Thursday, September 29, 2011

Catholic Charities

Tessa and I have been working at the Catholic Charities in Pittsburgh for almost a month now and it's much more than I expected it to be. Rarely have I see any doctors office or organization as organized as this place is run and it's run primarily by volunteers. At most hospitals or doctors offices you often see people who are not excited or happy to be there and therefore are not very friendly at all. But at Catholic Charities I've never been around a group of people that were so nice, friendly and happy to be where they are.

The patient population at Catholic Charities ranges from the homeless to people that just lost a good job and even some people who are making decent money but not enough to meat their means and lack insurance. Every patient that comes in is more than grateful and appreciative to the care that they are receiving and there's nothing more rewarding to me that being able to help someone that really needs and appreciates my help.

At this capstone Tessa and I take the patients back, get vitals, a history and general complaint. We then follow the doctor back during the appointment, go over the plan of care and direct the patient so they can get any labs, tests or follow up that they need.

I've had such a broad experience when it comes to doctors and patients because at this site we are offered to follow general medicine doctors, gyn doctors, endocrinologist's, eye doctors, podiatrists, cardiologists, psychiatrists and nurse practitioners.

So far I've seen everything from diabetic foot ulcers that were as round as soup can and 2 inches deep to something we commonly see such as a heart murmur.

Tessa and I are learning a lot and both feel we are lucky we are able to have this experience.

Sunday, September 25, 2011

there's more to a patient than meets the eye...

Prior to my time at the Catholic Charities Free Health Care Center, when I thought of a free health care clinic, the patient population that came to mind did not include college educated engineers, lawyers, businessmen or medical professionals. In fact, I envisioned quite the opposite… homeless men and women, people who are either unemployed or working at minimum wage, or who are disabled. However, that assumption has been completely dissolved. The Catholic Charities Free Health Care Center of Pittsburgh is a unique organization. It is the only Catholic Charities in the nation that has a healthcare clinic. The religious focus and mission of the clinic also provides a distinctive focus to the care of patients.

One of my favorite aspects of working at this clinic as opposed to a “typical” healthcare facility is that no one is in a big hurry… neither the providers nor the patients. I hate having to rush a patient through assessment just because medications are due for another patient or a call light is going off. Also, if we are running a bit behind in bringing patients back to be examined, they don’t get offended or upset! They truly appreciate the service that the clinic is providing and are as patient as can be J This is great because our physicians are between 70-90 years old and definitely work at their own pace!

As the nurse, or in our case, nursing student, we are the first ones to see the patient when they arrive. There are four exam rooms at the clinic and so we lead the patient back to one of the rooms, take their vital signs, and ask for a description of why they are here for an appointment. It is wonderful to be able to take as much time as necessary for the patient. The nurse then documents the findings in a nursing note and communicates the information to the physician and pharmacy students. There are three 6th year pharmacy students from Duquesne University who are doing a clinical at CCFHC. They are great resources for finding out which medications are on the $4/$10 plans at Giant Eagle!

I had a particularly touching patient encounter last week and I’d like to share it J. This gentleman was in his late forties and was a new patient to the clinic. I greeted him in the waiting room and invited him to come back to an exam room. He and I sat down and I asked him to tell me why he was seeing a physician today. Being an astute nursing student, I was surprised to notice he was very well-dressed with a Chaps polo shirt, crisply ironed Dockers slacks, and a large expensive-looking wrist watch. However, his explanation was more than enough to justify his appearance. Openly, he told me his story: he had been a successful lawyer who had worked his way up the ranks and finally lead his own firm, catering to national clientele. After ten wonderful years, he was indicted by one of the companies his firm was representing. He was sentenced and served seven and a half long years in the state prison. After many attempts to repeal the conviction, the senator of the state of Pennsylvania finally got involved and it was determined that it had been a wrongful accusation. This man had missed out on almost a decade of watching his children grow up due to a simple misunderstanding. He was no longer outwardly angry about the ordeal and expressed his anxiousness to get back on his feet and rebuild his company. I was very impressed by his composure and humble outlook on his situation. He had gone from making a six-figure salary to being without insurance and needing to strictly budget his finances. The case was in the process of finishing the paperwork to clear him of all charges and once that is over, he will get monetary compensation. However, until then, the CCFHC is a resource that he will use to get his life and his health back together after not seeing a physician for the past eight years. Fortunately, after our comprehensive assessment, the patient had no immediate health concerns. This story just goes to show that assumptions are no substitute for real people, real lives, and real experiences!

