Archive for June 30, 2011

Looking Back

Now that we are back in Atlanta and South Georgia once again seems very far away, I have had some time to reflect on this experience and what it has meant to me. The experience was so incredible in so many ways that is hard for me to pinpoint exactly how it has changed me… and yet I know that I look at the world differently than I did six weeks ago.

Before the Moultrie experience, the migrant farm worker population was not one that I had ever really considered before. Like most people, I hadn’t ever really stopped to think about who picked the fruits and vegetables that I ate. I had never considered what their life might be like or the challenges they face. Now I can’t stop thinking about it. When I was at the grocery store the other day looking through the produce I found myself wondering who had picked it…. Did they have a family? When was the last time they saw a doctor? Did they have macerated feet and a tiny flap skin encroaching on their eyesight? It makes me feel both proud to have served these people, however briefly, as well as helpless. Although I know that the work we did in South Georgia benefited the farm workers that we saw, the whole operation sort of feels like putting a bandaid on an artery. I sometimes wonder if the people we saw with hypertension will ever get medication for it or if they even have the means to make the lifestyle changes that we suggested. It’s so heartbreaking to think about the children that we saw in the schools, so full of energy and potential, may end up dropping out of high school to work in the fields just like their parents. This population faces so many challenges, which are only increasing in the current political environment and sometimes the scale of the problems just seems way too big to even conceive of a solution. I know that as nurses it is our job to care for individuals, but in a setting like this, the inadequacy of the whole system can be very frustrating. I guess that is the constant struggle of the public health nurse… which brings me to the other great impact that this experience has left on me.

Ever since I started nursing school I have been doing hospital clinical rotations and I know that as a nurse you are supposed to be excited about working in a hospital but I was not. Ever. Hospitals are not where I fit; they are not where I feel that I make a difference or where my skills are best used. Although I knew that there were other options out there, I didn’t really know what being a community health nurse would look like.  Being able to work in a community setting with a vulnerable population has really renewed my faith in nursing and has confirmed for me that I am definitely in the right place. This is the kind of nursing that I want to do, I just felt like it fit! I am so encouraged about having such a great first experience with public health nursing and I know that it is where I am meant to be.

Adios o hasta luego…?

The three-hour bus ride to the airport provided ample opportunity to begin to digest everything that we’ve seen, heard, smelled, touched, experienced and felt over the past two weeks.  As things seem to always go, the time has flown by.  Reflecting over it though, it is truly amazing the amount of work we managed to accomplish despite the major forces slowing us down.  The depth of the relationships we were able to forge despite language and cultural barriers is truly amazing.  I have made friends here in the DR that I will certainly never forget.

As the bus waited for us to finish tying up loose ends, Carmen came to the house to bid us adieu and wish us well on our journey home and in our careers as nurses.  She asked me when I was going to come back, and I explained (careful not to make promises I couldn’t keep) that Emory’s program is designed to circulate students so that as many as possible have the opportunity to have the same transformative experience as we have been privileged to have.  I could tell she tried to keep a smile on her face, but her expression was indescribably bittersweet and made my heart melt.  Later, Dhaysi, our new Dominican best friend who I consider a sister figure, asked the same question—when were we going to return.  Dodging the question, we said, “When are YOU coming to the states to visit us??”  With a touch of lament, she responded that it’s much easier for us to come down here than for her to come to the states.

It’s true.  Obtaining an American visa, especially if you’re not among the elite in the DR, is terribly difficult.  As we all know, many foreigners arriving with a temporary visa decide to take the opportunity to stay undocumented for a hope of a “better life”.  Well, from those few Dominicans that have visited the US that I’ve spoken to, and from my experiences down here, most would not consider American life better at all.  Regardless, it serves as an important reminder of the privilege I have for simply being born in my country and the world of opportunity that that provides—literally.

Winding Down

The final few days of our trip were a whirlwind of activity, as we stormed ahead to finish our pending projects.  But, of course, we certainly found time to enjoy ourselves, too.  The Dominicans wouldn’t have had it any other way.  On Wednesday afternoon, the DR’s former Minister of Health invited us over to his house.  I’m not sure exactly how Jenny came to know him, but in her words, “he’s just a really nice man and a great person to know.”  Expecting him to live in the city, we were surprised that the ride lasted a good 45 minutes.  By the time we arrived in his town, I said to myself, “I’m definitely not in San Francisco anymore…”  The upscale area was peppered with construction of new, gated developments.  Billboards advertising the ritzy homes and amenities appeared all along the main road.  Eventually we turned between the gates of this man’s upscale neighborhood.

