All posts by Ashley Skinner

Shortage in nurses, lack in respiratory therapy specialty

By Ashley Skinner

In Guyana, specialties in almost every other area of the medical field can be found in the hospitals, except respiratory therapy.

The lack in the specialty stems from two major areas: a nursing shortage and the absence of the curriculum at the university level, according to Sheik Amir, the director of medical and professional services at Georgetown Public Hospital Complex.

During a training day at Georgetown Public Hospital, Sharon Armstead speaks to a group of nursing assistant students about the importance of respiratory care.

“Getting respiratory care to Guyana rests on the arms of the Ministry of Public Health,” Amir said. “It has to start at the university level.”

The University of Guyana is responsible for introducing students to the curriculum specialties. Once the students go to nursing school, they are taught basic respiratory care techniques.

However, the experience the students receive in the hospitals is mostly the traditional duties of a nurse like taking blood, checking temperatures, cleaning up the patients and all about the body, according to nurse Natasha Cameron at the Linden Hospital Complex.

“Since we don’t have the specialty, we do check the ventilators and listen to the patient’s lungs,” Cameron said. “But we weren’t really taught to do much else. In school, I learned the respiratory tract and what causes lung diseases, but the rest I am still learning as we get new patients who need different treatments.”

Through a series of collaborations with universities around the world, the most prominent including the U.S., Canada and China, the country has been introduced to and adapted many specialties like neurology, radiology and mental health.

Yet, while a Canadian university is collaborating with some hospitals in the country, few have specific respiratory care units. Linden Hospital Complex is an exception.

“We recently got a spirometry unit to help diagnose asthma,” Gerald Thompson said, general practitioner and spirometry unit assistant. “We really need respiratory therapy in the country though, especially this mining town because bauxite produces a lot of contaminating things.”

Bauxite is a sedimentary rock that is used in making aluminum, as it has iron oxide in it. While the rock itself is not toxic the red mud that is created when the bauxite is being mined for is very harmful. The dust that is made from the dried red mud can cause chronic illnesses and asthma, a driving force in Linden.

After a press conference at Georgetown Public Hospital, Sharon Armstead exchanges contact information with Emanuel Cummings, the Dean of Health Science at the University of Guyana.

“Respiratory therapy is a specialty for a reason: because putting our job on nurses in its totality is overwhelming,” Sharon Armstead said, respiratory therapist and Professor at Texas State University. “You have to know causes for the illnesses in your area and everything there is to know about them and the machines that go with them. If a human cannot function without lungs, why would you let a hospital function without respiratory therapist?”

Armstead also said the country needs to look into curriculum for the specialty and installing spirometry units in all of the hospitals.

However, the nurse retention problem must be solved before the curriculum can be instated to the university.

“We don’t have shortage in people who want to be a nurse,” Amir said. “We have a shortage of nurses coming back to the country once they’ve left for training.”

Once nurses become certified, some are given the opportunity to do their training abroad. Many of the nurses do not come back to the developing country once they have been in a more developed one.

“It’s not unusual that they never come back,” Amir said. “The top neurosurgeons in Jamaica are Guyanese. There is not just a need for specialist in this country, there is a need for employees since some leave and never come back.”

Many of the doctors in the country are from other places around the world. Between Georgetown and Linden, 10 doctors are from China alone. Other major specialists include doctors and nurses from Cuba, Brazil, the U.S., Canada and Japan.

Elizabeth Gonsalves, deputy CEO of the Georgetown hospital, said she is aware there is room for improvement in the curriculum, nurse retention rate and the hospital overall.

“I want our hospital to be first-world-like,” Gonsalves said. “We are doing pretty good with what we have but I know we can do better once we get these issues solved. We definitely need to improve the education of our nurses because they don’t get all the attention they deserve.”

Cleopatra Barkoye, principal of the Georgetown School of Nursing, said in press release on the University of Guyana’s website that the system has failed the nurses who are in training. This statement is in regards to the 2016 Professional Nurses State Final Examinations, where the school has a 90 percent fail rate.

“We don’t have enough lecturers in the classroom, in none of the schools,” Barkoye said. “We don’t have enough materials. The curriculum specifies that you must have a clinical instructor, we don’t have any clinical instructors in Georgetown and New Amsterdam, what we have are clinical supervisors.”

