Moultrie Farmworker Healthcare Program

By Robbin League and Kiersten Roesemann

The Moultrie Farmworker Program serves both migrant farmworkers and their children. Migrant farmworkers come here on a special visa called an H-2B visa which allows them to work on a farm in an area that was unable to hire residential workers. They fill an important gap in human capital and without them you’d be hungry. Oftentimes they leave their families and their home country and go months or even years without seeing them. In addition to emotional stress, they also face multiple challenges such as long work hours, sub-optimal working conditions, and limited access to healthcare. This benefits not only their families but your families across America. 

The interdisciplinary team that comes to Moultrie for two weeks every summer seeks to alleviate some of the physical and emotional pressure that is inherent to these individuals. For some, this is the only interaction they will have with the healthcare system while they are in the United States. By the end of week 2 we were able to do more than 300 well-child exams, and provided episodic care about 300 farmworkers. While this is a small drop in the bucket, we hope to have alleviated some of the discomforts faced by this population during our time in Moultrie.

Each discipline was able to expand their cultural and clinical horizons during our time here and we feel grateful and humbled by this experience.

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Eleuthera, Bahamas-Day 1

Boarding the flight to Eleuthera

After 5 am wake ups, we were all eager to begin our day of travel. Our first stop on our journey to Eleuthera was Nassau – the capital of the Bahamas. Nassau is a city on the island of New Providence and is a popular destination spot for tourists. As we would also soon learn, it is also where the closest major hospital to Eleuthera is. Critically ill patients on Eleuthera must be air lifted to the hospital, or if they are stable enough, they can take a commercial flight or boat ride (ranging from 2-3 hours long). Once it was time to board our final plane, we got a nice walk in some rain showers and then loaded up. The flight to Eleuthera was only 30 minutes and filled with amazing views. Then finally – we arrived! Eleuthera is what is called a “family island,” which basically means it’s a small, tight-knit, and non-metropolitan island. The island itself is very long and skinny – 110 miles long and only 1 mile wide. From the north to the south, there are many small settlements that we were going to be spread amongst to work in the clinics. The northern group would be split amongst the Lower Bogue and Bluff settlements and two small islands associated with Eleuthera – Harbour Island and Spanish Wells. The Southern group would be split amongst the Hatchet Bay, Palmetto Point, Rock Sound, and Tarpum Bay settlements.

When we first arrived on the island, we were driven to where the Southern group would be staying – a mission house in Tarpum Bay right on the ocean. We were introduced to Audrey, Vince, and Andrea with Island Journeys, the non-profit organization that would be facilitating our stay. Island Journeys organize sustainable development-oriented trips in Eleuthera and also work with locals and partner organizations to, according to their website, “rebuild and transform island communities.”  Audrey gave us a quick history of Eleuthera and the Bahamas and introduced us to the space. We learned that Eleuthera means “freedom” in Greek and is one of 40 inhabited islands in the Bahamas out of 700 islands in total! With dinner we all got to try some conch chowder – the first of many conch dishes we would be eating throughout the trip. Finally, though we were all exhausted, we had to take a walk along the beach before bed. The beaches on Eleuthera are absolutely stunning. The water is unbelievably clear and clean, and the sand has a subtle pink tint to it. We knew we were in for an amazing time in the coming week!

View of Tarpum Bay
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Mérida Day Seven

This morning we headed to the once thriving and largest city of the Mayans, Chichen Itza. We were greeted by a tour guide who directed us to a map of Chichen Itza. He briefly explained the different architectures and its relationship to astronomy, religion and Mayan culture. Then, he led us to the entrance while we were filled with excitement and anticipation of seeing the monuments with our own eyes. Finally there it was, the Temple of Kulkulkan! This sacred pyramid caught everyone’s attention and we were in awe with this 75 feet tall marvel.

