Burn Nurse Education Teams Head to Honduras and Costa Rica

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Physicians for Peace recently had the opportunity to have a great impact in Central America by training burn nurses in basic and critical care techniques. The International Infirmary Congress was held this month in Tegucigalpa, Honduras.  One of our teams, comprised of volunteers Carolyn Ramwell, Susan Vinge, and Diane Strout, was invited to present at a special two-day, pre-congress event on burn nurse education.  The number of nurses in attendance from all over the region made this an excellent opportunity to reach as many health care workers as possible and have far-reaching effects in one of the poorest countries in the western hemisphere.

The team leader, Carolyn Ramwell, then met her second group in San Jose, Costa Rica – Nicole Farrar, Eugenia Lindsey, Briana Morrison, and our own Physicians for Peace staff member, Sharon Gabriel. There they were able to assess the needs of a local pediatric burn unit and bring supplies, training, and asssistance to their staff. 

The teams posted the following updates on their experience.

12-06-08   Tegucigalpa, Honduras

Hello,

We arrived safe and sound.  Sue is here from team Minnesota and will be fantastic.  She is ready to go with the flow.  We found out today we are teaching the entire precongress with an audience of 300 nurses.  They gave us the schedule and certificates to sign.  We will pull together, but what a challenge!  We will be giving 10 lectures and then having 2 four hour sessions of hands on wound care.  We will pull the cases together from both units (adult and pediatrics) so we can focus on many wound dressing changes and hands on wound care education.  Mobility will also be a huge focus. We toured the hospital today, and I did a quick needs assessment.  I will flesh it out later in the week, but it is nothing unexpected.  This is a good site for PFP.  The staff is eager to learn and the improvements for better outcomes can be implemented right away.  With the insight from other missions, this is fertile ground to implement our burn program in its entirety.  That is it for now.  We will pick up Diana tomorrow.  This will be a crazy week.  Talk about an amazing opportunity to impact clinical practice throughout an entire country!  The nurses at the congress are from all over Honduras.

All the best,

Carolyn

 

12-08-08  Tegucigalpa, Honduras

Hello,

Well today was unbelievable.  We gave the precongress talks and then rounded in the burn unit.  This is a country in great need of our help.  75 nurses were in attendance.  We are all well but tired.

Carolyn

 12-09-08   Tegucigalpa, Honduras

Hello,

It has been another wonderful day here in Tegucigalpa, Honduras. We spent the morning speaking at the pre-congress meeting. Our topics were pain, professional nursing, psychosocial aspects of burn care, and wound care. Again we had about 70 nurses from all over the hospital and many from rural areas and clinics. We also spent time on the peds burn unit rounding with both MD’s and nurses. We were able to help with some smaller dressing changes on the unit, with supplies that were brought from the USA. The nurses and doctors were very excited to receive an O2 sat monitor as a donation from PFP. They were very excited to be able to monitor their patients as they give IV pain meds for dressing changes. The children here are beautiful, and the staff does an amazing job with limited equipment and supplies. We also toured the adult burn unit and the rest of the hospital. During the Christmas season, it is very humbling to be working here in Honduras with people who have so little and still find joy in the little things.

Susan Vinge, Diane Lohrenz, Carolyn Ramwell

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12-15-08     San Jose, Costa Rica

Dear Team,

Thank you so much for this opportunity for our team to be here in Costa Rica.  As always, we volunteers receive so much more than we give.  Today we meet the entire medical team in the burn unit.  Dr. Carlos Siri, chief of medical staff of the burn unit gave us a tour of the unit and then began to share his dream for the children that are burned in Costa Rica.  He spoke with passion and commitment about the team he is building and his commitment to excellence.  Since our mission here last year, the burn unit has added a physiatrist and a psychologist. The next staff member will be an occupational therapist.  They are also in the process of starting a skin bank.  Dr Siri spoke passionately about his team. “They are young and need more experience. If we have the same dream and the same plan we can grow together over time.  It’ s not what I want it to be yet, but we do have a vision and the plan to get us there.  I just want to keep giving the staff the skills they need.”  The compassion and gentle, kind care that the children receive is because of this team’s commitment.  The nurses care deeply for the children.  The wound care is managed by anesthesia and a pain team rounds for consultation.  The commitment to a pain free unit is inspiring. The work continues here with a dream for a new unit fully staffed as a state of the art burn unit.  They are well on the road to this dream and we are so proud to be a small part of their success.