The professional system requires one tutor for every 20 nursing students. In the Georgetown School of Nursing alone, there are 343 students, but only seven tutors.

“Due to the shortage of tutors across the three nursing schools – the Georgetown School of Nursing, the Charles Roza School of Nursing in Linden and the New Amsterdam School of Nursing – there is no room for specialization.”


Photos by Ashley Skinner/Global News Team


The adventures of storytelling in a different country

By Ashley Skinner

I was the editor-in-chief of my high school newspaper.

I wrote for my local, hometown paper for three years.

I won State in the news competition my senior year in high school.

I was a reporter and news editor of the Texas State newspaper, the University Star.

Through all that, the hardest thing I’ve had to do regarding journalism was travel to a different country and gather information to write stories weeks later.

At McKenzie High School in Linden, Guyana, we were able to talk with students of all ages. One student, Sharisee, asked me about my field of journalism, and told me she wanted to go into broadcast journalism. Talking with these kids made me realize how they make good out of unideal situations.

Journalists love new experiences and a change of scenery. Going to Guyana, I knew I would get a change of scenery, a new perspective on life and a new experience with storytelling.

However, weeks later, I did not know I would long to tell more of the Guyanese peoples’ stories.

While our team was in Guyana for 11 days, we spent our time listening. We didn’t go through the hospital each day looking for sources; we went through the hospital listening deeply to the community members of Georgetown and Linden, looking for a niche where we could fit to best tell their stories to our communities back in the states.

As we were leaving the high school, I saw a group of kids practicing basketball. Their coach was helping them learn how to work as a team and shoot the ball. I could help but reminisce on my days of playing basketball, wanting to go out there and teach these kids as much as I could.

The hardest part was listening to their voices, so full of passion and pride for their country, and being the person designated to transfer that same passion into a story for others to read.

Like I said, I’ve done this before in my high school community and in the Texas State/San Marcos community. But this, this was so different.

I was dealing with a completely different country that doesn’t really matter to people in the United States, honestly. People here are interested in what we as a team did, not necessarily the content in our stories.

Listening to the people of Guyana broke my heart in some ways. They have gone through so much, but they are strong. They endure life in such a different way than we do and have so many stories to tell about it.

All they needed was a bunch of kids from Texas to listen to them for a few days. In that time we managed to do everything a journalist should do:

We told people’s stories in a way that others can relate.

We showed people how others live; we made them see how good their lives are here in the U.S.

We gave people a reason to take action on things they feel passionate about.

We informed people.

We helped people.

We inspired people.

We are journalists.

Curious, caring, compassionate: three characteristics of an aspiring respiratory therapy student

By Ashley Skinner

Death: a fact of life Texas State University senior respiratory therapy student Jacki Brewer is becoming familiar with as she takes on her career goals of becoming a respiratory therapist.

Brewer calculates the right dosage of medicine to give to a young patient in the emergency room at Georgetown Public Hospital. Too much medicine can cause complications, such as more difficulty breathing.                                                           Photo by Ashley Skinner/Global News Team.

“Of course I get scared and worried when things start to go wrong,” Brewer said. “You’re always going to worry about your patient, but the best way to put those bad thoughts aside is focusing on how to make the patient stable. You can’t worry about your feelings or yourself.”

When a patient’s family decides to take him or her off life support, a respiratory therapist is the one who disconnects the patient from the machines. For Brewer, this comes at a cost.

“Personally I step aside and get some fresh air,” Brewer said. “I’ll go pray and take a few deep breaths to clear my head. You can’t let it affect the rest of your day or you because you have other patients too. Your patients are your priorities; you can deal with yourself later.”

Brewer came to Texas State in 2014 from Carrollton, Texas. She chose Texas State because of the location between San Antonio and Austin, and because she felt like she immediately fit in on the campus.

Upon entering college, she did not know exactly what she wanted to do. However, once she realized there was a respiratory therapy program, her search for a major was over.

“In high school I was a home health aide and I took care of this really sweet, elderly lady,” Brewer said. “That experience paired with my asthma history is why I wanted to get into the field. I did my research once I heard about the profession at Texas State and I decided I wanted to be a part of that profession.”

