Archive for Immersion Learning

Black Lung

Across Appalachia, coal miners are suffering from black lung in record numbers. There has been a major resurgence of the deadly disease, also known as coal worker’s pneumoconiosis. Miners develop black lung from breathing in coal dust. The dust particles settle in the lung where they cause inflammation and, eventually, fibrosis. Black lung causes shortness of breath, fits of coughing, and chronic bronchitis. It is progressive, incurable, and deadly. The Centers for Disease Control estimate that more than 76,000 Americans have died as a result of black lung since 1968.

Why the resurgence now? Many attribute the rise to changing mining practices. As the coal seams that are being mined shrink in size and become more difficult to reach, mining operations must break up more rock to get to the coal. The rock in these mountains contains high amounts of silica, which aerosolizes into very fine particles and is implicated in other fibrotic diseases of the lung. This may be the reason that case numbers of the most serious form of black lung have risen dramatically.

More miners are also coming to clinics for care. Although it is against the law to fire miners for getting chest x-rays or being diagnosed with black lung disease, many believe that if the mining company finds out that you’ve been tested–they’ll find a way to replace you. With the decline of the coal industry, more than 40,000 miners have lost their jobs since 2010 and six hundred mines have closed. Those laid-off miners are now coming in to clinics for care–and black lung diagnoses are sky-rocketing.

Here in Cabin Creek, The Breathing Center in Dawes, WV is a comprehensive pulmonary function facility with a rehab clinic and a federally approved Black Lung Center. The clinic provides pulmonary testing and rehabilitation, and a community-centered approach that allows people suffering from this difficult disease to come together and support each other. Importantly, the clinic also provides legal help to miners filing a claim for benefits under the Black Lung Benefits Act of 1973. This is a federal law that provides monthly payments and medical benefits to miners disabled by black lung. It’s an arduous process, so navigation help is critical. These benefits make a huge difference to the miners and their families.

Many in our group have able to spend time in the Breathing Center, learning about black lung and seeing patients in pulmonary rehab. This is a unique experience, as this disease is rarely seen outside of Appalachia. These miners worked very hard, in very dangerous settings, out of a necessity to provide for their family in a place with few other options. Getting to spend time with them is enlightening, and helps to illustrate the brutal legacy of occupational hazards endured in the pursuit of profit in this country.

 

Abandoned mine site. Source: https://www.nytimes.com/2016/12/24/opinion/sunday/black-lung-incurable-and-fatal-stalks-coal-miners-anew.html

 

West Virginian Word of the Day:

Red Hat (n.): For the first year on the job, a new underground coal miner wears a red-colored hardhat to signal to everyone on the crew that he (or she) is a rookie.

Guatemala Days One & Two

In all seriousness, our first day was wholly a travel day. The travel adventure began at 0400 for some of us and others at the slightly more reasonable time of 0700. The day did not end until 1900, Guatemala time, which is 2100 for those of you reading on the East Coast – which roughly equates to 14-17 hours of travel, depending on who you’re talking to from our trip. We flew into Guatemala City and were ushered onto a bus by Sofia (She’ll make lots of appearance on this blog, I’m sure. She’s our fearless leader and organizer from CEDEPCA – the organization we came with) and Oswaldo (He’ll also make lots of cameos – he’s our bus driver and we all love him. PS you say his name OsValdo). We quickly learned that things didn’t really run on a schedule as what was supposed to be a four hour drive to Cobán became a six hour long trek down a well-loved road. Our hotel was lovely (see picture below), dinner was delightful (think well-seasoned eggs with onions and tomatoes with some plantains and beans), and then we all crashed.

This morning we met with the ministry of health and the nurse who’s in charge of all the midwives here, Erica (she’s also in charge of TB, but that’s a different story for a different group). We talked all about our role here, educating, and how the midwives have historically been viewed in this country. As a future midwife, it was fascinating, but I won’t bore you with all the details. I do think that it’s significant to let you know that the midwives deliver 45% of the babies born out in the community, which is an impressive percent when compared to the out-of-hospital births in the United States (according to one source, it’s roughly 1-1.5% of births). These midwives do this with limited resources and the closest hospital/back-up provider about two hours away (if they can find a car).

