Hi Ryan Van Nostrand here in Georgetown, Guyana. This is the end of my second week and it has been an educational and enjoyable experience working in the GPHC. Over the last two weeks I have been able to gain an insight to the difficulties and similarities between medicine in the US and Guyana. It has been a pleasure to work with the doctors and staff in the Emergency Department and I have really enjoyed being able to teach and learn from the residents here.
This is now my third trip to Guyana to work at Georgetown Public hospital, fondly referred to as GPHC, in the Accident and Emergency Department (A&E). Each trip has been eye-opening, motivating, inspirational, at times frustrating and heart wrenching, and always immensely rewarding. I am fortunate to be the current Global Health Emergency Medicine Fellow at Vanderbilt, meaning I will spend much of my time this year working in Guyana.
I am sitting on the terrace of my hotel in Kathmandu, sipping spicy masala tea and looking out at the cityscape for the last time. Below me, the pudgy, fresh-faced toddlers of affluent Nepalis learn to swim in the crystal-clear swimming pool, a far cry from the muddy, leech-infested floodwaters of the nation’s rivers and lakes. The all-seeing eyes of the Boudhanath stupa, the holiest Tibetan Buddhist temple outside of those in Tibet, gaze placidly down at me from their towering perch above Kathmandu, watching over the nation. In the distance, somewhat obscured by the dust and smog of the capital city, I can see the Himalayan foothills, their dark, untamed beauty seductive in its wildness. I think of my ten SBA students, scattered now throughout isolated villages in those very mountains, providing contraception services and prenatal care and delivering babies in remote clinics. I offer up a silent prayer for them, and for the women, children, and families they are serving.
Yesterday, the ten SBA participants, their nursing instructors, two representatives from One Heart Worldwide, and I all celebrated the final day of the program, during which the students received official certificates testifying to their new status as skilled birth attendants.
Last week, I traveled from Dhulikhel to Dhadingbesi, the center of one of Nepal’s more remote districts, Dhading. One Heart Worldwide has supported the upgrading of many of the health facilities and birthing centers in this area and has also funded training for many local birth attendants, nurses, and other healthcare providers in the region. With the assistance of One Heart’s talented, good-humored field training officer, Malati Shrestha, who gamely put up with my love of walking despite her preference for the bus, I spent the week visiting many of these health centers, observing the physical buildings, performing needs assessments and quality of care analyses, meeting with the skilled birth attendants, auxiliary nurse-midwives, and nurses who provide maternal care, and assisting with skill development as well as providing hands-on patient care.
Many people I know, both here in Nepal and back in America, ask me why I am drawn to global health and development work, especially in light of the inherent difficulties of such pursuits. My Nepali friends cannot understand why anyone would voluntarily leave what they perceive to be the abundant comforts and riches of the United States in order to work in a country with limited resources, endemic corruption, myriad systemic challenges, and a lack of basic necessities and rights, such as gender equality, accessible healthcare, running water, and effective sanitation.I try to explain to them that I enjoy helping those in need, that I find answers I do not even know I am looking for when traveling, and that America is currently also dealing with a flood of social and political problems, and thus is not the proverbial Promised Land that those in the developing world frequently perceive it to be.
Women are, by and large, second-class citizens in Nepal. In some families, they rank more on the level of third-class citizens, as they are valued below both the men and the livestock. Simply being female here seems to mean that you are supposed to give up your seat on the bus to any man who wants it, keep your legs crossed, your eyes downcast, and your behavior in check in order to avoid stirring up male lust, demurely apologize should you dare to voice an opinion (or even to state a proven fact) that goes against the beliefs of any man in authority, and dutifully pray every morning for the blessing of sons and the long life of your husband.
My field experience gave me the opportunity to visualize and understand concepts that had been discussed in class. I was able to perform evaluations, data analysis, and community assessments based on the skills I have gained from my prior coursework. As a doctoral student, leadership is at the core of our curriculum, and we had often discussed different leadership styles and work cultures, this field experience gave me a better perception of just how varied and important this aspect of leadership is to increase work efficiency.
The initial aim of my main project was to review trends and surveillance on Non-communicable diseases (NCD) in Zambia. However, due to the unavailability of an NCD database and the availability of a cancer registry, the project was re-focused to review trends and surveillance on cancers in the country.