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Help Women and Families in Crisis

Nurse-Midwives are urgently needed beginning August 23rd to assist the Syrian American Medical Society (SAMS) with medical relief efforts in Northern Greece for Syrian, Iraq, Kurdish, and Congolese refugees.

Volunteers are needed for:

  • Breastfeeding
  • Family planning
  • Health education
  • IYCF support
  • Pregnancy care

*A two-week minimum commitment is requested*

To find out more information or to sign up to volunteer, visit: https://www.sams-usa.net/take-action/ or email Nikiforos Papachristos, Volunteer Coordinator for SAMS Global Response-Greece, at sgrvolunteers@sams-usa.net.

 

To read about Emory MSN Alumna Barbara Lockart’s own experience providing care for families in crisis in Greece visit:

Day 7 and 8 at Moultrie – Going with the Flow

A nursing student checking the hearing of an elementary school student

It’s nearing the end of the last week of our Farmworker Family Health Program trip in Moultrie and I can’t believe my time here is almost done. Every one here has gotten so much into their routine that the days almost seem to meld together, flowing from one task to another. In the past few mornings at the elementary school, we have been seeing the last few kids that needed to go through the stations as well as a few kids that needed to be re-screened if they didn’t pass certain tests or assessments. Wednesday morning I was doing vision screenings with another BSN student and we were testing a boy in the second grade. As we were having him read the shapes in the chart we noticed he could barely make it past the first few lines of shapes and was squinting and leaning forward; after the full assessment it was very obvious he had vision problems and would get a referral to a clinic where he would likely be getting glasses. He was right at the age where having difficulty seeing would make it more difficult for him to learn and pay attention in class and ultimately affect his overall education, but because we were able to catch this problem early, his vision will be able to be corrected. A lot of times doing so many of these screenings for hearing, vision, blood pressure, and blood glucose can seem repetitive, especially if a majority of the kids are healthy, and I sometimes lose sight of the fact that these tests can catch major problems early on for these children.

A view from the camp we worked at Wednesday night

BSN Student, Molly Murphy, providing foot care to one of the farmworkers while two Nurse Practitioner students help assess

On Tuesday night we went to the same camp as Monday night, but this time we were prepared: we knew it was going to be raining again that night so we set up everything inside the screened in building so we didn’t have the delay of relocating all of our supplies and tables inside. It was a small, compact space we were working in but everyone stayed focus and we were able to move around each other without any major collisions. On Wednesday night we were at a new camp that was slightly smaller than the previous two nights so the pace was slow going at first. This came as no surprise to us, but it of course began raining around 30 minutes into seeing the men through the stations. This camp had no coverings to go under, but luckily there was no lightening so we knew we could stay and find a way to continue working. Some of us braved it in the rain with ponchos and umbrellas and others were set up in some collapsable tents where we tried to keep as many people dry as possible. Everything out at these camps is an unexpected adventure and this night was no different.

BSN Student, Jenny Choe, providing education on high blood sugar management with the help of a translator

When we are working with the men, we have amazing translators that are with us at each station as well as with each dental hygiene student, pharmacy student, and the student nurse practitioners as they complete their physicals. However, there aren’t always enough translators to be at every spot we want them so they often have to get relocated where they are most needed at the time, which is what happened to me when I was working at the blood glucose and hemoglobin station when our translator was needed at another location. At first I was worried to be without a translator to help explain to the patient what I was going to be doing and how to explain and educate them on their results, but as I have talked about previously, this group of people here is always so willing to help anyone.We almost immediately had one of the pharmacist students come over to us and offer help translating what she could as we had other nursing students go ask others for some key Spanish phrases to tell and ask the men. Even in times of chaos everyone here is able to pull together and make sure we accomplish the goals we came out here to do. We are seeing one final group of men at a camp tonight and then finishing charting and packing up at the elementary school in the morning. As I write this we have less than 24 hours left on this trip and I hope to enjoy every minute and help everyone I can!

 

 

Carchá

This past Friday, Monday, and Tuesday we spent time with the midwives of Carchá teaching them the same three topics that we taught the midwives in Chisec. That’s where the similarities end though. This group of midwives was vastly different from our first. There was a wider range of education to begin with, some couldn’t write or read and others who could read and write in multiple languages. There were women who were activists trying to fight for more rights for midwives. There was a mother of 19 who had delivered all of her babies herself – two of her daughters were there as midwives with her. There was a woman who had been a nurse for the government and changed to become a midwife.

