Wednesday, May 22, 2013

Segundo día en HENM y caminando el centro por la noche

I had wanted to post this yesterday but we were without internet again. I'm now at the UAQ computer lab with wifi so here is a recap of Tuesday:

Today we went back to Hospital de Especialidades del Niño y la Mujer (HENM) for our second day in the NICU and on the L&D floor. At first, I thought I would be going to the NICU with the group who was on L&D yesterday with me. However, after thinking about the rare opportunity to see so many deliveries in a short amount of time, I asked Mary if she would mind if I went back to L&D with Hannah and Ellie B. She graciously let me go with them along with Marlen (the UAQ student substituting for Nanci again today) and Ryan, who joined us today in order to see a live birth and observe a PT working in the hospital. 

We met at 8:15am and piled in one of the UAQ vans as usual. However, this van had some strange seating going on that resulted in me not being able to see out the windshield despite sitting in the first row. This coupled with the fact that our driver was very stop-and-go left me with the worst headache and a slight bout of nausea. Luckily these subsided as soon as we arrived at HENM and my feet were able to touch solid ground. We dropped our bags off in a conference room, shoved our snacks in pockets for later, retrieved our protective wear, and split up into separate groups. 

Mary had been telling Ryan (who had never seen a birth) before we even left for Mexico that if he observed a delivery, he was NOT allowed to faint by any means. This morning she reiterated this, along with the fact that he MUST IMMEDIATELY leave the room / delivery area and sit down if he felt at all faint or dizzy or ANYTHING out of the ordinary. I added to this sentiment by telling him that if he did in fact faint, I would by no means attempt to break his fall, as he's well over 6 ft tall and probably 200 lbs and I am a dwarf next to him. It's not like I really doubted his ability to handle the delivery, but considering yesterday the air conditioning was broken and there was so much movement in and out of the room that even experienced nursing students who had seen births had to leave the room as a result made me wary. In fact, the other girls with me (Hannah and Ellie B.) had also not yet seen a birth since they haven't had their OB clinical yet, so it was also pressed upon them to remove themselves from the area if they felt uneasy. 

Thankfully, the air conditioning was working just fine right from the time we got there and there also seemed to be a lull in deliveries. I showed them the two laboring rooms, the postpartum area in the back, two c-section rooms, two urgent delivery and general gynecological procedure rooms, and the room designated for spontaneous and elective abortions. I encouraged the nursing students to seek out opportunities to get involved with patient care. We met the charge nurse for the day and were then informed of a c-section that was getting started in one of the rooms. I was so relieved when all the students handled it well! Nobody felt faint or had to leave the room and were able to see the whole process. When the baby was lifted out of the uterus by the doctor, I heard Ryan behind me saying, "Oh, there it is! There's the baby!" almost in awe. It was too precious (both the infant and Ryan's reaction). Not too long after the c-section we were all able to observe a vaginal delivery, which the students handled well, too. Ryan left soon after to follow the hospital PT around while Hannah, Ellie and I stayed behind. 

It was during the vaginal delivery that I introduced myself to the pediatrician, Dr. Perez, who was standing by. He asked where we were from and what we were studying and I told him him that me, Hannah, and Ellie were nursing students from the U.S. Once he learned that I was a senior student and the other two were still early on in their nursing education, he made it a point throughout the day to get us involved in different deliveries to see and learn as much as we could about the role of the OB nurses at the hospital. He also had us assist every now and then throughout the day, such as having Hannah tie his surgical attire before he assisted in a c-section and hold oxygen for a newborn delivered via emergency c-section due to meconium. 

As we watched three more vaginal deliveries, two more c-sections, a dilation and curettage (D&C) for a miscarriage, and postpartum mother / baby care, it was interesting to see how the nurse acted in so many different roles for each situation. With so many responsibilities, it's no wonder the nurses are all over the place and running back and forth between patients and rooms. Today I got to see some of the nurses act as encouragers for laboring women, which answered my question from yesterday about it possibly being culturally driven. This encouragement was slightly different from that in the U.S., though. It seemed to be more of a "tough love," with nurses and doctors encouraging the mother to stop crying or yelling out and to instead put her energy into pushing. However, they used terms of endearment such as "mija" (mi hija = my dear) and it was evident that they were trying to be supportive and empower the women in having the ability to get through the hardship that is birth. Another thing that I saw today that I didn't observe yesterday was presenting the mother with the baby after completing the newborn assessment and medication administration. The nurse (or the pediatrician, in the case of emergencies) completes a full newborn assessment, checking APGAR scores, vital signs, reflexes, etc. as well as administering prophylaxis eye drops and vitamin K injection. After wiping the infant off and swaddling, the nurse or pediatrician then brings the baby to the mother's side to "introduce" them and have the mother give the baby a "besito" (little kiss). It was so beautiful to see the instant connection between mom and baby each time. 

