Brilliance in Guyana: Notes from the field
The Skippers discuss neonatal jaundice care with clinical staff at West Demerara Regional Hospital, just outside Georgetown, Guyana.
Earlier this year, two friends of D-Rev, Andrew (“Skip”) Skipper and Laurie Skipper, did 10 days of volunteer fieldwork for D-Rev in Guyana, South America. The work that they undertook has led to D-Rev improving the quality of data used to estimate the impact of Brilliance in Guyana. It also produced useful insights into user needs and constraints. Below are some reflections from the Skippers on their trip.
When we visited Guyana in March, we went to collect data on D-Rev’s Brilliance devices, but discovered so much more while we were there.
Guyana is the third smallest and the only English speaking country in South America and the third poorest country in Latin America and the Caribbean.
We visited six hospitals in Guyana, where 36% of the population lives below the international poverty line of less than US$1.75 per day. We spent our ten days visiting six hospitals there, where we met doctors and nurses who revealed the many challenges they face.
There is a lack of experienced, healthcare professionals in Guyana because doctors trained there often leave to work for higher pay in other countries like Canada, England, and the United States (based in part because they already speak English). Those that stay confront a lack of medicine, medical supplies, and medical devices. They make do with donated supplies or creatively re-purpose what they have on hand. In all of the hospitals we visited, for instance, they used only surgical face masks to cover infants’ eyes, instead of infant-sized eye protectors simply because it’s the best they could do. Some donated devices sit unused because they broken and no replacement parts are available.
One of the most interesting insights we gained during the visit was how “advanced” training and standards can backfire in low-resource settings. We came across one hospital where no babies had been treated for jaundice for two years—even though they had phototherapy devices that could have used the national protocol calling for visual screening (checking for yellowish skin tone on a newborn) to diagnose jaundice. Instead they had not been treating jaundice at all because, as they explained, they did not have access to diagnostics devices or laboratories that would give them the precise bilirubin (jaundice) measurements to quantify the severity of jaundice. Limited though this occurrence was during our trip, this phenomenon was a surprise to us, and a reminded of the importance of observing and understanding how devices are used—or not—in the field and why.
Despite the challenges that the health sector faces in Guyana, there are reasons to be hopeful. Guyana Help the Kids (GHTK), a Canadian-based charity run by Guyanese living in Toronto, work with hospital staff and government officials in Guyana to identify areas of need and procure devices and other support to improve health outcomes. So far, they have purchased 35 Brilliance units for hospitals throughout Guyana. The effects were immediate.
“In 2015, after we received the Brilliance phototherapy units, baby deaths from jaundice dropped to zero,” said Dr. Winsome Scott, the Head of Pediatrics at Georgetown Hospital, the largest hospital in the country.
Dr. Winsome Scott, the Head of Pediatrics at Georgetown Hospital.
This kind of dramatic change in health outcomes, along with the chance to speak with nurses and doctors and see conditions firsthand, gave us a deeper understanding of the needs of hospitals in Guyana and a stronger grasp of what more could be done, such as improvements in diagnosis, communication, and training.
At the end of the trip, we remain inspired by the doctors and nurses we met, and by the work of D-Rev. As Chief Executive Officer of New Amsterdam Regional Hospital, Collin Bynoe, said: “Getting better equipment gives the doctors the energy to go higher and puts a bounce in their step.” It’s harder to measure this, but certainly easy to understand.