Archive for Lillian Carter Center

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.

How Nursing School Showed Me a Difference World

Elizabeth Balogun, BSN Class of 2017, BUNDLE Scholar

Whenever I get the question “Why did you choose nursing school?”, I almost always respond with my usual, “You know, it just kind of happened.” That question takes me back a bit and makes me think about why I chose nursing and how I got here. Occasionally I even think back to an information session where we were presented with the wide varieties of undergraduate studies at Emory. I remember that I turned to my friend, and laughed at the idea of becoming a nurse. Although it often feels like nursing school was just something that just happened to me, I sure am glad that it happened. I am glad that I tagged along with my friend to a pre-nursing club “Meet the Juniors” event that got me thinking about nursing school. I am glad that this profession, that is rooted in caring, found me.On my very first day of classes in nursing school I hoped and prayed that I had made the right decision, and I have found over the course of my four semesters here that I am indeed in the right place. I did not know much about public or global health or the role of nurses in those settings until I got to nursing school. I did know, even before nursing school, that I would like to spend my career providing care in any way I could to anyone who needs it. As a scholar in the Building Nursing’s Diverse Leadership at Emory (BUNDLE) program I have learned about public health nursing, the need for cultural diversity and awareness in nursing and nursing care, and being a nurse leader and a force for change. Between my classes and my BUNDLE experience I found that I wanted to be a public or global health nurse. My alternative winter break trip to Montego Bay, Jamaica (which I was on the fence about going to) really confirmed that for me.Upon arrival in Montego Bay, we were on the road and ready to take on our first project a few hours after arriving. I had never been happier and filled with a greater sense of fulfillment while immensely exhausted as I was on this trip. We were gone from early in the morning to late at night setting up clinics in churches, teaching reproductive health, doing yoga with hearing impaired students and so much more. One of many profound moments for me was when a man who had visited our church clinic came back with a bunch of plantains for a student who had taken his blood pressure to show thanks for the care he received. Our clinic on that day simply offered blood pressure and glucose checks, BMI calculation, some health education, and a few incentives such as anti-fungal cream and reading glasses. These are things that do not seem like much to us in the United States, but a farmer in rural Jamaica valued these simple things so much that he was willing to give us his produce as a token of appreciation.This experience solidified my goal to become a public/global health nurse. It reminded me that there are people around the world, and even in the United States, who do not have the resources that we take for granted. Whenever I think back to the experience, I want to continue to strive toward the goal of sharing the skills and knowledge that I have been fortunate enough to gain through my nursing school experience and training. I want to use these skills to empower others around the world to take charge of their health. I hope to continue to learn and push myself as an individual and a nurse from my experiences with the diverse groups of people I encounter.

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Elizabeth Balogun is a BSN 2017 student and a BUNDLE scholar. She is from Lawrenceville, Georgia and hopes to become a public/global health nurse providing care for low resource and underserved populations around the world.

¡Wepa!

Yesterday we drove from Caguas (near San Juan) to the south side of the island. We are in Ponce to work at a nursing home for our last service day, but first we had a delightfully warm welcome from the Ponce civic representatives, including the head of tourism. We explored the quaint and colorful town square and some of the city’s main sights, including a tree believed to be more than 500 years old.

At Parque de la Ceiba

The director of tourism passes out “Ponce Passports” for our tour of the city. Credit: David Zhao

Ponce town square. Credit: David Zhao

 

Today we served at Asociacion Benefica de Ponce, home to about 35 senior citizens. We helped with bathing and dressing, medication administration, and wound care. We also attended a lecture on palliative care by one of our leaders, Dr. Weihua Zhang. Members of the nursing home staff as well as nursing assistant students sat in on the lecture, which included an insightful comparison of end-of-life care in the continental U.S. versus Puerto Rico. As one might expect, many of of the emotions and rituals are the same, but we did learn that some people on the island practice Santeria, a Caribbean religion with its own spiritual traditions.

 

One of the most profound parts of our visit to the Asociacion was connecting with the clients one-on-one. One of our leaders, Gladys Jusino, took out her guitar and sang traditional Puerto Rican songs with the clients.

Gladys Jusino plays guitar for a nursing home client. Credit: David Zhao

A bed-ridden woman listens to music at the Asociacion. Credit: David Zhao

A client and nurse of the Asociacion clap along to music. Credit: David Zhao

 

We were reminded that a smile and a gentle squeeze of the hand are universal gestures that transcend language barriers.

