Shalini’s Guyana Blog – Guyana wrap-up

Guyana wrap-up-part 1 – Sept. 10th

My 5 weeks volunteering trip with CASIEF has come to an end. I will be wrapping up the trip in 3 parts. I have met many new people, made many new friends and seen a different way of life. I came here with a notion of poverty and suffering. It just goes to show how wrong one can be when one makes an opinion without actually experiencing it.

I found out that the perinatal and under-5 mortality is high, much higher than most countries of the world (shocking numbers: perinatal: 2.8%, under-5: 3.6%). Obstetric analgesia is a rare occurrence, the C-section rate is high. SAO providers (surgeons, anesthesiologists, obstetricians) are stuck in the 20th century with minimal CME possibilities/desire/both. None of the patients speak Spanish but the majority of doctors have been educated in the Spanish language in Latin America and therefore communication with patients is not their forte! Postoperative pain management is limited to IV morphine for all patients in the recovery room. The patients appear very sensitive to opioids and do not seem to need much. However, the Wong-Baker pain scales posted at each bay in the PACU by my predecessor are just posters on the wall, still there. Over and over again, I heard patients tell me “pain is life“.

External partnership programs for post-graduate anesthesia training are being implemented so hopefully there will be changes. Perhaps the success of the CASIEF endeavour will be defined by not the number of people who go to Guyana but the strength of the partnership programs and the effect it will have on the residents. Residents are very keen. I would say they are hungry for knowledge and try and do their best with the limited opportunities for learning. I felt sad when I was teaching ‘massive transfusion’ to a group of residents who have very limited access to blood and none to blood products.

I think I learnt more than I taught! I learnt how to provide anesthesia when supplies are irregular; sometimes drugs and equipment were available and at other times, not. Choosing between absolute sterility and reusing the sparingly available supplies was a hard task, probably the hardest during this journey. Here in Canada, we take disposable single-use equipment and drug availability for granted. When local anesthesia shortage happened in North America (a few months ago), I remember how disturbed everyone was. This is a common occurrence in Guyana! During my stay, the supply for bupivacaine came and it was called ‘Numbicaine‘. The pediatric tylenol is called ‘babygesic‘. How appropriate!

The best part of the trip was teaching regional anesthesia to a bunch of very enthusiastic residents who couldn’t wait to practice their skills (sometimes on a patient and at other times on a pumpkin). The nadir of the trip, however, was not in Guyana but when I returned. With new eyes, I saw the absolute waste of drugs and equipment in Canada whereas ORs in Guyana (and I am sure in many parts of the world) are cancelled due to lack of equipment, drugs, sterile gowns; absolutely anything!

Guyana wrap-up part 2 – Sept. 10th

What I learnt in Guyana was the ability to have a sensible judgement without judging. Safety is an issue in Guyana, this is a known fact. However, that did not mean that we did not go out or socialize. Like anywhere else in the world, there were good people and there were bad people. To be able to survive in a place considered risky/corrupt is a valuable skill that I needed to bring back with me, after 5 weeks in Guyana.

This was a poster on one of the streets of Georgetown.

The other thing I learnt was to stop seeing Guyanese healthcare with a Canadian eye. These healthcare providers work with extremely limited resources so who am I to judge? In similar circumstances, would contemporary healthcare providers be able to provide the same level of care?

I carried an ultrasound machine that Sonosite had loaned me for the purpose, specifically. I wonder if I should have collected donations to buy the machine from them for the purpose of teaching. Guyanese anesthesia and ICU residents would have benefited so much. Though the whole ensemble fitted in a backpack, it did give me a bit of trouble during the check-in process at the airports (it was 14 kg and had 2 lithium batteries) but overall, it was an excellent idea and worked well. I am attaching a picture for you, Lina Lee!

For most of our days in Guyana, we stayed at a wonderful place, Project Dawn, a brainchild of Sister Carmen who was a nun and later became a doctor to help Guyanese people. After her passing, the place is being maintained by Marcie Gravensande. The place was wonderful, safe, spacious, with 24 h security and air-conditioning, had an excellent kitchen and lounging space. Each person was given a loaf of bread, a jar of peanut butter, a bag of ground coffee and a litre of milk that was good to give us a headstart. Each group marked their own food supplies and we did as well! Marcie told me that though many doctors come, only a few come back.

Guyana wrap-up part 3 – Sept. 10th

When I landed in Guyana, I crossed the threshold into a completely novel environment, spiked temperatures, intense greenery and an overwhelming sense of a placid way of life. My first exploration of the country was an extraordinary trip to the heart of the rainforests to see the famous Kaieteur falls. The Orninduik falls were fascinating, separating the country of Brazil from Guyana.

I was also introduced to “chutney music“. Has anyone heard about it? Believe it or not, it is a mixture of rural Indian ‘Bhojpuri‘ music that has amalgamated with the local and English tunes and has become very popular in the Caribbean. I also visited a Hindu temple. It was a strange feeling at first. Even though the scriptures were being read in an accented tone of Hindi, no one understood and the priest explained in English. This was a first for me, I mean Hindu temple with the puja (read service) in English! However, after a few minutes, the language of the puja became irrelevant and I could have been in India.

The streets of Georgetown are lined with red flaming gul-mohar trees, coconut, jackfruit and mango trees loaded with fruits, as well as blooming lotus and water lilies. Nature appeared at its best here.

I also came to know about the only musical instrument that was invented in the 20th century. The steel-pan! I could not fathom how the Beethoven’s sonatas could come out of this simple steel drum but they did!

Beth and I had an extraordinary time together. I don’t think residents ever spend 1 whole month with a consultant or vice versa. We came to know about each other’s lives, families, wishes, likes and more importantly, dislikes! I now know that Beth is an excellent teacher and has a lot of patience. Together, we experienced a 7.3 Richter earthquake, watched a Bollywood style dance drama, ate dhal poori and craved for cucumbers! She now knows that I am terrible with board games, love to cook and hate doing dishes. I now know that she loves animals and will pet stray dogs, cats and even donkeys, regardless of their cleanliness and ticks/fleas status!

Thanks to all of you who followed me during this 5 weeks journey! This will be my last blog regarding Guyana. Let us see what happens in 2019.

Bye for now.

Shalini’s entire set of blog postings is at < https://traveldocanesthesia.wordpress.com/ > including her great photos.