Arrived Guatemala

Have you ever watched the TV show pimp my ride? The school buses here look like they’ve been a contestant on that show. The school buses look like the ones back home but have giant wheels raising them up at least another foot and they have detailing like they were competing in the show to be the most outrageous. I think the school buses function like regular buses and pick people up. They also have roof racks, almost the entire length of the bus. No pictures today because we were in every mode of transportation except trains.

I woke up at 2:30 to go to the airport. TSA stopped me to examine all my food. First breakfast was before we boarded at 4:30 am, falafels. In Miami, I bought avocado and toast at 8 am. We arrived at 3 pm, in Guatemala City and I ate my lunch of tofu and spinach. In Guatemala City, they have special McDonald delivery motorbikes. Think a motorcycle with a 3ft. Happy Meal attached to it. Pretty smart advertising, I thought.

We hopped on a bus for 3.5 hrs, to a small puddle hopper ferry to bring us to village of San Juan. We’ll stay here tomorrow visiting all the artisans in the village and Monday early make our way to the project site… a 10-12+ hr bus ride on a very windy road.

On my way to Guatemala

What time do you go to sleep if you have to wake up at 2:45 am?  Our group is meeting at the airport at 3:30 am. Apparently the little RDU airport is going to be packed with other students leaving on 5:30 am flights to alternate destinations for spring break.

I’m gearing up for my alternate spring break week to Guatemala and I’m more apprehensive than excited.  I’ve packed enough snacks and entertainment for 2 flights with layover, and two (10-12 hour) bus rides.  My brother hopes my bus ride is not like the bus ride we had in Laos where everyone was throwing up.  I don’t recall that bus ride being the worst of my life.  I think the worst was the overnight bus ride along the coast of Vietnam.  I recall that one being less than pleasant.

I downloaded 6 Kindle books and have a back up two paperbacks of homework when my electricity and batteries run out.  I am bringing an ipad and Lord of the Rings DVD set.  I am planning to buy my children’s gifts today – staying within the scope of what I am comfortable with – chalk/crayons/coloring books and maybe a soccer ball if I can find a pump.  My one week of luggage is a quite large.  I think the majority of items will stay there instead of returning back.  I packed both warm climate clothes for when we arrive to Guatemala City and winter clothes for when we head up to our project site in the remote mountainous region.  I was surprised to find out too, we are bringing on the plane the very expensive simulation mannequin.  I don’t think we are bringing the one that gives birth, but all of them do amazing things like breath and have heart beats.

I’m apprehensive about this trip because I acknowledge all the privilege and entitlement I have traveling to Guatemala for this one week cultural exchange.  I’m packing enough things for my one week of travel that likely cost more than a local person’s yearly salary.  How much can we actually share/teach?  The topics my group (fellow students) will be presenting on are: CPR, first aid, accidents, burns, care of newborn and the premature infant.  These are topics the community asked us to speak on.  We are also not speaking directly to the community members.  I am told we will be speaking to potentially two translators from English-Spanish-local dialect Chuj.  Our presentation materials also will need to be translated as such.  We were told most do not read, so our handouts will be mostly illustrations.  I am excited to learn from the midwives and hope our exchange is equally beneficial to them.

Day 1 Peds

I am told if someone has not peed or pooped on you, it’s a good day in peds. Well, then I will call today a win. Entering the world of pediatrics, I’m not all that surprised that I think peds is not the unit for me, but today is only day 1. Some nursing students know immediately when they found a home. They found a place they want to work every single day. I have yet to find that place and we are half way through our nursing program. Can you believe the time has gone by so quickly? Just when I thought January would never end, we have moved into March. I have two more populations to work with (grown ups and older people) during the summer.

In our first peds lecture, we talked about the role of the caregiver to the child, and the importance of leaning into that relationship. I wonder why in our first semester, we did not lean the other way. When working with adults, why was there not an emphasis on looking at the patient as a whole? For the adult patients to be well, I should have looked more into thinking about their support network to be well too, (their children, parents, or partner), helping manage their illness. Maybe we talked about this holistic way of viewing the patient, but I don’t think I recognized it until today. When I cared for my patient today, I cared for the family.

Also, today, I came across a chaplain note that read provided: compassion, presence and prayer. I really liked that, perhaps we can all do that with everyone: have compassion, presence and prayer.

Engaging Women. Exceptional Weekend.

Prefiero que sea un reto a que estés aburrida en clase…. translates to I would prefer you be challenged than bored in class, said the Spanish professor when I asked if I should take the beginner or intermediate level.  Sums up the story of my life.

