Archive for June 29, 2018

Windshield Survey of Emilano Zapata

By Marissa Bergh

Can you imagine walking the streets of a neighborhood you don’t know, in 105° weather without shade for two hours? No? Neither could we, and yet that was our reality today. It was very uncomfortable, our scrubs soaked in sweat, and our 1 liter water bottles quickly depleting. While it was a challenge to say the least, we remained focused on the task at hand, because successfully completing a windshield survey is a key piece to any community assessment, as it allows us to gain a glimpse into the reality of people’s lives in Emiliano Zapata.

As community health providers, it would be impossible to provide care for a community without understanding the conditions in which they live, and the community they inhabit. For example, we found that many of the markets only sold a handful of fresh vegetables, and the vegetables that were sold were very expensive, thus it would be irresponsible for us to tell people that they need 5 servings of fruits and vegetables per day for their kids to be healthy.

As we jotted down our observations (i.e. the number of food marts, the cost of food, the types of houses, family gardens, water reservoirs, handicap access, etc.) we were mostly greeted by kind faces, and welcoming voices. A generous woman even offered us some homemade, and refreshing popsicles (for a discounted 10 pesos). Throughout our day, we were pleased to find that many people in the community had access to some form clean water (though many still didn’t), and that family gardens were still somewhat common (hope for a future community garden!!!). Like many food deserts here in the US, the biggest frustration remained the access to healthy food. There were very few food markets in the community and the majority of the food being sold were filled with fat, sodium, and sugar. Food stalls filled with snow cones, candy, and fried pork rinds waited for the children as they exited the school for their lunch break.

Cross-contamination also remains a concern in the community, with many stands displaying raw meat on hooks above the produce (dripping its juice in the meantime), and store owners handling meat while stocking shelves at the same time.

While we are here, a few of us will work on compiling all of the information we are gathering into one report to use in a formal grant request, so hopefully we can get funding for future trips to Mérida in order to further support Victor and his visions for Hogares Mana, and the underserved communities within Mérida.

Tour gives a glimpse of farm work

Loading up the van.

By Colleen Closson and Sophie Katz 

To provide healthcare that can truly meet vulnerable populations where they are, it’s good to know about the lifestyle of your population. For example, if a population tends to have high blood pressure, then you should analyze their abilities to access healthy food options and places to exercise.

To understand the farm workers and their occupation so that we can better serve them, we decided to go on a farm tour provided by Ellenton Health Clinic. This was a tour of the crops that are grown in and around Moultrie. We learned how to pick corn, squash, zucchini, cucumbers, and all types of peppers, from sweet to spicy. It was every bit as challenging as one would expect, and more so. For example, cucumbers have prickly spines when initially picked, which must be gingerly removed to avoid poking your hand (and you inevitably do). It’s incredibly hot, and we only stepped out of the air-conditioned van to pick produce for 10 minutes at a time. You can’t wear sunglasses because otherwise you can’t see the produce, so sunlight (and along with it, dangerous UV rays) shone right into our eyes. The rows between vegetables are narrow and often overgrown so you must carefully look out for any animals, like snakes, while also keeping your eyes open for produce ripe enough to pick.

What we learned through this process is how easy it is to go to the grocery store and not think twice about where the food that you buy is coming from. Nothing comes out of thin air, and the process of the vegetables being picked in the fields to being cooked is quite laborious. As we move forward, we will certainly remember the incredibly hardworking hands that make it possible for us to eat healthily. As Dr. Wold frequently says, “If there’s food on your table, thank a farm worker.”

Increasing nursing competencies in Haiti

Two students talk with a mother and child.

By Helen Clark

Helen Clark

Bonswa from Haiti! I’m Helen Clark, one of two Helens on this trip, and I’m writing a guest blog for Sam while she plays Uno in the courtyard. Today was another fantastic day on this beautiful island as we traveled to the community of Balan. We had an hour drive from Santo through some lovely Haitian countryside framed by the mountains and Lake Ajuree.

