Friday, October 29, 2010

Public Health in Gila River

Olivia and I have been with the public health department for the past two weeks and have worked with the RNs, LPNs, and CHRs (community health representatives) in districts 1-4. I was quite surprised when I saw the type of work public health does on the reservation. Instead of patients coming to an office or building, the workers go out to them. Some of the day is dedicated to home visits, going to the pharmacy to have prescriptions filled, and arranging meds in the patients' pillboxes. But the most time-consuming and dreaded part of each day is charting! The nurses often struggle with going out into the community to provide care, then having to return and document all of their work.

During home visits, the nurses generally take vitals, do a quick assessment, and ask the patient if anything is needed. The CHRs also do vitals and assist the patients with their needs, but they take more time talking to each patient. Since each CHR is a community member, the patients feel more comfortable around them and tend to open up more. Generally, the patients are fine with having a student assist with the visits. However, there was one instance, while doing a home visit with Michelle (LPN) and Linda (RN), where the patient complained. She was upset that the nurses did not warn her they were bringing someone along, so she pouted and refused to acknowledge my presence. I didn't take any offense to her reaction; some people are not as open to having outsiders in their homes as others.

While with Janie in Districts 1 and 2, I did flu shots at the Elders Center. Once every month, the elders play bingo for hours and have a potluck lunch. Since there would be a good amount of elders there, Janie figured it would be a great opportunity to have a mini flu clinic. After giving the shots, I ate lunch with the elders. I felt like it was Thanksgiving; there were so many delicious foods!

Olivia and I have also been involved in the flu clinics at the schools. While at Sacaton Elementary and Blackwater Elementary, we administered over 320 flu vaccines (nasally and with the Biojector).

It's hard to believe our days in Gila River are coming to an end. Time is going by so quickly! We have a presentation on our project tomorrow at the Patient Family Centered Care meeting. On Friday, we will do another dental presentation with a third grade class in Gila Crossing Elementary.

It's Flu Season!

Sneezes, coughs, and runny noses will not be found among the children of the Gila River Indian Community this season! I am truly enjoying myself as I administer the flu vaccine to students of all ages.  Although I hate causing the children any sort of pain, I know that I am helping to prevent them from getting the flu this season.  We have administered mostly nasal vaccines which most children have tolerated very well.  I must admit that my pediatric nursing skills have definitely come in handy as we work to safely and effectively vaccinate hundreds of terrified children.  As student nurses we administer all the vaccines to the children as we try to incorporate play as best we know how.  I was very pleased that we came up with a game to encourage the children to sniff with the nasal vaccine. We ask the children whether the vaccine smells like flowers or candy.  It's so funny watching the children choose what it smells like as we eagerly compete with a scoreboard drawn on the table! The funny thing is that the vaccine really has no fragrance at all! Surprisingly, only a very small amount have the courage to go against us both.

     Among our very entertaining encounters at the flu clinics we have also been able to teach dental health to a group of third grade students! Once again incorporating play along with our teaching strategies has served us very well.  I had a blast having the students do a return demonstration of appropriate brushing and flossing techniques on Ally the alligator!  I look forward to my last two weeks here in Arizona! 

Tuesday, October 26, 2010

The infamous P.O.D.

SO this past saturday, October 23, 2010 we had a Saturday flu clinic, also known as the Point of Distribution or P.O.D. for short.
This was the best experience i had, in terms of coordination. Because of the new CERT (Community Emergency Response Team) Trailer, the time for setting up the P.O.D. was cut back to half an hour. WHich is significantly more than previous years (over an hour and a half). Kayleigh, the intern, and I had printed numbers and placed them on big clear boxes so we could neatly pack them in the trailer for each station. We had 11 stations in general, and we had more than one box for each station, and at we put all the things necessary in each box for each station.

The drive through was such a success for the P.O.D., which is where i spent most of my time. The tent for the payments was the really nice and it made more people stop by to see what was happening.

As for team work, the CERT members, police officers, and fire department were all present for security, as workers and in case of an emergency.

After the P.O.D., packing up took less than half an hour. Our meeting went smoothly, and everyone gave their thoughts about what might need improvement; having a triage for the drive thru to make sure someone is not sick etc.


Sunday, October 24, 2010

Flu Shots

This past week, Lisa and I spent with school health. It was our first week with school health. I had mixed feelings about starting school health: excited for something new, but sad to be done with public health.

We started with school health at a great point; they were ready to begin flu shots to students in the schools. The flu shots are given in two different ways: nasal and with a Biojector, which is a gun that uses CO2 pressure to “shoot” the vaccine into the muscle.

The beginning of the week consisted of administering flu shots to Head Start students, ages 3 to 5. We did get some pre-Head Start students who were 2 years old. The challenge with this age group was administering the flu vaccine while they are moving around and crying. We had a person hold the child while we held the head for the nasal or the arm for the Biojector. The nasal route had to be done quickly because they seemed to move their head around after the first mist. With the Biojector, it seemed that fear was most of the problem. For this, Lisa and I did a lot of praising after the injection.

