Living with Sleep Apnea

San Jose, Costa Rica, November, 2006

“My soul, wait thou only upon God; for my expectation is from Him.” Psalm 62:5

It’s hard to believe that I’m finally in Costa Rica after wanting to visit this country for the past ten years, ever since I worked with Dr. K. who mentored me when I was in graduate school. He grew up in Costa Rica and moved to the USA when he was 16 years old. I signed up to go on a tour last April but had to cancel it when I had complications after cataract surgery. The Lord sold my condo after ten months on the market and I was able to buy another house. They are fixing my new house over the next few weeks while I tour Costa Rica for 10 days and then stay with a friend from church for a couple weeks. It is so kind of the Lord to give me this break between moves.

My flight last night was smooth and on time. I sat next to a Costa Rican grandma and her teenage grandson. She only spoke Spanish, but he spoke excellent English. She asked me what time it was and I told her in Spanish! I’m glad I finished my 16 Spanish lessons on CD. How I wish I would have learned Spanish as a child. It’s kind of tough to learn at my age.

I fell into bed last night at midnight at this beautiful hotel in downtown San Jose. It took about an hour to go through customs followed by a 30 minute taxi ride. The only electrical outlet in the room is about 7 feet from the foot of the bed. So I  blew up my air mattress and switched all the sheets and pillow around so my head was at the foot of the bed. I put my CPAP (Continuous Positive Air Pressure) machine on a chair and stretched the cord to the outlet as far as it would go. I should have brought an extension cord. It worked well and I slept soundly which was a blessing. I remembered to get out of bed on the opposite side so I wouldn’t trip over the taught cord. I was cold and there is no heat in the room so I slept in my heavy sweatshirt. San Jose is the city of “eternal spring” with average temperature of 70 degrees since they are at 3800 feet elevation.

I enjoyed seeing beautiful Lake Arenal in Costa Rica.

Reflection

At the age of 40, I told my doctor I couldn’t stay awake during the day and often woke up tired with headaches or choking. He ordered an all night sleep study at a sleep center. They glued electrodes all over my head, put a belt around my chest, and then told me to sleep as they recorded me all night on video and by electroencephalogram (EEG). They concluded that I stopped breathing many times during the night, my oxygen level dropped, and I had no deep stage sleep. The doctor prescribed a CPAP machine which blows humidified air into my lungs all night to keep my airway open. He said I was born with a small airway which collapses as I’ve aged. It took me several months and several different masks before I was able to sleep all night. I always encourage newly diagnosed patients to keep trying to sleep with CPAP for several months and not to give up. Many people say the mask makes them feel claustrophobic.

If a person does not treat his sleep apnea, he has a much higher incidence of heart attack, stroke, depression, and death. They now can diagnose it with a simple sleep test that can be done at home with a pulse oximeter attached to your finger. It is much easier to sleep in your own bed at home rather than go to a sleep center.

I discovered very comfortable nasal pillows (Swift Fx) rather than a mask. The mask actually made a permanent bump on my nose that had to be removed by a plastic surgeon. Occasionally, I still have trouble going to sleep some nights so my pulmonologist prescribed Lunesta that does not affect my apnea. I never take it two nights in a row since it can be addicting. It also helps me adjust to a new time zone when I fly east or west and have jet lag.

Transcend travel CPAP with 3 night battery and Swift nasal pillows.

I’ve learned how to travel internationally with my CPAP machine. The airlines allow you to carry your machine on board in a separate bag since it is medical equipment. I never put it in my checked bag because it is a fragile machine and could break as they toss your bag around, or your luggage could be lost. In the USA, most insurance companies will only pay for a new machine every five years. They cost $400-$700.

Four years ago before I went to Ecuador, I invested in a small travel CPAP (Transcend) and a three night rechargeable battery since they have frequent power failures there. Insurance does not cover the cost, but I like to do international travel so the small size and rechargeable battery was worth it to me. It includes converters for different electrical outlets around the world. I wish I would have had the battery when we lost power for six nights during a blizzard six years ago. That was tough to go to work every day without any sleep.

