The other side of Compassionate Care: The role of Nurses in providing dignity and voice, Cusco, Peru
Thanks to the opportunity offered to me by the Edith Cavell Leadership scholarship, I spent four months working affiliated to the Adolfo Guevarra Hospital in Cusco, Peru. I worked with a team of research and health promotion nurses in order to tackle some of the more problematic issues faced by this region, including the impact of mining on indigenous health, as well as the increasing problem of obesity, diabetes and hypertension. Although I was based at a hospital in the city centre, I attended various health promotion outreach projects. These ranged from jungle areas (where we encountered infectious disease and crude oil in the water) to remote villages at very high altitudes (where malnutrition and heavy metals in the water were more of a problem).
Hopes and Intentions:
I left England with an interest in the therapeutic intent of nurses and their acknowledgement of the holistic elements that surround physical needs. This includes the social, personal and spiritual as well as, the too often ignored, political element, such as the provision of dignity and voice. I had two main goals. One was to generate research material that would reveal the issues faced by the residents of mining areas within Cusco. The other was to see how the role of nursing practice could be developed to better reflect the needs of those it is meant to represent. This is not only something of global significance, but is also pertinent in the UK at the moment, what with the release of the Francis Report (2013) and the promotion of the 6C's - care, compassion, competence, courage, commitment and communication (NHS 2013), so demonstrating that patient-centered care and compassion have become the focus of health care today. This is not to say these priorities are new. We only have to turn to Edith Cavell to be reminded of such compassion and commitment for the cause of her patients to see that, despite new packaging, the 6C's have been the foundation of nursing for over one hundred years. It was with these core principles and the inspiration from such a formidable woman who challenged boundaries, that I set out to take on (a much more humble) challenge of my own.
What I did:
The communities where I worked lay in the outskirts of the city of Cusco within the Cusco province, Peru. People here have been exposed to a multi-billion dollar gold and copper mining projects that have had a negative impact on local health and well-being, due to depleted and polluted water supplies as a result of smelting at the mines. This has resulted in high exposure to heavy metals in drinking water, which appears to be having long-term implications on the population, such as higher cancer rates, birth defects and miscarriages. Yet the concerns of the population are falling on deaf ears, as seen by the current protests in the Cusco region. This is due to a clash of interests; where the government has become motivated by economic factors (large investments from abroad), over the well being of a relatively small proportion of the population. Thus the issues faced by this community are not only physical health concerns but also social and political ones.
A typical day looked something like:
- 6am - Get up, walk to the clinic (and buy an avocado sandwich en route)!
- 7am – 12pm: Work at the hospital, either at the emergency drop-in, vaccination clinic, geriatric care or baby clinic. These were mostly routine checks and where much of the research material was generated via questionnaires, interviews and feedback from regular patients. Suspicious symptoms were monitored and documented here.
- 1– 5pm: Outreach work, usually health promotion/education. This involved attending schools, work places or public areas, like the main square or market place.
- 6 - 8pm: Quechua class (where I learned basic communication and body/ health terms for our more distant outreach visits)
When not in Cusco, days varied depending on the location:
- Clinics at high altitudes were only open in the mornings (partly due to daylight hours) and were often closed if a house visit was required. Nurses were responsible for most interventions, as doctors would only visit once a month.
- In the jungle, clinics opened for sun-rise, closed throughout the middle of the day and opened again towards evening due to the heat, so having an impact on how many patients could be seen.
- These outreach expeditions tended to last one week on average, so that the clinics could rotate around the variety of isolated areas.
- Health promotion pushes, tended to last three days, for example, the diabetes pop-up clinic was based in the market for two days and then the main square for one
I encountered many barriers to nursing whilst in Peru, the most obvious being the lack of resources and education for patients. Nurses need to learn how to prioritise very limited supplies and try to balance need with ideal outcomes. For example, in one of the clinics where I worked, there was only one packet of pain relief available per month. The nurse then had to decide who needed it most, a decision which is almost impossible to make.
Another barrier was the attitudes of health professionals. Many were quite rude and abrupt (compared to what is expected from practitioners in the UK), or treated patients as though they were primitive or stupid. This often appeared to prevent patients confiding in staff for fear of stigma or embarrassment.
A highly significant barrier however, was the very strong set of locally held beliefs that differ so radically from our own perceptions of health, illness and the body. By learning about these, a nurse can better tailor patient education to meet specific needs and understandings.
What I got from the Edith Cavell Leadership Award:
- The importance of leadership skills within the field of nursing (and health care)
- Wrote a report for the local hospital on nurse-patient relations
- The beginning of a care model to address the hidden issues within health promotion
- Research materials for further study/ dissertation/ paper. I undertook interviews and gathered statistics from a selection of government bodies as well as local NGOs, medical staff and residents
- A better awareness of global health concerns, in particular the rise in obesity, hypertension and diabetes- How to prioritise limited resources in a situation where supplies are truly restricted
- Realised how lucky we are to have the NHS! No system is perfect, but what we have is actually pretty wonderful…
- Learnt to speak some Quechua