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Introduction - Joanna Po lecture series | Advancing Radiology and Nursing through Global Health Outreach
Introduction - Joanna Po lecture series | Advancing Radiology and Nursing through Global Health Outreach
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What is Rad Aid | Advancing Radiology and Nursing through Global Health Outreach
What is Rad Aid | Advancing Radiology and Nursing through Global Health Outreach
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How to implement the Rad Aid model | Advancing Radiology and Nursing through Global Health Outreach
How to implement the Rad Aid model | Advancing Radiology and Nursing through Global Health Outreach
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How Does Rad Aid Translate to Front Line Nursing | Advancing Radiology and Nursing through Global Health Outreach
How Does Rad Aid Translate to Front Line Nursing | Advancing Radiology and Nursing through Global Health Outreach
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Profile of Georgetown Public Hospital- Guyana | Advancing Radiology and Nursing through Global Health Outreach
Profile of Georgetown Public Hospital- Guyana | Advancing Radiology and Nursing through Global Health Outreach
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Highlights of the GPH 2018 Education Visit | Advancing Radiology and Nursing through Global Health Outreach
Highlights of the GPH 2018 Education Visit | Advancing Radiology and Nursing through Global Health Outreach
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Education and aid for GPH | Advancing Radiology and Nursing through Global Health Outreach
Education and aid for GPH | Advancing Radiology and Nursing through Global Health Outreach
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The Future- An Ongoing Partnership with GPH | Advancing Radiology and Nursing through Global Health Outreach
The Future- An Ongoing Partnership with GPH | Advancing Radiology and Nursing through Global Health Outreach
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Rad Aid- IR Nursing in Tanzania | Advancing Radiology and Nursing through Global Health Outreach
Rad Aid- IR Nursing in Tanzania | Advancing Radiology and Nursing through Global Health Outreach
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Educating Role Clarity in Tanzania | Advancing Radiology and Nursing through Global Health Outreach
Educating Role Clarity in Tanzania | Advancing Radiology and Nursing through Global Health Outreach
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Closing Remarks from Joanna Po | Advancing Radiology and Nursing through Global Health Outreach
Closing Remarks from Joanna Po | Advancing Radiology and Nursing through Global Health Outreach
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Transcript

good morning it is such an honor and privilege to be here this morning with my fellow nurse colleagues Sarah Wilson and Carrie Ferber and to be given this incredible platform to speak as part of the formidable joanna poe lecture series it has been a wonderful meeting with

many of you who have stopped by the rad aid booth and have offered your support over the past couple of days this morning we will share with you the exciting collaboration between rad aid International and Erin and the work that

is being done to advance radiology and nursing through global health outreach I recall trying to explain to my elderly father who is 88 years old the work that I do in global health we went to dinner one night in his assisted living

facility and he introduced me to his friends who were all 90 plus years old and he explained to them that I was a nurses nurse I thought that was a pretty neat description and so I speak to you this morning about the global work that

rad Aid and Erin are doing I encourage you to consider becoming a nurses nurse and think about how you can help advance nursing education globally and pay it forward when I began working with red aid international just over three and a

half years ago it was quite evident that in this highly technical field of radiology Nursing needed to have a greater presence within red aids global programs navigating an increasingly challenging global health landscape

required our partners to think innovatively with an interdisciplinary team approach that put nursing at the forefront so that we could think more holistically about the actual patient beyond the image as Oprah Winfrey would

say what I know for sure is that Radner Singh could not do this global work alone it was clear we needed the expertise and knowledge of the greatest radiology nurses in the world simply put we needed the leadership

support of organizations like Aaron and you our nurse volunteers together we have grown stronger in expanding radiology nursing's global footprint so today I'll share with you the disparities of radiology and nursing and

global health rat AIDS mission and our nursing model for advancing nursing education and developing communities around the world the various roles nursing has within Rite Aid's global programs and future plans on the horizon

for 2019 radiology services are scarce

or non-existent for most of the world's population according to the World Health Organization more than half of the world's population lacks adequate to basic imaging technology such as x-ray

and ultrasound and on the basis of a recent global population census of approximately seven billion people this suggests a radiologic scarcity afflicting three to four billion individuals throughout the world and in

terms of nursing's role in the context of global health the World Health Organization states that nurses are the largest group of health care providers and we account for over 50% of the global shortage of healthcare workers we

have the greatest exposure to the world's population however it is estimated that by 2030 the shortage of nurses and midwives will be about nine million with the worst shortages in Africa and Southeast Asia

so the United Nations recognized that it is imperative that nurses skills and abilities are harnessed and maximized globally and in 2015 the United Nations set forth the 2030 agenda for sustainable

development where Nursing has direct impact on several development goals including advancing health through education and clinical care supporting health promotion and disease prevention programs and advancing gender equality