This is a humidifier that attaches to the hose, but it only lasts for a week and doesn’t humidify the air very well for me.

 

The water chamber humidifier for the travel CPAP is quite large unfortunately and requires a separate electrical cord. It does not run off the battery.

I also used it for ten weeks in Costa Rica last year and it worked well. The battery solves the problem of outlets far from my bed. I just recharge it the next day. I forgot to bring extra filters for my machine. The active volcano ash in the air clogged the filter so I washed it daily until it fell apart. It’s almost impossible to get medical equipment through customs, so I placed a paper tissue over the air intake port to try and filter the air as much as possible.

I also forgot to bring normal saline nasal spray with me for my dry nose. I couldn’t find it in the pharmacy or make the pharmacist understand what I needed. I finally went to the school doctor and paid him $40 for an office visit. He told me to ask for “Steri Mar” (sterile sea water). I did and finally purchased it for $30. So for $70 I had sterile saline nose spray which I normally buy for $3 at Walmart.

My $70 sterile saline for my dry nose. It’s called Sterimar in Spanish.

I hope these hints I have learned the hard way over the years can help you instruct your patients. If anyone has symptoms of sleep apnea, encourage them to tell their health care provider and have a sleep test. Our bodies heal during deep stage sleep and are refreshed. If you would like more information about sleep disorders, go to http://www.mayoclinic.org

Sleep is such a gift from the Lord. I thank Him that these devices are available for us in this day and age.

“I will both lie down in peace, and sleep; for You alone, O Lord, make me dwell in safety.” Psalm 4:8

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A Chinese Atheist Receives Christ

Midwest, USA – 1989

About two years ago, my friend and I were going door to door calling to share the gospel with my neighbors. One lady from China named Nina (pseudonym) invited us to come in. She was formerly a radiologist in China, but had moved to the Midwest recently with her husband for his new job in research. She said she was very lonely and was so happy to have some friendly visitors. We spoke slowly so she could understand our English better, and I told her how much I had enjoyed visiting China three years ago. We also shared the good news about Jesus Christ; how He died for our sins on the cross, was buried, rose again, and lives today. We shared how He wanted her to receive Him as her Savior. We asked if she had ever heard this before? She said that she had as a girl when she attended a school run by missionaries. After the communist takeover, the school was closed and the missionaries were forced to leave. We invited her to Bible class and she eagerly began to attend.

After about 6 months of faithfully hearing the Bible taught, Nina received Christ as her Savior. She was so happy and really began to grow in grace. We all were praying that her husband, Daryl, would also receive Christ as Savior. One Saturday evening, I invited them to my home to dinner to get to know them better along with a couple other people from church. We had a pleasant time together and the others left first. As Nina and Daryl were getting ready to leave, I mentioned something about how thankful I was that God loved us so much. Daryl said angrily, “How can God love us? I saw hundreds of people starve to death in China during the famines!” I softly replied that the important thing was that he had the opportunity to receive Christ now and that God wanted all men to be saved, but He wouldn’t force Himself on anyone. Nina stood there silently with a pained expression on her face. I bid them both good night. All I could sadly think about was Psalm 14:1:

The fool has said in his heart, There is no God.

About a year later, Daryl burned his legs during an accidental fire at work, and his legs became badly infected. They did not have a primary care doctor, so he continued to return to the emergency room for treatment. Nancy called me and asked if I had any suggestions? I called Dr Pete, my friend who was a Christian surgeon, and he asked Daryl to meet him at the ER where he was on staff. After examining Daryl, Dr Pete admitted him so he could receive intravenous antibiotics.  While Daryl was an inpatient, one of the elders from church visited him daily and read scripture to him and prayed with him. Nina shared that Daryl was deeply touched by the kindnesses of Dr Pete and the elder, even though he was a total stranger to them and an atheist.

In January, Nina told me that Daryl was being transferred by his employer to Miami, Florida. I was heartbroken as she seemed to be growing so much in her faith and he seemed so much more open to the gospel. But we prayed for them to be guided to a good church.

In March, Nina called me and said how much they enjoyed attending the Chinese Baptist Church! She said Daryl had something to tell me and she handed him the phone. “Miss Pam, I heard the gospel in Chinese at the church from the Chinese pastor. Now I understand what you were trying to tell me. I received Jesus Christ as my Savior! I am so thankful that my sins are forgiven and that I have a home in heaven and that I will be with Jesus forever! I am so sorry I yelled at you when you tried to tell me about God.”

I replied through my tears, “Daryl, I am so thrilled that you are now a Christian and my brother in Christ. Let’s pray together right now and thank God.” We had such a precious time in prayer together on the phone, thanking God for His wonderful grace and mercy to us.

March, 1990 – Miami, Florida

The Lord opened the door for me to visit my parents, who now live in Florida, as well as Nina and Daryl and attend church with them at the Chinese Baptist Church. For my sake, they took me to the English service rather than the Mandarin one so I could understand the service. We entered the large bright sanctuary and were greeted by friendly Chinese believers. The service began and after the opening hymn, the pastor asked for visitors to be introduced. Daryl motioned for me to stand up among the hundreds of Chinese brethren. He began, “This is Miss Pam who first gave me the gospel of Jesus Christ when I was an atheist. I hated the gospel back then and yelled at her. But she did not give up on me and now she is my sister in Christ.” My tears rolled down my cheeks as I marveled at the wonderful work of grace God had done in Daryl’s heart as well as my own!

But God commends His love toward us in that, while we were yet sinners, Christ died for us. Much more then, being now justified by His blood, we shall be saved from wrath through Him. Romans 5:8-9

Reflection

Nina and Daryl returned to China

Nina and Daryl returned to China

After about a year, Daryl and Nina moved back to China. For a number of years I received a card from them every Christmas. One year, Daryl shared with me how his elderly mother also received Christ. I don’t know exactly when Daryl and Nina went to be with the Lord, but it will be wonderful to be reunited with them in heaven above some day and worship the Lord together!

Face to face with Christ my Savior, Face to face –what will it be? When with rapture I behold Him, Jesus Christ who died for me. Face to face I shall behold Him Far beyond the starry sky; Face to face in all His glory, I shall see Him by and by! –by Carrie Breck

 

Surprise in Labor and Delivery – Part 2

March, 1982 – 12:50 a.m.

I glanced at the white board after we transferred the surprise twins to Neonatal ICU for observation (see Part I of previous post). Bonnie, the health tech, had put a new admission in my other room named Wanda. Bonnie handed me her blood pressure and temperature on a piece of paper, and warned me, “Pam, she is extremely overweight, so I think she will have a difficult delivery.” I walked in the room and introduced myself to Wanda who was accompanied by her equally large husband, Martin. She told me she was 23 years old and this was her second pregnancy. She had a miscarriage at 14 weeks last year. Her last weight in the office was 305 pounds. She said her contractions began about 5 hours ago and were now 5 minutes apart, so her doctor told her to come to the hospital to be checked. I had brought the doppler stethoscope with me which was a very sensitive electronic stethoscope that is more sensitive than the manual fetoscope.

Manual Fetoscope to listen to baby's heartbeat. Curved part is placed on nurse's head for conduction.

Manual Fetoscope to listen to baby’s heartbeat. Curved part is placed on nurse’s head for sound conduction.

Electronic doppler to listen to baby's heartbeat

Electronic doppler to listen to baby’s heartbeat

I placed ultrasound gel on the end of the doppler and began trying to listen to the baby’s heartbeat on her very obese abdomen for an entire 5 minutes. I couldn’t hear anything through the layers of fat. Wanda grimaced and said she was having a contraction as she looked at her focal point and started Lamaze breathing. I placed my hand on her abdomen to feel the contraction, but felt nothing. After she said the contraction ended, I did an internal exam and felt her tightly closed cervix with the baby’s head up high in the canal. I did not have an elastic band long enough to go around her abdomen for the external monitor, so  I asked her to walk around the halls with her husband for one hour and then I would recheck her. This was our standard procedure if we were unsure if the woman was in labor.

