The Beginning of an End

by katie nugent photography

As we sit here in a cabana on the beach watching the waves at Coconut Grove Resort, it's hard to believe that five weeks have gone by so fast. Throughout this trip we have not had much down time to reflect on what we have accomplished in Ghana until now. Quite frankly, and literally, it has been a bumpy ride. We have faced many physical, emotional, and professional challenges. In spite of this, we have grown as nurses, individuals, and global health citizens.
Our global awareness has developed drastically since the beginning of this practicum. We have witnessed some of the most resilient and resourceful nurses, as well as, some of the most passionate and committed community members. We have learned from them in ways that words cannot describe. We are so thankful to the Ghanaians for welcoming and supporting us through our experience. We will take home many lessons that we will share and incorporate into our practice as Registered Nurses and global citizens. A special thank you to Dr. Vida Yakong for all the work that she has done and for continuing the partnership with UBC Okanagan.

by katie nugent photography

As a group of 20, we have shared many laughs and tears. We have learnt how to pee on the side of the road as a group, and survive off of Cliff bars and instant oatmeal. We can calculate exactly how many millilitres of water we will need to drink in a day and accept that sweat and dirt will be everywhere, always. We are now pros at 10 hour bus rides with no air conditioning, and some of us even perfected the art of puking into a glove.

Jeanette & Maggie
by katie nugent photography

Thank you to our amazing bus drivers Jacob and Peter for getting us to our destination safely even with a chicken in the back seat. A huge shout out to Clifford, Francis and Samed for watching over us and being our Ghanaian phone experts. Thank you to our instructors Maggie and Jeanette for supporting, guiding and loving us at our worst and best moments. Ghana has captured our hearts. We came as 18 UBCO nursing students, and we now are leaving as new grads with a shared experience that will bond us no matter where we end up.
***Posted by: Alishia Huston, Kelsey Bellerive and Emma Miller

Gala Girls in Ghana: Project GROW Day!

Women of Project GROW
Katie Nugent Photography

Our final day of practice in our nursing program was the celebration at Nyobok for Project GROW: Ghana Rural Opportunities for Women. This is a community development project aiming to empower women and build community capacity. Over the last 5 weeks we have had the pleasure of working with the inspiring Dr Vida Yakong, the founder of this initiative. Throughout the year, this organization helps provide sustainable opportunities for women of northern Ghana.  This celebration is the day that Project GROW gives away goats and donkeys with carts, as well as other items that have been identified as a priority by the women.  All the women who are involved in the communities are registered in the Project GROW program, and the women determine who has the greatest need each year.

Gala Girls with Goats!
Photo by Katie Nugent Photography

This year, we had 49 new goats for the women, 8 donkeys with carts, as well as 20 goats brought back from women already involved in the Project GROW initiative. The women agree to return their first female baby goat to Project GROW, and they do this without question.   As of today, this organization has over 500 women involved.  

Photo by Katie Nugent Photography

The celebration involved many prominent community members, including the Chief of the Nabdam district, health commissioners and an assembly member. One of the reasons Project GROW has been so successful is that the Chief of the Nabdam land has been supportive of Dr. Vida’s vision from the very beginning. We were fortunate to meet him, listen to his prayer for the ongoing success of the program, watch him pour libations to bless the day and listen his speech expressing his support for women’s empowerment in the community.  The speech and prayer were translated for us as this beautiful man has never been to school and doesn’t speak English.  His understanding that when women thrive, communities thrive comes from his heart.    

Nabdam Chief
Photo courtesy of Katie Nugent Photography

The five of us in our fourth year leadership and change project organized a fundraiser in Kelowna for donations towards Global Health initiatives.  We partnered with OkaZHI and all the proceeds from the fundraiser went towards health initiatives in both Ghana and Zambia. It was an honour to participate in the celebration of the distributions of goats, donkeys, and carts that were bought at the Global Gala.  It has been wonderful though the past five weeks to see the physical manifestation of funds generously donated by community members at the Global Gala.    

