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Final Blog
Now that nursing school is almost at its conclusion I have some time to reflect on the past three years in my final blog. I see how much I have grown as a student, person and friend. As a student, I believe that I have proven to myself how far I can get. I do admit to times where I wish I could re do things because I tend to get complacent at times. Sometimes I do struggle to stay motivated and achieve my true potential. As I continue to search for that motivation, I will do my best to put my best foot forward in this profession. I have high aspirations for myself but for everyone in our class. I am extremely proud to say that I was among a class represented by many accomplished individuals. As a person I can definitely see many differences. I was proud of my ability to gain so much confidence in regards to nursing. I definitely feel confident as a new grad entering the nursing profession. Physically I think I am in the best shape of my life. I am proud to have been part of the championship team in my three years playing basketball at CSUCI. I continue to develop my lifting mechanics because they play a critical role in my ability to stay healthy and be a nurse for a long time to come. Lastly, I feel like I am a more compassionate individual because of the things that nursing has taught me. I recently became Big in the Big Brother Big Sister program of Ventura County. I have been a mentor before and received great satisfaction in bringing success to the life of my friend. I want to continue to make an impact on other individuals on a more personal basis. Right now I am paired up with a 9 year old boy and hope to change his life for the better. In doing so I think I will continue to find satisfaction in life and be even happier than I am today.
Haiti Earthquake – January 12, 2010
I recall the images that came across my television after the 2010 Haitian earthquake. The country was yet again devastated after another natural disaster. This time it was a magnitude 7.0 earthquake and approximately 54 subsequent aftershocks that would bring an already dysfunctional country to its knees. The quake affected 3 million people and killed approximately 220, 000. To understand how the earthquake affected the county and its people it’s important to understand Haiti’s history. The country which has a long standing history of natural disasters, corruption and a nonexistent infrastructure magnifies any disaster many times over. The beginning of the fall of Haiti’s infrastructure began when Haiti became independent from France. In order to become its own republic the country took out loans from US, German, and French banks to pay the French reparation from 1825-1947. After this came a time of governmental corruption whereby tens of thousands of Haitians were beaten and tortured until 1986 when those in power exiled from the country with an estimated $900 million.
Since then the country has dealt with poverty, overcrowding and deforestation. The country in 1950 had a population of 3 million people and today that figure stands at nearly 9 million people. This coupled with the fact that Haiti is now 98% deforested as its impoverish people have cut down the forest to cook with. This deforestation which makes the makes the soil unstable makes the country incredibly vulnerable to any assault by Mother Nature.
When the earthquake hit it destroyed 70% of buildings in the country’s capital city Port-au-Prince due in large part to unregulated construction standards. Sixty percent of the health care system was destroyed in an instant. In addition, 10% of Haiti’s medical staff were either killed or subsequently left the country. It was a catastrophic event. Medical aid came from around the world and one agency that is still there to date is Doctors Without Borders (DWB). DWB has been in the country for the last 24 years aiding to fill pre-existing health care gaps due to the poor health care system. After the earthquake they set up temporary shelters and set up inflatable hospitals.
Today there is still a large need for medical aid and funding. While a great deal of donation money has gone directly to building hospitals in Haiti, quite a few still stand empty because of inadequate planning to ensure properly trained staff, sufficient drugs, maintenance, and medical supplies. It seems that a country with money without infrastructure is no better off than it was before. While I am well aware that the US health care system is not without its faults, it makes me appreciative of the layers of infrastructure that surround it in order to check and balance varying agencies along the way. It has been personal mission of mine to provide medical aid in Haiti and I hope to do so in the very near future as a Registered Nurse.
Henley, J. (2010, January 14). Haiti: A log descent to hell. The Guardian.
Final Reflection
As we approach our final weeks of school, I am truly thankful for the amazing cohort and instructors that I have met throughout this journey that we call nursing school. I can still remember my initial plan, which was to apply to Ventura’s nursing program since I did not have much faith in making it to CSUCI. Speaking to one of our classmates, one who I went to high school with but did not really talk to, Cesar encouraged me to apply to CSUCI instead to purse my nursing career. I was fortunate to have a friend like him because he had faith in me and believed that we could both make the program and flourish throughout the 3 extensive years. In disbelief, I received a letter stating that I was accepted into the program. From this point on, I realized that my life would change forever and there would be a lot of sleepless nights, but it would all be well worth the pain.
