Ever wonder what the missions are like for our volunteers? Please take a moment to read this touching article written by our very own volunteer Kate Earley. This article was originally written for The Canadian Federation of Nurses Union International Solidarity grant.

Picture this…

Eleven month old Juliet sits on her mother’s lap just inside Hospital del Niño in Ecuador. Juliet is small for her age, but despite her size she is the center of attention in the hallway outside the exam room where all of the pediatric surgical candidates are getting echocardiograms. She has a constant pout and cries out each time she is reminded that she is not allowed to eat. Her mother surveys the hallway, observing the other families, looking nervously on. She has traveled from another city to be assessed by the CardioStart doctors and is deeply concerned that Juliet will not be selected for the cardiac surgery she so desperately needs. She has been waiting for months for Juliet’s surgery and is worried each time Juliet gets a cold or flu that her sick heart will not be able to overcome the illness.  Juliet is the first patient we decide to operate on.

In Ecuador, the waiting list for pediatric cardiac surgery is impossibly long, now exceeding over 850 children requiring surgical correction. As in many countries around the world with severely restricted healthcare needs, children can be on waiting lists for months or even years. Many die while they wait for surgery. Knowing this, the purpose of our mission to Ecuador was twofold, to save lives and spread knowledge. We wanted to give some of the children on that long and merciless waitlist their chance at life saving surgery. Equally important was the opportunity for the team to share expertise that would enhance the existing cardiac program in Guayaquil.  We hoped that by increasing the efficiency of the program, waitlists would become shorter and outcomes eventually improved for children receiving surgical intervention in the future.

When we arrived at Hospital del Niño Dr. Francisco de Icaza Bustamante, the public hospital where the mission took place, we had to discern in exactly which areas of care the local team needed the most help. After the first week it became evident that the intensive care unit (ICU) lacked nursing autonomy. Nurses took a generally passive role in bedside rounds, while the physician took the lead. The physician who was on-call at night would give a detailed summary of the patient’s surgical procedure, and make a few recommendations for ongoing post-operative care. There was no head-to-toe assessment or an overview of the patient’s current status and the nurse who had looked after the patient was not consulted. Our suggestion regarding the merits of introducing nursing leadership in conducting the rounds was initially met with resistance.  However, after identifying examples of pertinent issues that were missed in rounds and after explaining the vital importance of the nursing bedside report, everyone agreed to try this new method of providing a well-defined structure to patient information sharing.

On the Monday of week two, armed with a newly created Spanish nursing bedside report sheet and a bag of donated stethoscopes, we were ready to tackle bedside reports. Paula, a Spanish speaking physician assistant representing CardioStart from Los Angeles, USA, jumped into an empty patient bed and I handed out the stethoscopes to the three nurses on that day. The nurses laughed at Paula, our “volunteer patient,” and they were deeply touched by receiving their own stethoscopes to keep. As I spoke, Paula translated, “Your assessment of each patient is vitally important to the outcome of your intervention.” We assured the nurses of the key role they played on the team and the value of their observations and suggestions.  As we checked Paula’s pupils and felt her pulses, she translated the nurses’ review of each of the systems.  During this exchange, I realized how much they actually already knew and, how eager they were to learn. This approach helped them to organize their assessments into a comprehensive head-to-toe report.

The next morning, Maria, a nurse with 15 years of experience, confidently held her nursing bedside report sheet. She commanded the attention of the small ICU, packed with staff from both Hospital del Niño and CardioStart. The ICU was silent while she went through each body system.  The local intensivist stopped her during her report on the cardiovascular system, saying in Spanish, “I thought we turned the milrinone off two days ago?”  She shook her head. In that moment, the value of the new rounding system gained merit with everyone in the room; it was another small yet profound measure of the success of this clinical nursing model. On the first day, rounds took three hours for just two patients with a lot of questions and interruptions.  As the days went on, the rounds became more and more disciplined and, by the end of the second week, the morning nursing bedside report was comparable to one you and I would expect to experience in an advanced pediatric heart program.

On the final day of the mission, I walked through the doors of the Operating Room and there was Juliet and her mother walking the halls.  Juliet had been home for almost a week. Along with some of the other families, she had come to say goodbye!  Juliet was in a spring dress and was chewing on the tail of a balloon animal. Her mother couldn’t stop smiling.

When people ask me, “How could you work in the pediatric intensive care unit? It must be so sad”, the answer is easy. There is no greater gift that you can give to a family than to restore health to their child.  I share those experiences with families; when their worst days become their best. It is impossible to share the intensity of those moments but I can say that for me, the impact lasts forever.

It is only when we encourage others to be an active protagonist in their own story of development that real long-term change is possible. If the medical team at Hospital del Niño didn’t see the positive impact of nursing bedside report the practice would not have lasted after our departure. Guided by the local team’s vision, with the support of the CardioStart nurses, the nursing bedside report sheet has now become a legal part of their chart. It is filled out by both residents and nurses each morning.

Nelson Mandela once said, “Education is the most powerful weapon which you can use to change the world.” I believe this to be true and while you can’t change the world in two weeks, or even a hospital, or a small medical unit, you can make small and meaningful changes through the sharing of knowledge. After our short time in Guayaquil, 10 children have a new lease on life; the Pediatric Cardiac ICU has new information, new resources and new processes in place that enjoin all of the involved staff. I believe that children with heart disease in Ecuador are one step closer to excellent, and more timely, cardiac care.

Kate Earley