Sunday, October 15, 2017

Two Field Trips - Both Disturbing and Rewarding

Scary Till You Get to Know People

Right after we arrived... using the mini bus for protection.
Last week, we traveled on our first road trip to New Amsterdam about two hours east of Georgetown.  I realize how young many of our students are as many really have never talked to people who have psychiatric problems and who they see on the street or in the newspapers ..... violent, anti-social, non-communicative.  

Although Guyana is a small country, most of the students had never been to New Amsterdam or the  Jumbie Tree (see last week's blog).   It is wonderful to see how reticent they are when they first get there and how comfortable they are when we leave in a couple of hours.   It is still going to be a hard sell to get any of them to work there after they graduate.  In fact, there are none of my previous students who have ever worked there.   

I have only one requirement.  I pair them up with one patient and I tell them that they must stay with that patient for 15 minutes no matter what. Not long, eh. Almost all of them can't do it; they get too bored, too uncomfortable, too anxious.   Of course, being the old soccer coach, I throw them back.  Why? Because I want them to get a small experience of what it is like to be there... so 15 minutes is 1% of a day and 15 minutes is what percent of a year (if my sister Maggie was here she could tell me)?  Not very much, for sure ..... and then think about being here for 10 plus years... I'll let a student share her experiences:
Does this look like one student and one patient?
My first time at the Psychiatric Hospital was on 6th October, 2017 with (student) batch 70. The day started out rainy. The journey to New Amsterdam was indeed a long drive.  As we traveled along the east-coast highway, there were many small villages with villagers looking happier than town people. 

Arriving at the gate finally, I just wanted to get off the bus and stretch while waiting for instructions.  A man was walking towards the bus; everyone was afraid, and they all hopped back quickly in the bus and some used others to cover for them if they could not make it back into the bus.  This was the best part about our visit. SN X grabbed onto me extremely tight as I was in front of her and she was scared for her life.  Honestly, I was not scared; I was excited, and because of this SN X stayed with me throughout the visit.
The big guys: backs to the wall and grouped together for protection .....
We spent about 15-20 minutes with each patient that reacted to us, and tried to convince others to talk with us.  I enjoyed the company of D from ward D and J from ward C. D  had survived an accident that damaged her right-side brain; she had been in there for 25 years.  Her daughter would visit and sometimes she was allowed to visit her relatives but later got sent back to the hospital ..... D looked physically healthy; she seemed polite and friendly. She had packed her clothes and was waiting to go home because she does not like the hospital.  She also has problems standing up for long. [Her family is not coming.]  J in ward C greeted us with a friendly smile and began to answer my questions. She told us she used to sell drugs and to my surprise J said she is only 1 year old and is the mother of nine boys and she doesn’t have any friends in the ward. J looked creepy but had a wonderful smile that reminded me to smile too.

I found out that most of the patients wanted to go home; they were non-violent ; have no visitors; are able to give us some information about themselves.  The population was mostly elderly persons who said they were between ages 1-12 [very interesting].  The layout looks very uncomfortable, with no proper sanitation, and the food looked awful.

Our visit was just before Mental Health Week which was observed under the theme “Psychological and Mental Health First Aid for All” and because of this, preparation had been done and we got to see the creative side of the patients; they had beautiful crafts, shoe bags and pot holders.

The New Amsterdam Psychiatric Hospital is a community that works with patients of all kinds of mental illness and disability. They are observed and offered medication as treatment. The environment is very welcoming to an outside but the surrounding is nasty. I never neglect people but this trip taught me to always ask questions and to be aware of people because not all mental problems mean MAD.

Our last visit was to the male admission facility. The men weren't so aggressive and the place seemed more clean and less smelly. Two of them however were in isolation. Here we met Akeem who was a previous classmate of one of my batchmates. He explained to us that he was hooked on pills and his parents just sent him in here to teach him a lesson and he's leaving soon. It was unfortunate to see how two persons from the same classroom took two completely different paths.

I realized that mental illness finds a way of touching us ,because this does not only affect the patients, but also their families.  If any of those patients was a family member of mine , It would have hurt me even more to see my family in that state of mind and place.

It was something I wasn't mentally prepared for, even made me question my choice of profession for a second , but it made me realize how important my job as Nurse is, how much society needs me, the difference I could make, the lives I could touch and influence, and just gave me an idea of what to look forward to and of what is to come!!!

The best part of the trip... Lunch at Chicken Heaven
The Dreaded Day Had Come

The Before .....
I have been taking students to see an autopsy for many years; it now has entered the realm of legend, almost paralleling the horror tales of jumbies.    The upper batches delight in scaring the newbies as soon as they arrive by telling them that one day they will have to go to the morgue, "so be prepared".   During my first class with the first year, someone will ask me, "Are we going to the morgue this year?" "Do we have to go?"  "Yes", I say.   They have been anticipating the scary unknown with increasing anxiety ..... and it was to be on Friday the 13th.  What could be better?

