Nursing in India

International reflections by Camosun College Nursing students

A final few more photos

As the Field School experience winds up and students expressed their appreciation for those who helped them become comfortable in the environment they found themselves.  The two taxi drivers, Kalum and Prem took our group with fully loaded bags in stride as we waited to board the night train to Delhi - this trip seemed so much easier for all of us as handling lots of baggage and cramped spaces didn't seem quite so foreign for the group!  Aarti and Pooja, our two interpreters came to visit one last time on Friday, and showed everyone how to best wear a sari.  Renee cooked a fine meal for us, completely delicious and nutritious which we enjoyed before we left for the train station.  
Thank you to everyone who helped share to make this a wonderful experience for all of us!
Renate

Final Reflections, Farewells and Thanks


As our time here at the Doon Hospital comes to an end, I'm sure I can speak for all of us when I say that we are so very excited to have completed our second year nursing in India, but sad to leave this crazy, emotional, but rewarding hospital experience. It has been a complete roller coaster at times; seeing the unexpected and some of us falling ill while being so far away from the comfort of our own home. Although many of us have been through our separate struggles, it has been amazing to see how we can all pull together and support each other when needed most.
 
A big thanks to all of the doctors and nurses who have facilitated our learning and welcomed us into their world of Indian health care. Also a special thanks to Aarti and Pooja, our two dear translators, who helped us find our way through this new territory and language barrier. We could have never done without those girls! This was to say the least, an experience of a lifetime.
 
It has been our pleasure having stayed at The Shri Krishna Guest House, run by Renee and her husband Jan, for the full length of our stay in Dehradun. Being able to share our personal stories and beliefs with Renee, while learing so much about each others culture, over homemade Indian and Canadian dinners  was certainly a grand part of our experience; Renee never leaving a conversation dry with her fun and cheerful attitude. The two of them have shown great hospitality and generosity to us all, especially when one of us has had to stay away from the hospital, sick for the day all alone. Renee always made a point to pop in to check up and bring up a little homemade Indian cuisine.
 
Our cab drivers Kalum and Prem have been with us our entire adventure. Driving us every week to the hospital, and to our various cultural excurtions on the weekends. They both graciously invited us into their homes for chai tea and lunch, to spend some time with them and meet their families. Being welcomed into their homes has been a priviledge, in getting to know them a little better and see a personal glimpse of the culture they live.
 
My experiences here are far from what I had ever imagined, as we had been told before departure, "Leave your expectations behind, and keep your heart open to every experience." Every part of this journey has helped build my views and change my nursing practice in ways I have yet to discover. I am so grateful to have had the support from my classmates and instructors throughout this time, and again, cannot even see the extent I have changed on both a professional level, as a nurse, and also as a person.
 
Cynthia
 

The Hap-hap-happiest time in Peds India Style

Pediatrics, a place where we can cuddle away tears, discontinue mini IV sites, dance and sing all while applying our famous finding Nemo bandaids. To create a picture of the peds ward in Doon hospital imagine a room with 10 simple metal framed beds, attached to a corridor that has 14 more beds. Children are stacked two or more to a bed and there is still room for family! There are two little nooks, one that houses IV solutions and the Drs secret cabinet of supplies. The other nook houses the "table of terror" as we appropriately named the medication area where children line up one by one to receive their antibiotics pushed at the speed of light into their IV site. Accompanied with their meds, are their screams and tears, "Quick Bonnie, get a Nemo out" I say and she swoops in and saves the day. The nurses are kind yet stern, they have good hearts and have welcomed us openly to their unit. The doctors let us follow them on rounds and toss diagnoses to us like throwing crumbs to hungry birds. How we will miss thee.

Dr R starts his rounds at 0830. He is so compassionate with the children and his quick rap on the back will wake almost any tyke. He explains the diagnosis and if you want more information you must think of clever things to ask. "The shadowing around the parietal tumour, is that cerebral edema Dr R?" "Yes", smiles and continues to his other 22 patients.

