Archive for January 18, 2019

Jamaica, Day 3

Today we had two sites on deck; Blossom Garden’s Children’s Home and the Church Street Police Station!

At the Blossom Garden’s Children’s Home, nursing students spent time playing with and giving some well needed TLC to the children in the home’s care. Students could be found playing jump rope, tag, or just sitting and cuddling with the home’s 30 or so children ages 2-10. Students remarked that, while troubling that such a place must exist, there was a radiance and warmth exhibited by the children and staff that was infectious and uplifting. A fantastic start to the day.

Next, we were on our way to the Church Street Police Station to provide blood pressure, blood sugar, and BMI screenings for the staff. A highlight of this site visit was having all the students cheer on one of the men who was afraid to get stuck for his blood sugar and a little girl who was very excited to receive reading glasses in her goodie bag.

A late dinner at an Italian restaurant on the resort topped off the evening leaving everyone full and tired. 

Grady Hospital – Day 1

First off, I’m grateful for the opportunity to be part of the Grady immersion experience. This trip provides the unique opportunity to work with a specific patient population within the local Hispanic community: undocumented individuals suffering from end stage renal disease.
Today our group started the morning with a tour of Grady, including the emergency, trauma and dialysis units. Afterwards, we had a group huddle to discuss the pre-experience assigned literature we read. The intersection of healthcare and government policies, specifically access to health care services for undocumented immigrants, was the key topic.

To offer a brief recap, individuals from this population cannot qualify for government health insurance and, often, cannot afford private health insurance. Without insurance, they cannot receive the routine dialysis treatments they need to survive and maintain a decent quality of life. However, no one can be denied emergency health care services in the United States. Undocumented immigrants must therefore wait until their condition worsens to the point of crisis and then report to the emergency room for dialysis treatment. While this loophole offers some hope, it severely impacts the quality of life these individuals are able to have. Grady has sought solutions to this issue while staying within bounds of current policies.

After our roundtable discussion, we went to the dialysis unit and met with some of the patients and staff. We broke into groups of three and met with individual patients, asking them general questions about their day-to-day lives and current health issues. One of the other topics we discussed during our roundtable was patient adherence to the renal diet. Patients in end stage renal disease have to avoid certain potassium-rich foods, in addition to other dietary restrictions. Adherence to the diet is an issue within all populations, but I wondered if there were cultural-specific reasons within the Hispanic community.

I asked the patient we interviewed, a man in his mid-40s who has been receiving dialysis treatments for six years, what he thought the reasons were behind non-adherence. He explained that economic barriers were a factor because many families couldn’t afford the healthier foods they were suppose to eat. He also said it was very difficult for one person to maintain a specific diet when they lived with many people who did not follow the diet. I also asked him what the morale was like between the Hispanic patients and the health care staff. He replied that, just as it is everywhere, some people were kind and some were not. When asked if he believed there was trust between the two groups, he said “no.”

Why is there a perceived lack of trust? It could be because these patients and the health care providers aren’t able to establish routine schedules and, therefore, are incapable of building the same kind of relationship that insured patients are able to have with their health care team. It could also be due to burn out within the health care staff, who are faced with a large patient population, a lack of consistent scheduling and staff shortages. Or, perhaps, the lack of trust is related to the fear undocumented individuals have of any agency that is driven by government policy. It’s difficult to say, but it may factor in to the issue of diet non-adherence. Are we more likely to take diet advice from someone we trust, like our family and community, or from people we barely know?

Our interview concluded and, as we prepared to leave, I told the patient “nos vemos el jueves.” (We’ll see you on Thursday.) He responded automatically, “primero Dios.” (First God.) This is a common response, as Latino communities’ concept of time is oriented in the present. They don’t worry about the future, but rather live for today.

“Hay más tiempo que vida.” (There’s more time than life.)

Que Dios los bendiga,

Ginger Rodriguez

Jamaica Days 1 and 2

By Carly Whalen

Greetings from Montego Bay, Jamaica!

Our group of 15 Nursing Students arrived in Montego Bay on Saturday, January 5th. We were greeted by both warm weather and the warm smile of our driver for the trip, Willie! Wiped from the trip, student nurses and faculty enjoyed a quick dinner and were in bed early.

The next day, we visited the New Testament Church of God in Montego Bay. We were greeted by the joyful faces of the minister and his congregation. Word of our arrival spread like wildfire, and people from all over the surrounding area flocked to the church to have us take their blood pressure, blood sugar, calculate their BMI, and to receive education on diabetes and hypertension. We quickly set up stations for people to flow through, and almost immediately had an efficient and effective way to manage the large volume of people who sought our care. By the end of the day, we had seen 70 members of the community, both adults and children.

In debrief, we talked about seeing many similar health problems that face Americans in this population. We identified that the Jamaicans we encountered were concerned and informed about their own health, asking us very pointed and specific questions about diabetes and hypertension, as well as management of co-morbid conditions. Additionally, we were amazed at the values of patience and generosity exhibited by the community. The wait times to see nurses at the education station were long at some points, and there were times blood sugars or blood pressures needed to be taken twice, yet no one complained about the wait or the extra time. Additionally, the congregation provided us with a local staple known as patties; after a long day of work these were greatly appreciated and received with enthusiasm!

A great start to a week of service!