Postpartum and other experiences

My group and I have been working on a lesson plan on dental hygiene. There are 4 people in every group, with two strong Spanish speakers and two that may or may not speak Spanish. Each group will use our lesson plan in all of the different comedores. We will be distributing toothbrushes and some toothpaste, but we will be teaching them that the actual brushing, even if they have no toothpaste, is the most important thing.
I wrote a little song in Spanish that we will be teaching the children to help them remember where to brush and also to help them know how long they need to brush. They sing or hum it 4 times while they are brushing their teeth. It is sung to the tune of Row, row, row your boat. It goes:
Lava, lava los dientes,
lavalos otra vez,
en frente, atras, encima y mas,
y estan limpios despues!
Basically, it says wash (brush- they use the two interchangeably here) wash your teeth, wash them again in front, in back, on top, and more, and then they will be clean!
So, hopefully that goes well. We will also be teaching lesson plans that other groups are developing. The only other lesson we'll all be teaching this week besides dental hygiene is natural family planning. The mothers of the children will be coming to this class held in the comedor. Here there is a real problem with adolescent pregnancy. The attitude here is that is is normal to start having babies at a young age, and probably the majority of the women are not married, especially if they live in poverty and have little education, but even among the more wealthy, it is common. I am not exaggerating. Also, most are Catholic, which means that they do not use any form of contraception. I have also seen a number of women with STDs. It is a very difficult situation. We will be teaching a class on natural family planning with the calendar method, which can be used either to try to have children, or not. But the main thing is that it goes right along with what their religion says and hopefully that will help with compliance. We use a bracelet with different colored beads. Each color means something different. I realize many people might be reading this blog, so I won't explain much more than that. If you want to know what we are going to be teaching the women, let me know, and I will show you a picture of the bracelet, and the teaching materials we will be using. I think it is fascinating, personally, but I'm interested in everything about health, so that's not too surprising!
This week on Wednesday and Thursday, I worked in postpartum. This unit is spread over three floors of the hospital. I learned that this hospital really serves the poor. The wealthier women have their babies in the doctor's office, apparently, or in a private hospital. The women are required to stay at the hospital for at least 18 hours after birth, and they can't leave until they are tested for HIV, anemia, and I can't remember the other thing right now. They don't let adolescent mothers (under 19) leave without someone accompanying them to make sure that there will be someone to help care for the baby. One whole floor is dedicated to adolescent mothers with their babies, but the reality I discovered was that there were adolescents on every floor. Many of them had their mothers with them, but many seemed to have little support. There is one nurse on each floor. One. There are quite a few doctors and even more medical students. The doctors here do many of the things that nurses do in the United States. The nurse here just sits at a desk, really far away from the patients' rooms (there are at least 4 beds in every postpartum room, some with 10 beds) and she does mostly documentation, and one set of vital signs at 5am. Most of the women have to bring their own sheets. It is either really hot or really drafty in the rooms. Forget HIPAA laws. There is very little privacy.
My first day of postpartum was not great. In the US, during clinical, we are assigned to a nurse and we follow them, and do patient care. This is not at all the same. There are hardly any nurses, and they don't do much patient care. We are basically just let loose on the floor and are told to make rounds and assess each patient (hundreds of patients). We all felt unempowered if that is even a word. We tried to talk to the nurse, and ask her about her job etc. and she basically just told us that she sits there and writes, and helps with other things sometimes. She wouldn't tell us anything else. We would go into the rooms to do assessments and take vital signs only to find that they had just been done by medical students. Nonetheless, we went into every room on those three floors, and talked to every woman, and did what we could in the way of assessments and vital signs, and also just talking to the women, which went better at some times than others! One great thing about the day is that we ran into the patients we had been with in labor and delivery 2 days before! We were able to have a wonderful conversation with my patient and her sweet mother. It felt great to make a really strong connection with a patient, especially when it felt like I was struggling to speak their language! When we left, those kisses were 100% genuine! (For those who may be confused about kissing, see previous blogs for an explanation of the cheek kissing customs here.)
The second day of postpartum was a very different experience. We did our assessments and vital signs, but wanting to do a little more, we approached a doctor named Marta who we had been intimidated by the previous day, and explained who we were, why we were there, and we asked her if we could follow her and learn from her as she made rounds. We also explained that in the US, the nurses did a lot of the things she was doing, and that we would love it if there was anything she could teach us. Boy, that was the best idea in the world! We spent the rest of our shift with her, gaining invaluable experience and knowledge. She had 30 years of experience, and she taught us some really great assessment skills that didn't depend on technology. Also, when she had finished making her rounds, she invited us to her office where she did a sort of prenatal exam program for adolescents, which was free to them. She taught us how to use the doppler machine to find the fetal heartbeat etc. and to measure the fundus (basically how far out the stomach is) to find out the gestational age. Plus, we learned a lot about the culture and health care system here. The time went by so quickly! We learned so much, and were glad that we had decided to take our experience into our own hands.