Nursing in Peru

September 6, 2011

   

Community Hospice Team for September

         I love hospice!! I am really enjoying my job so far!! Hospice is perfect for me. I am able to use my nursing skills, orient myself to the community (since I do house visits all day), learn more Spanish, form personal relationships with families, and get closer to my co-workers who I go out in the city with. I am also learning some great nursing skills here. At the same time, I am seeing a lot of nursing practices here that I know are wrong and harmful to the patient. It is hard to walk a line between respecting the culture and traditions, and being a patient advocate when I know something is wrong.

         We meet at Hospice at 8am, debrief on the patients we will go see that day (two teams of two people) and are rationed out supplies: 2 packets of gauze (and not even enough to pack the wounds, and once we are out of gauze they cut up menstrual pads to tape on, not kidding), 1 IV start kit (and if the vein blows or you don’t get it in the 1^st/2^nd/3^rd time, you keep reusing the same IV start catheter and needle), a small bottle of iodine and “sterile” water (that was boiled and left out for a day or two), and some masking tape. Around 9 we leave to go out into the community. We do about 5-6 house visits in the morning from 9am-1pm. We return and visit 2-3 patients in the afternoon from 3:30pm-6pm. I have been going out with a nurse named Maria (Mary) who is really cheery and fun to be around. I like her a lot and she is very patient and teaches me a lot.

         

Mary and I!!!!

         So far I have performed really basic care, and I have a feeling that is all I will do while in this specific position. Wound care (there are bed sores here like I have never seen), dressing changes, IV starts and hangs for those who are dying and can afford the comfort of hydration and possibly pain meds, vaccinations, bed baths, starting catheters, administering meds, changing colostomy bags. I am going to be a pro at taking manual blood pressures by the time I leave. I have also gotten to learn a little about the natural medicine that is used here. For example, a boy burned his bottom lip and it got infected, and Maria wrapped his lip in a penicillin leaf. We also do a lot of reflexology massage for pain (narcotics aren’t really a thing that happen here). I am really excited to learn more about natural remedies.

Mary hanging an IV from a wood and estera ceiling in a patient's house

         All I can say about the care here is that they do the best they can with what they’ve got. Literally the skin breakdown is so horrible here that it goes down to the bone. People die from bedsores. I have seen lots of bones and muscles just open to the air. I was cleaning an old lady’s leg wounds from skin breakdown, and I was cleaning her femur bone with no analgesics or pain meds at all. She was screaming the whole time but it had to happen. There are people so skinny that their muscles have completely disintegrated and they are just skin and bones – in a very literal sense. You can see the outline of every bone and joint. Range of motion exercises are barely something that is a priority, so many of these peoples’ knees and arms are permanently curled up in a flexed position. This is a project that I may want to start a movement for in the Hospice center.

Preventative care isn’t really done here because it really can’t be. IV antibiotics aren’t available, by mouth medicines are sometimes available but so expensive people cannot afford them. In the States where it is a goal to turn patients at least every 2 hours, here it is MAYBE every 2 days, or whenever Hospice visits and turns them, which could be twice a week or even just every Monday or however many times the family can afford it. All they do is change the dressings and put antibiotic cream on the wounds. Palliative care is also very different here than in the States. As I said before, pain medication isn’t really used and comfort isn’t the priority. The priority is prolonging life…. Which is pretty much the opposite of back home. Sterile procedures are also impossible. They have gloves that are packed in a sterile packet, but we only get one pair for the whole day and have to decide which patient and procedure has more of a priority. Today Maria put in a catheter with only clean gloves and had layed it down on a table before inserting it. I was shocked, but I guess that is just all they can do here??

Sol, one of my patient's grand daughters. She always tries to help when we are there.

We go to many different types of neighborhoods and houses. There is no specific socioeconomic class that Hospice caters to, it is just for anyone that can pay the minimum amount for the services. We have gone to houses with walls made of cardboard boxes and dirt floors, and houses with cement walls and tile floors. It really is interesting to see the economic class differences in such close proximity to each other.

Some diagnoses that my patients have had so far: Uterine cancer, breast cancer so bad that it is eating her breast away, spinal fracture causing waist down paralysis, Alzheimer’s, Diabetes, Cerebral Palsy, Epilepsy, brain tumors, and dementia, to name a few.

Me and one of my patients, Paula.

While this all sounds really sad and depressing… it is also very eye opening and I am learning a lot from the patients, their families, and the nurses, especially Maria. I am forming some great friendships out in the Chimbotano community. Things are done differently here but I think it will make me a better nurse in the end. I love being able to go into people’s homes and share this deep experience of caring for a loved one with them. Every hug and besito that I receive is an affirmation of why I am here; to embrace and learn from the Peruvian people and to do all that I can to walk in solidarity with them and offer anything I can to promote their health and well being. And I think that kind of love goes being lingual boundries.

P.S. Random fact: Almost all of the houses here look only half finished, and we were wondering if it was just so they could add on or build a second floor in the future. Well, Kyle found out that if a house is considered under construction then they don’t have to pay property taxes. So people just pretend their homes are still being built, but really they have no intention of adding on and are just avoiding taxes. Que interesante.