Credit: David Zhao

Credit: David Zhao

Credit: David Zhao

 

We ended the day with a bird’s eye view of Ponce and sleepy car ride back to our headquarters near San Juan.

Credit: David Zhao

 

Our service learning trip has come to an end, and tomorrow we fly back to Atlanta. I think I can speak for everyone in our group when I say that we were humbled and honored to have been a part of this trip to Puerto Rico. We met incredibly gracious and intelligent people, we learned about the island’s vibrant culture and history, and we aimed to care for, in however small a way, some of its most vulnerable citizens. Thank you to our brilliant and fearless leaders, Gladys Jusino and Weihua Zhang, and their family members that accompanied us.

Wepa, a Puerto Rican word that implies joy and good cheer, was brought up a lot during this trip. Gracias, Puerto Rico, for welcoming us with open arms. We will be back! ¡Wepa!

Un Llamado Superior: Day 4 in PR

Today we spent the morning at the Colegio de Profesionales de la Enfermera, an organization for nurses in PR similar to the American Nursing Association, learning about nursing and the state of health care in Puerto Rico. In order to practice as an RN, nurses here must have a college degree in nursing as well as membership in this professional association. The director of the Colegio, Juan Carlos, told us that a recent Puerto Rican law decreased the number of sick and vacation days for all workers, and increased their probation time before becoming permanent employees. Juan Carlos also told us that in recent decades, Puerto Rico has seen a “brain drain” of its workforce to the continental U.S., including the departure of nurses. The Colegio is hard at work advocating for better pay and working conditions for its members.

Posing with Florence Nightingale at Colegio de Profesionales de la Enfermera. Credit: David Zhao

Juan Carlos ended his talk with a quote in Spanish from Florence Nightingale that referred to nursing as “un llamado superior,” a higher calling.

After another yummy Mofongo meal for lunch, we traveled to a local hospital where a very special organization – PITIRRE – is headquartered.

Mmmmofongo. Credit: David Zhao

 

I’ll let one of our team members, Tara Noorani, take it from here:

“My admiration for nurses was born from an exposure to street medicine. Their ability to address the entirety of the person was something displayed during each client interaction.

Wednesday (March 8th) began at PITIRRE de Iniciativa Comunitaria, an addiction treatment program offering healthcare, education and prevention services to homeless and HIV-positive clients. The pitirre is a bird found in Puerto Rico weighing nearly 1.5 ounces and personifying somewhat of a powerful underdog. El pitirre serves as a symbol of hope and resilience in the face of adversity. The staff at PITIRRE emphasized the bond between ourselves and our fellow human – the tie between providers and clients. They encouraged us to understand our intersection as brothers and sisters and the power in our collaboration with one another.

With this lesson in mind, we began our night by making sandwiches with members of Operacion Compasion de Iniciativa Comunitaria, a mobile clinic project rooted in Rio Piedras, Puerto Rico. We assembled hygiene kits, brewed gallons of coffee, and collected juice boxes, medications and wound care supplies into their mobile clinic truck. From 10pm to 3am, we combed the streets, in search of possible clients.

Led by two of the most humble leaders of Operacion Compasion, we treated a total of 38 clients and performed wound care on 6 of these people. We offered blood pressure screenings, glucose checks, coffee, juice and sandwiches. We witnessed the isolation a person endures in the street and how the label “homeless” overlooks their humanity. Inevitably this manifests into a marginalized community drowning in stereotypes and misconceptions.

When I reflect on this experience, I’m reminded of the importance of being present with those who suffer. The nature of homelessness obscures the client’s voice and visibility. By meeting these people where they are, we are choosing to resist the poverty and injustice of their circumstances. As student nurses, we have an obligation to uphold the individuality and autonomy of each client and oppose the forces impeding their access to care.

As Emory students, it is a privilege to serve the people of Puerto Rico, a pleasure to have been enriched by their culture and an honor to advocate for their health care needs.”

Montego Bay: 16 nursing students, two professors and one breast model take Mobay

DAY 1| The bustling of the footsteps resonated throughout the Atlanta International Airport. All 16 of us arrived with high anticipation. Dr. Muirhead and Dr. Horigan, our two faculty instructors, directed as we quickly checked in eight packed suitcases of medical supplies and incentives (blood glucose monitors, gloves, band aids, hygiene kits, glasses, lotion, etc). We promptly started walking through TSA security with no concern or doubt that we would be stopped. However, we were completely wrong. Although most of us walked through smoothly, Dria (ABSN ’17) confidently knew that she would be stopped. “I just knew it,” she said as she shook her head after the incident. The red lights immediately flashed as her luggage passed through the security scanner. The TSA officer started searching through her personal items before pulling out the breast model she had for her breast self exam presentation. The officer’s eyebrows raised as she questioned, “what is this?” Without a second thought, Dria went nurse mode and preceded to educate her about breast exams. She even encouraged her to perform her own self exams and emphasized the importance of it. By the end of the conversation, Dria walked away with not only her breast model but also with the satisfaction about her premature patient education. We knew right then that this would be a good trip.