After our meeting we got back into the van and drove two hours to the city of Chisec. Parts of Guatemala seem so untouched, like humans have never stepped foot on the majority of its land. I keep mentally comparing it to Jurassic Park because it has the same level of lushness and similarly impressive mountains. It’s crazy to think about the Mayan people walking these mountains that felt so uncomfortable to drive along. The cities and neighborhoods themselves are obviously impoverished, but a few of us have noted that in spite of the poverty, they feel exceptionally clean and friendly in comparison to other countries we’ve visited. As we drove along the roads we could see two of the major commodities in the country – corn and coffee. The corn is essentially grown over every square inch of available land and comes right to the edge of the road with the occasional rectangular house breaking up the jungle. On the other hand, the coffee is grown in beautiful lines or concentric circles up and down the mountains. It looked like my version of heaven – caffeine and order. Chisec itself is much lower than where we stayed last night (and when we return to Cobán on Thursday, I’ll give you the scoop), and it’s hot and muggy. Imagine Florida during the dead of summer and you’ve got the weather we’re staying.

Tomorrow is the first day where we actually get to meet the midwives and all of us expressed excitement at the thought tonight during our reflection time. Don’t worry, we do this every night so I’m sure you’ll get to hear all about them at some point. Anyway, it’s almost 2100 my time (2300 Eastern), so it’s time to go tuck in bed, watch an episode of Arrow (no, I’m not kidding), and set my 0630 alarm.

Jenny Foster and Marissa Storms [me!] enjoying all the fruit and yogurt for breakfast.

The courtyard at our hotel in Cobán

Our hotel in Chisec – it’s rained like this on and off since we got here.

Welcome to Appalachia: Or, how to bust up your stereotypes and learn something.

Coasting down the backside of a curving mountain road in to West Virginia, our car fell quiet. “It’s so beautiful…” someone muttered, almost surprised. The mountains here, older that the Rockies by roughly 400 million years, jut up sharply from the road, covered in lush dark foliage and looking almost jungle-like. A wild wide river rushes to our right. It is beautiful and… perhaps… we are surprised.

West Virginia is a place that many are quick to judge. ‘Poor’, ‘backwoods’, ‘gun nuts’, ‘hillbillies’, ecological disaster. The truth is, there is much more to the people who call this place home. Appalachia is a place steeped in tradition, it is more diverse than you might think, it is hard working, it is stubborn, it is friendly. And, many feel it is getting left behind.

While the world turns on, and the coal seams that built this state shrink smaller, West Virginia remains desperate to find a way to stay economically relevant and keep moving forward. People here seem to live in contradiction: a deep love for home on the one hand, and a pull to leave in frustration on the other.

As part of the Emory nurse practitioner program, our group of 12 students will be working and learning in the Cabin Creek Health System, a network of rural primary care clinics. We are tasked to enter this rotation as listeners. Primary care is more than just vaccinations and check ups–it’s an opportunity to check our preconceptions at the door and hear our patient’s stories. Over the next two weeks, we’ll be exploring this incredibly unique culture and place, and reporting on the beauty and the flaws that make up West Virginian life.

We are excited to be in the mountains. “Take Me Home, Country Roads” has already been belted out at least 3 times since we’ve pulled in (all of five hours ago). We can’t wait to see what this wild and wonderful place has to teach us.

West Virginian word of the day!

Holler (n.): Version of the word “hollow”, meaning valley, in the Appalachian dialect.

Day 1: Eben-ezer Hospital

Our day started off bright and early where we were greeted by the Foundation For Peace staff with breakfast. Shortly after we boarded our bus to visit Elbenizer Hospital for our first patient encounter in Haiti.

This is a local hospital that sees patients outpatient of a variety of ages, has a lab, operating room, an emergency room with 1 bed, and a few about 10-15 inpatient beds.

Our team split up to work with the Haitian doctors and nurses to efficiently treat a room full of patients.This was our first day working with Creole translators and providing care which had it’s difficulties taking a history. We also were introduced to diseases that are common among Haitian populations and learned how they present and how to treat.

After enjoying another delicious Haitian meal, our evening concluded with packing and sorting supplies for our next day’s clinic.

