I have been a registered nurse/registered midwife in Jamaica for 15 years. During my years of practice, I have had the opportunity to work in primary healthcare in St. James, Jamaica, located on the rural, western end of the island. During my tenure in primary care, my most rewarding experience was conducting home visits, not for the financial gain (there was none!) but because I felt like I made a difference in someone's life.
I remember visiting a teen with paraplegia and extensive pressure ulcers requiring wound care. For those of you who have not been to Jamaica, our rural areas tend to be very mountainous, with rocky terrains and lush green trees. My patient happened to live at the bottom of a very steep hill. It was raining cats and dogs that day. There I was in my angelic white uniform trying to navigate a steep hill with dignity. It was a war between nature and man and unfortunately for me, nature won! I went from walking to sliding to being caught by the patient's father!
On the island, there is a group of nurses who have the privilege of conducting home visits every day. The Hyacinth Light Bourne Visiting Nursing Service, a nongovernment organization, has been in operation since 1957. It has a singular objective to bring professional nursing care to patients in their homes irrespective of their socioeconomic status. The visiting nursing service is a struggling industry in Jamaica. A once vibrant industry with several offices islandwide has now been reduced to a single entity located in the city of Kingston. The organization struggles to provide services with the aid of sponsorships, donations, and a small annual membership fee. Denise Smikle Grant is a visiting nurse, and today allowed me a brief glimpse into a day in her life.
Her first patient suffers with dementia and required a bed bath. Sounds simple enough but she also completed a thorough nursing assessment and provided much needed social interaction. The family looks forward to her visits as she not only helps them to care for the loved one, but encourages and supports them in every way possible. Her next patient was a man with paraplegia and pressure sores who required wound care. She ably assessed and dressed the wounds, and was particularly pleased to see the improvement that continuous care and teaching has brought him. She reflected on the financial struggles the client has and was pleased to be able to help. The final visit for the day is a nursing home. Though practical nurses are there during the day, legal regulations require a registered nurse to ensure competent care is delivered to the residents. Denise greets them one by one and monitors their vital signs and blood glucose levels for those with a diagnosis of diabetes.
Mosquito-borne diseases like Zika are a recent health problem in Jamaica. The Zika virus is transmitted from human to human by bites of infected mosquitos, through sexual contact, or perinatal transmission. Symptoms include mild fever, joint pain, nausea and vomiting, and fatigue. It is also common to see "pink eye," skin rash, and sensitivity to light. Most people recover completely, but pregnant women can pass the disease on to their baby, where it can cause microcephaly and other birth defects, so no visit is complete without teaching patients and caregivers about mosquito control.