Stethoscopes or "steths" as they are known in India are horrible scary creatures, the brown eyes of any child will tell you this. They usually proceed a needle in the arm or being woken from a peaceful slumber. Also, they imply that we are now in school for medicine, that's right we just got bumped to MD status. Now please diagnose that child... "Very obvious case, very obvious." We palpate the stomach- very tender. Is the spleen enlarged? "No but it is sore." Mucous membranes are good. Lungs sound fine. She is awake enough. "Lets go with typhoid" Bonnie meekly suggests. "Typhoid sir" we offer hopefully. Dr R takes the child and holds her in the light. A fine rash covers her stomach. "This child has measles." "Drat! Wrong again."

Mostly we assess the babies thrust one by one. We coo and smile and become the inner child that we both have. Krystal cuddles the baby as I asses the lungs and encourage copious amounts of drool (on Krystal`s neck) if that is what causes happy babies...too bad that one had TB. Dehydration is the biggest antagonist of our show. So re-hydration recipes, water...salt...sugar the perfect elixir are passed out to families, desprate for a miracle. We had our wonderful translator Aarti write multiple amounts of these miracles in Hindi to ease the cultural collision of Hinglish.

Bonnie has taken to tattooing the children. Her olive branch on her arm has been quite a hit. Today alone 6 children under 10 are running around with blue penned olive branches. Krystal keeps the children entertained by making odd noises and making faces that are only reserved for the special children in peds. 

The experience of working in peds in India has not been an easy feat. There has been lots of blood, sweat and tears. Many moments when we needed to escape to our tree, hug, breath and collect our thoughts. The resilence of the  children is absoultely beautiful and they really do bounce back quickly with a little love, support, and crayons. Our everyday motto was to make Peds the hap-hap-happiest place in India and that is just what we did. They were small things that we could do, a cool cloth, a gentle hand, and the time of day to listen and answer what worries the families had. We are better nurses for it. We have gotten so much back for all we put in. The personal exhaustion, tears, and sweat were well spent for the knowledge we have attained and the daily batltles we have won.
 
Krystal and Bonnie  (and the seven small kids in their backpacks)
 
 
 
 
 
 
 
 
 
 
 
 

The Experience of the Male Medical Unit

It's hard to believe that we have just completed our last day at Doon Hospital. Over the past five weeks, I have had the pleasure to work on the male medical unit along with Stacey and Marc. We were exposed to many different disease processes, with the vast majority of patients suffering from HIV and/or tuberculosis, liver failure, renal failure and strokes.

Fortunately for us, most of the physicians were extremely accommodating and allowed us to follow them on their rounds while they explained X-ray, MRI and CT scan results; discussed and questioned us in regards to disease processes and treatment regimens; let us observe invasive procedures (lumbar punctures, thoracentesis) and would prescribe required treatment according to our assessment findings. Being able to go on rounds and discuss our patient's treatment regimen was very beneficial to our learning, as well as seeing and caring for patients at the end stage of their disease.

On almost a daily basis we had to respond to patients in respiratory distress, strongly advocate for vital treatment regimens and were asked to assess and care for patients by their family members. It was extremely rewarding to watch a patient's condition significantly improve just by providing simple comfort measures and nusing actions such as oxygen, daily dressing changes for pressure ulcers, cooling bed baths and repositioning. Our presence, focused nursing care and advocacy made an immense difference in the lives of our patients. Seeing the gratitude in the families and patients definitely made all of our efforts worth it.

India is estimated to have the second largest population of people living with HIV/AIDS and TB is the most common opportunistic infection among people living with HIV. These facts were made undeniably clear on the medical ward at Doon Hospital. The Indian government has a policy and program committed to provide free antiretroviral therapy free of charge to people living with HIV/AIDS. Along with this antiretroviral therapy program, India also has a TB Directly Observed Treatment, Short-course (DOTS) program in an attempt to treat and cure all patients suffering from TB. This program is designed to control TB by providing a regular, uninterrupted supply of anti-TB drugs (free of charge) under direct observation by healthcare providers and systematically recording and reporting data to assess treatment results and the effectiveness of the program. With the emergence of multi-drug resistant TB (MDRTB), the use of the DOTS program to achieving good TB management is essential. TB is currently one of the leading causes of mortality in India, however, in time this will hopefully change as the DOTS program has an 80% cure rate. These programs are imperative for a lot of the patients we encountered on our unit as they would not have been able to afford treatment for their disease.

