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 .....

Saturday, September 30, 2017

Friends and Staff - Old and New, a Farm ----------------------------- and Graduating YES! Nursing Students

Old In More Ways Than One
Dr. Tony Carr has returned to Guyana after a six year absence.   It is great to have him here.   Tony and I created the PBL pages that we are still using today and with great success.  Before that we often had those days as a teacher when you felt you were the worst teacher in the world or more likely, your students were.   Our traditional ways of teaching were not effective in Guyana.   So we decided to steal McMaster Medical School's model, Problem Based Learning, and we have never regretted it.
Tony's first night in GT and he needed to go to Taju's, 
where he had a huge cup of ice cream before supper.
Yesterday, I was chatting with one of the first year students about how they felt the PBL course was coming.  She replied,  "It is great.  Your course is the first one that has asked and listened to us about what we think ...."   And then she went on to complain that there is too much work ..... so I'll just remember the first part.

Tony has come down principally to teach and supervise the psychiatry residents in the new Master of Medicine - Psychiatry that began late last year.    He brings the same enthusiasm that he had a decade ago.   And since he is here he wants to get involved with the nurses here at Mercy.  So, with enormous reluctance,  I'll let him use my classes during the week and I will be left with nothing to do .....😢😢😢😂😂😂.   Tony will be here for three weeks and since he never gives me the last word, I am sure he'll replace my blogging for a week. [Repeat emojis]

Another Old, But Not Nearly as Old, Friend
Donna Joy Tai, has been a Scarboro Fathers lay volunteer for 6 years, and I have known her all those years.   She retired as a travel agent in Montreal to do something with her life...   She has invested herself in the Boys Home, John Bosco, and the parish there in Plaisance.  She once sold me $1,000 worth of fair tickets when she knew I couldn't go that day .....  so "Give them to Rashleigh and Gregory" -- very persuasive!  She used to lead a weekly hymn/song session at Mercy Hospital, and  has continued at the new Mercy Resident Care facility on Pere Street.  She is quite involved with the diocesan committee on justice and human rights, and I am sure she is involved in other activities but I don't want to suggest she is working harder than I am .....

On a sad note and symbolic of out times, the Scarboro Fathers need to cancel their support of the Lay Missionary programme for financial reasons.  So Donna and her colleague, Bev Trach, will be leaving permanently at the end of the year.  I find it incomprehensible that as North American societies we have billions for war and self-protection and nothing for those who teach love and compassion.    Yes, I know she comes with her missionary baggage, but that has to be way better than wiping the burning napalm off your child's skin.    Maybe our children's children will shape a world we can only dream of.

And a New Friend
More accurate pictures next week
How new? I hear you asking.   I haven't even met her yet!  We have very lax recruiting criteria here:  if you have enthusiasm, Welcome.  (I'm glad Sister Sheila Walsh used those same lax standards with me 15 years ago!) And Tracy Meeker does have eagerness as so far she has not said no to any request to teach.  Tracy only found out about this work in Guyana in August and a couple of weeks ago decided to come .  She will arrive on Sunday for eight days.  Unless she starts saying no at the end of her time here, I'll get her to write a blog.

Tracy is an "advanced practice" nurse from the Faculty of Nursing, University of Ottawa.  She has her expertise in Mental Health and is currently the manager of a Shared Care Mental Health team at Ottawa Hospital, a small team working with usually very complex presentations but people who are not acutely ill.  She is also a clinical instructor and a guest lecturer for the University of Ottawa Nursing programme.   (More next week.)   

I have had housekeeping clean up the flat, asked laundry to wash all the towels and linens, warned the kitchen of both Tony's and Tracey's presence.   I had planned on Tony staying here with us, but after he got to Project Dawn, he wrote, "I walk through the guarded locked gates, into this block building, and into a different world.  Neat, painted and tiled corridors, beautiful hardwood floor in HUGE living-room, electronic keys, my own palatial room with working window-blinds which dwarfs the two double-beds, en-suite bathroom, wifi, nice ladies Samantha and Rima who can fix anything, all clean and shiny and functioning!!"  So, as the old saying goes, and it looks like it is still  true, "After they've seen Paris, how can you keep them even in my 'executive volunteer suite'?"

Here's a quiz about the uniqueness of my flat.  (I should have a prize for the first person to identify it, but I don't have any prizes.   And before I get this posted, Tracy will already be on the plane .....)
The answer will come "from above".
Nursing at Mercy and in Guyana
Last year, it was discovered that some students had paid to receive the questions and answers from members of the Guyana Nursing Council.   So in true Guyanese style, instead to trying to figure out who cheated and who sold the answers, everyone was forced to do a retake ..... and not only that, the whole style of the exam was changed and drawn up by the Department of Education.  So a huge percentage of student nurses failed the final exam. .... and they had to wait almost a year to retake.    The School couldn't cope with all the students, so they had to fend for themselves, working at call centres, cooks, restaurants, etc.  So now, that group and the present crop of students will be writing exams this Tuesday.   

