A Day in the life of a Global Health Intern (Part 1) Biryogo Health Center - Day 2

Today was a BIG day at the health center! Yesterday we were assigned partners for the rest of the trip as well as a University of Rwanda student to help us translate this week! I got paired with Suzanna from BYU and Elise from the University of Rwanda! I was really excited when I got my partners. Suzanna is hilarious and so smart and observant so it will be good to have her on my observation team! Elise is also very very smart. She wants to go to Johns Hopkins when she graduates from the UR. I have the dream team! Our job today was to spend 30 minutes in each section of the health center and write down any observations we had, good or bad, regarding IPC (infection prevention and control). We were assigned 5 areas; the ARV clinic, the nutrition education and vaccination area, the waiting room, the lab, and the minor surgery room. Here are my observations from today:

ARV Clinic *working with an immunocompromised population* The nurse didn’t wipe down the consultation desk in between each patient We saw a Tupperware container filled with ARV pills and a spoon to distribute. It was just sitting out on the desk. Fans available in the room but they aren’t running All of the nurses are wearing sandals Nurses coming in with their lab coats on from other areas (issue bc of immunocompromised population) There are no bug screens on the floor-level windows (+) There are numerous informational posters for patients and nurses to refer to (ex. the relation of TB to HIV) (+) There is a handwashing station supplied with LIQUID soap! It was 1/2 full (+) There are bug screens on the higher windows (+) There are counseling services available to patients with HIV to teach them how to properly live with their disease and prevent transmission (+) Pictures of nurses on staff posted on the door	Nutrition and Vaccination  *Very crowded area today with A TON of newborn babies. The District hospitals where the babies are born send them to the health center to receive their vaccinations.* The nurse does not change her gloves in between each baby. She had the same pair of gloves on the entire time we were observing She touched her phone and other non-sterile medical supplies while gloved There was no waste container for dirty diapers There was only one nurse vaccinating The room was very crowded, mothers were breathing on other babies as well as children accompanying their mothers There were windows but they weren’t open. When measuring the babies weight, the baby was laid down naked on the scale with no sheet or liner on the scale The scale was not sanitized in between each baby The vaccinating nurse evaluated a baby under its diaper with the same pair of gloves she had been using all day, she didn’t change them before vaccinating the next baby (+) There was a malaria education class going on (+) They were very careful with the needles and used the sharps box properly! (+) Handwashing station available
Waiting Room *This area included the reception, consultation rooms and waiting areas for pediatrics, minor surgery and general medicine* Babies were in the same area as sick children and adults. Ants were all over the ground We only saw two waste bins, neither labeled for the type of waste. One was for normal waste but it has a biohazard liner in it, probably due to resources There is no handwashing station for patients I haven’t seen any cleaners in the waiting area or in any other areas of the hospital yet there is a triage station in the middle of the waiting room and the patients are stepping on the scale with their shoes on There was no soap in the public bathrooms In the private employee bathroom there were a couple of buckets with dirty water. This is a concern because these types of standing water and breeding reservoirs for mosquitos There is a single dirty towel in the private bathroom for employees to dry their hands There is no cleaning sign off sheet anywhere in the waiting room	Lab *There was a small lab that processed patient samples such as tissue biopsies, blood, urine and other body fluids* There was a dirty bar of soap at the only sink in the lab There was only one dirty white towel 3 out of the 4 techs were not wearing gloves while handling specimen I didn’t see a box of gloves anywhere The one tech that was wearing gloves was only wearing one and she didn’t change it in between samples She was also touching all of the equipment with her gloved hand There was a huge plastic bucket of used slides on the floor I saw the tech handle blood smear slides with bare hands There were old sed rates in the corner of the room The phlebotomist had her phone out in between patients with her gloved hands It was very cluttered, I can see spills and cross contamination happening easily The windows were open and samples were set on the window sill. It would be easy for a child or other patient to grab a sample and transmit disease (+) waste containers properly used and labeled (+)hand rubbing poster by the sink (but no hand sanitizer available?) (+) Large sharps container available
Minor Surgery *This was a small room separated by a curtain. The nurses here often performed sutures and wound cleaning and dressing* Gloves available but in a cupboard near the floor They do not wipe down the table after each patient Cleaners don’t come in throughout the day Bowl of disinfectant liquid with instruments just on the floor Nurses came in and out with lab coats on from different areas of the health center Patient used her own shawl to lay on on the examination table. No disinfecting after she left (+) Autoclave and small sterilization room available (+) There was a properly labeled biohazard bin (+) Bug screens on the windows (+) disinfecting dilutions guide posted by the door	Additional Comments In the ARV clinic the nurses had their lab coats unbuttoned Every single female nurse we saw was wearing sandals!! The procedure for post exposure prophylaxis was not well known among the staff. The lab techs told us that if there is exposure to a body fluid they will test the patient immediately for HIV, if they don’t have it the patient and the person who was exposed go on their way. Only if the patient is HIV positive will they send them to the ARV clinic to receive treatment There is no filtered water available for patients or staff. The only filtered water is in the pharmacy and that is for patients to use when taking pills that need to be taken immediatly

After we spent the morning observing at the clinic we got lunch at the Nyamirambo Womens Center! It was at a woman’s house near the center and it was SO good. She made a huge buffet of pasta, beans, rice, potatoes, plantains, and cassava. Once we were done with lunch we met as a group ad discussed our findings. We agreed that the clinic was actually doing amazing with the location, population and resources it was dealing with. We talked about the major concerns we had and concluded that GLOVE USE and handwashing were the biggest *fixable* problems we saw. It is a challenge because we can’t come up with any solutions that will cost them money since they can’t afford to buy more supplies. Waleed assigned each group to write a report on a given area of the health center to present to the IPC coordinator, Cecille. My group was assigned the nutrition and vaccination area. I was really excited about this because that is where I noticed the most practical solutions. Elise helped us write up our report in Kinyarwanda and we are ready to present it to Cecille tomorrow!

   

Our Proposal: