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 6^th 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"