When we finally made it to Jamaica, we went straight to work. After refueling our energy with food, we took two hours packing first aid kits as incentives for our very first event! After designating leaders for this event, we headed over to The Church of God to speak with the individuals about the health related issues in Jamaica and Montego Bay.

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Elianne Carroll (ABSN ’17) and Fauziya Ali (BSN ’17) created and executed the health module about the Zika virus. The ladies of the church listened intently as they followed them through their poster. In order to guide their understanding, we also provided them with an educational handout that had additional information to address any concerns.

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After the presentation, we provided free blood pressure screenings and patient education. Dr. Muirhead floated around to assist and provided further patient education about actions individuals could take in order to help lower their blood pressure. Each participant received a gift bag with deodorant, anti-fungal cream, and their own personal first aid kit. The ladies and specifically the kids at the event enjoyed both the information and our presence.

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We returned to the hotel in good spirits and hungry. After eating, debriefing, learning about hypertension education tips, and creating aromatherapy rice bags, we went straight to our rooms to say hello to our beds. FIRST DAY, SUCCESS.

 

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.

 

A different World: The best experience of nursing school

Have you ever traveled? Visited different countries, cities and resorts? I’m sure at this point in your life you have done so at least once. The real question is, have you ever traveled on a mission trip? I can say I  have been blessed to have accomplished this one on my check list and hope to do many more. This past week I went to Jamaica on an Alternative Winter Break trip and I can only say it is one of the best experiences of my time in nursing school.

The trip to Jamaica started the day after my last final which made it a bit stressful. I then started to wonder about my level of insanity to have chosen a trip during this time, but I can definitely say it was all worth it. Along with volunteering at different churches and communities doing different health screenings, my group and I had a chance compare the Jamaican and U.S. Health systems. This was the icing on the cake for me. We toured the Cornwall Regional hospital, the main hospital in the St. James Parish, and shadowed the nurses. It felt like we were in a different world of nursing. It truly amazes me that even through the differences in healthcare and resources, we still manage and survive. It means so much to go on this trip as a student because the experience humbles you and allows you to think about how you can help change or improve things.

While, on this trip I learned more than a handful that will supplement my nursing role and career. If you have not had the chance to participate on a trip abroad or getting ready to do so, don’t you worry it is totally worth it. You will grow, adapt, mature and enjoy your time. I am brave enough to promise you that!

 

By: Nadege Pierre, BSN Class of 2016

 

Montego Bay: Girl’s Home, Hospice Center, Women’s Centre, Children’s Home

Day 2 (continued):

After finishing our tour at Cornwall Regional, we arrived at the Melody Home for Girls at about 4:30 on Tuesday ready to enrich the lives of some young teenagers. This is an orphanage for young girls who have gone through some tough times in life, have no parental support, and need guidance. Heather Balenger (BSN ’16), Jessica Rutledge (BSN ’16), and Xueying Cao (BSN ’16) pioneered the way with health education presentations on the importance of exercise and STD and safe sex practices. The group drew the girls first with an icebreaker known as the human centipede followed by some stretching and group talk on the importance of exercise led by Jessica Rutledge. Heather and Xueying kept the girls attention with safe sex practices by involving them with the proper condom administration performed on bananas; and it was a hit!

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Sabrina Jahani (BSN ’16) followed their well received module with a very informative and interactive teaching on domestic violence equipped with a moving domestic abuse skit read by Erin Pollock (BSN ’16). The girls were very engaged in this subject and were most vocal on this matter. To round things off for the night, Chuncey Ward (BSN ’16) and Heather joined Sabrina for teaching on dating older men and the dangers associated with this matter. Everyone had a great time in fellowship with one another and smiles were everywhere at the end of the night. This was the first time for Emory SON at Melody Home for Girls, but I’m sure it won’t be the last.