After an hour, I rechecked her and there was no change. I called the resident MD and gave him my assessment. “Give her one Seconal now and another to take at home if she is not asleep in one hour.” I went back in her room and told her that since her cervix had not changed in an hour, she was having false labor pains (Braxton Hicks) caused by her ligaments stretching and gave her the Seconal. She was NOT happy to be going home and told me so.

I finished that busy night, and as I was walking out the door at 7:30 a.m., Barb, one of the day shift nurses came up to me. “Pam, they just brought Wanda back up from the emergency room. The ER doctor delivered her baby in the parking lot! She is furious with you for sending her home and said she is going to sue you.” My heart sank and my eyes filled with tears as I walked out the door. Sometimes, nursing is a very tough job.

When I arrived home, I opened my Bible to Psalm 46 and asked God to comfort me.

God is our refuge and strength, a very present help in trouble. Therefore will not we fear, though the earth be removed, and though the mountains be carried into the midst of the sea…Be still and know that I am God; I will be exalted among the nations, I will be exalted in the earth. The Lord of hosts is with us; the God of Jacob is our refuge.

I prayed that Wanda and her baby would be healthy.

October, 1982 – 7:30 a.m.

After we gave report to the day shift, my head nurse came to me. “Pam, the hospital attorney wants to speak with you in the legal department at 8 a.m. about a law suit from one of your patients.” I took a deep breath and asked God to give me a quiet heart. I entered the office and a tall thin gray haired man greeted me and introduced himself as Attorney S.

“I asked you to come review a chart with me because a woman named Wanda S… is suing the hospital for emotional trauma, inaccurate assessment, and negligent care of her when she was in the labor and delivery unit. You were the only one who examined her,  and then she came back later that morning and delivered the baby in the parking lot. Please look at your charting and tell me about what you remember about Wanda.”

I opened her thin paper chart and read my brief notes. I read the verbal order I wrote from the resident to give her 2 Seconal capsules and discharge her home. Thankfully, he had cosigned it. It seemed strange to be reading my handwriting six months later. Attorney S said, “Did you forget to write any other assessment or do you remember anything else about what happened with Wanda that night?” “No, she was only there an hour. She was very difficult to assess because she was so obese. My charting is complete.” He thanked me for coming and I went home.

I never heard the outcome of the law suit. It was a good reminder to me to chart completely and accurately immediately as things occur, especially in a place like labor and delivery where things change dramatically in mere seconds.

Reflection

One of the huge problems in medical care in the USA is the cost which is driven up by exorbitant malpractice suits against medical professionals. When I took a nursing tour of China in 1986, I was amazed that each patient only had a single piece of paper on a clipboard hanging on the end of their bed. I looked with longing at that little clipboard, wondering what it would be like to only have to write a few characters on each patient each shift. The head nurse explained that since it is a communist nation, the people were not permitted to sue any doctor or nurse for malpractice. Each patient has their personal health notebook that they bring to the clinic or hospital and then take back home. Therefore, there are no departments for medical records or malpractice attorneys.

Minimal charting in China in 1986

Minimal charting in China in 1986

Much of the charting we do is to prove we are practicing nursing according to the standard of care and to cover ourselves if we are ever sued. My college nursing instructor drilled into us, “If it’s not charted, it’s not done.”

The following is an exerpt from “Make Your Nursing Care Malpractice Proof” – January 2012, Vol 7, No. 1 by Deanna L. Reising PhD, RN

Six categories of nursing malpractice claims have been identified:
•failure to follow standards of care
•failure to use equipment in a responsible manner
•failure to assess and monitor
•failure to communicate
•failure to document
•failure to act as a patient advocate or follow the chain of command.

As I thought about the situation with Wanda, thankfully I did not commit any of those “failures.” Babies simply have a mind of their own, and they don’t read a book about how or when to be born. Expect the unexpected in obstetrics.

Mary Slessor of Calabar (Nigeria) – Pioneer Missionary

Free Book Recommendation!

