Thomas Jefferson said “Laws and institutions must go hand in hand with the progress of the human mind as that becomes more developed, more enlightened, as new discoveries are made, new truths discovered, and manners and opinions change. With the change of circumstances, institutions must advance also to keep pace with the times,” a quote which is inscribed on the wall of the Thomas Jefferson Memorial. The group reflected that this quote is a great summary of the immersion experience. In fact, during their Capitol tour, the group learned that the Capitol was originally one small building, which is now just a wing of the current Capitol. This fact is an important reminder to continue growing with the times and to continue advocating for changes to be made to improve healthcare as it evolves. As circumstances change and as technology advances, there will always be a need for nurses to continue advocating for legislature that adapts. It is important to stay up-to-date and involved, even when careers become busy. The group learned that the Statue of Freedom, the figure resting on the top of the Capitol, was assembled by a recently freed former slave. This individual was the only person who could figure out how to assemble the pieces of the statue after the sculptor passed away. This shows that everyone has talents and perspectives that should be respected and utilized, and no one should be overlooked due to bias. As Franklin Delano Roosevelt said, it “Cannot be the work of one man, or one party, or one nation. It must be a peace which rests on the cooperative effort of the whole world.” The group was incredibly humbled by the many names on the wall at the Vietnam Veterans Memorial, which reminded them of the importance of the work that Veterans Affairs and the Wounded Warrior Project continue to do, which they can assist with inside and outside of the VA facilities. These words may be inscribed on monuments, but they represent sentiments that can be easy to forget, but should be continued to be remembered.
To develop the most well-adjusted generation of veterans to date: a lofty goal, but one that the Wounded Warrior Project is making great strides towards through their 13 different programs offered to service members who have incurred a service related illness or injury on or after 9/11 and their support members. Though the efforts are focused towards the more recent generation of veterans, the Wounded Warrior Project connects veterans of previous wars with the correct resources to help them as well. The group had the privilege of speaking with the Regional Alumni Director and learning about 13 programs that the Wounded Warrior Project provides, including the Alumni Program, Resource Centers, Peer Support, Government and Community Relations, Benefits, Warriors to Work, Physical Health and Wellness, Soldier Ride, WWP TLC, Combat Stress Recovery Program, Warrior Care Network, and the Independence Program. The Warrior Care Network partners with 4 academic institutions, one being Emory, to conduct 2-3 week intensive outpatient programs for PTSD. The important aspect of this program is that the academic institutions are required to share their research findings from these programs, so that outcomes can be improved for all. The group learned that the function of Wounded Warrior Project is to build rapport, assess needs, and connect veterans with the services that will most benefit them. Veterans are recruited through outreach programs, hospitals, Warrior Transition Battalions, and networking. Trust is built by bonding over veteran status, connecting individuals with the people that can best relate to them, and by working not to be patronizing. The Alumni Director even told the group that he keeps a beard because it is a symbol of community for those who are veterans. After spending the first part of the immersion learning about the legislative process, it was very interesting to learn about all of the Wounded Warrior Project’s lobbying efforts, and how they played a crucial role in the development of the Mission Act. It was interesting to learn that many veterans prefer the VA to community options because of the specialized care that the VA can provide in many areas such as mental health, spinal cord injuries, and traumatic brain injury. It was also very interesting to realize that if the group is interested in politics, there are many different avenues to become involved in certain causes.
The day continued with another organization that provides amazing services to veterans: the Fisher House. The Fisher House provides a home for families of patients receiving medical care at major military and VA medical centers at no cost to the families. The families are welcomed if they live 50 miles or more from VA medical centers after referral by their social worker or primary care physician. The group loved to see that the Fisher House truly is a home. The house at the DC Veterans Affairs Medical Center was beautifully decorated and offered a gourmet kitchen, cozy living areas, a patio, and 20 comfortable suites. The house always tries to keep at least two rooms open in the evenings in the event that families come into the emergency room and need a place to stay. The Fisher House was a mere 20 steps from the front door of the hospital, offering convenience and community within walking distance. The group was able to prepare a home-cooked meal for the residents followed by a paint-and-sip activity. It was amazing to talk with the guests, and to learn about how easy it is to take things like freshly-prepared food for granted until one is faced with medical treatment far from home. It was heartwarming to see the impact that the Fisher House has on families, providing them a stress-free environment during a difficult time in their lives.
