Archive for Immersion Learning

Graduate Immersion Experience During West Virginia Flooding

Flooded streets and businesses in Clendenin, West Virginia

Graduate students in the School of Nursing’s Nurse Practitioner program Phil Dillard (Emergency) and Abby Wetzel (Nurse-Midwifery) discuss their immersion program experience with Cabin Creek Health Systems. The students worked alongside staff of the Clendenin Clinic to evacuate medically-fragile residents during the region’s recent storms and devastating flooding. Cabin Creek is a federally-qualified health center that provides essential health services to vulnerable populations in rural West Virginia through several community-based clinics.

 

Graduate Students Reflect on Immersion Experience during West Virginia Flooding

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School of Nursing graduate students participate every year in a two-week immersion program in West Virginia through the Lillian Carter Center for Global Health and Social Responsibility. Our students work in partnership with area federally-qualified community health centers to promote health and prevent disease throughout the region. Led by faculty Advisors Carolyn Clevenger and Debbie Gunter, students Andrea Brubaker, Phillip Dillard, Kimberly Eggleston, Hannah Ng, Jill Peters, Allysa Rueschenberg, and Abigail Wetzel, were providing essential health services through four community clinics located in cities to the north and south of Charleston. Two of our students, Phil Dillard and Abby Wetzel, were working in a clinic in Clendenin, a town 25 miles northeast of Charleston that was hit hard by the storms.

Phil Dillard discusses the experience in this WSB-TV Channel 2 interview. WSB Interview – West Virginia Flooding

First Week at the Atlanta VA!

Hello from the Atlanta VA Group! We have had a great start to our two week immersion experience with our Veterans! There are so many experiences to be had here at the VA, so we have been jumping in where ever we can. We started last Friday by attending an M, M and I meeting (Morbidity, Mortality, and Improvement). During this monthly meeting, a topic is chosen and a case within that topic is discussed. This month’s topic was Delirium vs. Dementia. It was so interesting to hear the experts discuss their views on something we have been discussing in class recently!

This week we started off by doing a scavenger hunt to orient ourselves with all the VA has to offer! We were able to introduce ourselves to many of the employees and volunteers that serve here. We were so impressed by the warm welcome we have received by everyone (patients, employees, volunteers, etc.). We can tell that the VA really takes pride in the amazing work that they do every day.

We have also been helping out with some research by transcribing interviews for part of a project called “Choosing Wisely” which focuses on starting a dialogue on how providers and patients can avoid unnecessary tests, treatments and procedures. As future providers, it is essential to be conscious of how we are utilizing resources while providing quality care for our patients.

Coming up next, we are excited to participate in Internal Medicine rounds and participate in another quality improvement project involving Value Stream Mapping.

D.R. Wrap-Up

Our final two days in San Francisco de Marcoris included Q.I. presentations about both programs we observed. The five of us who worked at the Hospital San Vicente de Paul, invited hospital administration, staff, and students to our presentation on the Kangaroo Care/Programa Caguro. Everyone did a wonderful job and the hospital team was very receptive to, and happy with, our observations over the two weeks. Later the same day, the second group presented to the Manhattan community and were also well received. No doubt we all learned a lot about a vastly different healthcare system than our own, and are so very grateful for our time in the D.R. Many of the people we met during our journey there will be faces remembered for the rest of our lives.

On the day before we flew back to the U.S., Dr. D gave a wonderful presentation on her research on Health and Spirituality, at the hospital. It was a big turn out! After grabbing our bags, we packed in to a minibus with fewer seats than people, and began a loooooooong, hot, squished journey to the capital, Santo Domingo. Many acres of rice fields, mountains, small towns, and farms later we arrived at the University, where we had a meeting with the new administrators about the purpose of our trip/projects.

Then piled back into the bus and drove around until we found our hostel for the night. Hostel Nomadas is a little slice of heaven in a beautiful city. We got out to do a bit of sightseeing, which included setting foot in the oldest cathedral in the New World. Amazing. Then the night ended with a lovely dinner on the rooftop of the hostel.

We all learned so much on this trip. And though it’s nice to be home, the experiences and people in the D.R. will be missed.

