Approaching the light...

... at the end of the tunnel, that is!

Tomorrow marks my last first day of placement, EVER! This is, of course, totally depending on whether I make it over the mountains today or not.

As I'm sure everyone is up to date (my Australian audience), NSW is experiencing its worse bush fires in over a decade. The fires are still threatening Winmalee, Springwood and Lithgow, with over 100 houses already lost. At the moment the Great Western Highway is still open and I will continue to regularly check for updates.

To keep to you up to speed with other news, I featured on a university page that offered a quick blurb about the experiential nursing program. See it here!

I submitted my last essay on Friday! Extremely exciting! That means only two assessments to knock out of the way and hopefully I can get them done during placement.

I have also submitted my application to register as a Registered Nurse! Eeeeeek!

Aaaaand the most exciting news of all... November 8 marks my last day of class for my Bachelor of Nursing! I cannot believe how quickly the end has snuck up. The end of a very testing, stressful, challenging and empowering four years of study, caffeine, tears, travels and triumphs!

Not to mention the week in Fiji I have booked for late January to look forward to!


SO much happening in such little time! I hope to keep updating my blog during my last placement so watch this space :)

Four weeks out west

I have been incredibly busy on a nursing placement in Central NSW! So far it has been absolutely incredible; the nursing staff are supportive, welcome and lovely, the hospital* I'm at has only opened in recent years and is well designed and equipped, aaaand I have finally had a chance to get in to the operating theatre and LOVED it!

During placement, I am sharing a house with three other students. It is a huge and beautiful house, though the living arrangements have proven a little stressful for me. Then add demanding assessments on top, a rotating roster and a sprinkle of sleep deprivation and you got one reeeeally tested nursing student.

Daffodils grow everywhere here!

The massive house

Ice on the first morning

Gorgeous sunrise

The neighbour's cat loves us

However, I can't complain about the rotating roster; this placement has been absolutely incredible. We do not have a university facilitator with us so the onus falls on the hospital's onsite facilitator who has been amazing! She has organised for each student to be on a different ward and shift each week which I've never experienced on any other placement. It makes sense though, especially when I want to experience as much as I can during this four weeks!

Last week I was working on an extended day surgery unit and learnt a lot about pre-operative and post-operative patients. The staff were fantastic and for the first time ever I felt a part of the team and was even called by my name, rather than "the student"! It was fairly busy and has a high turnover of patients, but all of my questions were answered and I was able to do so much; there were many opportunities to practice IV fluids and medications, wound dressings, and I even took out belovac drains for the first time.

During my time on the extended day surgery unit I fulfilled many objectives:

• admitting patients from recovery and remembering to do half-hourly observations
• getting patients ready for theatre: pre-operative checklists, anaesthetic checklists, ensuring they have two ID bands and a correctly coloured cap, etc.
• practicing drug administration, particularly IV medications
• getting in to theatre!
• learning as much as I can and being able to educate patients, for example teaching post-operative deep breathing and coughing exercises, and explaining the rationale and technique for self-administered clexane injections
• getting to know patients and establishing a relationship through effective communication strategies

SCRUBS!

Getting in to theatre was most definitely the highlight of last week. I got to see a cesarean and watch a baby be born which is something I will never forget. I also got to see urology procedures; transurethral lithotripsies, one via flexible and the other a rigid ureteroscopy. These procedures involved passing a camera up the urethra and shooting laser beams at kidney stones which really just looked like I was watching someone play Call of Duty. Being in theatre also allowed me to learn about the roles of people in the OT, anaesthetic agents used, and rationales for patient positioning. I even had a surgeon take a few minutes to educate me on anatomy via a CT scan and locate the kidney stones.

Heading back out west after spending the week in Sydney

This week I have been working afternoon shift on a surgical ward. It's been a great opportunity to consolidate more clinical skills and I got to administer an IM injection for the first time. Totally not as hard as I thought it would be. I've also learnt a little about how traction works as I had never seen it in practice before. Yesterday I was lucky enough to get in to theatre again for the whole day, and saw a few orthopaedic operations and three colonscopies. It is all fascinating!