On Thursday, Olivia and Briana joined us with the flu clinic at Sacaton Elementary School. We were able to give flu shots to 200 students. The whole process went smoothly with little crying and/or moving around by the students. With this group, we were able to explain to them what was happening and why they needed to sit still.

Lisa and I will continue to administer flu shots this coming week. By the end, we will be able to do it in our sleep!

This week also was filled with our group presentation on dental health. We were all happy that it went very smoothly. Preliminary results show an increase in the average pre/post test scores of 20%!! We were given the opportunity to present to another third grade class. This will take place this Friday. We are hoping that it will go just as well.

Friday, October 22, 2010

Busy, Busy, Busy

These past week was very busy and exciting! Briana and I began Pulic Health on the reservation. The staff is wonderful. They have such strong teamwork and has given me a view at how an organization should run from the director all the way to the nurses and patient care assistances (called CHRs).

Public Health is different out on the reservation. It is a lot more home visits and the nurses traveling to the patients than the patients coming to see the nurses at a clinic or their offices. There is one nurse and two LPNs per district plus a CHR, who is a community member from Gila River Reservation. The reason there are CHRs is many times patient relate better with a caregiver who comes from the same background and is a community memeber themselves.

I did about 4 home visits each day. Most community members are open to letting a vistor come into their home. Some of the duties of the public health nurses include filling weekly pill boxes with the patient's perscribed medicine, checking vitals, and calling the clinics or hospital if the patient should need transportation to an appointment. They also run to the pharmacy for patients if their medicine is all out.

Public health has taught me a lot about the community in just one week. While in the patient's house I learned by observing how the family interacts with each other, the quality of their living situations, and the resources avaliable to them.

Many times if the public health nurses do not make it to a patients' home to fill their pill boxes, the patient will simply not take their medicine. The community these individuals live in many of their healthcare is done for them or it is expected by the community members for the nurses and doctors to do. Unlike our healthcare system at home were it is promoted to take part in your healthcare and course of treatment.

For fun this week and for Cemile's birthday we went to a Phoenix Suns Basketball Game. It was awesome, because we bought tickets in the balcony section way up at the top and when we arrived their were signs on our seats saying, "YOUR A WINNER". We won tickets 19 rows from the floor of the court. It was a lot of fun. We also got to see downtown a bit and ate at the Hard Rock Cafe.

School Health in Putnam County

This week we have spent a lot of time helping the health department’s school nurses do hearing, vision, and height/weight screenings at a local elementary school. Over the course of two days, we screened kindergarten, first, and third graders. Even though I have helped with several screenings in the Cleveland Public Schools, there is still so much to learn from the experience.

At the health department, there are 3 school nurses that cover all the schools in Putnam County. Although most schools have an LPN on site, much of the responsibility of the students’ health needs fall to these 3 nurses. Each year, they are responsible for screening each and every student in the county for vision, hearing, height, and weight, and they must follow up with the students who fail any part of the screening. The nurses receive help from various sources: women from the Lion’s Club, volunteer students from local high schools, and faculty at each school. So they were very appreciative that Maya and I could help out.

This week we focused on J.A. Long Elementary School which is located in Palatka and is only about a 5 minute drive from the health department. Overall, we screened 12 classes in about 6 hours. The nurses from the health department are able to bring quite a bit of screening equipment to the schools. They have two height rulers and scales, 2 audiometers, 4 Snellen Charts, and 4 “house, apple, umbrella” charts. With all the equipment and volunteers, we are able to screen many children in a relatively small amount of time.

And working with the kids in the school makes for an environment that is always changing. It can be so rewarding and fun. During her vision screening, one little first grade girl said to me in the most innocent voice, “I’m not a letter sayer.” It can take some dedication and technique to get the kids through the screening exams, but it is well worth the effort.

Tuesday, October 19, 2010

Boiled Peanuts and Pulled Pork

Greetings again from northern Florida! If you couldn't tell from the title, my post today is going to be about food. While most of the food I've encountered during this experience has been familiar to me, there are a few things that stand out in my mind. The first thing is pulled pork. I have now twice encountered pulled pork that was amazing. The first time was at a restaurant, and sidedishes traditional with pulled pork, coleslaw and baked beans, were also good.

However, Melissa and I went to Cracker Day this past Saturday. It's a local festival that is meant to honor Florida Crackers, whose name is derived from the crack of the whips they used. We saw a lot of cracking whips on Saturday, and a lot of horse games like barrel racing and jumping. In jumping, a rider and horse must go around a barrel. However, during the turn around the barrel, another person "jumps" onto the back of the horse, and both ride back across the finish line. While I know there is a great deal of skill involved, it appeared to me that the second person said a quick prayer and launched his/herself onto the horse. In any case, it was a good way to spend a few hours on Saturday, which brings me back to food.