We registered for summer classes already and I signed up for the required elective.  I feel it’s an oxymoron.  An elective is a class selected by the student, but it is still mandatory to take.  I signed up for Spanish, hoping to move past naming body parts to progressing to conducting a health history in Spanish.

This week was a tough week.  I asked my “difficult conversations” patient, if she had prepared her children for her death?  It took me one week to think about that idea before asking her about it.  I knew the answer before I asked but I wanted her to think about death from a different perspective.  Two more weeks will go by before I see her again and I want to ask her about plan A – hoping for the best, and having a plan B – planning for the worst.  I am so humbled by the experiences she so freely shares with me.  I do not think, she thinks of our conversations as learning for me, but I know I could not continue to grow unless I was challenged.

Thinking about death often is like a regular dinner conversation for me, always not far from my thoughts.  It makes me consider if I am living the best me.  If you do not have time left to live, did you spend your time the way you wanted to, with the people you wanted to be with, and doing the things you wanted to do.  These questions help guide me most days.

I listened to a panel this evening called Dignity, Diversity and Visions of a Good Death at Duke Chapel and I was most moved by one panelist, a Pastor said, “there is beauty in death, suffering is not eternal.”

Today… on my day off, I listened to two other panels.  This weekend is the (6th) Duke Alumni Women’s Weekend, “Engaging Women. Exceptional Weekend.”  Over 500+ alumni returned to campus.  I was a little blown away by the marketing and resources for this event.  I wonder if anyone else said to themselves that is a great logo, great color, design and tag line. I liked the program design, the pen and tote bag.  Seriously, someone spent some effort and money into making “Forever Learning.  Forever Duke.”

The plenary session was called, “Leadership: Fear, Failure and Other “F” words” by five (women) school deans.  The panel talked about the importance of mentors, being purposeful to create culture change, being a leader, a support network, and excellence in diversity.  They talked about how Duke was different from other schools, in that every single Duke student is exceptional and the vast resources.  The session made me feel inspired and uplifted.  It made me feel grateful to be surrounded by talented and brilliant faculty.  It made me feel grateful for the privilege of being a Duke student.

The other session was “build a life you love.”  I wasn’t supposed to sit in on this session (being a student) but I followed the lunch line.  Again with the resources, they had a really tasty catered lunch.  This Duke alumni speaker talked about using your strengths, values and priorities as your compass in making choices.  What we think, how we feel, what we do – utilizing your strengths will lead to satisfaction.  Below is the exercise we did.  It was kind of fun, I would recommend it.

Exercise #1:  A. Describe a time in your life where you felt on top of your game, peak performance.  B. Help your partner (the person sitting next to you at lunch) identify your strengths.  I liked this exercise because it was not asking you to identify your strengths but having a partner listen to your story and identify them for you.  (Link to finding your strengths).  My top 5 were curiosity, gratitude, social intelligence, bravery, honesty.

Exercise #2: Life Priorities: what areas of your life are important to you?  How satisfied are you with each on a scale of 1-10?  Buckets are things like: Relationships – naming each one separately (partner, family, friends, children), career, rest, health, personal growth, finances, fun, travel, physical environment – (home, community), self care, community service.

Exercise #3: Focus on one life area (from the bucket above) where you scored a low score, identify something that is off balance, needs attention, giving the bucket the time and energy it deserves.

Life Area: (list one of the buckets where you scored low) – i.e. health.

Vision:  example: I will feel good about my health and my body.  I will feel active, engaged, and spend more time outdoors.  I will embrace my body without negativity.

Current reality:  I sit all day every day in lecture and studying.  Not moving is having an impact on my health (weight), and impacting my self image.

My commitments: SMART goals – in the next two-six weeks, I will do: (Name your 5 commitments).  (i.e. I will visit the YMCA for membership in the next week.)

Potential Challenges: (Time, stress, weather)

To overcome these challenges I will: i.e. I will go to the gym as soon as I wake up to not conflict with other priorities of the day.

It was a nice exercise to think about areas of your life that are important to you but out of balance with your time and energy.  I liked taking a moment in my day to reflect on and refocus my priorities.  Homework is to complete one of those exercises for each of your buckets.  Are you spending your time and energy on the things you want to do?