Population health

Alex King, BSN Junior, BUNDLE Scholar

My name is Alex King, and I am a junior BSN candidate. I was born and raised in Atlanta, Georgia, and I started my college career at Georgia College and State University and transferred to Emory University for the Nell Hodgson Woodruff School of Nursing. For my community health rotation, I was fortunate enough to work with Dr. Phan at the Atlanta Housing Authority site. For this clinical rotation, we focused on identifying health disparities within the community then planned interventions accordingly. We identified social anxiety as the major health disparity among the population. We conducted a literature review and found that group therapy was very beneficial for people with social anxiety, so we decided to hold a session for them. I decided to take on the responsibility of leading this intervention. I had never conducted a group therapy session before, so I did some research and found out that the best way to conduct the group therapy session is to come up with discussion questions beforehand. I came up with “would you rather” questions such as “would you rather pause time or go back in time.” I thought that these would be fun and light way to get the ball rolling, but little did I know they would become heart-opening questions that would create new friendships. When I started the group therapy session, I was very nervous about how it would go and whether people would have a hard time opening up. Almost immediately once I started asking the would you rather questions people began opening-up. It was amazing how deep people got in answering the questions. When I asked them the question about pausing time or going back in time, it allowed people to reminisce with each other about the good times they had in the past when they were younger. What I found to be even more beneficial was when they started to talk about past life events that were hard for them or things they regretted. This then created a scenario where they started to support each other. When someone said that they lost their job, it instantly created an environment where people supported that individual in realizing what a good learning experience it was. They concluded that hos job loss created a life experience that allowed him to realize that if he could overcome that, he could overcome anything. This went on for more than an hour, and I ended up having to stop the session because it went over time. I would have never dreamed of this hour group therapy session being so productive, especially with having no experience beforehand. It made me realize how productive and beneficial it is to go into a community and provide services based on the needs of the population. This has given me a taste of how awesome it is to assess a community, prioritize their health disparities, research the issue, plan outcomes, and see the results that come from these outcomes and the wonderful benefits that follow. I am so glad that I got to do my public health clinical with the AHA, my Emory Nursing peers, and Dr. Phan.

Caryn’s Big Word

Ariel McKenzie, BSN Candidate 2018, BUNDLE Scholar

The encounter I had with Caryn happened at the International Bible Church in Clarkston, Georgia. My service learning group was delegated the task of encouraging language nutrition amongst refugee mothers and children as a part of the Mommy and Me family literacy program. Encouraging mothers to engage their babies and children as their conversational partners can be difficult when a language barrier already exists between the volunteer and the family. I had the privilege of working with the young toddler class and the ease with which they pick up words boggled my mind at times.

Caryn, a young toddler from Vietnam was one of the more social kids in her group. She would come into class and made sure all the volunteers saw how pretty she looked that day. She played with all the children and chatted away as she moved from station to station. The room was equipped with playing stations that included cars, blocks, a play kitchen, books, and a large box filled with treasures buried in dried black beans. There was a stipulated schedule for each day and play time was the first item on the list. When I came into class on a Thursday morning, I sat down by the cars and train playing station and began talking with the kids. On any given day, few kids even respond to my over-the-top excitement and enthusiasm, but Caryn thought it was so funny. She came and sat at the station with me and we began to play with a green bus. The bus had a Triceratops dinosaur on it and I thought it would be worth a try to see if she could pronounce the word Triceratops. I pointed to the dinosaur and said di-no-saur slowly and clearly. She repeated the word “dinosaur” with ease so I proceeded to say Tri-cer-a-tops. She sounded out the word and within minutes, she was calling every dinosaur in our bucket a Triceratops. I was shocked to say the least. Few kids even spoke to me and here was one that was sounding out a word that some elementary school kids rarely use.

Empirically knowing according to Carper’s fundamental ways of knowing involves scientific, evidenced based practice (Johns, 1995). Approaching our encounter empirically, I acquired some background knowledge through the Talk with Me Baby training that my service learning coordinator organized. Through the training, I learned the importance of engaging children as soon as they’re born as our language partners and promoting language nutrition within the family. The training provided evidenced based methods for language development in children and the results of implementing those methods as early as infancy.

In addition to applying an evidenced based approach during my interaction with Caryn, I applied Carper’s aesthetic way of knowing by grasping the nature of this specific encounter and acting according to what I believed was appropriate (Johns, 1995).  I noticed Caryn’s behavior in class and I knew she was an outgoing, eager learner. She demonstrated no intimidation while happily playing and talking to the other kids in the class. Taking into account her personal attributes, I thought that encouraging her to pronounce a word might benefit her language development. Additionally, the likelihood of Caryn trying to pronounce that word was high based on her natural curiosity.