I feel blessed to be able to have this opportunity at the clinic and I look forward to sharing more stories!

Thursday, September 22, 2011

Hong Kong Hospitals

During our first month in Hong Kong, Alexa and I have learned so many new things! It is so fun exploring the city, and we have found it very easy to make observations related to health care. First, there are signs pretty much everywhere you go reminding you to cover your mouth when you cough or sneeze. There are also sinks in a lot of public areas so that people can wash their hands. It is very common to see people walking around either with a mask on, or covering their nose and mouth with a tissue. We have also learned quite a bit about traditional Chinese medicine in one of our classes, which I can say is very different than Western medicine!

We got a tour of Queen Mary Hospital, which is the teaching hospital for HKU. QMH is a 1,500 bed hospital that serves 3 of the 18 districts in Hong Kong. It is the most comprehensive of the 7 hospitals in the surrounding area, with 60 wards and 19 different specialties. There were a few things that struck us, not only in the hospital, but also in the way nursing works here. One thing that is different about nursing itself is that nurses must work for at least five years before they can specialize is anything. Pretty much, they must work on a general medical or surgical floor before moving to a different area. Another interesting thing is that nurses can train at the hospital and not go to a university. This three year program requires the nurses to live in dorm/apartment style housing right on the hospital’s campus for their first year as a nurse.

One of the biggest differences that we have found in the hospitals here is that there are different units for male and female patients. It is extremely uncommon for a male nurse to care for a female patient, and mostly male nurses care for male patients. One of the units we had a chance to visit on our tour was a holding floor for patients who came to the emergency department and need to be admitted. The unit was mixed with both genders and the nurses expressed how uncommon this was and that it was against their culture. We found this very surprising, as patient’s genders do not usually play a role in nursing assignments back at home. Another interesting thing was the way the units were set up. There are no private rooms, and the curtains that are there to provide privacy are always open. It was basically just one big room with a bunch of beds! The beds were all very close together and when a doctor or nurse was talking to a patient, everyone in the vicinity could also hear their conversation. They do not use much electronic charting, but there was one computer that showed patient records and x-rays. This computer was not hidden at all, and at least 3 patients could easily see the screen. They have patient confidentiality rules here, but they don’t seem to be as strict as ours. One other thing that was interesting to us was that there was only one sink on the unit, which had 27 beds. We found this to be a potential problem for many different reasons. All of these things were interesting, but I think we got the biggest shock when we heard how many patients a nurse usually has each shift. On average, each nurse is responsible for ten patients!! This number can be increased to fourteen patients, depending on how busy the day is.

We are meeting with our project facilitator today and look forward to finalizing our project! We plan to try to improve the social skills and acceptance between Chinese children and ethnic minority children using a fun and interactive game that will allow the children to share things about themselves and get to know their peers. Until next time!

Tuesday, September 20, 2011

Wuhan, China

Beep beep! Yes that is the oh so familiar sound of cars and mopeds honking at pedestrians to move even though the pedestrians have right of way. In China, there is no such thing. We must dodge cars and take two buses in order to get to the traditional Chinese medicine clinic, a journey that takes about an hour. When we finally get there, the first thing that we do is get breakfast at this small shop that sells fried bao zi (pronounced "bow dzuh") which are buns with meat inside. They are delicious and only cost us about 30 cents! Most of the food here is very good (and cheap), and you would love it if you like spicy food which seems to be their forte. Unfortunately, I cannot handle spicy foods well but their food is nevertheless extremely scrumptious.