I left the Peace House a little early with our triage nurse Christa and most of the Foundation for Peace staff to set up the pharmacy at the church in Balan. We had a very pleasant drive with the windows rolled down and the sun warming us, until almost an hour into our trip. It felt like we were sliding down the road until we came to a stop. Pastor Valentine jumped out of the truck and confirmed we had a flat tire. We were less than a quarter mile from the clinic, so we decided to carry all the pharmacy supplies the rest of the way. Pastor Valentine hopped on his cell phone and asked a leader in the community to send us help carrying our many boxes. The ten of us set out loaded down with medicines, and only made it several hundred yards before we were greeted by a crowd of Haitian people offering to help us. By the time I reached the clinic I had nothing left to carry but a tiny box of vitamins

After this uplifting start to the day the rest of our time in Balan flew by in a flurry of treating babies with diarrhea, children with scabies, and several staph infections. Seeing such a large number of patients while having very few resources to help them has been difficult, but I’ve been encouraged by the many patients we have been able to treat. It’s very cool as a nurse practitioner student to feel competent enough to independently treat a vaginal infection or show a pregnant woman the position of her baby’s head.

As we packed up to leave for the day after seeing over 200 people, a group of boys from the community were playing a lively game of soccer next to the clinic. Two small boys nearby also wanted to play, so they started kicking around one of the many glove balloons we made to comfort fussy babies. To cap off a wonderful day we saw a rainbow out of the window of our bus as we drove out of Balan. Tomorrow we travel to Croix Coq to host a clinic at Pastor Valentine’s church. I can’t wait to experience more of Haiti.

Cultural enrichment in downtown Cusco

Plaza de Armas in downtown Cusco, Peru.

By Kiah Ford

Today we were scheduled to do a pap campaign in a village about 2 hours away from Cusco. Unfortunately, we got word that a portion of the road to the village was impassable due to recent weather and we weren’t able to go. Although we felt pretty disappointed we weren’t able to provide such an essential service to women whom some had walked nearly 6 hours to attend the campaign, we acknowledged that the situation was out of our control and that safety was the priority. As nursing students, flexibility has become second nature to us so we shifted plans to venture to Plaza de Armas in downtown Cusco instead. The plaza was filled with so many locals, a parade, dancers in costume and beautiful music celebrating Inti Raymi, the Festival of the Sun. It’s a month long celebration in June honoring the Incan god Inti. We spent hours absorbing the culture and ended our evening with a group dinner at Morena Restaurant followed by salsa & bachata dancing at Mama Afrika.

Meeting the Women of Emiliano Zapata

 

Talking with a family using an interpreter.

By Marissa Bergh

Today we made our way to Emiliano Zapata, where one of Victor’s community centers is. Mérida is divided into north and south, with all of the wealth residing north of the city. The further south you drive, the more impoverished the city becomes. Emiliano Zapata is a Sur (a neighborhood) of Mérida, about 30 minutes south of the city center where we are staying. The homes in this area vary greatly. Some houses have multiple rooms, painted in radiant blues, yellows, or pink (and cost around $30,000 US to build), and others have a no true windows or doors, barely larger than 8×8 square, and no bathroom or kitchen (cost around $3000 US to build).

Victor’s center, an extension of Hogares Mana, lies right in the heart of Emiliano Zapata. We got the great pleasure to meet and speak with a few of the women from the community who volunteer at the center. With the help of our incredible interpreters, Carolina, Leslie, and Victor, the women told us about their daily lives, their perceptions of the community, their frustrations with healthcare, and their appreciation for the work Victor does in their community.

It was really incredible to listen to their individual stories, but also difficult. The majority of us are accustomed to living with certain comforts and luxuries. We complain when our AC goes out, or when we don’t get the class we want because Opus/Sign-Up genius decided to freeze at the worst possible moment. Most of these women initially denied any desire for change, but to us there seemed to an abundant of things that could be improved to increase access to goods and services that we often consider a fundamental right. For example, the women expressed frustration that the closest hospital is over 40 minutes away, the closest grocery store is 45 minutes away by foot (most of the women do not have cars, and they must walk in the heat with their children in tow. There is no community health clinic in the neighborhood, despite “universal healthcare”, and many medications are not accessible nor are they affordable to the women and their families.

Students with Victor.

There was a unanimous sentiment among the women, that Victor and his organization are the best things to come to the community in years. He has worked with them for over 15 years and has grown his community center from just a table in an empty lot, to a large complex that serves as a hub and major resource for families in the community. From here he feeds the neighborhood children, connects families with medication resources, and promotes general health and safety for the community.