Awareness + Choices = Satisfying Life

Failure and success

I love the story of Nathan Chen, a 18 year old US figure skater.  He fell in the short program, overcome by pressure and expectations of the Olympics.  Due to his failure, he had nothing to lose for the long program.  He scored the highest of all competitors #1 in the long program, raising his combined ranking from 17th to 5th, not enough for a podium finish but enough to make history with 6 quad jumps in his long program.  He would not have the audacity to take a chance on his competitive long program if he had not failed his short program.  I love that he changed his perspective of failure into motivation to succeed.  All of us can be so luckily to have that perspective.

I felt like a failure this week, doubting myself if I belong in this nursing program, questioning if I can pass all my exams, my classes and Boards at the end of the year.  I say this – not for sympathy but to know that not every day is a success and not every week is amazing – that I need to know failure is a chance to succeed tomorrow.

This week was rough – we had ATI maternity exam (which is like a national comparison exam on all things maternity, a predictor if you will pass Boards on this section of your learning), a midterm in Pharm/Pathology, quiz in Community Health, quiz in Professional Nursing, pop quiz in maternity and an Exam #2 in maternity the previous week – which ended poorly with some problems in administration and then a fix, which leads to more pressure for #3/final to compensate for fairness.

At some point in studying, you feel like something has to give, you cannot retain all this material.  Your eyes are tired.  You feel all of this is not sustainable and you can’t keep up with this pace.  On Monday, after our maternity final, our 6 weeks of maternity end and we transition to Pediatrics.  It has been a challenging 6 weeks of enormous learning.

At our last maternity clinical, I was able to work with a lactation consultant (LC) and it was life changing – at least it felt like that to me.  I could have said the same words to my patient but I would not have the success at delivery like the LC. It was her tone and experience that lead the mom to have confidence in herself and her abilities to breast feed.

I first observed the LC knock on the patient’s door and wait for a response.  When the patient said, come in.  She opened the door and before entering – at the doorway, she said, I’m [insert name], the lactation consultant, may I come in?  Right there, that stopped me.  She asked for permission to come into the room.  Every time, I knock on the door, I don’t wait for a response and just say hello, I’m here for x task.  It is presumed as a nurse, you will walk in to do what you need to do, where as the LC, waited for the invitation to be accepted.  By waiting for permission, she gave autonomy to the patient.

When we were in the room, she talked to the patient and asked about her pain around breast feeding.  The patient said her nipples felt sore, and the LC looked at her nipples and said, see this line – it shows the baby is not feeding correctly/latching and if continuing like that, it would lead to infection and the baby not getting enough feeding.

  • She then demonstrated the patient how to position the baby – that it should be belly to belly with you and on the same plane as your breast – propping a pillow under each arm.  She showed how to put her non dominant hand under her feeding breast like underwire and the other hand behind the baby’s back to help it feed and pull it closer to her.
  • She pointed to acupressure points on the baby – under the shoulder, near the clavicle and in their hand to put pressure in these spots to re-engage the baby’s interest in feeding.
  • She described the baby’s tight arm as still showing interest in feeding, but when the arm becomes floppy – it shows their “tank” is full.
  • The LC shared how colostrum – the new breast milk is thick as honey and will take a few days to flow into breast milk.  The mom had not understood this point with her previous baby, it lead to turning to formula to feed.

The mom failed at breastfeeding with her first baby, but now felt she could exclusively breastfeed and succeed.  She had the education to feel confident in her abilities.  The LC also shared a breastfeeding support group that was nearby and a phone number to call anytime she had questions.  The LC said at her check up with the pediatrician, there are LCs available if she had questions.  She put her phone number on the board so she could come back during the day if she had a question.  It was amazing to watch the LC give this mom confidence in her abilities and the follow up with resources after the visit.  It was so thorough, she walked her through every step and gave her support after her visit.  The LC was patient, gentle, caring and her voice/tone was understanding.

I hope to emulate my patient care like hers, to allow for patient autonomy and help in their learning/education to make them feel empowered in their choices.

Going for gold

Can we talk about Chloe Kim for just a second?  In between studying for Patho/Pharm exam – I can’t get enough and I probably watched her winning victory run a dozen times.  If you have no idea who I am talking about – go google it now.  I’ll wait.

I love that she tweets she’s “hangry” – that’s angry and hungry for not finishing her breakfast sandwich – in between her Olympic runs.  She tweeted about eating churros to calm her nerves.  Her dad is amazing – talk about goals – he quit his engineering job when she was 9 so he could support her by driving to Mammoth to train – almost 5 hours round trip – that’s 8 years of driving.  Talk about dedication!  He made a hand written sign that was laminated that said Go Chloe!  with a heart.  When she finished her first run, she went over to the family area and said to her parents, don’t cry.  Her 75 year old grandmother from Seoul, made a sign that said Go Chloe in Korean.  Her gold metal debut was the first time her grandmother had ever seen her compete.  Makes my heart melt.  I can’t even comprehend the love of a dad/parent to sacrifice all for your child.

