Tuesday, September 28, 2010

Anaktuvuk Pass, Alaska

Welcome to Anaktuvuk! An Inupiaq Eskimo village in the heart of the Brooks Mountain Range, well north of the arctic circle and only 250 miles south of the Arctic Ocean. The village is home to approximately 250 Alaskan Natives, some of the only descendants of the Nunamiut people. The village is only accessible by airplane and no roads lead in or out of Anaktuvuk Pass. This is one of many places I have the opportunity to work and visit while I complete my Senior Capstone project at the Fairbanks Regional Public Health Center.

For the past five weeks I have been living in Fairbanks, Alaska. It is the second largest city (35,000 people) in all of Alaska, and furthest north on the road system. The public health center, staffed by approximately 30 public health nurses is responsible for the vast Interior of Alaska. While most people in the Interior (100,000 people) live outside of Fairbanks, some live in villages only accessible by river or air. As I work primarily in Fairbanks, I will travel throughout the villages to get a better sense of the unique strengths and needs that accompany village life.

So far, I've spent two days in Anaktuvuk Pass. It is the end of September and snow is already falling. Temperatures warm up to about 20 above in daytime and falling to about 5 above at night. An itinerant nurse from Fairbanks and I are responsible for bringing immunizations and TB skin tests for all school children as well as the seasonal flu vaccine for the entire village (from 6mo old infants to village elders). While we are here we will also see children for well-child exams, write referrals for children to fly into town (Fairbanks) to see Pediatricians, Dentists, Ophthalmologists, and any other appropriate specialists. We will also provide STD screenings, pregnancy testing, family planning, and other important public health services.

Villages have no permanent physicians, physician assistants or nurses. Each village employs one or two Community Health Aides (CHA). They have 16 weeks of formal training and anywhere from months to decades of practical experience. They are a dependable and trusted source of health care (the only health care) amongst their people. For most client visits, the CHA functions independently, otherwise she consults a physician by phone. Life and certainly health care look much different out here.

Saving Lives in Shaker

Two weeks ago, my second week, at the Shaker Heights Health Department I came back from Lunch to find the office in a bit of chaos. The atmosphere was very heavy with tension and the office the intern and I use was occupied by a man who was laying on the exam table. When I asked Sandy, the nurse director (and only nurse) of the health department she explained to me that on her way out to lunch she had decided to check her email when this community worker came in to see her because he just was not feeling right.

His story: this community worker was a Russian immigrant who has been in Shaker for close to 30 years. He has had perfect attendance at his job for 10 years and was very worried because he had left his sweeper outside in the street, and it might be a traffic issue. He told Sandy that he had been out of his blood pressure medication for about 2 days, and because she knew him as a very honest person she took his word that it had only really been 2 days, because sometimes when someone says 2 days they really mean 4 or more days.

Sandy decided to take this man's blood pressure and it was a little on the high side, but she waited until he relaxed and took it again 10 minutes later, and listened to his apical pulse.
She said she heard some irregular beating and asked him if it was ok that she called the squad from the fire department. Arriving withing 5 minutes of the call (its really nice to have a small department because everything is close by) they hooked up the worker to a heart monitor and we watched as his heart rhythm showed on the screen. Sandy picked up some p-wave irregularities and as the minutes passed she realized his answers, to the questions asked by the squad, were changing. She asked the squad to send him to the emergency room.

Last week we got a call from this worker telling us that his life was saved and that Sandy was working in the right place. He was having a stroke when he was in the Health Department with us and he had gotten to the emergency room with only 10 minutes to spare; he as able to get tpa. He has started doing therapy already and will be able to keep his job, because his boss called us to thank Sandy as well. He only has a droop on one side of his lips and a limp but he is alive and it was wonderful being able to see this kind of care at a small Department. It truly lets us know that no matter where you are, you don't know what could happen, and nurses are really needed everywhere.

Sunday, September 19, 2010

Gila River Week 1

Our first week was filled with many new experiences and HEAT (the temperature here is consistently around 108*F). We arrived last Sunday and quickly unpacked, so that we could settle in and rest before our first week.

The first couple of days were filled with orientation items. We got a tour of the hospital and the districts that we would be visiting. One of the things that stuck out at us was how big the community is; to get from Sacaton (District 3) to Komatke (District 6) it takes about 30-45 mintues! We were delighted to feel so welcome by everyone in the hospital, not only staff, but community members too!

On Thursday, the hospital had food and art vendors to celebrate Native American Day. Students from the private school in the community performed some native dances. Delissa and I tried a local dish called fry bread with beans and cheese. It was very tasty, but very high in calories. Olivia and Briana did some shopping with the vendors. They got some very beautiful items.