Dear Readers,

Since I mentioned Mary Slessor last post, I decided to republish this about her life.  It’s now a free book on Kindle, so I hope you are blessed in reading about this heroine of mine.

by W.P. Livingstone

I have been reading it this time through the lens of life experiences since I have now visited several “third world” countries, including jungles, and can better appreciate the hardships she endured. She had such passion to give the wonderful good news of Jesus Christ to cannibal jungle tribes in Nigeria from 1876-1915, and endured much physically and emotionally as she trusted God to transform the people by His power.

Mary Slessor- a Scottish single lady who devoted her life to reaching the cannibal tribes in Nigeria

Challenged by the life of David Livingstone, Mary Slessor offered her services as a missionary in Calabar, Nigeria. Arriving there when she was 28 years old, she overcame her fears and inexperience with a genuine love for the people and shared with them the hope of the resurrection through faith in Jesus Christ. Earning the nickname “White Ma” she became mother to many adopted children and never failed to preach the love of Christ to all she met. Many times she was ill with fever from malaria, but God renewed her strength repeatedly so she could carry on the work.

The natives believed that any mother who gave birth to twins must be cast out and the twins be killed immediately. Mary rescued many twins and raised them herself to demonstrate the love of Christ to them.

Mary Slessor with some of her beloved adopted children.

She worked long hours as a mill worker in Scotland before coming to Nigeria in 1876. She was a diligent student of the Bible although she never received any formal training herself. When no worker could be found to go with her into the jungle, she went alone with some natives, trusting God to open doors. She wrote in a letter home in 1888, “I am going to a new tribe up-country, a fierce, cruel people, and every one tells me that they will kill me. But I don’t fear any hurt –only to combat their savage customs will require courage and firmness on my part.”

Even though she was not a formally trained nurse, she did what she could to relieve the people’s sufferings who usually went to the witch doctor when ill. In 1896, she decided to move further up the river with her many adopted children since most of the tribe had moved there. However, there was much sickness among the children by an infectious disease which caused the death of four of them. To make matters worse, smallpox then swept through the country, killing hundreds of people. For hours daily she vaccinated all who came to her hut. A man from the mission downriver arrived when her supply of lymph had run out and assisted her to take blood with a penknife from the arms of those who had already been inoculated so they could inoculate more.

She returned to her old house and converted it into a hospital, and people flocked to it. When she heard her beloved Christian chief Edim caught the smallpox in the new village, she tramped back alone through the jungle to nurse him, but it was in vain.  The Lord took him home to heaven in the middle of the night. Since she had no one to help her, she fashioned a coffin with her own hands, placed his body in it, dug a grave, and buried him.

Mary with Chief Edem who later died of smallpox

Two white Christian men arrived from the Mission House down river to help, and she asked one of them to go back to her old house to gather some supplies. When he arrived in the village, all was total silence and he knew something was wrong. He opened the door of her house to find it full of corpses of those who had died from small pox. The place was never fit for habitation again, and gradually was engulfed in bush and vanished from the face of the earth.

Later in her life, the British government appointed her as Vice Consul because of her unique command of the native language, her understanding of their customs, and the great respect and love the people gave her. People would flock to her from miles around so she could preside as judge over their cases. Sometimes her judgement was to assign hard labor for 1 to 3 months, while other times she would box the person’s ears! This was a huge change from when they would administer the poison bean to some while pouring boiling oil over others. Previously, whenever a chief died, they would kill many of his wives and children to serve him in the afterlife. As more and more became Christians, the twin killing and killing among the tribes gradually stopped.

Mary presiding at Okoyong Court

So I hope I have told you enough to whet your appetite to read or reread this classic biography. You will be blessed, amazed, and challenged as you see how God used this humble little Scottish single lady to transform  tribes of cannibals through the power of Jesus Christ! Her image is now on the 10 pound note in Scotland.

Mary's image on the 10 pound note of Scotland!

“and ye shall be witnesses unto Me both in Jerusalem, and in all Judea, and in Samaria, and unto the uttermost part of the earth.” Acts 1:8

Modern day photo of Cross River, Nigeria where Mary labored.