I am extremely proud of myself so far so diving in and giving everything a go. I've tried really hard to not let myself get overwhelmed and have been open to new clinical situations. I cannot wait for the next two weeks; ICU and CCU!


*I shall keep details as anonymous as possible - my intention is to merely reflect on my experiences.

Progress notes

I cannot believe that tomorrow marks week 4 of semester already! Time has been flying, yet passing so slowly at the same time :\ I haven't got much time to spend blogging but here is what has been happening...

I had my New Grad interview on Monday (12th Aug)! I'm not feeling 100% confident but it's over! My questions weren't too hard; I just found that I had a complete thought block and I put that down to how nervous I was :( Hopefully the panel take nerves into consideration! My questions were about: skills and role of an RN; a scenario; the multidisciplinary team; social media; CORE values; and infection control. Unfortunately now the long wait continues until early October when we get the result - offer, or no offer. I have also applied for a New Graduate Program within the private sector to increase my chances of getting something.

I'm yet to really get on top of any of my assessments - yes, partially my fault, but many thanks to factors out of my control. Last week a burst water main affected a few of the university buildings, and a result our online library was offline. That meant no access to databases, journal articles, etc. This proved frustrating on one hand because I was unable to access academic sources of information. However, on the other hand, I didn't feel guilty continuing my procrastination and even allowed myself a few sneaky wines! As of this afternoon, all systems are back in action; eeeeek, deadlines are looming! I am a little worried about having all the work done in time, especially because placement begins soon (read on!).

Lastly, placement begins soon! My four-week placement starts on August 26 and for that time I have AM shift. I'm surprisingly feeling good about placement (which is rare - I only ever associate really negative words with placements!) and am not only looking forward to consolidating my clinical skills, but also getting my head around AM shift and giving everything a good go. Up until last semester I'd never had an AM shift before. EVER! And it sucked, but that's another story. There are four of us that are renting a house in Orange and I am able to take my gym membership with me which is fantastic! My man plans on driving out to visit on the weekend too!

Besides university and work, I've been trying to keep myself sane and get back into some kind of routine! Before uni went back, I went camping for a weekend in Karuah National Park. Absolutely beautiful there and our campsite had a great view of the river. The following weekend, made it to Awaba State Forest for a 4WD which was good fun and resulted in another part of the 4WD giving in. Yay for repairs...

And last Friday, most of the Wolfpack reunited for a Thai dinner in the city! It was amazing to catch up with everyone and see what people have been up to since Thailand.

Aaaaanyway, I best be off to prepare for class tomorrow and get my bag packed. I hope to post more regularly but I'm sure you understand how hard it is. I just keep reminding myself that there is finally light at the end of the tunnel!

Cheers to a productive day today!

A video summary

Lisa made this wonderful video, perfectly summing up our experiences in Thailand  - check it out.

Elephants bring good luck, especially when the trunks are up

I'm sitting in my home in Sydney, where the weather is 16.9 degrees, a drop of 15 degrees from what it is currently in Bangkok. It's been almost 2 weeks since I arrived home, and the trip now feels like a dream. I flick through my photos and think about what I experienced... and it all seems like a million worlds away. The most trippy part for me is wrapping my head around the fact that I finally made it overseas for the first time!

When I think back to arriving in Bangkok and venturing out for the first time I can't help but laugh. I had these horrible ideas in my head of being followed or pick-pocketed, yet I felt so safe and accepted. I remember worrying about what I'd be eating and feared getting sick, yet I ate fresh fruit, drank iced drinks and brushed my teeth with tap water! But most importantly, I kept my mind open to what lay ahead of me and what I would be experiencing as part of the Experiential Nursing Program. I knew before the trip that barriers in verbal and non-verbal communication would exist, and these barriers required me to be flexible and adaptable when interacting with people. Learning a few words in Thai definitely helped and it is evident that a smile can mean a lot. Also, being immersed in an unfamiliar culture compelled me to be aware of my own beliefs and customs and I remained open-minded to new and differing scenarios, always conducting myself in a culturally safe and appropriate manner.