Throughout my time at Doon Hospital, I had the privilege to work in and see a variety of areas in addition to the male medical unit. I was exposed to severe stages of disease processes and was able to advocate for imperative treatment for my patients. While it was difficult to see patients in such dire conditions, I am extremely grateful for all of the experiences I had. I will always remember the difficult and heartbreaking moments and they will forever influence my future nursing practice.

-Morgan Boone

Generosity and Spirit Found on Orthopedics

During our time in India we had the privilege to work on the male orthopedics unit in the Doon Hospital. This unit consists of 40 beds, all full of people with various injuries. There are many differences between the units in Canada and those in India. To begin with, in Canada it is predominantly hip, shoulder and knee replacements with a older population, whereas at Doon hospital it is mostly made up of a younger population with injuries due to traffic accidents, amputations or falls. 
 
One thing that we have noticed with many of our patients we have worked with is that most of them have been there for longer than a month. This was somewhat shocking to us, as patients on the orthopedics units in Canada are usually there for 2 to 7 days. In Canada it is more rare for a patient to stay a month. Due to the complexity of the wounds and for some of the patients having to come a far distance from home, they would not receive the required care needed at home and therefore have longer stays at the hospital. 

One of our patients we have worked with during our time here in India was a young boy of 18, with a broken femur, tibia and fibula from a road traffic accident 2 months ago. His dressing change is one of the more complex and is quite painful for the patient. His family is quite involved with his care and have shown us great appreciation for what we have done for him. Although the family that this boy comes from, money is not easy to come by for them, but to show their appreciation and thanks, they went out and bought us each a chai tea. This has ultimately shown us their generosity and appreciation for the nursing care we have given. 

This unit also has some children on it and during our time we have gotten to know an 8 year old boy. This boy is accompanied by his grandfather and he has a very engaging smile and curiosity about what is taking place around him. We brought a coloring book along with us one day and the smile that was on his face was enough to make anything that went wrong that day go to the wayside. He was so excited to own something and is very happy when we come around so he can show us what he has colored and spend some time interacting with us. 

It has been amazing experience to work on the orthopedics unit at Doon hospital and get to know each of the staff and the families on the unit. The experiences we had here will forever being on our mind and will influence the nursing care that we give to future patients we have for the rest of our lives.  

Cynthia and Nicole

Tiger Tails

As we look forward to completing our final week in the practicum, students have had many opportunities to care for people in both Doon Hospital and an adjacent hospital for women and children (where they were invited to have the option to participate with women in labour, attend a cesarean section or care for newborns who needed more monitoring in Neonatal Intensive Care).  Taking on these experiences, while remaining sensitive to the culture and needs of those hospitalized has been both very rewarding and challenging for all involved.  

A weekend excursion into Corbett National Park took us to what was the former United British Provinces of India, now Uttaranchal.  Named after Jim Corbett, who for over 32 years hunted and killed man eating tigers with amazing bravado, but his memory lives on largely due to his later years when he campaigned for the conservation of the tiger and set into momentum an environmental consciousness in this part of India.  Corbett later said "until India realizes that wildlife is an asset, the killing will go on.  A country's fauna is a sacred trust, and I appeal to you not to betray your trust."

At the beginning of the 20th Century it was believed there were as many as 40,000 tigers in India.  In the 1930's tigers had taken thousands of lives, and Corbett understood the terror of being under this shadow and spent 3 decades clearing the forests of the big man-eating tigers.  Often women of the villages who moved into the jungle to herd cattle, gather fodder, cut firewood for cooking or wash clothes at a stream were killed.  Although humans are not the natural prey they will replace more difficult prey when the tiger has been wounded or simply reached old age.  One tigress reportedly took 436 lives in a 5 year period, but the heavy toll on hunting these cats have reduced India's tigers to number less than 2,000 today. 