Sharon Armstead, clinical assistant professor for respiratory therapy at Texas State, said Brewer is meant to be a respiratory therapist.

“She’s not scared to ask questions,” Armstead said. “She’s curious and shows initiative, and she isn’t afraid to take control of tough situations. That’s what a respiratory therapist needs to be.”

In January, Brewer went on a study abroad trip with Armstead to Guyana, South America, where she worked on patients with breathing issues in Georgetown Public

Brewer works alongside a doctor at Georgetown Public Hospital, attempting to stabilize a patient in the CICU.
Photo by Ashley Skinner/Global News Team

Hospital . Within 10 minutes of Brewer entering the cardiac intensive care unit (CICU), a patient began to show signs of being hypoxic: a condition in which the parts or regions of the body are deprived of adequate oxygen supply.

“I was really scared, this being my first time in their hospital with their equipment that I wasn’t familiar with,” Brewer said. “Once I got into it, I wasn’t scared and I think I handled it well. We got his stats back up and that’s all that matters.”

Armstead said at first she was worried about having Brewer in the CICU alone, but was impressed with how well she handled the patient with such urgency and care.

“She noticed the settings on the ventilator and that the patient was hypoxic immediately,” Armstead. “She bagged the patient. She suggested what changes should be made. She took control and she cares. That’s what I like about Jacki.”

Stephanie Kelley, senior respiratory therapy student at Texas State, went on the trip to Guyana and worked closely with Brewer while they were in the hospitals. Kelley also noticed how caring Brewer is with her patients.

“I don’t think anyone else is as observant as Jacki,” said Kelley. “She cares about her patients and people in general, and that’s one of her best characteristics.”

Listening to a person’s breathing before a treatment versus after, Brewer said, is a very rewarding feeling, as is being able to take a healthy person off of a ventilator.

“Their lungs go from sounding wet and crackly to sounding dry and clear and that’s proof of the work you’re doing,” Brewer said. “When someone is on a vent and is able to extubated, you get to take that tube out of their throat.  The first thing they say is ‘oh my goodness that feels so much better, thank you’ and hearing those words is the most rewarding part of my job.”

Above is a video of Brewer helping a doctor draw blood from a patient to test the level of gases in his blood.

This video is of Brewer aiding a nurse during a hospital-wide oxygen shut down. 

Videos by Ashley Skinner/Global News Team. 

Georgetown Public Hospital receives knowledge, training about respiratory care

By Ashley Skinner

A group of Texas State University respiratory therapy students traveled to Guyana over the winter break to assist nurses and provide training to the developing nation.

Sheik Amir, director of medical and professional services at Georgetown Public Hospital Corporation, said there is a need for the specialty in Guyana.

“Respiratory care is a program we are trying to train our nurses to do more and more,” Amir said. “It has its advantages as a specialty, as it relieves nurses from doing all of the duties. A dedicated person doing something is always better than someone doing something they have to do only when they have a bit of time.”

Located in the northeastern tip of South America, Guyana is home to 10 hospitals in the private and public sectors. Respiratory diseases in the country are not regularly documented, due to the insufficient equipment to diagnose the problems, said Sharon Armstead, a respiratory therapist and Texas State University clinical assistant professor who led the study abroad program to Guyana.

“If you look at the diagnostic numbers, they’ll be low,” Armstead said.

According to the numbers that are reported, Guyana ranks second highest in asthma mortality rates. Graphic by Ashley Skinner/Global News Team

“This is because you can’t report a disease if you don’t have the tools to diagnose it.” 

While the diseases are not frequently detected, they do not go unnoticed.

“I hope the hospital staff will learn more developed procedures from the [respiratory care] team,” said Elizabeth Gonsalves, deputy CEO of Georgetown Public Hospital. “We are happy to have Texas State here to help us deal with the respiratory problems of Guyana.”

The Ministry of Public Health oversees the delivery of health care services throughout Guyana, as well as distributes funds to hospitals from the financial resources allocated to the Ministry.

“I take great pride in my country,” said the Honorable Volda Lawrence, the minister of public health. “The ministry is doing everything it can to make Guyana a First World country health system.”

Amir said a lack of funding plays a big part in the country not having respiratory therapy as a specialty in the country.