and women's health programs just to mention a few so what is rad aid and how are we addressing these global health disparities we are an international nonprofit organization celebrating our 10th anniversary and are affiliated with

the World Health Organization our mission is to develop and improve radiology services where people have little access to radiology and create sustainable education programs to improve the health and well-being of

people in impoverished countries red aid was founded in 2008 by dr. Dan Melora who is a radiologist currently practicing at NIH and red aid had its first meeting held in the basement of Johns Hopkins Hospital and now it has

grown to over 30 global programs in 55 hospitals around the world our volunteers have increasingly grown over a decade chapters at leading academic

institutions throughout the United States we have multiple affiliations with professional and international medical nonprofit and corporate organizations so within this growing organization what is rad aids Nursing

mission red aids nursing program seeks to promote the advancement of Nursing Practice throughout our global programs by increasing nursing capacity knowledge and clinical skills while advocating for the health and well-being of populations

in resource-limited settings we do this by building a foundation of collaborative partnerships between our u.s. nursing institutions and organizations and our global nursing partners that together support the five

pillars of our educational programs including clinical skills training advancing the use of technology public health education health policy development and research to measure outcomes and evaluate our programs these

educational strategies are then targeted to the particular needs of each country and extend out to patients community health centers hospitals and nursing schools so how do we implement this

model with every rod a program we begin

with a comprehensive rad aid readiness assessment survey that basically asked the question is a community ready for radiology last year an additional nursing assessment tool was created that creates that assesses the five pillars

including the policy clinical skills technology public health and research and follows the same circular readiness assessment model after assessing a community's needs we develop a specific plan then we implement that plan and

then we analyze what worked and what didn't and then we reassess how we can improve and then it starts all over again nurses who work in global low resource communities involving radiology have

roles that span the continuum of care from IR and CT patient care management as well as extending to areas involving primary and emergency care and triage breast cancer screening and women's health ultrasound and maternal fetal

care and finally public health initiatives that raise awareness and facilitate access to care and across all our global programs nursing education is critical to improving workflow organization

50 in the radiology setting and infection control so how does this all

translate onto the frontlines of global health this slide provides a snapshot of the countries where Radig Nursing is working to advance nursing education as

well as some new emerging nursing programs across all specialties spanning the globe from South America and the Caribbean to various countries in Africa and Asia for instance in May of 2018 our Columbia University read a chapter in

collaboration with the Columbia School of Nursing supported women's health and Haiti by providing education and training in breast health clinical breast examination and the primary and secondary prevention of breast cancer in

many low resource communities like Haiti breast cancer is one of the leading killers of women these are women with no knowledge of what a breast lump is what a mammogram is or how to access any level of care they present late-stage

with high mortalities future goals for nurses and nurse practitioners and radiology residents that we are training in Haiti and in other countries like Peru and Guyana we're ready nursing is active will

include providing advanced education in breast cancer screening mammography and ultrasound training in Washington DC were developing a new program and often times people inquire if Rite Aid has any programs in the United States so this

new domestic program is being launched in May of 2019 and will be in Washington DC where rad Aid has partnered with another nonprofit organization called breast care for Washington rad Aid has donated a state-of-the-art health mobile

that will provide mammography services to women in underserved communities in Washington DC Maryland and Virginia nursing will play a critical role in this program in terms of supporting the role of the nurse navigator as well as

providing public health education on the prevention and early detection of breast cancer in Grenada where nurse midwives deliver most of the babies and manage most maternal fetal healthcare Radig Nursing is working in collaboration with

Vanderbilt School of Nursing to develop a pilot program on the use of point of care ultrasound training for nurse midwives this emerging program will begin this June and will also focus on providing education and training on the

management of obstetric 'el emergencies interventional radiology is rapidly developing within rad AIDS programs in November of 2018 and Tanzania Erin made significant contributions through the donation of curriculum materials and

through our and board member Sara Wilson who helped launch this new I our program with rad Aid and Yale Sara will be sharing more details of that collaboration during this presentation new and emerging programs 4i are

beginning this year will be in Kenya and Vietnam with Ethiopia and Nigeria on the horizon I our nurse volunteers will play a critical role in all these programs to provide nursing education and training a moderate sedation as well as pre intra

and post procedural care some of our global programs in China Kenya and Tanzania are focused on radiation oncology and the clinical management of patients undergoing radiation therapy pictured here is a nurse at the bedside

in China where nursing education and training is centered on skin and mouth care pain control medication administration and management of psychosocial issues this was a really big deal

to have this nurse brought to the bedside with the medical team and so an important aspect of our role as nurse educators across all of our rad aid nursing programs is to be role models to empower nurses within our

global programs that they are critical members of the healthcare team in Guyana rad Aid recently developed the first radiology residency training program and brought in CT scanner technology into the country Erin contributions towards

this program again played a critical role in terms of curriculum development and advancing education in the clinical management of CT with contrast that carry furberg we'll be sharing with you in more detail next and in May we will

be incorporating 3d tomosynthesis mammography into this program as well on the horizon for this coming year we seek to increase our volunteer nurse base and funding sources strengthens sustainability in our existing programs

with continued nursing education initiatives and expand curriculum development through webinars distance learning and hands-on support central to all our goals is to continue to strengthen our partnership with Erin

leadership through collaboration with board members to support increasing our global outreach in terms of curriculum development and supporting our Erin nurse volunteers promotion of our partnership through social media outlets

through publications in the Journal of radiology Nursing Thank You Kathleen gross for all your support as well as webinars and conferences in sharing our vision to advance nursing and global health