Best Regards,

Carolyn       

 

 

12-17-08  San Jose, Costa Rica

Happy Birthday!  Feliz Cumpleaños!

It is a rare occurrence on a PFP mission. Two of our five team members are celebrating their birthdays this week – RN and social worker Eugenia “Genie” Lindsey today, and EMT and 3^rd year UVA Nursing student, Briana Morrison, tomorrow.  Like most of us, and millions of other people around the world, we typically expect to receive gifts on our birthdays. But first-time PFP volunteers Genie and Briana wanted to join a mission trip to celebrate their special days –an opportunity for them to give, not receive—or so they thought.

These volunteers, like so many others, generously give of their time, expertise and knowledge. But they are receiving much, too.

“I thought spending [my birthday] in another country doing what I have a passion for would be better than being home. It is an excellent opportunity as a student,” said Briana. “I get to come on a mission, share what I know and contribute to the mission.”  She adds, “But my experience in Costa Rica, with the people, and the other team members has helped me learn a lot, too. And I am treated like an equal among my own team.”

Genie shares, “It is much more meaningful to me to be able to give what I know and help enhance the burn program in Costa Rica. To be with like-minded people who want to serve children and improve their own skills to help heal children is a real gift to me.”

Today, Genie walked into the Burn Unit at the hospital and was greeted by Chief of Medical Staff, Dr. Carlos Siri and his entire team. “Everyone came up and gave me hugs and said, ‘Happy Birthday!’ “ (Or rather, Feliz Cumpleaños, in Spanish.) Genie remarked, “I think this is the best birthday I’ve ever had.”

As the old biblical adage goes, “It is more blessed to give than to receive.” Well, perhaps it is both.

–Sharon Gabriel, Costa Rica mission team member and PFP Director of Events

 

 

12-17-08  San Jose, Costa Rica

We have just finished our first official day of teaching here in Costa Rica, our third day in the Burn Unit.  I am very impressed with this team in Costa Rica.  I use the term team because I think it is such an important part of burn care.  Back home in Arizona, our approach to burn care is multidisciplinary: clinicians, nurses, therapists, nutrition, social workers, all working together; and I see this unit here working to achieve a similar goal.  The staff is so friendly and inviting to us and very open to our suggestions on how to improve their unit.  They are so motivated to do what is best for their patients they are working on finding appropriate materials to start making their own compression garments, and have a dedicated workspace for that endeavor. 

Yesterday I was able to spend the day with them while they did wound care, which by many standards is very innovative.  All patients had their wound care under anesthesia, including tub debridements.  I was able to discuss different wound care options with the physicians and made suggestions about how to improve mobility.  

This morning I brought an entire suitcase of donated compression garments with me, along with a few other gifts for the staff, to which the physiatrist responded, “It’s like Christmas!”  I was so happy to be able to share those resources with them.  

Today we also began a 24 hour seminar for the hospital and others in the surrounding area about the care of burn patients.   I gave a lecture on the initial care of burns and fluid management and shock.  Unfortunately, my espanol es no bueno.  So, the burn unit was nice enough to arrange for me to have a translator.  My lectures went really well, and luckily some of the nurses in the room spoke English and could help out the translator with some of the technical terms like “hemodynamic” and “compartment syndrome.”

So far, this has been an incredible experience, and I have been very well received, although, it is a little difficult to explain what a Physician Assistant is exactly.  I have been treated with respect by the staff, and my experience with burn patients appreciated.  I hope this to be my first to many missions.

