Another private hospital visit

When I arrived this morning, I was told that the hospital visit had been cancelled. That was ok with me, since I had plenty of work to do, since we had been gone. Five minutes later, I was told that I was scheduled to tour the hopsital. OK, that was fine with me also. I was going by myself, since Kevin was at the hotel working and the students were already at the hospital working. I was told that I may or may not see the students.

I arrived at the hospital via auto-rickshaw. It was a long ride. I was met by a clinical instructor for the Symbiosis students. She had graduated with her BSN, just six months ago. I was surprised that she was hired to facilitate clinical instruction when she had limited experience herself. She was kind and seemed to know her way around the hospital.

I met with the Director of Nursing. She was great and very energetic. Her office was very tiny (6' x 5') maximum. It was tucked away in the basement. I commented on her office size and location. She said, "You can determine the quality of any Director of Nursing by the size and location of their office. If the office is big and has a nice view, they are not doing their job. Any good director will be out of her office - directing the nurses in the hospital." With that comment, we left her office and basically began to walk at a brisk pace over the 6 floors of her hospital. She knew the name of every nurse at every location.

She explained that the computers at the nursing station were mainly getting lab reports and printing forms. She said that very few nurses knew anything about computers, so she had given up on that aspect of nursing. She said that Indian does not require any form of continuing educaiton of nurses, so in-service training was all she had to enforce. She was frustrated.

Here is a great example of her leadership skills: We entered the Pediatric ICU. There were 5 nurses at the nursing station. She asked how many patients were in the unit. The response was two. She called them by name and asked why they were not in the patients' room. She also quizzed them on the diagnosis and treatment of the two patients.

At other locations, she praised nurses for good care and a variety of other items. At one of the large wards, there were about 20 patients in one large room. No curtains between the patients. She noticed that a nurse was in the process of going from one bed to the next to take vital signs. She called the nurse by name and asked what she was doing and hadn't she forgotten something. The nurse jsut looked at her. She said, "Wash your hands!!" It was loud enough that any person, patient, nurse or visitor in the are heard her demand. There was one sink available for hand-washing and it was on the opposit side of the nursing station and a long walk from any patient bedside on the ward. I can see why the nurses did not bother to wash their hands as regularly as expected, but that is no excuse. She told me that she was trying to get hand-santizers at each bedside, but had only been successful in the ICU units. And with that, we were off walking to a Labor and Delivery for a visit.

In Labor and Delivery, no one was in active labor, so I got a great tour. The unit reminds me of TGH in the early 1980s. The women in early labor are in a 6-bed unit with curtains and a common bathroom. They are given an IV, an enema, and their pubic area is shaved, exactly like TGH when I started working there. The patients can have one family member in this area. Whewn labor is "active enough", they are moved to a labor suite which consists of a hard metal bed with a thin mattress and a sheet. About 70% get an epidural, but it is all based on the ability to pay. No family member is admitted to this room. Except there is an exception, if the women are rich, they go to a US version of labor, delivery and recovery room. Family members up to 3 can stay in the room, even when the baby is born. These rich women are then admitted to a private suite for 5-6 days with a private nurse.

The middle class women (keep in mind that this is a private hospital) are moved to a ward after the birth. They do keep mom and baby together for the duration of the 4-5 day stay. Breastfeeding is almost mandatory while in the hospital. Most women breastfeed for about 3-6 months here depending on income. Rich women only breastfeed a few weeks. They do have milk banks here, but I have not been able to investigate this option yet.

Cost of private hosiptals is based on ability to pay. Every room that I was shown was attached to a specific price per day. Example: The super deluxe room (only one in the hospital) on the top floor had 3 bedrooms, 3 baths, kitchen and living room. One room for the patient, one for the family, and one for the private nurse. The cost is 15,000 RS per night ($300 US) and this includes the private nurse and food for the family and patient. The other private rooms were about 3000 RS or $60 US. Semi-private rooms were nice and cost about 1500 RS ($30 US). I tried to explain that there is not a single nurse in the US that could tell a visitor the price of any hopsital room. I explained that pricing is bundled with insurance contracts and nurses never knew what anything (drugs, procedures, rooms, treatments, etc) cost. She thought that was very starnge, because here every treatment is explained in terms of the total cost. The patients pay per day per procedure. Lots of time is spent deliberating among families on what they can or can't afford for their family member is in need of health care.

This hospital did not have an MRI - only CT scan and X-ray. Like the cancer hopsital, none of the chemo patients had ports. They had mulitple IV sticks for each treatment. It is very sad to know that so much pain could be eliminated with a simple port.

Lastly, the tour ended with a tea break with the nursing supervisors. There are five and they match the energy level of the Director of Nursing. They had many quesitons about nursing in the US. They have never heard of the concept of nurse practitioners. They liked the idea and wondered if they could do such a program online with a US university. When I handled everyone my USF business card, several asked about public health. They thought it was focused on community health nursing. When I described the departments in the college, they were surprised and agreed that India needs the concept of public health. They espcially wanted to know about EOH. It was a new concept for most of the nurses, especially to think that a nurse would be present in industry to monitor the safety of the workers. They said that they see many patients who have been injured at work.

I was at this hospital for about 4 hours. It was a great experience, because the students were not present. We had time discuss the real issues of nursing in a large hospital. This hospital has about 450 beds.

I was invited to come back and provide a 3-4 hour seminar on nursing in the US. It will be scheduled for sometime in April. I will make it very interactive, because I also want to know more about nursing in India.

Kay