As you would expect from me, I wrote to everyone including the Minister of Public Health:

I do not think there has been a year when there wasn’t some “talk” about leaks from the exam.   The only difference this year is that the Council got caught adding a little to their own pockets.
I really believe it is unethical to have only the students punished when it is the lack of control from the Council.  There needs to be balance in order to be fair.   This is especially true, as the “leakee” Council members bear the prime responsibility for the problem.  

The whole Council needs to resign… and a new leadership elected by all Guyana nurses with a mandate to bring Guyana Nursing into full accreditation in the Caribbean.   There is no redemption for the present Council members… They have been given more than enough time to move towards the 19th century!     The whole concept of the present four days of exams is crazy ..… It is so archaic and of very questionable value for the evaluation on nursing knowledge and skills.  The present style of the exam has no integrity… that is certainly one of the reasons the rest of the world has little respect for nursing education in Guyana.  The exam is highly subjective with no real testing for validity and reliability.

I believe unless this opportunity is not used for significant reform, then you can forget Caribbean respect for a decade.  As well, if your long term goals is for these new nurses to feel that they are welcome in Guyana to practice nursing, then screwing them around isn't going to help and making them the victims of the nursing council’s lack of integrity.   They will remember how you sacrificed them for your immediate solution.  Really, why stay in Guyana or even why stay in nursing here.
 With this in mind, I offer my suggestions:  There are techniques to determine who cheated on the exam and hold them accountable.  At a minimum, require these students to re-write.  Students deserve to be considered innocent, unless you have proof of their guilt.   

So far no one has responded to my letters, except personal friends. Do you think I should give up waiting for a response?  Nor have there been any conclusions about the parties responsible for leaking the answers; nor has the Nursing Council been overhauled.

However, for the last month the present seniors and for the last two weeks the previous seniors have been in school full time.  Crowded is too nice a word to describe the situation.    The PBL small groups are meeting all over, including my flat.    And the crowding has only increased the heat.. The tearful, sweating students have made me let them have two fans from my flat ....   (I hope I get some points in the afterlife for this!)

We will have a "double" Massive Prayer Service on Monday to show our support for these nurses taking their exam ..... and (in case you are RC) there will be enough petitions to convince God to be merciful.  My favourite Saint for exams was Joseph Cupertino...   When being examined for the priesthood, he was not good with the books and so only knew one answer -- and guess what?   That was the question the examiner asked him.  I needed him on my side for some courses.   The students have studied and the older ones have persevered to keep their dream of being a nurse alive...   How could a saint named Joseph not intervene for students from Saint Joseph's!

Speaking of Old - Mercy Day
Most of the Long Term Service Awardees
Last year I got over the shock of seeing some of my former students get their ten year service awards..  but I had forgotten...  So when Tracy Allen got her ten year pin - I questioned Human Resources' counting... it's true.. 
Tracy is now on  Nursing Faculty , part time.
And the five year crowd seems like they were First Year yesterday ....  There are other old students who are still working in Guyana at almost every health care facility in the country ..... and this is a good thing for Guyana.    Anecdotally, it does seem that the exodus of nurses has slowed from a decade or so ago -- and there is still way more Guyana needs to do to keep its skilled nurses, like salary raises, eh?

Martina, Mishea, Alicia and Bibi


You Need to Have Vision - Home in the Country

Huge Back Yard - Tilapia pond front

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My friend, Taju, is building a home outside the city and across the river in a small town of Bagotville.  He has always dreamed of having a farm and raising chickens, fish (tilapia), and even pigs.  (He's a liberal Muslim).   He is doing almost all the work himself except for some skilled construction stuff. He has dug by hand the big fish pond -- now really a dirt hole.   When he walked me around last Sunday, as he was talking you could see he had finished everything in his mind.  He works at the farm 6 days a week after starting his day at 4:30am delivering food to the food truck outside the Public Hospital, shopping for supplies and food for the Princess Kitchen,  and sometime after lunch is finished, he heads across to work for several hours before returning at dark to help with the restaurant on Durban.   

I am afraid that I didn't have that much vision..   or energy.   My consciousness is framed by lawns, level ground and sculptured gardens .....  and certainly not by a neighbouring pond with huge alligators -- he has killed one already.   (I tried to convince Taju to make friends with the O'Connor like him, my brother Tony who is a real alligator whisperer.)  

In a compliment to me, he said that he marks his work by a year from where he was last year when I visited Guyana.       And last year this property was bush with no cleared areas or even a bridge...  The neighbours on either side could not even see through the bush to each other. That is progress.   However, I did have to ask myself:  What the hell did I do in that year?  

Enough... probably more than enough for the week.  Thanks for reading with me.

And a welcome to his new home with a Sunday Morning Beer!

Saturday, September 23, 2017

The Week in Review - A Few Stories

Better Than The Dog Ate My Homework

"Only in Guyana?"   A student in my class told me that he was not able to complete his research requirement for the whole weekend... "Okay, lay it on me." (This will be good, I thought.)
Friday, he was riding home from school on his motorcycle when he got stopped by a traffic police officer on a routine stop.   After showing the officer his id's, the officer told him that he needed to accompany him to the local police station.   Once there he was informed that he looked like one of the escaped criminals from the jail.    They needed to hold him till they could verify his claim... He said that he wasn't released till late Sunday night.. and that is why he didn't do the assignment.

I love a good story and would have granted him a pass even if it was all a fabrication, but I thought I should inquire a bit more.
"So you were held all weekend and you were never charged with anything?"
He nods affirmatively.
"Did you get your one phone call?"
"Yes, I called my mother."
"She said there was nothing she could do. I just had to sit there till they figured it out."
There goes her Mother of the Year Award.  My look of disbelief encouraged him to continue.
"Yes; the last time it happened ......"

Stop!  This can't be true ..... "The last time"!??!   And then I remembered:  I am in Guyana.
He continued, "She came down to the police station and explained to the police who I was and everything.   They said that they had to conduct their investigation all the same even though they realized I was not the escaped criminal."
"Did you think of calling a lawyer?"
"It wouldn't have helped. They were doing their job."
Ugh, he wasn't angry at the whole thing.   He went on to describe the cell he was in .... and I'll spare you the squalid details.

I am overwhelmed by the passivity and hopeless acceptance of so much here, from simple things like someone receiving a traffic ticket for stopping at a red light but across the stop line (while the whole concept of stop signs and red lights are usually considered optional here) to this serious kind of detention.

Of course, I gave him a pass on his assignment... and I got myself a beer.  (Later that evening!)  I raised a toast with a can of Stag:  "Thanks to any god available that O'Connor lives in Canada."  Pretty selfish, eh?

Kim - Trump -- and Me in the Middle
On Thursday night, I went to a University of Guyana public debate on Constitutional Reform.  I was interested in how the human rights of  minorities were to be better protected... I think that technically any same-sex behaviours are illegal.  Cross-dressing even on Halloween is going to get you locked up.  If I lived in Guyana, I could have been arrested many times .....

The Debate on Reform started on time, but the introductions before the introductions were about 40 minutes long.  The event was not very academic and it certainly wasn't a debate; it was more a parade of people who wanted the audience to know how much they are already doing .....   such as the woman who addressed us on women's situation and stated often how they had the same rights as men ..... I wonder where she lived in Guyana?   It is not a right if you are not able to exercise it .....   And the woman who spoke on children's rights .....   more of the same.

I left and since I was at the Pegasus Hotel, I thought I'd have a beer.   Unfortunately, the tv was tuned to CNN ..... and there was the tragedy of earthquake deaths in Mexico and Kim calling Trump "mentally deranged".....  Does not the world have enough suffering without two boys still playing who has the biggest willie?  I was upset.

From the Worst to the Least Worse
The next morning, I was scheduled to teach Psychiatry Residents, as I did last week.  I attended morning rounds where there were four male patients:  a strong-looking patient (acutely psychotic) who thought that I was his father and who had not responded to treatment; a calm older man who was somewhat delusional; a sixteen year old gay youth who had left a lot of shelter placements and finally was brought in by the police as he was in someone else's house watching tv.  (He was described as demon-possessed since he was eleven and had survived a rat poison suicide attempt.)  And finally a man in his twenties who was described as schizophrenic and who said nothing but walked away to a corner of the room.  They all had family who had been exhausted by years of trying to help them.   And there was no shelter willing to accept them.

So the decisions about these four people was about trying to figure out the least bad option ..... and there seemed to be none!

And while I was thinking that what I had to teach was irrelevant to the Psych. Residents' world,  an even bigger black man (handcuffed and dragging Security with him) came into the Residents' office proclaiming his own particular gospel for all to hear.
"I smell a white man here."
"Wow, you are quite observant."
He looked me in the eye up close:  "I want to kill white men."  Security escorted him out.