Left to right (back row): Camille Volper, Dr. Valerie Mac, Brianna Aalborg-Volper, Carly Hendricks, Tessa Shevlin, Lauren Higgins, Alex Alvarado, Ashley Pugh, Amy Yu, Roxana Chicas, Natalia Aranda (front row): Mary Schaeffer, Julia Spaar, Monica Schweizer, Megan Anderson, Tiffany Guo, Amanda Loyal, Dr. Vicki Hertzberg, Genesis Peniche

An impressive astronomic feature of the pyramid is that during the equinoxes each year, an illusion of a shadowy serpent created by sunlight makes it way down the platform. Another interesting element was that every time our tour guide clapped his hands near the pyramid, we heard a mysterious echo of a bird’s chirp. Specifically, we were told it was the sound of the quetzal, a divine bird to the Mayans. Several of us attempted to replicate this impressive sound; unfortunately, we could not execute the clapping technique correctly.

Surrounding the Temple of Kulkulkan were many other major monuments, such as the Platform of Venus, Temple of the Warriors, Observatory, and the Great Ball Court which had acoustic sounds of its own when the tour guide clapped his hands underneath the court’s rings. Again, we could not execute the clapping technique! Our final stop was the enormous Sacred Cenote –also known as the sacrificial Cenote to the Rain God, Chaac. Jewelry, weapons, tools, as well as humans, were among some of the offerings. It was clear that all monuments had social, astronomical or religious significance. Chichen Itza was a prominent ceremonial center for the Mayans. Being able to see the marvels that the Mayans constructed was definitely one of the many highlights of our Mexico trip. 

After walking around Chichen Itza in the hot sun for most of the morning, we were able to cool down and relax at the Xcajum cenote. The cenote was surrounded with amazing wildlife and a natural landscape. After spending over an hour and a half swimming around with the fish in the cenote, we ate at the cenote buffet which had some really great tacos. Following eating, some of us decided to hang out in the hammocks before heading back to the hotel.

On our way back, we decided to stop in Izamal, also known as the Yellow City. Almost every building in this city has been painted yellow.

In the center of the city is a convent and church, which was built atop a flattened Mayan temple/pyramid.  This convent boasts the largest atrium in the Americas and the second largest in the world following the Vatican atrium. Pope John Paul II visited Izamal in August of 1993 and performed a mass here during which he celebrated not only the Mayan indigenous population, but all indigenous populations across the Americas. The people of this town were very honored and erected a statue in his memory which can be found by the entrance of the church. Scattered around the city you can also find crumbled remains of Mayan pyramids that once were.

After returning to our hotel, we decided to make the most of our last night in Merida and explore the night life once more.  As some of us headed out around 9:30 pm, restaurants were just putting out their outdoor seating on blocked off roads inviting us inside. We found our way to Mercado 60, but not before stopping for the crunchy and extremely delicious marquestia filled with your choice of gouda cheese, nutella, or cajeta. Mercado 60 is an outdoor market with lots of food options and a live band.  As the live band played, people would go up and start salsaing with others to the music. Two of our very own found the courage to ask some of the locals to show them how to dance! 

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Mercy Care- Summer Immersion Trip

Today was our last day at Mercy Care and we spent the day truly observing all the services and did a windshield survey of the surrounding area and neighborhood. There were not many resources or healthy food options surrounding the clinic. The MARTA station was right across the clinic which allowed for more affordable transportation methods to the clinic. The only issue with the MARTA is the reliability because we had one patient tell us that the MARTA went off course due to a track incident which made them late for their appointment. Mercy Care offers in house dentistry, primary care, behavioral health, and pharmacy services. We valued our time in this clinic and it goes to show how much work is still needed within our healthcare system here in Georgia to provide care for all those who need it.