For the past three weeks, we have observed so many great things at the clinic! Acupuncture is the most common treatment with needles that can be placed pretty much ANYWHERE...We have also seen and even done cupping which was a really neat experience. The feeling is so weird! I could literally feel my skin being pulled into the cup! Other treatments include moxibustion which is where herbs are burned in a box and placed on the affected area with the belief that the vapor will carry the medicine through the skin and throughout the body. Steam treatments are very similar except patients lie supine on a bed with holes from which the steam exits. The most common indications for these treatments that we have seen are pain and paralysis or weakness as a result of stroke. It is very hard to communicate with the staff members and the patients, but luckily the other students have been so kind as to help with translating!

In our free time, we have dared to venture off on our own to explore. We have found a movie theater which we have yet to experience and a square plaza where numerous couples dance every night! It's the cutest thing! We have also visited the Hubei Provincial Museum which has a lot of interesting things, but it is so huge that multiple trips are necessary in order to see its entirety. I hope to see other famous sites such as the Yellow Crane Tower and even the Great Wall in Beijing.

In general, people are extremely friendly, welcoming, and honest. They all seem very excited and eager to speak with foreigners as if they want to practice their English. In the shops, they follow us around maybe to make sure that we're not shoplifting or maybe they just want to be at our immediate assistance. Who knows. We also learned how to play mahjong, a game that you may see installed on your computer. However, traditional mahjong is a 4 player game, one that is super fun! We bought our own sets to bring back home! I'm eager for many more adventures to come and for our project to go smoothly. Hopefully the language barrier won't keep us from obtaining the appropriate information, so we will have the students help us as much as we can. Until next time!

Monday, September 19, 2011

Juneau, Alaska

For the past five weeks I have been living in beautiful Juneau, Alaska. It is the third largest city (about 30,000 people) in all of Alaska, and the closest to Seattle of the top three. There are no road systems entering or exiting Juneau, therefore the only way in is by boat or plane. At the moment, mid-September, it is rain season and temperatures range from 50 to 60 degrees each day. Locals are already warning me about snow flairs in the near future! The public health center, staffed by approximately 15 people including 8 public health nurses is responsible for a large portion of the Southeast part of Alaska (Closest to the State of Washington). I am currently working primarily in the Juneau Public Health Center with walk-in patients, home visits and teen clinics in the area but also traveling throughout the villages only reached by ferry or bush plane to get a better sense of the distinctive living strategy’s and strengths of the village lifestyle.

My first trip was a three day stay in the rural village of Hoonah. After the trip and soaking it all in, I was really able to sit down with the itinerant nurse and get a sense of the culture. The Juneau public health center presently only has one itinerant nurse who does all the travels and averages one village every two weeks. While only at the villages for a short time, she and I are responsible for working with the Public school systems, City Hall, the Senior Center and as well as partnering with SEARHC, which is a well known non-profit tribal health consortium that serves 18 Native communities in Southeast Alaska. When appropriate and scheduled the itinerant nurse and I will help the local clinic will immunizations, well-child exams and referrals to see appropriate specialists. As well as provide STD screening, pregnancy testing, family planning and other important public health services. While in Hoonah, we held smoking cessation classes in the City hall, blood pressure readings at the Senior Center and met with schools officials about exercise and nutrition. I even led Zumba and Salsa dancing activities at the Youth Center and local hotel.
Even during my short visit to this village, I felt very close to the natives and will never forget.
Other exciting opportunities that I have already had the pleasure to observe and participate in include: Whale watching (got to see humpbacks, killer whales and sea lions!), first ever helicopter ride/tour (future flight nurse?!) - where we landed on a glacier that extend 1500 square miles and hiked up it two miles and first ever bush plane flight to rural villages. I also had the chance to meet the Governor of Alaska at a community picnic, meet a few flight nurses from Guardian Life flight who travel the whole state and hike and mountain bike up the famous gold mining trails. Finally, for the people that know me best, I had to bring my love and passion of Latin/Salsa dancing to Juneau, Alaska where I have started to instruct Salsa and Zumba classes to local youth groups, high schools and downtown outings =]
Love and miss you all.

