ReSurge International Blog

Mali: Screening Patients

Bamako, Mali - Len Sterling, ReSurge volunteer burn nurse educator.

The first day we screened somewhere around 100 potential patients and accepted 71 for surgery. The state of malnutrition and medical needs was overwhelming. So many people brought their family members to be evaluated for treatment that the open air corridor outside our makeshift assessment and screening clinic doors was left with barely enough room to walk. Many hours of team labor went into preparing the area to work in and unpack our supplies and organize our work areas. The first two days yielded approximately 20 surgeries, and many children were seen for evaluation and orthotic splints to be made and fitted.

Photo from 2006 Mali clinic day.

Surgical Volunteers Head to Mali

 

The first surgical team of our 2011-2012 volunteer trip season headed off to Bamako, Mali, last week where they'll spend two weeks providing free surgeries to burn survivors. Accompanying the team is our international partner in Vietnam, Dr. Hien Thi Nguyen, who will be one of three anesthesiologists on the team. 

Meet 11 of the team members in this two-minute video, which captures their departure from the San Francisco airport and shows viewers why they volunteer.

One Thousand Surgeries

A heartfelt thank you goes out to our partner, Barco’s Nightingales Foundation, for their commitment to care for those who need it most. To date, the foundation has helped fund 1,000 life-changing surgeries for children around the world. On behalf of ReSurge and all our patients, thank you!

“[This milestone] is a great achievement and we are very proud,” said Michael Donner, founder of the foundation.

Visit the Barco's Nightingales Foundation's website and see their mission to “elevate and promote nursing, while also honoring the spirit of the profession by focusing [their] funding on helping children," in action.

Mali Volunteer Medical Team

These are our medical volunteers at the San Francisco airport headed to Bamako, Mali, where they will spend two weeks providing free surgery to burn survivors. This team's departure marks the beginning of ReSurge's team trip season in which we'll be sending nine volunteer medical teams to Africa, Asia and Latin America.

Visit our blog for updates on this team's time in Mali!

 

Teaching: A Collaborative Effort

Kathmandu, Nepal - Ingrid Crocco and Molly Attell, ReSurge volunteer nurse educators.

Molly and I have been exceptionally busy floating between nine wards.  We are involved with patient assessment and teaching alongside the Nepalese instructors—truly a collaborative effort.  We are having fun with this experience.

Assessment and Care

Kathmandu, Nepal - Ingrid Crocco and Molly Attell, ReSurge volunteer nurse educators.

Our first day of clinical was great.  The students were divided between nine wards with nursing leadership/instructors by their side.  Molly and I floated between assigned wards to help with patient assessment and care.  There were several opportunities for us to engage in this process, all of them extremely satisfying.  Dr. Rai was present part of the time as he was rounding on his patients.  After lunch we regrouped in a conference room to discuss the students’ patient assessments.  The students took turns presenting their case studies.  All of them did an impressive and thorough job in their assessments.  Molly asked them questions about applying the concepts globally, including interventions they might consider for a particular diagnosis.  It was a lively discussion group. 

Ideas to Empower Nurses

Kathmandu, Nepal - Ingrid Crocco and Molly Attell, ReSurge volunteer nurse educators.

Today, we had a long discussion of ideas on how to empower nurses to expand and elevate their practice.  These ideas included nurse rounding with physicians and their patients, nurse-driven practice committees (e.g., policies and procedures, skin integrity, competency development, ethics), and  nursing continuing education. We also had a discussion on staffing ratios.  We talked about how they might look into hiring per diem nurses and/or having an agency where they can obtain nurses to fill staffing gaps. They currently do not have per diem nurses or any registry nurse agencies.

Earthquake

Kathmandu, Nepal - Ingrid Crocco and Molly Attell, ReSurge volunteer nurse educators.

Ingrid and I were writing an e-mail when our room starting shaking.  This went on for several seconds until the shaking became violent.  We ran out of our room leaving the door open and everything behind.  Other guests were evacuating as well to the parking lot next to the hotel.  It took quite some time for us to settle back in.  We heard later that it was a 6.8 earthquake centered in Sikkim, India. After that we were unable to access the internet.  There have been several aftershocks since then.

Applying Concepts

Kathmandu, Nepal - Ingrid Crocco and Molly Attell, ReSurge volunteer nurse educators.

We thought it might be best to bring the nursing students into a clinical setting to practice applying the concepts they have been taught.  We designed a clinical patient assessment form outlining the concepts that the students can use to assess their patients.

A decision was made to assign nursing students and their nursing instructors/teachers to nine different wards.  From 8 am to noon each student will be required to complete one full assessment form.  After lunch from 1 pm to 3 pm the students will take turns presenting their case studies.  We have also asked them to speak to what went well and what could be done better.  ReSurge volunteer nurse educator Ingrid and I will have an instructor with us and we will be circulating between the nine units in order to aid the students with their assessments and make our own observations. 

Transformations Gala Invitation

Invitations went out this week for our fourth annual Transformations Gala. For the second year in a row, celebrities Adam Curry and Micky Hoogen will be the masters of ceremony for the event. Also returning this year is exclusive wine sponsor Wente Vineyards who will be serving their delicious wines to our guests. Take a look at our invitation by clicking here. 