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Merida Day 6

Today we worked with the community of San Luis to try to prevent future flooding of some of the most devastated houses.  We were trying to help with the environmental hazards that are associated with standing water- such as providing a vector for disease and a breeding ground for pests. To help, we spent time using dirt to fill in the floors that were wet from the flooding rain. We also used rocks that were already around the houses, along with gravel we found, to create a barrier between the ground and the holes in the wall to prevent water from entering that way. Everyone had their own jobs, whether that be loading the wheelbarrow, ensuring everyone was hydrated, or carrying buckets of dirt for the community to place where they thought was best. The members of the community had expressed the day before how the flooding had severely hurt their self-esteem, but we hope that by helping them that they are empowered a bit more. In the afternoon, we attempted to teach our community partners the modules we had prepared, but it began to rain too hard to teach. However, we finished the community assessment we had started earlier, getting the chance to ask our community partners questions about things we had not gotten answered.

The question of how much to help is always a complicated one. Meeting physical needs like this was never really the intent of this trip but we knew that basic physiological needs have to be met first before anything else. With people’s houses being basically destroyed, there’s no way we could try and teach about oral health or composting and ignore those needs. So, we decided to help. Being a nursing student, I automatically default to wanting to help as much as I physically can. But, I’m continually learning that taking a step back and letting people do things on their own is sometimes just as powerful and impactful. Because of our short time there, we weren’t able to do as much as I’m sure a lot of us would have liked to. I do think we were able to meet some immediate needs and provide the community with the materials and hopefully the motivation to finish the job themselves. I’m proud of the work we were able to do today and am leaving feeling ever thankful for the opportunities we are afforded here at Emory and in the United States.

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Mercy Care Clinic – Summer Immersion Trip

by Kishauna Reid

“Like the lotus flower that is born out of mud, we must honor the darkest parts of ourselves and the most painful of our life’s experiences, because they are what allow us to birth our most beautiful self.”  This quote by Debbie Ford stood out to me today as I encountered a patient that said he was “spiraling out of control” and needed help. It was very insightful working with the psychiatric registered nurse at Mercy Care, today. In order for a patient to be admitted to the behavioral health program at Mercy Care, he/she must first complete a nursing assessment to determine medical stability and readiness to receive treatment. I assisted with the nursing assessment of this particular patient getting renewed for the behavioral health program.

During this assessment, we performed a systematic review of systems, a urine drug screen, and spoke to the patient about his challenges. The patient’s willingness to start treatment showed his perseverance through adversities. Although he knew it would be challenging, he was still willing to continue treatment because he was confident that treatment was the best thing for his health. Individuals that have mental health disorders may have many painful experiences in their lives, and when they choose to seek treatment, they can begin to let those painful experience birth something beautiful. Mercy Care’s behavioral health program includes counseling and group therapy sessions, such as substance abuse and anger management groups, case management, psychiatric visits and many other resources for the patient.

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Grady Memorial Hospital – Summer Immersion Week 1

Welcome to our final blog post from Courtney and Abbie. Over the past week we have had the privilege to learn about and interact with vulnerable populations in our backyard of Atlanta. We began on Monday by teaming up with Catholic Charities Atlanta to learn about the refugee resettlement process in the United States. We went to Clarkston to move in furniture and set up an apartment for an Eritrean single mother and her five children. On Tuesday, we went to Grady’s dialysis clinic for immigrants with end-stage kidney disease. We were able to speak with patients about their life stories, current medical condition and educate them about their disease and how to manage it. On Wednesday, we went to Clarkston Community Health Center to do patient education on colorectal screenings, help organize the clinic and price out traditional grocery lists for refugee families to get a glimpse into their financial situation. On Thursday, we went back to the dialysis clinic at Grady to learn more about the dialysis process and update patient information packets so they can better understand their disease. On our last day, we got to tour and prepare lunch at Good Samaritan Health Center for the homeless population in Atlanta.

Abbie’s favorite part of the entire immersion was interacting with patients, gathering histories, doing a grocery store assessment and updating new patient education packets. Courtney’s favorite part of the entire immersion was exploring different parts of Atlanta and interacting with populations with interesting stories and backgrounds.

