First day of School!

It was our first day at our service placements; it felt like our first day of school! I was excited to meet new people and be in a new place, yet feared the unknown.

We dropped Mariza off at the YWCA (where Di and I would be joining her later), then walked to St. Martin de Porres School to drop off Josh and Milea…only school wasn’t in session today. Apparently, there was a teacher’s conference for Catholic schools, so Josh and Milea came with us. Lauren dropped us off first, then walked Josh to YWCA. While she was gone, Milea and Di went to deliver food to homebound individuals. I got a quick intro to the clinic, but within minutes I was assessing patients. The one nurse who works at the clinic was out sick, so the receptionist was doing all the nurse’s work (which is obviously not in her scope of practice)!
I met with about six older adults (Mercy Clinic is a geriatric clinic). I checked them in, took their weight and vital signs, tested their blood sugar (if they were diabetic), and reported any abnormalities to the one doctor who worked at the clinic.
After I walked my first patient back to the waiting room to see the doctor, Lauren walked into my exam room. The doctor told her to give a patient Voltaren 1 amp IM. Not familiar with the drug, we looked it up in a drug book. It’s an anti-inflammatory, which was supposed to be given in PO form, but we had the drug in a glass vial (with no filter needles!) to be given IM. The patient was a middle-aged man who was experiencing back, head, and neck pain after falling off his back porch steps. When I asked him how he fell, he said he blacked out; but usually he knows when he’s about to black out so he can sit down and keep himself safe. So, Voltaren will treat his neck pain; a symptom secondary to other issues, such as seizures, low blood pressure which could be causing blackouts, and spinal injuries as a result of the fall. The doctor wrote an order for an X-ray to be done, but when we asked the man about it he said he’ll get around to it later in the week. I assisted Lauren in giving the shot, but every step of the process made me nervous for my nursing license. I had to keep reassuring myself that it’s just different here and people do what they can with the resources that they are given.
My second patient had a blood pressure of 196/98. I asked her if she takes BP meds, she said yes but she “forgot” to take her water pill this morning. The doctor advised me to give her Captopril 25mg PO. The bottle was already sitting on my desk, which probably means that’s what everyone gets for high blood pressure. There were no doctor’s orders written. The best documentation I could do was a detailed scribble underneath her vitals signs. There was probably no follow up either. What if her blood pressure bottoms out after she goes home to take her water pill? What about tomorrow morning when her blood pressure is that high again? The Captopril will solve her BP issue for today, but what about the next 30 days until her next visit?
One of my last patients had a fasting blood glucose of 168. She told me she doesn’t eat breakfast on the days she comes into the clinic because she knows we’re going to test her blood sugar and she doesn’t want it to be high for us. What about the other days that she has breakfast and her blood sugar is in the 200s?
Most of these patients are healthy though, if you take a quick glance at them. They have enough to eat, most of them either walk or ride their bikes into the clinic (many are over the age of 80!), and they don’t have very many complaints about their health. But Lauren told me that many of them remain undiagnosed until it’s too late. If an older adult passes away, it’s just assumed that it’s due to old age. The top two epidemics in Belize City among elderly patients are hypertension and diabetes; two diseases that are so easily managed in the United States (with adequate health insurance/resources). Yet these are the causes of many deaths in this city. Could these individuals have other diseases or disorders that nobody knows about? The more important question is, would it be worth it to diagnose individuals if there were no resources to treat them for the illness? Sometimes ignorance is bliss.

We stopped by the YWCA after the clinic, but we only had enough time for introductions and a tour of the facility. I instantly fell in love with the beautiful Belizean babies! I can't wait until tomorrow!