We also want to thank our fellow fourth year students who solely focused on fundraising for Project GROW.  This group volunteered their time at the Global Gala in November to sell shea butter made by the women at the Vocational Centre in Nyobok: Laura McBride, Mckinnley Massey, Mckenzie Gabara and Katie Hall.  Thanks Ladies!  The money from the shea butter started the work on the nurses’ accommodations at the Okanagan Community Health Centre.  It will be completed in the next few months.  Yay!

For more information about this amazing organization please visit:

www.projectgrow.ca

Posted by Emily Plant, Meagan Lentz, Stephanie Bandura, Mikaela Noble, Kenya Mokoena 

Konge-Logre Clinic

The Logre Team 

The Amanda's and Mikaela had the pleasure of working at the Kongo-Logre Clinic last week. This clinic runs several programs such as, antenatal care, child welfare screening, and an ART (antiretroviral therapy) clinic throughout the week. During our time there we were able to participate in the antenatal clinic which included maternal assessments and monitoring of the babies growth. We encountered a complicated situation where a mother was struggling with breastfeeding and engorgement. We were quick to notice that this situation was being handled much differently than what we are familiar with in Canada. They were using an alternative method to express breast milk which was causing the mother a great deal of discomfort. A few minutes in to the procedure, the midwife asked us what we would do at home. Upon discussion, we realized that the protocol we would follow at home was not able to translate directly to this culture and context, and therefore were able to collaborate with the staff to find the best solution for the mother with the resources that were available. We really enjoyed all that we learned during our time at the antenatal clinic.

The child welfare clinic was also an experience we were grateful to be a part of. We assessed growth and development, immunization status, nutrition, and general health screening. We were quick to dive right into the hands-on work and were thankful that the nurses and midwives were so eager to teach and encourage us.

Our last day was spent at the ART clinic, which was started and is predominately run by the midwife we had the pleasure to get to know so well over the week, "Mama B." Her passion for the clinic was very apparent in the care and follow up with every HIV positive individual. Assessment, counselling, and medical treatment is provided on a weekly basis. When barriers to accessing necessary treatment were apparent, mama B would go above and beyond to deliver medication and counselling to each individual who needed it.

Overall we found this experience very humbling and inspiring and we will use all that we have learned in our future practice. 

Posted by Amanda McCrate, Amanda March & Mikaela Noble

Okanagan Community Clinic - Nyobok

Last week we had the opportunity to work at the Okanagan Community Clinic in Nyobok. Over the years this clinic has been supported by various individuals from the Okanagan region. During our week at the clinic, we participated in health screening, HIV and Syphilis testing, well-baby checkups, and home visits. Over the course of our time at the clinic we screened approximately 205 adults and children in addition to the unregistered babies at the well-baby clinic. This would not have been possible without the teamwork between our peers and the staff of the clinic. The individuals we encountered had walked sometimes upwards of 12km to be screened by us in the clinic and for some, this was the only time they would come to the clinic all year. 

The biggest barrier we experienced was language. Clients at the clinic may have traveled from very far away, and therefore we encountered many different languages and dialects. In many interactions the workers at the clinic were also unfamiliar with the languages clients spoke, and used other patients or surrounding people as translators. Sometimes a phrase would go through several people in order to have it translated to the individual correctly. This posed a challenge of receiving accurate and timely information. Overall, we were thankful for the staff and community members support throughout this process.

 

We also had the privilege of being invited into the homes of the people of Nyobok during our home visits. During these visits, we talked with the clients about hygiene, assessed the homes for cleanliness and gave them an opportunity to express any concerns they had. During this process, many of the home dwellers rushed around to provide us with chairs to sit and we were continually asked if we wanted to stay for food. The respect the individuals had towards the nurse’s opinions “wow’d” us all. At one house in particular a women welcomed us into her home. From one of the back rooms a gentleman appeared and promptly fell over, drunk. Our nurse translated to us that the man was admitting to being an alcoholic and we had the opportunity to do some teaching regarding the impact alcoholism had on the body. When translated, the man was genuinely agreeable to the instructions to stop drinking and was very appreciative of guidance and information. After leaving the home, our nurse explained to us that they encounter alcoholism often, and that while the man may quit for some time, he may start again. The common theme between the six houses was their positive, welcoming attitude and innovative use of resources.

