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Providing Post Anesthesia Care Education in India

As promised, I am following up on my latest trip to India. In January reports of a new flu virus in China was starting to surface, and on January 30th the World Health Association (WHO) declared the virus a public health emergency of international concern. Safety in travel is always a priority, but at this point China was the only country affected. My planning continued.

The India Operation Smile foundation is experienced in organizing missions and has several excellent cleft centers. This mission was in Durgapur, a large city about 100 miles from Kolkata. Durgapur established a cleft center about 2 years ago. It is part of a large university teaching hospital with medical and nursing schools. The cleft nurse training is in cooperation with the nursing college and took place prior to the arrival of the international medical team. The goal of the pre-mission education was to expose local nurses to the Operation Smile Global Standards and Policies and provide training to meet those standards. The full day of lectures took place in one of the hospital auditoriums.

Of the 30 who attended 10 were student nurses who would be helping during the mission, 3 were OR nurses, 2 were post anesthesia nurse trainees and the rest were pre/post-operative ward nurses. Lectures were presented by a retired US nursing professor, an India trained OR nurse now working as a quality manager in the US, and myself, a post anesthesia nurse. Topics included Operation Smile Standards and policy review, Cleft Nursing 101, Emergencies, Infection Control, Quality, and the 3 areas: OR, Post Anesthesia, and Pre/Post-Operative Ward. Hands on items such as vital sign monitor, cardiac defibrillator, emergency box and surgical instrument tray were displayed. Written evaluations and post lecture questions let us know the day was well received. The international team arrived while lectures were going on.

Screening of 300 patients took place the next day. The Durgapur Center had previously advertised the mission thought media and posters. Many patients were pre-registered, meaning that demographic information was already obtained, all others had this done as they arrived. In addition to the medical record station, the other stations were set up in the large room that would be the ward once surgery began. After the medical record were created the stations appeared in this order: medical imaging, vital signs, weight and height, surgeon, anesthesia,

pediatrician, dental, speech therapy, and laboratory. It took an average of 45 minutes from start to finish for each patient to complete the screening process. The patients were then directed to the final station for a chart review, confirm understanding, and had questions answered. Instructions were provided about when to report to find out if they were on the operating schedule, what day and time to be in the pre-op ward, or did they come back to the center on a later date after the mission.

The regular mode of this center is to operate a single OR table about 15 days a month, the mission served to complete a backlog of many patients during a short period of time. This mission completed 148 surgeries in five and a half days. Only about 70-80 patients can be done in a normal month at the center. The mission experience also brought expertise from many different countries and skill sets.

The mission team represented medical professionals from 15 countries, all were Operation Smile credentialed which meant they had achieved experience and a skill set required under the Operation Smile Standards. The trainees were scheduled to work with experienced staff and my trainees included 2 nurses with very different backgrounds. Dibendu was a new nurse with no clinical experience who was recently hired by the Durgapur Center to do multiple tasks. He had been working with the extensive equipment needed by a center or mission. Tinku was a mature community health nurse working on her master’s degree with a focus on developing feeding techniques and skills for the cleft child. Both were highly motivated and wonderful to work with. They quickly mastered the post anesthesia care unit (PACU) flow sheet. I always needed to check it over and sign it. They were very helpful in watching a sleeping child at busy times when we had more critical patients arriving from the OR, and during the slow times we talked about critical thinking skills, fluid balance, pain control, when it’s okay to bring the parent to the bedside, and when it’s appropriate to send the patient to the post-operative ward.

It was an enjoyable week and the PACU team bonded well. The PACU physician is an anesthesiologist/pediatric intensive care specialist from Holland, the other two PACU nurses were from Denmark and Ghana. We had 3 local Indian translators/transporters who worked closely with us.

The week seemed to end quickly, and the reality of the emerging virus hit us as we thought about departing from the mission site. I learned that about the time I was traveling to India the WHO named the corona virus COVID-19. The other educator and I flew to the far northeast state of Assam to visit friends from a previous cleft center that we helped develop a few years ago. On March 6 I flew to New Delhi to catch my international flight to home. I was now starting to sense a bit of fear in people. India announced that they were bringing home a couple of people from China who had COVID-19. When I arrived at New Delhi airport I saw many, masked travelers, and most workers wore masks. It seemed like they were being super careful as they asked me to open my carryon bag to look at a spoon!

I flew Italia from New Delhi to Rome with a very short stop-over (50 min). Stopping in Rome did not concern me because the news reports were of virus in the northern part of Italy – not Rome. However, I was surprised to see the airport was a ghost town. I saw only our flight as I moved to the train to take me to the waiting plane. Then at the new section it was dark, closed except for my gate loading. There was a written paper I had to complete about where I had been, where I was going and was I ill. This was followed by a temperature and once over by a health professional. The plane had so few passengers. It was starting to seem very strange. Once home in Arizona I was marked as contaminated because I traveled through Rome. I was not allowed to visit my clients in any facilities. As I write this I am still confined pretty much to home as we see how this pandemic plays out. I am rewarded knowing the India education goal was accomplished and well received.

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