My time in a NICU in Honduras

[LilPeanut, MSN, RN, NP]

Some of you might remember me :) I'm an infrequent poster (I go in spurts) Well, I'm taking my boards tomorrow and to help calm myself, I'm going to share with you all my experiences from my recent medical mission trip to Honduras.

Now, the part of Honduras we were in was a smaller city that was absolutely decimated by Hurricane Mitch in 95, as was much of Honduras. It wiped out their infrastructure and they've never really recovered. Before going down there, I'd heard a lot of conflicting information, that they had vents, that they didn't, they had drugs, they didn't, etc, so I was very interested to see what was really down there.

Firstly, they have some very sick babies down there that would break your heart. 2 kids we were pretty sure were TORCH kids and liver issues (bright yellow and you could see the liver it was so enlarged), as well as a fair amount of "sepsis" and "birth asphyxia". I put those in quotes because it seems they give that dx to any child they aren't sure why they are sick.

Our first day there, my instructor and the NNP student who is almost done with school (go her!) and I split up to assess the pts and see what we were dealing with. There was one child in an oxyhood, but no pulse ox, no monitors, just a hood with 5L of O2 going in, who was a twin vag birth, she was first out, but had a prolapsed cord Then the TORCH kids, the plain jaundice baby, the macrosomatics, the birth asphyxia. We got an admission while we were there, and this kid was dx'd with r/o sepsis, but when we listened to him, he had a major whomping heart defect. No one there apparently recognized it His chest xray showed a heart taking up about 2/3 of his chest cavity. His chart says "normal rate, rhythm, s1, s2". *rolls eyes* Not. Our instructor suggests that this kid might have a heart defect - the doc seems surprised. After this, we leave for the rest of the day, so as not to completely overwhelm them.

Next day, we're back, learn a little more about the kids. One of the TORCH kids has a huge necrotic spot on his arm - IV infiltrated with his TPN One child's mother is suspected to have HIV. They don't use pacis or bottles at all in the NICU. Everything is syringe or breast. The hospital does not typically provide formula, though the attending does try and get samples to be able to feed the babies whose mothers essentially abandon them (like the prolapse twin). The babies are in open cribs, unswaddled, no positioning done. Moms are expected to be there around the clock to feed and change them. Cloth diapers are the norm, though there are some disposables.

We see some incubators in a little glassed in side room, and they tell us those are for their preemies. We asked what gestation they consider viable. The answer: 36w. *sigh* The only good thing is that they aren't great with telling gestational age, so healthier younger babes can easily slip through. They do not have ventilators or monitors, they do not check their IV sites frequently, they determine fluids needed for the baby by the specific gravity of the urine using dipsticks. We do find that the 2 babies with ng tubes do, in theory, get their tubes checked for placement and residual at each feed. I say in theory, because I never saw it happen. Oh yeah, and they use 18-20g needles for the ivs on these kids

The nurses have a lot less education than the nurses in the US. They take daily weights, but vitals are only done 2/day. No schedule is kept of feeding or intake/output. They were very nice and wanting to learn more. We did some basic developmental positioning teaching that day. Mom of the heart kid is crying at bedside, I have to defer to the nurse, because I don't know what they've told this mom, and the nurse says the baby is fine, he just has a fever, he's going to be aok.

next day, GOOD NEWS! Apparently the attending heard what my instructor said finally, because although nothing was changed in the chart assessment data, they were transferring the child to the capital for a cardiac consult.

We also have a mom of a cute little doodlebug, trisomy 21. After confirming with the doctor that yes, mom was already aware of the dx, I was able to have a nice therapeutic conversation with her. She thought her child would never speak, walk or recognize her. They do have an early intervention type program for trisomy 21 kids there, amazingly, so I was able to reassure her that while it was perfectly fine to mourn and be upset, her child would be able to do those things, just maybe on her own schedule.

We bring ambu bags that day too, but then realize that the bags that were sent to us by the manufacturer did not have masks, and they have no masks. I'm going to be trying to collect them to send out to them.