 

Vámonos al la playa

This weekend we had a wonderful getaway adventure. Our trusty driver, and our hostess, drove took us through the city of Nagua. Where we visited the Nagua campus of University de Santo Domingo. It was very impressive! The center is open air and feels as big as a futbol pitch.

We kept going on to Playa Grande. It was everything we’d hope it would and more: white beaches, clear water, sun, and great company. A few sunburns later, we were all ready to head to the hotel Bahia Blanca. It was a hidden gem in Río San Juan. Owned by a lovely Canadian woman, it is tucked away amongst a few small beaches. We ate dinner at an Italian restaurant in town called La Casita. With stuffed bellies, we returned to the hotel and continued the adventure on Sunday. We explored beaches and enjoyed wandering

Early morning swim

Early morning swim

around town. Then we returned to San Francisco de Macoris by bus (with air conditioning!).

This morning we all squeezed into our little red mini bus and headed out to the community of Manhattan for a health fair for the pregnant women who lived in the area. We talked about preeclampsia, baby development, and prenatal nutrition.

This afternoon a few of us went out to the countryside to enjoy an afternoon at El Rancho de Don Lulu. The bravest of us all headed up the mountain for a hike. The hiking group had some hiccups along the way, but returned safely after a few hours thanks to their trusty guide…who happens to be the pet dog of the man who usually guides people to the mountain top. He was off today but his sweet pooch made sure everyone was accounted for. Back at the ranch, the hikers cooled off in the natural spring pool there.

Tonight, we are finalizing presentations for tomorrow morning!

It’s Friday in the D.R.!

This morning we sent a few people to the hospital, while the rest of the group headed out to Manhattan’s La Casita de Salud, where a CPR training session took place. Community leaders were trained in CPR (RCP, in Spanish), and taking blood pressure readings. The road there was a bit bumpy (literally) thanks to road construction. Despite getting started a bit late due to the costruction and a non-functioning projector, it was a great program. A large, stuffed batman doll and an inflatable CPR doll, MiniAnn, served as the willing patients during the demonstration. Back at the hospital we intended to interview the hospital administrator about both programs in which we are involved. Unfortunately, he was not there. But as Dr. D says, “Flexibility is our motto.”

After lunch together, we all piled into a couple carritos (small taxis) and headed to La Sirena, which is basically a slightly smaller version of our super Walmart in the States. They have air conditioning and ice cream with marshmellow fluff topping. Needless-to-say, it’s a small piece of paradise here in beautiful, hot, sticky San Francisco de Marcoris. There we worked on our presentations while munching on snacks in the food court.

Tonight a few people are going out dancing in town, while the rest of us are staying home to write blogs and get ready for our one-and-only trip to the beach tomorrow. Happy Weekend to all!!

We’re on island time now…

We have been busy since Christina’s last update.  The group has been at the East End Medical Center- collecting ambulatory care surveys, observing through put, creating educational materials, organizing charts, and shadowing providers.  Everyone has pitched in to get our quality improvement data in and we are now working on the results and projects that we will present to the Leadership team at the health center.  We are also preparing to assist with a health screening this week!

Mackenzie helps organize and pull charts.

Mackenzie helps organize and pull charts.

Mary Macon helps organize and pull charts.

Mary Macon helps organize and pull charts.

Annie and Kelly work on a bulletin board- just one of our many educational projects for this trip.

Annie and Kelly work on a bulletin board- just one of our many educational projects for this trip.

We have interviewed and surveyed locals here in St. Thomas for our quality improvement projects.  However, we have also had the opportunity to talk with some providers to get more information about what it means to provide health care to St. Thomians.  Tuesday, we had the opportunity to meet with the Dr. Hughes, the Radiation Oncologist here on the island.  He and his physicist, Damien explained not only what they do but why they choose to do it here.  Hearing these men speak gave new meaning to what we want to accomplish here.  The medicine that they practice is awe-inspiring, but their reasons are what motivates me to follow my passion for patient care.

Entering the treatment area.

Entering the treatment area.

Damien explains how the radiation is delivered.

Damien explains how the radiation is delivered.

One final picture of our group with Dr. Hughes and Damien.

One final picture of our group with Dr. Hughes and Damien.

Community Immersion

Over the past several days, we have been working on our evaluation project and have been interviewing leaders in the community and hospital about the vision they have for improving maternal care.