Rettig Nursing is co-sponsor of the third annual International Nurses Day event at the United Nations in New York City we invite all of you to attend on Friday May 10th where will loot be honoring

nurses who have made significant contributions towards global health also the second edition of radiology and global health textbook has been released with nursing's interdisciplinary contribution addressed we also invite

you to write aids annual conference which is always held on the first Saturday of November this year November 2nd at the Pan American Health Organization in Washington DC so I'd like to express my sincere gratitude and

appreciation to Joanna Poe for her support to rad aid and in providing this incredible opportunity to highlight the amazing work that Erin and rad aide are doing together to support the advancement of radiology nursing and

global health I would like to thank the Erin board of directors that are in planning committee Bruce and Liz both are in the Buller management company and to my nurse colleagues Sarah Wilson and Carrie furberg and to all our past and

future nurse volunteers for their dedication and hard work to support nurses around the world and so now I'd

like to turn it over to Carrie furberg who will speak to you about her experiences as a clinical nurse

volunteer for rad aid and Erin for ready Guyana in which she participated in last September thank you very much good morning and thanks patty for that introduction that it does all over the world

I am incredibly honored to be up here with these two women this morning daddy'd on us now that better okay okay I think that's gonna work for me so like I said I'm not really honored to be up here with these

two ladies to my right and I'm also incredibly grateful to a Rin for sponsoring my working guy on the last year and for the trust you all have placed in me to represent our specialty in another country I'm going to be

talking a little bit about CT in Guyana and when Patti first asked me to do an outline of topics that should be addressed for this project I wouldn't really believe I would be standing here in front of you today talking about it

in September I traveled to Guyana with a group of nurse volunteers from rad aid to assist with education related to the care of CT patients the public hospital in the capital there had just acquired its first and only CT scanner it ratted

saw an opportunity to provide assistance to the nurses there as their practice expanded to include the new technology this project was initially created to provide training for a group of nursing students who were working toward a

Bachelor of Science in emergency nursing but it grew to include teaching of technologists radiology residents and to our delight and surprise for new radiology designated nurses in the hospital in Georgetown a friend of mine

who I work with refers to radiology nursing as kind of a secret society and so I'm very happy to report that we're expanding the the secret society of RAD nursing in to South America so first I'd like to provide a little

bit of background on the country of Guyana for those who might not know much about it it's known as the land of many waters and as you can see it's also a

incredibly beautiful place it's located on the northeast coast of South America

and it borders Venezuela Brazil and Suriname and the majority of the population speaks English and identifies with a Caribbean culture unfortunately Guyana also has an incredibly high poverty rate

and many of its people lack access to definitive care Patti mentioned the coming shortage of nurses nurses in the developing world in her talk and brain drain is a big problem in Guyana as well medical professionals emigrating to

other countries and leaving the home country kind of short of medical staff I spoke to the principal of the Georgetown School of Nursing while we were in Guyana and she told me that she prepares approximately eight transcripts per

month for application of nurses there to work in the US and the UK and so a lot of nurses do end up leaving that country

this is one of my favorite pictures I took on my trip of the Georgetown public hospital and I just like it because it's

so bright and and you can really see the Sun kind of shining off of everything the hospital is located in the capital city of Georgetown it's the only tertiary referral care center in the entire country which has a population of

article about Georgetown public hospital it was described as the last stop for care and that seems really accurate for most Guyanese most of whom find the cost

of private care prohibitive so this is really where everybody goes to get taken care of the hospital is operated by the Guyanese Ministry of Health and it has between 4 and 500 inpatient beds depending on who

I've talked to or or what report I'm reading its affiliated with both the National Medical School and the Georgetown School of Nursing and I should remember I should mention that the number of radiology patients on this

slide does not include ultrasound studies so that's a pretty big number you can see there on the the last bullet point the accident and emergency or A&E department prior to the arrival of the CT scanner used ultrasound to diagnose

internal injuries and that isn't even reflected in the number of radiology patients on this slide so some facts about the radiology department at gph prior to 2018 only x-ray fluoro and ultrasound were available for imaging

there before our trip last September there was one nurse working an ultrasound but no dedicated radiology nurses biopsies as far as I know are still only performed in the Oh are as as CRM use limited to the O R an MRI is

only available at outside facilities so to put this in perspective I just wanted to mention a case study from a 2017 article and academic radiology and it described a man who was severely injured in a car crash in Georgetown prior to

the CT capability at gph there was a long wait for x-rays and the AME physicians used an older model ultrasound to image this patient who had significant abdominal injuries to get the needed CT scan the patient had to be

transported to a private hospital and that as you might imagine caused a significant delay in treatment and greatly increase the overall cost of his care CT imaging is something that we really I think take for granted in the