Labor and Delivery Student Nurse

Junior in College of Nursing – Winter Quarter, 1976

Another quarter has passed with its joys and trials and my junior year is completed! Only three quarters to go before I graduate in March 1977. It’s hard to believe I have completed three years of college.The Lord kept emphasizing to my heart again and again that His grace is sufficient and that He wants me to enjoy Him and glorify Him forever.

My nursing courses were excellent this quarter! I studied Reproduction the first half of the quarter and had my clinical days in labor and delivery and post postpartum. Since I only had an 8 hour shift two days in a row, I never was able to see a woman in labor from admission until the birth. But I was so excited when I finally was able to see a baby born during my clinical hours! What a miracle to witness how God brings us into this world! I also sadly witnessed a therapeutic abortion to save the mother’s life. She was 16 weeks along, but her blood pressure was so high that they were afraid she would die from seizures or a stroke, so they did a caesarian section to take the baby.

During the second half of the quarter, my clinical days were in Nutrition and Elimination, so I cared for patients after their gastrointestinal surgeries, urology surgeries, and those who had absorption problems requiring tube feedings. My other two classes were Microbiology and the Modern History of the Nation of Israel. It was fascinating to study how modern day Israel was formed in 1948 and how God has been bringing the Jewish people back to Israel from all corners of the world just as God prophesied! “That then the Lord thy God will turn thy captivity, and have compassion upon thee, and will return and gather thee from all the nations where the Lord thy God hath scattered thee.” Deuteronomy 30:3  I wonder if I will ever visit Israel before I am there in my glorified body during the Kingdom Age?

My greatest joy is simply the Lord. It is so wonderful to be truly satisfied with Him and to be learning more about Him every day. The joy that surges through my heart as I study the Word and meditate upon Christ is indescribable! My greatest trial was when I had a virus the last two weeks of the quarter, and I was too weak to do anything but simply lean hard upon Christ. But it was a privilege to see my nothingness and Christ’s all sufficiency. II Corinthians 12:9-10 became very precious to me: And He said unto me (Paul), My grace is sufficient for thee; for My strength is made perfect in weakness. Most gladly therefore, will I rather glory in my infirmities, that the power of Christ may rest upon me. Therefore, I take pleasure in infirmities, in reproaches, in necessities, in persecutions, in distresses for Christ’s sake; for when I am weak, then I am strong.”

Reflection

Little did I know in 1975, that the Lord would open the door in 1981 for me to work full-time on night shift on a very busy ten bed labor unit that had 4000 births annually. I witnessed about 2000 births during my two years there, and it never ceased to amaze me the wonder of how God brings babies into the world and that the great majority are healthy. When I studied to become a nurse practitioner, I took a graduate course in Dominican Republic in 1994 and was able to deliver a baby on my own since the nurses do all the normal deliveries.

Pam holds baby boy she delivered in Dominican Republic as his Mom looks on.

Pam holds baby boy she delivered in Dominican Republic as his exhausted Mom gazes at him. 1994

God also gave me the great privilege of taking a Bible tour of Israel for ten days. It was truly the trip of a lifetime and helped me “Pray for the peace of Jerusalem” as it says in Psalm 122:6. In preparing for the trip, I read many books on the modern day history of Israel. I highly recommend Zvi by Elwood McQuaid, which is the true story of a ten year old Jewish boy who survived the holocaust and found his way to Israel and faith in the Messiah. He was one of the freedom fighters in 1948 and the other wars that followed. (available as e-book or from http://www.foi.org) Our tour group had the joy of meeting one of his sons who is involved in a Bible ministry in Israel. Shalom.

Zvi, the true story of a holocaust survivor.

Zvi, a true story of a holocaust survivor.

Blog Update

Dear Readers,

I mentioned in August that I retired from nursing a year earlier than I anticipated. God has opened a wonderful door for me to learn Spanish this year in a very intense language program for missionaries. God has laid a desire on my heart to minister to Spanish speaking people during my retirement years as He gives me the strength and health. I am enjoying the program immensely, but it is a tremendous amount of work every week as I go along “poco a poco” – little by little. God has also given me several opportunities to assist the other students and my professors with their health problems, so I am still using my nursing skills unofficially.

