Nurse Anesthesia Bhutan Program Description

Transcription

1 Nurse Anesthesia Bhutan Program Description GOAL: To improve the quality of patient care and availability of anesthesia providers at the Jigme Dorji Wangchuk National Referral Hospital (JDWNRH) in Thimphu by: Providing continuing education to the anesthesia providers through lectures, presentations, and hands-on instruction and Developing and implementing a formal 2 year training program for 2-4 nurse anesthesia students. PROGRAM DIRECTOR: Richard Henker, CRNA, PhD Work: (412) EST Home: (412) EST Cell: (412) EST [email protected] Please note: Potential volunteers should not contact Program Directors until they have submitted a profile form and contacted a recruiter at the Washington office. LOCAL CONTACT: Dr. Singey Dorji Head of Anesthesia Department JDWNRH Thimphu, Bhutan [email protected] Copy Dipra Mukhia, nurse anesthetist, on s to Dr. Dorji: [email protected] LENGTH OF ASSIGNMENT: 1 month minimum. VOLUNTEER QUALIFICATIONS: Volunteers must be active or retired CRNAs. Volunteers must hold a current license to provide anesthesia in the United States or Canada. Volunteers with all areas of expertise are sought, with particular interest in those with OB and pediatrics experience. Volunteers should be in good physical condition, as a considerable amount of walking at high altitudes is required. Volunteers are required to provide copies of their CRNA license and any certification documents to HVO prior to their assignment. PROGRAM: The anesthesia department at the Jigme Dorji Wangchuk National Referral Hospital (JDWNRH) is staffed with 4 anesthesiologists and 5 nurse anesthetists. The head of the anesthesia department is Dr. Dorji. Second in charge is Dr. Gosar. The nurse anesthetists provide hands-on care and the anesthesiologists are involved in pre-op evaluation and consultation. There is typically an anesthesia technician that assists the nurse anesthetists with placing monitors, and transporting patients. In addition, the nurse anesthetists and the anesthesiologists manage the care of patients in the intensive care unit. A wide variety of cases are done at JDWNRH (pediatric, orthopaedic, C-

2 sections, GI surgery, ENT, etc.) The nurse anesthetists received their basic nursing education at the School of Nursing at JDWNRH and have usually worked as nurses in the operating room before entering the nurse anesthesia program. Currently, the nurse anesthesia program consists of 3-12 months of training at JDWNRH and then 1 year of training in Bangkok. Volunteers provide continuing education to the current anesthesia providers (anesthesiologists and nurse anesthetists) through lectures, presentations, and hands-on instruction. All areas of anesthesia training are needed, with a particular need in OB and pediatric education. An additional focus is to prepare the anesthesia providers to become educators so they can teach in the student nurse anesthesia program. This includes providing presentations to the anesthesia department on clinical teaching, infection control practices, precepting, presentation development, exam construction, and evaluation. The hospital schedule for many departments is 9:00am - 3:00pm. Once the day starts cases move quickly, with a typical turnover between cases of approximately 5 minutes. New elective cases do not start after 3:00pm. It is not unusual for the call person (one anesthesia provider is on-call) to work late and do more than one emergency case after 3:00pm. Volunteers provide at least 1-2 lectures per week and focus on clinical teaching the remainder of the time. Saturday between 9 and 10am is a great time to provide lectures as the staff is generally available. There is no board to write on so an 'around the computer' presentation and handouts may be the best to provide didactic training. Rounds with the anesthesia staff and nurses in the ICU are beneficial as the nurses in the ICU are very interested in discussing the management of cases. As the program develops volunteers will also educate 2-4 nurse anesthesia students per class. Dr. Deepak will assist volunteers in training the students. Volunteers will overlap in Bhutan with the volunteers that precede and follow them. When communicating with the site, volunteers are encouraged to copy Dr. Gosar ([email protected]) and Dipra Mukhia, staff nurse anesthetist ([email protected]) on the message. BACKGROUND INFORMATION: JDWNRH is a government institution with beds. There are 3 operating theatres and 3 ICU beds. The preop holding area and recovery rooms are in the hallways outside of the operating theatres. A new hospital is being built next to the old hospital, with a proposed open date of January 2009 and will have 8 operating theatres and 350 beds. For additional information see the "Bhutan General Information" document. EQUIPMENT/SUPPLIES: Volunteers should take their own scrubs, OR jacket, lab coats, hats, stethoscope, scissors, pens, OR shoes, masks, gloves, and pocket size hand sanitizer. Two anesthesia journals go to JDWNRH, "Anesthesiology News" and "Anaesthesia". There are recent editions of anesthesia texts in the hospital library and some texts are also present in one of the offices close to the operating theatre. The library includes the latest version of Morgan, Dorsch and Dorsch, Stoelting s Coexisting Disease, and an older version of Miller. The nurse anesthetists