Week 1 at CCBH

We have just begun our second week here at the Cuyahoga County Board of Health (CCBH) and I realize that there is so much to do and see here! Last Monday was our orientation day where several staff members working in different areas came to talk to us about what they do. We heard about the Help Me Grow program and learned about home visiting nurses and what they do. We learned about BCMH which is the Bureau for Children with Medical Handicaps.

Our coordinator, Sandi, had us meet with several different staff members afterwards and set up dates to shadow them. Throughout  our time at CCBH, we will get to work in the Family Planning clinic, inspect restaurants with the sanitarians, go on newborn home visits, and observe in the immunization clinic. The big project Sandi would like us to do is community outreach for the new family planning clinic which we will get to work in as well. We will be running a kiosk at the Tri-C western campus as well as distributing flyers, cards, etc in the areas surrounding the clinic. We are going to try to target areas where teens and people ages 18-25 hang out because this is a high risk population. The clinic is run through grant money and needs to increase the amount of patients in attendance in order to keep receiving grant money.

On Thursday, I went on my first home visit to check up on a week old newborn who's mother was very low income. The nurse and I drove down to a house in East Cleveland where we met the mother and her week old newborn. When I first walked into the house, I couldn't help but notice how extremely empty it was. There was not even any furniture which was an eye-opener for me. This family clearly did not have much money to begin with and I could imagine how the expenses of the baby could make things very difficult.

The nurse began the visit by confirming that the the patient's info in the computer was correct and asking the mother some additional questions. She got the pulse, BP, and temperature of the mother right away. She then gave the mother a few surveys to fill out including a post-partum depression risk assessment. While the mother was busy filling out paperwork, I watched the nurse do a full assessment on the baby. After that, she tallied up the score for the depression assessment and went over several useful papers that were provided to the mother. The mother actually told us that she lays the baby on her stomach! We took the opportunity to educate her about the risk for SIDS and emphasized the importance of laying the baby on her back to sleep.

So far, we have been brainstorming ideas for our community outreach and planning observation days with different departments. This Wednesday, Abby, Hannah, Mary Clare and I will be going out with the sanitarians to inspect restaurants in the county. After just a week, I can't believe how much the board of health does. I had no idea there were so many different community needs being handled here!

~Jill Belsan~

Hong Kong

We have been in the beautiful city of Hong Kong for almost a month now, and we have seen so many amazing sights! After almost thirty hours of traveling and arriving to a foreign country, it's safe to say that we had a little bit of culture shock. There are so many little details about Hong Kong that are so different from home. From the fresh fruit, meat, and live fish being sold on street corners, to all of the skyscrapers that line the waterfront, this city is so unique and bursting with culture!

We have had the chance to have not just one “clinical site” but also multiple areas in the city to observe. In all of the areas that we have visited, one common health problem that we have noticed is a large amount of people smoking. It is mostly just seen as people are walking down the street, for it is prohibited to smoke in restaurants and many other public places, like at home. There are an abundance of "No Smoking" signs posted in various areas. We also noticed yesterday while in the MTR subway station that cigarettes being sold had health advisories and pictures of lung cancer on and x-ray and other various consequences of smoking. I thought this was really cool, for it made me even more disgusted in smoking. This should certainly be used at home!