United States but it's still very much a luxury in many parts of the world if it's even avail at all so here's a picture of the new scanner down in Georgetown it is a Phillips ingenuity 64-slice

scanner does anyone here looking at this picture see anything missing anything conspicuously absent I'm looking at my CT Tech's correct no contrast injector when we arrived in September the contrast injector had not yet arrived at

the hospital and so a lot of our training about contrast use was kind of hypothetical during that time they do have the contrast injector now it's up and running but it didn't arrive until November of 2018

this machine is currently only used for Diagnostics since there's only one machine in the hospital as you can imagine since you know they have a lot of trauma cases coming in they can't really tie up the machine with biopsies

or other procedures so it's difficult to imagine it being used to for procedures until the hospital has another scanner

I'm not gonna read these to you you can see what our main goals for this trip was it was mostly about education but we

did a little bit of other work as well and I hope I don't sound like a commercial but I just want to say we achieved all of the things on this list and more while we were in Ghana for that week and a rin donated a small library

of reference materials and also an a Rin membership for the new radiology nurses at G pH and they are very excited about that so thanks now they have their own reference library and they have a lot of

about journals and they know that they have the support of all of us this is just a little more about some of the things we did down there I was lucky to travel with Patti and two other nurses from Long Island Jewish Hospital in New

York and they're pictured here along with some of the administration staff at G pH we also got a lot of internal support from the staff there they fed us they provided transport to and from the hospital and were just overall great

made everything really easy we did three days of kind of intensive eight-hour workshop sessions covered seven topics and all and then we had a day of hands-on skills training toward the end of the week we also created a prep and

recovery room for the CT staff there to manage patients before and after scans and for emergencies and we established the library with the AR ein materials that I just mentioned and of course we made lots of friends in the process

these were the topics that we covered the biggest challenge for me when planning this curriculum was figuring out what the nurses and other radiology staff would really need to know about caring for CT patients it was difficult

to narrow down topics and we really had to to prioritize and get back to basics like I mentioned they aren't really doing procedures on this machine so we talked mostly about safety contrasts when and what to do when you get the

contrast injector and you start giving contrast to the patient's possible complications and emergencies that might arise and CT IV access that was a big issue the new radiology nurses were coming from med-surg units infectious

disease units within the hospital and a lot of them didn't have much experience starting IVs we did talk a little bit about central venous access devices and those that can be used for injecting contrast but they really don't see a lot

of those central lines there so that was also just kind of hypothetical just to let them know that you know that might be coming in the future and then for down the road we also talked about informed consent and procedural sedation

for hopefully when they get that going in their department each participant received a certificate and a reference booklet containing a summary of topics with key points and some treatment algorithms as well as examples of

radiology nursing documentation from other institutions we spoke a lot about you know how it was done at our home hospitals things that were important to document and assess and then this just served as kind of a reference for all

the topics that we talked about there I am talking with my hands a lot workshop classes were attended by a mix of radiology residents nurses and and rad techs on two of the three days that we taught the class was held in the

hospital proper and then we also spoke to the group of emergency nurse trainees that I mentioned earlier and I'll talk a little bit about that right now it's a Bachelors of Science program that's a collaboration between

Vanderbilt you versity in georgetown public hospital this is a flyer for the program that I saw hanging up in the hospital while I was there and it was really wonderful to work with this crew because Jessica

VanMeter who is the director of this Bachelor of Science program they're loaned us a lot of our supplies for the scenario training and in Patti talking with her and making plans for our new radiology nurses they are actually going

to get to do a lot of training alongside these emergency nurse trainees and so that's very helpful one of the biggest things was that we arranged training for BLS and ACLs for the radiology nurses and so they have been working on ACLs

training this month and and we'll be in April as well

here on the left you can see Jessica Van Meter with sue podracing one of our nurse volunteers who traveled with us and on the right is another

nurse volunteer Evette grant and she's speaking to the the cohort of the emergency nurse trainees as we all know emergency nurses and rad nurses really need to work together closely to achieve good patient outcomes and part of our

mission also involved attempting to foster improved relationships between the A&E nurses and the radiology department which admittedly weren't always great but I think that working together with the Vanderbilt group is

just really helping everybody on the ground work a little bit better together I want to mention to you that the emergency department in wait can I go back here the emergency department are the A&E as they call it there is a long

