By Francine Westergaard, MSN, RN, JCI/JCR Consultant with Joint Commission International, Joint Commission Resources, Oak Brook, IL. Francine graduated from a diploma school many years ago, eventually returning to school to obtain a BSN and MSN. She is currently enrolled in an MBA program. The majority of her nursing career has been spent in pediatrics in various clinical and administrative positions in pediatric critical care, out-patient pediatrics and transport medicine. She is a member of Sigma Theta Tau, The American Academy of Pediatrics, and an active volunteer for the American Heart Association. 

In October 2006, I had the opportunity along with nine other health care providers to travel to China and visit several pediatric hospitals. This was a wonderful opportunity for us to see the differences and similarities in healthcare outside the U.S. The invitation to participate in this cultural experience came earlier that year. The Medical and Teaching staff from Fudan University  and Children's Hospital inquired about holding the First International Intensive Care Symposium.

Francine with one of the nurse managers in Shanghai Children's Hospital. Right: The course participants starting intraosseous needles into chicken legs and listening to the didactic session.
 

The event was held over three days. The first day consisted of didactic lectures. The course participants were pediatricians, pediatric intensivists, pediatric residents and pediatric nurses. The slides were displayed on two screens, one in Chinese and one in English. The symposium content covered fluid resuscitation, traumatic brain injury, ethics, pediatric transport, pediatric cardiology and EMS systems. The second and third days were filled with a pediatric advanced life support course.

The students enjoyed inserting intraosseous needles into chicken legs. They were fascinated while intubating simulator manikins. Our main obstacle was the language barrier. We pantomimed our way through several procedures. At one point, I was trying to explain the ideal insertion site for an intraosseous needle. I looked out at the audience and saw many confused faces. I lifted the leg of my pants and pointed to the land mark by the tibial tuberosity. Every student in the room bent down and lifted their pant leg and pointed to the medial aspect of their shin, below their knee. One student reached over and did the same to one of the other instructors.

The Chinese nurses had many questions for us about nursing in the United States. How did we recruit nurses? How did we retain them? Are there different pay scales for experienced nurses versus new nurses?

The pediatricians were proud to show us their newly opened pediatric sleep center. One facility has had a neonatal/pediatric transport program for more than two years. They transfer more than 2000 children each year from rural areas. Children in the pediatric intensive care unit are on PRISMA, high frequency ventilation and the Chinese are developing an ECMO program. EMS is eager to standardize care in the country.

The differences amazed us. The pediatric outpatient clinic saw 3000-4000 patients a DAY. The children didn't have primary care pediatricians so they would come to the clinic when they were ill. The nurses start over 700 IVs each day. The infusion room isn't large enough to hold all the children so IVs are placed at the top of a wooden pole. One parent carries the child and the other carries the pole. Supplies that we take for granted are not always available, for example, personal protective equipment is not available in many units. Nurses wear caps to distinguish them from the other staff. The nurse-patient ratio is very different from ours. Parents are expected to stay with the child to assist with care. There are no registration clerks, respiratory therapists, patient care assistants or computer information specialists because the nurse does it all.

A pediatric infusion room (top) and a family walking their child outside until the infusion is complete.  

There is a tremendous amount of building going on as the Chinese prepare for the 2008 Summer Olympics in Beijing. Private investors are building new hospitals in each of the major cities. The current hospitals do not have air conditioning and in the summer temperatures can reach more than 110 degrees. Open windows and fans provide the only relief for patients that are admitted for dehydration, sepsis, and encephalitis from mosquito bites.

This was a wonderful opportunity for the physicians, nurses and respiratory care practitioners that participated in this program. Our students were excited and eager to learn from us. We were humbled by their intense desire and curiosity. So much of what we have, such as supplies, equipment and knowledge is a valuable, precious asset for our children and future. I believe each of us left China with a new appreciation for the care we provide each day and the teaching we were able to provide.

By Teresa R. Wilmore, BSN, RN, nursing supervisor, St. Joseph's Hospital, Philadelphia, PA. Teresa is also pursuing her MSN in community health at West Chester University, West Chester, PA.

Are you aware that cardiovascular disease is the leading cause of death in African Americans, killing over 101,000 men and women in 2004 alone? Did you know that nearly 52,000 African American men and women between the ages of 45 and 84 died of cancer or that their incidence of stroke was almost twice that of whites in 2004? As the American Heart Association has noted in the above significant facts, the African American community is being ravished by diseases that could be better controlled through more effective health education and promotion. Many communities have programs that offer sessions on the top three offenders -- hypertension, stroke, and cancer -- but unfortunately, somewhere between the healthcare system and the community a communication gap exists. As healthcare providers, it is time for us to speak up and do something about it.

