April 14th Yuri, Day 3

This is a direct quote from my journal today: "Exhausted once more. Literally exhausted. I don't know how people do this full-time. I feel spent, Lord - I need your strength and your energy."

Today was teaching day! Arrangements had been made for hospital staff to come to the Hogar for the teaching session so that there wouldn't be issues with so many people crossing the strike lines. 21 Nurses, Physicians, and Technicians filled the little conference room at the Hogar and away we went! I felt very nervous today. My greatest fear in coming to Peru was that I wouldn't be able to provide the information the hospital staff here were looking for. At the hospital yesterday they made it very clear they wanted to learn more about intubation (the placement of a breathing tube). Many times their Doctors are far away and unable to get to the hospital in time to intubate. The nurses felt that they wanted to be able to intubate in order to potentially save a child. Intubation is not in my scope of practice as an RN. It is a part of the Neonatal Rescusitation Program, of which I had planned to do most of my teaching from. I have assisted in hundreds of intubations and can intubate a rubber doll pretty darn well! but I really wanted to drive home the risks and complications of intubation to these staff members. The reality is that intubation in the real world is a much different thing than a controlled environment with a rubber doll (: It was quite something when we reached the topic of intubation to watch their faces as I talked about the complicaitons of intubation - their eyes got bigger and bigger. I felt like, yes! it's getting through to them!

Teaching, with Susan as my translator

One of the most amazing things I discovered when we visited the hospital is that just a week or so before we arrived, someone had donated a CPR baby to the hospital. The staff had never taken it out of the package, not really knowing what to do with it (all the instructions were in english). This baby is fantastic! and was exactly what I needed. Basically, the most important part to me was that when the baby ventilated properly, you actually see the chest rise on this doll, because there are little balloons inside its chest. Because it's such a visual aid, I was able to stress the assessments to ensure a baby is being ventilated properly.

The teaching baby and one of the two hosptial ambu-bags. It's hard to see because I cut it off in the picture, but the bottom of the ambu-bag is taped together.

The hospital mask with the one from McMaster behind it.

My most exciting moment came the day before when I was preparing for this teaching session. I took the bag and mask (the black one above) that the hospital uses and tried to ventilate the fake baby. Nothing...no chest rise. There was absolutely no seal on the mouth with that black mask. I then took one of the masks that McMaster University Hospital had donated for me to take (they donated about 14 of them, I believe) and the chest rose so beautifully!!! I was ecstatic...this could save a baby! It's vital when you're ventilating a baby with a bag and mask that the mask is the right fit for its face and McMaster sent different sizes of masks with me. The hospital in Yuri has been using the same mask for every sized baby because they didn't have anything else. Once they could see that you can ventilate so well with a bag and mask (when you have the right equipment), I think the urgency to be able to intubate fell by the wayside and I felt remarkably relieved simply because the zeal to intubate doesn't mean that it should always be done, especially when properly trained professionals aren't present.
So it was a good day of teaching: long, hard, but successful I think. The humidity was stifling at times and when we paused at one point, I downed a good 500 ml of fluid within seconds. It was new to teach with a translator and that brings a whole new challenge to your mind...remembering to break your sentences up in smaller pieces so that the translator can actually translate!
Dr. Valentin was at the teaching session today and she brought with her sad news: the 8 month old baby that we had seen in hospital yesterday died overnight. In many ways I was not surprised, but this was the first "in your face" realization for me that people are dying, that adequate health care is not reaching this part of the world and it is profoundly sad, but it is reality.

A few highlights from later on in the day:

* Meeting baby Jesús (pictured with me to the left). Jesús is 13 months old and is staying at the Hogar along with his two brothers and Mom while his Mom waits to give birth. He is one cuddler! and I thoroughly enjoyed our times to cuddle, sing and rock together.

*Lindsay's birthday today (one of the Hogar team members). It's Peruvian tradition to crack an egg over the head of the birthday person! Pretty funny.

*Meeting Levi and Laura. They are from Tarapoto and were in Yuri visiting friends but because of the strike are now stuck in Yuri, unable to pass the blockades to get home. As it turns out, it's to our benefit, as we are in need of another translator to go to the jungle and Levi happens to speak english!

*loving the life around the Hogar...the children are absolutely full of life and energy and they are so full of love...always looking for a hug or someone to sit with.

*Peruvian food - my favourite so far: cucumbers, tomatoes and avocados in this lime/oil mixture. SO tasty!! Papaya every morning and again...anything that has to do with chicken! Lots of eggs...always good.

*learned 15 new spanish words today! Thank heavens I'm actually writing them down!