Living outside my comfort zone...embracing the experience

I am now within my third week of placement and wow what a journey I have experienced so far. My initial week was a massive adaptation in terms of settling into the team, environment and most importantly my own role. The initial week provided me with a vast array of emotions, at first feeling excluded and even an alien outsider within the community, as every person would quizzically stare stone faced towards me. I reflected upon the area and district I am based, it is traditionally communist and apart from myself and another intern who has been here six months, we are the only foreigners within the whole district. I tried not to take it personally and instead responded with a smile and saying hello in Hmong or Laos. In time, I noticed people would react with a huge warm smile back to me and surprised perhaps that I have said hello in their own language. Living conditions are pretty tough in Nonghet, daily power-cuts and for three days I had no running water at all...a hot shower was a distant dream for me! It is sometimes hard to eat here too, if I want to eat meat here...I have to pop the market and buy a pig, duck or chicken alive then kill it...safe to say I'm thoroughly enjoying the vegetables and sticky rice!

My time in the hospital during my first week was really good, I was able to spend time getting to know everyone and understanding how it all worked and what the structure of seeing and treating a patient would be. Within days I felt I was immersed in it all, assisting with taking observations and following on the morning team rounds visiting each patient. I am blessed to have Mr. Sau Yang with me, who is a lead nurse at the hospital but speaks extremely fluent English. Sau has helped me communicate with all patients and also develop my own understanding in both the Hmong and Laos language. Within this province, it is predominantly populated by the Hmong ethnic group, this group have their own language and do not speak Laos. Therefore, I have been working to learn basic levels of both languages in order to communicate within the local community.

During my first week, I witnessed one of the most magical experiences I have ever had in my whole entire life, I was able to assist in the delivery of a baby boy in the Mother and Child Health Centre. A lot of work has been made by ChildFund Laos to encourage pregnant women within the villages to come to the centre to have a safer delivery of their babies. Slowly the numbers are growing and this is a wonderful approach to ensure safety of both mother and baby throughout the pregnancy and delivery process. The centre offers pre-natal checks, post-natal checks, delivery facilities and most importantly family planning. I was able to observe this new approach to family planning, as each week a clinic runs to women within the villages to attend and receive contraception, whether it be implant, injection or pill and most interestingly a lot of education is provided to try and work with the women to understand the importance and functioning of contraception. Reflecting back to the moment of the delivery of the baby boy, the mother was 19years old and this was her second child. She didn't have any pain relief and only when she moved from her own room into the delivery suite, fluids where administered and she began to have more and more contractions. From the beginning of pushing to the delivery of the baby, the healthy boy was safely delivered 45minutes later. He was instantly placed onto the mother's chest and let out an almighty cry, it was beautiful. He latched on and fed quickly from his mother, then after a few minutes the umbilical cord was cut and the baby placed in the incubator for checks. After 30minutes, both mother and baby move into the next room...the mother just gets up and walks into the next room and I helped by carrying her baby boy wrapped snug in his blankets. The Hmong people do not name their babies straight away, it will occur in three days time when they have a ceremony within their home village. This day and the event of the birth will be an experience I will cherish forever. 

My second week ran smoothly and I finally felt I was embedding myself within the team. I was able to assist on observations and follow the patient journey throughout. I even attempted to document patient information within the records, grasping an understanding of how they identify symptoms and leading to a diagnosis. One day Sau said Laura come we will go to the operating theatre, next minute I'm in there with gloves and face mask on assisting in the removal of shrapnel from a 10year old boys left hand. I have learned to adapt to the way things work here and perhaps it is more the Laos culture and way of life. Everything is not set in structure, it will be a case of let's just do this now and it happens...no preparation, just get up, go and do it. Each afternoon, I have been teaching English to all staff within the hospital, I covered topics from general questions in getting to know a person, to identifying the English terms for signs and symptoms. I also attempted to share and give a perspective to what nursing in the UK is like and showed some video's from the UK on nursing. Nursing here is extremely different to nursing in the UK, I tried to express that we have separate nurses for adult, mental health, child, learning disability and we also have midwives. Here in Laos, the nurse will take on all of these roles as one. Therefore, this experience has been a huge learning opportunity for myself, gaining more experience in working with children, babies and pregnant women. 