The cost of attendance also included a bbq lunch. And they served bbq beef or pulled pork. Naturally, I got the pulled pork, and was so completely impressed with it, along with the best baked beans and coleslaw of my life, that I had to take a picture of it!

My other food encounter involves boiled peanuts, a Southern favorite. I admit to not knowing much about peanuts. So when I saw signs for them and heard people talking about them I figured it was the same way they get cooked before they show up in my jar in the store. Not true. Those peanuts are roasted, which is apparently common knowledge to everyone but me. Anyway, with as many crops are grown in this area, there are vendors parked in lots all of town, selling anything from cucumbers to shrimp to, you guessed it, boiled peanuts. I was skeptical when I was first given a boiled peanut, especially since the outside is all soggy from being boiled. And I was told to squeeze it open, but watch out, because you may get squirted! What? By a peanut? Strange. In any case, I pressed on, squeezing the shells open away from my body, and inside are peanuts! Except, they're soft and kinda slimy, wet from being boiled. But don't be fooled--when seasoned properly, they are delicious and addictive! They come in any flavor you can imagine; from what I've heard, cajun and just salted are the most popular. I later found out it is common to use your teeth to open them, so that you also get the flavoring that is inside the shell.

I am now on a quest to make boiled peanuts with some resident boiled peanut expert so that I will be qualified to try and make them back in Ohio.

Hope I didn't make you too hungry!


Monday, October 18, 2010

Fire-Cupping Therapy

Through our experience in the Traditional Chinese Medicine clinics, Hannah and I have developed a particular interest in the use of fire-cupping therapy to treat a variety of ailments, including pain, colds, muscle tightness, sciatic nerve spasms, and digestive complaints.

The process of performing cupping therapy requires not only technical skills but also extensive knowledge of the philosophy behind TCM. If a patient has back pain, for example, the patient will lie prone on the treatment table with the skin on his or her back exposed. The Traditional Chinese Medicine physician or nurse will dip a cotton ball in alcohol and pick it up with metal tongs. The cotton ball is then lit on fire.

The healthcare practitioner will take a glass or bamboo cup and put the flaming cotton ball in the cup to remove the oxygen and then quickly place the cup on specific areas of the back, along the 5 meridians. Qi, the “energy of life”, flows through these meridians. The lack of oxygen in the cup creates a tight seal to the skin with negative pressure. This opens the meridians, allowing the Qi to flow more freely throughout the entire body.

The cup is left on the patient’s back for 10-20 minutes. During this time the patient may experience some minor discomfort. The theory behind cupping therapy is complex, but it was explained to us simply that the “toxins” and “disease” are drawn out from the back through this process. When the cups are removed, reddish circles are present where the cups were. The colors range from light red to dark purple, depending on how much toxin was in the body. A darker color indicates more toxins as evidenced by blood stagnation. The warmth of the cups and the effects of the suctioning increase the flow of blood and lymph, and also stimulate nerves and muscles. This has very positive effects on the patient’s immune system.

The colored circles resemble bruises, and may remain on the skin for a few hours, or up to several weeks depending on the circumstance. Walking on the streets of Wuhan, you may occasionally notice a person with these darker circles on their necks, shoulders, or arms. The first few times I saw strangers with these circles, I had no idea what could have caused it, and immediately though it resembled some form of abuse. However, the circles were simply caused by cupping and this is a very culturally acceptable form of therapy here in China--natives wouldn’t think twice of seeing the dark circles on strangers.

In America, some traditional Chinese therapies such as fire-cupping or Gua Sha are mistaken for signs of abuse by teachers, social workers, or healthcare workers. Having initially assumed the marks to be a sign of abuse myself, I can now understand how much confusion it could cause in the United States.
After studying cupping therapy for a few weeks, Hannah and I were permitted to both perform and receiving fire-cupping therapy. I had a cold at the time the cupping therapy was performed on me, so the TCM nurse informed me that there would be a high concentration of toxins in my lungs which would make the circles darker. She was right—my marks were a very dark shade of purple.

The marks left by cupping are very similar to that of a bruise—however unlike a bruise, there is no nerve or blood vessel damage done to the area, thus making it a non-harmful therapy when used appropriately.

