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Friday, February 18, 2011

Life's not always a beach!

I have been working in the hospital the last few days and what an experience that has been.  My first day I went on a tour of the 200 bed hospital where we will be starting the liver transplant program.  Currently, they are the trauma/burn center of the Northern States of Brazil (ie the Amazon region), Hospital Metropolitano.  It is like our own little Harberview but add a few more states, like California, it needs to cover! Then put jungle, lack of roads, and rivers in your way and imagine how patients get to good medical care!

Hospital Metropolitano

The future Transplant Program and current Trauma center covers the State of Para, Amazonas, Acre and Roraima!

Walking through the halls I had a mixture of first impressions.  Much to my surprise, they had a fair amount of technology from a MRI machine (even though it is broken right now), CT machine, several ORs, to even a special burn ICU (only two beds). But the building was still humbled by its simple appearance, with almost a minimal sense of "state of the art". Despite this, the units were full of patients, nurses, and doctors busy at work.  The healthcare system is very different in Brazil.  In one ICU or on the floor you have far fewer nurses and far more nursing techs.  At any given time for the 14 bed ICU you have 1-2 nurses and about 5 nursing techs.  ICU internalists in Brazil are notorious for not being "eager" to work, so sometimes it's hard to even find a doctor.  There 1-7 ratio makes me feel blessed to work where I do.  

I met with everyone from the director of the hospital to the nursing officer to the director of Nursing Research and Education.  It is incredible to see a functioning institution where the administration is personable, present amongst the hospital staff and not locked away in an ivory tower.  I also was greeted by the director of finance, several doctors, and even more nurses.  I wonder if the US could learn a thing or two about how to conduct human interactive management.

The next day I had my big presentation at a different hospital.  After visiting this much older hospital, I later learned, contrary to my initial impression of the worn in Hospital Metropololitano, it was only built 5 years ago!  I was looking at the top of the line! It scared me for what lay ahead. The older hospital was built over a 100 years ago.  With social medicine, the government felt it would be cheaper to build a new hospital (Hospital Metropolitano) outside the city instead of fixing this one.  So with no renovations but still an overload of sick patients, the decrepit building still stands as a working hospital.  I have to say the only perk in the place was instead of cots for patient families, they all receive a hamick!  I think that would be the best improvement I could bring back to the US.  They take up less space, are easy to store, never break (unless you put two very muscular people on them...right Norm?), and provide a sense of tropical leisure to help decrease the anxiety.  All in all, a great idea.

We had come to visit a patient in need of a liver transplant.  Down a dark and dingy hallway with static from an old TV in the background, we entered into the patient's room.  He was a young gentleman in his 20's in full liver failure and no where to go.  He is the type of patient they are working to save.  The room was depressing, with paint chipped from the walls, an old gurney for a bed, and a single bag of IV fluid hanging from the ceiling.  He was to stay in the hospital another night for observation.  As we closed the door behind us, no one said a word.

This same evening, I held my first presentation ALL in PORTUGUESE.  Ok, not all...but most of it.  They even pretended to understand me! Not knowing what to expect I was a little shocked to walk into a small auditorium!  Present was the Director of Liver Transplant, the medical staff, nurses, and even physical therapists.  I shared about the UW's protocols, introduced the new idea of standardized order sets and showed a colorful power point about the nursing process.  They asked good questions and even sparked debate about our immunosupression practices in the US verses their beliefs.  The Director of the Liver Transplant program invited us to his house for dinner (for tonight) so I'd say it went well!

After our meeting we finally went to the downtown of Belem.  Old town Belem was breathtaking.  Covered with antique Portuguese buildings, sitting on the mouth of the Amazon River within reaching distance of the open ocean this poor city transformed into a beautiful piece of history.  Filled with open markets, historical land marks, and green grass parks with huge tropical trees, you can feel the essence of Belem.  We eat in an old Portuguese house right on the river with live music.  Belem is famous in Brazil for their love of live music and delicious cuisine.  I have to say, trying one of the typical fish dishes of the region, it was one of the best fish dishes I have had in a LONG time!  The tender white fish with Belem's herds and fresh pimento, I could eat that every day!

Belem, Brazil

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