At one point, a nurse who was teaching some Mexican nursing students allowed us to be part of one of her lessons. We used a Pinard horn (which is like an ear trumpet) to listen to fetal heart rate on a couple of laboring women. It was fascinating to learn how to use this instrument, since I had only learned about electronic fetal heart rate monitoring during my OB clinical back home. My OB professor had mentioned the Pinard horns at one point, but we didn't go in depth about them since we are not likely to come in contact with them working in the U.S. However, I'm so glad I had the opportunity to learn about it here in Mexico. When I saw the nurse using it and teaching her students, I pushed Hannah and Ellie to politely ask questions and if they could try it since they most likely wouldn't get the chance otherwise. 

By the end of the day, we were exhausted from the constant movement and hustle and bustle of the unit. It was an awesome experience and I'm so grateful to have had the opportunity to be on the L&D floor twice. While I intended to observe in the NICU today, I may try to get that unit back home for my internship this fall so I can get some experience that way. I am really happy Mary let me stick around the L&D unit to experience more births. While it was very sad and difficult to watch, I am also grateful for the chance to stand in on a D&C and see how that process is carried out. The past two days have been an amazing learning experience and I can't believe I had all of these opportunities to observe. 

After removing and throwing away our disposable scrubs, we met back up with the Mary and the other students. We headed back to UAQ on the dreaded van with all the stop-and-go driving and I felt even worse than this morning when I was able to jump out. Mary wasn't feeling well either (but due to dehydration) so we quickly walked home. She decided to take a nap while I changed and headed downtown back to Express Arte Caffe for a light lunch and iced coffee and to start writing this blog post. It was such a relaxing and refreshing afternoon sitting in the cafe with the doors open and breeze going in and out. I stayed for two and a half hours, taking my time eating, sipping, and writing. I decided to wander around the area for a while before heading home, walking through bookshops and other little stores as I zigzagged through the streets. As I made my way back to the casa, I stopped at a little panadería along the way that Mary and I have gone to countless times since arriving in Mexico. We've always gotten a variety of sweets each time and I've come to love these cookies called "orejas" (ears). They're made to look like elephant ears and are very crisp and taste like sugar cookies but lighter and more buttery. They're fantastic :) 

After I got back home, Mary and I had to go to the Mega mercado (grocery store) to pick up some more items for the dinner we are having at our house tomorrow. Ryan and his host brother, Alex, had hoped to have the group meet up for some drinks and catching up but nobody in the group felt up for the trek to the bar they had chosen. After some texting, I said I would be interested in hanging out with them in the downtown area since it was within walking distance and then I wouldn't have to take a bus or taxi alone. So they swung by our casa to pick me up and the three of us walked downtown. We went to a "tranquilo" (calm) bar, had some cervezas Mexicanas (Mexican beers), and had some great conversation. Alex and I spoke a lot in Spanish while Ryan tried to follow, and then I talked with Ryan in English and Alex attempted to follow the conversation. We talked about each others' lives, the differences in nursing and nursing school between Mexico and the U.S., and we joked about how Ryan is "un niño consentido" (a spoiled child) in Mexico because his host mom loves him so much and does so much more for him (cooks him his favorite foods, washes all of his clothes, picks up his room, etc.) than she does for her own son, Alex. After finishing up our drinks, we decided to just walk around between different plazas. Along the way, I learned so much cultural stuff from Alex! For example, he told me that Querétaro is so clean because the government pays workers to wash the plazas, sidewalks, and streets every night. They drive around with large water tanks and hoses and spray down each plaza and along the road. They also pay workers to sweep all of the sidewalks and storeowners also regularly wash these with soap and water. Additionally, he explained to me the difference between "mudarse" (to change positions) and "moverse" (to move places) and taught me cultural phrases, vocab words, and social norms (such as calling a person "naco" who is of lower socioeconomic status - saying this to someone's face is acceptable and taken as a joke between friends but is very offensive with strangers). He also told me that it is safer for me at night to walk in the middle of the street rather than the sidewalk because there are so many places people can lurk and hide for snatching. The middle of the street is out in the open and more well-lit and thus safer for walking at night when alone. To be noted, he DID say that this is NOT common in Mexico (the lurking and subsequent snatching, that is) but sometimes it happens and it is better to just stay on the safe side. I was also able to learn about both Alex's and Ryan's aspirations and goals in life and just get to know them better. It was both fun and relaxing to hang out with them and I'm so glad they decided to come to the centro (downtown) area so we could all go out together. 

Tomorrow is our last free Wednesday and I can't believe that we leave to go back home in exactly one week - where did the time go? It has FLOWN by and I've truly loved every minute of it. It has been wonderful learning about the Mexican culture, specifically their health care system and the many roles of nurses in this country. I've even enjoyed the challenge of sharpening my Spanish speaking skills, since the practice was lacking the past four years since graduating from Hope with that degree. As we head into our last week here I hope to enjoy and really soak everything up :)

Hasta la próxima vez!

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