distance from the CT department there's no dedicated code or Rapid Response Teams either so that made it really imperative for the new rad nurses to receive that training and and also have sufficient equipment to manage

emergencies until help arrives so the radiologists and emergency physicians at gph have also worked out an agreement that emergency nurses are going to accompany their patients to CT until at least until this training is

completed for the rad nurses we also did a knowledge assessment we gave a total of 35 students a quiz it was a 20 question quiz in a multiple choice format it had a bonus unscored fill-in-the-blank asking how each

student would summon help in the case of a patient emergency and that was how we sort of assess how they were handling emergencies at that time and how we could improve that the good news is all groups showed

significant knowledge gains and overall the scores went up from 55 to 75 percent as might be expected the resident physicians and the rad techs had the highest scores on the pretest but the new rad nurses should great improvement

and the emergency nursing students affiliated with Vanderbilt actually had the greatest increase in scores between pre and post-testing on our last full day in Guyana we borrowed some supplies and did some scenario based training and

we focused on care for moderate and severe contrast reactions and cardiopulmonary arrest situations so there was a lot of chest compression practice use of bag-valve-mask I'm talking about oxygen airway adjuncts

initiation of IV access again and medication administration and plans were made for the rad nurses to spend some time in the emergency department practicing their IV starts here's one of the new rad nurses assisting her patient

with ventilations gph purchased an emergency cart for the CT department and it was stocked with supplies and medications donated from the Long Island Jewish Hospital and we assembled that cart while we were

there for for the new nurses they were pretty stoked about it so there was some underutilized CT storage space that we also helped convert into the prep and recovery room and here we have a before-and-after picture we also got a

desk moved in there with a chair the rad nurse library that I mentioned and we got a oxygen wall outlet place with a regulator and the emergency cart lives in there too so we were pretty pretty proud of that

and what a difference a week makes so there it is all finished

I wanted to mention briefly that Patti and I met with the principal of the Georgetown School of Nursing to discuss the state of nursing education in Guyana

in general and how rad aid might support the school and provide some education and radiology it looks like it would mostly have to be through guest speakers at this time the principal said there really was not much room in their

curriculum to to spend any length of time on radiology training but we're hoping that the students can do some shadowing and have some guest speakers about radiology topics on care of radiology patients we also met with a

gph administration and the faculty from The Bachelor of emergency nursing program to ensure the continuing education for the rad nurses alongside the emergency department nurses and we're going to have some follow-up

training in the coming year stuff we're still working on is job description and policies development of a reporting structure for the rad nurses within the institution trying to get some additional equipment and radiation dose

monitoring for the staff that's been a huge issue it's been really inconsistent and currently only the physicians and technologists are being monitored so we are working to get dis emitters for the rad nurses as well thanks everybody for

your time thanks to Christina as well who provided just invaluable support in editing some of the content that we developed for this mission you were a big help I really appreciate it

thanks again patty I'm going to turn it over to Sara Wilson now to talk about Tanzania all right good morning you guys

so let me just be honest you know two things about me when I speak I can't stand still if you've ever heard me talk

before so he always has to make me up but secondly I don't think I'm gonna make it through this without getting emotional I feel like if I can get through this whole spill without it being an ugly cry then I look like it's

a success and if you don't know what that is you can Google Kim Kardashian ugly cry so all right so I had the opportunity to go to Tanzania in October November of this year and be part of the first ground zero nurses on the ground

and the first IR there and let me tell you how this went down the end McNamara was really involved with rad aid before she got off our board and one day I had a wild hair and told Bruce from our management company was like hey I think

I want to do one of those trips can you hook me up with Patti over at Rite Aid and he was like yeah sure so Patti calls and she said you know I think he'd be great for a tanzania project I'm like great let's go and she's like wait now

who are you and how do we how are you even affiliated with Arab and I said no where's Tanzania so that's where it's at and if you know me I'm kinda like eh let's go and I don't even know where we're going and it's a 23 hour flight in

case you're interested but Tanzania is a country of 60 million people for you to get a perspective of what that looks like it's California and New York State's population combined and could you imagine not having an IR we've

have five IR s in Little Rock Arkansas going down one small interstate that looks like no biopsy no drain no just the very basic IR procedures that we take for granted don't exist there or didn't before we got there so in October

of 2017 the Yale read a chapter went down there and they assessed the potential for establishing an ir intends and so based on these findings they decided with went collaboration between the movie and Billy National Hospital

the orthopaedic Institute which you're actually like toothed small hospitals on the same campus or actually excuse me MNH is very large and then mo I is kind of smaller but on the same campus there University and the Rite Aid chapter they

would joint plan to start the first ir so the program consists of three components which is practical training a curriculum development and then finding a way to create some sustainable product development you're probably probably

aware you hear about people donating products to these countries but there's the sustainable how do I create a program in a process where we're not just waiting on someone to donate something where we can keep this our