The hospital is resourceful in every way, they try to utilise the equipment they have and they have developed ways of trying to promote safety. They use old IV fluid containers as sharps bins and they dispose and burn once full around the back of the hospital. An aspect that blatantly sticks out to me though is the levels of hygiene within the environment, this is quite poor. Facilities and equipment are not cleaned, when I originally viewed the emergency room and viewed the equipment I was greeted by lots of dust, dirt and a couple dead flies! Therefore, I tried to implement cleaning, one day along with three staff we ventured with some soapy water and clothes and give the room a good scrub, I am actively promoting personal and environment hygiene daily and I feel this is slowly being developed and improved. Privacy is not a major focus here as sometimes they can have two or three patients in one room at one time with the doctor, all receiving different types of treatment. The culture of the Hmong and Laos people is more relaxed and pace of life is a lot slower to what we have in the UK. There is a strong sense of community within the hospital and all staff connect well to patients. It is brilliant to see how close all staff work together and relationships are strong, happy and positive. I feel sometimes in the UK we have a strong hierarchy and at times within hospitals a feeling of dominance, authority and perhaps even intimidation can be present, this is something I never enjoy or relish the experience of. However, here the approach to MDT and teamwork is one I admire and will hopefully embed and engage within my own practice. 

I was invited to a wedding by the nursing director and doctors at the hospital one evening, I gladly accepted and at 6pm I was on my way to my very first Hmong wedding in a village. I was quite nervous to begin with, as I knew I would be the only foreigner there but I was instantly greeted at the gate, the tradition is the bride and groom offer you a shot of beer then once you drink you enter. Everybody looked at me as I gulped my shot down, I then popped my glass down and said thank you in Hmong, this instantly made everyone smile and laugh and I was welcomed warmly. The sense of family and community was huge, all family welcome you in a line and before I knew it I was sitting eating and drinking lots, embracing the whole electric atmosphere. Within an hour, the dances had begun and I was able to learn and dance many of the Hmong traditional wedding dances. Everyone was so friendly and nice, I left feeling happy, comfortable and fuzzy...nothing to do with the endless Beer Laos I had drank! 

At the end of the week an emergency arrived into the hospital, a small 4year old girl was very poorly. She was semi-conscious, blood pressure low and oxygen saturation showing at 64percent. She was swiftly moved to the emergency room, all staff asked for my help in terms of oxygen, they only had nasal specs available, therefore I placed on a small amount 2L and observed closely on the monitor, slowly the patient stabilised and sats showed 99percent, we all worked to try and stabilise her blood pressure and ensure she was being looked after well. Every ten minutes I recorded her observations and within a couple of hours, the patient's condition had improved. I slowly titrated the patient down on oxygen and eventually she did not require and her other observations improved. This was a challenging situation as it allowed me to realise how little resources the hospital has and how well they apply their own knowledge and skills wihtin emergency situations. Afterwards, I was able to learn the hospital only has that one set of nasal-cannulae therefore they would need to be re-used again if another emergency patient arrives. Within the room, they do not have any adult oxygen face masks or any cardiac electrode stickers. They have the wires but no stickers therefore they can not fully use or utilise the equipment they have. I reflected on what we have in the UK and the endless amounts of stock and equipment readily available at our fingertips. I reflect poignantly as I truly value and respect how fortunate we are in the UK and for what we have available within the NHS. 