As a community clinic, one of the barriers this location has encountered in functioning at its fullest capacity is finding staff that are willing to do the commute. In recognition of this barrier, funds from the UBCO Global Gala 2016 have been used to begin building an eight-bed residence for nurses. This building was started in February of this year. Once this building is completed, they will have the ability to offer accommodations for a midwife to open their maternity clinic. In addition, they will be able to house the current staff, and others, to lessen the burden of the commute. As four of the five Gala Girls, it was amazing to see the walls of this residence under construction because of funds that we worked so hard to raise. Seeing the physical representation of the money raised in November is the perfect completion of the Gala project.

During our time at the Nyobok Clinic we had a challenging experience when a patient came to this rural setting in an acute hypertensive crisis, meaning his blood pressure was dangerously high and he was presenting with symptoms that needed immediate medical attention. This situation was challenging for a few reasons. To begin with, as amazing as the Nyobok clinic is, there are limited resources including medications and equipment that are needed when a patient such as this requires help. This patient in particular required blood pressure medication and to be monitored regularly. This is where we were able to witness the amazing critical thinking and resourcefulness of the staff. With our suggestions of what needed to take place, the nursing staff began calling nearby clinics to try and secure medications, as well as arrange for an ambulance to take the patient to a hospital or clinic with more resources. The nearest clinic was about 20 minutes away and the nearest hospital was about one hour away. One of the nurses opted to take his own motorcycle and go pick up medications with one of the nursing students and bring them back to the clinic. The remaining staff, students and our instructors were discussing ways to transport the patient if an ambulance was not able to be secured, the last resort being a donkey and a cart. Luckily, an ambulance was eventually secured and the staff was able to provide medications and assist the patient to the hospital after he became stable. The tireless effort that these nurses went to to make sure this patient was going to be cared for was amazing to witness and we our thankful to have had this opportunity to see what needs to happen in an acute crisis in the most rural setting.

This was also challenging for us as students as we were not clear on our defined roles in an emergent situation where resources are limited. We came to this clinic as visitors looking to learn and expand our practice, however we did not anticipate this situation nor did we fully understand the proper processes and barriers that these rural clinics have to go through when presented with an acutely ill patient. We were not prepared for the amount of work that goes into transferring someone to a higher level of care in a rural setting as we are lucky enough to work in a place where there are well established protocols and procedures for these situations. We used this experience as a learning opportunity and reminder that we have the knowledge and skills to care for all patients in all settings and to trust ourselves and all that we are capable of. 

We are so grateful for our time at the Nyobok clinic and for the close ties it shares with the Kelowna community and all the learning we were able to accomplish during our short time there. 

Posted by: Stephanie Bandura, Emily Plant, Megan Lentz, Kenya Mokoena, Danielle DeYagher, Carmen Morgan and Rebecca Ellis

Nangodi Clinic

Our group has moved North to Bolga. We split into four groups to serve four community clinics surrounding the city of Bolga. Our clinic was located in the village of Nangodi and was the largest and the most acute serving this region. The clinic consisted of a mental health unit, a child and maternal health department, a consulting room, a lab, a dispensary, and a two bed ward. The villagers of this community are challenged with transportation so this clinic serves as their primary health care facility. Having such an comprehensive clinic to serve a rural population is essential in Ghana and could be a model for our rural communities back home. This facility is staffed by medical, mental health and community nurses, in addition to midwives, and a physician’s assistant. Our group worked alongside these health care providers for four days and had the opportunity to experience all aspects of the clinic.