We pulled through the gates of his house onto a large plot of land filled with fruit trees and beautiful flowers.  His wife greeted us at the door explaining that her husband had not yet arrived (we should have known better than to arrive nearly on time).  She showed us to the back yard, which was filled with not only fresh vegetation but also all types of birds roaming around freely and a few other livestock.  There were ducks and swans and doves and peacocks, and—of particular interest—turkeys.  Unprompted, Cassie began to make turkey calls, which was a hidden talent she had never previously revealed.  Immediately the turkeys returned the call in a wildly entertaining conversation.  We passed the time egging Cassie on to continue turkey calling.

We were then escorted inside and “the help” was ordered to fetch fresh coconuts.  A skinny, deft Dominican man promptly left bearing his machete and returned with a green coconut for each of us ready to drink the water inside.  Never before had I drank directly out of a coconut, which I learned is an acquired skill (I ended up leaving with more water on my shirt than in my belly).  Regardless, the kindness, generosity and hospitality of this man reaffirmed the warmth of the Dominican culture.

Similarly, on Thursday we were invited to Ortencia’s home, who is essentially the COO of the Hospital San Vicente de Paul.  She, likewise, lived a good 45 minutes outside the hospital in a beautiful upscale home.  The occasion served as a reminder that our presence down here provides a cause and an inspiration for many special interactions that don’t seem to occur otherwise.  For instance, even though the hospital members work closely together within a network of extremely close relationships, none of them had ever been to Ortencia’s house before—even the other executives.  Yet this night hospital members and their families, as well as the community leaders, joined us at Ortencias in a gathering of close to 50 people.

Like the homes we had seen thus far, the large piece of property contained innumerable fresh fruit trees and gorgeous flowers.  Ortencia’s friendly assistant and the hospital director took us through on a walk across the street through a farm to an area where they kept horses.  Apparently there was a beautiful river a bit further, but an approaching thunderstorm prevented us from proceeding further.  Of course, on the way, the assistant insisted we stop at a neighborhood bar for a quick spin on the dance floor.  She pulled a man from the crowd and directed him to show Christie a few moves while the rest of us watched.

While we had expected to stay for some snacks and perhaps a beverage, we returned to a feast of a traditional Dominican stew containing various root vegetables and several kinds of meat.  When we asked what kinds of meat, Ortencia responded, “Oh, you know, a bit of everything—chicken, pork, beef, and whatever else.”  I’m glad she stopped there because the stew was delicious and I’m sure there were protein sources that we Americans are not accustomed to consuming.  I’d rather not know.

After dinner, the music was turned up and dancing ensued.  Before we left, Ortencia gave each of us a souvenir hand-painted dish depicting scenes from typical Dominican life—a gift which was absolutely unnecessary, but which I will certainly keep as a reminder of our experiences over these two weeks.

Serving with You’ns in the Hollow: A West Virginian Odyssey (Part III)

“Only a true West Virginian knows exactly how long ‘directly’ is – as in: ‘Going to town, be back directly’. Only a true West Virginian grows up knowing the difference between ‘rightnear’ and ‘a far right piece’, and also that ‘just down the road’ can be one mile or twenty.”

– Unknown

 

Collect, Enter, Put it all Together:

Through the second week of our experience in this community, we wade and sift through virtual pools of information, with progress toward the end of our data collection for our quality improvement project.

Cabin Creek Health Systems (CCHS) felt it a worthy endeavor to investigate potential drivers of no-shows for scheduled appointments within their Patient Centered Medicaid Medical Home population, a group of ~480. We chose a specific subset within that sample and got to work.

After several nights of tireless chart review, we were hopeful and excited that with a little help from our resident data wizards (thank you S & A), we might be able to offer CCHS some significance to work with and advance their understanding of and response to the needs of complex clients.

The providers and staff could not have been more grateful for the work that we put in on the project. One veteran provider from Cabin Creek even referred to our cohort as “The QI SWAT Team”, which put many smiles on our faces.