Traditional Chinese Medicine in Wuhan, China

Over the past month Maura and I have been observing and learning some techniques of Traditional Chinese Medicine (TCM). TCM takes an approach to health and well being that is very different from Western medicine. TCM is stemmed from the philosophy that disease is a result of an imbalance of the body. So the treatment therapies are designed to correct the imbalance and return the patient back to a general state of well being. Even the diagnosis process varies greatly from the assessments that we have grown accustomed to performing. While I was shadowing in the clinic I got the opportunity to have a well respected TCM doctor to assess and diagnose me, which consisted of feeling my pulse and observing my tongue. He then asked me if I was feeling well. Actually, I had currently been suffering from nasal congestion and upper respiratory symptoms. He proceded to tell me that the center of my tongue was more yellow than normal, and that I had a heavy pulse. Based on these symptoms he diagnosed me and told me to drink more water and sleep more. Afterwards I found out the assessment process contained four steps: 1. Look at the patient's skin, tongue, and their overall appearance; 2. Ask the patient questions and listen to their voice; 3. Smell the patient; 4. Feel the patient's pulse. Through doing these four steps a TCM doctor can assess, diagnose, and suggest a treatment plan.

Additionally, we have gotten to observe various TCM treatment techniques such as massage therapy, acupuncture, and cupping. One treatment plan that is completely different yet relevant to Western society is one for weight loss. This treatment uses a natural fiber that is often utilized as dissolvable sutures in Western medicine. The doctor inserts the fiber into the subcutaneous space in the abdomen and bilateral lower extremities using a needle. The treatment plan starts by inserting six fibers and then is adjusted as necessary. After the fibers are inserted into the body, natural defenses are activated, and the body attacks the foreign substance. As a result the patient's metabolism is boosted, which leads to weight loss. The nurse at the clinic told us that the biggest success story was a person who lost eighty kilograms after five treatments! This success story is one of many that occur at the clinic. Through interviewing many patients it has been revealed that most, if not all, patients report satisfaction with their TCM treatment plan.

Sunday, October 17, 2010

Primary Prevention in Gila River

Olivia and I will start working with public health Monday, and I am looking forward to all of the educational opportunities associated with that. Even though we will be with public health, we will still participate in at least four of the flu clinics held in the schools. Public health often teams up with school health services to ensure all of the children, after their parents fill out a consent form, are given flu shots. I'm pretty excited because we will be using the Bioject, a needle-free instrument used to deliver the flu vaccine.

Aside from working with school health, I have participated in several breast cancer awareness events. On the 8th, the Komatke clinic had booths set up with educational materials for community-members to become more informed of ways to be healthy. There was an area set up for people to learn how to and practice doing self-exams. Also, the mobile mammography unit was available for community-members to have an exam done. Guest speakers shared their stories about the impact breast cancer has had on their lives and those of their families and friends. Their heart-felt stories brought tears to a lot of people's eyes, including myself. On the 10th, I went to the breast cancer walk in downtown Phoenix, helping with Gila River's booth. It's great to see the health care team places a large emphasis on raising awareness on breast cancer, since it is one of the leading causes of death among women on the reservation.

Friday, Olivia and I helped Janie and Estella with the Elder Conference in Blackwater (District 1). There, we administered flu shots, distributed pamphlets with health information, and did vitals and blood sugar checks. The conference was intended to bring the elders together to share experiences while providing support and information on raising their families. Many elders on the reservation have taken the responsibility of caring for their grandchildren or great-grandchildren so that they are not placed in foster homes. With this heavy burden, a lot of them put the needs of their family members before their own. By holding this conference, the goal of the health care team was to keep the elders as healthy as possible. Having a healthy, aware elder will impact their families and the community as a whole.

Saturday, October 16, 2010

Raising Awareness

I am really enjoying my time here at Gila River Indian Reservation. Recently were granted some great opportunities to volunteer within the community.  Cemile and I were able to help give flu shots with the public health nurses during the annual Elderly Picnic. It was very rewarding to see such a large number of eldery community members interested and commited to staying active and healthy.   The group gathers to feed the elderly breakfast and lunch and encourages the seniors of the community to play a variety of activities which include archery and chair volleyball. I was able to serve food and watch some of the games being played. As always I was eager to be involved with the task of helping others.  What better way to continue to learn about the community than to dive right in the middle of community activities?  Along with this great opportunity I was also able to volunteer on two separate occassions with an effort to raise awareness about breast cancer. It shocked me  to learn that Breat Cancer is one of the leading causes of death among Native American Women. I learned this fact as I volunteered at a Gila River booth during the Susan G. Komen race for a cure. Naturally, I was eager to accept the invitation to volunteer during the breast cancer fair held on the reservation. While there I had the opportunity to observe as nurses taught the community how to conduct a self-breast exam.  Many women did not know what a lump felt like before this workshop. It was truly an excellent learning experience.

Friday, October 15, 2010

Primary Care for Migrant Workers

Hello from Putnam County, Florida! Maya and I are staying quite busy working with Catherine, our nurse preceptor, and the migrant farm worker program here at the health department. Because of the partnership between Putnam County Health Department and St. Vincent's Hospital (located in Jacksonville) we are able to provide primary medical services to migrant farm workers. Maya and I go out 3 days a week on a mobile unit and stay in the office the other days catching up on charting and working on our own project.