Now in my final week, I am cherishing each day I am experiencing and absorbing all learning opportunities. Each patient pays for medication, equipment used or tests here. The pricing is relative to the local community, however some of the Hmong villagers have little or no money and can not afford to pay therefore the hospital will offer no charge for these patients. Each time a doctor reviews a patient, they give the patient or family member the prescription of what is needed, everything is noted from cotton, syringe to medication and fluids and then they go and pay then collect from the pharmacy room. The patient then brings the bag back to staff and a nurse will administer and provide medication. This happens each time a patient requires more medication or equipment to ensure the medication can be taken. The patient's do not pay to stay in the hospital but conditions are extremely basic and not so comfortable. When a patient remains in hospital, the whole family will come, so perhaps you will have maybe an extra three people staying at night and during the day upto 10people around the bedside. It is the families responsibility to feed and water the patient. If the patient arrives alone or lives far, the patient's own village will arrange for food to be sent for them to ensure they have food and water. I expressed to staff how different it is in the UK and how our patient's are able to select from a menu and have three meals a day. I am continually reflecting and pondering upon how fortunate we are as professionals and also patient's of the NHS in the UK in what we have available. I have previously been a patient within the NHS and I have witnessed patient's become aggressive and rude in demanding the food is not what is liked, I ponder upon what I am seeing and experiencing here and have an intrinsic respect for the patient's within Nonghet, they are eternally grateful to their own family and villages for helping feed and water them. They are extremely appreciative of staff for helping them feel better and when patient's leave for home, many smiles are exchanged. 

I am cherishing each day I have left in Nonghet and working now on my final report to provide to ChildFund Laos. I am providing a reflective report of my placement experience here, highlighting positive practices and also identifying recommendations to improve upon services and practice. Three posters went up in the hospital yesterday and one of them really hit home with me. It was promoting diet and nutrition, on one area for protein the image of meats and eggs, however on the other side insects and various bugs. I joked saying you would never see that in the UK diet to my friends at the hospital. However, when Sau explained many people here can not afford to eat meat or eggs as they have no money so they offer education and guidance to eat insects and bugs to try to gain some protein. I stood motionless thinking this is real and this is happening now, they are so poor they have to eat bugs! I had a further conversation with Sau and his chief and they asked whether in the UK if I know of any old equipment or anything at all that I could possibly send over to them. I felt my heart instantly ache, for Sau and the chief to ask this has taken great courage and swallow in their pride to ask me, I said I will try and help in anyway I can. He said anything from maybe an old computer, oxygen regulators, observation equipment to simple hand gels. When I return home I am going to embark on a journey to try and help this hospital further, the small things we perhaps take for granted in the UK mean so much here and are deeply valued. 

I now embrace my next few days, enjoying the time and experiences I have each day. I know in time, this experience will be a fond memory, however, I will work to keep my connection with this hospital alive...working to promote and improve services, sharing best practice and giving whatever I can. The staff and people within the community are beautiful people, who openly care, embrace and appreciate each individual for who they are. 

The emergency room

Cleaning the emergency room

In-patient room (ward)

Preparing for class

Sharing best practice

Scales...weighing babies

Sharps bin...resourceful

Operating theatre

Hmong Wedding

 

Nonghet

Xieng Khouang Province

Nonghet District Hospital

Arriving into Laos...

My first taste of Laos life and the culture of how Laos functions was experienced on my arrival at the border. It was chaos in a sense that no immigration official was around and nobody seemed to know what was happening. I just sat down and smiled thinking...I'm now in Laos. This is not a criticism of the Laos way of life, it is more of an acceptance as I am already aware of Laos culture and life from my previous trip here, therefore perhaps I am more attuned to this type of situation. After some hassle of getting my visa sorted, as I am to have a specific visa so I am able to work...I was finally allowed in an hour and a half later! 

The initial two days in Vientiane was spent meeting a friend who enjoys running Carlo, we met for our evening meal and had a lovely walk around the city at night. The next day I met my old monk friend Ping, who is now longer a monk but now a teacher in the city. We enjoyed a day of sightseeing with Ping and then had a lovely lunch by the river. Later in the evening, we met up with Carlo and ventured on a 10k run along the Mekong River at sunset....it was hideously humid but I managed to survive! It was wonderful to just relax by the river and enjoy some food and drink afterwards. Meeting up with friends is an important element for me as it enables me to feel connected to the place I am in, reflecting on old memories and creating new experiences.