Thank you for this opportunity!

Nicole Farrar

 

12-18-08  San Jose, Costa Rica

Burn Nurse Seminar at Children’s Hospital in San Jose, Costa Rica

Fifteen nurses from various provinces and hospitals around Costa Rica attended a two-day workshop at Hospital Nacional de Niños, presented this week by a PFP volunteer burn team. Dr. Carlos Siri Adema, Burn Consortium member and Chief of the Burn Unit at Hospital Nacional de Niños, invited the PFP team to increase the number of burn nurses and burn knowledge in Costa Rica.  He was instrumental in developing the curriculum presented.  The program itself was hosted in partnership with hospital Educational Coordinator, Sra. Lorena Gomez Alpizar and APANQ Foundation President and Burn Consortium member, Sra. Nayra Gaspar.

 

Led by team leader Carolyn Ramwell (RN,MSN,PNP), the classes were taught by team members Physician Assistant Nicole Farrar (MMS, MBS,PA-C) from Arizona Burn Center, nurse and social worker Eugenia “Genie” Lindsey (RN,BSN,LCSW) from Virginia, and EMT and 3^rdyear UVA nursing student Briana Morrison from New Jersey.

Briana taught a session on Pre-Hospital Burn Emergency Care so the nurses could instruct their lay communities on guidelines for handling burn traumas prior to getting victims to a hospital. The nurses also received teaching/advocacy materials such as posters and pamphlets on prevention from the APANQ Foundation.

Nicole led an in-depth clinical session and lively professional exchange on Initial Burn Management, giving an overview on the types of burns including scalds, which make up 60% of the burn injuries in Costa Rica. Her sessions also covered Fluids and Shock, and how these can affect different organ systems in the body.

“These classes are important because there are different ways to approach the patients; it has been very interesting to learn different protocols and the different technologies for burn care,” said Angelina, an Intensive Care Unit Nurse from Hospital Nacional de Niños.”

Genie taught about the psychological issues related to post-traumatic stress disorders as well as non-accidental trauma and how to recognize the signs of child abuse. She gave practical demonstrations of child-centered therapy interventions, such as puppet therapy with ChaCha the Cat, color visualization therapy, story-telling, play therapy and sand-tray therapy – all designed to help heal the soul and spirit of a victim.

In addition to the educational lectures and materials, the nurses were given CDs of the presentations to take back with them. Equipped with additional knowledge, new ideas and friendships, and practical tools, these indigenous healthcare providers can leverage the seminar with Physicians for Peace to exponentially further burn education within their communities.

Sra. Gomez was very excited about the seminar and bridge-building that occurred, as well as the participation and cooperative efforts between the organizations. “They [Physicians for Peace volunteer educators] have caught the attention of the audience with the topics and material presented. It was both professional and fun at the same time.”

She added, “It doesn’t matter what country you are from, it matters more what kind of heart you have for the people. And you can tell what kinds of hearts people have – that’s why I am so glad to have met you.”

–Sharon Gabriel, Costa Rica mission team member and PFP Director of Events

          

 

 

 

 

 

 

 

 

 

 

 

Healing in Honduras

 

Photographer Doug Bruns travelled with Physicians for Peace volunteers on a plastic surgery training mission to Tegucigalpa, Honduras. He sends these updates…

Sunday, September 21

 

Arrived at Toncontin Airport, Tegucigalpa shortly before noon, amid rain, and caught up with Dr. Brody, or Garry, as he prefers. Today is his birthday. He’s 76! Happy birthday Garry – the airline lost your luggage! Dr. Luis Gonzales is our host and picked us up at the airport. He tells me there there is a strike on at the hospital, that soldiers are filling in for staff. That should be interesting.

