This past year, representatives from the country of Grenada and The Brooklyn Hospital Center (TBHC) met on two occasions. The first meeting with the Prime Minister, Dr. The Right Hon. Keith C. Mitchell, MP, included presenting the country of Grenada with an ambulance; the second meeting was to explore opportunities of working together. This meeting included the Minister of Health of Grenada, Senator Hon. Ann Davids-Antoine and staff, Dr. Carol McIntosh SLRHC, Carriacou Health Services, and several clinical and administrative Brooklyn Hospital Center representatives, including Paul Albertson, Sr. Vice President/Operations at TBHC; Jeovanni Rivas, Director of Biomedical Engineering (and a 2 year volunteer to Grenada); Deborah Wright, RN, ANP, Wound Care Specialist; and Sharon Hasfal, RN, ANP, also a critical care nurse from Lenox Hill Hospital. At the end of this meeting, Dr. McIntosh invited TBHC staff to Carriacou Health Services in Grenada to assist with best practices in health care. The TBHC staff happily accepted her invitation and embarked on their trip in July 2005, visiting the following locations: General Hospital of Grenada, St. George's University, the Minister of Health, and the Carriacou Health Services. Medical students from the University of St. George have long rotated through the TBHC and more recently, there has been discussion with Dr. Carol McIntosh about collaborating with the leadership of the Carriacou Health Service.
Explained Mr. Rivas, "I started working with the Grenada group as a volunteer two years ago. I have been participating in medical visits in Grenada ever since. A group of doctors and a contractor decided to build an ambulatory care center ( Carriacou Charity Health Center ) for people with needs. As a Comprehensive Equipment Management Corporation employee and Director of Biomed for The Brooklyn Hospital Center, I have been able to experience the needs first-hand of this Caribbean country during my visits. For the last several years, we have been able to donate medical equipment that has been discarded by the hospital and, along with the assistance of our Biomed staff, we have restored them for utilization in Grenada . We wanted to help Grenada as much as possible, so we asked the country's Prime Minister and Minister of Health to visit The Brooklyn Hospital Center to appeal for further assistance. We then met with the Senior Management at The Brooklyn Hospital Center to request additional aid. With Mr. Albertson's assistance, we have been able to put together a request for Wound Care and a Diabetes Symposium that will take place during the last week of October and in the first week of November in Grenada."
In particular, the TBHC staff and the Grenada representatives discussed wound care management, an important issue that needed to be addressed. Dr. Mitchell stated 90% of the wounds he sees are from diabetics, and that by the time the patients come to the hospital, they are usually so advanced that they require debridement (surgical excision of dead, devitalized, or contaminated tissue and removal of foreign matter from a wound) or worse, amputation, and there are only limited prosthetics available. Through better education, self-management, and better monitoring in the community health centers, it is possible that the incidence of debridement could be significantly lessened. Ms. Wright's and Ms. Hasfal's discussions with the nursing staff on wound management reflected gaps in current practices in the country, versus what is considered appropriate wound care management in the United States. For example, staff use of undiluted hydrogen peroxide actually exacerbates the wound rather than healing it. Furthermore, there is no vascular surgeon available to perform bypass surgery in lieu of amputation, and no angiography equipment to evaluate vascularity.
Explained Debra Wright, RN, "Despite all of the disparities and the conditions they work in, the nurses are extremely professional and caring, and they were quite receptive to our suggestions. Both the nurses and nursing students are looking forward to the educational conference that we are about to put together for them - they expressed their excitement to us. They are also very short-staffed, but this does not see to deter their commitment to their profession."
Ms. Wright added, "Ms. Hasal and I worked with a group of nursing students where we had an opportunity to role play a scene to illustrate the proper way to discuss diabetes with patients, once they are diagnosed with the illness. The staff nurse told us that their patients are not compliant, and that they have a very difficult time dealing with them. For example, when they would announce to their patients that they were afflicted with diabetes, they would simply say, "Your pancreas is damaged". This would scare the patients to the point where they would actually refuse treatment. Instead, we tried to teach them alternate solutions, such as "Your body requires insulin to be utilized for energy. Right now, it's not making enough and that's why you are feeling tired. We can give you medications that you have to take daily to make you feel better, etc." In other words, we taught the nursing students proper communication skills - you need to bring it down to the patient's level with a humanistic approach. It's just as important to have the ability to communicate properly with your patients as it is to treat them."
In addition, Ms. Wright has prepared an educational flyer on diabetes and wound care symposium to further educate the nurses & nursing students. Since press time, she has attended a special Wound Care treatment conference in Chicago to learn state-of-the-art treatment procedures and manage chronic wounds, with an emphasis on prevention of amputations related to diabetic complications. In response to the lack of proper facilities and outdated treatment methods, TBHC introduced a proposal that would expand the symposium to include a concentration on diabetes management. This would include the development of a consensus for wound care management (clinical protocols) that is sanctioned as approved standards of care for Grenada , prior to the symposium.