If you would like us to mail you an invitation, please contact Libby Hart, development coordinator, at [email protected].

Passing the Baton

Kathmandu, Nepal - Cheryl Wraa, ReSurge volunteer nurse educator.

Sadly, this will be the last email report from me. Friday was a great day and an emotional day. It was the last day Katie and I would spend with the new nurses and the leaders. We are passing the baton off to ReSurge volunteer nurse educators Kim, Tina, Molly and Ingrid.

Molly and Ingrid were introduced to the new nurses for the first time. The new nurses spent the morning with the pharmacist attending lectures while our team worked with the nursing leadership and instructors to plan the teaching activities and help them complete standards of care. The nurse leaders and educators then presented us with beautiful necklaces and there were many warm goodbyes, tears and pictures.

We ended the day by meeting the director of PHECT Model Hospital-School of Nursing, Dr. Rai and his wife for dinner. Janice, a nutritionist from Australia, joined us for dinner as well. It was a long day and we were all tired when we got back to the hotel. Some ideas that have been discussed during our time in Nepal were for the new hospital to have a PACU in the burn operating theater and in the plastic surgery operating theater. This is a new concept for them so it will be helpful to have a PACU nurse and a burn nurse come back at that time to do some more training. They will also be hiring another group of nurses that will need to be trained.

It has been a busy and intense two weeks but we believe that it has been fruitful, collaborative and well worth it.

Teaching in Nepal: CPR and the Heimlich Maneuver

Kathmandu, Nepal - Cheryl Wraa, ReSurge volunteer nurse educator.

We visited the PHECT Model Hospital-School of Nursing this morning. The principal is very involved in nursing on a national level and was very proud to show us their school. The school is across the street from the Monkey Temple in a beautiful part of the city up on a hill. Katie, Tina and Kim then went to Kitipur where Katie presented the concept of tissue perfusion and gave a lecture on blood administration. Kim and Tina spent the afternoon teaching the nurses CPR and the Heimlich maneuver. I went back down to Kathmandu to welcome ReSurge volunteer nurse educators Molly Attell and Ingrid Crocco who will be taking over once Katie and I leave. Tomorrow we will all be together at the Model Hospital in Kathmandu. Katie and I are sad to say that tomorrow will be our last day with the new nurses and the nursing leaders. We will always carry with us the friendships and amazing experiences we have encountered on this journey.

Active Learning

Kathmandu, Nepal - Cheryl Wraa, ReSurge volunteer nurse educator.

Today was another great day. Dr. Rai spent the entire day with us again and participated in the activities. We started the day with a brief presentation on SBAR (Situation-Background-Assessment-Recommendation) reporting and then did practice scenarios. We followed that with lectures on mobility, positioning and skin breakdown with activities on splinting surgical wounds while transferring patients from a bed to a wheelchair or trolley and how to correctly position a patient in bed to prevent pressure sores. After lunch I gave a lecture on fluid and electrolytes which was followed by a discussion on IV therapy. Kim and Tina (ReSurge volunteer nurse educators) also did an exercise on evaluating urine color and what may cause the changes.

We ended the day as usual having tea and talking with the students and the leaders. On the way back to the hotel Dr. Rai said some of the new nurses told him that there are other nurses who originally did not want to take the training but have heard about it and would now like to be a part of the new hospital—he was very pleased. Tomorrow we are meeting with the head of the nursing school early in the morning and then will continue the training in Kitipur.

Teaching in Nepal: Presentations

Kathmandu, Nepal - Cheryl Wraa, ReSurge volunteer nurse educator.

Today was a long but fruitful day. The energy was very positive and very open.  Dr. Rai spent almost the entire day with the nursing leaders and us. I am so honored that he has taken the time and has so much invested in this program. They had asked my colleague, Katie Osborn, and I to prepare presentations and exercises on conversational skills and how to "break bad news." We gave our presentation in the morning—it was great. After lunch we talked about how to be a mentor, teach and set up a nurse residency program. By the end of the afternoon we were all exhausted. Everyone has the day off tomorrow, after which we’ll meet again with the nurse leaders, Dr. Rai and the administrator of the hospital to present the plan for the first week with the new hires. We are re-energized after today and will be ready for the next segment of our wonderful work.

Developing a Partnership

Fran Cunniffe, ReSurge associate director, medical education and outreach

We met with Partner for Surgery's president and co-founder, Frank Peterson (pictured far left) and in-country director Lindsay Coker (pictured far right). Partner for Surgery provides impoverished Guatemalans in the most rural, underserved areas of the country with sustainable access to health care and surgical care.  They focus on teaching and empowering the poor to be advocates for their own vital health care needs. According to their website, 1 out of 10 Guatemalans suffers from a surgically curable condition/disability; however, only 11% of the population has access to surgical care. Partner for Surgery is working to change those statistics, and recently opened a new surgical clinic in San Juan Sacatepequez, about an hour outside of Guatemala City (pictured below). 

