Journey of a Student Nurse: August 2015

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.