I struggle to think of anything that would have enriched my life or influenced my personal or professional development to the extent that this trip has. I can say that without a doubt, I returned home with a greater appreciation of the health care available in Australia and a greater understanding of socioeconomic issues and their impact on health in developing countries. Where do I begin describing what I witnessed? Diseased and injured organs and limbs. Forensic photographs of horrific accidents. Babies born with lethal abnormalities. Women swaying around poles atop bars, expressionless. The sad result of sex tourism and children left in orphanages. Rubbish dumped in streets. A homeless man and his dog sleeping underneath the train station. Unprotected motorcycle and scooter riders transported 2, 3 or 4 passengers. Polluted waterways filled with rubbish and dead fish. Exquisite temples standing between rundown apartments and tall commercial towers. Markets selling medications that would require a prescription if sold in Australia. Women begging for money with children asleep in their laps. Private hospitals filled with international clients. People living with HIV socially isolated and forgotten about.

All of this just emphasises the fact that health care should be a right, not just something that exists to those who can afford it. The focus of health in Thailand needs to change from elective and cosmetic, to prevention of illness and promotion of health; through increasing education, eliminating stigma, and reducing social inequalities. Our visits during the program also highlighted the need for better equipped rural and remote facilities and recognition of their importance in the health care system for reaching disadvantaged populations.

Overall, this experience confirms my choice of career: Nursing, the art of care and healing that translates universally regardless of language, country, and culture. I know that I am destined to do more than work on a general ward; I want to be working to help the disadvantaged, I want to work in rural Australia, I want to travel overseas and see where nursing can take me, and I want to contribute to changing the culture of nursing in Australia.


Things I'll miss about Thailand:

• Living in a completely unfamiliar environment and culture
• Walking through the city and exchanging smiles with strangers
• Meaningfully relating to people non-verbally
• Venturing out in to the city not knowing what to expect
• Seeing squirrels scurry along power lines
• Playing with gorgeous and happy children
• Sleeping less than 6 hours a night and dreaming about the buffet breakfast I'll wake up to
• The buffet breakfast
• The street vendors and fresh produce
• Being able to afford to eat prawns in every meal
• Conversing in a new language (Sawaadee-ka!)

I will even miss:

• Waking up so early to allow copious amounts of time for traffic
• Eating too much food because it is too delicious not to consume
• The heat and the interesting smells
• Sitting on a bus for hours being able to absorb the views of changing landscapes
• Blowing my nose every 30 seconds while eating the spiciest meals

What I'll remember for the rest of my life:

• Being so welcomed into an entirely different environment and culture
• Discovering an absolute love and passion for travel
• Participating in a rich learning experience and further discovering my interest in health care
• Pushing myself beyond my comfort zone and surviving
• Immersing myself in the experience and making the most of every moment!

But for now, reality beckons. A few days ago I received my subject results for last semester; 3 Distinctions and a High Distinction - absolutely stoked! On Monday, I'm back at university for the last 6 months of my degree! It's all starting to feel a little more real, especially with my New Graduate Interview date fast approaching. I also have an upcoming placement in Orange (Western NSW) which will give me a perspective of rural nursing and I cannot wait!

Until next time, Thailand!

TG 471

So back to first experiences in my life... flying down a Bangkok freeway at 140km/h, wearing no seatbelt, with the driver tailgating like crazy, all before the sun was up!

Yep. What a way to start my trek home. Kate and I allowed plenty of time to get to the airport, departing the Ibis at 5am. The taxi didn't have a meter so we agreed on 500 baht; probably a rip-off but we had cash that wasn't going to get spent otherwise. We threw our bags in the boot and we were off! Literally. It's like this guy was trying to beat a personal best. Or see how many runs to the airport he could do in one morning. I could feel my kidneys aching as my adrenal glands pumped more adrenalin than my body knew what to do with it. I looked over at Kate who had slumped down in her seat to avoid seeing the speedo. I couldn't believe the traffic, or lack of really. Compared to Sydney which seems to never sleep, Bangkok is definitely snoozing of a morning. 

5:25am- stop the clock. We'd made it to the airport with the driver only just slowing down in time for a speed hump. I was in disbelief at the drive I had just experienced and the time that we arrived at the airport (after imagining being stuck in kilometre long traffic queues!). We were barely in line for 15 minutes before handing over our passports and luggage. Would you believe that our bags were 17.5kg and 17.4kg?! 