And then it got worse.  Friday is not an Outpatient Clinic day and yet there were maybe thirty patients sitting and waiting to be seen.   So the residents would have to see them because "Everyone gets seen!"  The residents were already exhausted before this .....

The four Residents: Stephan, Veneta, Shonnette and Elizabeth.
And then my "I want to kill white men" patient came strolling back into the office... He had given Security the slip...    He smiled at me, so I guess I didn't look white anymore.  And then, a woman came in who was going to need to be admitted, but there were no female beds.. So a quick decision was made to send four men to the National Psychiatric Hospital in New Amsterdam...  It would free up a room for the woman.  And no one believed it would do much for the four -- but it was the best of the bad options.

There were no beds or spaces, no good treatment options, not nearly enough professionals ..... just not the resources for those in dire need.  And there's Trump, with unlimited resources, and Kim, depriving his people of everything, and CNN covers their tantrums as if they were more important, more spectacular than the world's real problems and appeases the soap opera addicts.    It is a sad state of affairs that mercy and compassion seem to have no place.

And there were still the thirty patients in the clinic, waiting .....  and a woman was brought in by her sister; she had not eaten, not talked, not slept for three days .....  And the Residents did not stop working.  I said to them, "I don't know what I taught you today, but you have taught me much. Thanks."   And I left  (maybe fled is a better word) knowing that in a small corner of the universe there is compassion and mercy.

Oh yeah... forgot the Nursing Students

I seem to have overlooked my brilliant class of students ..... I needed to exaggerate, as I yelled at them this week that their research was junk .....  and when I checked research from previous years they were at about the same level of junky-ness.   Anyhow, we had a field trip this week to a show of Amerindian crafts, dancing and stories.   A field trip is even better for teachers than for students! We arrived almost a half hour before the time we were told two weeks ago that the programme  would start ..... and that was only about ten minutes before it ended!  However, they did get to see the crafts and meet Michael Khan a marvelous storyteller.   And there was a free lunch of Pepperpot, cassava and soft drinks .....    


Some Pics from the week, including the Girls

My photography exhibit at the Ayr Public Library will be ending this week.   I was pleased with the display.  However, it is hard for me to hide my dismay that the Art Gallery of Ontario hasn't called me -- yet.

Saturday, September 16, 2017

How Long Have I Been Here?

Suicide Prevention Day - March and Speech 

No sooner were we leaving the airport two weeks ago than Bhiro told me that I was doing the keynote talk for the March in Better Hope on last Sunday.   I said, "No way.  You know I don't like to speak at public gatherings."  This is not because I don't like to speak; it is because I try to live by the fact that the Guyanese have a parade of "whites" proclaiming truths.   "I'll write your speech and you give it,"  I said.

After a period of hard negotiation, I lost and was told to give just a 10 minute speech in the middle of the speakers' list. Uh oh, now I knew it was the familiar barrage of important people talking to the assembled who were hoping that there would be food afterwards.   Fortunately, no matter what I said, it couldn't cause too much damage ..... kind of like preaching.

The March was to begin at 3:00 and walk  a mile to raise public awareness of doing something about the high rate of suicide in Guyana.  There is actually some good news: Guyana is no longer Number 1 at 44 per 100,000; We have dropped to 30 per 100,000.   This is quite significant and something to be proud of for the mental health system in Guyana and the numerous NGO's who have provided counseling and educational sessions throughout the country.

About 3:30, one of the organizers thought that maybe there should be some water as it was a scorcher, even by Guyana's standards.   So off we went to the nearest store to get water for 100 marchers ..... At this time, there were about 10 people - three of whom were driving.   And someone had to pay for it.  It is a good thing Bhiro was there ..... and he wasn't even one of the organizers.
Now it was 4pm and the crowd had come close to 20, with 5 of them driving... And we were still waiting ..... for what? We weren't going to get anymore people.  We were waiting for the police to arrive to guide us along the busy Public Road.   They too had been given a three o'clock time...  
But we were off -- after a fierce debate about whether we should walk in 3's or 2's.  The 2's won out because it was decided that we would look like more people.     We were raising awareness alright ..... The traffic driving west with us was stopped for us to walk the mile .....  

I took this pic from the end of the marchers!
When we arrived at the community centre field, there was already a cricket match that had been scheduled for this time. We had not!   However, the cricketers were gentlemen and sat down to listen to the brief speeches as we were already late.    The microphone was set-up to be at the backs of the audience as it was the only power outlet ..... interesting but the Guyanese took it as normal. To be honest, it wasn't a big crowd, with half the crowd being the cricketers, but at least the crowd outnumbered the speakers.