I like to think that the six days we spent teaching these midwives has changed us all. We complain about salaries and hours and working conditions in the States, but it’s nothing compared to these women. They don’t get paid for anything that they do. They are on call 24/7. They don’t get vacations or sick leave. They walk at night for miles without lights to show them the way and then deliver babies on dirt floors by candlelight. I know they don’t have the same risk of malpractice – but they have a greater risk of maternal/fetal morbidity and mortality.

While I would like to say that all midwives in the States do what they do because they love it, I’d also like to think I’m not naive enough to believe that. The midwives here do this because they view it as a calling from a higher power. They do it for the love of their community and the love of their women. They do it in spite of constantly being put down by the government, of constantly being scorned, of constantly being waved off like they are unimportant – like they’re something less than others. I’m just in awe of them.

Teaching here was harder for all those who did it. We’re tired and languages are harder when your brain isn’t firing as sharply as it normally does. We all struggled to understand and to communicate. We struggled to accommodate the variety of educational levels. We struggled with illnesses taking out two of our more proficient speakers on the last two days. We struggled with patience for each other. It’s definitely been a harder go this time around on all fronts.

 

Day 6 at Moultrie – Teamwork Makes the Dream Work

BSN Student, AshleyAnne James, checking hemoglobin and blood glucose while a pharmacy student helps comfort the child

Sunday night we arrived back in Moultrie, Georgia to our hotel that was comforting and familiar. They welcomed us back with dinner in the lobby and we got to meet and mingle with the new pharmacy students and dental hygiene students that would be joining us for our last week of work. Monday morning we were back at the Elementary School making sure we got off to a good start to help try to get the rest of the kids at the school seen by all of the stations this week. I was back at the kids’ favorite station, blood glucose and hemoglobin. Unlike the very first day where some kids didn’t know they would have to get their finger stuck, word of mouth had spread and they all knew that it was coming. Some kids had prepared themselves as they sat down with me, handed me their finger of choice, and looked away trying to focus on the stickers. Other kids had gotten so nervous that they were in tears before they even got to the table, thankfully there were not too many like that. Over the last week we helped learn and teach other some tips and tricks to make it easier for the kids such as having them count stickers when we did it or even holding their hand a certain way so they couldn’t see the blood. Even though this was the pharmacy students’ and dental hygiene students’ first day at the school and they were getting used to the flow, they were always so quick to lend a hand and help; whenever they would see a kid sitting with us starting to get nervous or cry they would immediately come over and comfort the kid and ask if there was anything they could do. Even in an unfamiliar environment, it’s so nice to see that everyone is so willing to help each other across our disciplines of work. All around the Elementary School the saying “teamwork makes the dream work” is proudly displayed on various posters and it definitely rings true for our team.

Dental Hygiene students setting up inside after escaping the storm

The storm at the camp approaching fast! Photo taken by NP Student, Geoffry Hall

After a little bit of rest back at the hotel, we headed out to a new camp to help provide services to the men. We drove through quite a few muddy roads but finally arrived and began setting up. After the first few men came through we noticed some dark clouds in the distance but were keeping our fingers crossed it would just pass by us. Every thing started getting busy which meant I normally just focus on my patient in front of me and not many other distractions around me, so I was startled when one of the faculties members came up to our station and told us to pack up because the storm was coming right for us and it looked bad.Thankfully, the night would not be a waste; there was a portion of the camp that had a building and screened in windows we could move to instead of heading home. We all crammed into this small space, setting up chairs and extra tables where we could and made do with what we were given. It was definitely a challenge working in a smaller space that got noisy and hot very quickly, but we were happy that we could help out everyone that came to see us. Not every thing goes according to plan when we are out working, but in the last week we learned so much about flexibility and cooperation and have seen in person how important it is. It really is a team effort these two weeks and I am so thankful to be on a team with everyone here.