So with over an hour to kill it was time for food! I devoured a toasted sandwich as I sat and watch travelers flood into the airport. I was now beginning to feel more anxious about getting on the plane. Not being I hate flying, but because I usually hate coming home, and Bangkok had treated me like royalty.

Suvarnabhumi Airport

At 7:20am our flight began boarding. Rows fourty-one to seventy-something. Perfect. That was us. We found our seats and got comfortable and thankfully the plane was not hot and stuffy this time. However, despite our flight being due out at 8am, we didn't take off until almost 8:45am. This time there was no excitement as Kate slept beside me. 

The flight was largely uneventful with only the passenger with the window seat requesting the aisle seat due to feeling nauseous. I was happy with that as I'm a sucker for the window seat. I love the view, however, sitting right above the wing proved too glarey for most of the flight.

First course

Back over the NT desert

Prawns again!

An entire day passed in transit

Following a movie, a nap, a few walks up and down the plane, and another two impressive meals, we were starting our descent. We were lucky enough to get a lap of Sydney as we approached and had a spectacular view of the lights as well as the Harbour Bridge and Opera House. 8pm marked our arrival at the airport and I think that such an early check-in resulted in our bags taking forever to appear on the carousel. Getting through customs was a breeze and a few steps later I could see my partner and my parents waiting for me in arrivals! It was hard to believe that the trip had come to an end as I gave Kate a huge hug goodbye! It all felt surreal sitting in the car on the way home, recounting stories and sharing a few photos. 

I had finally made it overseas! 

Farewell dinner

Thursday 11th July

After a busy day filled with informative meetings, unfortunately the nursing program had come to an end. The last official spot on the itinerary was dinner at the Hua Chang Heritage Hotel, just down the road from the Ibis. The food was absolutely divine but the company was even better :) As sad as I was that it was the last day of the program, it was a great chance to reflect on our time in Thailand and spend time with some pretty awesome people. Emma and Nok were both received thank-you gifts from the group and we all feel very lucky to have had such wonderful leaders guiding our tour. I also feel so privileged to have received this opportunity; a massive thank you to UTS BUiLD!

Health for Wealth Day 11 - UN & TRCS

UNAIDS - United Nations

Yet again, we arrived at our first destination, the United Nations, extremely early. The bus drove us to the Grand Palace area just down the road and we had time to have a look around and take a few photos. Since 1792, the palace has been the official residence of the Kings of Siam, the Royal court and the administrative seat of government.

United Nations Building, Rajdamnern Nok Avenue, Pranakorn, Bangkok 10200

Upon entry we were required to go through security, have our bags x-rayed and hand over our passports in exchange for a name and security pass. We made our way to a small board room within the UNAIDS department and had the pleasure of meeting Steve Kraus. Yes, Steve Kraus, the Director of the Regional Support Team for Asia and Pacific, a pretty big deal! We were all buzzing and in that moment I felt so privileged to have such an opportunity. He also gave praise to Australia's financial and technical involvement and support of UNAIDS, outlining that many interventions have so far proven successful, e.g. safe injection sites and opiate substitution therapy.

VIP for a day

*there is an abundance of information about HIV/AIDS in Asia and the Pacific and regarding strategies to decrease new infections, reduce stigma and increase education, but I will just outline some basic information that I learnt during my visit*

HIV and AIDS estimates in Thailand in 2011:

• Number of people living with HIV - 490,000
• Adults aged 15 to 49 prevalence rate - 1.20%
• Adults aged 15 and up living with HIV - 480,000
• Women aged 15 and up living with HIV - 200,000
• Deaths due to AIDS - 23,000
• Orphans due to AIDS aged 0 to 17 - 250,000
• 70% of new HIV infections happen in 27 provinces          (Source)

(Image source)

Epidemic is concentrated among key populations:

