
Fanny Lu
10/29/14 - concert we saw, Yarita yasa
**playing for change (Colombia)
Sri Lanka:
Blog ideas:
learn to not always ask questions about what I'm eating and just try it because more often than not, it is going to be delicious.. ask later.
Not did and never will get used to seeing army guys walking around with massive guns...
Crazy how unpredictable labor can be, for example seeing a 4cm primip deliver before an 8cm multip
Labor and Delivery work notes:
Dr. Saman - OB consultant
Vaginal deliveries: 42
IUFD: 2 (baby goes into cardboard box, no contact with mother)
Vacuum deliveries: 1
Twin deliveries: 1
Episiotomies: 41
baby to mom: 12 (approximately 30 seconds to 1 minute, never skin to skin)
manual placenta removal: 2
C/sections: 3
shoulder dystocia: 2
Differences:
1. episiotomies with every patient, if no episiotomy staff panic
2. intermittent catheterization after every vaginal delivery
3. one room with 7 beds, curtains used minimally
4. once admitted to labor room, patient stays in bed, no room for movement
5. no use of doulas... other than me
6. minimal pain medication used (fentanyl and pethidine and other before 6 cm, nothing after)
7. babies to warmer, minimal contact with mom until after episiotomy repair completed. no skin to skin. baby left under warmer unattended, no VS or assessments completed (1st day, I was assessing a newborn that turned blue... makes me wonder what would have happened if I hadn't been there)
8. 10 units pit given following delivery IV, no fundal massage or other third stage management. sometimes ergometrine, syntometrine
9. constantly have videos playing for breastfeeding and baby cares on their mother/baby unit, very cool
10. once mom is complete (10cm), they will start pushing... with or without contractions... how exhausting
11. patient given oral antibiotics after ROM... which is immediately once they are in delivery room
12. time of birth of very important for astrology purposes and is only told to the mom and dad
13. some cultures here, on the tenth day, the head of shaved, nails are trimmed and the naming process is started
14. minimal fetal monitoring, when done it's with a mini megaphone type thing, I couldn't hear anything... no monitoring once pushing has started
15. with manual placenta removal, after 10 minutes and injection of oxytocin into the umbilical cord, sometimes use pain meds, mostly not
16. always have an excess amount of staff
17. filaria/filariasis from mosquitos
18. vacuum delivery after one hour of being fully dilated and done by the doctor
19. push without contractions, one position to push in midwives push on the tummy to push baby further down
20. twin deliveries done by midwives and in labor room, no ultrasounds between deliveries
21. lack of sterile technique
22. no bulb suctioning after delivery, no VS or assessment on baby
23. king coconut water given to mom's during labor, nothing else
Things I have taken note of and hope to learn from:
It's crazy how much we/people are complaining/being critics 24/7... recognize that and understand that you have not right. There is a time and place for you to express those feelings
How important and how much I value independence
How much I value family and even little things like eating meals together
Importance of language in the work place, how lucky we are to have interprets but also how little the US stresses and values language... I've met so many people who speak 1-5 different languages, what an awesome quality to have.
mutual respect and mutual learning is awesome.
Communication among staff in the workplace is vital.
trusting in one another - here people want to know you and know more about you but in a genuine manner, stop thinking that people are being nosy or crossing a line when most the time they just want to know you on more than a surface level - ex: nurse that invited us into her home and introduced us to her family
value of privacy
importance of cultural humility and respecting cultural practices as difference and never bad
Importance of empathy and being gentle
how much people, myself included, need to come to terms/accept the way we are as us and not as what we think other people want to see.
Look up:
NICE guidelines
Magazines: MIDRS, BJM
Things I will miss about Sri Lanka:
the hill country... one of the most beautiful things I've ever seen
the storms... crazy thunder and lightening and so relaxing
the beach
Work, it's crazy how close we became with the staff in the delivery room, they never stopped amazing me with their skills and also their excitement to learn from me too
my host family/host sister, I can't begin to understand how hard it must be for them to do that, they were the most welcoming family ever and so interested in me but also SO excited to teach me about their culture
the buddhist culture, these people are so passionate and knowledgable and their cultural practices amaze me, one of the most interesting cultures i've come across
lazy afternoons reading
tuk-tuks - those things are crazy and sometimes life threatening but so fun
all of the exotic animals and lizards on my walls
Things I am excited for about being HOME
organized traffic
sidewalks
proper bathrooms
work
my bed. my bed. my bed.
christmas lights/holiday season/winter activities
coffee
stability
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