The MC reiterated many times in his opening (not so brief) remarks that this was a short programme. The first speaker from the Ministry of Public Health went 25 minutes.  Mercifully the other half dozen speakers and pray-ers were shorter but by no means brief.

My Speech

I had offered to be cut from the programme, as it was going on and on, but a guest is a guest.   I decided that I would be Canadian-brief and cut my 10 minutes to five.   I said that with the reduction of the still-high rate, about one half of the suicides in Guyana are impulsive and spontaneous with the ingestion of a lethal herbicide/ pesticide called Paraquat.   It is used in the fields for many crops; before the cane is harvested it is used to clear out weeds, snakes, etc...  One teaspoon ingested is lethal, so lethal that even if you drank it in an Emergency Room there would be no antidote or treatment. You will die a not-nice death within a few days.   There are in reality no restrictions on its sale ..... It is not unusual for a street vendor to be selling fruits, candy and Paraquat.   Banning Paraquat or at least lessening its easy availability would probably reduce suicides by half!

It is banned in all of Europe and most developed countries, except the US -- no one can explain the US today!   One Syngenta plant is in England where it is illegal to use for anything...  and shipped to -- you guessed it -- poor and less regulated countries.

The theme for the day was "Take Time; Save a Life"  which is almost identical to the previous year's, so I decided to be different.   I suggested that they forget about those contemplating suicide and think only of themselves - Be Selfish.    When they work in the fields and spray crops, did they know that it is absorbed by breathing and through the skin .....  and in 15 minutes you can't wash it off.   Paraquat stays in soil for at last 20 years... and in water some say 300 years...  There are trace amounts in the cereal they had for breakfast .....

Exposure to Paraquat, according to research by independent investigators (but not by Syngenta's researchers) leads to an increase in birth defects, elevated risk for Parkinson's,  trouble with lungs, kidneys, liver and more.   This is because it is a "Hit and Run" chemical:  it immediately attaches, but goes away and returns years later .....

And a line that got the cricketers' attention was this: "Hey guys!  Long term Paraquat absorption decreases testosterone production.  And (with my out-pointed, straight index finger) you want to know what happens?"  I slowly bent my index finger and it went limp... "And those little blue pills don't help with this problem.

"So be selfish:  get rid of this stuff!   Clean it out of your homes ..... tell local merchants to lock it up and label it.  Don't wait for the government -- a recommendation for a ban has been on a minister's desk ever since I came in 2002.   Do it for your wives and your children and yourselves."   (I chickened out of  adding, "You don't want your cricket bat to be the only part of you that's hard!" as the newspaper reporter had stopped writing.)  "And if you look after yourselves we will also reduce the number of impulsive suicides dramatically .....and you will maybe even get a Mother Teresa Award for caring about young people."

Dr. Harry (Bhiro) had a good speech on the theme.   He has become like a Psychiatry Saint ..... or since he is Hindu a Swami.   If you want credibility you invoke his name.  People need to be seen with him and just touch his "cloak" or the hem of his garment.

 You Never Know Whom You'll Meet  

The gentleman on the left kept staring at me throughout the whole programme.  After I had finished he came up to me and wanted to know where he had seen me recently... He knew he had.   We finally figured it out; it was at the Everest Cricket Club where I was writing the speech over a beer and some Banga Mary.  He (Primrad) said he was at the Everest praying!  He had to introduce me to his friends and told me that a custom in Better Hope was to have all guests have a beer....  Okay, I can handle that.   And then when I was leaving, he said,  "Well the first beer was for coming and you need  a second for leaving..." and all the guys agreed with him - so it must have been a real tradition.    I had a great chat with them about their lives and struggles and as I was was about to leave again, they told me about another custom.. "You can't leave on an even number of beers..."  by now I figured they might have been making this up...  Bhiro was leaving after having shaken the hand of everyone there, so I had an excuse to break tradition.

A Festival Dinner

As if  Bhiro had not had enough handshaking,  he had 4 tickets to an Indian Arrivals group dinner that evening.   He had to find two people to go with us, and with a stroke of luck he found two young women and off we went.  It was an Indian [South Asian] celebration to be catered with Chinese food by a Chinese restaurant and some karaoke accompanied by a single steel drummer and his computer who played Reggae most of the night.   It was a good time and good food... and we didn't see Bhiro the whole evening as he was making his rounds.

And I got my picture taken at the arrivals monument which is usually off-limits.  And this was just the first day of the week .....

I'll Let "My" Girls Speak for Themselves

I actually had a full week of PBL Classes and they were good.  Some other stuff like doing psychiatry rounds and teaching at Georgetown Public Hospital.  Those things will have to wait.

Thanks for joining me this week.