 

Parting and Thanking:

Thursday marked the end of our stretch shadowing the providers at our respective clinics. With several thanks and goodbyes, we had an opportunity to reflect on what had been most valuable and essential to us through this unique experience.

Several stories were shared and all centered around a few key concepts and values:

  • Rural West Virginians face transcultural health disparities and health literacy issues. Much of the educational and resource shortages faced in international sites are being faced right here at home
  • Shadowing providers of different backgrounds, disciplines, and philosophies provided an opportunity for introspection and development of our own core values, philosophies, and care priorities and future practitioners.
  • Observing the daily administration and operation of primary care  in a rural setting was not something we’d been exposed to previously, and honed our understanding of the grand successes and unfortunate shortcomings associated with people determined to make the best of limited resources.
  • Rural healthcare with limited resources did not bind this community or health system to lower standards of care, but rather fostered progressive thinking and attitudes to quality improvement and patient-centered systems and practices.
  • This was an amazing experience, and while a lot of work, a whole lot of fun.
Cabin Creek Health Center

 

Administrative Offices, Miami, WV

The QI SWAT Team Goes on a Trip:

To clear our heads, and observe more of the landscape that defines the beauty of this wonderful state, the group took a brief excursion to New River Gorge. A beautiful area of lush, rolling mountains, an historic bridge, and walking trails, New River Gorge is a perfect exemplar of what West Virginia is by geography.

Bridge

The Group at NRG

 

There will be a final entry in this blog series about reflections. Until then!

Divide and Conquer!

On Thursday, we divided and we conquered.  Much was left to do in the two short days remaining.  Xanthia and I met with Nieves, who is employed by PATH and USAID in Washington, DC as the director of the Kangaroo Program for the entire DR (which for now means the Hospital de San Vicente de Paul..).  Finally, all of those implementing the Kangaroo Care program were able to sit down and discuss the challenges that the program faces.  To my relief, Nieves expressed the same concerns that we, the American partners, had expressed separately.  While there are major cultural barriers separating the paradigms from which we and the Dominicans are working, it was encouraging to see that these were far from insurmountable.

We scheduled a couple home visits of Kangaroo babies in a town just outside San Francisco, which Nieves directed.  The level of detail with which she interviewed and the type of information she collected was just what had been missing previously.  The collaborating doctors and nursing students were present ensuring everybody knew the expectations of these home visits.

Meanwhile, Cassie and Larkin were preparing a presentation to give to the current doulas of the hospital regarding education about unnecessary cesarean sections.  They delivered their presentation today, and it was magnificent.  Expecting an audience of about 10 people, they were surprised to walk into a room filled with about 100 doulas, hospital personnel and medical residents.  Even the bigwigs of the hospital attended heightening nerves.  Regardless, they presented research, recommendations and even a role-play beautifully—all in Spanish.

Before this presentation, though, April, Christie and Larkin were able to see the fruits of their labor.  They spent a lot of this week meeting with the nurses and community members that had carried out the pilot study in a town called Vista del Valle.  They analyzed the data and trained the nurses in data collection, analysis and presentation.  The study essentially looked at maternal and infant outcomes.  Interesting findings included that 75% of the women received C-sections, between the first and third prenatal visit most women had received their screening panel, and by one week post-partum only 27% of women were breastfeeding exclusively.  The women reported that they perceived that American women formula-fed, and, thus, it was better.

Christie has been working on a project for our ethics class on sustainability.  In particular, she has been interviewing people from all levels of the hospital about their lack of running water.  Private clinics and many houses, including the one we’re staying at, have plenty of running water, yet the hospital only receives running water for about an hour a day.  Each ward has a communal bathroom (well, most wards.  Some bathroom doors are locked and those patients have to go to a different ward to void—regardless of their condition).  In the shower is a large barrel that collects water for this one hour.  Patients bring their own small tub to collect water and bathe.  Personnel that are on call return home to shower, if they can, but many simply do not bathe.  As one nurse put it, what’s the point in donning sterile gloves, gowns and masks (when they’re available…) for surgery when your hands are filthy?  Great question.  She interviewed nurses, residents, Jenny, community members, the director of the hospital and the director of the province.  And each reported a different cause for the water shortage.  The issue merits an entirely separate document (and a 30 minute presentation, which we have to give in August…).