I thought I brought all my needed journals with me to complete this blog, but I discovered that I put some of them in my storage container, so I am unable to write new material at this time. I don’t trust my memory of events nearly 20 years ago!

Since many of you are new readers, I have decided to start over from the beginning and repeat the past posts. For of those of you who have been with me from the beginning, perhaps you won’t mind reading them again. I enjoy rereading some of my favorite books and am amazed how I notice things anew because I am at a different stage in life.

So thank you for praying for me in my language studies as I desire to glorify the Lord here and keep my eyes and heart on Him.

I will close with this poem they found in Hudson Taylor’s journal. He was one of the early missionaries to China in the 1800’s and was used by God to found the China Inland Mission which is now Overseas Missionary Fellowship. I am enjoying translating the English flash card story (by Child Evangelism Fellowship) of his life into simple Spanish for my classmates.

“Lord Jesus, make Thyself to me,

A living, bright Reality;

More present to faith’s vision keen,

Than any outward object seen;

More dear, more intimately nigh

Than e’en the sweetest earthly tie.

Hudson Taylor flashcard story I am translating into Spanish. (CEF)

Hudson Taylor flashcard story I am translating into Spanish. (CEF)

“O God, from my youth You have taught me; and I still proclaim Your wondrous deeds. So even to old age and gray hairs, O God, do not forsake me, until I proclaim Your might to another generation, your power to all those to come.”  Psalm 71:17-18

Pamela, APRN

Transcultural Nursing Course – Dominican Republic – Part 4

Transcultural Nursing Course – Dominican Republic – Part 4

January, 1995

Over the next few days, I was assigned to work in the Mennonite clinic which was hosting us in nice motel-like rooms. I watched Dr Nancy examine patients all day long in much the same fashion as USA physicians do. She speaks some English and many of the medical terms are the same in Spanish, so I was able to understand quite a bit. One mother brought her newborn to Cora, NP. We looked at the baby with sadness who was born with a micro tongue, stubs for feet, and a lobster claw for a hand. Cora instructed the mother to pump her breasts and feed the baby girl with a syringe, and referred the baby to the specialty clinic in the capital, Santo Domingo. I also met Dolly, the clinic sheep, that supplies blood for the agar used in the laboratory plates for microbiology cultures.

Dolly, the lab sheep who supplied them blood for their agar plates.

Dolly, the lab sheep who supplied them blood for their agar plates.

At 11 a.m., a group of clinic workers started singing hymns and everything stopped. Then the Pastor preached a gospel message for 15 minutes and one young man prayed and received Christ as his Savior which was exciting! One of the young men who volunteered, Johnny, enjoyed practicing speaking English with me. I also observed the surgeons in the operating room which seemed to be done the same way we do it in the States.

Each student was required to prepare a health topic to teach the patients. I chose to teach them on how to prevent getting worms since it is endemic in tropical countries. I remembered treating it when I was in Honduras. I studied Cora’s tropical medicine book and then taught the patients with the help of Cora’s poster while she translated for me. The main thing I emphasized was hand-washing after using the bathroom and before eating. This is challenging when many of them don’t have access to clean water as I discovered in the village where we stayed and in the city hospital. If one doesn’t have running water, one has to get it from the river, boil it after building a fire, and then let it cool which is a tremendous amout of work.

Teaching the patients on how to prevent getting worms.

Teaching the patients on how to prevent getting worms.

Round worms are widespread in tropical countries.

Round worms and other parasites are widespread in tropical countries.

On our last evening, I watched a lady weave her baskets and hats. All the children gathered around, and she let them model her hats as I took a photo. I will miss these children. We closed tonight by sharing how this trip has changed us. I said it had increased my observation skills, and that I now realized that maybe we didn’t need nearly as much expensive equipment to get the same patient results. The most positive experience for me was delivering the baby. The most negative experience was dealing with the filthy outhouse in Pan Dia. Cora thanked us for being so culturally sensitive. She is such a sweet godly lady. She has been so sick all week with recurrent typhoid fever. I pray for God’s healing hand upon her.

Cute village children model the hand woven hats!

