As a second-year College of New Caledonia nursing student working in a third-world hospital, Rebecca Ellement's healing instincts were triggered into alarm mode.
She knew her maternity patient, who spoke no English, deserved better treatment as the doctor prepared to insert an arterial line into her arm without first cleaning her skin with a swab of alcohol.
"I felt really uncomfortable with what was going on and the doctor didn't want to listen to what I had to say," said Ellement, recalling her May 2016 practicum experience in Bangalore, India.
"It's good to go with your gut but it can be uncomfortable when you're in a lower position. But I just went for it, I had to do this for my patient's sake. My patient was afraid and I kind of called the doctor out on that. They called their supervisor in and kind of felt offended that I said something. I stayed as long as I could and ended up being asked to leave. But now I'm not afraid to talk to doctors or nurses in a higher power here and I think that's fostered growth in my own practice."
Ellement was part of the first cohort of second-year CNC nursing students to earn their stripes working for five weeks at the Mazundar Shaw Medical Center in Bangalore, a city of 10 million in southern India. The 3,000-bed private acute care hospital specializes in surgery and includes a cardiac centre with the world's largest pediatric intensive care unit. it offers neurology, spinal surgery and organ transplants, which gave the students exposure to types of medicine they don't see in Northern Health Authority hospitals.
"We came back changed people, it was a learning experience for all of us," said CNC nursing instructor Crystal Lawrence, a featured speaker Sunday morning at the Healthier You Expo at CNC. "When you take people out of their comfort zone it makes a huge impact on their learning. The staff there (in India) also learned from us."
In the first year of the India practicum the CNC students were shocked to see medical staff in the hospital wearing opened-toed flip-lops, in contrast to their own WorkSafeBC-approved shoes with no-slip soles. It wasn't like that on the return trip last May. None of the hospital nurses were wearing flip-flops.
Patients in that hospital are required to pay upon arrival and are responsible for whatever materials or supplies medical staff use while treating them. The user-pay system made the student nurses aware of the need to avoid waste, something they've never had to worry about in Canada.
"That gave us as students and nurses more anxiety about what we should have to think about," said Mary Kate Dalla Lana. "They literally had to pay for every pump of hand sanitizer, every napkin, so it was hard to gauge your practice and adjust it to make sure they're getting the best care, but you're also using their resources the best way possible."
Signs of poverty were never far out of sight and piles of garbage were common on city streets. The Canadian students were prepared for that, but it was still overwhelming to them at times. Unlike their experiences in Canadian hospitals, where staff try to explain procedures and talk with the students to try to teach them on the job, that type of workplace environment for nurses was rarely on display.
"It's such a culture shock, so it took a week or even longer just to get used to everything," said Courtney Hatley.
"In their culture there is a hierarchy in regards to gender and that was bit hard as well but we seemed to establish and fairly good rapport with their physicians, whether it was just that we were able to provide rationale and show our education, which they understood when we voiced that. I think it's hard for their nurses to voice their opinions on stuff like that."
Language barriers made it difficult at times for the Canadian students to communicate with patients and medical staff but the used sign language or just pointed to get around those difficulties. Sometimes they had to become advocates for the patients unable to communicate their concerns to medical staff.
"If something unsafe is happening to a patient it is so important to report those unsafe things," said Danielle Bott. "I had one patient whose blood pressure was 270 over 180, something crazy. I'd never seen that before and the nurses were doing nothing and I was getting anxious and all of sudden his eyes rolled back and I yelled, 'I need a doctor now.' It's just so different from here.
"There, they have their doctors up high compared to the nurses, and they do not talk to each other. Communication is huge in a hospital setting. There was days when it was very frustrating and you wanted to leave but there were days when it was amazing how much we learned. I'm so happy I went because I learned how to advocate for my patient. It's amazing how much more confident I feel now."
The students were housed at Casa Piccota Cottage, about an hour-long bus ride away from the hospital, where they were immersed in Indian culture living with a Bangalore family which gave them a home-stay type of experience.
"We always felt safe," said Lawrence. "The people at Casa Cottage always looked out for us."
In Indian hospitals, medical staff wear different coloured scrubs which identified if they were nurses, physiotherapists, dietitians or janitors. In India it was one nurse for every two patients. In Canada it's more like one for every eight patients.
The students took 11 suitcases stuffed with donated books, toys, flip-flops, school supplies, sanitary napkins and toothbrushes to give to underprivileged people. Away from their hospital duties, they visited an orphanage connected to the Dream India Network and spent time playing and teaching hygiene to young girls who had lost their parents to HIV infections. The kids lit with delight when the nurses arrived.
"It was heartbreaking at times but they were so receptive to what we were teaching, they just loved that someone was there to be with them," said Ellement.
Lawrence and CNC nursing instructor Anita Muchalla Yeulet are making plans to send a third cohort of students to India next May.