Kids celebrating after receiving their vitamins

One of the most fulfilling and engaging components of our time in Nangodi was working alongside the community nurses. We were able to accompany them to the local schools to administer Vitamin A supplements to children under five.. The children were as excited to see us as we were to see them. You have never seen kids so excited to take their vitamins!

In our partnership with the community nurses we also did home visits for well-baby checkups. There was visible frustration in the community nurse due to lack of adherence to the vaccination schedule from some mothers. Our nurse had a discussion with the mother of a 2 ½ year old child who had not followed up with the health care team for his 18 month checkup. We asked the mother why she was finding it difficult to come down to the clinic, hoping to find a solution, but the mother was silent. We could only guess at the reason for her hesitation, leaving the community nurse to simply shake her head and move on. The clinic is working to educate families of the importance of proper health and ways to do so to increase engagement between nurses and mothers. For example, this Monday there will be a cooking workshop to teach moms how to best preserve nutrients in their meals.

We also worked with a physician’s assistant who acts as the primary health provider for not only Nangodi but also neighbouring communities. We nurtured a very collaborative relationship and taught each other a great deal. Learning the care of tropical diseases was a new experience for us all and we were able to witness the care for malaria, typhoid, a snake bite, and digestive worms to name a few. Having a patient pull a snake out of a bag that had bit him earlier was definitely a first!

Staff at the Nangodi clinic

Despite the variety of services the clinic currently provides, the staff is aware of a lack of access to health care for their youth population. In acknowledging this they are currently expanding the clinic to include an adolescent reproductive health unit. We were inspired by the determination of the staff to educate and care for the community and we are hopeful that we will see more of this model of holistic healthcare at home. 

Posted by Andrea Naka, Kelsey Bellerive, Harveer Pooni and Carolyn Grinham. 

Sakote Clinic!

Sakote Clinic Tree
Photo credit @katienugent

This week we were welcomed with open arms to the Sakote Clinic. Our journey began at the Sakote community health meeting that is held every three months. The Chiefs, "Queen" Mother, Sub-Chiefs, Elders and other village members greeted us with singing and dancing. Once again our dancing skills were put to test as the whole village hysterically laughed at our slick moves. At these meetings the community discusses health concerns and the Sakote clinic staff addresses them. Topics include exclusive breastfeeding, proper nutrition, anemia, malaria, and encouragement of early detection and treatment for all other health needs. 

For the next three days at the clinic, we screened several pregnant women and newborns for prenatal and postnatal care. Lets just say our ovaries were exploding and we all caught a case of baby fever! We worked alongside the midwife, Lamisi, where we focused on prenatal teaching, monitoring pregnant mothers, providing nutritional education, interpreting lab tests, and assessing the overall well being of the clients. 

Cooking Day with the women

According to the Sakote Clinic statistics, anemia is present among 57% of the pregnant women in the community. In order to address this issue, the midwives and nurses provide the women with prenatal vitamins during each visit, regardless of insurance coverage. They even held a cooking class where over 70 women were taught on how to properly prepare and cook nutritious meals using strictly local and iron enriched ingredients. We embraced the Ghanaian culture by helping prepare aleefu, bitter, dawadawa, small fish and the fowl with the women. 

                                                             

Mashing up dried fish

One of the challenges that the Sakote village faces is accessibility to higher level of care that is located in Bolga (60 minute drive away). The lack of transportation and financial constraints for individuals make places like the Sakote clinic vital for the well-being of a community. The primary health care system in Ghana exceeds any thing we have in Canada.The primary health care model empowers individuals to access healthcare locally, and focuses on health services like health promotion, prenatal screening, family planning, illness and injury prevention, home visits, child welfare as well as minor emergency services, all under one roof. If there were something that we could take home and change about our Canadian health care system, it would be to strengthen our primary health care. We are in awe of how well this clinic serves their community with the little resources that they have. For example, women of the community bring water to the clinic every morning so the staff members can wash their hands. It is truly amazing to see the resilience and passion of the staff for the well-being of the community. At Sakote, the nurses live steps away in residences located on the clinic property which allows them to provide 24 hour care. They live and breathe community health care and this is shown through the love and relational practice they have with their clients. Learning from them was a privilege and we will forever cherish this time spent with them.