Facts our group found most interesting/What our group enjoyed doing:

  • Chronic Kidney Disease of unknown etiology(CKDu) is hypothesized to be the first chronic disease that could be caused by climate change
  • Learning the importance of dialysis and its process
  • How to work with interpreter services while still engaging with patients
  • Showing compassion to all because you never know what someone has gone through
  • Importance of establishing a therapeutic relationship
  • Health Care services available to the underserved population
  • Touring Good Samaritan Health Center and seeing all the resources they offer from their own food gardens to their fitness classes
  • The process of interviewing patients in general or for a research project
  • Hearing the life stories from the patients
  • Learning the history behind Ponce de Leon and how it was the street that was the divide for segregation

That’s a wrap from week 1! Thank you to our clinical instructors and clinical partners we worked with throughout the week! Stay tuned to read stories from our week 2 classmates!

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A Peruvian Adventure

by Julie Pizzat, ABSN ’19

Welcome back to the blog! This is part 2/2 detailing our ABSN journey to Peru.

Day 7: CerviCusco and Pisco

Friday, we stayed at CerviCusco and helped out in the lab as well as the clinic. Since the clinic wasn’t very busy, we were done with Pap smears (“examen del Papanicolau”) and biometric tests by lunchtime, so we headed to La Plaza de Armas to explore some more. We had some great burgers (including veggie options!) at Papacho’s and then stopped by the Museo del Pisco to learn how to make our own Pisco sours. Our bartenders/instructors were very helpful and played fun music while we relaxed after a long week. We headed back to the clinic for dinner and went to bed early to prepare for our big day on Saturday—Machu Picchu!

Day 8: Machu Picchu

Machu Picchu archaeological site

Saturday, we were out the door by 6am to take our first bus of the day—our amigo Jesus was back to guide us throughout the day with a new friend, Jennifer, serving as our second guide. We took the bus to Ollantaytambo and then boarded a beautifully scenic train to the town of Aguas Calientes. Part of the Inca Trail parallels the train route, so we saw some hikers along the way, as well as more of the Urubamba River and surrounding mountains. Once in Aguas Calientes, we boarded another bus that took us on a winding and bumpy road up the mountain to the entrance of Machu Picchu. Jesus and Jennifer brought us inside the site and we saw the extensive terraces and remnants of the Inca civilization. We saw various levels of Machu Picchu, from the Inca Bridge to the Temple of the Sun. Apparently, it isn’t explicitly clear why the Incas left Machu Picchu, but some people believe the citizens experienced a natural disaster (such as an earthquake) and saw it as a sign from their gods to vacate the site, even though it was still under construction. We also learned while touring the site that the mountain seen in the background of most pictures of Machu Picchu is called Huayna Picchu (“young mountain”); the mountain, Machu Picchu (“old mountain”), is actually on the opposite side of the archeological site, often behind the viewer. The site sits in the shadow of Machu Picchu, the taller of the two mountains, and that is how the site got its current name. The original Incan name of the site is technically still unknown. Jesus told us all of this and more as we walked around the city and marveled at the architecture and the scenery surrounding us. Once our tour was over, we went to lunch at a nearby restaurant and then took a bus down the mountain back to Aguas Calientes. We had some free time there until our train left, so people split up and explored by shopping or going to the hot springs. Around 6pm we boarded our train home, climbed into our bus at Ollantaytambo, and were back at the clinic by 11pm. It was a long day, but everyone enjoyed the experience of Machu Picchu!

Day 9: Free Day

Sunday was our free day of the trip, and the majority of our group decided to participate in a private cooking class with a local chef in Cusco. The chef took them to the market where they bought the ingredients for their meal and then returned to the kitchen where they learned how to make Palta rellena (stuffed avocado), Lomo saltado (sautéed beef), Pisco sours, and homemade chocolates for dessert. 
Another group decided to hike Rainbow Mountain instead, waking up very early (before most of Cusco had even gone to sleep!) and taking a bus several hours outside of town to the trail site. After a challenging hike, they reached the summit and although there was snow on the landscape, it was still a magnificent view.
Everyone met up later for dinner at Limbus, a restaurant/bar with a great view of the city, and went to bed to prepare for our final day of service on Monday.