The group was able to take time to reflect on the many organizations serving veterans and making a true impact on them, outside of federal funding or the Veterans Affairs system. These organizations are able to partner with the VA and supplement services to help reinforce and improve upon resources being offered. These organizations were both the essence of veteran-centric care, as the employees under both roofs were driven by their passion for the military community, rather than a salary or benefits. As the VA creates more community partnerships, and starts to refer out more services through the Mission Act, nurses outside of the VA will see veterans more and more. Therefore, this passion for improving quality of life for veterans was inspiring to the group, and it is a notion that they will be able to carry forward into their careers within the VA or outside of it.
We just wrapped up our first week of the 2 week immersion in Moultrie, Georgia, where an interdisciplinary team of students are working to provide medical care to the migrant farm workers and their children. Each morning at 8am, we head to the local elementary school to do conduct well-child exams with the BSN students from Emory along with Physical Therapy students from Georgia State University, Pharmacy students from University of Georgia, dental hygienists, and volunteer interpreters. In the evenings, we head to different farms every day to provide episodic care to the farm workers from about 6pm-12:30am.
We arrived in Moultrie on Sunday! Unsure what to expect, anxiety quickly disappeared as we received a warm welcome from the community including the Mayor! Southern hospitality at it’s finest.
The Pediatric Nurse Practitioner students made sure we were up to speed before doing well-child visits at the local elementary school.
Camp quickly turns dark, but we are equipped with headlamps to assess many musculoskeletal, dermatological, and many eye complaints of the farm workers. Unfortunately these conditions are common as these workers spend long days in the field.
At the night camp, the BSNs, NPs, Pharmacy, and Physical Therapy teams all set up their own stations. BSNs even provide a foot care station where they work one on one with the farm workers to care for their feet and address any specific conditions.
Having Pharmacists and Physical Therapists readily available for consultation and treatment is an invaluable asset to providing holistic care in a nontraditional environment.
Night camp is set up outside of the farm workers’ living quarters. Although it can be a beautiful view, we are vulnerable to the elements. One of the evenings this week, a thunderstorm descended in the midst of our night camp. We had to quickly relocate into a covered area and continue operations. Flexibility has truly been our motto for this trip thus far. Looking forward to what next week brings!
Today I was at the Mercy Care
Chamblee Clinic which serves a large Hispanic population. We began the day with
a morning huddle and everyone dispersed to work on their own projects for the
day. I learned about the services provided that ranged from vaccines to patient
education. I saw how the scope of the RN is different in the public health
setting and that a lot of clinical work is delegated to the medical assistants.
We saw patients being triaged but ultimately sent the ER because the lack of
resources from the clinic. One of the nurses was calling patients to check in
on them in regards to their blood pressure readings for the American Heart
Association BP program. The level of bilingualism the clinic maintains is very
impressive and the medical staff is very competent with the limited resources
available. Mercy Care Chamblee is unique and has housing services for the
elderly and disabled right across the street which is pictured below. The staff
make it their priority to make sure all the patients are treated with respect
regardless of any socio economic or language barriers. This clinic is truly
admirable for their dedication to their patients and bond they have as a staff
PS: Mercy Care
cares for EVERYONE… literally pictured as our classmate Kayla was given two
stray kittens after her shift to take to the animal shelter and provide a safe
The Emory School of
Nursing’s neighbor across the street, the Centers for Disease Control, reports that
West Virginia has the highest rate of drug overdoses in the country. Opioid-related
deaths in 2017 was nearly
50 per 100,000 people, up 14% from the previous year. This epidemic has touched
nearly every patient I have seen at the New River Clinic either directly or
indirectly. I love podcasts, so to get the rundown on the history of the Opioid Epidemic before
it came to West Virginia, I listened to Throughline’s podcast from April 4th,
2019 called America’s
Opioid Epidemic and The Uncertain Hour’s third season: Inside
America’s Drug War. Historically, so much of West Virginia’s industry has
been comprised of very physically demanding, but poorly compensated work.
