Emilee, my Guest Blogger

Stories by Dr. Emilee

 My niece, Emilee Flynn has spent the last three weeks in Guyana and most of her time here at Mercy with me.  I got to thinking -- I may have spent almost as much time with Emilee as I have with her mom, Monica, who was a lot younger than I was...and still is!  It was a great visit for me.  Emily writes:

Guyana:

For the last 13 years I have read my Uncle John’s “Ramblings.” I have read about his “other sons,” his girls at St. Ann’s, and the nursing students that he teaches. I have looked at the pictures that he has sent and posted and have marveled at their beauty. And I have waited for the last 13 years hoping for a chance that I might someday be able to join him and experience just some of the work that he and his many colleagues partake in. Well, my chance finally came and now it is my privilege to contribute to these “Ramblings.”

I am currently in the third and final year of my pediatrics residency at St. Christopher’s Hospital for Children in Philadelphia, PA. After much discussion, I received approval to travel to Guyana for three weeks as part of an elective in Global Health. I plan to practice in a global setting after residency and have applied to a number of different Global Health Fellowships and Programs. These three weeks have allowed me to at least get a glimpse of what I am signing up for in the future.

I was warned that it would be hot in Guyana. And yes it is hot, but I am adjusting. I was warned that there would be bugs and other critters, but that has never really bothered me. I was also told of the incredible kindness, hospitality and wonderful life-energy of the Guyanese people. And while people can tell you about that, such words can never fully express or do justice to the actual experience.

First time for Emilee and 28 years for Doc
Devi.

Dr. Devi who is now Medical Director
and my doctor for Uncle John's bronchitis, now cured,
invited us over for dinner with some friends.

Dr Bhiro Harry invited us for dinner and his lovely wife Georgia
did all the work.  On the right is their daughter, Indira.

At my Taju's restaurant with the new
Mercy Corps volunteers.

During my first week I had the opportunity to see the work that Uncle John as well as many, many others have put into the Problem Based Learning Curriculum for the nursing students. I had the chance to sit in on some of their sessions and hear their thought process as they worked through the cases. I participated in some problem based learning sessions in medical school, but it was still a relatively new process when I was there. It was exciting to see how seriously the nursing students took the cases and began to direct their own learning and education. 

I was able to see one of Uncle John’s ethics classes in values and morality and then even helped to “grade” these papers after the session. In all fairness I warned Uncle John that I was an easy and generous grader before I started… pretty much the entire class scored a 15/15! And in true Uncle John form, I even taught one of the classes. I had only been in Guyana for 15 hours and he was already putting me to work! Fortunately he just wanted to give his students the chance to ask me questions and get to know a “young professional woman.” After so many years of reading his “Ramblings” I pretty much knew to expect something like this!

Dr. Rosa with Medical Students

I had the opportunity to discuss the medical care in Guyana with a number of different physicians my uncle has formed relationships with over the years.   My first experience was with Dr. Mallika Mootoo, a long standing Mercy paediatrician, who let me join her in two different clinics. (I will blame Uncle John for not getting a picture of us together.)

Dr Jabour

And through these conversations and experiences I witnessed the similarities as well as differences that exist between our health care systems. Parents are always going to have the same concerns, hopes, and dreams for their children and their futures regardless of where that child is living. It is a struggle both in Philadelphia and Guyana to help parents understand that children with asthma (or any chronic medical condition for that matter) need to take a medicine every day even though they may not be wheezing or having trouble breathing on that particular day. Parents still threaten their children that if they are not well behaved that they will get needles or shots, or “bored” as they refer to it in Guyana. This, by the way, is one of my biggest pet peeves as a pediatrician. It means that the child is going to associate going to the doctor with being bad and having to receive immunizations when in reality many visits have no immunizations.
Anyway ..… The hospitals in Guyana are promoting breastfeeding and keeping mother and child together in the same room. Both are AAP (American Academy of Pediatrics) recommendations and yet are initiatives that many US hospitals are still trying to promote and facilitate. There are relatively few subspecialists in Guyana, and the majority of care is provided by internists, family medicine physicians, and general pediatricians. There is no EEG machine (a test that helps to diagnosis specific types of seizure disorders) in Guyana as there is no one who has the training to interpret these test results. As I know my uncle has discussed in previous posts, there is still an incredibly negative stigma associated with mental illness in Guyana that has inhibited many from seeking appropriate care. And there are few training opportunities for providers to receive advanced or continuing psychiatric training or education.

