General Nursing, home care nurse, International Nursing, Labor & Delivery Nurse, Nurse Practitioner, Pediatric Nursing

Transcultural Nursing Course in Dominican Republic – Part 2

January 1995 – San Juan, Dominican Republic

After awakening, I began reading my English-Spanish Bible in my Pan Dia village home, when Maria, a ten-year-old girl came in and shyly started reading over my shoulder. I gave her a Spanish gospel tract to read, and she was thrilled.  Before we said goodbye, the cute children gathered around us for a final photo.

The village children loved chatting with us!
The village children loved chatting with us.

After we returned to the clinic, we compared our clinic stays. It sounds like Debbie and Julie stayed in a much wealthier community and even had an indoor bathroom, but I think Paula and I had a truer picture of Dominican life for the majority of people. We all watched Paula analyze the water samples she had collected from the boiled water they had given us, the town pump, and the clinic. Paula is doing an extra project on water quality since her first degree is in biology.

The next day, Paula discovered the water that we drank in Pan Dia was unboiled and the filtered water here at the clinic is almost as bad. The tap water here came out clear of bacteria. She will repeat all the tests to confirm her results.  Thankfully, neither Paula nor I became sick from the unboiled water. Perhaps I’m building up some immunity since this is my fourth trip to the Caribbean region. But it does make me realize how much I take clean water for granted in the USA. (We later learned that the clinic’s board of directors took steps to improve their water filtration system as the result of Paula’s work.)

Watching Paula analyze village water samples.
Watching Paula analyze village water samples.

The next day, Dr. Elaine asked me to work in the city hospital in the Intensive Care Unit (ICU). There was no running water or electricity that day, so no one was on an EKG monitor. I pitied the patients lying in the sweltering heat without fans or air conditioning. The only way I could wash my hands was with wet wipes that I brought with me. The nurse pulled out their only stethoscope with 5-foot long tubing and no diaphragm on the bell, so she grabbed a piece of paper and held it over the bell. After she checked a 46-year-old woman’s blood pressure who had a blood clot in her lung, I rechecked it with my stethoscope. I was shocked that it was dangerously high at  180/120 and that they only checked her blood pressure every twelve hours.

The nurse gave the woman Procardia under her tongue and pushed Ranitidine intravenously quickly through her IV line. I checked the patient’s blood pressure twice after that and it came down to 150/88. There was a can of pear nectar on the woman’s bedside table, so Dr. Elaine and I helped her sit up. She gulped it down in appreciation. There was no water pitcher beside her bed.

The doctor then came in and changed the abdominal dressing of a man who had a ruptured appendix. The nurse asked me to give him a gentamicin antibiotic injection in his arm. Normally I would have given it by IV drip slowly or given it in his thigh. Then the nurse mixed up 1 gram of ampicillin in 5 ml. of normal saline and gave it rapid IV push through his line. She asked me to give it, but I refused and told her I was used to dripping it slowly through the IV over 30 minutes. She gave him 100 ml. of Gatorade with brown sugar added for lunch. There was a quart of it, but she said he couldn’t have anymore. Then she offered Dr. Elaine and me a glass of Gatorade as she drank one, but we politely declined.

The third patient in ICU was a woman who had been stabbed by her husband. She had a tube in her stomach with the drainage bag lying on the floor under her bed. She also had a tube in her bladder, with that bag also laying on the floor. Her torso was exposed from the waist up. She was behind a curtain so no nurse could observe her, and her IV ran dry.

When the nurse discovered it, she hung a new IV bag and ran a tube full of air into the patient. Since there was no running water, none of the patients were bathed and the nurses never washed their hands. All the patients appeared dehydrated from a lack of fluids in the heat.

The medicine cabinet had three more bags of IV fluids, and medicines in bottles with labels. Another nurse came to the door and asked for a pill, so the ICU nurse took one from the bottle and handed it to her. Each patient had a chart with doctor’s orders, an operating room record, and nurse’s notes. The nurse’s note was divided into four sections: date, hour, medicine, and observation. Dr. Elaine pointed out that the nurse’s note didn’t have much room, but at least they had a chart.

On our way to lunch, we stopped by to see Julie in the pediatric ward.  There was a baby in severe respiratory distress. She watched the nurses try twenty times to start an IV in a baby with the same butterfly needle. One male nurse accidentally stuck himself with the needle and then continued to stick the baby with it.

Since the operating room was closed for the holidays, we went with Cora, NP,  as she made home visits to families who have infants on her nutritional program. The first village had several shacks beside a bean field and the river. We watched them wash their clothes in the river and cook their food over a charcoal fire. One home had two babies because one baby’s mother had died in childbirth. The remaining mother was trying to breastfeed her own baby and the orphan, who appeared to weigh only about 3 pounds.

Cora spoke with an 18-year-old woman about family planning who already has four children. Many women have their first baby before they have their first period. The poor people don’t marry but just change from one man to another. It is estimated that 25% of the population is HIV positive.

After walking down dirt roads and fording several streams, we arrived at the local midwife’s home. She delivers one hundred babies yearly free of charge. She was a dear friendly 40-year-old grandma who got down on the ground and demonstrated how she delivered her own twins alone.

Until last year, when she spent three days training at a local hospital, she had never received any formal instruction. At the end of our visit, she handed us each a chicken egg as a gift. It was difficult for us to accept this gift since we knew we were taking most of her food for the entire week, but Cora said our refusal would have offended her. In turn, we gave her several boxes of gloves for her home deliveries. She hugged us all as we left.

Local midwife tells us the amazing story of how she delivered her own twins!
The local midwife tells us the amazing story of how she delivered her own twins.

My days working in the city hospital with few supplies and visiting the homes of people who had few goods once again brought home to me the material wealth in the USA. One missionary in Ecuador told me the people there think all Americans sleep on mattresses stuffed with money. She offered to let them look at her mattress to prove there was no money in it.

I read through some of the many verses in the Bible about poverty and wealth. The only kind of wealth that lasts for all eternity is our relationship with Jesus Christ. The person who has received Christ as Savior is the richest person in the world and the only one who can know true happiness.

“For you know the grace of our Lord Jesus Christ, that though He was rich, yet for your sakes He became poor, that you through His poverty might become rich.” II Corinthians 8:9 (NKJV)

“Do not lay up for yourselves treasures on earth, where moth and rust destroy and where thieves break in and steal; but lay up for yourselves treasures in heaven, where neither moth nor rust destroys and where thieves do not break in and steal. For where your treasure is, there your heart will be also.” Matthew 6:19-21

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