We have finished our interviews and are now compiling our data.

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Over the weekend we had the chance to go to beach! Quite a few of us got some pretty bad sunburns 🙁 but the beach was absolutely beautiful!

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On Monday after we got back from the beach, we had the opportunity to accompany community leaders on home visits. During these home visits, we were able to observe the living situations of those living in the city and see some of the health problems within the communities. We talked with the patients about their health and answered some of their questions. One visit in particular that stuck out to me was a visit with a 23 year old lady that was 4 months pregnant with her first child. Her baby hadn’t moved for over a day and when we started to talk to her, she told us that she fasts 4 days a week including fasting from water. We talked to her for about 40 minutes to emphasize the necessity of food and water for her baby. These visits enabled us to think on our feet, especially how to address these health problems in low resource areas.

 

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Embracing Eleuthera

bay street
Monday
 
Walking back from the picnic tables at the library (good wifi, scary bees nest) Elisabeth and I took the long way home. We headed down Lord Street waving at patients we had met last week, hanging laundry and preparing supper.  As we headed to the waterfront we passed Tarpum Bay Primary and a group of boys playing basketball.  We hooked a left onto Bay Street, passing conch salad stands closing for the night. Separating the road and the Caribbean is a cement wall with a few wooden staircases leading to the sand.  Recent storms left high waters and today the steps took us directly into the ocean. We took a quick dip and looked back on the past few days…
 
Friday was bitter sweet as we said good by to our week one clinic spots. After 5 days we felt competent screening patients, answering phones, filing, filling prescriptions, and communicating with the nurses, physicians, and locals. Earlier that morning Rock Sound Airport had a flag raising ceremony commencing the start of a 40 day celebration for the upcoming 40th anniversary of Bahamian independence. Why am I mentioning this you may ask?  Patrice and I walked into our clinic with a packed waiting room and no clinic staff. 
 
We jumped in and started the patient log, pulled files, and began screening. Filling out either a “general encounter” or “child health encounter”, Patty and I took turns taking blood pressures, recording medication histories, and establishing chief complaints. Did I mention it was wound day? We assisted Dr. Smith in draining an axillary abscess, suturing a leg wound, redressing a gangrene toe from a diabetic patient, and assessing an ocular puncture wound.  Patrice and I were moved by Dr. Smith’s empathy and tireless work ethic. He knows his patients beyond their acute or chronic conditions and provides compassionate, holistic care. He also provided us with numerous educational moments, calling us in to hear a murmur, or see an ear infection through the otoscope. We feel so fortunate to have had such a dynamic clinical experience. 
 
Friday night we headed North (or down the island as Eleutheran’s say–South is up island–we learned this the hard way) for the fish fry. We dug into the food–actually dug, with our hands (sorry Patty I had to put a picture in). We watched a man prepare fresh conch salad and participated in some fish fry festivities. Not to toot our own horn, but Emory really delivered-Joanna won second place at the limbo contest and went head to head with Jasmine in a dance off, having already out danced the other fish friers.
 
Saturday Robyn took us on a tour to preachers cave where British settlers first discovered the Bahamas after a ship wreck. On the way home we stopped by glass window bridge where the Atlantic meets the Caribbean. We also made a stop at the Governor’s Harbour library where the first annual youth art show was displayed. There was a band on the porch of the historic building playing what we’re fairly sure was “brick house” (Commodores).
 
On Sunday we attended a lengthy Methodist Father’s Day service at the church below our house. It began with a “welcome” time to meet and greet the congregation. As I reached out to shake the hand of Alia, a 7 year old girl who later read a poem, she bypassed my hand and leaned in for a full hug. We’re so thankful and appreciative of the warm welcome Eleuthera has given us.
 
Today was the first day at our new clinic spots and we all seemed to have a packed day. Patrice and I both removed sutures (two different wounds, two different fights), and provided diabetic education. The nurses at Hatchet Bay are encouraging and make sure to include us in every educational moment.
 
Meanwhile as we experience new clinic sights and gather feedback from the nurses, we’re pulling together some exciting quality improvement initiatives. While it’s hard to imagine coming home, I am beginning to developing heat rash in some unfortunate places…
I’ll leave you with as many pictures as this bandwidth will allow me. Much to my chagrin there is some documentation of my mosquito bites etc, I’ll spare you those. 
 
