Our new medication fridge. Previously we were forced to store refrigerated medications in the food fridge because that is all we had. This new mini-fridge was donated a few weeks ago, and it is kept in the nurses' station (aka my office) and is used only for medication. This is a great improvement and Martin and I are really excited!
New beds! I'm really looking forward to using these. It looks like most of them have raisable heads (only about half of our beds right now do that), and they appear to be low to the ground, which is great for patients who are confused and at risk for falls.
Are those chairs in the back there? That'll be so great! We can get patients out of bed and sit them up for a while!
This month I've been doing some work with the home-based care team from the care centre. The home-based care program is part of the government health care system, and is run by the local clinics. In Hawston, the home based program is housed in the care centre building because it's such a nice building and we have the space. Day-to-day delivery of home health services is done by home-based carers, whose level of practice and job description is very similar to our inpatient carers. Each carer has somewhere between 9 to 15 patients. The carers work with a community health sister (nurse), who coordinates the care for several different towns. The coordinator for Hawston, for example, also oversees Fishershaven, Vermont, Onrus, Paradise Park, and Stanford. That means that the coordinator might have 250 patients, so I think my work with home-based care will be a big help!
A patient could be referred to home-based care for a variety of reasons. Some are frail and elderly and have no family and no resources to pay for a care giver. Some have wounds that need cleaning and dressing several times per week. Some are bed-bound and cared for by their families, but they need supervision and extra help. Some are on chronic medications that have to be picked up from the clinic or even the hospital over in Hermanus, but they have no transport to get there, other than hitchhiking, which is not really a viable option to pick up monthly meds. Some are TB positive, which means that a qualified health professional is required to ensure that the medications are being taken daily.
The types of services a carer could do for a patient vary depending on the reason the patient is in the program. It could be anything from stopping by every day, Monday through Friday, to watch the patient swallow their pills or take a blood pressure reading. Or the carer could be doing a full bed bath for the patient three times per week. They could be doing wound care or changing a urinary catheter. The sister in charge of the carers tries to see each patient as often as possible (which may only be every 3 months or so because of the volume of patients). The sister needs to know about all their patients, and only the sister can recommend changes to the care plan.
Where do I fit into this picture? I've been going out with a couple of our home-based carers to see what resources they have for tasks like wound care so that I can make recommendations about how to improve the current practices. I've also joined the sister in charge when he has been in town two days last week. The home-based carers are responsible for handing out chronic medications to all the people in Hawston who get them from the clinic. This medication day happens once per quarter, and it happened last week. It reminded me of coming to get your race number for a big marathon. The carers tote all the boxes of everyone's medications to the community centre, and people line up to find their meds. I helped out by taking a blood pressure for anyone on cardiac medications. I probably did a hundred manual BP's that day, and my right hand was sore from blowing up the cuff so much! My favorite day with home-based services so far was the day we went around to all the creches (day cares) to give out vitamin A drops.
Working in people's homes has been really eye-opening. Some patients are really quite sick, but they live in shacks, sometimes by themselves. The work that the carers are able to do with the few resources they have is really amazing. I'm so privileged to get to meet these patients and try to offer what I can to make their lives a little better.
Last weekend we had a giant rain and wind storm. Apparently it's called a 'black southeaster', and I have to say that is an appropriate name! It's always windy here, but it was so windy on Friday night that I kept answering the door, only to find it was just the wind rattling it, not someone knocking! Luckily, there are very few trees in this area of the cape, so power loss wasn't a problem. So I weathered this storm just fine, but I ask your prayers for the people in my area affected by flooding, especially those who live in informal settlements (townships).
Speaking of storms, please keep the people of the Philippines in your thoughts and prayers also. And I will also tell you that yes, we do have two YASCers, Ashley (ashleyecameron.blogspot.com) and Margaret (seriveandstories.blogspot.com), stationed in the Philippines. But they are in the North and did not get any of the storm, so thanks to God for keeping both of them safe and out of the path of destruction!
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