As I said in our first post, this is the inaugural trip for Emory School of Nursing and our primary goal is to build a good relationship with Victor and his community. But we are also here to do a thorough community assessment to determine sustainable interventions for future groups and Victor’s organization to continue in the months and years to come.

Collaboration is key during ‘Night Camp’

Setting up stations for Night Camp.

By Colleen Closson and Sophie Katz 

Night Camp is what all seasoned participants of the Farm Worker Family Health Program call the flood of medical professionals and students at the farms where the migrant farm workers work.

After a day’s work at the elementary school and a generous lunch put on by one of many wonderful churches in the local Moultrie area, we have about three and a half hours to rest. Since the work never stops, more than a few of us study or read for class. At 6 p.m. sharp, we are expected to be ready to put our cars in drive to follow the caravan of volunteers out to the farm.

It is astounding to see the sheer number of people, supplies, and equipment necessary to set up a makeshift medical center in rural Georgia. The phrase, “It takes a village” is made manifest in the areas we create. Around 8 p.m., farm workers leave their barracks to visit our stations.

BSN nursing students provide screening stations, including checking blood pressures, measuring height and weight to calculate BMI, checking blood glucose and hemoglobin levels, and providing foot care to those who request it. BSN students are also responsible for intake and beginning the charting that is required for each patient.

Every man (and almost all our night camp patients are men) comes for different reasons. Some are aware of the services offered and want a specific need met, such as dental care (provided by dental hygienist students from Clayton State during Week 1, and from Central Georgia Technical College during Week 2). Others may have some sort of pain or muscular issue, and they may see a physical therapist student (Georgia State physical therapy students were present during Week 1, and Brenau University physical therapy students are present for Week 2).

Many are unaware of what we are there for and walk up just to see what is going on. At the intake table, the farm workers are asked what their needs are and how we can best meet them. This can be quite the feat at times—although some on our trip speak Spanish fluently, others may have only had a few classes years ago, leading to difficulties in communication that often require the aid of an interpreter.

Providing care at the night camps is certainly an exercise in humility and patience, and there are more than a few laughs over fumbled words and mispronunciations.

As we have moved around various stations, we have learned how to interact with our patients in various ways based on what the situation requires. Taking a blood glucose level, for example, is very different than providing foot care. Furthermore, we’ve learned how critical patience is in this process, and we are also grateful for the patience of the farm workers as we have learned.

Clinical creativity brings hope in Haiti

Assessment and history taking.

By Samantha Stacks

We woke up ready for our first day of clinical. And if the day went anything like our morning coffee, we knew it was going to be hot and steamy (spoiler, it was). Sitting around and discussing the upcoming day eating pancakes under the shade of the giant almond tree in the compound, we wondered what types of patients we would be seeing and what the day would bring.

We arrived after a bumpy bus ride past some of the rubble that still remains post earthquake while seing the effects of Haiti’s current drought, and thought of all the respiratory problems that arise along with the dust from these factors. We walked into the church where we’d be seeing patients and were greeted by a crowd patiently waiting for clinic to open. Pastor, the director of Foundation for Peace, opened with a prayer and a song, ‘How Great Thou Art’ (or rather the Creole version of it). Hearing the many voices harmonize was a powerful moment for many of us, and instilled a sense of community that would stick with us for the entire day. We saw not one patient at a time, but usually an entire family of 4+ people, all having various (occasionally the same) illnesses. Neighbors and friends came to the clinic together, all searching for an answer for whatever was ailing them. We worked as a team doing intakes, taking histories, diagnosing, and treating what we could, and referring the rest.

Treating people in a low resource setting where a few Tupperware boxes are your pharmacy, three thermometers are shared to treat 200+ persons, and you’re lacking even glucose and pregnancy tests definitely means you have to get creative. However, we also realized that our assessment and history taking skills were more important than ever. We have AMAZING interpreters that worked tirelessly with us to ask question after question to get the information we needed. All in all it was an exhausting, sweaty, and fast paced day, but ultimately rewarding and left us all optimistic for the days ahead.

Hiking in the Sacred Valley

Kiah Ford

By Kiah Ford

It’s Day 2 here in Cusco or shall I say Cosco. Yep, pronounced just like your favorite wholesale club in the States. According to our tour guide Jesus, that is the city’s original name.