 

Day 5 at Moultrie – Rained Out and Moving Out

BSN students getting ready for the last night of the first week (featuring stylish rain boots and fanny packs)

Lightening lighting up the sky as we begin to pack up our stations

Yesterday and today are the last two days of our first week and the time absolutely flew by!! Last night we once again lined up in our cars and headed out to a new camp to work with. We set up quickly on the main road leading into the camp so everything was flat and there weren’t too many bugs bothering us. The men who come to us are usually just coming off from the work in the fields and they were running a little late yesterday so we had extra time to all hang out. Over the week everyone in the disciplines has gotten close and become great friends so we no longer spend our free time with just a small group of people in our same specialty; instead, we used our free time to organize a quick soccer game for all of the specialties to play while others watched and cheered on their friends. After a few good soccer games, the workers started coming and and we all headed to our stations. I was at the blood glucose and hemoglobin station, which has become by favorite station to work at during the camps at night. All of the previous camps we had been to this week had only men, but there was a fair number of women who were working that came and saw us which was a new experience. Unfortunately, a few hours in we heard lightening cracking nearby and had no coverings for any of us so we had to pack up quickly and head back to the hotel. Normally when we are in class as students and we hear that we get to head home early everyone gets very excited, but there was a different tone when we were told we would be leaving early last night. Many of else felt sad and disappointed. We knew there was nothing we could do about the situation since the approaching lightening was a major safety concern, but it was hard for us to leave knowing there was a lot of men and women that we could not see or help out, but we hoped that we made an impact on those we did see.

BSN Student, Jessica Yang, testing blood glucose and hemoglobin on an Elementary Student while a pharmacy student helps keep her distracted and happy!

Today we woke up with our cars packed to go home and ready to head out to the last morning session at the Elementary School for the week. There were not too many kids to see and we got them all in and out quickly. I was working at the audiometry station testing the kids’ hearing with another BSN student which went smoothly since the kids knew there were no needles involved and they got to wear cool headphones instead!! We did not have to pack up too much since we would be back again on Monday but we made sure our stations were clean before getting into our cars and making the drive back up to Atlanta to be able to rest and refresh ourselves for a few days. I have had such an incredible experience this past week and feel like I’ve already learned and grown so much. Working in this unique setting has taught me so much about teamwork, flexibility, cooperation, and patience. I am so excited to be able to come back for one more week with people I’ve grown so close to and some new faces as well!

First week group with all of our BSN students, NP students, Pharmacy students, Dental Hygiene students, Physical Therapy students, and faculty!

Day 4 at Moultrie – Blood, Sweat & (no) Tears

The farmworker camp we worked at and set up our stations

Last night a little after 6:30pm we arrived at a new farm, covered head-to-toe in bug spray and ready to tackle whatever the night threw at us. Thankfully there was no rain on the radar for the night, but this camp definitely brought some new challenges and surprises; there were no coverings at the camp so we were outside with the grass coming up to our knees. Even though we were at a new location, the set up went smoothly since we have settled well into all of our roles throughout the different disciplines. I was placed at the blood glucose and hemoglobin stations where we were doing finger sticks on the men that came through. Doing the finger sticks on the farmworkers can sometimes be challenging because their fingers are often very callused making it harder to draw blood for both machines. We’ve all learned techniques from each other to make the process easy for us and the men so we don’t have to stick them again. Sometimes we have to squeeze and massage down their hands (a process some nurses have termed “milking” the arm) and holding their hands down at their side to let gravity help the blood flow. The men were able to go around and see all of the nursing stations, the nurse practitioners, physical therapy, and dental hygiene throughout the night and get the help and referrals they needed.

 

One of the nursing students getting a good stretch from a physical therapy student during a break!

This morning we went back to Cox Elementary School to continue our care and screening for the kids. Another one of the nursing students and I went upstairs and got ready at our station that was testing height, weight, and BMI. Working with the children at the station was pretty simple, all we had to do was weigh them and measure their height but it required a lot of charting so, like yesterday during the vision screening, we took a lot of turns charting and keeping the kids entertained who were waiting. In our room we were testing in we also had a physician from Guatemala who was sitting with the kids waiting teaching them about Zika virus. She used coloring books and pictures to explain to them what the virus is and how they can help prevent it for themselves and others. The Zika virus is becoming an increasingly difficult problem, especially here in rural South Georgia during the summer months, so teaching these kids from a young age is very crucial. Our hotel we are staying at is also very kindly serving all of us dinner tonight before we head out to our last night at a farmworker camp for the week. We head home for the weekend tomorrow afternoon but we’ll be back Sunday night to start our second week of service here!

Day 2 at Moultrie – Feeling the Pressure

High fashion for nursing students at the first camp!

