Wednesday, April 5, 2017

Okanagan Community Clinic - Nyobok

Last week we had the opportunity to work at the Okanagan Community Clinic in Nyobok. Over the years this clinic has been supported by various individuals from the Okanagan region. During our week at the clinic, we participated in health screening, HIV and Syphilis testing, well-baby checkups, and home visits. Over the course of our time at the clinic we screened approximately 205 adults and children in addition to the unregistered babies at the well-baby clinic. This would not have been possible without the teamwork between our peers and the staff of the clinic. The individuals we encountered had walked sometimes upwards of 12km to be screened by us in the clinic and for some, this was the only time they would come to the clinic all year. 

The biggest barrier we experienced was language. Clients at the clinic may have traveled from very far away, and therefore we encountered many different languages and dialects. In many interactions the workers at the clinic were also unfamiliar with the languages clients spoke, and used other patients or surrounding people as translators. Sometimes a phrase would go through several people in order to have it translated to the individual correctly. This posed a challenge of receiving accurate and timely information. Overall, we were thankful for the staff and community members support throughout this process.
We also had the privilege of being invited into the homes of the people of Nyobok during our home visits. During these visits, we talked with the clients about hygiene, assessed the homes for cleanliness and gave them an opportunity to express any concerns they had. During this process, many of the home dwellers rushed around to provide us with chairs to sit and we were continually asked if we wanted to stay for food. The respect the individuals had towards the nurse’s opinions “wow’d” us all. At one house in particular a women welcomed us into her home. From one of the back rooms a gentleman appeared and promptly fell over, drunk. Our nurse translated to us that the man was admitting to being an alcoholic and we had the opportunity to do some teaching regarding the impact alcoholism had on the body. When translated, the man was genuinely agreeable to the instructions to stop drinking and was very appreciative of guidance and information. After leaving the home, our nurse explained to us that they encounter alcoholism often, and that while the man may quit for some time, he may start again. The common theme between the six houses was their positive, welcoming attitude and innovative use of resources.

As a community clinic, one of the barriers this location has encountered in functioning at its fullest capacity is finding staff that are willing to do the commute. In recognition of this barrier, funds from the UBCO Global Gala 2016 have been used to begin building an eight-bed residence for nurses. This building was started in February of this year. Once this building is completed, they will have the ability to offer accommodations for a midwife to open their maternity clinic. In addition, they will be able to house the current staff, and others, to lessen the burden of the commute. As four of the five Gala Girls, it was amazing to see the walls of this residence under construction because of funds that we worked so hard to raise. Seeing the physical representation of the money raised in November is the perfect completion of the Gala project.

During our time at the Nyobok Clinic we had a challenging experience when a patient came to this rural setting in an acute hypertensive crisis, meaning his blood pressure was dangerously high and he was presenting with symptoms that needed immediate medical attention. This situation was challenging for a few reasons. To begin with, as amazing as the Nyobok clinic is, there are limited resources including medications and equipment that are needed when a patient such as this requires help. This patient in particular required blood pressure medication and to be monitored regularly. This is where we were able to witness the amazing critical thinking and resourcefulness of the staff. With our suggestions of what needed to take place, the nursing staff began calling nearby clinics to try and secure medications, as well as arrange for an ambulance to take the patient to a hospital or clinic with more resources. The nearest clinic was about 20 minutes away and the nearest hospital was about one hour away. One of the nurses opted to take his own motorcycle and go pick up medications with one of the nursing students and bring them back to the clinic. The remaining staff, students and our instructors were discussing ways to transport the patient if an ambulance was not able to be secured, the last resort being a donkey and a cart. Luckily, an ambulance was eventually secured and the staff was able to provide medications and assist the patient to the hospital after he became stable. The tireless effort that these nurses went to to make sure this patient was going to be cared for was amazing to witness and we our thankful to have had this opportunity to see what needs to happen in an acute crisis in the most rural setting.

This was also challenging for us as students as we were not clear on our defined roles in an emergent situation where resources are limited. We came to this clinic as visitors looking to learn and expand our practice, however we did not anticipate this situation nor did we fully understand the proper processes and barriers that these rural clinics have to go through when presented with an acutely ill patient. We were not prepared for the amount of work that goes into transferring someone to a higher level of care in a rural setting as we are lucky enough to work in a place where there are well established protocols and procedures for these situations. We used this experience as a learning opportunity and reminder that we have the knowledge and skills to care for all patients in all settings and to trust ourselves and all that we are capable of. 

We are so grateful for our time at the Nyobok clinic and for the close ties it shares with the Kelowna community and all the learning we were able to accomplish during our short time there. 

Posted by: Stephanie Bandura, Emily Plant, Megan Lentz, Kenya Mokoena, Danielle DeYagher, Carmen Morgan and Rebecca Ellis

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