We then flew to Xieng Khouang, meeting my lovely mentor Bouaphone, who is the Health Officer at ChildFund Laos. After arriving, Bouaphone picked us up with her husband and children and we ventured to the Plain of Jars. These are ancient ruins, that hold so much mystery and beauty around them. It was a fascinating afternoon enjoying the Jar Sites and also appreciating the history of the province and how it was so heavily bombed during the Vietnam-American War. They called it the secret war, as Laos was not supposed to be at war at all, yet there country was used as a battlefield where millions of bombs dropped on it's beauty. Today there are still over 80million unexploded bombs within the province and continual work and efforts are being made for bomb clearance and education to support this is being provided everyday.

The following day, I began placement this first began in Phonsavan, meeting the minister of health of the province. I was so nervous, filled with anxiety of meeting a government official. The visa and paperwork aspects are crucially important here, I am not able to move province or do anything until all paperwork is checked and cleared. The minister was friendly and I communicated through Bouaphone and was he expressed his thanks for coming to Laos and spending time in the Nonghet District. We then ventured on a three hour journey to Nonghet. 

Once we arrived, Nonghet was hustling with people, animals and all kinds of beautiful village chores of daily life. We settled into our staff house, then went out to eat some traditional Lao Soup. I began my morning by meeting the ChildFund Team and being welcomed by everyone. I will venture to the Nonghet District Hospital shortly and begin my time working with the local people. I am feeling excited, nervous and strangely at home, the environment is so welcoming it is hard to not love the Laos way of life.

Getting ready for my first big day on placement

Arriving into Nonghet

 

Asian Adventure Awaits...

So today is the day that I embark on my International Placement experience. I am feeling excited, nervous and perhaps a feeling I am not even able to express. When I originally set off on my travels around the world in 2011, I had this exact feeling and what I learned to realise is that it is the fear of the unknown. Fear can be a dominant feeling, in the respect that it impacts my sleep, my thought processes and how I am feeling within myself. Reflecting upon my original adventure I am now able to absorb this fear more easily and perhaps even empower it and turn it into something else. I am able to focus on my inner self and take time to consider a more relaxed and calm way of thinking which in turn relaxes my physical state of being. 

In society and routine of life especially in the UK we love structure, fast-pace, organisation and having set patterns to everyday life. In planning for this trip, I began to realise that the way of life in Asia is very different to the UK. I was liaising with my link at ChildFund Laos consistently and at times asking for particular aspects of information. When I did not hear back from my link immediately, I would fret slightly and then begin to worry. However, once the information arrived and was confirmed a couple days later, I reflected upon how urgent I felt I needed the information when in fact it was not needed immediately and that perhaps I am caught up in a way of feeling urgency, speed and closed-focus. It enabled me to consider the Asian culture and particularly in Laos, life is a lot slower paced and aspects of routine of life can be a lot different; almost the opposite at times to the UK. So, a small voice expressed to myself....take a breath, relax and take my time. Time importantly for myself, being able to not feel so uptight but more laid-back yet still in control. This approach in my planning process will hopefully help me once I arrive in Asia to settle into way of life and embrace all aspects of culture. 

I will begin my journey will my allocated annual leave. This will enable me to have time to relax, recoup and reflect upon my life both professionally and personally. I am sharing this journey with my partner and will excitingly meet up with my best friend and her partner in Thailand at the beginning of our trip. Quality time to share life stories, ponder upon life and explore Asian cultures together is an important element I am thrilled to embark upon. 

