The last week of our placement found us working up in the NICU, or for anyone who doesn't know, neonatal intensive care unit. Let me be the first to tell you that Canadian NICUs and Ghanian NICUs operate very differently. To dwell too long on those differences would only discourage you and lead to a very pessimistic view on our time there, so it's important to keep in mind that the staff in the NICU are doing all they can possibly do with the resources that they are granted. We found similar to before that the procedures are the same; they're just modified to the supplies that they have available.
NICU Facts
1) They do not have the resources to support intubation. If the neonate cannot breathe after delivery, it will die as they just do not have the equipment required to support a mechanical airway.
2) Ants crawl on the babies. Most babies are on a dextrose IV drip, which is basically sugar water. This attracts ants to the sugary solution. This is perhaps one of the most disturbing things I experienced; every time I went to take a set of vitals on the babies, I would end up covered in ants because they'd run up my arms after I disturbed the blankets to listen to the chest. They would pour out of every blanket fold and it was tough to see little premature babies being swarmed by ants and unable to do anything about it.
3) Mothers are responsible for feeding and changing their babies. If the mother is not there, the baby will usually be found wailing away because it's hungry and laying in a soiled diaper. That's another thing... Mothers are responsible for buying the formula (if they're not breast feeding) and diapers for their babies. In the circumstances where babies were abandoned, they would only be fed at certain hours and diaper changes would happen as few times as possible because the hospital would have to pay for the diapers. Kiri and I fell in love with one abandoned baby who was nameless and spent a lot of our free time cuddling him and sneaking more formula to him because he was always hungry. We wanted pretty desperately to bring him home with us but Kiri figured her boyfriend wouldn't be too pleased to be a dad already and I eat canned pineapple for every meal if no one is home to cook for me so we figured we probably wouldn't be the best fit for this little baby.
4) Infant to nurse ratio is very high. Quite often, one nurse will be alone in a room full of 10 premature babies and will be deemed responsible for all their care, which is why they loved having students on the unit with them. Because of the increased workload, vital signs are not done on time or regularly; at times 28 week old babies will go 12 hours without being seen by a nurse. There are also no safeguards in place to alarm the nurse when something is wrong; if a baby stops breathing, they will not know until the nurse comes upon them and sees that they're not breathing. At home, there are many monitors with ringing alarms that will activate if a baby's oxygen sats drop too low; here they just have to rely on their eyes to visibly see if a baby isn't breathing.
5) Premature babies are not all on tube feeds. I spent 25 minutes one day spoon feeding formula into a 32 week olds mouth. In contrast, I also spent a lot of time feeding babies with a syringe by way of their naso-gastric tube. We never really understood why some babies had NG tubes and why some did not and the nurses were unable to really tell us.
There is just a few of the major differences we noticed; there are countless more. I can say that we really enjoyed our time in the NICU as it was very hands on. Each day we'd spend close to 2 hours just doing vitals on babies... It took so long and there were so many babies! The nurses would let us tube feed babies by ourselves so we really felt useful. It was very eye opening as I can say with certainty I've never handled such tiny babies before. It made me wonder what the edge of viability is is Ghana, as I watched a tiny 28 week old who weighed 0.8 kgs breathe on it's own with only a dextrose IV solution. I'm not sure what medications and other resources would've been used on that baby if it had been born in Canada, but I would bet there'd be a lot more medical interventions going on.
Aside from tube feeding and doing vitals, we didn't do a lot of medical interventions, simply because they don't tend to do anything too advanced. I hung a couple IV solutions by gravity for the first time in real life... I'd never done it without using a pump since learning it way back in a nursing lab and it took me forever to get the right number of drops per minute... I realized just how reliant I am on machines like IV pumps and even heart rate monitors. In Ghana, you have to really have a solid base of basic skills in order to carry out nursing tasks; I am sure many Canadian nursing students could learn something from the nurses here.