They are hosting teams made up of international and local medical professionals to work at their facility, Clinica Santa Barbara, to provide care for the patients they recruit. Their operating rooms are fully equipped with new, U.S. standard of care equipment, and they have many supplies in stock so that visiting teams do not have to spend thousands of dollars shipping everything to Guatemala.  Adjacent to the clinic, they have built housing for the patients who come from far away and they provide meals for everyone who stays there, so that the economic burden of time spent away from work is minimal. Their service model is unique, impressive and fully aligned with the mission of ReSurge International, and we are excited to make plans for a partnership in the near future.

Remembering September 11, 2001

On September 11, 2001, ReSurge International (formerly Interplast) had U.S. medical volunteers teaching and providing surgeries in Nepal, Peru and Brazil.  While families of the volunteers asked that they return home immediately after the attacks, that was not an option, as planes were not flying.  More importantly, the medical volunteers wanted to stay overseas and complete the work they were doing.  For some, giving back by building surgical capacity and healing children was the best way to deal with their sorrow and anguish.  In addition, ReSurge’s partners in those countries, and around the world, embraced the volunteers and staff with an outpouring of support and solidarity.   Susan W. Hayes, ReSurge International president and CEO and InterAction board member, remembers the day in this 3-minute video.

Making Progress

Kathmandu, Nepal - Cheryl Wraa, ReSurge volunteer nurse educator.

Today was an interesting day. We started by attending the resident conference at the hospital in Kathmandu. We then spent the morning with the nurse leaders/educators preparing the schedule for next week when we will begin teaching the new nurses. We met with the nurse leaders in the new hospital where we began to work on policies, committees, staffing ratios and the nurse residency program. The new hospital will have a medical school there and eventually a nursing school. The current nursing school which PHECT supports is close to the new hospital. The administrator is very supportive of the project and changes Dr. Rai envisions. It was a challenging day but we feel positive and are moving forward.

A Holiday and Lectures

Kathmandu, Nepal - Cheryl Wraa, ReSurge volunteer nurse educator.

Today is a special holiday where the women dress in beautiful red saris and dance so that their husbands will have long lives. Therefore, we did not meet with the nurses today. Instead, we were invited to attend lectures being given to the surgical residents. An intern gave a presentation on breast cancer that was very well done. We then heard a lecture on burn care from Dr. Kamal, a guest from Bangladesh. He is the new director for the plastic surgery and burn surgery department. His presentation was very interesting and he acknowledged us and told all of the residents and physicians present that nursing education and the care given by the nurses is very important. It was an honor to be recognized.

The Meaning of Nursing in Nepal

Kathmandu, Nepal - Cheryl Wraa, ReSurge volunteer nurse educator.

We went to Kitipur today for the opening ceremony of the nursing education program. All of the nursing leaders, Dr. Rai, the health minister for their health association and the head of the new hospital including its new staff were present. Everyone gave speeches; the health minister's speech in particular was very moving. The new hospital is in a beautiful location and the facilities will be very nice when they are complete in about four to six months. They have an entire floor dedicated to acute burn patients with its own operating room, PACU, ICU and ward. They will need lots of support when they are ready to open the burn center. It will be the largest in Nepal! 

We were part of the inaugural ceremony and Dr. Rai talked a lot about ReSurge and their dedication and support.  He then listed 16 mantras for the new nurses. The new nurses read them and then talked about what they meant to them. They have all agreed to give at least two years to this hospital. We spent the afternoon with the nursing leaders and educators and Dr. Rai. We gave lectures on “Novice to Expert” and “Relationship Based Care”.  We then broke into groups to discuss what they wanted nursing to look like at the new hospital and how they wanted to change nursing in Nepal. We will spend the next two days working on how to make this a reality.

The nurses we are training are a very willing and energetic group. We are tired but energized by their enthusiasm and Dr. Rai’s support!

Teaching in Nepal: Day One

Kathmandu, Nepal - Cheryl Wraa, ReSurge volunteer nurse educator.

We spent the whole day with Dr. Rai, nursing leaders and two nursing instructors from the nursing school who have been working on a curriculum for our visit. We got to see it last night and gratefully it is not far from what we said we would help with. We spent part of the afternoon in the different areas of the hospital in Kathmandu. The PACU has six beds where they keep the patients for 24 hours after their surgery. The ICU has five beds and they had some nice equipment. The ICU nurse manager does all of the training for the ICU nurses. The wards have around 15 beds and around five private rooms (called cabins) which the patients can request and cost more. There are two nurses on during the day and one at night with an aid who helps clean. The hospital was clean and if they don't have enough beds they transfer the patients to another hospital which apparently is a daily occurrence. The things they were most interested in us helping them with were procedures and policies, scope of practice, nurse patient relationship, documentation, nursing assessment, nursing admission assessment form, pre-op checklists, how to break bad news and ICU skills. They are also very interested in a nurse residency program. When they looked over our teaching plan it was close to theirs - just a little different approach. The plan is to work with the nursing leaders first and then we will start teaching the new nurses on Monday. They are very interested in the active, scenario-based learning.

Photo by Darcy Padilla.