 

Monday, September 22

 

Into the OR at 7:00 am to repair the thigh of a young man. A month ago in a motorcycle accident he broke an arm, but of more concern was the thigh where the skin had been scraped off. He was back into the OR for a skin graft. Dr. Brody, Garry, is a plastic surgeon. He is here to teach. The goal of this mission is to leave the country with a medical staff, interns specifically, with more education than they had previously. Garry’s method is Socratic. “How would you do this?” “How can you repair that?” The interns and the occasional medical student speak good  English. It is a requisite of their program. They respond to Garry’s challenges with good humor, mustering every bit of training and education they can so as to impress and not disappoint.

            The day flagged and cases were lacking. Garry observed, “They weren’t ready for me.” He anticipated that cases would be queued up, that he’d have a steady stream of patients and opportunities to teach. The cases did not materialize.

            But word got out that Garry was in the hospital and in the hall we were stopped by a man who wanted a nose job, a woman who wanted a face lift and a young man with a cleft palette. His eyes spoke volumes and his mother watched on as Garry and the interns examined him in the hall, our make shift exam room. When I left the hospital late in the day the young man and his mother were standing outside the OR, looking down the hall through the glass. He has been added to the docket and presumably will have a new smile when we leave town.

 

Sept 23,  Wednesday

 

I am a photographer. I volunteered to come to Honduras to document the work Dr. Brody and Physicians For Peace does here. He and I were sitting at a table yesterday, in between operations, when a young medical student approached us. We were dressed in scrubs. Dr. Brody looked like a physician–and I guess I did too. The medical student shook my hand and asked me what my speciality was. I smiled coyly, “photography,” I said. She laughed good heartedly. “No really,” she insisted, “What’s your speciality.”  “Really,” I replied, “photography.” I showed her my card and pointed to Dr. Brody who was watching with a grin. I pointed. “He’s the talent at the table.”  The point of the story for me was her eagerness. She wanted to learn, a desire I see in abundance.

 

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I mentioned earlier that Dr. Brody’s method is Socratic. Here are a few of his questions to the staff here at the hospital:

 

“If that were your girlfriend, how would you treat that injury?” (To a young, male, intern.)

 

“How are you going to feed him?” (About a patient who had a major face reconstruction yesterday, including lips.)

 

“Do you notice what he’s doing?”

 

“Once this heals, what’s the problem going to be?”

 

“How are you going to deal with this?”

 

And what I gather to be his two favorite questions:

 

“What’s your plan?”

 

“What are you going to do?”

 

 

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We visited the burn unit this morning during rounds. It was difficult. An adolescent sat in the hall, his legs burned, completely despondent, tearing up, staring at his legs. A woman burned in a club lay still on a bed, struggling to live. Two members of her party have already died. A man doused in gasoline by a gang and set afire seems resigned to his pain. I struggle to compose a photograph that will not be something other than reflective of utter hopelessness. Then I see Dr. Brody talking to a patient. He reaches over and touches the man’s hand. Therein lay hope, compassion and the human connection.

 

 

Thursday, September 25

 

            I mentioned earlier in the week the strike. The problem is, I think, a conflict between health care workers (i.e. nurses and technicians) who are on the public payroll, and those in the private sector.The government decided to allow private sector practitioners to come to public facilities, like our hospital, to train and study. The hospital is a limited resource and those now working in it see this as an invasion of their turf.

            When we arrived at the hospital on Monday, there were, say, two dozen nurses and technicians milling about at the front doors. Today, four days later, I’d guess at least twice that. Further, they had a look of steely resolve in their eyes. And of course there was media. And we all know that when media shows up and people get on television, well, that changes everything. And it did.

            We had no patients this morning. The OR was empty. The halls were empty. There were doctors aplenty, however. But how much coffee can a doctor drink, really? By the afternoon there was a slight break-through and our interns had found enough sympathetic ears to come to our aid, ever so limited, but help out nonetheless with a patient. Tomorrow looks dicey at best. So, I have bailed and will be heading home a day early. Doctor Brody, like the professional he is, is staying the course, one more day in the hope that he can help the interns, patients and doctors at the hospital. I suspect he will find some way of imparting his experience, strike or no strike, one more day.