Critical care, our last nursing course, has truly taught me a lot about nursing and the importance of truly using “critical thinking.” This discipline takes a special type of nurse because nurses are faced with seeing individuals at their worst along with families grieving for their loved ones. It’s difficult not to imagine your own family members in such critical states, but being in this profession makes it inevitable. I had the opportunity to work with many nurses who were delighted to have students, which made my experience even better because I was able to learn a lot and take note of their personal practice. I have probably performed more skills during this semester than all of the other clinical semesters combined, which is always a plus for us since we rarely have time to perform skills in the clinical setting. Aside from my experiences, I also wanted to commend our instructors for sticking throughout this journey with us and providing us with their knowledge and experiences. A famous quote that has always stuck with me (also because my dad hates it when I don’t know how to do something) states “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.” While this quote highlights the importance of knowledge and ability to work, nursing school has taught us more than we can ever imagine. I have learned to give my time and presence to patients and their families when no one else would listen. I spoke to patients and truly sat down to listen to their stories because I knew that they have not had a decent conversation since their hospitalization. As I reflect on the last 3 years of nursing school, there is one thing that I will never forget. That is to be genuine in all that you do and do not let anyone change who you are because we are all special in each of our own ways and contribute equally to this profession that we call nursing.
2010 Earthquake in Haiti
Haiti Earthquake
On January 12, 2010, a 7.0 earthquake struck Haiti and resulting in the loss of over 230,000 lives, and the country is still working to recover from these horrible natural disaster five years later (CNN, 2015; Laurent, 2015). The effects of the large earthquake were much greater due to the poor infrastructure of buildings – a great majority of them were not built to handle earthquakes (BBC, 2014). Since the country is extremely poor, with families living on as little as $2 per day, the money to redevelop after the earthquake was simply not there and, despite the billions of dollars received in aid, the country is still struggling to redevelop and return to its previous state before the earthquake (BBC, 2014; Laurent, 2015). As a result, more than 1.3 of the country’s population was left homeless and at least 300,000 people were injured while many of the hospitals collapsed in the quake (BBC, 2014). Today, individuals can walk into the country and still see damage waiting to be fixed – buildings which are still broken, and families (at least 85,000 people) are still displaced and living in “shacks” (CNN, 2015; Laurent, 2015).
In regards to healthcare, initially, as stated, many of the hospitals collapsed, leaving the primary source for medical care inaccessible (BBC, 2014). However, shortly after the earthquake, the worldwide community brought in resources: the Dominican Republic provided medical supplies and emergency water, many countries (e.g. United States, Iceland) sent in emergency rescue teams, the Red Cross arrived and set up field hospitals, the United Nations came to provide help, and individuals from all of the world donated money to help with the care of these individuals (BBC, 2014). Additionally, as a result of the earthquake and the difficulty in accessing safe water, there was a massive cholera outbreak in October of 2010 with over 700,000 people contacting this deadly bacteria (CNN, 2015). Since the outbreak, over 8,500 people have died from cholera (CNN, 2015). While aid was able to come and act as a primary intervention, the country is still struggling at rebuilding and providing healthcare for population (Laurent, 2015).
I feel that being a nurse in this country during a huge natural disaster such as this one would be extremely challenging. While I do feel that we receive training on how to handle disasters, the accessibility to healthcare resources makes a big difference. During a crisis like this, the ability to obtain clean water is definitely at risk (especially as seen by the cholera outbreak). So, the big challenge to nursing wouldn’t necessarily be handling all the patients (although that definitely is a big concern), but it would be nursing using the resources that are available.
“I don’t have any more bandages and this person is bleeding. What can I use?”
“There is no more clean drinking water. How should I proceed?”
“This person has a compound fracture. What is my best course of action?”
These are questions and issues that we don’t normally have to deal with in a developed country, even during a natural disaster. And yet, these are big issues during a natural disaster in an undeveloped country and are definitely an issue in providing care. As a result, we need to have a combination of training and intuition in how to handle these situations.
While I believe that developed countries are prepared to handle these situations, I do not believe Haiti is yet better prepared to handle another large-scale earthquake because they have not yet managed to recover from the first one. A big portion of their recovery has come from outside aid, and, while outside aid will come again in the event of another earthquake, families are still displaced and buildings are still not all repaired. The resources are simply not there to handle another disaster.