While the others presented, Xanthia and I finally had an opportunity to teach a few of the Dominicans working on the project how to use Epi Info, which is a free data collection and analysis program.  AND its free AND in Spanish!  As the appointed translator for the project, it was a challenge for me since I am computer illiterate in English, much less in Spanish.  With the patience of the Dominicans and especially Xanthia, and a good sense of humor we forged ahead.  This tool will be an excellent resource for them to have, and they expressed much gratitude for our help.

And with that, our work is essentially finished!

Trabajo, Trabajo, Trabajo!

On Monday night we went to a talk given by the two residents with whom we are working on our projects.  We went to essentially a large gazebo that serves as a community center.  A table “of honor” was set up framed by two TVs playing advertisements for a local bottled water company.  The gregarious MC for the evening was the husband of Carmen, the nurse who invited us to her house on Monday.  Dra. Rivera gave a talk on the dengue fever and Dra. Duarte gave one on cholera.  While this part of the evening was everything I expected, we left just as the party was getting started.  There were prized to be handed out and regeton to be danced.  By the time we left, it was already 9:30, we hadn’t eaten, and we were brain-dead from the length of the day up to that point.

On Tuesday, we started this morning with a breakfast at the university CURNE.  Of course, before we left, Rosa insisted we have a bite to eat to tide us over.  This consisted of coffee, fruit, cereal and ham and cheese sandwiches.  (We have certainly not been starving).  We met with the director of the university, which is the second largest public university in the country.  He has been extremely supportive of Emory’s work in the DR.  He expressed a strong interest in extending the partnership beyond maternity issues and even beyond health sciences.  While this would be wonderful, of course, Jenny herself is interested in maternity development and simply cannot take on more than her already impressive agenda.

It was interesting spending time in his office because it was clear that he was a bigwig around those parts.  His secretary was waiting on him hand and foot, brining him specially prepared coffee in delicate espresso cups with sterling silver holders.  She served him his breakfast literally on a silver platter.  She basically did everything short of wiping his mouth after each bite.  Must be nice…

We were whisked in the University’s bus to the hospital where Sheila and Cassie frantically finished their data analysis of the pilot study performed by the nurses in the hospital over the course of a month.  What Jenny found during her research a couple years ago was that doctors attended very few births.  It was the nurses and even auxiliary nurses that attended the vast majority of births on the ward.  Without formal training in the skills involved, it is no surprise that maternal and infant mortality and complication rates were much higher than they should be.  Jenny’s initial idea was to train midwives and train trainers to implement a midwifery program in the hospital.  After an intensive training session, she got tremendous pushback from the doctors in the hospital making it clear that this approach would be neither effective nor even feasible.

This pilot took a different approach by empowering the nurses themselves to document the births that they had attended and keep statistics—something which was a pretty foreign concept in the hospital previously.  An interesting cultural difference between the US and the DR is that the Dominicans represent the world in the form of individual stories rather than generalizations.  The first challenge was getting the nurses accustomed to documenting in a uniform way rather that writing long-winded narratives of each woman for whom she cared—something with which we still greatly struggle.  Then there was confusion of what we were actually documenting.  For instance, the nurses counted first and second degree episiotomies as complications when, in reality, they’re not so.  Likewise, low birth weight was not recognized as a complication, when in reality, it is.  So the data themselves are flawed, but the practice was a tremendous advancement.

Then when it came to analyzing the data, it was a challenge to try and influence the mentality of the nurses to generalize the information in to averages, ranges and medians.  They kept wanting to elaborate on each woman they saw and tell each story filled with rich details.  While it was super interesting, this sort of information sharing isn’t quite practical.  Sheila and Cassie had the task of helping them practice compiling the data and seeing the larger picture comprised by the individual stories.

Well, together they were able to put together a slideshow with a few simple charts and graphs providing descriptive data of the study’s findings.  The nurses themselves gave the presentation to other maternity nurses, the director of the hospital and other people involved in ADAMES.  Of course we had planned a 20 minute presentation with 10-20 minutes of discussion, but by the time the meeting had actually started, the information was finally presented and Jenny finally dismissed us from the meeting, 2.5 hours had passed.  And Rosa stayed another 30 minutes discussing ideas for further improvement after.