Being a young African American woman who grew up in the inner city, it was understood that the importance of "community" served as the heart of many activities. The word "community," as defined by Merriam Webster's dictionary, is a unified body of individuals. As a culture, the advancement of our community, in all aspects, will always remain a great focus. Though there are other important issues that tend to take precedence, health must come back to the forefront.     

Health promotion within the community has been in place in various settings over time, from hospitals to churches to recreation centers. These are important places to hold information sessions because it is where the people are. As healthcare providers, we need to improve on thinking outside of the box to begin delivering more health promotion sessions and activities that reach the African American community in other places. Venues such as concerts, social gatherings, and shopping areas, encourage crowds and may include the target audiences that need to be addressed. Information given there should be in a straight-to-the-point fashion, with pamphlets or handouts with catch phrases and attention grabbers. Awareness is the first, key step to change. Once the people become familiar with the issues, more engaging health promotion events can be developed. These events should be detail oriented, yet captivating with creative and innovative ways of delivery, focusing on health promotion such as screening and risk reduction for example.

We are nurses -- healthcare professionals who the public trusts for our skills and compassion. Health issues, like those greatly affecting the African American people, challenge us to showcase our knowledge and experience. Take this time to speak up; not only for the nursing profession, but more importantly, for the African American community.

Dispatch from Michael Paras - Wednesday April 23, 2008

By Wednesday the medical team on the ground in Honduras had already seen and treated 230 patients and performed 40 surgeries. Although the team focuses mostly on children, they don't turn anyone away that they can treat.

There are so many obstacles that each family has had to endure just to see the medical team in Tela. Some have traveled for hours on stifling hot school buses, the Telan version of a Greyhound coach. Others just walk.

They always arrive in their Sunday best (if they have them), and with no air conditioning and temperatures hovering in the high nineties, each patient waits patiently to receive care from the Lutheran HealthCare team.

In a country where the majority of its citizens have no access to basic health care, many of their stories highlight the lengths families in Honduras have to go to receive any type of medical help. Fortunately, the volunteers have done everything in their power to provide high quality care and, more importantly, compassion. Those that can't be seen this week will wait until next year to see the medical missionaries.

Dispatch from Michael Paras -  April 22, 2008

Jean Hemmans, R.N., and her husband, Ruperto, started the New York Honduran Committee along with a small band of fellow Telan immigrants. Since 1999, they have completed more than 12 medical missions bringing hope and a chance for a new future to thousands of families. In a country where most people can't afford basic health care, the chance for free medical care can be a life-saving opportunity. Early on the organization got connected with Lutheran HealthCare surgeons and nurses. Since 1999, the group has continued to grow and has branched out to offer a wide variety of services from general surgery, to hearing, to speech and language testing. 

Dispatch from Michael Paras -  Monday April 21, 2008

A critical member of the Lutheran HealthCare team in Honduras is otolaryngologist Ramez Habib, M.D. The New York Honduran Committee, the group that Lutheran partners with each year, informed the Telan community that an ENT expert would be accompanying the team.

It was quickly evident when the team arrived that there were many Telans suffering from a variety of ear nose and throat issues. After examining dozens of young children on Sunday, Dr. Habib was able to schedule six surgeries for Monday.

One of them, 8-year-old Christopher Flowers, who lives in the nearby town called Barrio Way, was having tonsils issues. After a visit with Dr. Habib Sunday morning, he was admitted to the hospital and by 9 a.m. the next day, his tonsils were removed. 

On March 29, 2008 Lee Woodruff gave the Agnes M. Marshall keynote address entitled ‘In an instant: Lee and Bob Woodruff's journey of recovery and healing' to open the 40th annual educational meeting of the American Association of Neuroscience Nurses. It was a great fit with the theme of the conference: Celebrate the Journey! Building on excellence with vision and venture.

Lee began by telling us she had good and bad news. The bad news was that her husband, Bob, who was supposed to co-present with her could not make it. She told us she knew that, as nurses, we would understand that as a result of his injuries suffered when he was hit with an improvised explosive device in Iraq and suffered a traumatic brain injury he needed some urgent dental work. She reassured us that the good news was that she was the better speaker of the two. I believe she was right, we all sat spellbound and, at times teary eyed, as she told us over the next hour the intense story of Bob's injury and the entire family's journey to heal and recover from the explosion that changed all their lives in an instant.

I am a veteran conference attendee, sometimes going to as many as 10 conferences all over the world in any given year. So I am usually quite ho hum, to say the least, about these big name keynote speakers, especially celebrities. This keynote was different though. First of all I was keenly interested as Bob had suffered a traumatic brain injury and as a neuroscience nurse I am well aware of the challenges of caring for these patients. Secondly Lee won me over totally with her comments about nursing and her insight about the pivotal roles the nurses played in Bob's care and ultimate recovery. I was so inspired that I promptly bought not one but two copies of their book: In an instant: A family's journey of love and healing (2008).