The mobile unit is able to go to many different locations in order to meet our patients in their own community. We go to Crescent City, Fl and park in church parking lots, outside of a grocery store, or next door to a daycare center. The health department also borrows clinic space from a full service school, so some days we work inside a building out of a full service clinic. On Monday evenings, we go to Hastings, Fl and work out of a full service clinic.

There are many different services we are able to provide. With our mobile unit, we are focused on primary care. We have an on-board pharmacy that is able to dispense certain types of medications at no cost to the patient. Some days we have a podiatrist, and other days we focus on women's health or family planning. If a patient is in need of more extensive or follow-up care, we can refer them to other services.

Maya and I have also been able to work with other nurses in the health department. We helped our school nurses with screenings at an elementary school. We worked with our immunization nurse and helped administer flu and hepatitis B vaccines. We were also able to host a table at a family health fair at a Georgia Pacific Plant with our nurses that work in the colorectal and breast/cervical cancer departments.

As the weeks go by, I am learning so much about public health in this part of Florida. And there are so many opportunities to be involved in the community and in the health department. Not to mention all of the beautiful places to visit along the coast! Going to a beach and swimming in mid-October is a new experience in itself!

Wednesday, October 13, 2010

Roundtable on Youth Suicide

Suicide is a major problem in Alaska. From 2004-2008, it was the leading cause of death for the age group of 10-19 years old. In any culture, suicide is a hard topic to talk about. That is especially true in the Alaska Native cultures. This topic, among many others, is taboo to talk about to one another. However, if this issue is not discussed and children are not taught that this is not a natural thing, this problem will only become worse.

On Monday, October 4th, the city of Bethel held the first ever “Roundtable on Youth Suicide”. Many representatives from across Alaska and the country came to discuss their feelings and actions towards this topic and allowed the community to share personal testimonies and suggestions on how to handle this problem. The roundtable board consisted of Senator Lisa Murkowski, Myron Naneng the President of the Association of Village Council Presidents, Gene Peltola the President of the Yukon Kuskokwim Health Corporation, Governor Sean Parnell, and nine others who represented local, state, and nationwide organizations.

The most rewarding part about this event was hearing the testimonies from members of the community. Various youth and adult community members spoke of personal matters of suicide relating to self attempts and/or family and friends that were successful. They shared how they’re lives have been affected by this and pleaded for change. Suggestions that were brought to the forefront included: never do things on an impulse, using the Yup’ik way of life as a model for teaching youth, having family meetings, speaking up if you see someone getting bullied, and the most important, which was shared by a young adult, was showing someone you love them.

I have worked with and been around many of these surrounding communities, and have heard stories that no one should ever hear, let alone live through. The tragedies that lie deep within the hearts of these people are devastating. Although this is a difficult subject to speak of, it is important to do so in order to promote change. Addressing the matter and talking about it is one of many steps that are needed to cure the problem.

Flu Shots

So far, I am excited to say that we have almost everything ready for the P.O.D. for flu shots next week. Today I went to Shaker Square to drop off flyers at different stores, and so far I have reached 30 stores all over Shaker (including day care centers, super markets, hardware stores and dry cleaners).

Next week we are preparing for the Employee Health Fair, Senior Health fair and then the P.O.D. all thursday, friday and saturday in order. A bit overwhelming but exciting as well.

So far this week I have also gone to Laurel School (private school in shaker) with a nurse and helped with flu shots, and tomorrow we are going to both Hathway Brown and University Schools to vaccinate the faculty.

Flu shot clinics: we also have been giving flu shots at the Health department itself on tuesdays starting this tuesday for the next 4 weeks, and already we have vaccinated 90 faculty members of Laurel, 48 Senior citizens at tuesdays flu shot clinic and about 90% of both the fire fighters, police department officers, and almost all of the city employees.

This alone goes to show, for me, that although my goal is to increase those who got flu shots at the P.O.D. from 365 to 450 residents, i think that we have done more than that. I think that from all these experiences i have learned that even though not many people come to the P.O.D. we are still vaccinating Shaker, and if i count how many people we vaccinated total so far, there would be more than 450 residents this year alone from the schools, police department, city employees, and fire department, however it doesnt mean we should stop trying to get more people at the P.O.D.

So far the GIS map Kayleigh (the intern at the Health department) and I have, we can see that last year, we vaccinated people from all over cuyahoga county, and the map is amazing with what it shows. I was surprised to see people vaccinated from all over, so it will be interesting comparing this year and last years map and seeing if those we vaccinated have increased in number and in the places from which they come.

Tuesday, October 12, 2010

Greetings from Putnam County

I'm new to this blogging thing and I just tried to publish my post, and of course it didn't work and deleted everything I had written! So frustrating.