I will then venture back towards Bangkok and begin my journey upto Laos. Laos is an enchanting country and one that holds a special place in my heart. Laos is relatively untouched and being landlocked between China, Vietnam, Cambodia, Thailand and Myanmar it is at the heart of South East Asia. The Mekong River traverses through the whole of Laos and plays an important role in the life and living of the Lao People. The population is small around nearly 7 million compared to it's neighbour of Vietnam who stands around nearly 90 million. The country remains communist and standards around healthcare and education remain extremely poor. Despite these factors of hardship upon such a aesthetically pleasing landscape; the power of beauty the people express is phenomenal. The people are so caring, compassionate and deeply thoughtful. The focus is within the community settings and community living is strong, embracing traditional approaches to beliefs and cultures across all aspects of life. 

I know my natural apprehensive feelings will be extinguished the moment I arrive and I am excited and happy to begin my journey as a student nurse. I will be reflecting deep into my own soul continually as I open my inner self up to the wonders of Laos. I will hopefully keep you updated on my journey, experiences and reflections (internet dependent) once I arrive in Asia. I promise to stay safe, absorb, embrace and enjoy it all. 

The beauty of the landscape in Laos

The majestic Mekong River

The villages within rural Laos...I am excited for my village stay!

Life is connected to the power of the river

Reflecting upon my original Laos experience

The natural untouched beauty that awaits me

Enchanting memories and excitement grows as a embark on another journey

Feeling happy and connected to Laos...the moment I knew this country had a place in my heart

Let Third Year Commence...

After a wonderful couple of weeks break from university, I have now transitioned into third year and embrace the new journey ahead. Reflecting back to the end of my second year, I was feeling ready for the break, I was drained mentally and physically and going through what many other student nurses will feel at certain points during their own course...exhausted! 

I did enjoy many 'Lazy Laura' days, which I felt was just as important as getting out and enjoying some culture and arts on my break. I can not begin to describe how lovely it was to stay in my pyjamas all day and do nothing but sort out my university files, breathtaking bliss. So after many enjoyable sleep-ins and tourist days around the city and countryside, I felt ready to get back to my university reflective student nurse mode. I must be honest, as my first week approached I did feel a pang of slight anxiety, not so much around university but more so around the fact that I would be a qualified nurse within the year. I will become a fully qualified, accountable, hardworking, motivated nurse in practice and this was something I felt put an instant smile on my face. 

Now this has been an interesting start to my third year, as we have just all experienced an election in the UK and the introduction of a new government, which I know most definitely will influence, impact and have massive changes within the NHS currently and on future plans and policy. We all have our own opinions and beliefs and we all have the right to our own political views but I feel we will begin to see a huge shift on nursing practice as well as nursing education. Change is sometimes that hardest thing to experience; change can instigate a mixture of emotions and feelings whether it be in our personal or professional lives. I am a positive and empowered person to champion for change, however before change is possible we must perhaps consider what are the plans being proposed and most importantly will the new changes work. Many people I have spoken to have expressed a sense of apprehension around the future of the NHS and even the field nursing practice. As I embark on my nursing career within the next year, I am trying and almost forcing myself to remain positive and engaged, however acknowledgement must be made to the anxiety, apprehensive and perhaps even negative atmosphere that permeates around the profession at the moment. I almost sense a feeling of uncertainty, therefore I feel now more than ever is a time when people need to connect, engage, work together and develop a solidarity of support and strength to be proud of and ensure the NHS remains one of the best healthcare systems within the world (I am a secret unionist through and through). I know I know, I am slightly bias here in saying one of the best in the world, however from my own experiences of travelling the world and spending time in developing and developed countries, I must admit our NHS and practices in my experience have been nothing but the best. 

I am currently task avoiding....I know it's not the most productive and motivated outlook, but I am task avoiding focusing on my assignment. I am a person who enjoys the process of research and writing an assignment however I find I work well in mornings and as this day is moving towards my afternoon nap, I shall reschedule my assignment writing to another day. I have really touched lucky with my assignment, I have chosen to focus upon a scenario that involves a patient being treated with COPD. Reflecting upon my last community placement, I feel so happy to have had that experience and now relating back to my theory I can truly value and appreciate how much I did actually learn whilst out on placement. 