While working with a professor at the University of Hong Kong, Kim and I were able to attend an event with ethnic minorities and Chinese children that he had been working with. In Hong Kong, there is a large amount of immigrants from other nearby Asian countries. There seems to be a lack of social harmony between locals and immigrants, which is especially tough for the school-aged children. We had the chance to observe, interact, and interview the children at this event. We noticed that the children only played with others of their own cultural background. When discussing this with some of the Pakistani children, we learned that some of them are in classes that only have one or two other students of their cultural background, which leaves them feeling uncomfortable and unwilling to make friends with the Chinese children. It was really interesting to hear this, because a good amount of the ethic minorities that we interviewed were in fact born in Hong Kong. This provides question to where this ethnic divide stems from.

We have so much more to learn about this social problem in children. There are so many opportunities to observe this problem and the other health problems that are common in Hong Kong. It has been such an amazing experience here thus far; so more updates are to come!

Sunday, September 18, 2011

Fun with Chinese Medicine

Ni hao from Wuhan, China! It has been two weeks since we’ve been here, and we’ve already seen and learned so much. To be honest, since I had read that Wuhan was the 8th most populated city in China, I had expected it to be more urban and developed like Hong Kong or Shanghai. Perhaps this wasn’t the most intelligent assumption, but I didn’t really think too much about it. Perhaps I was just assuming that since China has been working on becoming a superpower in the modern world that it would be more like the United States. I was wrong. China is a country that seems to be somewhere in between developing and developed. There are certainly aspects that are very modern – they have similar technologies, there are some stores that sell expensive, brand-name clothing, there are some who drive very nice cars, and there are American fast-food chains in some areas. However, the streets are dirtier, there are many very small shops with dusty products or little trinkets, people spit on the streets, and traffic patterns aren’t as orderly as in the states. So far, however, all of the people have been extremely friendly and helpful, and I love exploring around the city. In the clinic we have been going to, the equipment is not as modern, and they don’t have the same ideas of hygiene, but it is a very nice clinic and so different from anything I’ve seen in the US.

Fortunately, we have had the opportunity to see very many different kinds of Traditional Chinese Medicine treatments since we’ve been here, and that is definitely the most interesting part of our time spent here. Before I had ever seen acupuncture, I had an image of it being done on someone’s back. The first two people I saw with acupuncture being done in the clinic, however, had needles all over their faces. Needless to say, it looked a little scary. It was unbelievable to think that the doctor knew exactly where and how to place the needles so that they would touch specific, effective points without causing injury to the person. Not only have we seen acupuncture being done all over the body, but we have had the chance to see cupping, massage, moxibustion, steam treatments, and traction treatments being done as well. We even got to practice doing cupping on each other! Cupping is often used to pull poisons out of the body in order to rebalance the body’s blood and qi (pronounced “chee”), and many people receive it as an adjunct to acupuncture or alone as a means of pain relief. For cupping to work, one must first place a cotton ball into alcohol. The cotton ball is on a metal stick and is then lit on fire. Next, the flaming cotton ball has to be put into cup (made of bamboo or glass typically) very briefly and immediately placed on the skin in order for the vacuum to be created and the skin to be sucked up into the cup. The doctor or nurse then leaves the cups in place for a few minutes (or for as long as 30 minutes sometimes). When the cups are taken off, red or purple circular marks are left on the skin and usually disappear within a few days.

Intrigued to see what cupping felt like, I nervously had cups placed all over my back. It was a very strange feeling, but it was so neat! I could feel my skin being sucked up into the glass like someone was pulling on my skin at first, and then it hurt a little. After a few minutes they took the cups off, and it felt so relieving to have them removed! Although I had the same red marks all over my back, I knew they would go away in a few days. That has definitely been my favorite experience so far, and I think it is the one that helped opened my eyes the most. Actually experiencing the treatment will allow me to be more empathetic in the future toward the patients who use it at home or seek the treatment at a specialized clinic. My eyes had been shut to the Eastern world and its different forms of medicine, but now I already have a greater appreciation for the amount of knowledge it takes to provide that care as well as how effective it can be for some people. I can't wait to experience more!