Posted by:  Jessica Sherbinin, Jade Geddes, Emma Miller and Alishia Huston

Sakote Staff

 

Chanshegu Grand Opening!!

Chanshegu Clinic 

Chanshegu is a rural village located in northern Ghana, just outside of Tamale. There is very limited access to healthcare resources in this village and as a result, many preventable deaths occur. In addition, the hospital is located some distance away so people are unable to receive medical care in time. In 2013, nursing students from UBCO started the initiative to build and fund a healthcare clinic in this rural village that will allow its residents to have access to healthcare resources. Once the clinic is up and running, many services will be provided such as maternity and well baby checkups, immunizations for children, and routine public health screenings.  It will be awhile before it is commissioned by Ghana Health Services, but Jeanette and Maggie started the process by providing funds to secure the land title, and register the clinic in Accra.  These funds were raised by a group of fourth year students (including Harveer).  The funds were also used to purchase an examination bed, maternity bed, standing scale, hanging scale, delivery kit, benches, and some very basic supplies.  Harveer was able to purchase and deliver the equipment and supplies and set up the clinic with a group of students. Yay!  We  had it all ready by Thursday afternoon.

Traditional dancers doing their thing!

Canadians trying to keep up...

Last Friday we held the very first community health screening at the clinic! Upon arrival, we were warmly welcomed by the residents of Chanshegu. We had the opportunity to meet both the Chief and the village's respected elders, as well as sit front row for three cultural dances. The dances were performed to celebrate the opening day of the clinic. The traditional style dances and music consisted of drums, beads, colourful clothing, singing, and a range of movements. We even got to participate in the final dance!! YAY! We had such an incredible time trying to learn the various traditional dance moves and the people had an entertaining time laughing at our dance moves. We are grateful to have received such a warm welcome in Chanshegu and had a beautiful start to our very jam packed day!

The Chief - Our first Client

We knew very little about what to expect when running and organizing a health screening clinic for the day, but we worked together as a team successfully. We set up tents and chairs just outside the clinic and had three stations set up to record each individual's blood pressure and health concerns. Those individuals that needed to be seen by the lovely Nurse Practitioner, Francis, were sent into the clinic and waited to be seen. There was also a newly graduated mid-wife, Joanna, who assessed all the pregnant women. As nurses, we triaged the people according to their blood pressure readings, blood glucose results, accompanying symptoms, and whether they were pregnant or not. The most challenging part was the language barrier and trying to get someone to translate in order to provide education or information.   The Chief was our first client.  He expresses his gratitude to everyone back home who has contributed so generously to his village and this project.

The Community waiting for screening

Overall, the day was a HUGE success and we saw about 350 people! We even had time to play soccer and other activities with the children of the village. 

From here, Dr. Sumed (an obstetrician at Tamale Teaching Hospital) and some volunteer midwives and NPs will begin working with Ghana Health Services to provide antenatal care, child welfare clinics and health talks.  They will start small, and grow as they are able.  After 5 years of tireless fundraising and perseverance, waiting for the right people to come together, the clinic will begin!  It feels good. 

Playing soccer with these beautiful children

After a long but fulfilling day, we loaded the bus and headed to Dr. Vida Yakong's house, who graciously opened her home to all of us for dinner. Their hospitality was much appreciated after a long day in the sun! We were blessed to have cold drinks, a delicious dinner, and even ice cream for dessert. The fellowship, laughs, and stories made for a great night! It was also Carmen's birthday, so we all serenaded her by singing happy birthday and celebrating together. And we FINALLY convinced Francis to sing for us and he was amazing!

