Why did I sign up for this?
The purpose of my time in Bangladesh is to work as a nurse in the Rohingya refugee camps near the Myanmar border with Medical Teams International. I had been following the genocide of the Rohingya very closely in the news for quite some time, and felt compelled to not just sit back and watch their plight. As hundreds of thousands of refugees poured in, the need for humanitarian aid has grown. And as a nurse, I have been gifted with great skills to help others. That, coupled with my desire to travel and serve others, led me to feel as if this is exactly the kind of thing I have been called to do. So, what exactly does this mission look like?
Capacity Building:
At this stage of the response, the purpose of international medical workers is “capacity building.” This means that the goal is to train up the national Bangladeshi staff so that they gain the skills, knowledge, and self-sufficiency to eventually function well without foreign assistance. In short, we are training them to be more capable doctors and nurses. The healthcare needs in the refugee camps are great- yet they are not at a crisis level at this time. There are no major disease outbreaks- the diphtheria outbreak has passed, and a cholera outbreak was avoided during monsoon season. And I think that is pretty darn amazing considering the size of the camp, and the crowded and unsanitary living conditions.
What are the clinics like?
My organization has three primary health centers and two health posts, all functioning 10am-3pm, 6 days a week. We provide primary care and take care of urgent health needs, have antenatal and post-natal care provided by midwives, an in-house counsellor, health education officers, vaccinators, and an army of community health workers. The community health worker team is amazing- they are Rohingya themselves, and have been trained to go into the tents and educate the people on health and hygiene issues, follow up on patients seen in the clinic, do contract tracing for certain communicable diseases, and so much more. They are an awesome and indispensable resource. The clinics are relatively large, made of bamboo and wood with high ceilings. There are generators to run the fans and a handful of lights, but sometimes they aren’t working and it gets rather hot inside. There is no running water, but handwashing stations have been made from buckets with spigots, which totally work. I would not call the facilities or equipment fancy by any means, but they are absolutely functional and adequate for safe patient care. We have anywhere from 2-4 doctors, 4-9 nurses, and bunches of other staff such as midwives, pharmacists, translators, CHWs, vaccinators, porters, and health education officers working each day.
What I actually do every day:
Since my work in the refugee camp is capacity building, I am not supposed to provide direct patient care in the clinics. Instead, I fill the role of nurse educator/mentor. I am there as a resource to the national Bangladeshi nurses. I watch that they do vitals and growth monitoring properly, can calculate medication doses accurately, and perform procedures correctly. I try to help them think critically- such as rechecking vital signs that seem inaccurate, or the importance of assessment and reassessment pre/post medications and treatments. I assure that they are triaging patients effectively, and correctly identifying urgent priority patients. I encourage them to educate and advocate for their patients. I also function a bit as the infection control police, ensuring that equipment is properly disinfected, isolation is done correctly, and that hand hygiene is performed. I’ll admit though- as an ICU nurse that likes action, this is not my natural habitat. This role is not one of high acuity, and that has been an adjustment for me. The Bangladeshi nurses are pretty well trained and do a good job at this point, thanks to the many volunteer nurses who came before me, so the tasks now focus on fine-tuning skills and developing critical thinking.
In addition, training is a huge part of my role. The national nurses are enthusiastic and eager to learn just about everything. Sometimes that takes the form of classroom skills training, but it can also be using moments of downtime to discuss small things come up during the day (such as troubleshooting equipment that isn’t working, pain assessment, what to do in an emergency if a doctor isn’t available, etc.) I am one of several international nurse volunteers in the organization, and the other nurses have a number of excellent ongoing education projects. And in the spirit of capacity building, the “train the trainer” model has been developed and is widely used. Doctors, nurses, or midwives in each facility will receive training or research a topic, then teach it to their own staff during the week.
Patient population and most common complaints:
We get a good mix of pediatric and adult patients. I have not touched a pediatric patient since nursing school, so I’m definitely learning quite a bit on that front myself! The most common complaints are dyspepsia, pain, diarrhea, upper respiratory infections, cough, and fever. We’ve also seen a handful of conversion disorder cases, too. I’m actually a bit disappointed that things aren’t more exotic- I want to put my tropical nursing diploma to use! Where is the malaria and dengue and typhoid? Worms definitely are a thing though, and there have been a few cases of mumps.
Frustrations:
There are many frustrations! Funding issues directly affect the medications and equipment we can purchase- we often run out of important medications and have to find the next best alternative. Some medical equipment, particularly nebulizers and oxygen tubing, is in short supply and must be disinfected after each use, before another patient needs it. One oxygen tank means that two people cannot be on oxygen at once. Patients often get lost to follow up after they leave the clinic, and frequently forget to bring their medical records back to the clinic. However, considering everything, I think our doctors and nurses provide very good medical care with what is provided.
Interesting things I have encountered:
Nebulizer treatments are given from a battery power pack; when that is broken, a bike pump is used instead.
Porters are used to carry sick patients that can’t walk, as much of the camp is not accessible by vehicle. Sometimes the “stretcher” is the patient wrapped in a large blanket, with the ends tied around a bamboo pole, carried at both ends by the porters.
Instead of IV catheters being placed for a one-time IV medication, the med will be directly infused into the vein via a butterfly needle.
There is a special IV solution for acute watery diarrhea, called Koloride (cholera saline)
No one (except expats) wears scrubs – the women wear 3 piece salwar kameez always!
No IV pumps… IV drip rates must be calculated and the drips actually counted! (talk about forgotten nursing school skills).
If you want a patient to have an x-ray, blood test, EKG, or sputum test, they must be referred out- often to different facilities for each of those tests (And you can’t guarantee the patient will actually go there, and come back for follow up!)
So, it has been an adjustment and learning experience for me so far, but the national Bangladeshi staff- every last one of them- has been so fantastically open and welcoming. This environment makes you realize how privileged we are in the United States to have excellent medical care, and also how we take for granted and misuse some of the resources that we have.
If you want some more background on my experience, check out my last post- Bangladesh: The Beginning