While all of these meetings can be tedious, it is wonderful how there is so much enthusiasm, energy and interest in this idea of carrying out research and finding ways to improving things on a systemic level.

Perspective

We complain about hospital food.  The Dominicans have to bring their own.

We wish maternity units had birthing tubs.  The public hospitals here have no running water.

We complain about lines in the bathroom.  Several wards have to share the same single bathroom (that lacks running water—even in the postpartum ward).

We’re annoyed when the nurse doesn’t promptly tend to the call button.  Most women are barely seen postpartum.

We complain about three hour waits in the emergency department.  Some women in labor ride up to three hours on the back of a moped to the hospital.

We’re annoyed when the doctor doesn’t return our call.  Many Dominicans can’t afford to make a phone call.

We often lament the things that we lack.  The Dominicans celebrate their riches.

We are constantly rushing to tomorrow.  The Dominicans stop to enjoy today.

Home Visits

Got up reeealll early to hop on the school bus to go on some home visits.  We were going to make the three-hour trek to the province of Samana, which is a peninsula on the far eastern side of the island.  The hospital San Vicente de Paul receives more pregnancy complications from this area than any other, so we were very interested to find out why this may be.  We had four home visits scheduled, one of which was for a baby that had passed away.  We packed PB&Js (a timely and welcome taste of home), and made our way out of San Francisco.

The first visit was in a remote town called Nahua.  The further from San Francisco we travelled, the worse the driving conditions became.  We swerved around paved roads with potholes big enough to engulf an entire moped.  Eventually the paving discintigrated into a haggard dirt road that tossed the bus around like a rag doll.  I started counting how many times we bottomed out, but lost track when I reached 20 in a 10-minute period.  Figuring that the bus couldn’t possibly make the trek without something breaking, I found myself praying for a flat tire (as opposed to a broken axel).

We learned from the home visits in March that addresses are certainly less systematic here than in the US (“town of Nahua, main road, near the fruit stand, Number 5”—there may or may not even be house numbers).  As we approached the town, we asked random people if they knew where the mother-who-had-given-birth-to-a-preterm infant lived.  They would point us in the right direction until we reached another fork in the road, and we would ask again.   At one point, a man atop a moped motioned us to follow him, and the big school bus trekked behind the tiny moped bouncing around in the potholes.  In this way, we eventually found the little shack on the dirt road where the woman lived.  We asked her questions about her gestational background, medical history and details about the birth of the premature child enrolled in the Kangaroo Program.  We asked about the length and duration of her “kangarooing”, as well as about her education and the type home she lived in.

Meanwhile, others conducted a windshield survey (although it was on foot…) of the community and asked people questions about the population, resources, occupations, schools, churches, transportation, etc about the community to get a sense of where these women are coming from and the conditions to which they return when they are discharged from the hospital.

We also took anthropometric measurements of the now nine-month-old.  From first glance, we could tell he was not developmentally appropriate, as he couldn’t lift his own head and was not babbling like normal nine-month-olds would.  Without even looking at growth charts, it seems pretty likely that he hasn’t kept up physically, either.  Apparently this baby was admitted to the NICU because he had repeated seizures after birth.  His head circumference was greatly above normal, and he was diagnosed with hydrocephalus.  Whereas in the US, rapid intervention including placement of a surgical shunt would have prevented long-term complications, this baby stayed in the NICU until his head shrunk a bit and he was sent home without much further intervention and probable permanent brain damage.

We then made our way to another town where we visited the public health clinic.  The lobby looked like a train station with a gated counter where people reported their chief complaint and were given a number.  Rows of chairs lined the rest of the room where patients waited patiently to see the doctor.  A nurse there immediately recognized the Dominicans that were working with us.  She kindly gave us a tour of the small facility, which included one ward for men, one for women and one for children.  She brought us back to the delivery room, which held a medieval-looking bed where women gave birth.  The operation room that regularly provided Cesarean sections looked more like a torture chamber.

The nurse answered all of our questions.  The DR, like the US, has a severe nursing shortage and often only one nurse works the entire patient care area of the clinic.  She, herself, is the only nurse qualified to attend surgery.  This clinic, like the Hospital San Francisco de Macoris, lacks running water.  But these patients are privileged with a shared bathroom in each ward, unlike those in San Francisco.  We were supposed to meet with the father of a Kangaroo baby that had passed away, but couldn’t get in touch with him.  We thanked the nurse for her time and hopped back on the bus.

