As part of my time in Queretaro, I am volunteering at Casa Hogar. This came to be when I asked the school if there was an opportunity to volunteer as I wanted to practice my Spanish outside of the classroom and give back in any small way possible. Without hesitation, they placed me at Casa Hogar thinking it would be a good fit since I am now a nurse.
The center is extremely welcoming and thankful to have my help, even if it is just a couple hours everyday. The doctor placed me in the medically fragile unit which houses ten children, give or take. Most are bedridden, non-verbal with cerebral palsy. A few others are severely autistic. One girl sleeps ALL the time, and she sleeps like an acrobat, her legs are literally over her head while sitting in a chair—no exaggeration. I asked what was wrong, and all they could tell me is she has a syndrome of some sort. I have never seen her awake, never! Then there is this little guy who is bright, quick and acts like a typical six year old. But he can’t walk and his growth is stunted due to his “crystalized” bones. He is adorable, and his eyes are as big as his head. When I asked him what his name was, I couldn’t understand him. So I asked if he could spell it, and with his finger he pointed out in front of him and traced letters in the air. Needless to say, I didn’t catch his name, but definitely got a good laugh out of it.
My three special amigos are Elijoh, Mario and Antonio. I visit them everyday, as I am to flush their G-tubes with water three times within 30 minutes. (Yes, the process of doing things here is very different than the states). Elijoh, 12 years old, doesn’t talk and I watched them cast his leg…didn’t really get a clear answer on how he broke his leg, especially curious since he can only move his upper extremities. He has a ton of secretions, and one day it was so bad that it looked like his skin was sloughing off, but it was just a collection of dried mucous, essentially boogers all over his lips. Thankfully, Ana (the nurse) had no issue with me cleaning him up. Mario on the other hand is autistic, and I found him sleeping for the first few days. But towards the end of the week he was wide-awake sitting up in bed, clapping his hands. I would try to ask him questions, but I’m not sure if he is non-verbal…but I have gotten a smile out of him a few times. Finally, mi mejor amigo Antonio is 21 years old and such a sweetheart. You can tell that he enjoys the attention as he immediately opens up his eyes when I come near. He was able to tell me his name, how old he is, and how he is feeling…he always replies with good. He loves to grab my hand and give me a kiss. He recently asked me if I had a boyfriend, so now I try to get a high five instead of a beso ☺. Antonio has cerebral palsy and is a spastic quad, but he’s got a lot of life to him compared to the other residents.
Besides doing G-tube flushes, I do vitals for the doctor since she cares for staff and outside patients too. I’ve also done some in and out catheters on children who are paralyzed or don’t have control of their bladder. The process is almost the same, however they flush with antiseptic after, hmm…
I have been working with the lead nurse, Ana. Again, she has to be awesome just because her name is Ana. More importantly, she has a lot of heart, and a strong work ethic. She is not technically a nurse, but has been going to school for nursing—guess it takes five years here. Not going to lie, she talks a lot faster than most and I sometimes struggle with what she is telling me. Plus, I’m overly cautious, as I don’t want to miss something, especially when it comes to the children’s health. So with wound care, we go together. Here is where things begin to change for me. Wound care consists of applying regular liquid soap, rinsing with water all while scrubbing HARD with guaze. Finally after drying the site, honey is applied onto guaze and then placed over the wound and taped into place. When we first grabbed the supplies to do wound care, I was caught off guard by the yellow liquid soap, but understood their resources here are different than ours in the states. However, I couldn’t make sense of the honey. Ana shared that honey is used to promote healing, though I wondered about it’s potential to increase the likelihood of infection. Most of our wound care consisted of bed sores. Other wounds consisted of one girl who fell out of her bed (she wasn’t placed in a bed with rails), another spastic quad had scraped her hand repeatedly on the wall and now had a large wound. An adult woman had a giant, benign tumor at the base of her head. It was the size of a mini nerf football, but it had an abrasion on the tip of it. Crazy!
But after a few days of doing things with Ana, I became confused and discouraged.
1. I understand that culturally there is a different way of caring for patients, however there is a part of me who is uncomfortable with some of these practices, as I don’t know if it does more good than harm. Side note, one of my nursing friends looked up honey and some research has found benefits to the use of honey. But I don’t know how I feel when I’m told to apply so much pressure that I take the scab off or cause the wound to bleed.
2. Now, imagine going to a SNF (Senior Nursing Facility), not necessarily a place where residents are receiving one to one attention. Many times, you just see basic care being provided. Staff care for their physical needs, not necessarily their emotional. It’s definitely very different to the environment of a hospital. Now imagine a SNF in Mexico, this is the best way I can explain Casa Hogar. Though this site has a lot of heart, their resources are limited. I wear the same gloves for the whole day, as most of the nurses don’t wear any. I look at G-tube sites and am unfortunately not surprised at the signs of infection. I can recognize a dirty diaper by the drenched bed sheet or the heard of flies that gather on the child. You always see flies on the kids, just more with the dirty diaper. And diapers aren’t changed with baby wipes, just use the current diaper and scrape off any residual stuff. The children/adults aren’t changed immediately since they are on a schedule. (I understand why, the staff would be changing diapers all day and nothing else if they took care of everyone immediately). Mattresses are on the floors and outside on the concrete, where children and older residents spend the day lying down. Some of the autistic children can be found behind doors with bars alike to a prison cell where they are left to themselves, crying, screaming, or sleeping. Though there is a classroom and physical therapy equipment, I have seen only a select few children utilize it. Granted, I am only there for a small window of time. But in my gut, I know these children are receiving limited care and the staff is so immune to the severity of the situation, that they aren’t motivated to do anything outside the norm—I can’t blame them. Feeding them, giving them medication and changing them is really all there is time for. For 30 children, I saw 2-3 staff members who assume total care.
So last week I left in tears, saddened by what I was seeing, feeling helpless and frustrated with not practicing my Spanish (the kiddos are non-verbal and the staff are busying working) and I considered leaving and volunteering at a typical orphanage. In my heart I didn’t want to abandon these children and even though I’m only there for a short time, I still have the opportunity to bring something to them. I can’t define what that something is, but maybe just a smile, a touch or laugh as my improper Spanish is comical.
Tomorrow I am going to talk to the doctor and ask NOT to do nursing care. I’m hoping she will be open to me doing range of motion with the children as many are in their beds 24/7 and becoming contracted. To be honest, I really just want to wipe off their faces, clean them up, hold their hand, and shew away the flies. Hoping God gives me the opportunity and strength to do so…
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