system going so the program overview so this was we're going on two-week rotations over three years and the teams consist of an IR doc and RN and Artie we were the first group to go over in 2018 and so our goals are in year one to do

basic percutaneous procedures biopsies and drains year to going to vascular access and in year three doing more angio type cases like tase's embolization zan etc and developing a teaching curriculum because while there

is a radiology program for residents there was an IR specific one and they're creating that now so our goal is the first nurses on the ground was to provide this comprehensive nursing assessment to help map the project over

the next three or five years now when they went in the year before you can imagine all of the infrastructure assessment all of the you know the equipment there was so much that went into that but the nursing piece was our

job as the first people on the ground and this was so incredibly well received in Tanzania and they were so excited that we were on the front page of the Guardian you can see our doctors Eric and aza down at the bottom right who are

actually here at SAR this week on what looks like to be Good Morning America in Tanzania and when I arrived I was I found out we were having a first conference and there was a camera in my face so I'm

not sure what's which Swahili speaking news outlet I was on but I think I might have been on one and to the left you can see David Pro logo was the attending that I worked with at the same press conference so what I'm trying to say is

no pressure I was like we got it no pressure we have to create this nursing assessment and we wanted to do a good job because it was very well received in the media and we wanted to make sure this all went off really well I would

like to introduce you to someone very special meet Brigid facha she is the first ir nurse in a country of 60 million people this is yeah y'all this is the first lady that's ever pushed IV conscious

nation in a country of 60 million people I'm gonna lose it so it but for all the infection control givers in the room I am sorry that I did have my mask under my nose so you don't have to put it on the comments that the dead serious I was

so hot there wasn't really much air and we were working constant and we didn't need but she was a machine and I couldn't leave her and and I wanted I was before the first time in my career almost passed out and so I was like

forget it I've seen a brain our serum was shutting off a couple times because we just kept it hot all day but anyway and you can tell by my hair and sweat that it was hot she was definitely a workhorse so this is what the first

couple days look like in Tanzania to the top left you can see this the head of a patient this was a drain or something we were doing but that was an elderly lady and I noticed something really interesting they called her mama mama

mama mama which is a term of endearment there and respect and something it's just endearing to call someone and I thought it was interesting because I have the person who runs our pre-procedure area and Nicole thinks at

home she's the mama of the pre-procedure area like she's protective it's like don't bring that patient in here with her I on our team you better fix that like so it was just really an interesting

correlation that I made early on and I felt like Bridgette was the mama of that I are we were teaching her I was trying to teach her this was the first day or two about moderate sedation and I noticed her calling things in meals

instead of micrograms or milligrams and I but there was a really thick language barrier so I was trying to figure that out and it was a little hard to communicate but um I was still with her and you can see at the bottom

thanks to Burlington giving us literally donating thirty thousand dollars with the lid we had a packed house and even I was a little nervous to do a time out I really had to be like time out you know like let's get this all together because

there was just a lot of chaos there was just a lot of motion or a lot of flurry of activity a lot of excitement and I also noticed that our friend Bridget was very shy and I thought at first I think she's just shy er maybe it's me maybe

I'm making her nervous and maybe I'm talking too much and insert joke I noticed they were all the guys at the bottom they were like a little below Sarah and I did know what they were saying because it was in Swahili and my

Swahili is horrible it's like Mambo high and that I couldn't don't really have together and so one day I was a first second day I was like Bridget what are they saying I feel like they're talking about me and she said why you care I was

like well I mean they just because you can tell and she said they say you're charismatic you're beautiful but you talk too much was like okay shocker so I just thought well maybe they don't talk a lot you know I don't

know but we're on that we have to talk and like a the patient's hurting time out you know that's what we do right sorry so I gained some more insight though on her shyness and the mil-mil milliliters

versus like the micrograms and when this little earth danger a little Peter Makena came into the picture Peter actually I thought I was being catfished at first because a couple weeks before we went on the trip I was getting these

Instagram messages from somebody I'm Peter and it was like I will help people get your phone when you come to Tanzania I will drive you knows like oh my goodness who is this so I was texted our program manager and I'm like

do you know this guy and he said oh yeah we know Peter he's a legend he's a real guy he's a nursing student begging to do a research project with our IR team he just wants to learn anything and everything you can imagine and he just

wants to connect so he couldn't wait to meet me when we got there and as it turned out Peters parents made him read English written books when he was a child on up so the language barrier there was none and it I'm so thankful

for his parents investment in that because and they it sounds funny but because of that we were able to communicate and he worked in the ER at the at Mahim Billy and he gave me a personal tour through the facility which

you don't understand like that's more than VIP you've got to go in and know the director of each department just to go look through their wards like we had to go to each one and he had to kind of sell his case because they were not

exactly trusting of outsiders coming in that's when I learned some really cool things the first BSN program wasn't developed till about 10:00 and most of the BSN nurses are in admin roles and the most

important feature of this though is that there is no continuing education right now when you graduate nursing school that'll work I thought oh wow well that's that's not looking good for me when why I'm trying to teach moderate

sedation right so during one of our hospital tours we went through and ICU unit and I have you ever been in a code situation and you see something like not going right and you spoke up well of course you did right

like show of hands you've been in a code and you're like hey if y'all considered atropine right at beat like so okay we walk into this and I'm with Jeannie Burke who's from now if anybody is here from Yale anywhere but

and with Jeanne Burke she has a very we're a lot of like she's not afraid to speak up very smart talented woman we walk into this ICU unit and I'm seeing this code go on and I was thinking this is so interesting the guys in v-fib but