Yesterday we had our first night working with the farmworkers at their camps and it was quite an operation; everyone in the program throughout all of the disciplines lined up in their cars next to our hotel for a giant caravan drive to our first farm of the week! We all arrived together through muddy roads and began unloading and setting up numerous truckloads of supplies in our finest rain gear: ponchos resembling giant plastic bags and our scrub pants tucked nicely into our rain boots.

 

Sun goes down, head lamps go up!

Everyone was very excited setting up and preparing to meet and work with the men here. One of my favorite parts of this program is how we have so many different medical fields working together and learning from each other. Molly, one of the other nursing students, and I got to teach a group of the pharmacy students how to use the blood sugar and hemoglobin machines and then they were able to help us throughout the night when that station got busy. Even dental hygiene students helped the student nurse practitioners identify problems in the mens’ mouth. It was really great to see all disciplines finding ways to help each other and give the men we are assessing the best help they can get. Once all of the workers started filing in, I was definitely feeling the pressure… possibly because I was assigned to the blood pressure station… but also because I was facing the reality of trying to assess and educate these men when we didn’t have a language in common. I felt confident in my technical skills in taking blood pressures but that confidence was immediately lost when I tried to introduce myself, explain what I was doing, what their results were, and education on high blood pressure management when I only spoke English and they only spoke Spanish. Thankfully, like all students do in nursing school, I figured out a way to make it work. I learned a few phrases to help build some connection and realized how important a smile and a reassuring hand on the arm can be. We also have amazing translators with us that helped with some more complicated translations and education between us and the men. At around midnight we finally had everything packed up and drove our long line of cars back to the hotel.

 

After what only felt like 30 minutes of sleep, we were up again today and back at Cox Elementary School in the morning. Thankfully, almost all of our supplies were still set up from yesterday so it didn’t take too much work before we got to start seeing the kids. I was at the blood pressure station, but unlike last night I also had the added bonus of handing out stickers to the kids who came through. Many of the kids were very young and could only speak a little bit of english but we still made sure to have fun! They all got excited to get their blood pressure taken by a cuff that would “give their arm a big hug” before picking out the perfect sticker. I loved being able to joke around with the kids and show them how all of the equipment worked, which for them included squeezing the air pump of the blood pressure cuff until their hand got tired and tapping on my stethoscope as soon as I placed it in my ears. All of the kids there are so sweet and I’m so glad we can come and do our part to help them the next two weeks. Tonight we are back at the same camp we were at last night to continue our care for the rest of the men. It’ll be another muddy night but I know it will be worth it!

All smiles in the car ride back from the Elementary School!

Guatemala Day Three-Five

Part of the fun of international travel is always finding reliable internet connectivity. Since my last post I have been fighting quite aggressively with the internet and my computer, but finally I overcame (which is impressive if you knew how little I understand about computers). Anyway here is what I had typed up for day three and then some extra added to it to include days four and five (so it’s crazy long):

Afternoon storms are becoming a normal part of our routine – I think that they’re the only thing that actually runs on schedule here. Those of us who need internet, for homework or more leisurely activities like Netflix viewing, are watching the clouds and lightening roll in from the open, covered area where we get internet at this hotel. It’s making things significantly cooler here, which is such a blessing. The rainy season has begun in Guatemala, which means that the entire night was filled with rain falling on the tin roof of our room and that the entire day felt sticky and hot.

This morning, as the midwives started walking into the courtyard this bubble of excitement overwhelmed the table that where we were all sitting. We wanted so badly to go and greet them, and know them, and express our appreciation for them being there. Two issues with that desire: we didn’t want to overwhelm them and none of us speak their native language. Instead we settled for the traditional “Buenas días” and a pat on the arm/kiss on the cheek as they headed to our conference area.

Rebecca Gloss and Hannah Lake-Rayburn did the teaching today. The spent the entire morning dialoguing with the midwives about high blood pressure during pregnancy, preeclampsia, symptoms of these conditions, and when women were traditionally referred out. We then broke off into small groups and taught these midwives how to take blood pressures using the BP cuffs and stethoscopes we brought down for them. It was so exciting to realize how veracious these people are to learn new skills and about new equipment that they knew would help the women that they love so much.