Saturday, September 17, 2011

Case for Community Day at Michael R. White STEM School

This past Friday, Case for Community Day had made a great impact on Michael R. White STEM School. This school has been chosen as a Capstone site for myself along with three other senior nursing students. Now one may ask "What is a STEM school?", and I had the same question myself. To be a STEM school means that there is special emphasis placed on curriculum in Science, Technology, Engineering, and Mathematics...hence the S.T.E.M acronym! What is so unique about this type of course work is that our own school has joined a special partnership with Michael R. White to help bring forth these educational needs to the children. Michael R. White is one of the few schools in the Cleveland Metropolitan School District area that has been selected to participate.

What brought forth the idea to help create a Capstone site at Michael R. White STEM School, is that this school has a community garden and greenhouse located behind the school. Members of the surrounding area have dedicated many hours of hard labor to help create and sustain this large (and impressive) garden: there is a plethora of peppers, corn, cabbage and even eggplant! One of our group members even took an eggplant home to make Eggplant Parmesan- yum! One of the first visits our group had at Michael R. White, was assessing this greenhouse and planning on how we can create a learning space and incorporating STEM educational requirements for the children. This is when Case for Community day had come to the rescue.

Now, the greenhouse was dirty to say the least and there was a very slim chance that all 4 Capstone members could get this greenhouse cleaned up and presentable by our goal date of this upcoming Tuesday- for the school's open house. Thankfully, a group of 19 volunteers were present to do major work on this greenhouse site: members from various communities, faculty members, and students all rolled up their sleeves and dove right in to the tasks that lied ahead. The volunteers were enthusiastic to see the community garden and were astonished to see the various plants that were growing. Within the time span of three hours, the windows were clean, the bathrooms had been painted, and all of the trash/useless items had been thrown away! We were also able to lift this heavy chlorophyll model and put it on table: it was eye catching and I knew that this was a great starter piece to create a STEM learning environment.

The principal of the school, had stopped by to check on the progress and her facial expression was priceless: she was grinning ear-to-ear and kept repeating "WOW, look at this place! It looks so clean!". The children of the school had come to check out all the commotion and were so giddy to see that this space was now fully functioning. They were curious about the chlorophyll model and had no clue that it was even in the greenhouse. When we plugged in the model to the wall, it rotated around and light up. The children LOVED it! They stated that they were looking forward to having classes in the greenhouse and couldn't wait for more people from Case to come back to visit. It was a gratifying feeling, to know that the children were so enthusiastic about learning and utilizing this space.

Overall, I believe that Case for Community Day served as a major steeping stone to help Michael R. White. By utilizing the greenhouse , and bonding with the members of the faculty and children we were able to see their true passion for learning. I was honored to be apart of this experience and I can't wait for more events that are going to unfold. It is going to be a great school year.

Friday, September 16, 2011

Case for Community Days

Throughout my capstone project I am going to be working in Michael R. White and our focus is to address what can be done to improve the health of the students by exploring changes in nutrition and physical activity during the school day. Michael R. White is an elementary school that was recently named as a STEM school which, stands for Science, Technology, Engineering, and Mathematics and the school is looking to enhance the curriculum by focusing on these subjects. As senior nursing students the school principal asked if we would help clean up the greenhouse. The school has a large greenhouse behind the school with about an acre of community garden surrounding it. The greenhouse was in need of cleaning so it could be used as an additional learning space and showed off at the school open house. As a result, we partnered with Case for Community Days and had several volunteers help clean and organize the things in the greenhouse. This was a great experience. We had students from several different majors come together to make a difference. We were able to clean up the greenhouse and by the end of the day it looked a lot better. The principal brought a few of the students over to help at the end of the day. It was really neat to see how eager the students were to help us. It was the first time some of the students had seen the greenhouse and they showed a lot of interest in the greenhouse. I am excited for the school to be able to use this space for teaching or other functions.