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Walking into the white walls of UREMMCI Monday morning at 5:45am sent feelings excitement and nervousness into our stomachs.  We had not been in a hospital for a while and we were apprehensive about this busy, urban, public hospital.  We met briefly with our clinical instructor who then took us to our respective wards for the week.  Three of us were left in the cool, air-conditioned Pay wards, while Lerissa and Elaine took the bridge across to the Charity building.

Lerissa was dropped off first onto the Neuro ward.  This cramped ward held 12 patient beds down a long corridor that branched off into surgery recovery.  The only privacy given to the patients was one green portable screen that was used during morning care and shared with the surgical unit.  Elaine was dropped off next, into the ICU.  It consisted of a tiny room off a busy 30-bed medical ward.  The room had three beds, a nursing desk, some outdated equipment, and a lot of people in very little space.

We were shocked when comparing these units to our Canadian ones, where patient privacy is an important design incorporated into each ward, even if it is only a curtain separation.    The equipment on the units was very old in comparison to the technology in Canada, though it was still in good working condition.  Also, the few fans and open windows could not rid the unit or us of the heat.

We were definitely on Charity wards.  These wards are units that have been subsidized for patients that cannot afford the Pay wards such as described in Leah’s blog.  These wards are typically overseen by residents, student nurses and experienced ward nurses.  A bed that would cost you to rent on a Pay ward is free on a Charity ward, but the medication and other equipment cost money to use.  The amount of money needed for the improvement of health is very expensive when you set out the figures.  The patient’s family would be sent out to buy medications prescribed by the Nurse under the Doctor’s orders.  Even supplies as simple as wash cloths are brought in by the family.

The resources on these wards were then very limited and in some cases supplies used were not ideal.  For example clean gloves are often used during sterile procedures due to cost and availability issues.  Additionally, if a new endotracheal tube was needed, the family would have to go buy one.  If residents inserting the tube were unable to make it the first time, due to lack of experience, the tube would be re-inserted multiple times or the families would have to go buy another one, costing them yet more money.  Furthermore, this increases the patient’s chances of infection.

The idea that you have to bring your own wash cloths or worry about what every pain pill would cost seems like a reality out of this world.   It unearthed another harsh fact that became reality for us; many people could not afford to pay for everything and as a result some patients died.  This was a very challenging concept for us to accept, coming from a system where death is not usually directly associated with a lack of resources.

Although there are limited resources there was great ingenuity in creating something from nothing.  The staff on the Charity wards made their best attempt to reduce waste while using highly innovative ways of caring and treating patients.  The ways that certain items were reused with successful patient outcomes made us question again if our system was wasting certain equipment.  The creativity seen here we find may sometimes be lacking at home because only in rare cases is there a deficit of resources.  This fact also made us appreciate the abundance of supplies we have at our fingertips in Canada.

It was very difficult for us to work in an environment knowing that someone may die because they cannot afford medication or lifesaving equipment.  We struggled to cope with feeling helpless, and seeing how a health care system can fail its people in which everything could be lost in the process of healing.  Then a set of wise words were spoken by one of our preceptors: “If you have helped someone today, even if it’s the only person you will ever help in your life, consider yourself lucky because you made a difference for someone.”  So even though we cannot change the whole system, we can make a difference to one person and that is what nursing is about.

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