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Day 3:

To get our third day in this beautiful city started, we visited a hospice center to provide companionship and laughter to the patients who lived there. We thoroughly enjoyed getting to know those patients and hear their life stories. Some students performed massages and others went room to room singing Christmas carols. The Christmas spirit was certainly in the air!

We arrived at the doors of the Montego Bay Women’s Centre at around 11:30 as the second stop on our Thursday leg of the trip. This is a place where young teenage girls who are pregnant can come and continue their schooling as being pregnant  is not allowed in the public schools. We found that the girls have the option to stay for 3 months post delivery if they choose and once they have given birth. Xueying Cao (BSN ’16) led the discussions by informing the girls on pregnancy prevention. Heather Balenger (BSN ’16) tag-teamed Xueying’s efforts with a presentation on HIV and STD awareness and safe sex practices equipped with her patented condom-on-the-banana race. Kate Yuhas (BSN ’16) finished everything up with a group interactive presentation on healthy food choices and nutrition pointers to keep in mind as young pregnant women.

Throughout the day the girls had several opportunities to win prizes that included baby bibs, board books, diaper rash cream, socks, nipples, bottles, diapers, and much more. At the end of our day we sat individually with groups of the girls and discussed similarities and differences between life in United States and Jamaica as well as their plans after pregnancy and high school. Gift bags including shampoo, soaps, toothbrushes, toothpaste, combs, lip balm, and candy canes were given to each of the girls on our way out. For our farewell, we sang Christmas carols for the group. Our holiday spirit carried us over to a daycare next door where preschoolers were enjoying popcorn and a bouncie house. We made lots of little friends there and also gave them a good helping of Rudolph the Red-nosed Reindeer and Jingle Bells…and they of course loved it!

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Our bus driver for our stay, Mr. Willie Smith (Not to be shortened as just “Will”) took us through down town Montego Bay for lunch to introduce us to what he described as “the best beef pattie spot on the island,” Juici Pattie. Everybody enjoyed the tastes of Jamaica indulging in patties with beef, curried chicken, curried shrimp, and beef and cheese.

After lunch, we continued on to the Blossom Garden’s Children home, an orphanage that took care of many children from infants to school-aged children. We performed health screening for all the workers in the facility including BMI, blood pressure, blood glucose, and counseling afterwards to discuss the results. Other students spent time with the children, feeding and interacting with them. Jessica Rutledge (BSN ’16), Nadege Pierre (BSN ’16), and Jaine Lee (ABSN ’16) provided education about physical activity and used the game “Simon Says” to show one way to perform exercise. Marcela Sanchez (BSN ’16) demonstrated how to correctly brush teeth and all children were provided a goodie bag that included a brand new toothbrush and bottle of toothpaste. Kate Yuhas (BSN ’16) provided education regarding healthy eating.

After a long day, the group returned to the our hotel and enjoyed a meal together along the water at one of the nearby restaurants.

Montego Bay: Comparing Jamaican and US hospital systems

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Day 1:

Our trip started off to a great start with our arrival to Montego Bay on Tuesday morning with 17 nursing students, our two faculty instructors Dr. Muirhead and Dr. Erin Ferranti, and four full suitcases of supplies for our work in Jamaica. Some of the medical supplies we brought include blood glucose monitors, lancets, gloves, first aid kits, hygiene kits, blood pressure cuffs, sharp containers, and stethoscopes. In addition, we collected other supplies and donations to give to the Jamaican community including bibs, pacifiers, lip balm, toothpaste, toothbrushes, candy canes, glasses, bar soap, socks, lotion, shampoo, razors, diapers, and combs.

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After checking in to our hotel, the group headed to The Church of God to speak with the men’s group about healthcare problems specifically associated with  Jamaican men.

Erin Pollock (BSN ’16) led our discussions with an education module about smoking cessation and the problems associated with both firsthand and secondhand smoking. The men were very engaged in learning about how nicotine affects the body and ways to quit smoking and/or share with friends and family. Afterwards, each participant received a handout to help develop an action plan to ditch the habit and a pack of gum to show one way to support smoking cessation.

Chuncey Ward (BSN ’16) continued with an educational module about the risks and symptoms associated with benign prostatic hyperplasia and prostate cancer, which is a very prevalent issue in the country of Jamaica. The men received handouts with relevant information to bring back home with them in hopes that they will educate their peers and community.

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After both presentations, we performed blood pressure and body mass index (BMI) screening. For those whose BMI was elevated, our nursing students provided one on one patient education regarding exercise, diet, and lifestyle modifications.  The men were receptive to our advice and felt very motivated to maintain healthier lifestyles.  Afterwards, every participant received a gift bag which included anti- fungal cream, condoms, and razors.