I only see two male physicians and then a circle around the bed of nurses just standing quiet and so they're doing chest compressions and they're pushing drugs and we're like Jeanne goes you get arrested you know you can't we got week

like you and so they all turn around and we got exited stage left quickly the point of all of that though is that I realized that the nursing role and then the inherent and the culture was that you don't you don't talk to a doctor you

don't tell him what to do which is bad for me but um but we could I had a good understanding thanks to Peter of what the nursing culture looked like and what we were kind of up against so to speak

so I'll be honest there was an

expectation set I was a little upset at that point because I thought I mean here we're supposed to be blazing a trail right and I don't even know I don't know that she can do it I can't let her

sedate patients she's been studying them for about a week Jeanne got there a little bit before I did and of course Jeanne was with her the whole time right but I went to the attending I was working with David Pro logo and I just

said that the culture here after going through a tour I have a better understanding of the education and the culture I just they can't do it there Tanzania is not ready for IR and that hurt because it I knew she could do it

eventually but just I had to stop the probes like we're not saying anymore we're not for the patients I can't let her harm a patient due to hurt like of nothing in any of her own thought right but I've got to protect her and that

created more cogs in the wheel because now we've got a coordinated anesthesia which that's hard to do at home much less in the country where they weren't really keen to IR in the hospital just at first because they thought we were

taking the patients away from surgery so you can see anesthesia being a little reluctant before we educated them about even doing a case with us and so I felt like I failed her I took it kind of deeply personal and it was really hard

for a couple days but when I talked to David he said you know what you're right you're on to something all the missing pieces we have are really about teamwork and everyone's role because they don't know they didn't know that at the time

what a nurse actually does in the States or what the tech does so he said that's fine we're gonna educate tomorrow so he came in this is David Pro logo and to the right as a tech we work with named Chris and we had a talk he said we want

to dress the whole team so we did the entire servant leader and the upside down triangle you know and he addressed the team and the docs and he said listen we're at the bottom he said you don't have a case without a nurse and I

explained to them the mama concept and I said you know how mama she's the mama of the IR and Bridget jumps up and she hugs me she said go thank you thank you and I didn't realize I gave her a compliment until you know but that's what she is

she was was the mom and the IR and I told them from this point forward we're calling her mama she's the mom of this I art without her you don't let you have nothing you have no case so we were able to do some role modeling through the

trip and again the expectation when we went in was about moderate sedation but it really wasn't about that at all it was about blazing a trail for the culture of Nursing and identifying our role is actually who and what we are for

her and for the program because 60 million people that's a huge country and that developing the nurses role is integral and making the entire program work right and we so we discuss those things and the interdisciplinary

collaboration so I thought okay we're gonna go and we're gonna work slowly we've got anesthesia set up now so the next day we go in I'm feeling like let's just do a time out if I can just get her to do time out

I'll stop talking I will empower her to talk do the time out so the first case you know we had the flurry of people in the room right she's like timeout I'm twitching yeah I was like I wanted they just jump in and

like do it for her okay so I was like okay you got a you know you guys know you have to command the presence of the room nothing else can happen while that timeouts going on second case she almost did it third case I don't know what

happened to her but it was time out and so this is you're straight from Instagram but I just was in awe of her because watching the code watching the Tanzanian culture and for this woman who's been a nurse for 20 something

years stand up and do a timeout and a group full of a group of physicians that was a big deal for her so days are measured by small victories but today's victory I heard Brigitte give a loud and proud timeout for her to frost I'm not

gonna agree cry the next day I we went to insta anesthesia were set up right and I said hey Anastasia hey man I we've got this abscess case on this kid I need you know I'm trying to do this the morning workup and he was like oh my god

emergency over it moving but you know there's two campuses right he goes we have emergency over there so I cannot come I was like Oh bet okay great well um what are we gonna do because here I'm like we're not sedating and then I'm

getting now I'm feeling pressure sure sure sedate I thought no I'm not going to sedate because that's not teaching a process so I thought okay what am I gonna do and then I'll watch the CRNA guy walk to

the coaxed and I was like well must be some big emergency boom that's great so I sat down just kind of flopped in my chair I was like what are we gonna do and Brigitte walks up and she says hey good morning and I