They all write reflections after the experience as I find it a good way for them to get hold of their thoughts and feelings by having to put them as subject-verb-object... even though their English is even worse than mine.  I have attached a few student reflections:

And on the long walk back, I buy them a pop.
On the 13th October, 2017, I was given the opportunity to witness my first post mortem at the Georgetown Public Hospital Corporation.   Although I was scared to witness the operation, I was able to contain myself minutes before entering the operating room. I would describe my experience as breathtaking and unbelievable. The amount of lifeless bodies just lying around was shocking for me. I was only expecting to see one corpse in an enclosed room.

After a brief introduction by the doctor, he then began cutting a thirty-six year old female down the middle of her body. Seeing that made me feel a little weak. My thoughts were all over the place.  I wondered about what her life was like before she died, if she was a mother, her children and even how she felt as she was dying.  It was a very sad moment for me, but due to my curiosity, I was forced to look even deeper. 

The internal organs of the human body reminded me of the organs of a chicken.The size was smaller than I expected. I was told the scent of the dead would have been unbearable, but that wasn't so.
The corpse had suffered third degree burns to the posterior part of her body. I was puzzled as to why the doctor still needed to perform the postmortem, but then after he explained, I was able to understand. 

My experience today was unforgettable and very emotional.   Although I am more knowledgeable as to how it's being done, I don't think I can witness a postmortem of a family member, or with someone I knew or had spoken to.


I imagined that a morgue would be a clean, well ventilated area, but to my surprise, the Georgetown Hospital Morgue was far from that. The first thing that I saw was a body fully exposed. I really didn’t understand why. I noticed that there were a lot of dead bodies all over the place. It made me think about my late grandfather. I started to wonder if he was like those persons. One of the workers was opening a skull, so we can get to see and feel an actual brain and while cutting, he almost stepped on the head of a body that was right at his feet..

Apart from that, getting to see the parts of the body with the naked eye was pretty cool. I actually got to feel two kidneys and differentiate between a healthy kidney and an unhealthy one. I even got to see and touch a real heart, and a real brain. Basically, getting to see all the organs that I have been learning about for years was pretty awesome, but the condition of the morgue was horrible. This is an experience that will probably affect me for life and also give me a broader understanding of what the organs in the body actually look like.

After they write their reflections we talk about it as a whole class.   Some are too emotional to speak at first and some stoic, but all have been impacted with the good opportunities to learn about human bodies, the fragility of life, the importance of relationships with family and friends.   The other universal is the upsetness with the lack of respect for the dead, as well as the crowded and dirty conditions of the facility.  

As I am fond of saying, "Many things are true."   Yes, the conditions at the morgue are not up to even Guyanese standards. And Guyana is a poor country with limited fiscal resources.   So where does one take the dollars from to improve the care of neomorts in Pathology?  From Obstetrics? Psychiatry? Emergency?   There are no easy answers to really great concerns.   

Faculty Member Roberta Binda poses with the 2017 Survivors

St Ann's Girls

I still get to see my girls at St. Ann's though I have spent a lot of my time trying to keep their old computers operating.   I used to say that you really can't screw up a computer because you aren't smart enough to do serious damage; however, that was before the little girls there got access to the machines.  They have no fear of the machines - or the matrons-- so they unplug stuff and replug it in somewhere else.   This week there was no ethernet cable and it was there last week.   Anyhow they still enjoy my cameras and so they enjoy me.

This week I was the subject of much of their discussion.   They concluded that I could use a plastic surgeon to get rid of my chin waddle and the bags underneath my eyes; a hair transplant specialist; and a good barber to get rid of nose and ear hairs... and their list went on... They were brutal.   So I quoted a Guyanese proverb: "Mannish puppy nah live fuh turn daag."

        Dr. Tony & One Big Kiss (Not Dr. Tony)

Tony hosted a swim and dinner celebration with his psychiatry residents.

 My long-suffering companion (or maybe it's me who has been long-suffering) Tony Carr will be finishing up his three week stay, mainly educating the psychiatric residents at GPHC and coming over to teach at Mercy many times, on Tuesday.   Certainly all his students will miss him terribly as he brings a unique blend of knowledge about medicine/psychiatry and enthusiasm to everyone he encounters.  He has promised to write a blog after he gets home.

/He only posed with his student  nurses - no dinner!