Cute village children model the hand woven hats!

Santo Domingo

We have returned to the capital city for our final few days. I was greatly blessed in worshiping with the brethren at the city church started by Pastor N and his wife 30 years ago. On Monday, they took us to see their daughter, Dr Marilyn, and the clinic, church, and school which she started. It was very impressive. The people have a much higher standard of living here than they did in the western city of San Juan where we were earlier.

Then we went to a stately old white colonial building which houses the Peace Corps offices for the Dominican Republic. The Chief Nurse gave us a lecture on her role here. There are 7500 Peace Corps workers worldwide. The overall attrition rate is 30%, but only 14% in the D.R. Contracting HIV is a big problem among the volunteers. They are given birth control and condoms, but some of the women still get pregnant. They are counseled  and flown to Washington DC for an abortion. If they have more than two abortions, they are dismissed. Everyone must take anti-malarial medicine weekly and wear a helmet when riding on a motor scooter or they are dismissed.

These facts broke my heart. I thought to myself about how much better it is to follow God’s way of only having sex within the marriage relationship of one man and one woman.

“Marriage is honorable in all, and the bed undefiled, but fornicators and adulterers God will judge.” Hebrews 13:4

Then we toured a city clinic where Mary, a Peace Corps volunteer works. Mary has worked here for 18 months doing health promotion. She started out in San Juan, but was in two bus accidents. In the second accident, the driver and all the people riding toward the front of the bus were killed when the bus rolled over. Mary broke her cheekbone and was flown back to the USA for surgery. She lives here in a poor slum area where the houses are close together on a hill with lots of steps. When we saw a huge rat, a woman ran after it and smashed it with a big rock.

The clinic nurse attended vocational school for six months after she finished the eighth grade. They are taught how to take vital signs, give injections, and a few other basic things. I’m guessing she is equivalent to somewhere between a certified nurse’s aide and a licensed practical nurse in the USA.

Then Dr Elaine gave us a lecture on Culture Shock. She said there are three stages. The first is the Honeymoon stage where everything is exotic and wonderful about your new country. It usually lasts 1-6 weeks. The second stage is the Frustration stage where everything is awful, backward, and makes no sense. The third stage is Stabilization where the person appreciates the new country and learns to be flexible with its flaws. One missionary told me the best way to get through culture shock is to stop comparing the new country with one’s country of origin, but just accept the new country as it is.

On January 6, Three Kings Day, all the stores were closed for this major holiday. This is when the Dominicans exchange gifts rather than on Christmas day. I think they calculate that it took the wise men about 12 days to travel from the east and find the Christ child to present their gifts of gold, frankincense, and myrrh.

On this holiday, we enjoyed touring the 500 year old colonial part of the city and seeing the oldest cathedral in the New World, and the oldest protestant church started in Dominican Republic in 1922. I also had my photo taken next to the statue of Christopher Columbus who discovered the island in 1492.

The oldest protestant church in D.R. built in 1922.

The oldest protestant church in D.R. built in 1922.

Pam and Christopher Columbus who discovered D.R. in 1492.

Pam stands beside Christopher Columbus who discovered D.R. in 1492.

Julie and I had a scary experience as we were leaving D.R. at the international airport. This strange man nearly tackled me, saying he would get us to the front of the long check-in line. We told him “NO” and checked our baggage, but he would not leave us alone ,and said he would get our departure tax for us. We told him “NO” again, but he would not go away. Julie gave him 5 pesos and he gave it back and almost spit, “That is only 5 cents in the USA!” She asked him how much he wanted, and he didn’t answer. He kept badgering us, so I put 4 pesos in his hand and ran for the locked gate and told Julie to run too. I heard him throw the coins on the floor in disgust. I was so thankful he couldn’t follow us through the security gate. I was so glad when the plane took off and then later landed in Miami, back in the good ‘ole USA!!

Reflection

And so ended my two weeks in Dominican Republic. I thank God for all I learned about other cultures during this journey which has helped me in my encounters with patients from other countries over the years. It is fun when I can tell patients from the D.R. about my two weeks in their country!