was like I don't know what we're doing about the first case project the anesthesia guy had an emergency at the Koch Stan so and she goes what and she kind of stood there for a second and goes I go

to head I was like go to head of what what are you talking about she was I go to head of surgery I was like huh they had a surgery she was yes I go now and I was like wait where we going do you like and so this African Queen

literally got up and marched herself all the way to the other campus to the head of surgery's office and acted like a boss and got us in the o.r within an hour and so this is photo evidence of me as static and in shock when for sure and

this photos actually Jonathan one of our medical students from Germany was like what just happened I'm like I don't know what's going on right now so I was really terrified of what I had just created a monster

and this is the sweet baby that actually we were able to take care of that day she drink contaminated water and had a 300 ml hepatica abscess so um if we had not she was septic and so we're not able to aspirate that they probably would

have punted the case of surgery and she would have maybe died because I'm not sure you know for my large incision in an extended hospital stay these are the

successes that our team had while we were there we did 37 cases but lots of

biopsies drains and one follow-up but there's stories behind those cases and their stories about turning a nursing culture on its head in spite of overwhelming odds and a story of having great leadership in the

midst of a country where they had not seen a nurse and identified in that kind of role before and empowering so never doubt that a small group of thoughtful committed citizens can change the world because indeed it's the only thing that

ever has one more thing before I'm done Sylvia Miller up if she's in right now but are you in here Silvia no no she took one of these pictures from social media and added it to a Facebook group and I don't remember the name of

it it's an african nurses of the world or black nurses of the words it's embracing african culture in nursing and had overwhelming response to Brigitte and women from Tanzania said that she's her idol and she's their hero and she's

somewhat of a celebrity now on social media unbeknownst to me no until I got to this conference that wasn't aware of that but in essence rad 8 is a beautiful thing we have the ability as air members to become connected within and become a

part of expanding global health and empowering nurses all over the world so I invite you to blaze a trail with us thank you

ladies thank you um it's been an honor to know all of you and to work with you

on this and first and foremost the planning committee would like to thank each of you before we move on this is the Johanna Poe lecture series and I'd like to ask Joanna to come up several of you through the course of this week have

asked me about my pin that I have been wearing this pin is part of the Joanna collector Series award it is a dragonfly and I'm going to leave Joanna because nobody can explain it as well as Joanna can as to why this is part of those

Awards Julianne if you wouldn't mind thank you thank you very much thank you very much for that amazing and inspiring presentation we are going global ladies and gentlemen I am so honored and proud to stand

before y'all for so many years that I have worked as a nurse specifically as a radiology nurse for almost 40 over 14 years it's been an honor to come and see as we grow and all the progress we have contributed not only in the United

States but we are going global there's recruitment going on to have nurses not only here but as you said Patti we are really going big time and I know something that some of you does not know yet but the news paper will come

out of that sooner or later regarding the awards that I am giving to these three wonderful ladies one of them is a check in honor of the 35 nurses who really braved the coldness and the basement of McCormack has a McCormack

King in Chicago Illinois and that was in 1981 it was Sherlock's Godwin's work that got us the place and the connection with the regulative Society of North America or known as RSA name and I happen to be one of those

nurses and I feel very committed in their honor each and every one of these presenters will receive a check in addition to that mention about Christa had mention about this this dragonfly I personally feel that as nurses we are

very very flexible this but this dragonfly came about through my readings and also through my cure rucifee about united states that one day i was looking at the greater good in the bittern site and I found this dragonfly

to them dragonfly represent freedom and to me as a radiology nurse as under person we as radiology nurses we create a lot of stuff that's not available to us and I can share that as a personal experience at the same time because when

I became a radiology radiology nurse there was nothing I have the opportunity to develop from the ground up policy and procedure job description documentation all of those instruction given to the patient before and after the procedure

connecting to the division of Nursing because I don't report directly to the digit of Nursing connecting to the higher-ups to ensure that our policy and procedure or order our documentation will be part of the chart because we are

not considered as part of the nursing service but overall we are taking care of the same patient because they are the patient's of the institution in the first place where they go is radiology they need to have their x-ray go back to

the dragonfly it represents creativity flexibility and our ability to initiate and adapt to the constant changes in health care industry all of you who have been working as nurses technologies if doctors you have seen the progress

that's going on we let go of the old and bring in the new but one of the things that I would like to sleep with all of you is this the old are all our old old stuff is the foundation our future and this is the dragon fly I

hope I give you that build the description why this is very very important every time you see a dragon fly it represents really freedom freedom for all of us to create what is best for our patient and our bill and our ability

to develop as you did you all did you're all doing what's best for that patient and if a million members always remember that one more thing is this we as nurses health care providers who we need to

reach up to one another we need to educate one another and help one another don't be greedy share what you have the more we collaborate and cooperate the better for all of us thank you very much for your attention

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