Fully accustomed to the Dominican culture, Jenny made the executive decision that the beach in this part of the country is far too spectacular to miss.  Sooo we stopped for a quick dip in the crystal blue ocean and an ice cream break.

The last home visit scheduled for the day was a woman whose infant had passed away.  Upon asking where the woman-who-had-given-birth-to-a-preterm-infant lived, a gentleman took off on his moped and returned with the woman on the back.  We expressed sympathy for her loss and asked if she would be willing to answer a few questions to help the hospital understand more about infant death and prevention.  We would keep this one short.

She told us that her water broke at about 32 weeks (very few women actually know the gestational age).  Because of work, she delayed visiting the doctor at the local clinic until the next day.  There he explained that this flood of fluid is normal during pregnancy and that she had nothing to worry about.  She remembered thinking that was strange since during her previous (successful) pregnancy, her water broke and she was in labor.  Regardless, she trusted her doctor and returned home.  Ten days later, she eventually made the three-hour trek to San Francisco where she delivered her baby.  The baby spent four days in the NICU before he passed away.

The woman was told that women between the ages of 19 and 24 often have difficulty giving birth.  At this, Rosa (a very vivacious woman), firmly told the woman that this is the age TO give birth.  Apparently multiple doctors are disseminating this type of information.

Leaving on a solemn note, we boarded the bus to make the long trek home.  Unbeknownst to us, there was a sale on shrimp in a random town on the way home.  Before we knew it, we had stopped in a park and the Dominicans got off the bus to make their purchase.  Expecting to pause for 10  minutes, we ended up waiting nearly an hour to continue on the journey.  We didn’t get home until nearly 10pm making it quite a long day.

BP, Weight, Chest, Waist, Hips… repeat

Oh, what to share about days 10, 11, and 12… Well, we’ve been working hard since you last heard from our group. Our days our full. Our brows are full of sweat. And we’re really refining our mosquito-killing abilities.

Day10

Monday was a busy clinic day for some of us. The Rock Sound group was running from 9am-4pm, helping to screen patients, assisting the nurses, and being quizzed by the doctor. Those in Governor’s Harbor did a half day in the clinic and gathered the data for the 40 Day Challenge in order for us to perform follow-up with the participants. We all worked fastidiously to enter data for our project in the evening.

Day 11

What a day! Surveys in the community, data entry, and a flat tire made for a long and tiresome day. One of the old 12-passenger vans we’ve been driving around was struck with a flat tire, so four of our group members had to drive very carefully from Governor’s Harbor to Tarpum Bay (usually a 30 minute drive) to have the tire replaced. Along the way, that group gathered more community surveys and began the follow-up visits to complete our data. Thank goodness they made it back safely! The rest of us were busy in Savannah Sound and on the southern tip of the island doing community surveys in order to have a representative sample from all parts of Eleuthera for our program evaluation. Let’s just say, Tuesday was exhausting!

Day 12

HAPPY BIRTHDAY ERICA!!! Today we had the great fortune of celebrating Erica’s birthday with her in the Bahamas. A good mix of work and fun hopefully made her day a memorable one! Most of our group worked close to home today working on our presentation for Thursday at the Rotary Club pertaining to what we’ve been doing these past two weeks. Others got to attend a meeting and inservice on Malaria and Cholera at the Rock Sound Clinic. Cherish even got to be the guinea pig to show how the rapid Malaria test works. (Don’t worry, Student Health, the test was negative.) Some of us took several trips to the dump today – both during the day and at night when trash was being burned – to capture the waste management issues on the island. In the evening, we held a follow-up clinic for participants of the 40 Day Challenge at the Cancer Society building. We had a few people drop by, but hopefully we’ll see more of the participants tomorrow. Finally, three of us ended the evening with a trip to the Haitian church. The Haitians are not always welcomed on the island by the Bahamians, so it was interesting to get to worship with them (in Creole) to better understand this subsection of the population. Oh, and we had birthday cake, lots of Bahamian-sweet birthday cake! Cheers!