Next day, we plan on doing some teaching on IVs and stuff, but there was another new admission that needed some help. A "36w" (really closer to 34, but we weren't going to say anything!) Our NNP student noted right away that the IV was infiltrated, and luckily, I brought 22 and 24g angiocaths with us, so we got to use smaller needles, yay! Baby was jaundiced and dehydrated, so was a very tough stick, I was very impressed when she finally got it in.

This little one didn't need o2, but they had in an isolette. It was off, but all the doors were closed. We continued off our planned teaching path to explain the importance of leaving some of the doors open if they were going to leave the isolette off. I was shocked later when I was speaking with the nurses and suddenly she happened to look at that little room and noticed the baby was blue. Yeah, apnea. She stimmed her, she pinked up, and all was good again. (but this happens somewhat frequently. I was almost tempted to see if we could syringe feed her a little coca-cola for the caffeine! )

That day, I had to leave at lunch to teach CPR to the nursing school, and the NNP student was there alone. As she was eating lunch by L&D, she happened by a mom who abrupted and delivered. Baby was laying blue on the bed, and of course no one was doing anything.

Bless her heart, she sprang into action and tried to start working on the baby. No bags, no masks. She gets an adult bag/mask, but yeah, that wasn't working well, finally she gets a peds bag and mask, and resus's the baby. She says she was getting so desperate that she was about to start mouth to mouth, despite the fact the baby was covered in blood. (We all vowed to carry our cpr face shields with us everywhere from then on!) I am totally impressed with what she did, though she was thoroughly traumatized by the whole thing. (I can only imagine. I at least speak spanish, she does not, so trying to do this all without a common language would have been nightmarish)

I did not get to be there on the last day, I was assigned to a community health clinic that day, but that week in their NICU was incredibly eye-opening for me. On our plane trip back home, we were discussing how excited we would be to see a nice healthy 30w. *LOL*

When I got home and got a chance to visit my home NICU (for my job interview, which I got the job:balloons:), I took some extra time to walk around and truly appreciate all the technology we have and that there are a lot of babies that can be saved that we do save. And I feel confident that usually the babies that pass away, couldn't have been saved, if they had been born somewhere else.

So, hug your ventilator, your surf, your monitors, your RTs, your positioning aids, your PICCs and your supply of medication, because I've seen the other side, and it's not pretty.

[SteveNNP, MSN, NP]

Wow, thanks for the great story... I had the chance to go to Cambodia last fall and do some work with the locals, including some kids and newborns. The biggest thing that shocked me was that the locals get offended if you cover their child's head with your hand (cultural thing) I had to get special permission to do a fontanelle assessment! But seeing the medical care given in other countries really humbles you, makes you grateful for what you have..I will definitely be going back someday....

[EricJRN, MSN, RN]

Sounds like an amazing experience, LilPeanut. I would love to take on a similar challenge someday. Thanks for the post!

[Gompers, BSN, RN]

Awesome post! Good for you, both on the Honduras trip AND the new job!

[crissrn27, RN]

OMG, I think I will hug my vent, and my RT and my ambu with premmie mask tonight. Sounds like an amazing, and sad experiance for you.

[Elvish, BSN, DNP, RN, NP]

Thanks for this post. I think we in the technologically advanced, affluent world that we live in forget that the whopping majority of the world has little or none of the advantages that we have. Nice post.

[Elvish, BSN, DNP, RN, NP]

sorry...double post!

[2curlygirls]

I truly wish I'd had that kind of experience. Maybe when the kids go off to college...

[Shenandoah]

I would love to donate some time to a mission like this. I've looked online, but haven't found any related to our field. Does anyone have any info or websites?

[LilPeanut, MSN, RN, NP]

You mean related to the NICU? I was in the NICU because my group usually goes to the hospital and when we have NICU people, they go to the NICU.

[lovemyjob]

so interesting. What an amazing experience! Thank you for sharing.

[cherokeesummer]

Wow what an amazing story. Really makes us glad for what we have!

Amy

Mommy of one 17 month bugga bear

Semster 6 of 6 - RN school/Preceptor in NICU