Nursing in El Salvador

So far I've been pretty impressed with the organization within the nursing department of the Ministry of Health of El Salvador and within the community health centers here.  Regarding the nursing department, everything is very regimented as they have guidelines for everything; for instance right now I am reading "Guías Clínicas de atención a la mujer en los periodos preconcepcional, embarazo, parto, puerperio, y al recién nacido" and "protocolos de atencíon de enfermería para el primer y segundo nivel de atención de salud" ("Clinical Guidelines of care for women in the preconception period, pregnancy, childbirth,postpartum and newborn care" and "nursing care protocol for the first and second levels of health care").  So far in my clinical practice, which has been in the vacine department to start, all the nurses I work with seem to follow these guidelines to a "T", which  means I've been getting a lot of feedback as there are some differences between how they do things here and how we do them in the states, for instance the site of injection.  I am slowly learning the Salvadoran way of doing things.

During my first week in the clinic, I have also been overwhelmed by the amount of paperwork that is completed by each medical professional; absolutely everything is documented and in about five different places.  Everything is also very regimented, for instance the kids can't get their vaccines before receiving their well child check, so every child that comes in to get a vaccine also ends up getting a medical check up; which is very important in a country where many kids are underweight or infected with parasites.

Along with the guidelines for everything, the nursing department has a committee for everything; making sure that there is continuous evidence based research being completed throughout the clinics, community health centers, and hospitals in El Salvador.

In general the nursing department at the Ministry of Health has taken me under their wing and set up an amazing orientation for me and all in the name of cross cultural exchange as they are not being paid for any of the help that they are giving me.  To give a quick overview of my orientation, the first week I had the pleasure of reviewing the various guidelines and meeting with various committee members to hear about the research they are completing.  Two weeks ago I started in "La Unidad de Salud Barrios", a community health center, where I will be rotating between immunizations, child and women's health, adolescent health, family planning, TB & HIV programs, and various other programs.  Starting at the beginning of December, I will start rotating between different ECOS teams, ending with the family health ECOS team that is working in El Pital, which is where I will be based permanently when I finish my orientation.  I have to say, I have been highly impressed with how organized my orientation has been.

Now just to say a bit about a different system that is not so organized, immigration.  Unfortunately, instead of spending the beginning of last week participating in the health care of women and children, I spent the first three days of the week in the department for foreigners in immigration presenting my paperwork for my temporary residency.  So, basically the way it works is that there is a list of required documents that you need in order to apply for residency, which in reviewing this list last Monday, I supposedly had everything I needed but it seems that new requirements are made every day depending on who is processing your paperwork.  So, basically you wait for 3-4 hours just to be seen and then you are told that you need something else and then you go back the next day and the same things happens; can you tell I'm a little bitter (oh well, I guess that's just they way it is and I'm working on becoming more patient daily).  Well that's enough of me complaining; coming soon I will post about my amazing weekend in El Pital this past weekend for the celebrations of the patron saint San Francisco de Asis.