Staying home to heal was not a possibility for many, and painkillers,
particularly opioids, helped many people working people keep the lights on and
food on the table. They trusted their healthcare providers to do no harm, and
we failed them.
In true grassroots
fashion, the Fayetteville Health Department has created an innovative program
to help reduce the harm of this epidemic through a program comprised of
dedicated staff, both paid, and volunteer. On Wednesdays from 1-4, people are
able to turn in used needles and receive the same number of clean needles (30
needles max) in return. In addition, the program provides wrap-around health
and social services. Health services include Hepatitis and HIV screening,
vaccines and wound care. They also
provide birth control counseling and LARC placement. The social services they
provide include help with obtaining an ID, health insurance, housing, and food.
Patients trade in their dirty needles for clean with an addiction coach. Coaches
are others who are recovering addicts and can use their own experiences to help
steer others towards recovery. Coaches provide patients with clean needles, but
also dispense other supplies like alcohol pads, cotton balls (used for
filters), tourniquets and “cookers” to help avoid spreading infection. These supplies are
important because hepatitis can live on a surface for 14 days and is not killed
by the small flame used to “cook” IV drugs. Narcan is also given out to
patients, and patients are educated on West Virginia’s Good
Samaritan Law that allows drug users to give Narcan and call 911 without
fear of being arrested for drug possession.
Cliff Massy is the main addiction coach and the
coordinator for the Harm Reduction and Quick Response Teams. Massy is kinda a
big deal ‘round these parts. In 2017 1 on 1 Films, a
documentary production company based out of Ithaca, New York made a short film
called Out of Pills, which has won
a bunch of awards in the short film circuit. As Quick Response Team coordinator, he or someone
in his team follow up with everyone who overdoses within 48 hours, as people
are more open to recovery programs during this time. If recovery is not of
interest, they can at least be connected with the Health Department program for
harm reduction services. The health department is currently writing grants for
a new program called Engage. This would provide clean needles and harm
reduction services and education at local emergency rooms where many
underserved people receive their primary care.
The Public Health
Department the building seems innocuous, newly painted in fuchsia and lavender,
but it is surrounded by the Police Department, County Sheriff, Fayette County
Court, and Judge’s office. This location is obviously not ideal for illegal
drug users looking to access care.
Anita Stewart is a DO who
helps head up the harm reduction program. We talked about the importance of
community (particularly law enforcement) buy-in to ensure sustainability in the
program. Sometimes this buy-in comes with compromise. For example, While the
health department takes in more dirty needles than they give out (as measured
by weight) there is still minimal support for giving out more than 30 needles
because of fears that that will increase the number of discarded needles in
public areas. Similarly, the police have an agreement with the public health
department that they will not arrest people at the clinic, or after receiving care
there. Last month, however, the police recently broke this agreement, arresting
a patient who had a minor parole violation. The number of patients at the
clinic plummeted and are only just starting to rise again. The clinic is hoping
to have more sites to serve a wider population with sites away from the police.
However, while Anita Stewart says that it can be hard to “play nice in the
sandbox,” there has been greater acceptance among its critics as the program
becomes more established. She says that when people are skeptical about harm
reduction, she invites them to volunteer and see the wide range of people who
have become dependent on opioids. She says that type one diabetics, nurses, and
other people who have a greater comfort with needles seem more likely to become
IV drug users. Stewart also stresses the importance of healthcare providers
using their professional privilege for advocating harm reduction among
stigmatized populations. “After all,” she says, “many of these people got
hooked on opioids through legal medical prescriptions, we did this to
Needle exchange can be a controversial
issue, and until
2016 federal funding could not go to these kinds of programs. These
programs are still illegal in 15
states, but while stigma still remains, needle exchange programs are slowly
gaining popularity across the country because they work. Not only have decades
of studies shown that they reduce the spread of blood-borne diseases and the
number of needles in public spaces, they also can help connect people to
treatment when they are ready. Because of the increase in opiate-related
incarceration around the country, another controversial program is gaining
momentum in WV and across the country, called the Law Enforcement Assistance
program. It allows public safety officials to work with behavioral
health providers by diverting low-level drug offenders away from jail time and
towards treatment and support services.