After debriefing upon return to the hotel, the group got a good night’s sleep in preparation for our day at Cornwall Regional Hospital.

Day 2:

At 7:30 am, the group left the hotel and headed to Cornwall Regional Hospital, a ten-floor facility of the West Regional Health Area that served the Montego Bay population in a variety of specialties including psych, pediatrics, and oncology. We met the director of nursing services as well as other nursing personnel who helped explain the structure of the nursing profession in Jamaica. We then divided into two groups and toured all units of the hospital. We were able to engage with the nurses and ask questions, comparing practices between Jamaica and the United States.

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Some examples of the differences we found include:

  • No epidurals are performed, only spinal analgesia
  • Hospital facility was open to air in center of hospital and in almost every patient floor
  • No IV pumps, gravity based drip factor calculation
  • Medications are not locked, no Omni cell
  • Nurse to patient ratio is 1:15, can be up to 1:25
  • Average wait time in the ER is close to 24 hours
  • No heparin is used in the facility
  • They use water jugs for traction
  • There were wards instead of units; individual wards are separated by gender
  • No electronic files, all handwritten notes
  • Med cards are written on index cards instead of an electronic MAR
  • Nurses here work 8 hour shifts instead of 12 hour shifts
  • Very formal dress wear including a headdress
  • 1 male registered nurse in the whole facility
  • Nursing school onsight, 5 year bonding
  • Pale comparison in pay: $641/month, $7700/yr, 32% taxes
  • Security guards at front door of hospital
  • Full healthcare coverage for everyone

Later in the day, we were able to break up into different wards and observe the nursing role in the hospital directly.

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Fun Times at Cornwall Regional Hospital

After early morning preparations, we stepped onto the bus and started our two hour ride toward Cornwall Regional Hospital. When we first reached the place, we immediately noticed the difference between that hospital and our local Emory hospital. There were many people standing in front of the entrance, casting their shadows on the pinkish hospital exteriors, and waiting for entry into the hospital. Before anyone could enter, a security guard made sure no hazardous materials were allowed in. Unfortunately my Canon made that list so we had to store all of the cameras in the nursing administration room, which the nurses were kind enough to share with us. We were introduced to the various nursing officers of the hospital. They all wore very strict uniform consisting of bleached white attire and a little white tiara-like hat. It seemed to be the uniform that we used to have in the states many years ago. We then received a tour of the entire hospital complex. The hospital building itself seemed to be divided into various units like in the US. However, the interior were less technologically advanced and also lacked many of the strictness that we have in our nursing units. The patients were put into the same room, meaning patient privacy is significantly reduced and forget about HIPPA compliance. However, the hospital staff seemed to know how to efficiently use their resources and amazingly managed to run the hospital successfully with their constraints.

The nursing culture in Cornwell seemed to be consist of a supporting environment for coworkers and everyone seemed to respect everyone. They addressed each other as “sister”. Furthermore, the nurses and doctors also seem to be very friendly with each other. While many nursing units such as Emory G6 in the US have been improving on creating positive and collaborative workplace culture, we certainly have some road to go when it comes to the culture of “eating the young” that might still exist in some of the areas in our healthcare system. The Cornwall hospital did not seem to have the “eating the young” culture.

However, the hospital was extremely crowded and patients often have to wait more than four hours before seeing a physician. According to one of the nurses, many Jamaicans underutilize the primary providers and prefer to go directly to the hospital because it saves them time. The healthcare system in Jamaica is funded by the government, meaning patients do not pay for their care in the same extent as in the US. This might contribute to why many patients seem to be grateful and patient as they wait the long hours to get treated by a doctor.

After lunch, our group was divided up and sent to different areas in the hospital. One of those areas was the ER, which is where I ended up at. I was able to witness the triage model the clinicians used. Since they were still using paper charting, when a patient first come into the ER, a doctor would assign a colored paper, ranging from red, yellow, and green, indicating the acuity of the patient. That color also indicate how long the patient might have to wait so while it is bad to get a red paper since it indicates high acuity, it also means seeing the doctor faster. The nurses played a vital role in the ER like many other places. They had a special room where nurses assessed vitals, conducted labs, and other tests to help with healthcare issue. Despite the many patients, the workflow was efficient enough that they tend to get all their patient looked at by the time they close. With their limited resources and amazing culture between the staff, Cornwall was inspiring.