Ok – now, I want to share my day.  I met with my patient from the DNP (difficult conversations workshop) – and I think it went well.  In 45 minutes, I connected with my patient and she shared with me things that she hasn’t shared with her physician.  I was really humbled she shared with me her personal experiences – diagnosis, treatment, and story.  She shared some of her regret and wants.  I asked her had she thought about dying?  And, she did, but we didn’t talk about that very much.  I hope to see her again next week.  In my conversation, I was thinking – you have incurable cancer.  I know you are dying, do you know you are dying?  I hope our conversations help her get to a place of acceptance.

Global work – underserved populations

I no longer know where my nursing education stops and life begins.  At my 4 hour orientation on Saturday with Church World Service we talked about how work is a big part of one’s identity in the US and newly displaced people from other countries – work is not necessarily a large part of one’s identity in their home country, as it is here.  When you meet someone new, one of the first questions they ask is, what do you do?  For a while, I didn’t like that question, because my answers never felt like they should define me.  I have worked at a lot of places and I have a lot of identities.  My work should not define who I am but, right now, my life is nothing but nursing.  I cannot see anymore where those boundaries stop.

CWS is an organization that welcomes refugees to the Triangle area (that’s Durham/Raleigh/NC) and assists them with support/tools/resources to begin a new life in the US.  They provide English classes, employment resources, immigration/legal and case management.  Starting in March, I’m teaming up with other nursing students and we’ll take turns working with a family recently arrived.  Below is a map of where the refugees in NC come from:

I look forward to working with a family.  I’m learning in my class that this type of work can be social work/case work, but in terms of our learning it is community public health.

Other orientations: Guatemala in 4 weeks, Tanzania in 8 weeks…

Guatemala: school partners with Curamericas Global.  Curamericas’ local partner in Guatemala is Casas Materna.  I’m traveling with 8 students and one clinical instructor.  We are going a very long way to work in rural villages in the mountains region of Huehuetenango (about 10,000 feet above sea level).  This area has one of the highest maternal and child morality rates in the country.  I’ll work alongside local community health workers and midwives to provide support to pregnant women and children under age five.

The CIA overthrew the popular, democratically elected government of Guatemala in 1954, ultimately leading Guatemala to the state that it is now.  (“Bitter Fruit” by Stephen Schleisnger and Stephen Kinzer)  They’ve also had a 36 year Civil War that ended in 1996.  Almost half of Guatemala’s population is under age 19, making it the youngest population in Latin America. Life expectancy is around 72 years of age.  School life expectancy is 11 years. (CIA, Fact book)…. and 51% of the population live below the poverty line, less than $1 a day.

I’m traveling from Raleigh-Miami-Guatemala City… overnight, one tourist day to get acclimated.  We’ll visit a coffee plantation that coincidentally ships to 3 places in the U.S. – one in Durham – Counter Coffee Culture is the shop in Durham.  Next day, we’ll make our way to the northwest (almost bordering Mexico).  I think we stop at Mayan ruins on the way and eventually continue on a 10-12 hour bus ride to our site work at Calhuitz (the isolated mountain region).  I am told there is no wi-fi there.  I’ll only be off the grid for about four days, then we make our way back to Guatemala City and fly home – that’s my spring break.

In 8 weeks – to Tanzania – a 5 am flight to London transferring to Nairobi, Kenya.  We’ll do an overnight in Kenya, then hop on a small charter flight to the border in Tanzania, where we will then take a bus to our site – Teamwork City of Hope.  We’ll be in Tanzania for two weeks working with 100+ orphans giving them health assessments and providing health education.  From what I have learned, we’re staying in guest accommodations at the site which are posh – running water (maybe not heated), flushing toilets (only in the guest housing), and they do have internet.  We have one fun day at a safari and a visit to a local market on our way to visit the big hospital.  I’ll be traveling with 10 other students and 1 clinical instructor.  On Sunday, we also go to church.  I’ve never been to church – like ever, so that’s kind of a new exciting experience too.  I am presuming the service will be in English, but it would be cool if it was in Swahili.  Dress code for both trips – Duke t-shirts and long skirts.  Women dress modestly in both areas we will be visiting.