Anyway, greetings from Putnam County! Or rather, from Palatka, FL! Or Elkton, FL, since that is the address where we are staying. Or maybe from Armstrong, FL, as that is the name of the neighborhood (which consists of a road off of a state hi-way) in which we are staying. So, greetings from northern Florida!

Melissa and I have stayed quite busy down here these past few weeks, working three days a week on the St. Vincent's Mobile Health Outreach Ministry Unit. The Putnam County Health Department has a partnership with St. Vincent's, so we are precepting under Catherine, an RN who is employed by the health department but works almost exclusively with St. Vincent's and the migrant community. The unit is a fancy RV that parks at various places and provides primary care to migrant farm workers and their families. During the day the unit typically parks south of here in Crescent City, FL and serves a primarily Latino population working in the ferneries. These patients usually speak little or no English, and many have questionable immigration status, which provides many barriers to accessing health care.

We are also working a clinic on Monday evenings which services the migrant community around where we are staying, in Hastings and Armstrong, FL. This population of migrants is typically single African American men who work in crews, following the crops and living in camps that are located on the farms. I have greatly enjoyed working with both populations, but the Hastings and Armstrong clincs are my favorite, simply for the fact that language is not a barrier and I am able to learn more about the patients and their lives.

I am also very grateful that we have encountered so many wonderful people down here--the staff we work with obviously care very much about the patients and are constantly working hard to make the lives of others better. We have also been warmly welcomed by Ms. Margaret, who is hosting us in Armstrong and used to do farm work with her family. The entire community has welcomed us and allowed this to be more than just a 9am-5pm experience.

I don't want this to be a novel so I'll post more about our out-of-clinical experiences at a later date. Stay warm while we're working on our tans :)


Sunday, October 10, 2010

Inupiak Eskimos still practice Subsistence Hunting along the Arctic Ocean

Welcome to Barrow, Alaska. The most northern land point in the United States (320 miles north of the Arctic Circle) and one of the most northern towns in the entire world. Nearly 4,000 native and non-native Alaskans live in Barrow along the Arctic Ocean where temperatures stay below freezing from early October to late May. During summer months the sun remains in the sky, providing 24 hours of daylight; however, in the wintertime the sun sets below the horizon and isn't seen for more than 2 months.

The Inupik people have retained their native culture and language. Their heritage is centered around 12 core Inupiat values, one is hunting traditions. Elders teach their children about hunting for arviq (whale), tuttu (caribou), keviq (seal) and gathering kavirliq (cranberries). Every spring their people load their hand-carved boats onto sleds and begin pushing them across the pack ice to open water. A crew of four to eight men then paddle out to sea in search for the great Bowhead Whale, a centerpiece of the culture, traditions, and their main source of food.

Subsistence hunting and gathering are these people's means for living off the land, taking only what they need for survival. Their ancestors have taught them respect for the land, sea and animals. Taking a whale is extremely spiritual ritual. They say the whale can see the Inupiat's kindness and will sacrifice itself for a village and will allow the people to hunt it. Once the whale is taken, the whale's spirit is kept alive as a bright flame within a lamp tended to by an innocent girl. The Inupiats keep this flame alive so that the whale spirit may tell other whales of the people's kindness and its good treatment, persuading other whales to sacrifice themselves to the village in following years.

Since 1982, there has been a moratorium on whale hunting (with the exception of highly regulated hunting by indigenous people). The whale population was devastated by commercial whaling. Today many environmental agencies provide research for establishing appropriate quotas for the Inupiat hunters to follow. During this fall whaling season Barrow is allowed to take 12 whales (Estimated bowhead population is 12,000+). Other Inupiat villages are allowed smaller quotas or sometimes only allowed to hunt in spring or fall but not both.

The whales range in size from 20 to 50 in length. The largest have been recorded to weigh just over 100,000 pounds. It takes an entire village to move the whale out of the water and begin cutting the maktak (skin and blubber) into slices for storage. It is extremely healthy to eat every part of the whale except the liver. Even the remains are not wasted. some is turned into dog food or else hauled out of town for the Nanuq (polar bears) to eat.

Eating a diet rich in subsistence foods is extremely healthy. The all natural diet contains the correct amount of proteins and fats as well as adequate vitamins and minerals. Fish and whale are high in omega-3s and iron and berries have high amounts of vitamins A and C and plenty of fiber. The Inupiats absorb a majority of their vitamin D from their fish, a benefit when the sun is absent for most of the winter. Prior to encounters with Caucasian people, the Inupiak Eskimos had some of the lowest rates of cancer, diabetes and obesity in the world. But after being introduced to cigarettes, alcohol, processed foods and soda, the Inupiak way of life and good health are drastically different. These people are loosing their way of life and whaling is all they have left.