Day 10: The Final Campaña

Monday, we had our final campaign just outside of Cusco where we once more performed Pap smears, blood sugar, and blood pressure testing for our patients. There was a good turnout and several lucky students held some children while their moms underwent procedures.

After our service was finished, we presented the CerviCusco staff with gifts of our appreciation and took one final group picture. Some people went back to the plaza and San Pedro market to do some last-minute shopping, while others went home and began packing to leave the next day. We had one last dinner together at the clinic followed by a debriefing session to discuss our trip and our group project, and just like that, our time in Cusco was over. 

Our final group picture, including (L to R): Sam Phelan, Dr. Quyen Phan, Lexi Bradford, Alyssa Alias, Rachel Swart, Meredith Owens, Kelli Carlson, Julie Pizzat, Warren Gray, Lillie Russo, Erin Parker, Carson Gastil, Jacqlyn McKinnon, Mariel Box, Emily Gholson, CerviCusco staff, Alexa Bernstein, Pherrari Roy, Claire Pierson, Claudia Bellido, Dr. Lisa Thompson, and Dr. Weihua Zhang

Day 11: Traveling Tuesday

Tuesday was our travel day, and we made our way home starting bright and early. The new volunteer coordinator, Alyssa, saw us off at the airport and was waiting there to pick up the next group of volunteers arriving later that day. We all made it back to Atlanta safely (albeit later than expected thanks to a few delays), ready to get some rest before starting classes again on Monday. 
The past 10 days provided an amazing experience of Peru’s culture and history, and the experiences we had here will stay with us for years to come. Thank you to CerviCusco for being so welcoming and educational, to our wonderful instructors – Dr. Phan, Dr. Zhang, and Dr. Thompson – for guiding us throughout our time here, to the Lillian Carter Center for organizing this trip, and to my fellow classmates who made this journey as memorable as the adventure itself. 

¡Adiós, Peru, y muchas gracias!

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Merida Day 5

Flexibility was the word of the day for us on our fifth day in Mexico. Thursday started out like the other days, breakfast first thing before loading onto the bus to head into the community. Today Victor took us to the cemetery to learn a little more about the culture and history of Merida. It was shocking to see how different cemeteries are Mexico; they are bright and full of color. Our translators explained to us that in Mexico death is not feared but celebrated.

After our stop at the cemetery we continued on to San Luis, one of the neighborhoods in the south part of Merida that we had been working with during the week. The plan for the day was to work with community leaders to edit the health education modules we had prepared back in Atlanta, with the hope of teaching the community members later in the afternoon. When we arrived at San Luis one of the community leaders, Raquel, met us and told us how the rain the previous night had flooded many of the homes in the community. The mothers were currently trying to salvage their homes from the damage done by the rain and flooding.

Knowing that the mothers were focused on their homes we regrouped and decided to reassess the community to see what needs we could help meet in this moment. We sent part of the team on a mission to gather supplies while the rest of the team walked around to assess the community. Even with their homes completely flooded the people of San Luis graciously welcomed us, inviting us into their homes showing us the impact of the rain. After seeing the homes we saw that a lot of homes had deep pools of standing water that could cause a lot of health issues for the people. We decided to use our resources to provide gravel, tarps, shovels and other items that could hopefully prevent water from flooding in the homes. Our plan moving forward is to work with the community to remove some of the standing water and hopefully start creating some type of system that could prevent flooding in the future.

Though this day looked a lot different than what we had planned, it was truly an eye opening experience to see what the people of San Luis struggle with in their day to day. We were able to work with the community to come up with a solution to the problem they were facing today. It was just us nursing students coming in to fix a problem, it was all of us, students, faculty, translators, community members and partners, working together to move this community forward.

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Mérida Day four

This morning we headed to a second community called San Luiz, which is about five minutes from Emiliano Zapata Sur. Last year, the group focused on meeting the people in the community but this year, an important objective for us was the community assessment for San Luiz. Taking what we learned from Public Health Nursing, we explored the community limits with Victor and conducted a windshield survey. Along with Victor, other key informants that we interviewed were many mothers who have lived in the community for several years and a woman named Roquel, who coordinates visits with local members, such as Victor. We collaborated with the interpreters and received additional subjective data from the women in the community during our morning walking tour.