We made it to Cusco! 17 hours, lots of water, and a tight connection later, we were ready to take a long nap and get acquainted with our host clinic, CerviCusco, and our host city, Cusco! After some unpacking, we went to La Granja and enjoyed a Peruvian special, Pollo a la Brasa—roasted chicken. Afterwards, we went to the store to grab some food and tucked into bed around 8:30 PM. Day 1 complete!
Day 2: Sacred Valley
What a day! We had a long day of exploring many aspects of Peruvian culture in the Sacred Valley outside of Cusco. Our amigos (guides and drivers) for the day were Jesus, Denis, and Pierro. Our day started bright and early at 7AM with a departure to Chinchero for a weaving demonstration. We were greeted with hot tea and blankets and three women showed us how they washed and spun alpaca wool into thin soft fibers and then described the different meanings of colors used in their textiles. They also used different natural materials to dye the fibers, and demonstrated how they could change the color using other materials (for example, red wool was changed to orange with the addition of lime juice to the color mixture). After the demonstration, we shopped at their market and went on our way to our next destination, Moray. We saw three different terrace circles ranging in size and location. Jesus explained that the Incans used these terraces to test the resiliency of crops and to acclimate them to grow at different altitudes.
Next, we ventured to Maras; this is where we saw all of the salt terraces and salt miners harvesting their salt. Jesus told us that this was the only Incan site that was still functioning as it was when the Incans used it. We walked through the salt mines to Tunupa Restaurant, a beautiful buffet by the river. Everyone enjoyed their food, especially Ceviche and Pisco Sours (a Peruvian cocktail). Our last stop for the day was Ollantaytambo, a small town with an outdoor market and Incan ruins high on the surrounding mountains. We climbed up to the temple of the sun and saw the granary on the opposite mountain, marveling at how these stones were transported up so high. Apparently, the stones came from a different mountain from across the valley and the Incans moved the stones across the river by diverting it upstream of the stones! The creativity and ingenuity of the Incan people was very evident from seeing all of these different sites and traditions still in use and on display today. Today was so educational and fun thanks to our amigos and the people of the Sacred Valley carrying on traditions and welcoming us with open arms.
Day 3: Beginning our Work with CerviCusco
Today we went to downtown Cusco and set up a health campaign in a municipal office. We performed blood pressures, blood sugar checks, and pap smears. Many women were interested in the availability of the pap tests, which is important because of the high prevalence of cervical cancer among Peruvian women. It was also great to see the community interested in free biometric tests (blood pressure and blood sugar) to be aware of their health status. Interestingly, I’ve noticed that many food ads and labels in Peru have warning ads concerning the level of sugar and fat in them, prompting consumers to be more aware of their dietary needs. While we were downtown, many people were involved in the Inti Raimi celebration in the main square, so they were passing by in colorful costumes. It was great collaborating with our instructors, med students, and the physician from CerviCusco to bring care to the community. After working for several hours, we went home and had a lovely dinner of Lomo Saltado (sautéed beef) and got ready for the next day of work.
Day 4: Cusco Campaign Day 2
Tuesday, we returned to the municipal office near downtown Cusco, again taking blood pressures, blood sugars, and performing pap smears. We were done around lunchtime and had time to explore the city on our own. All of the students decided to go to a restaurant our guide Jesus had recommended and it was delicious! Most of us also shared a local delicacy—guinea pig (Cuey) and after that we split up to explore Cusco more. Some people went to San Pedro market and the others went to San Marco art district. In San Marco, we shopped and got to see a beautiful vista of the entire city. For dinner, the group reconvened at a different location of Tunupa restaurant (in La Plaza de Armas) for Pisco Sours, another great buffet, and live music and folk dancing. We even joined in with dancing, and the band loved us!