3 - 3 - all currently own copies of the latest edition of Morgan as a reference text. There is a computer in the library with (very slow) internet access. There are 2 computers in the operating theatre area, one currently has internet access and the second will have internet capabilities in the near future. Projectors and classrooms for presentations are available. Two Drager gas machines and a new Ohmeda machine are currently used in the 3 operating theatres. The anesthetic agent currently available is halothane but all gas machines have isoflurane vaporizers in anticipation of the availability of isoflurane. Propofol and thiopental are used as induction agents. Succinylcholine and vecuronium are the muscle relaxants available. Opioids used include fentanyl, meperidine, and morphine. Epidural and spinal anesthetics are frequently used and there is no shortage of equipment for these procedures. Endotracheal tubes are cleaned with Cidex and reused. A fiber optic bronchoscope is available for difficult intubations, most airway adjuncts including lighted stylets are available. The temperature in the pre-op and recovery areas are close to the temperature outside the building. Patients are wrapped in beautiful blankets. The operating theatres are kept warm, but there are no convective warming blankets available. HOUSING: Housing is provided. The Ministry of Health has provided some basic household essentials (bed, table and chairs, etc). Volunteers are welcome and encouraged to supplement the apartment with any items they think would make the apartment feel more like home (rugs, pillows, kitchen supplies, etc.). Any purchases made for the apartment can be considered a donation and listed on the HVO Financial Contribution Form. See "Bhutan General Information" document for further details. Dr. Jampel will help volunteers with details regarding the apartment, such as payments for the internet and phone. ATTENTION: In many cases, an accompanying spouse, companion or family member (age 18 and older) is interested in participating in a volunteer capacity. In general, HVO is able to facilitate such assignments, especially for those with health care training. However, it would be up to the individual to be pro-active in developing a volunteer assignment. Many times, a role for these volunteers is not defined until after arrival at the site. In order for an assignment to be under the auspices of HVO, a spouse, companion or family member will be required to become a member of HVO and sign a release form prior to their assignment. Site Suitable for Spouse/Companion? YES NO Site Suitable for Children? YES NO LANGUAGE: The official language of Bhutan, Dzongkha, is related to classical Tibetan and is written partly in the classical Tibetan script, Choekay. Nepali predominates in southern Bhutan. As many as 11 other vernacular languages are spoken. English, the official working language and medium of instruction in schools and college, is widely used. PASSPORT & VISAS: A passport and visa are required. See "Bhutan General Information"

4 document for further details REGISTRATION WITH US STATE DEPARTMENT: All US volunteers are encouraged to register with the US State Department. See "Bhutan General Information" document for further details. CLOTHING/CLIMATE: Bhutan is located in the Himalayan Mountains, which means high altitude, lots of hills, and cold winters. During the winter, long johns are recommended and frequently are lifesavers when you are in the operating room or other areas of the hospital. Due to the altitude, temperatures cool off in the evening, and even in May you may need a jacket or sweater in the evening. During mid-day it warms up; however, in the afternoon the wind picks up and cools things off quickly. In winter it is cold, particularly indoors where you expect it to be warmer. When working in the hospital or clinic, a white coat (brought by the volunteer) over a shirt is reasonable attire. Male volunteers are requested to bring one jacket with slacks and a tie which are mandatory in formal situation. Female attire for working is below-the-knee skirts or slacks (no blue jeans). Please note that local customs require that females wear long skirts while visiting monasteries and in formal situations. Operating room clothing etiquette: Procedure is to change from your street shoes into OR shoes in the hallway, but don t leave your personal OR shoes there (not safe) so borrow a pair until you can get yours from your locker. The street shoes seem safe left out. After changing into scrubs, the only places you should go with a lab coat on are the pre-op area, the ICU area, CT/MRI. If you have business with the administration or want to visit other wards do so before changing into scrubs. Volunteers are expected to dress in a professional manner while fulfilling their assignment duties at the program site. Professional attire does not include shorts, short skirts, sleeveless tops, flip flops or other casual attire not appropriate in a professional setting. RECOMMENDATIONS: There is an HVO Anesthesia locker in both the male and female locker rooms, thus the ability to leave masks, gloves, etc the hospital. Please keep in mind that the use of non-western toilets prevalent in Bhutan requires the ability to squat. Keep toliet paper on-hand. The new hospital projected to open in 2009 may alter the above -mentioned observations. A mobile phone was purchased by the February 2009 volunteer, to be passed on to each following volunteer. Minutes (regardless of whether or not previous minutes were used) must be added monthy, on the 9 th. Volunteers are responsible for keeping the phone paid for and for replacing it if broken. Volunteers accepted for this program will be provided with additional information regarding housing, visas, travel, and other topics. HVO MEMBERSHIP: All volunteers with confirmed assignments must be members of HVO. The costs associated with developing a meaningful volunteer opportunity, as well as recruiting, briefing and placing a volunteer exceed $900. Dues help defray these costs and provide essential

5 funding for HVO ensuring that we will be able to continue placing volunteers today, tomorrow and next year. Dues are $150 for physicians and dentists; $70 for nurses and allied health professionals; and $40 for those in training. To join, visit our secure web site ( or call the HVO office. For more information about HVO programs, please visit our web site at 7/09-5 -