Vol. 4 Issue 8
Nurse Anesthesia Overseas: Belize Travelogue
Beginning in January, Health Volunteers Overseas (HVO) established a Nurse Anesthesia Program with the Ministry of Health of Belize. The program is affiliated with Nurse Anesthesia Overseas (NAO) and the International Federation of Nurse Anesthetists, with a mission to educate two classes of Belize registered nurses as certified registered nurse anesthetists (CRNAs).
The first class will graduate in December 2002 and the second in December 2003. Volunteers to teach didactics and clinical are still desperately needed, along with supplies.
Belize is a small Central American country that lies on the Caribbean coast just south of Mexico's Yucatan Peninsula. It is marked by the world's second largest barrier reef, an incredibly diverse rainforest ecosystem, and one of the most complex mix of cultures in the world.
It is also home to one of the most fertile freshwater-to-brackish estuary waterways imaginable. From my highly biased perspective, the fishing for tarpon, bonefish, permit, snook, jack crevale, snapper and grouper is more than adequate justification to volunteer for assignment in Belize. For others it's the outstanding snorkeling, scuba diving, Mayan ruins, rainforest exploration, caving and eco-touring. For everyone who visits, the friendly, accommodating, creative and culturally diverse students and citizens are also a major attraction.
My February trip began with arrival at the Belize Airport in Belize City, where a driver from the Ministry of Health met me. I was dropped at the CRNA faculty house in Belize City, about 3 miles from the Karl Huesner Memorial Hospital in a nice residential section of town. It was very well appointed with most conveniences except air-conditioning.
I spent my 2 weeks in the company of Fred Welke, CRNA, one of the original program directors for the Belize NAO mission. While Fred suffered through teaching chemistry to the junior class, I had the pleasure of doing a regional anesthesia practicum with the seniors. This was the same group of student registered nurse anesthetists that I taught for their introduction to clinical anesthesia in May 2001.
What a difference 10 months of anesthesia experience makes! Our first assignment was to do an epidural blood patch on a 19-year-old woman who had a severe spinal headache after her spinal anesthetic for c-section the previous week.
To the best of our knowledge, this was the first blood patch done in Belize. Two hours later our patient was a new woman and ready to go home with her new baby. Next we had to do a spinal anesthetic for another 19-year-old woman for c-section. This patient was at 30-weeks gestation and in a severe sickle cell crisis with marked hemolytic jaundice and hepato-splenomegally. Both mom and baby did great. The mother's sickling crisis resolved within 48 hours post delivery.
In the 2 weeks at the Karl Huesner Memorial Hospital, Belize's major teaching institution, the students got to participate in administering spinal, epidural, combined spinal-epidural and axillary blocks. There was outstanding on-site support for all faculty and students from Keith Neal, CRNA, the clinical coordinator for the program. I will return, one way or another.
Various supplies are needed to help the Nurse Anesthesia Program in Belize operate effectively. Any donated supplies would be greatly appreciated. They can be shipped to: Keith Neal, CRNA, Anesthesia Department, Karl Huesner Memorial Hospital, Princess Margaret Drive, Belize City, Belize C.A. (there is no postal code). The needed supplies include:
• Preservative-free local anesthetic solutions
• Pencil point spinal needles
• Spinal trays
• Epidural trays
• Epidural needles & catheters
• Bupivicaine spinal solution
• Tetracaine spinal solution
• CO2 detectors
• Pediatric LMAs
• Pediatric airways & masks
• Mask harnesses
• Pulse oximeters
• EKG electrodes
• Regional block trays
• BP cuffs
• CVP kits
• Introducer kits
• LORA syringes
Additional information on HVO can be obtained at: http://www.hvousa.org or by contacting Colleen Deignan at C.Deignan@hvousa.org
Art Zwerling is clinical coordinator for nurse anesthesia education at Fox Chase Cancer Center, Philadelphia, and clinical and didactic faculty for PA Hospital and Montgomery Hospital Schools of Nurse Anesthesia.