References:
BBC. (2014). Case study: earthquake. Retrieved from: http://www.bbc.co.uk/bitesize/ks3/geography/ physical_processes/plate_tectonics/revision/7/
CNN. (2015). Haiti earthquake fast facts. Retrieved from: http://www.cnn.com/2013/12/12/world/haiti-earthquake-fast-facts/
Laurent, O. (2015). Haiti earthquake: Five years after. Retrieved from: http://time.com/3662225/haiti-earthquake-five-year-after/
U.S. Disaster
The Joplin, Missouri EF-5 tornado of May 22, 2011 claimed 161 lives, resulted in over a thousand injured, and damages were an estimated $3 billion worth making it the deadliest tornado in United States history since 1947 (Wheatley, 2013; Smith, 2011). This deadly tornado significantly impacted the Joplin community’s access to care as it demolished nearly ½ of its healthcare resources including the St. John’s Regional Medical Center (Missouri Hospitals Association, 2014). Emergency responders, volunteers (from over 400 different organizations), federal, and state responders all arrived to Joplin following the tornado to scour debris for human life and brought patients to designated triage areas such as the Memorial center where critical care patients were being cared for in-between stadium seats (Missouri Hospitals Association, 2014).Socioeconomics played a role in the number of fatalities related to this event due to many lacking safe rooms which can cost $6000 to $8000 to build (Johnson, 2013). The Joplin recovery efforts were still in progress as of 2013 with the new building of homes, safe rooms, schools, and a new hospital (Johnson, 2013).
I cannot imagine being a healthcare provider during this incredibly stressful time however; I know that if I had lived in this area it would have been required of me to know the emergency operations plan (EOP) of the state’s healthcare facility (Missouri Hospitals Association, 2014). According to the Missouri Hospitals Association (2014), hospital severe weather plans implemented a watch status at 5:11 PM on May 22nd and all three area hospital’s moved patients into safer locations such as hallways. St. John’s Regional Medical Center immediately evacuated to neighboring hospitals as protocol stated (Missouri Hospitals Association, 2014). And all neighboring hospitals set up triage areas in all possible waiting areas and because of this all hospitals were able to properly triage the large influx of patients the first 24 hours after the tornado hit (Missouri Hospitals Association, 2014). I can only imagine what must have gone on in a healthcare provider’s mind during this time, thinking of the status of their loved ones at home and their children all while trying to care for their patients. I think the only thing that would have kept me calm and focused would have been the fact that my patient is someone’s mother, father, son, etc. and just as I would be hoping someone was helping my family, I know my patient’s family would be depending on me as well.
According to recent research, it appears states in Tornado country, especially Missouri, are currently making progress to increase their preparedness evident by the Missouri Hospital Association release of a document (in partnership with the Joint Commission )called “Preparedness and Partnerships: Lessons Learned from the Missouri Disasters of 2011: A Focus on Joplin” (Missouri Hospitals Association, 2014). And according to the Missouri Hospital Emergency Preparedness Assessment, hospitals have made significant progress since 2011 in areas such as planning, their national incident planning system, communication, and safety and security (although much needed progress still needs to be made regarding a structured decontamination plan (42%)) (Missouri Hospitals Association, 2014). Evacuation-specific lessons learned from the Joplin tornado include the installation of battery back-up lit stairwells and disaster equipment in ready to go bags (Missouri Hospitals Association, 2014). With the tornado demolishing the St. John’s Regional Medical Center, a new hospital called Mercy Hospital has been built and has been constructed to better withstand future tornadoes (Johnson, 2013).
References
Johnson W 2013 Progress continues 2 years after Joplin tornadoJohnson, W. (2013, May 21). Progress continues 2 years after Joplin tornado. Retrieved April 22, 2015, from http://www.usatoday.com/story/news/nation/2013/05/19/progress-after-joplin-tornado/2322167 20150422225539387434840
Missouri Hospitals Association 2014 Preparedness and partnershipsMissouri Hospitals Association (2014). Preparedness and partnerships. Retrieved April 22, 2015, from http://www.jointcommission.org/assets/1/6/Joplin_2012_Lessons_Learned.pdf 201504222250231861290455
Smith A 2011 Deadly Joplin tornado could cost $3 billionSmith, A. (2011, May 24). Deadly Joplin tornado could cost $3 billion. Retrieved April 22, 2015, from http://money.cnn.com/2011/05/24/news/economy/tornado_joplin/ 201504222245461039591432
Wheatley K 2013 May 22, 2011 Joplin, Missouri EF5 TornadoWheatley, K. (2013, May 22). The May 22, 2011 Joplin, Missouri EF5 Tornado. Retrieved April 22, 2015, from http://www.ustornadoes.com/2013/05/22/joplin-missouri-ef5-tornado-may-22-2011/
Julia Greiner 2015-04-23 00:38:17
Cyclone Nargis, which happened in 2008, caused the worst natural disaster in the recorded history of Myanmar. It wreaked havoc, created catastrophic destruction and caused at least 138,000 fatalities and involved approximately 2.4 million individuals. This number of deaths may be inaccurate due to those occurring after the natural disaster due to health issues such as disease and lack of resources for health care. The WHO reported that the Government of Myanmar formed an Emergency Committee that had priorities of providing adequate food, safe drinking-water and shelter to the affected people. The WHO Regional Office for South-East Asia and the WHO Country Office in Myanmar were also involved in response to the crisis. The WHO published that the major health problems in Myanmar are communicable diseases (malaria, dengue, measles) and malnutrition. The State Peace and Development Council in Myanmar spend less than US$1 (i.e. 60 cents) per person per year, on healthcare. Approximately, 1 in 4 households live below the poverty line therefore lack of healthcare resources are commonly found in Myanmar. The structural damage caused by the cyclone and the flooding of water supplies, there was also an increase of waterborne diseases affecting the populations. Subsequently, damage to infrastructure and distribution systems will increase the risk of foodborne diseases.
One report written by an international rescue team called Team Singapore found that the most common diagnoses seen amongst adults were: upper respiratory tract infection, gastritis/gastroenteritis, and lower respiratory tract infection. Many adults and children also suffered from post-traumatic stress disorder from the experiencing the crisis. Emergency rescue teams like Team Singapore broke into teams that focused on different cities to offer aid to due to the lack of government set up emergency plans. Injuries from the cyclone were the highest reported cause of death (lacerations, blunt trauma and puncture wounds). Doctors without Borders in the first two months, aided 460,000 individuals with primary treatments geared towards diarrhea, malaria, dengue fever, and malnutrition. The British Red Cross reports that in 2010, Myanmar is on its way to recovery and has rebuild 24 schools and has been working to make sure the most vulnerable (elderly, disabled, women) are given the right assistance and support. They are focused on providing clean water and improving sanitation which has been successful due to the improvement in water quality and prevention of water-borne diseases. The British Red Cross is now offering basic first aid courses to encourage community-based disaster risk management training. In times of crises, local government often have to take the initiative to make certain policy changes or implement programs and training, in alignment with being prepared as a community in case of another catastrophic emergency.
I can’t imagine being a healthcare provider in Myanmar at this time. It would have been in such a hectic state especially due to the lack of resources and government set up emergency agents. It would have been very important to maintain hand hygiene in the efforts to prevent the spreading of disease during the crises and to offer the best educational support to affected individuals especially when medical resources were scarce. I think that the United States is better set up for a natural disaster if one were to occur because of increased resources and different government set up agencies such as FEMA. I reflect on natural disasters such as Hurricane Katrina and hope that our government and the citizens of the United States are better equipped and educated about what to do during a natural disaster.
References:
Doctors without Borders. (2008). Myanmar: Two Months After Cyclone Nargis, Needs Remain
Critical. Retrieved from http://www.doctorswithoutborders.org/news-stories/field-
news/myanmar-two-months-after-cyclone-nargis-needs-remain-critical
Lateef, F. (2009). Cyclone Nargis and Myanmar: A wake up call. Journal of Emergency Trauma
Shock, 2(2), 106-113.
The British Red Cross. (2010). Myanmar recvering two years after Cyclone Nargis. Retrieved
from http://www.redcross.org.uk/en/About-us/News/2010/April/Myanmar-recovering-
two-years-after-Cyclone-Nargis
The Who. (2008). Communicable disease risk assessment and interventions: Cyclone Nargis:
Myanmar. Retrieved from
Click to access MyanmarCycloneNargis090508.pdf
Watson, J. T., Gayer, M., & Connolly, M. A. (2007). Epidemics after Natural Disasters.
Emergency Infection Disasters, 13 (1), 1-5.
“Deadliest Railway Accident in Metrolink’s History”
The Chatsworth train collision occurred at 4:22pm on Friday, September 12, 2008, when a Union pacific freight train and a Metrolink commuter train collided head-on in the Chatsworth district of Los Angeles, California. A northbound commuter train, holding mostly Moorpark and Simi Valley residents, collided with a Union Pacific freight train, killing 25 and injuring 135 others; 46 of them were critical. The scene of the accident was a curved section of single track on the Metrolink Ventura County Line just east of Stoney Point. The Simi Valley Acorn writes that according to the National Transportation Safety Board (NTSB), which investigated the cause of the collision, the Metrolink train ran through a red signal before entering a section of single track where the opposing freight train had been given the right of way by the train dispatcher. The NTSB faulted the Metrolink train’s engineer for the collision, concluding that he was distracted by text messages he was sending while on duty.