Day 5: Small Groups
Wednesday, we split up into two groups; one half of us went to Urubamba on another campaign for pap smears, blood glucose, and blood pressure. The other half of us went to a retirement community run by a local Catholic mission. We provided foot care, assisted with serving lunch, and feeding the residents. Even though our tasks were more focused on daily care rather than biometric or diagnostic procedures, it was wonderful to serve the residents in whatever way we could. I felt even through helping with something as simple as foot care we were helping these women feel cared for and comforted. Nursing is holistic, and caring for people in every circumstance reflects the versatility and the importance of the profession.
Day 6: More small groups!
Today we split up again, with half of us going to Urubamba for another campaign and the other half taking the morning off. The bus ride was scenic and we got to see more of the stunning mountains surrounding Cusco. There was a good turnout and we did almost 75 blood pressures and blood sugar checks! Our entire group (including med students and PA students) did over 50 Pap smears. Through the campaign, women only had to pay 3 soles for the Pap smears as opposed to 20 soles they would pay to go to the clinic. It was great to see that the clinic could help overcome the financial and transportation barriers to care they might face otherwise. The other group went to the Cristo Blanco overlook via taxi and saw Cusco from there, then walked down to San Blas for lunch. Our group left Urubamba around 1:00 to go back to the clinic so the rest of our group could go to an orphanage in Cusco. There, students met the founder of the orphanage and he explained that he wanted to have a home with open doors that would support and raise these children. Our students played soccer against the residents (and lost!) but had a great time overall. People who didn’t go to the orphanage hiked up to another vista near the clinic and saw some great views of the city and the sunset. We had dinner at the clinic again and are now going to bed to prepare for the tomorrow. I can’t believe we only have 5 days left in Peru!
Today, I went with the Mercy Care CHOP team to serve the homeless community by aiding to provide nursing services and housing resources. We went to Central Presbyterian Church to do this and sat in a room where patients could sign up and then visit us and utilize our services. Today, we saw 3 different patients. We took their blood pressure, and provided them with housing resources, food resources, and we gave them information about the Mercy Care clinic closest to them so that they could seek out healthcare.
One thing I learned from this experience was the different resources that Central Presbyterian Church for homeless individuals. I learned that they provide ID’s, birth certificates, resume assistance, and job resources. Additionally, they had an art studio for individuals to do art work, which I loved to see.
second day in West Virginia was just as great as the first! Jean graciously
prepared us a delicious home-cooked breakfast, so I was fueled up for a busy
day at clinic. This week, I’m rotating at Riverside School Based Health Center,
which is part of the Cabin Creek Health System. Cabin Creek Health System is a
federally qualified health center that provides high quality comprehensive
primary care to residents throughout Kanawha County, WV. My wonderful preceptor
is Dr. Jessica McColley, a family medicine DO who completed a fellowship in maternal
child health (her background is perfectly aligned with my dual FNP/midwifery focus).
As it turns out, Dr. McColley completed her fellowship at the same clinic in
Chicago where I completed an AmeriCorps program back in 2012 — we were in the
same place at the same time and had never met. What a small world!
the morning session we saw a wide variety of patients, from well child visits
to colposcopies to dental abscesses. In the afternoon, I had the opportunity to
participate in a health professional mentorship program for recent high school
graduates who are interested in pursuing careers in healthcare. One provider
presented on the liver and hepatitis, and Dr. McColley presented on sexual
health. The opening activity consisted of crafting the internal female
reproductive organs from pipe cleaners – what fun! We then played a jeopardy
game with categories including contraception, let’s talk about sex, and
consent. The participants had a great time and we all learned a lot! I really
enjoyed the opportunity to observe medical providers engage in community-based
activities outside of the clinical setting.
first two days have been an incredible learning experience. I feel like I’m
truly experiencing family medicine here. Many visits have included several
family members receiving care from the same provider. I’ve seen patients for the
management of chronic conditions, well care, sick visits and family planning.