Established in 1936, Corbett National Park is a reserve for tigers covering an area of 1288 square kms, with 4 rivers and extensive jungles, scrubby woodlands and swampy grasslands.  Wild animals that can be seen include herds of Elephants, Tiger, Leopard, Sambur Deer, Cheetal, Spotted Deer, Hog Deer, Barking Deer, Boar, Slothbear, Civet, Marten, Otter, Crocodile, Tortoise, Monitor Lizard, Python, King Cobra and the Mongoose.  Over 580 species of resident and migratory birds also share this space.  We were able to take a few jeep safaris into the reserve to see many of the wild animals listed, but our biggest thrill came after a morning rainfall kept most of the animals huddled under cover when we stopped to overlook a river.  Within minutes a large male tiger emerged to cross the shallow river, he paused to look at us briefly, then carried on to the bank into the grasslands and disappeared into the bush.  Upon our return to the compound inside the park boundary, we were able to write on the board "Canadians sight the only tiger on High Bank - May 28th."  Almost as exciting, the bird sighting that generated the most interest was the Whopoopipop (?sp) amongst some members of our group.   We returned to Rajpur with stories of monkeys who chased us, mice who shared the bunk beds, and loads of jungle dust (also known as a temporary tan)!

Survival of the Fittest in India

                Greetings from the India group. Life has been a complete blur over the past few weeks as we have been working at Doon Hospital and exploring Uttarakhand. We`ve all been busy working on our respective wards of Medical, Orthopaedics’ and Paediatrics along with the great opportunity of working at the Woman`s Hospital, which includes labour and delivery (LDR), neonatal intensive care unit (NICU) and the Caesarean operation theatre.

                From the first contraction to the first breath, coming to life in India gives you a crash course in survival. On average at the Doon Hospital, there are 25-30 natural births and 6-10 C-sections per day. As you can imagine with the number of births, the staff is overworked, underpaid and unable to commit as much one-on-one time with mother and babe as we do in Canada. It is truly amazing how much these nurses do with such limited resources. Although the staff is incredible, there are many differences in nursing practice that at times left us stunned and shocked. For example, it is common to slap the mother in the face to focus past the pain of childbirth due to the lack of analgesic/anaesthetic. Also, stepping on the mother’s abdomen during delivery is a practice used to guide the neonate through the birth canal. In order to maintain our Canadian standards of practice, we were able to advocate for our patients through displaying comfort care such as breathing exercises, hand holding, back rubbing and being present with the client who would otherwise go through the birthing process alone. Our presence prevented a lot of the aforementioned routine practices. Even with the frustration of a communication barrier, it’s amazing how intuition takes over and forges a trusting partnership through the universal language of women.  It was extremely rewarding to be a part of something so personal and intimate.

                In our experience, approximately 60% of neonates required resuscitation interventions such as suctioning, oxygen and/or CPR. Out of the group, we had one student who was familiar with Canadian maternal practices through previous clinical experience, which was helpful when other students needed advice or guidance. LDR was exciting and eye-opening but nothing could have prepared us for the emotional toll that our experiences would entail. Our nursing actions, personal feelings and the vivid images will forever be etched into our memories. Due to these situations, we have become stronger beings and they will shape our nursing practice for years to come.

                Throughout this experience, there has been a whirlwind of emotions, such as anticipation as we breathe alongside the mother through each agonizing contraction; joy when the newborn takes its first breath; excitement when watching the mother and babe share the first bonding moments; sorrow when we console a grieving mother and guilt that in Canada we have the resources to prevent a lot of the unnecessary tragedy experienced daily in LDR at the Women’s Hospital. The emotions felt were unexpected and displayed the raw reality of beginning life in India.

                At this time, the Indian government is trying to promote safe, healthy deliveries by offering women and their families a sum of money to give birth in government run hospitals. The goal of this movement is to prevent women from staying in their villages to deliver their babies with limited or no medical resources (doctors, medication, or clean facilities) leaving them at high risk for post-partum hemorrhage and/or still birth due to multiple unforeseen complications.  This program has been successful in decreasing the mortality rate of countless women and children across the subcontinent.

                We are extremely greatful for this life-changing opportunity to work in LDR and will cherish our experiences forever. India has broadened our perspective on human life and has enlightened us on how easily life can begin and end in a resource poor setting. We came into this experience with the high hopes and expectation of influencing others’ lives but were completely blindsided by the impact they have all made on us. It has been an immense privilege to have made such a difference in the lives of the women and their families and to be a part of something so spectacular.

 

-Krystal, Morgan and Stacey