Posted by Megan Lentz and Harveer Pooni

The Shekhinah Clinic

All of us had the opportunity to spend two days volunteering at the Shekhinah Clinic in Tamale. This clinic was started by Dr David Abdulai who was the only child of eleven to survive from malnutrition and poverty. He dedicated his life to helping the poor and destitute through his food program (which began in 1992) and medical clinic. The clinic is run entirely by volunteers and depends on "divine providence" to continue.  All services are absolutely free. The clinic experienced a devastating loss this year as their beloved Dr. David passed away, yet the work continues.

We each spent a day working in the clinic, and another day working with the men and women who provide and deliver the lunches for the homeless mentally ill population of Tamale. We were amazed that this hot lunch program has not missed a day since it began 24 years ago because Dr. Abdulai was adamant, up to his death, that "the stomach knows no holiday."

The medical clinic consists of the outpatient clinic, laboratory, pharmacy, small operating theater and housing which is mostly occupied by mentally ill and HIV infected community members. All of the services provided are completely free of charge and the only request of the staff is that those who are physically able lend a hand cooking and cleaning.

The Operating Theatre Crew

Being at this clinic was truly inspiring for all of us. Each of the staff members, including Dr Abdulai's wife, share his passion and work tirelessly to keep his dreams alive. We felt very humbled by the community spirit and generosity that is clearly present at this clinic. It is difficult to convey the overwhelming emotion and selflessness that we experienced working alongside these volunteers, most of whom have duties and responsibilities outside of the clinic. Like Dr Abdulai, they demonstrated a "never ending work of love and service for humanity."

Jeanette and Maggie were able to share a generous donation from home with the staff. This $1000 CAD will keep the food program running for months.  Everyone was very grateful.  Divine Providence in action!

To date, this was one of the most rewarding experiences that we have encountered during our time in Ghana and we feel very privileged to have been a part of the Shekhinah Clinic.

Posted by Carmen Morgan, Danielle DeYagher, Rebecca Ellis & Mikaela Noble

Emerg at TTH

Walking into the Emergency Department at the Tamale Teaching Hospital, our senses were assaulted. The air hung heavy and still, the smells were overpowering and a heart rate monitor was pinging loudly. However, we were immediately oriented to the floor with a warm and welcoming nurse named Doris, who guided us through the triaging system. As soon as we introduced ourselves, the heart rate monitor began to alarm noisily behind us and a couple of us gravitated towards the noise to see if we could help. A male nurse, David, began to work on the male patient and allowed us to assist him. He quizzed us right off the bat and would later become our primary mentor. We even managed to teach him a thing or two, despite his high level of skill and knowledge.

The hospital is reserved only for the sickest patients. According to nursing staff and students, Ghanaians use the hospital as their last resort. This can be due to a preference for traditional healing, inability to cover medical costs, lack of family support, and fear of hospitals. Some of the common limitations to care were the inability to provide medications until the patient or family paid for them, lack of equipment and language barriers. However, family support in the emergency department was commonplace and frankly, essential. Almost every patient had a loved one at their bedside, washing them up, providing food, paying for medications, going to get the medication, and even arranging diagnostic tests such as running the blood samples to the lab. Where we have auxiliary staff at home, such as porters, dietary and care aids, they have family. At home in Canada, family is discouraged from gathering in the Emergency Department and we are quick to ask loved ones to leave when procedures are being done. There is still much work to be done at home in terms of family centered care. Here at the ED in Ghana, nurses recognize that they could not do their jobs without the support of families.

Although the conditions in the ED were less than ideal, nurses here show amazing resilience and collaboration. We now have a greater appreciation for the resources and systems established at home. We will take what we have learned here at the Tamale Teaching Hospital and incorporate it into our practice back home in Canada.