I am due to venture out on my next placement in the next six weeks, I am feeling excited and also nervous, perhaps a normal response for any student nurse embarking on a new placement experience. It is good to sometimes be nervous, as it enables me to research around the area, organise myself in order to feel fully prepared for placement and more importantly ensure I am engaged and attentive to the area I am set to work within. My placement will be a shorter one this time, therefore I will need to ensure I am fully organised in achieving all my learning outcomes and achieving competencies in practice. I will then embark on my 'Asian Adventure', spending my time on placement in Laos working alongside ChildFund Laos to support in developing and improving standards of healthcare and education to the people of Laos; more specifically in the Nonghet District where I will be based as a student nurse. I have all my paperwork cleared and have been given full support from university, which has ensured my experience of arranging the placement a lot easier. I am now in the process of organising a schedule to work around whilst I am out on placement, evidently the whole experience of being in Laos is making me extremely excited.

Another exciting journey I have embarked upon and I am hoping to incorporate into my practice is becoming a new SQA. A student quality ambassador is a champion who works with many trusts and organisation around the North West of England. I attended my induction at the beginning of the month across at Manchester Metropolitan University and was able to network with fellow student nurses and also other health professionals such as speech and language therapists, physiotherapists, midwives, medical students and many more. Now, I need to focus upon applying my role as a SQA into developing best practice in my theory sessions at university, out in my next placement area and most significantly introducing the SQA role to Laos. I have a sense this new journey is going to be something pretty special...

Calming Chaos of university work...

Perfect Preparation...all ready to commence third year

Embracing my new role as SQA

Enjoying the Community...

My last placement of second year is based within the community setting focusing upon COPD. I was really excited to begin my placement as I felt covering the topic of COPD would develop my own understanding and knowledge of a long-term chronic condition that currently impacts many patients within society. Therefore, I felt my previous placement on a diabetes medical ward has informed my student journey and this respiratory focus has developed my student journey. 

If I am honest, my initial week was quite unsettling for me as I wasn't sure what I would exactly cover and how I would explore my competencies as a student. The whole team welcomed me warmly and I felt at ease with so many friendly people and friendly faces, this always helps on placement, as it instills an openness to feel connected to the team and be able to ask questions and perhaps show the real me. 

After the second week, I realised I had found my feet and seemed to have a growth in confidence in what I was doing and how I was learning to adapt to the community environment. I noticed a slight shift in dynamics in comparison to an acute setting, therefore, it perhaps was time I needed in order to settle into my new placement and for me to adapt to the community setting. 

The community offers a more patient-centred approach and I feel collaboration within MDT is more apparent, which enhances patient experience and care. The patients I have met along my journey have all been friendly and really welcoming to myself as a student. I have really worked on trying to connect with my communication skills, really working to apply the right type of questions and more importantly how I am asking those questions. 

I had an experience in clinic where a patient asked me why I was asking about his lower limbs and whether any oedema was present. This was a question I was not necessarily expecting, therefore felt slightly unprepared but with the support of my mentor, I answered the patient explaining about identifying and looking for signs of heart failure. The patient seemed happy with my response, as did my own mentor. I felt happy with my answer, but afterwards it made me realise how perhaps I am not fully prepared or informed on what I am asking and exactly looking for within an assessment. This learning experience has allowed me to know consider the small details of the reasons behind why I am asking certain questions and how it can help patients become empowered and encouragement to monitor their own health. 

As I am currently half way through my placement journey, I am feeling motivated and happy for the positive learning experiences I am gaining. As the weeks pass me by, I realise I am now even closer to the real situation that in a year's time I will be graduating and beginning my career in nursing. This thought scares me at the moment but also excites me at the same time...I have a feeling I may not be the only student nurse feeling this way at this time in our study. I will continue to enjoy my placement and will shortly be making plans for my future international placement trip in the summer...I feel each experience and opportunity on placement now will inform my future experiences as a student nurse enabling me to continually grow. 

"What we think, we become"

Temple in Laos for Reflection...