Oh the irony!
Birthday Girl Takes BP

A Team Effort, A Farm Tour

More than a service project:

For me, the experience of being a student at Emory University is wonderful in part due to the size of my class. There aren’t so many students that I see someone new everyday in the nursing building. It really is a family atmosphere. Well, take that experience and shrink the feeling even smaller — we are a team of 16 BSN students that took the three-week community health course and are now immersed in an intense program together in a small south Georgia town. Talk about an opportunity to get to know your fellow classmates!

Our team is unique and everyone brings together a different personality and set of strengths. Some are born leaders, others are incredible organizers, and still others bring a great attitude of caring and compassion to the team. There are a few people in the group that I literally never spoke to during the entire first year of the BSN program, and now I can laugh with them as though we’ve always been close friends. My two roommates, Max and Andrew, are fun, respectful and sincere guys, and even the experience of rooming with them here at the Hampton Inn has been a rewarding one. We reflect together on the day’s events and how we have been impacted, we joke with each other about who snores the loudest, and we encourage each other through the long and tough days. As the trip is now coming to an end, I have been amazed by our entire group’s teamwork and ability to get things done when we need to. As Anna summarized in her post, “The Elusive Master Plan,” things always come together when they need to. I’m going to miss this team and the atmosphere here in Moultrie when the week is over, but I look forward to the new friendships I will carry forward into the fall semester.

The reality for farmers in southern Georgia:

This afternoon, I took part in a farm tour. A group from our team piled into a large van and headed south of town to a series of properties owned by a local farmer. Unlike our daily routine of working at the night camps, this tour involved getting an intimate look at the actual farms. Two staff members from the Ellenton Clinic were our guides at the front of the van. As we pulled off the paved road and made our way between the first two fields, I once again realized I didn’t know much about agriculture. “What vegetable is that?” or “What grows there?” were probably the most common questions as we passed a variety of crops. I’ve eaten about every vegetable and fruit sold at Publix, but I don’t think I could tell you the first thing about what each plant looks like … or how the vegetable grows. That was the first, and simplest, realization for me.

The rows of vegetables were beautiful and artfully arranged in perfect rows. Driving down the narrow lanes amidst the fields was almost hypnotic. As we pulled into a new field, we caught our first glimpse of workers. There they were, in the scorching afternoon sun, smiling vibrantly and waving at the passing van — a van that was stamped with the Ellenton Clinic name and logo. The relationship between the clinic and the workers was apparent, and I was appreciative in that moment to be able to volunteer with such a program. In my short 2-week trip to Moultrie, I am able to take advantage of the decades of service put forth by the volunteers and staff of the Ellenton Clinic … what an incredible opportunity to experience that kind of trust.

I was amazed at seeing the men, and women, hand-pick the peppers. I grew up fairly naive, as I suspect many people in this country do, assuming that most vegetables and fruits in this country are harvested by giant tractors — ripping easily through the fields in wide, sweeping motions to effortlessly remove the vegetables in a matter of seconds. I was wrong, and today I witnessed the reality for the first time. Each pepper was individually scouted, assessed, and picked by strong yet calloused hands. (I have seen the toughness of their fingers from acquiring blood samples at night camp.) Most crops are at waist height or lower. Many vegetables actually rest on the ground itself, requiring the workers to bend completely over — time and time and time again. The work is not easy, and the environment is not forgiving. I could see, in that moment peering out the van window, why agriculture is known as one of the most dangerous occupations in the United States.

As our tour progressed, we reached a series of fields toward the back of the farmer’s property. The field to our left was empty, and the field to our right was scattered with rotten squash. We learned in the next few moments, regrettably, that farmers this year are beginning to lose hundreds of acres of crops — to the climate and vanishing farmworkers. The intense heat and drought this year has caused the crops to ripen earlier than anticipated. To further compound the problem, the Illegal Immigration Reform and Enforcement Act of 2011 (known commonly as House Bill 87 or Georgia’s “immigration law”), has scared away many of the workers whom the farmers relied upon to harvest their crops.

We have also seen a similar trend at our night camps — sometimes seeing less than half as many men at certain camps as the program did last year.

I have no “premonition” about what will become of the farming situation in Georgia. I only know that today I was confronted with the harsh reality of the current condition. For me, it was a eye-opening. I was educated about something I take for granted on a daily basis. I will definitely have a new perspective the next time I walk down through the produce section at the farmers market. Maybe you will too?