Posted by:  Jade Geddes, Emma Miller, Carolyn Grinham and Jessica Sherbinin

Pediatrics at Tamale Teaching Hospital

We came into this week on Pediatrics at Tamale Teaching Hospital expecting to see some of the saddest stories imaginable. While that was true, our week was filled with an overwhelming sense of hope and positivity. For all of us, this week has been challenging and rewarding. Here’s just a snapshot of some of our experiences.

Most of the patients that are seen on this floor have multiple diagnoses, making them some of the most critical cases that we have experienced. The acuity of their illness is often because of how long families wait to bring them to the hospital due to cultural perception and barriers. These barriers can include finances, travel, previous experiences in the hospital and family obligations. While in Canada families contribute to care, in Ghana we have seen how much the health care system as a whole relies on families. They are required to buy medications, bring linens, provide food, do personal care, and organize medical testing.  All this while managing home responsibilities and work commitments.

Our Ghanaian colleagues and us on the peds floor at TTH

We were told about the resiliency and resourcefulness of our Ghanaian nursing colleagues, but what we witnessed this week on the Pediatric Ward at TTH blew these expectations away. At times, one nurse can be responsible for up to twenty critically ill patients. The limited amount of resources that nurses have access to, and we routinely take for granted, also challenges their level of care. These nurses are focused not on what they can’t do, but what they can do with what they have. Their scope is different from ours, but the standards of care they uphold are exceptional. Almost immediately, we made connections with these nurses that enabled us to have open and honest communication about issues and barriers in our respective health care systems. Nursing is universal, and the goal is to provide the best care for the patients in front of us. Through this, we are connected.

Us in our happy place!!!

Our underlying reason for being here is to teach, learn and deepen our understanding of global health. Not just with the medicine we deliver in the hospital, but by recognizing the impact of colonization. If we could heal the damage done by centuries of power displacement and hegemony we could repair the loss of culture, identity, health and autonomy. We have come into a low resource country, but we have seen how important the resource of family and community is. At home, we view resources as machines and “things”, whereas here their strongest resource is family and community. Being able to see the family-centred care being provided here has shown us how we can utilize it in our own health care system and nursing practice.

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Alishia Huston, Andrea Kouwenhoven, Megan Lentz, Amanda March and Emily Plant

Tamale Teaching Hospital- NICU

Skin to Skin

Last week we had the opportunity to work alongside the nurses and doctors in the Neonatal Intensive Care Unit. It was an eye opening, rewarding, and challenging experience for the three of us. We saw the tiniest and sickest babies imaginable. Although the NICU looked much different than our's does at home, the same principles were applied, with much more resourcefulness and creative thinking. These nurses individually take care of as many babies as approximately four nurses would in Canada. The infants are very sick with complex care needs. In the critical care unit, there were 19 babies, who each needed to be fed and given IV fluids every 2 hours. At times, there were as few as 2 nurses in that room trying to manage the workload.

Incubators

The doctors do rounds on every neonate each day to reassess their needs and plan for discharge so that the babies can be home with their families as soon as possible. We were surprised by the advanced nature of their equipment and supplies. They had incubators similar to the ones that we use at home. However, there is a high need for the resources, and a limited amount of supplies leading to multiple infants being cared for in one incubator. Ideally, the incubators should house one infant at a time, to provide an optimal environment for their healing, as each child has specific requirements .

In addition to the critical care room, there was a Kangaroo Care room, and an "open crib room", where the neonates who were almost ready to be discharged stayed. In the Kangaroo Care room, skin to skin and the teaching regarding its importance was practiced, as well as breastfeeding, and tending to their infant's needs. The language barrier was difficult and there were many things we wished we could have shared with the moms and were unable to do so effectively. The staff were very receptive to feedback and suggestions for improvement which was encouraging to us. We felt that our knowledge and opinions were valued and allowed for us to feel like we contributed something important. We are thankful that we received such a warm welcome onto the floor and for everything we learned and were able to teach. 

Posted by: Stephanie Bandura, Amanda McCrate, and Harveer Pooni