Warm regards, 
 
Elise  
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St. Thomas: Photo recap of our first week!

 

Greetings from beautiful St. Thomas! Where do I even begin? We have so much to share from the past 7 days, so we decided to do a photo blog so you could experience it with us!

As Holly mentioned in her previous post, the eight of us were split up for the first week (1/2 with Dr. Barzey, 1/2 at the FQHC). The lovely staff at the FQHC welcomed us with a sweet sign 🙂 Annie, Rachel, Eyelle, and Kelly have been working hard to distribute ambulatory care surveys, creating educational materials for patients, shadowing the providers, and making the health center more patient friendly.

Rachel, Eyelle, Annie  & Kelly at the FQHC

Rachel, Eyelle, Annie & Kelly at the FQHC

The other group worked with Dr. Barzey (the only endocrinologist on the island)  to create a comprehensive booklet on diabetes education that she can give to her patients. We also had the chance to go out into the community and survey the locals about their nutrition and exercise choices.

Mackenzie, Christina, Mary Macon, & Holly getting some cultural education from Dr. Barzey

Mackenzie, Christina, Mary Macon, & Holly getting some cultural education from Dr. Barzey

Speaking of food choices, the most popular fruit on the island are mangos! They are sold on almost every street corner, and are some of the most delicious mangos we have ever tasted!

A local fruit stand in downtown St. Thomas

A local fruit stand in downtown St. Thomas

If you don’t believe me, ask Eyelle!

Eyelle enjoying a mango!

Eyelle enjoying a mango!

Both groups worked dilligently all week to meet their goals and deadlines. We have learned so much about the culture here on the island. It is amazing how differently islanders live, and how much they appreciate the small things that we often take for granted.

The most frequent mode of transportation on the island: The "Safari" serves as a taxi to the locals. Usually less than $5 per ride!

The most frequent mode of transportation on the island: The “Safari” serves as a taxi to the locals. Usually less than $5 per ride, and can fit up to 18 people!

At the end of a long week, Dr. Wright invited us to have dinner at her and her husband’s beautiful ocean side home in St. Thomas.

The girls with Dr. Wright and her husband Chip.

The girls with Dr. Wright and her husband Chip.

Did we mention the view from Dr. Wright's front deck? (#nofilter)

Did we mention the view from Dr. Wright’s front deck? (#nofilter) p.s. that is St. John in the distance

Before we knew it, the weekend was here! We took a ferry (only $6, 10 mins) to the gorgeous island of St. John to enjoy our weekend off! Here are some pics of our trip:

St. John

Welcome to St. John!

The girls enjoying the view of Trunk Bay- one of the beautiful beaches in St. John

The girls enjoying the view of Trunk Bay- one of the beautiful beaches in St. John

A traditional dish of the island: curry chicken, yellow rice, boiled sweet potatoes, and veggies

A traditional dish of the island: curry chicken, yellow rice, boiled sweet potatoes, and veggies

The girls showing off their “Caribbean Hook Bracelets”

"Caribbean Hook Bracelets have been worn for centuries by islanders in the Caribbean, serves as "island time" to be a popular symbol of unity and love. The open end of the hook pointed up toward the heart means your love is take, the open end of the hook worn down away from the heart, means your love is free (unattached or single)"

“Caribbean Hook Bracelets have been worn for centuries by islanders in the Caribbean, serves as “island time” to be a popular symbol of unity and love. The open end of the hook pointed up toward the heart means your love is take, the open end of the hook worn down away from the heart, means your love is free (unattached or single)”

 

We had an amazing time in St. John and were sad to leave 🙁 But also excited to start another week, and this time, all eight of us were reunited at the FQHC!

Annie pausing for a smile while preparing her ambulatory care surveys!

Annie pausing for a smile while preparing her ambulatory care surveys!

Mackenzie and Christina going over some important details for their clinical day

Mackenzie and Christina going over some important details for their clinical day

Rachel and Dr. Wright at the FQHC

Rachel and Dr. Wright at the FQHC

We’ve had an incredible week so far here in the Virgin Islands, and look forward to this week’s adventures!

Nursing love,

Christina