Medical stuff

This posting is for the nurses and doctors that are following my blog.

It has been interesting to see the differences in caring for the chronically ill in Israel and in the US. Things here are pretty lax. As I have mentioned, I am working in the "Bayit Cham" which means "warm home". We are caring for 7 children between the ages of 2-12. All of the children, except the 12 year old are tube fed. The responsibility for the feedings fall with the volunteers and other, non licensed personnel. The "orientation" to tube feeding consisted of showing me the feeding schedule and a very rudimentary explanation of what needed to be done. This was not because I am a nurse, this is how they do it. So several times each shift I prepare and administer the tube feedings. One of the biggest challenges in "feeding" the kids, is to keep them from disconnecting the feeding and leaving a mess all over them and their environment. If it happens though, there is no one to report it to and no one seems to be concerned if a feeding is missing, they just clean the kid and continue on with their day. One day I came in and noticed that someone had switched feedings and Chezi got Muhammed's feeding and visa versa. Again, it was no big deal to the staff even though they receive different supplements. I was thinking about all the phone calls and paperwork that would have transpired if it had happened at home.

The other thing that I find amazing about the tube feedings is how they really don't worry about the prescribed amounts. One child is suppose to receive 216cc of Nutren at each feeding along with 80cc of water. The cup used to measure is in 50cc increments making 16cc just a good guess. Again, no big deal here! I was told to fill the cup "a little over the 200cc mark. All I kept thinking about is the surveyors at home and how they would shut us down!

There doesn't seem to be much infection control concern here either. After nap time, all the kids come into the sunroom and play with the toys. All toys end up in mouths, on the floor etc. The first evening I worked I asked if we wipe down the toys at the end of the night and I was told no. All the kids live together and I guess share germs as they would in a home with a large family. All the trachs and gastrostomies seem okay and although there was one "cold" that spread to a couple of kids, none were worse for it. Suction machines go from child to child without being wiped down between and all is well. I kept thinking about how we are supposed to wipe down the bingo chips at work and how there must be a middle ground somewhere.

We had one emergency since I have arrived. There are several children that are completely dependent on ventilators 24/7. The other trached kids can go on and off to varying degrees. The other morning the physical therapist was working with one of the dependent kids and his trach cannula came out. The pulse ox began to alarm and his saturation began dropping quickly. It took the PT a minute or so to realize that there was a problem. I started to come over and he said everything was ok (the alarms sound fairly frequently when the connection is lost so I was not concerned at first). Then I went over as the alarm was persistent and the nurse also came over and noticed that the cannula was out. She pushed it back in and I started bagging the child and the PT paged the doctor stat but by the time the doc arrived, all was fine. This was an unusual event but thank goodness he was fine.

I don't want you to think that the care is bad though. The kids really do fine which should be a lesson for those of us practicing in the US. They receive a tremendous amount of love and attention. They are constantly being hugged and kissed. There is a school within the hospital and there is one teacher and at least 2 aides for each 6 kids. There are also 4 nurses in the school. None of the trached kids are more then a few feet from their ambu bags at any time and there is a real effort to provide education and physical therapy for even the most compromised child. There is a pool and each child also goes swimming, vent and all. It is all done very lovingly.

There is not much in terms of amenities. The hospital receives funds for caring for the children but the extras come from fund raising. Much of the equipment is old, wheelchairs are in need of repair etc., but nobody seems to worry about these things, they keep soldiering on. It is a very dedicated group of people caring for the kids. It is inspiring.