During the walking tour, we began to see the stark reality of their living conditions. We were able to learn so much about how cultural, social, political and economic differences structured their lives, as well as how it affected their approach to health care. The homes are temporary structures that were either built from scrap materials the families were able to find, or that had been gifted to them. The materials varied from sheet metals, wooden frames to plastic tarps. We also learned many families did not have permits to build permanent structures and that it would take several years for the government to approve their application. As a result, they are technically considered squatters. They vocalized their frustration at the fact that some of the lots were empty or contained houses that had been abandoned, but yet they were still not allowed to build on that land. Many of the families are close to one another and we could tell there is a strong sense of support for everyone by the way they watched over other families’ children, advocated for the homes in intense distress, and simply from their conversations with each other. Lastly, the families lack access and face numerous barriers to essential resources such as schools, healthcare facilities, clean water, proper hygiene and plumbing, hospitals, costly surgeries, fresh produce, healthy foods, and better paying jobs. Despite these conditions, it was evident that these families worked really hard to make a living and to provide a home for their children. We were amazed to see their craftiness in their decorated homes and gardens of plants and vegetables. With all that they had, they still managed to display a sense of ownership, pride, happiness, and livelihood.

The severe poverty in San Luiz sets people up for an unfavorable environment that creates unsafe conditions, health risks and concerns, and unnecessary struggles. As nursing students and advocates for healthy living, it was clear that Environmental Health and its implications in San Luiz was our main concern. Health starts where one lives, learns, plays and works. Our community assessment shows that the people in San Luiz Community face multiple and complex environmental threats to their health and wellbeing.

The main problem each community member described was the flooding and water damage in their homes during the rainy season. Their homes would fill up to two feet of water and due to the structure of the homes and the surroundings, their only solution was to let it dry. The standing water commonly contains microbial contamination which poses a risk of human exposure and the likelihood of infection. Bacteria, fungi, and parasites quickly harbor these breeding grounds as there is no plumbing system to eliminate the water. Consequently, a high prevalence of illnesses from microbes is present. For example, the most common hospital visits for the children expressed by the mothers were gastrointestinal illnesses such as diarrhea, nausea, and vomiting. These illnesses are compounded by vector-borne diseases from mosquitoes, ticks, and fleas around the community. Furthermore, wet belongings in their homes can lead to fast growing mold that are hazardous to the community members and their pets. Spores can be inhaled through the air as family sleeps together in their unventilated, humid, small home. Because of these findings, we altered our plans for the rest of the week in order to address these environmental health issues.

Another environmental concern is the pollution and the practice of burning trash because there is no waste management system in place. Burned trash piles was common as we walked through the community. It contained leftover food, plastic bottles, plastic food wraps and electronics. This poses a health risk because air pollutants, toxics and compounds released from the trash are linked to lung and neurological diseases, increased risk for heart attacks and some cancers. In addition, shards of glass and rubbish scattered everywhere makes it unsafe for children to play around. We hope in future years to offer support through designing a waste management, composting, and environmental health program.

Multiple and complex environmental factors pose adverse health disparities and wellbeing to the San Luiz Community who are fighting to get ahead for their children and their future. Health concerns of several community members include deafness, blindness, congenital birth defects, cardiovascular diseases, dehydration, and gastrointestinal problems. Emotional distress and stress magnifies the health problems of the community members. These factors are further exacerbated by the social and economic disadvantages that the San Luiz’s children face. Such disadvantages and barriers include poor quality housing with fear of being kicked out, going to school that is several blocks away, playing around in a field of unpaved dirt with pollutants and contaminants, no running water, and having poor access to quality health care all add to the burdens of the community we encountered. It is essential that more support, programs, resources, research and individualized strategies need to be diverted to the San Luiz Community.

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