Andrea Kerr is a frequent contributor to Advance. With the help of Michael Paras, she will provide readers with daily updates on Lutheran HealthCare's medical mission work in Tela, Honduras.

Dispatch from Michael Paras - Monday April 21, 2008

Mary Haeney, a registered nurse at Lutheran has accompanied the medical brigade to Honduras for three years now. She's always level headed and calm. And that ability to deliver comfort and support was evident in two very different situations. 

As is usually the case, patients -- after waiting a full year -- are very anxious to see the health team.

Besides comforting nervous patients one-on-one during an exam, she has had to switch gears and perform crowd control. Nurses everywhere have to be both tough and kind, and like Mary, be calm and compassionate in a wide variety of situations.

Dispatch from Michael Paras - Sunday April 20^th

Lutheran's team of doctors and medical staff performed 162 examinations in Honduras the first day. Here are just a few patient snapshots.

Elsa Romero, 77, experiencing periodic but serious painful earaches. She heard about the medical missionaries on a little transistor radio she always keeps with her to catch up on the news.

Angeli Idalmir Arzu Palacios, 19, lives in a neighborhood in Tela called Barrio San Jose. She heard about the medical team and hoped someone could remove a mole from her daughter's chest. Although it's probably not too serious, young Shelsea Diana Arzu, 2, is traumatized by the whole experience so far.

Iladia Figueroa, 76, Martina Diego Guzman, 63, and Simona Diego Mejia, 66, visited the clinic together. The trio of best friends all had eye problems, high blood pressure and a variety of hearing related issues. 

The day before the Lutheran team landed in Honduras, Julian Acosta, age 5, was playing outside and had gotten a stone lodged in his right ear. He was in great pain and his mom, Miriam, age 22, brought him to the hospital's emergency room. The hospital staff suggested she wait and see the volunteers the next day. This was an easy one for the group, and after a thoroughly flushing, the pebble was removed.

Unfortunately, the team can't help everyone though, as was the case with Mariana Casellanos. Mariana had sought help before from other doctors but with little success. She was understandably excited to see the team from Lutheran and she hoped they'd be able to alleviate the severe pain and discomfort she'd endured for years from a sinus issue. The 41 year-old Honduran was at her wits end but was sure the American health crew could solve her problems. After an exam by otolaryngologist Ramez Habib, M.D., the team knew they couldn't help. She had a polyp, too large for them to operate. Mariana was crushed, and so was the team.

Andrea Kerr is a frequent contributor to Advance. With the help of Michael Paras, she will provide readers with daily updates on Lutheran HealthCare's medical mission work in Tela, Honduras.

Dispatch from Michael Paras - Sunday, April 20, 2008

Because of scheduling difficulties the team members arrive on three separate fights into Honduras. Regardless, the bulk of the crew is anxious to get settled and begin their work. Word quickly spread throughout town that the team would host their first clinic early Sunday morning even though some of the crew had arrived just a few hours earlier!

They arrive at 'La Hospital Tela' at 7 a.m. Sunday.

Already, there are around 60 people waiting to be seen. By 8:30 a.m. the crowd swells into the hundreds.

Inside, as the groups of people get bigger, the team immediately starts to triage and treat patients. They travel from all over Honduras to see the medical group. Some are seriously ill and the mission team is their last resort, others have minor pains and issues that they can remedy quickly. The nurses, doctors and support staffs are looking out mostly for kids who need operations they can handle in the time they have in Tela.

Andrea Kerr is a frequent contributor to Advance. With the help of Michael Paras, she will provide readers with daily updates on Lutheran HealthCare's medical mission work in Tela, Honduras.

About 20 Lutheran HealthCare volunteers arrived in Honduras this weekend; they'll be in the city of Tela until April 26^th providing medical care and free reconstructive surgeries in the medically underserved region.

They are there on behalf of the New York Honduran Committee, which began medical mission trips in 1999. The group, headed by Brooklyn's LHC Trauma Center surgeon Mohan Kilaru, M.D., consists of surgeons, nurses, physician assistants, technicians, and speech/language/hearing experts.

The volunteers will first focus on providing life-saving surgeries for children at a local hospital in Tela. As one of the poorest countries in the western hemisphere (second only to Haiti), the region's children suffer from a high rate of childhood illnesses that are often left uncared for.  Over the past two years the group has examined more than 790 patients and performed close to 100 medical procedures.

In addition to paying their own expenses the volunteers have raised much needed money to purchase medical supplies and gifts for the local children. Sponsors include the LHC Medical and Dental staff who donated $2,500, and Chief of Orthopedic Trauma Thomas Lyon, M.D., who donated $1,000 to support the medical mission's efforts.

We'll provide daily updates and photographs to Advance readers as we receive reports from the team's photographer, Michael Paras. So, hold onto your laptops because this team works at lightening speed to see as many patients as possible throughout the day!