Not that this teaching didn’t come without challenges: the majority of our group speaks some Spanish, but that becomes completely moot when trying to communicate with the majority of the midwives because they speak a traditional Mayan language that sounds and tastes nothing like Spanish. It’s harsher sounds, stronger syllables, thicker tongues. Luckily, we had a translator there, Maria, and quite a few of the midwives also spoke both, so in the end it all worked out from that standpoint. We were also educating a couple of illiterate individuals, which made taking blood pressures difficult for them because while they could hear the sounds and understand where on the monitor they needed to note numbers, they couldn’t dictate what the number actually was – which almost defeats the purpose. Our solution? Mark on the cuff monitor which pressures indicated an emergent situation and necessitated a referral. This job requires nothing if not adaptability.

After eating lunch with the midwives, they began there journeys back home – some of which would be more than two hours – and we returned back to our rooms for a quick siesta. At 1530, we met back up with one another and took the bus into the town of Chisec. We could hear and see the storm rolling in, but we were determined to get in a little bit of walking in spite of the obvious incoming weather. We paid for our stubbornness and got caught in a small shoe shop during a torrential downpour. All of the people who were in town took cover under something and we just watched the streets quickly fill with water. Luckily, the shop keepers were extremely pleasant and allowed us to stay under cover until Oswaldo came and picked us up in the bus.

The rest of the evening was spent putting together small packages for the midwives – consisting of gloves, umbilical ties (they don’t do clamps down here), new scissors to cut the umbilical cords with, sterile blue towels, and a couple of pairs of sterile gloves. All of these new goodies will provide the midwives with a very limited supply of some of the resources that they need – but we’re trying. These packages coincide beautifully with the educational session about sepsis and neonatal infections that will be conducted tomorrow by myself and Tamara Noy.

Our teaching went well. We got to have lengthy conversations about infections and how the midwives traditionally care for their women. I think at this point we were all quickly coming to the realization that these midwives are so so so knowledgable and so passionate. It becomes much more of a dialogue and much less teaching – an exchange of treatments and options and ideas. It’s so inspiring to learn from them and to hear what they go through on a daily basis.

We got to do a home visit with one of the comadrones, which was very eye-opening. The woman we saw five months pregnant with her fifth child. Her husband, her four daughters, and she lived in a building that is roughly the size of typical dorm room with dirt floors and a large curtain splitting off some of the sleeping areas from everything else. There were three chickens living in the house with them and a large (I mean large) bin of corn in one corner. Even though it was small, and the family was obviously impoverished, everything was clean and well-cared for – and the woman had pride showing us where she lived and introducing us to her daughters (all through the interpreter mind). We also got to see the return OB visit, the midwife did Leopold’s (basically felt the belly to determine the size and position of the fetus) and then did a mini rubdown of the woman’s legs and belly and arms – kind of like a massage. It was wonderful to see a midwife in another country utilize similar tools that we do in the States.

Finally, on Thursday, Chelsea and Michelle did their teaching on postpartum hemorrhage. They used chucks and poured different amounts of fake blood on to them to have the midwives determine which needed a referral and which was okay. We also supplied the midwives with headlamps and showed them how to use them so that they could see when they were walking in the middle of the night and check for tears in poorly lit buildings. Chelsea and Michelle mimed a birth with a postpartum hemorrhage and asked the midwives what they would do throughout. It was a very successful learning day.

We then went a stood in a circle with all of the comadrones and began throwing a ball of yarn from person to person. The person with the yarn would share what they had learned or what they enjoyed most about the past three days, would keep a hold of the string, and pass the ball along. At the end, we were all connected by this string which physically exemplified the way in which we were connected by our profession and our passion for the women that we get to care for on a regular basis. I think it’s safe to say that these three days in Chisec were inspiring and uplifting on both ends and just made me so much more excited to enter this profession.

BP practice with the midwives.

Erika, Hannah, and Becky teaching the midwives.

Jenny, Becky, and Tamara teaching more about BP

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.

Wild and Wonderful WV

Self-care is so important for providers… Here in WV, we took a day to explore the stunning beauty that surrounds us, and get to know this amazing place just a little better.

A day on Summersville Lake

Grace scales 30 feet of sandstone. Rock climbing and white water rafting are super popular activities. West Virginia is an adventurer’s paradise!

The stunning New River Gorge.

Kate masters a stand up paddleboard.

Admiring the New River Gorge from the trail. Tourism is now West Virginia’s most lucrative industry. It’s easy to see why.