This past weekend was dedicated to exploring the surrounding cities of Chandler, Gilbert, and Tempe. On Friday night, we went to Rawhide which is an "old western town" next to one of the casinos on the reservation. Chandler and Gilbert are cities that we go to for internet access (usually at one of the public libraries) or for groceries. On Saturday night, we ventured to Tempe to eat dinner at a Greek restaurant. Even though we are 2,000 miles from home, there were places in Tempe that reminded us of home like Jimmy Johns and Five Guys Burgers and Fries.

This coming week we will spend the whole week doing our assignments. Delissa and I are with the public health nurses making home visits. Olivia and Briana are in the schools helping out with screenings. This coming Friday, we were invited to join the public health nurses and team to celebrate their accomplishments of receiving regional and national awards. We will be celebrating at a restaurant in Tempe called Monti's. On Saturday, we are hoping to help out at the Diabetes Walk that is taking place on the reservation. Diabetes is a HUGE issue here in the community and we are thinking about making it our focus for our capstone project. After this week, we are hoping to have a better sense of what our project will be, especially after completing a community assignment and windshield survey.

Thursday, September 16, 2010

武汉大学, Wǔhàn Dàxué, Wuhan University

Since arriving in Wuhan, China in late August, we have had the opportunity to live and study at the HOPE School of Nursing at Wuhan University, Hubei, China.

Wuhan is a city in Hubei Province, with an urban population of roughly 6,100,000 (compare this to Cleveland City proper’s population of between 450,000 and 500,000). Wuhan University operates under the Ministry of Education of the People’s Republic of China. The undergraduate and graduate student population is roughly 53,000 (Case Western Reserve’s approximate student population: 10,000). It is known to be one of the most beautiful college campuses in China, so we’ve been enjoying the diversity of plant life on the way to and from our nursing activities.

In the past three weeks, we have participated in nursing courses regarding Nursing Management and Public Health, attended Nursing Management clinicals in nearby hospitals, visited Traditional Chinese Medical community health clinics, and participated in a Chinese language and culture education program.

Our priority for the duration of this Capstone experience is to observe and study the techniques and philosophy of Traditional Chinese Medicine (TCM). We find the holistic approaches to patient care utilized in TCM to be extremely relevant to nursing work, and we hope to further integrate this approach in our personal philosophies of nursing.

So far we have observed needling, moxibustion, electro-acupuncture, massage therapy, cupping, and the use of herbal medicine. The doctors working in the clinic showed us specific massage techniques to utilize for care of patients with pain located at and around the cervical spine due to postural problems and sedentary lifestyles (e.g. sitting in front of a computer day after day may eventually generate this type of pain). The treatment plan for these patients encompasses a variety of TCM techniques, which are drastically different than the treatment modalities for similar patients in the US receiving Western Medical treatment.

We were fortunate to have the opportunity to experience acupuncture ourselves this week. We feel better able to understand the physical and mental effects of needling, and we maintain great respect for the techniques of acupuncture that these TCM-trained doctors have mastered.

A view of Wuhan across East Lake (东湖) located near Wuhan University’s Medical campus:

Tuesday, September 14, 2010

Health Awareness in Shaker Heights

The Shaker Heights Health department is a small department that is run by 4 major bodies. Among the 4 bodies, there is only one nurse, who is in charge of the Nursing Department. This nurse is practically in charge of the department because nothing goes through without her knowledge and approval. with her there is one intern at all times who helps out with one to two of her programs (among many) and documentations.
The health department deals with the community of about 27,000 (26,214) people, and they are in charge of keeping the children immunized, making sure the community Emergency response team is educated and kept up to date, keeping in contact with the jail house for the patients there, keeping in contact with the community elderly homes (making sure they get their shots, or other services), doing drug testing for the community workers, having health fairs and shot clinics for different age groups in the community and many more things.
so far for my capstone project i am focusing on the Seasonal Flu shot Point of Distributions (PODs) that they have annually. Last year in 2009, they vaccinated almost a thousand people (), this may not seem like much but for the amount of time they were given to distribute these shots and the last minute H1N1 vaccines, as well as keeping track of data, they have improved from past years. My capstone is going to focus on improving that number (both participants, as well as volunteers) by doing surveys in the community to see the awareness of people about these events and if there is a reason why more people dont come to this event (are they getting their shots somewhere or not at all, do they have the means to get to the event, are they busy, are they not getting the advertisement of these events etc.)
I am looking forward to this project because it also lets me work at other events and see what works there and what we can use for the improvement of this years POD.