“There won’t be any funding until we have a person here telling us what we need for the specialty,” Amir said. “If you don’t think of something, you won’t be budgeting for it. Now that it’s being put out there and talked about, people will start looking at how to grow the profession.”

With funding allocated to the hospital for equipment, more places than just the emergency room will be able to tend to respiratory problems.

“Getting respiratory therapy brought to Guyana is definitely something we want and need to look into,” Gonsalves said. “Respiratory care as a specialty will help our hospital be able to have more diagnosis stations than just the ER, as that is where most of the diagnoses’ happen.”

Additionally, Gonsalves said there are plans to discuss growing this profession at the board level in due time, as respiratory diseases are becoming a bigger problem.

Originally from Guyana, Armstead remembers her asthma acting up as a child in the country due to the mining for bauxite in the town of Linden.

“Coming back here my asthma still gets bad when I go to Linden,” Armstead said. “When we come to this city, my chest gets a little tighter and it’s harder to breathe.”

Armstead travels to Guyana at least once a year on mission trips through Bridges Global Medical Missions. This organization is also the one that led the study abroad trip, headed by the Atlanta-based nonprofit’s vice president and medical director, Claudette Heyliger-Thomas.

“We wanted to bring Texas State and respiratory therapy to this country in hopes to push patient care to where it needs to be,” Heyliger-Thomas said.

In the Georgetown Public intensive care unit, students Xiomara Ojeda, Jacki Brewer and Stephanie Kelly listen as Armstead tells them their duties for the day. Photo by Skyler Jennings/Global News Team

“I’m glad they have gotten to experience what the medial world is like in a developing country.”

The CHEST foundation, an organization dedicated to championing lung health by supporting clinical research, patient education and community service, awarded Armstead a $11,530 grant to fund the donation of respiratory medical equipment to the Georgetown and Linden hospitals.

“We plan to donate as much equipment as we can because we want Guyana to see the importance of respiratory care,” Armstead said. “When I look around, I see nurses, not respiratory therapists. You can’t have a hospital without this profession and I believe we can bring it to Guyana.”

Why I chose to go to a developing country and loved it

We flew into the country around 10 p.m. on Jan. 2. My heart was racing. The flight crew announced we would be getting off of the plane from the back. I thought, “I never realized they could hook one of those hallway things up to the end.”

I could not have been more wrong.

On our journey back to the states, we boarded the plane from the tail-end just as we descended it at the beginning of our adventure to Guyana.

We walked down the airplane stairs right onto the tarmac. Everyone had their phones out preparing to snapchat the unfamiliar circumstance when most of us realized we did not have phone service. Through my phone camera lens, I saw a tattered building under construction, a structure resembling a home and a few planes stored off to the side.

We approached the home-like building only to figure out it was baggage claim and customs. What kind of airport was this?

Going into this, I knew it would be a different experience. I knew we would not have phone service unless we paid for an international plan. I knew Wi-Fi access would be limited. I knew it was a developing country. I knew people would be poor. I knew I would see things that in the states would be considered dreadful and horrific.

Yet, somehow, these people were (mostly) content with their lives.

Being from the United States, I wanted to experience a culture outside the privileged one I live here. Not only did I accomplish this, but I also began to realize the image we think of when we imagine developing countries is skewed to fit our mindset.

Most people who have not been to a developing country and are from the U.S. might think of the commercials we see on TV of starving kids in huts who have no clothes. While that perception of developing countries is not wrong, as many developing countries have these aspects, it is not all they have.

A wide variety of cultural booths can be found outside of Stabroek Market in Georgetown, Guyana.

They have a community who deeply cares for one another; a community who makes use of the resources available to live the best possible life. While diversity is a huge aspect of Guyana, people there identify as Guyanese, despite their African, Amerindian, British, Chinese, Dutch, Indian or Portuguese roots. Guyana has a society that takes pride in their country, even if, by some American standards, it isn’t a place to which many people would willingly move.

Tell any Guyanese on the street where you are from, and the first thing they will greet you with is, “Welcome to the greatest place on Earth.”

To the people of Guyana, life isn’t prioritized around technology and connecting through a screen.

Life in Guyana is about living in the moment, as you are, where you are and as best as you can.

And that is an amazing perspective I will carry with me forever.