Carper’s personal way of knowing begins with the nurse firstly knowing herself (John, 1995).  By addressing my prejudices and being willing to set any obstructive biases aside, a smoother interaction with the kids can occur. Having many close friends that came to the United States seeking a better quality of life, I knew that I was biased in Caryn’s favor. I’ve witnessed my own peers struggle to learn English and how successful they’ve been with continual effort. I know learning a second language can be challenging especially when a person is still learning new words in their native language. However, it can be done and I hope for nothing more than to see the students in the literacy program excel in their language development.

Carper’s ethical way of knowing entails differentiating right from wrong and taking appropriate action (John, 1995). After reflecting on the interaction I had with Caryn and my service learning experience in Clarkston, I conclude that the right action was taken. The families that participate in the program want to be there. They want to learn English and skills that will make their transition to living in America easier. This is why I believe encouraging them to reach their maximum potential is the right thing to do. Even though my interaction with Caryn might not seem extremely important in the grand scheme of things, it was. The satisfaction children experience when they successfully grasp a new skill is one even I remember. The least I can do is help kids experience that satisfaction while enhancing their language development.

My service learning experience in Clarkston differed from other experiences I had with people because this time I felt like I was representing something bigger than myself. Not only was I serving on behalf of Emory’s school of nursing, but I was a nurse to those kids. They didn’t know that I’m only in my first semester of nursing school. I was wearing nurse’s scrubs, so, therefore, I was a nurse. Our service learning group might have been the first nurses the kids encountered since moving here and I really wanted them to feel safe and happy around us so trust could be established instead of fear as early as possible. I’d like to think that with every human encounter that I have while I’m in uniform that I have the opportunity to increase a person’s trust in health care workers. The techniques I used to guide the conversation were building rapport, smiling, over enunciate, and offering positive reassurance. These techniques were helpful because the kids were very young and they often shy away from adults if they sense the person is unenthused. Hopefully, the program will continue to thrive and Caryn’s vocabulary will continue to grow.


References

Johns, C. (1995). Framing learning through reflection within Carper’s fundamental ways of knowing in nursing. Journal of Advanced Nursing, 22(2), 226-234. doi:10.1046/j.1365-2648.1995.22020226.x

It’s National Public Health Week (April 3rd-9th)!

Sheryl Boddu, BSN Class of 2017, BUNDLE Scholar

As a nursing student and a BUNDLE Scholar at Emory University, I come across the words “Public Health” more times than I can count on any given day. I first became acquainted with this term in my Community Health course, where it was defined as “the promotion and protection of the health of people and the communities where they live, learn, work and play.” But what does this exactly mean?  How does it play in the real-world as one’s job, duties and community outcomes?  I did not truly understand the importance of Public Health and the value its entities hold until my Capstone Clinical experience in Gainesville, Georgia.

Since February of this year, I have been learning about the duties of a Public Health Nurse (PHN) at the Department of Public Health (DPH) under the mentorship of David Donalson. As the designated PHN for District 2, David plays many roles and holds various responsibilities that I am fortunate enough to observe. On a typical day at the DPH, I learn how to answer emails and phone calls, track disease surveillance, observe emergency preparedness simulations, perform data analysis assistance and read about current guidelines and policies pertaining to Public Health matters. DPH in Gainesville particularly focuses on notifiable diseases and Sexually Transmitted Infections (STI’s), such as Chlamydia, Gonorrhea, Syphilis and HIV, because of the increasing prevalence of preventable cases. This trend has been attributed to poor access to health care, poverty, and language barriers among the underserved populations clustered in the 13 counties located in Northeast Georgia. I received first-hand experience of how Public Health officials can overcome these challenges and promote good health and well-being.

Likewise, I have been introduced to real-life examples and uses of resources and tools such as Online Analytical Statistical Information System (OASIS), State Electronic Notifiable Disease Surveillance System (SendSS) and Georgia Registry of Immunization Transactions and Services (GRITS). While these programs were just abstract ideas in my Population Health course, in the field I saw health care professionals such as Epidemiologists, Data Analysts and PHNs use them to identify patient’s trajectory and the following-step in the process of preventing disease outbreaks. What was particularly intriguing for me was learning about the expanded role of PHNs as defined by the Statute O.C.G.A. § 43-34-23. Under specific protocols, PHNs can perform screenings and physical exams, diagnose a condition, implement a plan, dispense and administer medications, and even follow-up with treatment management and symptom reduction. This allows for a broad scope of practice and application of skills and knowledge among PHNs, which is not otherwise available in the career path of Registered Nurses with a BSN.