One of the other reasons I came to Guyana was as part of the Bridges Medical Mission, a group of approximately 20 US based health care providers with skills in family medicine, pediatrics, Ob/Gyn, Cardiology, Urology, Dentistry, Nursing, Ultrasound Technician, and Respiratory Therapy. Many of the individuals in the group are originally from Guyana and some still have family living in the area. While some in the group assisted and provided direct care, many in the group worked on educational initiatives and helped to provide continuing medical education courses to local physicians and health care providers.

Guyana's population is approximately 800,000 with births of approximately 14,000 per year. According to the WHO statistics from 2012, the neonatal mortality rate (infants passing away in the first 28 days of life) in Guyana was 19.4 per 1,000 births. Compare this to other surrounding countries for the same year:
Trinidad and Tobago: 14.8/1,000
Surinam: 11.7/1,000
Jamaica: 10.6/1,000
Barbados: 9.5/1,000
Brazil: 9.2/1,000
Venezuela: 8.5/1,000
USA: 4.1/1,000
Canada: 3.5/1,000
Finland: 1.6/1,000

In terms of infant mortality (children passing away in the first year of life) Guyana ranks #65 in the world out of 224 countries.



As part of this medical mission I assisted one of the attending Neonatologists at St. Christopher’s Hospital for Children to teach Helping Babies Breathe Courses. Helping Babies Breathe is a neonatal resuscitation curriculum for resource-limited circumstances. It was developed on the premise that assessment at birth and simple newborn care are things that every baby deserves. The initial steps taught in Helping Babies Breathe can save lives and give a much better start to many babies who struggle to breathe at birth. The focus is to meet the needs of every baby born. Helping Babies Breathe emphasizes skilled attendants at birth, assessment of every baby, temperature support, stimulation to breathe, and assisted ventilation as needed, all within "The Golden Minute" after birth. The course is taught in a train-the-trainer model, thus allowing all those who participated in the course to take what they have learned and share their knowledge and skills with others in their communities.

The course is split over a two day period and utilizes role playing and simulation to work through scenarios that are meant to help participants recognize when a baby needs help making the initial transition into the world and taking their first breath. We conducted one course at Linden Hospital, which is about 2 hours from Georgetown. There were 7 midwives and birth attendants from Linden as well as the surrounding rural towns who participated in this course. We conducted a second course in Georgetown that was attended by 12 nurses and midwives including 3 nurses from Mercy Hospital. The other 9 nurses were from rural provinces and traveled 4+ hours for the course by taxi, boat, and bus. I was humbled by their willingness to share their experiences of delivering and caring for children in their rural and often resource-limited settings. It was inspiring to see the enthusiasm that many of these providers exhibited and their desire to share their knowledge with their respective communities while also continuing to seek out resources to further their own education and training.

Helping Babies Breathe is just one part of the Helping Babies Survive Program. Additional modules and courses focus on providing care for premature infants in resource-limited environments (Essential Care for Small Babies) and continuing to care for infants in the first 24 hours of life by encouraging breast feeding, ensuring that the child remains warm and dry to prevent hypothermia, continuing to monitor breathing, and providing appropriate vaccinations (Essential Care for Every Baby). Our ultimate hope is to return to Guyana within the next 6 months to provide these additional training modules to the same nurses and midwives that have just received training in Helping Babies Breathe. By identifying nurse and midwife leaders in each respective community and continuing to provide these identified leaders with additional education and training we hope to facilitate their own empowerment thus working from within towards the ultimate goal of decreasing neonatal mortality in Guyana.

And thus ends my “Ramblings.” Thank you for reading!  Dr. Emilee, Rev John's Niece

Stay tuned:  Dennis LeBlanc arrives in a week...