Prior to clinical, I was not sure about how much I could participate in and how much of it would be different. I figured that because of the language barrier, I wouldn’t be allowed to do much, but surprisingly I have been able to practice some of my skills. Our first week we split up in a group of seven (six of which are my roommates) and we went to the Centro de Salud de Monagrillo. This was much like a county clinic at home in which it was divided into pediatrics, gynecology, injections, and general assessment. The first day, I worked at the injection station and performed around forty vaccinations and other routine injections. I was surprised that although I couldn’t speak any Spanish, the nurse still patiently worked with me and allowed me to prepare and administer each and every injection. Before coming, I knew some of their equipment and techniques were different, but I did not know to what extent. One of the biggest differences is that there are no 
safety devices on the needles, nor do the nurses use gloves. Also, they would recap all the used needles using both hands which is enough to make you cringe. Another difference is that they do not use the Z-track method when performing intramuscular injections, but rather pinch much like a subcutaneous shot. My next day there I went to the general assessment room where they only do manual blood pressures as they do not have the resources to do it by machine so I was able to get plenty of practice which is great because it is rare to do manual blood pressures at home. I also assisted with wound care which I figured was practically universal, but I found out it is actually very different. There is no sterile procedure for such a task nor is there use of Bacitracin or other ointments. Instead, they just pour normal saline on the wound and use gauze to wipe it and cover it (even when it was a severe decubitus ulcer). The next day I went to pediatrics where I was able to administer injections in the thigh (which I have never done on a child before) as well as watch development testes and assess their growth progress by measuring their head circumference, weight, and height. On our last day I worked in gynecology and performed a pap smear by myself and completed a breast exam. I was surprised about the patient education regarding self-breast exams as the nurse spent a lot of time with each patient explaining to her about signs and symptoms to be aware of. I’ve been very impressed with the amount of work that the nurses do; they perform pap smears and are required to deliver a set number of babies in order to fulfill requirements. On the last day, this woman barged in our room and was screaming as she was holding her very young son who was actively having a seizure; it was a scary sight. The first people to respond were nurses and the physician did not come till minutes later. There are a few things about their care that I agree with and disagree with. One of the things I really liked about the hospital ER is that they had it set up in a way that people who just needed fluids (who were dehydrated, etc.) could immediately be brought to a hallway of chairs and receive their IV and fluids there; this allows beds to be freed up for more severe problems and for them to treat multiple patients at one time. Another aspect I liked is the responsibility of the nurses. They are in charge of so many aspects of care and float around to wherever they are needed throughout the day. Some of the things I dislike about what I’ve seen mostly stems from the lack of finances and resources. For instance, the lack of needled safety devices is dangerous (especially with the amount of injections they do a day) but these needles are more expensive. I think the most surprising thing about clinical is the lack of patient privacy. Social security cards are kept with their file that day which lay around the office and their numbers are written on whiteboards behind their beds (which they use for patient identification like we use name a date of birth). In the case with pediatrics, more than one family was in the room at a time, and meeting with the doctor occurred at a neighboring desk in the same room. I’ve learned a lot in regards to providing the best patient care possible with the resources available. They use whatever they already have on hand to complete all the necessary tasks and I’ve been very impressed with their flexibility. I’ve loved the experience in the clinics so far as I’ve been able to practice skills that may not be as common in America. I’m looking forward to this next week and a half as we will continue our time at the medical hospital and then end with a few days in the psychiatric hospital. Until next time,
-Christy
safety devices on the needles, nor do the nurses use gloves. Also, they would recap all the used needles using both hands which is enough to make you cringe. Another difference is that they do not use the Z-track method when performing intramuscular injections, but rather pinch much like a subcutaneous shot. My next day there I went to the general assessment room where they only do manual blood pressures as they do not have the resources to do it by machine so I was able to get plenty of practice which is great because it is rare to do manual blood pressures at home. I also assisted with wound care which I figured was practically universal, but I found out it is actually very different. There is no sterile procedure for such a task nor is there use of Bacitracin or other ointments. Instead, they just pour normal saline on the wound and use gauze to wipe it and cover it (even when it was a severe decubitus ulcer). The next day I went to pediatrics where I was able to administer injections in the thigh (which I have never done on a child before) as well as watch development testes and assess their growth progress by measuring their head circumference, weight, and height. On our last day I worked in gynecology and performed a pap smear by myself and completed a breast exam. I was surprised about the patient education regarding self-breast exams as the nurse spent a lot of time with each patient explaining to her about signs and symptoms to be aware of. I’ve been very impressed with the amount of work that the nurses do; they perform pap smears and are required to deliver a set number of babies in order to fulfill requirements. On the last day, this woman barged in our room and was screaming as she was holding her very young son who was actively having a seizure; it was a scary sight. The first people to respond were nurses and the physician did not come till minutes later. There are a few things about their care that I agree with and disagree with. One of the things I really liked about the hospital ER is that they had it set up in a way that people who just needed fluids (who were dehydrated, etc.) could immediately be brought to a hallway of chairs and receive their IV and fluids there; this allows beds to be freed up for more severe problems and for them to treat multiple patients at one time. Another aspect I liked is the responsibility of the nurses. They are in charge of so many aspects of care and float around to wherever they are needed throughout the day. Some of the things I dislike about what I’ve seen mostly stems from the lack of finances and resources. For instance, the lack of needled safety devices is dangerous (especially with the amount of injections they do a day) but these needles are more expensive. I think the most surprising thing about clinical is the lack of patient privacy. Social security cards are kept with their file that day which lay around the office and their numbers are written on whiteboards behind their beds (which they use for patient identification like we use name a date of birth). In the case with pediatrics, more than one family was in the room at a time, and meeting with the doctor occurred at a neighboring desk in the same room. I’ve learned a lot in regards to providing the best patient care possible with the resources available. They use whatever they already have on hand to complete all the necessary tasks and I’ve been very impressed with their flexibility. I’ve loved the experience in the clinics so far as I’ve been able to practice skills that may not be as common in America. I’m looking forward to this next week and a half as we will continue our time at the medical hospital and then end with a few days in the psychiatric hospital. Until next time, -Christy
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