Early this morning we began our day with a tour at 7:30 a.m., led by Jesus and our wonderful bus driver Daniel. We first took an hour drive to Chincheros to see firsthand how the women make authentic Peruvian textiles from sheep and alpaca fur. They shared their cleaning, dying, and weaving techniques followed by a private shopping experience.

Next we drove onward to the Sacred Valley where we hiked and took hundreds of photos. The sights were absolutely breathtaking! We then took a pit stop at a nearby town.

Afterwards we hiked through the salt mines where we learned about the complex harvesting process. We now have a new found appreciation for table salt! We finished our hike with a lunch buffet at the Tunupa Restaurant, where many of us tried pisco sour, a very popular drink native to Peru, and the fresh ceviche!

Tomorrow we have our first campaign where we’ll be traveling to a village a few hours away to perform breast and pelvic exams on the local women. Can you say excited!!! We’re pumped!

Overcoming language barriers in Mexico

Practicing interviews with interpreters.

By Marissa Bergh

Hello again! Or should we say HOLA! We made it safe and sound to Mérida, and our journey went off without a hitch. After a short three hour flight, we were warmly greeted at the airport by our friend and host, Victor Chan (head of the community organization, Hogares Mana). He and most people here were in especially high spirits this afternoon because MEXICO BEAT GERMANY in their first World Cup Match! (FYI: Fans were so excited after Mexico’s first goal that the cheers registered as a small earthquake in Mexico City)

After settling into our hotel, we spent the afternoon and early evening finding our bearings and taking in the culture of this beautiful city. Despite the frustrations of language barriers, everyone here was so patient and generous toward us. And even though many of us were nervous that we had forgotten every word of Spanish we had ever learned, most of us found that the words came flooding back as the afternoon progressed.

We capped of the evening with a group meeting. First, we had a discussion on cultural differences between here and Atlanta/USA, which evolved into a discussion around immigration, and the driving force behind migration to the U.S. and the bonds that keep Yucatecans close even when a border separates them.

Finally, we practiced doing interviews with interpreters. Having interpreters is necessary even though many of us speak descent Spanish because we want to make sure every word is understood correctly, so that we can more ensure that our future interventions are driven entirely by the community members themselves. This was more challenging than a lot of us thought it might be because we had to remember to slow down the pace and allow for moments of somewhat awkward silence. But we are all super excited to meet some of the women who volunteer at

Hogares Mana tomorrow, and learn more about how we can work with the organization this week, and in the years to come!

Students eager to serve unique patient population in south Georgia

Colleen Closson

Sophie Katz

By Colleen Closson and Sophie Katz 

Yesterday we arrived in Moultrie! There are 18 undergraduate nursing students, along with students from Emory’s MSN program, UGA’s pharmacy school, Clayton State’s dental hygienist program, and Georgia State’s physical therapy program. In all, there are over 100 of us here to volunteer with the farmworkers and their families! We started off last night with a scavenger hunt to help us learn the layout of the town before heading to an amazing dinner at the Colquitt County Center for the Arts. This morning we set up shop at Cox Elementary School and were able to organize files, clothing, and toiletries at record speed.

Tonight will be our first time at night camp with the farmworkers themelves. There is a great deal of nervous anticipation and excitement as we pack our vans and prepare for what we are told will be a long night. We’ve already had our first gnat encounters and are seeing the merits of neck fans! We are looking forward to working with this unique patient population and learning what we can do to best serve them. Those of us in the undergraduate nursing group have had three weeks of lectures, readings, and discussions about the complexity of working with farmworkers and how we can best meet their needs. We know we still have a lot to learn, but we can’t wait to get started!

Moultrie is an incredible opportunity for us as students to learn about a large and often ignored population. The men and women who gather our food—who are truly responsible for feeding the country—have immense difficulty accessing the healthcare they need and deserve. This program strives to provide that service as an extension of the Ellenton Clinic, and has done so with immense efficiency and care for the past 25 years. This work relies on volunteers and donations from across the state to continue. The dozens upon dozens of donations we have received over the past year are already being distributed to those in need of clothing, bedding, toiletries, shoes, and much more. The Moultrie Farmworker Program is truly a team effort, bringing together communities and disciplines of every kind. We are honored and thrilled to be a part of it. We can’t wait to see what happens next!