Saturday, October 9, 2010

Flu Season

Briana and I are wrapping up our experience in school health nursing at Gila River. All the health screenings are completed except for the private school St. Peters in District 5, which we are doing this upcoming week. The results of the screenings were shocking. 85% of the students in high school are obese based on their BMI results. Around 53% of the middle school students in District 3 were catagorized as obese based on their BMIs as well.

Since the flu season is beginning our next project is sending home the parental consents for all the students to recieve a flu shot. Gila River provides students with the oppurtunity to recieve the flu shot at school. This makes it more convient than the parents having to take their children to the hospital or the clinics. This way more children are immunized. Cemile and Delissa will be taking over this project as we switch to public health on October 18th.

This week I also got a day with the middle school nurse, Gloria, in District 3. Gloria works at the middle school 4 days a week and next door at the high school on Fridays. She was a good teacher and role model for me. She supervised me while I adminstered the medication to all the kids and provided basic care with bandaids and basic assessments. I hope some Friday I will be able to go with her to the high school. She explained the high school has a total of 64 students. Most of these students were previous drop outs that returned to recieve their diplomas. The teachers work one on one with the students. Some of the young women have returned to school after having a child. The school accomidates these girls by allowing them to bring their babies to school with them. The even have a life skills coach that shows them how to interact with their babies and other parental skills.

This Friday was the kick off to Race for the Cure. There was a celebration with informational booths about breast cancer and a mobile mammogram unit. Pima Basket Dancers performed and crafts and photos were provided. Briana and I volunteered with Renee, our supervisor, at this celebration. Tomorrow all four of us will be waking up at 4:00am to volunteer at the Gila River booth at the actually race in downtown Phoenix.

District 5 PHN

This past week was busy for Lisa and I. We were out in District 5 and spent most of the time with Shannon, who is the RN for that district. She had us do the assessments, vital signs, medication pick-ups, appointment set ups, and charting. I felt that I was more of a nurse in training than a student nurse, which is a great feeling. Sometimes it was hard to fit in everything we needed to do in a day, but some how it did come together.

One home visit stuck out the most for me. We went to visit an older woman at her house for a check up. When we got there, she immediately said that she was not feeling well. After talking to her, we found out that she ran out of her medications that day. We also took a blood sugar and found that it was high, so we told her to take her insulin in the hopes that this was what was causing her to not feel well. As this was all going on, Shannon realized that this woman's grandchild had lice in her hair. We encouraged the grandmother to cut the hair because this was an issue before. The single visit now turned into two visits. Before we left, we told the family that we would get refills for the grandmother and get Nix (lice treatment) for the granddaughter. Later in the day, we stopped by to deliver the medications. When we got there, we noticed that the grandmother had cut her granddaughter's hair. We gave instructions for the Nix treatment and made sure that the family was capable of doing the treatment. When we asked how the grandmother was feeling, she stated that she still did not feel well. We retested her sugar, which was still high but did come down a little bit. We asked if she was able to take all her blood pressure medications for the day. She stated that she did not take a couple. We told her to take them now and see how she feels in the evening. If she was still not feeling well by that time or even the next morning, we encouraged her to go to the hospital to get checked out. Shannon told us that she will follow-up with this family on Monday to see how the grandmother is feeling and to see if the Nix treatment was done and working. From this visit, I have learned that your purpose for it can change at any second. You might be going to assess one person, but since that person is part of a family unit, you might end up assessing the family too. I also learned that sometimes the best kind of medicine is just encouragement and assistance.

On Friday, Lisa and I helped out at the Elder's Picnic. We were mainly there to give flu shots, but the CHR (community health representatives) were there to take vital signs in the morning before the activities started for the day. This picnic started with a walk, then a mini breakfast. After that, the elders could participate in a variety of activities including chair volleyball, chicken toss, bowling, bean bag toss, and horse shoes. Everyone seemed to be enjoying themselves. The event concluded with a lunch. At the end of the day, Lisa and I were pros at flu shots (a total of 23 shots were given). We gained confidence and experience!

This coming week is our last week with public health nursing. Starting on October 18, Lisa and I will be in the schools. I am looking forward to this change, but I think I will miss the staff from PHN who made the experiences worthwhile.

Tuesday, October 5, 2010

Bethel, AK: The Last Frontier

Bethel, Alaska, a community of nearly 7,000, is located on Kuskokwim River near the southwest coast of Alaska. Many refer to this and several other areas of Alaska as the Bush because they are only accessible by plane, boat, ATV or snow machine. Comprised of 62% Alaskan Natives, Bethel is an ever-constant growing community.

My experiences so far have been more than I could have imagined. On my two village visits to Newtok (Population: 321) and Chuathbaluk (Population: 120), the Public Health Nurse and I performed tuberculosis skin tests to all of the school children. We also provided the village community with access to immunizations, STD examinations, well-child checks, and education including suicide and STD prevention. In addition, with flu season nearing, I educated the school population on proper hand hygiene and flu prevention. In educating this population, I tailor my teaching to their availability of resources; running water and soap are hard to come by in many areas of this region. When all of your supplies are either shipped in by plane or barge, prices of resources are much more expensive than we would find at home.