• People who inject drugs
• In some geographical locations, over 50% of PWID are living with HIV
• Female sex workers
• Clients of female sex workers
• Men who have sex with men
• 7-31% of MSM are HIV+, and this % is on the rise especially in large cities and popular tourist locations
• Male sex workers
• There is generally a higher % of male sex workers with HIV than female sex workers, and is as high as 18% in geographical hotspots
• Transgender and Transgender sex workers
• There is currently no data on population sizes and limited data on HIV prevalence
• Where there is data, it indicates high prevalence in cities

UNAIDS 10 TARGETS AND COMMITMENTS

1. Reduce sexual transmission of HIV by 50% by 2015
2. Reduce transmission of HIV among people who inject drugs by 50% by 2015
3. Eliminate new HIV infections among children by 2015 and substantially reduce AIDS-related maternal deaths
4. Reach 15 million people living with HIV with lifesaving antiretroviral treatment by 2015
5. Reduce tuberculosis deaths in people living with HIV by 50% by 2015
6. Close the global AIDS resource gap by 2015 and reach annual global investment of US$22-24 billion in low- and middle-income countries
7. Eliminate gender inequalities and gender-based abuse and violence and increase the capacity of women and girls to protect themselves from HIV
8. Eliminate stigma and discrimination against people living with and affected by HIV through promotion of laws and policies that ensure the full realisation of all human rights and fundamental freedoms
9. Eliminate HIV-related restrictions on entry, stay and residence
10. Eliminate parallel systems for HIV-related services to strengthen integration of the AIDS response in global health and development efforts

Division of labour:

UNAIDS brings together the resources of 11 UN system organisations for coordinated and accountable efforts to unite the world against AIDS. A division of labour guides the support offered to ensure that countries receive the best technical support and avoids duplication of work in specialised areas.

• UNHCR - The Office of the United Nations High Commissioners for Refugees
• UNICEF - United Nationals Children's Fund
• WFP - World Food Programme
• UNDP - United Nations Development Programme
• UNFPA - United Nations Population Fund
• UNODC - United Nations Office on Drugs and Crime
• UN Women
• ILO - International Labour Organisation
• UNESCO - United Nations Educational, Scientific and Cultural Organisation
• WHO - World Health Organisation
• The World Bank          (Source)

Stigma and discrimination still remain to be large barriers impeding effective HIV responses. So what is being done?

• Since 2010, China, Fiji and the Republic of Korea have all revoked travel restrictions for people living with HIV
• India, Indonesia, Papua New Guinea and Thailand have implemented programs to ensure that law enforcement does not pose as an obstacle to HIV treatment and prevention
• In Thailand in 2011, more than 60% of people eligible for antiretroviral therapy were receiving it
• The government is funding more than 84% of the HIV response with domestic resources
• Objectives include: support schools to teach sex education and promote safe sex for sexually-active youth; improve access to condoms; screen donated blood for HIV and appropriately used blood and blood components in treatment; provide treatment and holistic care to people living with HIV, their families and other affected people; create opportunities for learning and training to improve understanding about basic human rights and sexual rights among service providers and the general community with the aim of reducing stigma and discrimination; empower key affected populations so they know about their rights and can access protection services; and change attitudes of society in Thailand.         (Source)

"Today, we have a chance to end this epidemic once and for all. That is our goal: Zero new HIV infections, Zero discrimination, and Zero AIDS-related deaths." 

United Nations Secretary-General Ban Ki-Moon, at the United Nations General Assembly High Level Meetings on AIDS, June 2011.

"Don't be afraid to be a change agent." 

Steve Kraus, at the meeting with 20 University of Technology Sydney students, 11th July 2013.

More information on UNAIDS and the response in Asia and Pacific 

I found this presentation extremely interesting and educational and I will take a lot of this knowledge with me. I believe that my role as a Registered Nurse when caring for patients infected allows me to be supportive and reduce stigma and discrimination, thus aiming to reduce barriers to accessing and adhering to treatment. Despite developing countries having a higher prevalence of HIV/AIDS, Australia has seen a notable rise in HIV infections in the last year, reiterating the worldwide need for increased awareness and education, access to holistic care and treatments, and well-equipped health professionals free from stigma.

The first REAL coffee of my trip at the UN!