And the kiss... and more (but this is a wholesome blog)

This October 16th will be my wife Anne Treadwell's birthday, and it will be 15 years since I have been home for her birthday.   I can't say she has never mentioned the fact, but she has never asked, demanded or hinted that I stay home and not go to Guyana.  And it has been through the whole course of our marriage.
This was my proposal long ago
and I'd do it again today.
I get lots of credit for travelling here; however, credit also goes to Anne for supporting me in my travels.   I have been lucky and blessed in my marriage.    I do not know how to thank a partner who lets you run away and save the world for three or two months every year .....  I will just say, "Thank you, my partner and wife, Anne."

"Happy birthday my dear Annie.  Love John"

Saturday, October 7, 2017

Luck, Resilience, Workhorses, Flexible Schedules and Jumbies

My New Friend - Unlucky

As I went to print [?] last week on Saturday, everything was a "go" for Tracy to join me here in Guyana as a new volunteer.   Just a few hours before she was to take off I received this email, "Do you have a phone number I can call you at asap?"    Later, Tracy wrote this for for me to put on the blog:

“It was with deep regret that I made a decision to cancel my trip to Guyana on Saturday, a mere hours before I was due to get on the plane. One of my sons is experiencing some medical issues that reminded me clearly that my first duty, is here with my family. John mentioned my enthusiasm in a previous post and that has not waned in the slightest; I absolutely intend to visit Guyana, hopefully during John’s next trip. Before then, I will work on my 'saying no' skills as I’ve always found the idea of writing a blog quite intimidating!! I want to thank John for being so welcoming and working with so many other welcoming folks to find opportunities for me to get some exposure to Guyana and Mercy. Next time!"
Tracy had said she needed Peanut Butter, in fact couldn't live without it.
So -- in case Tony would think she was an addict, I had hidden an extra jar under her pillow.
I can't say I was thrilled with this development -- AND of courseTracy made the right decision.   As I have said many times before, "You need to be lucky to be a volunteer!"  You can have money and desire and talent and ..... but so many other events in our lives need to fall into place, including the health of our family (and ourselves)!

For those of you who are not lucky enough to be Canadian, it is Thanksgiving this weekend.   Some of my family will gather at my home to celebrate all we have to be thankful for ..... without me.   I am thankful to all of them for supporting me with their words and actions and by staying healthy!    I will look forward to Tracy coming next year ..... if I am lucky enough to be here too.

You have to be Tough to be a Nurse in Guyana

Almost every year I (or one of my guests like Dennis or Andrew) -- I love it when someone else does the work) have the students explore their family history -- at least, what they know of it.   And really these young people are no different than any others ..... pretty selfish.  Their world is themselves, which probably is necessary developmentally.  So when I introduce family history, in unison they say they know nothing.   Okay, "Do you know who your parents are?" And we are off ..... I distribute blank family tree diagrams that are so culturally biased they need to be considerably amended to meet the structure of a Caribbean family.   I give them a few pointers, and this year -- it might be because of climate change or because I am getting better as a teacher --  they worked hard at it and some could go back 5 or 6 generations and find some information.  (Still, some could not go back even one generation on one side of their families.)

This year I asked them to write a one page reflection on "Who Am I?" with the emphasis on what they had learned by exploring their ancestry.   I'll include just a couple of examples.  The first one has unique events, but the theme of resiliency is one that is common to all my students.   When the field of family therapy was just beginning, researchers were amazed at the resiliency of families who faced enormous obstacles with severely limited resources.   At first, the concept of resiliency was applied only to individuals in the family, like the strong single mom; however, it has shifted now to a more systemic awareness.   (I resort to my favourite expression, "Both are True.")   I am humbled by the resilience of my students -- though it does not stop me from criticizing them when they are "out to lunch."

I am 19 years old and I was born at GPH, but I was raised in Lethem, Rupununi.  I am my mother’s only child and the second for my father.   My mom and I lived alone because my mom and dad separated when I was one year old.  In 2003, my mom married my step-father and I went to live with my grandmother because my mom was suffering from thrombosis.  Her left leg was amputated and she was only twenty-two years old.  After she recovered and learned to walk with crutches, we moved to Georgetown.  There I completed my primary school education.  My mom fell ill again and I was home-schooled for one year in the interior of Guyana on the Essequibo River before moving back to Lethem.  I completed my secondary schooling there in July 2014.  I returned to Georgetown to re-write my maths and while there I lost my mom to a heart attack.  I returned home for one year to: grieve her death, deal with  my breakdown, and get my life together.

I returned to Georgetown in late 2016 and applied to nursing school where I was accepted.   I am being supported by my grandparents and aunt, both on my father’s side.  My father really never played a part in my life until the death of my mom.

Knowing about my family from both parents, makes me realize how lucky I am to belong to a loving family who support me through nursing, especially on my father’s side --  a family who are there for me when I break down and encourage me when I feel like giving up.  I am grateful to god for giving me such a blessing.

