I am writing this post by candle light because the power is out due to a thunderstorm and I have already used up the battery power in my flashlight from the electricity being cut the odd time. I am so thankful for the battery pack in my laptop. I am sure it will be fried by the time I return to Canada. Hopefully not too much sooner than that though.

The third week of classes I was not supposed to teach classes, because the second week of classes found my limits. Before arriving in India I understood the community health course would be in the second semester and I would have a full semester to prepare for classes and familiarize myself with the specifics of the Indian Health Care System. You can imagine my surprise when I found out the school year does not have semesters. The classes start in July and go until they are finished.  Which is sometime by the end of May.

I spoke with Mamta and arranged to have a week off of classes to get ahead for the first unit in the community health course, and if I was lucky the research and statistics course I am teaching.

Unfortunately, one of the faculty member’s had a family crisis and another faculty member fell ill. It left me and another teacher to hold down the fort.

Monday morning I find myself giving an impromptu class for all the students in the library, and teaching three other classes.

The first year students’ uniforms arrived from the tailor’s, so the students were to start their practicum in the hospital starting the next morning. The students needed supervisors. From then on, I was told, I would be leading the 1^st year students in the outpatient department, maternity ward, and covering the pediatric ward, special care nursery and labour delivery room for the ill faculty member for two hours every morning.

So much for my week to prepare for my courses. And I have absolutely no experience in the areas I had been assigned. I requested medical-surgical and the recovery room, but I guess I didn’t come to India to have things easy.

Mamta called to tell me that the students will need to use an assessment form on Tuesday morning. This form had not been made and it is my responsibility to make it.

Can all your brain cells explode simultaneously from frustration of no foresight?

So I get to work on a general adult in-patient assessment form to be implemented by our students for the use of the hospital. By the end of the week it was sent to the printers. The students went to the hospital without the form on Tuesday.

During my tour of the hospital on Tuesday I saw all the wards, including the stock rooms, pharmacy, and autoclave area. The man running the autoclave explained to me what the hospital sterilizes and what is one-time-use. When he told me the gloves are one-time-use, I raised an eyebrow and turned around to point at the rack of drying gloves behind me. “We reuse them only once or twice.”  I am sure that clause is not written in the hospital reports.

Many differences in quality of care by hospital nurses to nursing back home astonished me. A nurse with an equivalent education to a care aid with maternity education is the head nurse at the mission hospital on the medical ward.

There were two other staff nurses and four nursing students on the  medical ward one day when I was there. Two patients were on the medical ward. One had a temperature of 104°F. A chest x-ray was ordered when he was admitted the previous day. The x-ray had not been done. He head nurse could not say why it was not done. Within 5minutes of Ms. Singh’s questions about why it had not been done, the x-ray was done.

This patient had a hemothorax (blood collection in the pleural space which restricts the lungs from expanding and causes infection, shock and possibly death).

The student’s assessments were atrocious. These students are nurses returning for a degree. I asked the student assigned to the hemothorax patient to tell me about her respiratory assessment. I learn the patient’s respiratory rate.

“What is the quality of breathe sounds? What do the lungs sound like? Did you listen with a stethoscope?” I inquire.

“That is doctor’s work. Nurses do not check those things here.” The student responds.

There are differences between nursing in Canada and India. But I have checked all these things with Mamta and the Indian Nursing Council. I am not going outside of a general nurse’s scope.

So that afternoon I am taught the 1^st year students in the library how to do a proper respiratory and cardiovascular assessment. That sort of practical teaching is fun. We had stethoscopes, diagrams and textbooks (all donated from my nursing peers back in Victoria. Thank you!).

Just a tid-bit for the great nurses on 2 Royal. The hospital has a surgeon who does EENT surgery, mostly total neck dissections with free flaps. These patients do not routinely have tracheostomies. There are not enough suction machines for all the patients and not enough for all the rooms with patients with this surgery. One suction catheter is left on the machine and cleaned by nurses with rubbing alcohol. Judging by these nurse’s assessments I would not be surprised to hear if the infection rates are high. You ladies and lads are fantastic on 2 Royal (and we have not broached the topic of wound care or burns yet). Anyone want to come to run staff education?