Thai Red Cross Society

The TRCS was founded in 1893 with the objective of alleviating suffering. In 1920 it became recognised by the International Committee and quickly became the largest humanitarian society in the country.

4 Chang Wat, Bangkok 10330

We were welcomed immediately upon our arrived at the Thai Red Cross Society (TRCS) and had a few group photos taken. We were then led to a meeting room for a presentation on the TRCS and the work they do in responding to disasters in Thailand. Wanpen Inkaew and Somjinda Chompunud delivered presentations to us containing the following information and more.

The TRCS functions in four main areas:

• Medical and health care
• Disaster preparedness and response
• Blood transfusion services
• Quality of life promotion

Disasters in Thailand
Natural: flood, drought, storm, landslide, tsunami
Made-made: fire, chemical and hazardous material incidents, transport hazards, sabotage threat


TRCS response to the 2011 floods
Between 25 July and 9 December 2011, the Department of Disaster Prevention and Mitigation reported that as a result of tropical storm "Nock-Ten" a total of 65 provinces were affected - in 684 districts, 4,917 sub-districts, 43,600 villages - affecting 13,570,873 people, 680 people died and 3 people missing.

1. On 13 December 344,012 relief kits and 324,944 packs of bottled water were distributed
2. Between 22 September and 2 December, 4 mobile relief kitchen units prepared 439,830 meals for affected people in 8 provinces
3. Between 1 October and 9 December, 2-4 mobile medical units traveled by flat bottom boats to reach 13,393 affected people in 7 provinces. Each unit consisted of a doctor, pharmacist and nurse.
4. 22 flat bottom boats evacuated 78,680 flood-trapped people in 13 provinces between 6 September and 10 December
5. Between 6 September and 10 December, 8 water purification units were sent to 6 provinces and produced 5,160,000 litres of water for 258,000 affected people
6. 448 shelter box sets were distributed. Each box supported a family of 5 people and consisted of a tent with a raised floor, bedding, kitchen utensils and daily necessities
7. 20 floating toilets were provided in Pranakom Sri Ayutthaya and Nonthaburi provinces
8. 583 boats were distributed to affected people in 9 provinces
9. 48,000 ready-to-eat meals were distributed to 7 provinces

The Thai Red Cross College of Nursing

The College was established in 1914 as a contribution of Queen Sripatcharintra - Wife of King Rama V and the first present of the Thai Red Cross Society. It is recognised as the first nursing school that offered a general nursing practice program in Thailand and initially offered a three-and-a-half year nursing and midwifery program up to 1964. Currently the Bachelor of Nursing Science program and post-graduate programs are offered at the college with 700 students enrolled, of which only 5% are male students. The college offers onsite dormitory living to female students. To date, over 8,571 Registered Nurses, 976 Nurse Specialists and 1,687 Practical Nurses have graduated from TRCN.

Disaster education

There is no official disaster nursing course in Thailand's educational system (and certainly not in Australia's educational system either, well, at least not that I know of!). TRCN's current curriculum incorporates 3 credits of disaster nursing (2 credits of theory and 1 credit of practical demonstration) and integrated content of emergency/community health nursing in the third year of study. Supportive teaching materials include magnetic models of disaster situations and interactive computer games for triage care during earthquakes, floods and fires.

Costs

• The BNS tuition fee for full-time study is approximately 20,000 baht per semester
• Approximately $8,422 AUD for the entire degree
• Accommodation costs 20,000 baht per semester
• Approximately $2,105 per year
• Scholarships, awards and financial assistance from the college and the government are available to eligible students

I was quite impressed by the all the work the TRCS does in response to humanitarian crises and they appear to be well equipped. In operation is a Disaster Health Training Centre where child protection is its first priority and creates safe places for children separated from their parents or orphaned. The centre trains people to be capable and resourceful volunteers, and these volunteers are looked after during and after their volunteer work through activities such as yoga and meditation to alleviate stress. The TRCS are also very focused on improving disaster care education and are currently working on improving the nursing syllabus and textbook. I hope that one day I am able to return to Thailand and participate in volunteer work; perhaps with the TRCS or another organisation that helps people in crises in rural and remote areas!