First Week at the Hospital

Blog #2 - First week at the University Clinic

I have been working in Macedonia for the past two weeks as so far things are incredible!! The program I am working on is called the Strategic Medical Resupply Program. The goal of this program is to provide medications, equipment and training to hospitals in Skopje. Currently, the hospital that we are working with now is the University Pediatric Clinic (their word for hospital is clinic) in Skopje. This Pediatric Clinic is in the public sector of the health care system here in Macedonia. It is the most advanced Pediatric Clinic in Macedonia so they receive many cases from all over the country. For the past week, I have teamed up with another volunteer, Janet Kinney, and we have been visiting each department in the Clinic to talk to the Chief of each department to learn about what they do, and what they need for equipment and education.

We have learned that there are 18 departments in the Clinic. Each department consists of about 5 or 6 Physicians and a few nurses. One of the busiest departments is the Clinic is the Intensive Care Unit as they receive about one child a day. For education, physicians go through 4 years of general medical school and then they have another 5 years of specialized training to become a Pediatric Doctor. After that, the doctors have some continuing education to keep their license. For nurses, however, they go through nursing school in high school and then they have 3 years of training in college (which technically is optional). After that, there is no continuing education. Due to this, most of the nurses have not had any training in a very long time. This is where we have identified the best way to help. After meeting with each department, Janet (who is a retired Neonatologist, has had training in Infection Control, has worked for the CDC, and who is currently a General Pediatrician) and I have come up with three different ideas to help the nurses improve their education.

The first idea is to have a Nurse Mentoring Program. This program would involve bringing in general or specialized nurses that would work the day or night shift and would mentor and teach and learn from the nurses at the Clinic. The idea would be to make this a long term program where different nurses are coming in and working with each department in the Clinic. By bringing in a nurse that would work the shift with the other nurses we would be providing a resource for the other nurses to gain knowledge and expertise.

Since there is a large need for education, another idea is to design our own course that is based off of the Pediatric Advanced Life Support (PALS) curriculum. This course is required by everyone in the States who works at a Pediatric Hospital. It teaches resuscitation, drug administration, identification of respiratory distress/arrest, identification and treatment of shock, identification and treatment for cardiac arrest, and more. Our goal is to create a course that would be required by everyone to take before being hired as a standard hospital training. This would then unify the nurses abilities and make a stronger nursing staff. In order to keep this sustainable, we would like to make the course a "Train the Trainers" program. This means that we would teach the course to a few nurses who would then teach it to other nurses who would then make another nurse the point person so that the education continues over the years. 

One of the meetings we had was with the Chief Nurse. She is also the only person in Macedonia who has had training in Infection Control. She is an incredible person and has been working really hard to bring in protocols and knowledge to the Clinic in order to reduce the spread of Infection. Unfortunately, since she is a nurse and not a doctor, most people do not believe her or take her seriously. Due to this, one of my goals for the 3 months that I am here is to help her establish a database where we can record what infections occur, where they come from, how serious they are, etc. Hopefully, this will then allow her to create proof that the infection control is very poor in the hospital and that many deaths and suffering can be prevented by simple protocols (and a lot of money for the hospital can be saved). I am very passionate about helping her with setting this up and with getting protocols that the nurses and doctors will live by. 

For providing equipment to the hospital, most of the equipment they need is very standard - bedside monitors, portable suctions, nebulizers, medical pumps, and ultrasound transducers are some of the most common. It really is amazing at how the staff is able to operate and save so many lives when they lack so much basic equipment.

As for everything else here, I am really loving it! Last weekend I went to a small town called Ohrid. It is absolutely beautiful. It is a little quaint town on a lake and is AWESOME! There are 356 small churches in the town and visited a few. One was from the 13th century and the art work inside it was original and really cool! Other than that everything is amazing. The people are really fun and I love the city!