This is my first rotation with a DO, and I have had the opportunity to observe
osteopathic manipulation for vertigo and musculoskeletal pain. The support
staff have been so kind, helpful, and a lot of fun. I’m looking forward to
continuing to learn from the wonderful preceptors and staff here and enjoying
the beautiful West Virginia mountains. I also can’t wait for our whitewater
rafting trip on Saturday!
After two flights and a slight luggage fiasco, we landed safely at the airport in Mérida. Once we arrived, Victor, our community partner here, was there to welcome us into his city. He is a very friendly and charismatic individual, and he helped us to practice our Spanish while we bused over to the hotel. Dr. Mac discussed the plan for the next few days, so that we would be ready to hit the ground running.
But before we were going to run anywhere- food. We got to the hotel and quickly changed before heading out to dinner as a group. The restaurant we chose offered a variety of Mexican and Mayan dishes; one of the most grandiose being a hunk of pork ordered by our very own vegetarian, Mary. After dinner we explored the town center. The sun had just set, cooling the area down by at least 10 degrees. People suddenly emerged onto the square, and it began bustling with activity and life. Although we had just eaten, our mouths watered as we strode past vendors selling churros, street corn, and other foods. We stopped at one of Victor’s favorite ice cream places, which boasted interesting yet delicious flavors such as corn and guanabana. Overall it was a great way to kick off the trip. Can’t wait to visit Emiliano Zapato tomorrow to meet with the community leaders and get down to business!
The group began the day with the opportunity to meet briefly with Senator Johnny Isakson, the chairman of the Senate Veterans Affairs Committee and the Ethics Committee. They were then able to meet with the Professional Staff Members who handle healthcare for the Veterans Affairs Committee. The group was able to inquire about some of the potential complications of the recently enacted Mission Act, which changes eligibility for community care for veterans. The group learned that the act creates a Community Care Network, which is a partnership with providers outside of the VA. The Community Care Network is comprised of providers that meet certain quality and performance metrics, and it allows direct health information sharing between the VA and the community providers to allow for continuity of care. The hope is to provide expanded services and improved payments. The group inquired whether this increase in community referrals will decrease the amount of new services that are brought into the VA system, especially those related to women’s health, however the answer remained unclear. The VA Nursing Academic Partnership students in the group were excited to hear that there is a contract to update the outdated Electronic Health Record system, and that the committee is aware of the way that the long, slow hiring process deters applicants from working at the VA. After serving lunch to homeless veterans yesterday, the group was also glad to learn that there are programs to conduct outreach to register homeless veterans for housing and case management services through HUD VASH (Housing and Urban Development Veterans Affairs Supportive Housing). This was good to learn as members of the group have encountered homeless veterans who did not realize that they qualify for these services, and doing community outreach will help to educate and recruit.
To end the day, the group visited Arlington National Cemetery. The cemetery is on a property that began as a place to assist slaves transitioning to freedom, and became a burial location when Civil War casualties began to outpace other local cemeteries. The cemetery is the final resting place for more than 400,000 active duty service members, veterans, and their families. The large property amazed the group, as the precise lines of white headstones were vast. The group was able to begin to see the enormity of the volume of military service members through the years, and realized how likely it will be that they will encounter someone from this population whether they work in the VA or not. The group was able to visit the nurses memorial, and pay respect to the nurses who risked their lives to care for others. The group also visited the Tomb of the Unknown Soldier, which holds the remains of unknown service members from World War I, World War II, and the Korean War, and observed the changing of the guard. The Tomb Guard paces 21 steps, faces east for 21 seconds, and then north for 21 seconds to symbolize the highest military honor, the 21 gun salute. The guard holds their weapon on the side closest to the crowd to symbolize that they stand in between the tomb and any possible threat. It was amazing to have time to pay respect to the men and women who have served this country, and also see a bit of military tradition in person. It helped the group to more tangibly understand the military’s commitment to dignity, camaraderie, tradition, service, and sacrifice. The lessons from today will help the group better care for the military and veteran population as they progress in their careers.