Entering this position, I hoped to learn more about the purpose and duties of PHNs. Connecting principles that I learned in class to actual practice made me realize the importance of Public Health and led to my interest in this field. As a novice, beginning a career in healthcare, I feel more confident and prepared because of this unique experience. I look forward to tackling challenges and contributing to the future of Public Health.

***

Sheryl Matthews is a senior, undergraduate student looking forward to graduation this May. In addition to pursuing a future in Public Health, she is also interested in Critical Care and graduate programs in research and innovation. She is an Oxford College continuee, BUNDLE Scholar, Student Ambassador for the School of Nursing, and the treasurer of Savera, Emory’s Indian classical and fusion dance team.

A Global Health Opportunity in Our Own Backyard

Jessica Nooriel, junior BSN student and BUNDLE scholar

In my first semester of nursing school, my volunteer hours were spent at the Friends of Refugees program called Mommy and Me in Clarkston, Georgia. In this Family Literacy program, mothers are taught ESL while their children are exposed to the English language as well through language nutrition. This intervention is based upon evidence and multiple studies, and these studies have shown that the more exposure to words a child receives in his or her first few years of life, the higher their chances of achieving literacy in his or her younger school-age years and the better chances they have of attending university and obtaining jobs later in life. So, in short, language nutrition is of utmost importance, especially for this population of refugee children who are being raised in homes in which English may not be used often.

After my first semester volunteering with this program, I had spent sufficient time in the various classrooms interacting with the children and I thought that I had a grip on what public health meant for this community. It was plain and simple. Learning the language was the most important factor in the process of these refugees becoming integrated into American society, so I thought.

This semester, my second at the nursing school, was when I began my full population health clinical. Coincidentally, I was placed at the same site as where I volunteered last semester, the Friends of Refugees Mommy and Me program. Since I had spent some time volunteering at Mommy and Me last semester, I thought I knew what to expect for my clinical portion of population health at Mommy and Me. As before, I thought I would arrive at the Clarkston refugee school, be introduced to a new class’s teacher, and then spend the morning speaking and playing with the refugee children of that class until their mothers came to retrieve them at noon.

During my second clinical day at Mommy and Me, though, all of my expectations were exceeded. This time, I felt more empowered. During our pre-clinical meeting in the morning, we discussed our roles as student nurses in this clinical—which involves responsibilities such as noticing refugee children who may have health conditions that aren’t being treated or observing community-wide health issues or gaps in knowledge. This time around at Mommy and Me, I was given a task and a tangible goal, to improve the overall health outcome of the Clarkston refuge community, whether through individual or community actions.

My morning began as I expected. I joined an older toddler classroom, where I aided with snack time, played with the children during playtime, and gave the children as much language nutrition as I could. However, after lunch, my instructor took my group to a refugee resettlement agency, New American Pathways. All we were told was that we would be helping the agency with a program they were planning. I went into this meeting with few expectations.

When I walked out of the New American Pathways building after our meeting, I felt empowered. I felt that my one year of nursing education could already be used to make a difference. The opportunity that we were asked to help with was a Women’s Sexual Health Education class for Middle Eastern and Eastern African Refugee women involved in the North American Pathways organization. My clinical group was given the responsibilities of finding reliable academic sources, creating an appropriate lesson, and fully executing the class when the day came. The education of these women now fell in our hands. And we could feel the immense responsibility that we now all had. We have just begun research on topics in women’s health, and my excitement is growing with each step in the process.

In my time at Mommy and Me, I feel that this experience will equally benefit me as it does the refugees we interact with. I will have my assumptions challenged, and I will come out a more aware and conscientious person. Since my own parents came to the United States as immigrants just two decades ago, I am gaining a better glimpse through interactions with the families at Mommy and Me, just what my parents went through on their journey toward making the United States their new home.

 ***

Jessica Nooriel is a junior BSN student. She chose nursing for its holistic views on both preventative and curative medicine. Her passion for exploring the various health practices and beliefs of different communities and cultures drove her to join the Emory International Nursing Students Association (EISNA). She is tri-lingual in English, Farsi, and Hebrew, and hopes to use these skills for interpretative services within health care.

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

WV_Houses

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