While working with this population the greatest challenge non-natives face, especially in delivering health care, is trust. One nurse tells her employees that if there is one thing you can accomplish in your first two years as a public health nurse it is developing trust. Building trust with the native population is critical in your success as a health care provider.

Aside from providing care, my favorite experiences so far have been salmon fishing on the Kuskokwim River and traveling into the Kuskokwim Mountains in Chuathbaluk. I have been told that I have only scratched the surface of what Alaska has to offer, and I am so excited to see what else this beautiful country has in store for me.

Monday, October 4, 2010

Public Health @ Gila River

WOW! I never imagined that public health nursing could be so exciting!  I have been at the Gila River Indian Reservation for about three weeks working directly with the nurses to improve the health of the community.  This field of public health nursing extends far beyond health fairs, but provides the opportunity for the nurses to go into the homes and reach even the toughest patients.  This past Wednesday I went on a home visit with the nurse in District 4 to do a routine visit to prepare medication.  Although she had a multitude of health conditions including being legally blind, I noticed that her television set was on the food network.  I ended up sitting and just talking with her about the joy that cooking use to bring her and my personal desire to go to pastry school in the future.  She seemed very delighted to talk about food! I am certainly happy that I was able to be part of the reason why she had a huge smile on her face by the end of our visit.  

Along with the opportunity to meet and care for patients, I have been able to build a nice relationship with one of the Community Health Representatives named Marceline.  Her and I have the same love for a traditional Native American Dish called Frybread, also used to make an Indian Taco.  Simply explained, Frybread is pretty much HEAVEN deep fried in dough! Each time I am paired with Marceline we head straight to the vendors for lunch.

I am really beginning to admire how dedicated the Gila River nurses are to advertising the flu vaccine to all community members.  Some of the nurses carry the vaccine around with them, making it a point to teach and vaccinate all willing participants.  If these nurses are so passionate about getting as many people vaccinated as possible then it must be a really important thing to do.  I just might sign up to get a flu shot after all.         

Friday, October 1, 2010

School Health in Gila River

Over the past couple weeks, Olivia and I have been working with School Health Services. We have gone to four schools assisting with health screenings, which involved doing height and weight measurements, scoliosis checks, blood pressures, and hearing and vision screenings. In doing so, we have gotten a better understanding of the paperwork and filing involved in school health. For each student, a record sheet with the results from the health screenings must be completed, then those results are transfered to a referral form to be sent home to the parents. If the child does not pass the vision or hearing portions of the screening, an additional referral to the clinic is sent home. Next, all of the results from the screenings must be recorded on a database. Finally, each child's results are placed in his or her file. With each school having at least a hundred students, one can only imagine the amount of time and energy required to complete and file all of the paperwork! Though the work can be long and tiresome, it's great to know our efforts are really helping the school nurses.

In the upcoming weeks, I will be finishing up with screenings and starting flu vaccinations in the schools. I have also planned to work with the Dental Department, making visits to schools on their mobile unit. I hope to team up with OB and Family Planning, but I have not yet gotten an approval from Renee.

Being on the reservation requires a little adjusting. I never realized how much I depend on the internet until we got here. We do not have internet in our house, so we must drive about 25 minutes to the nearest city for a library, cafe, or Barnes and Noble. Surprisingly, although we don't have internet, the health care field utilizes a lot of technology. All patients have an electronic health record, and the charting system is pretty advanced. Another thing I had to adjust to was driving everywhere. Living on Campus at Case, I am so used to walking everywhere. Here, however, you rarely see people walking around. With all this heat, maybe it is for the best!

Gila River Week Two

During our second week here at Gila River, Briana and I continued to work in School Health while Cemile and Delissa worked in Public Health. There are seven districts total so there are many schools to visit. Over the past two weeks we have screened approximatley 650 elementary and middle school kids' hearing and vision. It has been hard and long hours, but very exciting and rewarding.

One of the nurses caught a young man with a heart condition after we took his heart rate and blood pressure during the screening. He would have never know he had a bad heart and the outcome could have been very different if we had not provided these screenings in the schools.

Later in the week we visited Blackwater Elementary doing the same thing. However, the process was interupted when the school had a lock down. Later we found out a man with a gun had been on the reservation looking for a school. It was an experience I never would have guess I would have, but it is a reality in the world we live in today. It was interesting to see the protocols and procedures taken at the school. The children actually left school early so the school would not be liable. All the teachers and staff worked collaboratively to keep all the children safe, and no one was harmed.

This weekend we will be attending a Rodeo with our supervisor, Rennee, and visiting the Grand Canyon. We are all having a wonderful experience out here and are loving the warm weather!