During our last few days at St. Gabriels, Yiwen and I got to go visit two HIV support groups with Angela, who leads all the groups. The groups are designed for both HIV+ patients in the community along with the village AIDS committees which are leaders from the village. The group also has an adherence monitor and a community health worker as well. These groups will be particularly important for Jasper and Tiffany’s microenterprise training project so read their blogs for a more detailed info. Yiwen and I mostly just wanted a chance to learn about them since it seems like a really creative approach to helping people deal holistically with their illness.
Yiwen and I also got to work in the maternity ward to demonstrate the adult Veinlite and the pulse oximeter. The maternity ward is where the mothers go with their children just after giving birth to wait to be discharged. Usually after the births, the child is placed on a warmer, of which there is only one, for a bit (or another child is born) until both mother and child move to the maternity wing (from the labour ward).
There is so much light in the maternity wing that is quite difficult to use the transilluminator with the light shield over the top. The light shield improves visibility by blocking out ambient light, but it limits access to the vein for veinipuncture so it is a bit of a trade off. The Veinlite works by epillumination, shining light on the surface of the skin. However, transillumination is shining the light through the skin from the other side of the veinipuncture site (ie light on the palm, through the hand so that you can cannulate on the back of palm). Transilluminator refers generally to the device, regardless of which mode it uses. I really think transillumination would be more useful since it doesn’t obstruct the venipuncture site and, if your are working with the hand as is typical, you can get the patient to hold the device for you, which frees your hand for starting the stick and stretches the patients skin, making the stick easier. Although you are sometimes limited by the thickness of the site where transillumination will work.
The pulse ox we didn’t really get to test out, but just demonstrated to the nurses. They take pulse rate as part of the vital signs of the mothers every day, so this would help with this, but now they can test the pulse rate and oxygen saturation of both the mothers and children. However, it isn’t really clear id this extra information will be useful since none of the mothers are children ever seem to be put on oxygen. Apparently there is a bit of a stigma against having a nasal oxygen tube being put on the children since it is mostly used on children who are really suffering and frequently die. Consequently, providing oxygen is associated with death by the mothers and some are resistant to its use. The lesson here, it seems, is to start a new technology on children who seem likely to do well, so that both nurses and parents are more amenable to its use, rather than putting everyone off it from the start by using it on desperate cases. Also, that you never really know what sort of cultural barriers there are to a technologies adoption without first-hand experience. No matter how well your device works, you might be foiled if the device is never used due to cultural perceptions.