The next one has an illustration of the sad history of indenture in Guyana.  Her great grandmother's death was not unusual on the journey from India to Guyana.    As well, there's a surprise conclusion:  I had hoped for it, but still was surprised when I saw it in print:

My third great grandfather from my mother’s side came from Southern India in 1880.   He was brought on the ship Bruce to work as an agricultural laborer at an East Coast plantation.  His wife was also with him on the ship and died on the way, near South Africa.  She died mainly from diarrhea and vomiting from drinking impure water; her body was thrown overboard.  My grandfather completed his five-year indenture; he remarried and settled on the coast of Guyana.

Family history is truly a righteous pursuit.  I have a desire to be more kind.  Family history becomes more important when you lose someone you love.  Something happens to my soul when someone whom I have loved moves on.  I have learned that I am an important person and I have things to pass on to my children, my society and to unknown future generations.

Maybe not all students are as selfish as I thought!

And Something to Make Anne Laugh

As part of the deal to get an extra class-slot, I had to promise the English teacher, Candy Mohan, that I would also correct the students' spelling and grammar.   I don't know how many of you know this, but my blogs have been censored for years.  Yes, Anne reviews all my drafts and corrects for spelling, grammar, and inappropriate content... And sometimes it takes her a very long time!   She said something about not being able to send it on to her friends in an unedited state .....   

You Really Can't Abuse Tony

Tony has been working hard since he arrived here.  He is at the Psychiatry Department of the Public Hospital every day, and many days has been teaching at Mercy as well.  This Tuesday he took over my two classes in order to teach a review of the Central Nervous System, Motor and Sensory Pathways, etc.  This is because our Problem Based Learning pages are built on the basis of neurological problems, with ethics, psychology and sociology woven in.    

He was so popular the senior students wanted to join in as well as the faculty.  It was a full house and he didn't disappoint.    He is an excellent presenter and has lots of weird examples, not to mention his unusual sense of humour.  However, the large class left the students hesitant to answer any of his questions.  At one point, Tony got a little frustrated and exclaimed,  "What idiot has been teaching Neurology?"

It has been good to have him back here.   I hope to have him write the blog for me next week or the week after.     Yes, I know, one less for me, but I'll suffer through... and you may suffer less. 

Plan Ahead ..... No, Don't Bother

This week was already quite different as Tracy was to be here and I had worked around her plans ..... I really shouldn't have bothered -- not so much because Tracy was unable to make it, but because it is Guyana. 

Monday, it was decided that the Massive Prayer Service for the students taking their national exams would be at lunchtime instead of the end of the day ..... ugh.  This basically meant that we could not teach PBL because we need the morning session in order to have the afternoon one.      Okay, I had many errands to run and would be back by noon as I told the secretary at 9 when I left for downtown.  About 9:30, I received a phone call from the Director, Elsie.  "Rev, where are you?" "I'm heading to St Ann's."  "Can you be back by 10? We changed the service so the students could leave and get their hair done."  "Okay, I'll be back."   And then -- the service started at 11.


Tuesday, normal for me, though Tony taught.

Wednesday, a normal PBL day ..... not.   When I got over to the school, I was shown a letter sent the day before in the late afternoon from the Ministry of Education requiring all faculty to attend a crucial meeting from 8:00 to 2:00.    Okay, there will be no tutors for PBL ..... We will just have them do the small group without tutors.   One tutor reacted as if  I had just killed her mother ..... "They can't do it without me."    Really?   I overruled her, and as I was thinking about how to do it Nurse Elsie informed me that PAHO was coming over to have their book sale.  Good event as they have really excellent books at discount prices... And they would be here all morning and the students were required to come.   No problem: I would just continue my shopping/errands from Monday.

Thursday, normal - Two days out of the week; not bad.

Friday, the Mad House!  No not just another day at Mercy ..... we were doing our field trip to the National Psychiatric Hospital in New Amsterdam.  More next week on the trip, but I do want to mention a really good thing.  The cost of the trip was paid for this year by Mental Health Without Borders.  This was a group which developed from the health professionals who came several years ago to look at how to improve mental health in Guyana.

An Old Tale of Jumbies

Between  Georgetown and New Amsterdam resides the famous Cotton Wood Tree in the middle of the highway, the only place in Guyana that a road separates .  And the reason is that "everyone" believes that Jumbies (Guyana equivalent of Zombies) reside in the tree and that the tree is possessed with magical powers to inflict harm on anyone who tries to cut it down.   So when the road was built, no workman would cut down the tree for the road.

This Cotton Wood tree was imported from Holland and is also known as the white man's tree.  When the tree was planted many years ago a slave was buried in the hole to provide fertilizer.  Usually, the slave was dead.  But for this tree he was buried alive.   And if you are brave enough to touch the roots of the tree you can still feel the heartbeat of the slave.   Only a few students got close to the tree and no one actually touched it .....