The crash left 25 dead, including the engineer, Robert Sanchez, who had reportedly sent or received 43 text messages while on duty that day. His last message – to a teenage boy who he had told could operate the train later that day -was made just 22 seconds before the crash. Following the 16-month investigation, the board recommended to the Federal Railroad Administration that trains be installed with audio and video recorders to be assured that railroad employees are following safety rules. This event became the deadliest railway accident in Metrolink’s history. There was more than $7,100,500 in damage.
Responders: this “mass casualty event” brought massive emergency response by both the city and county of Los Angeles, but the nature and the extent of physical trauma taxed the available resources. The captain of the LAFD called for every heavy search and rescue unit in the city. Responders included CEMP (California Emergency Mobile Patrol Search and Rescue) as first responders, requested by LAPD. Firefighters, EMTs, air ambulances, public health officials, sheriffs, police officers, and healthcare providers responded to this event in order to triage those involved. Hundreds of emergency workers were involved.
This disaster is incredibly significant to me because I watched it unfold for hours on my television screen. My education was scheduled to begin the following month, but I knew that I wanted to be there. I contemplated driving to the scene but knew I was not qualified to help even though it occurred less than 15 miles from my home. This is when I knew I wanted to enter the healthcare industry, somehow, someway. Seven years later (today), I would drive to the scene without hesitation. I hope that we are better prepared for a similar event. There was no discussion about Ventura County responders, but I would assume that they could help in any way they could. All I know is that I will be there as a responder who is now qualified to help next time something of this nature occurs!
Information and images included are courtesy of Simi Valley Acorn and Foxnews.com
Hurricane Katrina: Healthcare Perspective
Image Retrieved from: http://www.theguardian.com/world/2014/feb/07/hurricane-katrina-after-the-flood
Hurricane Katrina was the most destructive “natural” disaster in US History. It impacted about 90,000 square miles and displaced over two million people. The healthcare infrastructure in New Orleans ranked among poorest in the nation and the hurricane greatly impacted the healthcare infrastructure. Hospital basements were flooded and medications, food, equipment and supplies were lost. Electrical systems were destroyed and hospitals eventually ran out of fuel to power their generators. For many hospitals running water was not available and sewage systems did not function and communication was not possible. Food had to be rationed among individuals in the hospital and more problems occurred by additional patients seeking care and other members looking for temporary shelter. There were 16 hospitals in the New Orleans area and 8 were closed permanently. Of the practicing doctors 2,000 of the 3,500 were displaced. The available resources were insufficient to care for the community and affected individuals after the hurricane (Rodriguez and Aguirre, 2006).
The hurricane affected the quality of care of many patients. Not having running water inhibited hand hygiene putting patients at risk of HAI’s. Not having a running sewage system also did not work in their favor. Medications were not available, beds, and chaos occurred. The hospitals were filled to their maximum capacity and they were probably short staffed. The Hurricane depleted all the hospitals stores and not being able to communicate and know when assistance was on their way must have been a frustrating situation. Eventually other states, government, the Red Cross, volunteers, etc… were able to help and it has been a long journey in making New Orleans what it was before the disaster.
I cannot imagine being a nurse in this situation. It must be very frustrating knowing that your patient needs care and you are not able to provide it because you do not have the necessary supplies. Also it would be important to prioritize care and provide comfort measures. Also non-pharmacological interventions would be necessary due to lack of medications. It would be very difficult to be a nurse in this situation, but very rewarding. In order to be able to function properly you need to be organized, calm, and think out of the box. We all need to be prepared for any kind of disaster. After Hurricane Katrina, a few more hurricanes have occurred and the response has been better. I believe that we are now more prepared for any disaster, but we will never fully be prepared.
References:
Rodriguez, H. and Aguirre, B.E. (2006). The impact of hurricane Katrina on the medical and healthcare infrastructure: A focus on disaster preparedness, response, and resiliency. Disaster Research Center (DRC) University of Delaware. Retrieved from: http://udspace.udel.edu/bitstream/handle/19716/2380/Australia%20PP%20-%20Havid%C3%A1n%20DSPACE%20READY.pdf?sequence=1
