We have now spent a few days in the hospital and have adjusted to the routine. We are only going 3 days per week, which is nice. It takes an hour and 10 minutes to get there, and we´re supposed to be there by 7 am. I wrote about the first day when we waited for the bus for an hour and it never came.. Now we are walking from where we get off the 1st bus to where the terminal for the 2nd bus is, which is a good 20-25 minutes.
Everyone in the hospital has been really nice! It is generally pretty slow, because there are always 6 nurses for the unit, and there has been 3 patients, at most. It is a long narrow room with 6 beds. It gives us time to practice our Spanish some with the nurses, and we are glad that it´s not a really stressful environment. We don´t feel like it´s very cost effective to have that many people sitting around, but I guess the nurses are getting hours at least. They only work 3 shifts per week, and most of them work the same amount at another hospital as well.
All of the patients have been on ventilators and are sedated. There is a step-down unit where they are transferred after extubation, which usually has a few more patients. Last week there was a 6-year-old with Tetrology of Fallot who was on an external heart machine, I forgot what it is called. She had had heart surgery the day before, but was bleeding internally. They opened her back up, and suctioned the blood and placed some tubes, which we watched. She had no ventricular function, but they couldn´t figure out why. Later she went for a cardiac cath, but they didn´t have portable oxygen, so they would unplug the O2 from the wall and run to plug it in at the next bed. When they returned to the room, the were doing CPR the whole way until the heart machine was plugged back in. Apparently she had arrested in the hall, but they did save her. We had to leave for class shortly after, so I´m not sure what ended up happening.. I think she went to a different hospital.
The 1-year-old I wrote about last week had been on a high-frequency ventilator. The doctor said that there are only like 7 of them in Guatemala, so they have to prioritize which patient´s need them more. They have had to take it away from her before so that other patients, elsewhere in the country, could use it. I should read more about the difference in ventilators, or the rationale in using high-frequency, but he was saying that it reduces barotrauma. Anyway, the one she was using broke a few days ago, so they were having a hard time getting her O2 sats up with the regular ventilator. They seemed to be good when we left that day, but she wasn´t there when we arrived this morning. The nurse said she died yesterday. I didn´t ask details about what went wrong, but she had been very sick and in the hospital her whole life. Sad situation. Who knows, but if she had been in a more developed country she may have had a different outcome.
The doctor that coordinated this for us is named Ricardo Mack, and he is awesome. He is really friendly and always takes time to explain pathophys, show us Xrays, etc. Yesterday we attended a meeting where the doctors presented cases. I didn´t understand a lot of it, but they were discussing a 7-year-old with VSD. One doctor, who was visiting, thought they should look up research from developed countries on how to handle the case. Dr. Mack explained to us that it is impossible because developed countries don´t have 7-year-olds with VSD, or 6-year-olds with Tetrology of Fallot. They would operate and get it taken care of ASAP. I suppose it is a money issue, which actually really sucks.
We have been really impressed with the sterile technique of the nurses. They are very adamant about washing their hands before and after touching a patient, and they clean the thermometer and stethoscope before each use. There is actually a pediatric Litmann for each bed. There are signs on the wall explaining sterile technique for central lines, which Dr. Mack said he took from a research article done by Harvard or something. The medical terminology hasn´t been hard at all either. Most of the words, and names of medications, are very similar to the English terms. Most patients have 5-7 IV pumps at all times, which are labeled directly in big letters. Generally, they all have one for sedación (midazolam), dobutamina, electrolytes, furosemida, formula (or TPN, I guess), and heparina.
Enough of the depressing stuff. Steph and I arranged to have Friday off so we can go to Tikal! It is an 8 hour overnight bus ride away, and is Mayan ruins which Guatemala is famous for. We are pretty excited :) Our sister booked a hotel for us, which is cheap but looks pretty good. We will go overnight Thursday night, stay Friday night there, and come back overnight Saturday night.
Sorry this was so long! Have a good weekend!
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