By Kate Yuhas

We are now in week two of our immersion trip! It has been a wonderful experience learning from all of the providers about the healthcare system in West Virginia. This area of the US has been struck by many health, economic, and educational disadvantages and disparities. Two of their main health issues are related to opioids and black lung, which is a disease caused by coal mining. We have been rotating through several clinical sites in the area and many of us have been lucky enough to see pulmonary rehab and MAT (medication assisted treatment) sessions. We’ve collaborated with doctors, physician assistants, nurse practitioners, social workers, respiratory therapists, psychologists, psychiatrists, and pharmacists.

Today, we were lucky enough to attend an “all provider meeting” for Cabin Creek Health. This meeting happens every quarter and each meeting has a theme. Today’s topic was children and adolescents. We heard from a variety of speakers about periods as a vital sign, juuling in schools, and long term reversible contraception. This was a great time to get all of the providers together to discuss some difficult topics and ask the experts questions. 

Overall, I’ve been really impressed with these clinics. They are run so smoothly and all of the staff members are really motivated and invested in helping the patients. Despite facing several challenges, they have found creative ways to really make a difference in these peoples’ lives. This happens by creating ways to help them take their medications and educating them on lifestyle changes. This has been an incredible learning experience and I’m very grateful I was able to experience Cabin Creek.

As a part of this unique clinical immersion in West Virginia, I had the opportunity to shadow in the Pulmonary Rehab clinic. The Pulmonary Rehab center operates as part of the Cabin Creek Health System clinic at Dawes. In this setting, patients with chronic lung issues, such as COPD, sarcoidosis, and Coal worker’s pneumoconiosis, attend biweekly group sessions under the supervision of registered nurses and a physician. In these sessions, patients perform strengthening exercises and various aerobic activities. Additionally, the nurses incorporate an element of patient education care. For example, the nurses educated on the importance of adequate nutrition with chronic lung disease. During my time between both the primary care clinic and the pulmonary clinic, I’ve been exposed to the ways in which the populations in this region deal with lung issues which stem from culture and tradition.

Coal worker’s pneumoconiosis, otherwise known as Black Lung, is all too common in this region. Coal has indeed been an integral part of this state’s history and encompasses a sense of pride and hard work among many generations. The coal industry has employed a significant number of West Virginia’s population for some time, dating back to 1742 when coal was first discovered here. Though the coal industry has indubitably experienced a decline as West Virginia looks to other economical outlets such as alternative energy, the health of individuals has been uniquely and negatively impacted.  

Coal worker’s pneumoconiosis is attributed to chronic inhalation of dust from high-carbon coal over decades. The coal dust accumulates around the bronchioles and alveoli, leading to coal nodules as the collagen accumulates.  Ultimately fibrosis and functional impairment occur which obstructs airflow. The treatment of Coal worker’s pneumoconiosis entails pulmonary rehab, use of inhalers, and potentially supplemental oxygen. I had a chance to chat with a very nice gentleman who was participating in his session of pulmonary rehab this particular morning. He had worked in mine’s for nearly 30 years, and describes that he and his fellow employees in the mines just didn’t know the negative implications of not wearing proper protective respiratory gear. He was on his 21^st of 24 sessions of pulmonary rehab, and describes how it helps him maintain and sustain other activities in his day-to-day life despite his chronic illness.

Overall, this immersion trip has been an incredible learning experience. Cabin Creek Health System and New River Health Systems function as FQHC (Federally Qualified Heath Center) in underserved areas of West Virginia which are directly impacted by various health, economic, and educational disparities. I resonate with the mission of providing holistic care to patients in primary care settings who face financial barriers and have limited access to specialty care, and this experience has further inspired me to work in an FQHC myself as an FNP.  

Megan Kaylor, BSN, RN

Today I went to the Chamblee clinic and helped in the lab. This clinic primarily serves the Hispanic population. The disparities within Georgia are immense and it is always eye opening to serve in a Mercy Care clinic. I highly recommend volunteering within Mercy Care because it helps you see how socioeconomic status and language/cultural barriers relate directly to health disparities. There is only so much you can read in a textbook versus seeing the application in a real life setting.

by Kayla Ortiz

Today I worked with a psychiatric nurse in the behavioral health and substance abuse clinic at mercy care. We discussed general patient care for behavioral health and substance abuse, and we looked through the charts of patients who were referred to the clinic. Furthermore, we saw one patient who visited the primary care clinic and was referred to the substance abuse clinic, and performed a behavioral health screen that was required to be in the substance abuse program. From this experience, I learned how to screen patients for substance abuse, and help provide them with resources based on their condition.

Later on this afternoon, I went to a hypertension/blood pressure education class that was taught by a nurse from the American Heart Association for patients who were diagnosed with hypertension. In this course, patients were educated on hypertension and how to manage it. The patients were given their own blood pressure machine, and were taught on how to measure their pressure. The patients are required to measure their blood pressure regularly, and report their lowest blood pressure screening to the American Heart Association weekly. From this experience, I learned about how to educate patients on maintaining their blood pressure through their medications, diet, and lifestyle in a way that is sustainable and individualized for each patient.

by Leslie Burger, BSN RN

This week Cabin Creek Clinic in West Virginia has been hosting meetings and educational conferences in preparation for the rollout of their Medically Assisted Treatment (MAT) program starting in July. We had the opportunity to sit in during the meetings with staff and have been learning so much about MAT as well as the gravity of the issue of substance abuse, specifically opioids and opioid-related deaths in the community. West Virginia has the highest opioid-related drug overdose deaths in the country (West Virginia Opioid Summary).

Medically Assisted Treatment uses medication to help treat the physical symptoms of substance abuse and addiction. For opioid addiction, the first-line treatment is buprenorphine, also known as Suboxone. Buprenorphine is a partial-mu opioid agonist, meaning it doesn’t produce euphoria or a “high” which helps to dull or satisfy opioid cravings without creating a high (patients have described it as helping them just feel normal). Buprenorphine also has naloxone (Narcan) in it, which is an opioid antagonist (this is a medication used to treat opioid overdoses). One of the counselors of the MAT program in Charleston, WV said that Suboxone won’t produce a high regardless of the amount ingested. Interestingly, Suboxone has a very high affinity for opioid receptors, even more so than opiates, so if a person does use opioids while taking Suboxone it will block opiates from binding to opioid receptors in the brain so a person will not feel any of the effects of the opioids.

One of the documentaries we watched with the staff was about the physiology of addiction and the opioid epidemic in West Virginia. We learned that opioid addiction hijacks the dopamine receptors (pleasure centers of the brain) and causes physical changes in the brain. We also had staff from the MAT program in Charleston come out to speak about their experiences with their MAT program and answer any questions the staff had. They shared videos of powerful patient stories currently in treatment. It was inspiring to see how people were able to get their lives back from opioid addiction and truly thrive.

At Cabin Creek, the MAT program will include checking in to the clinic, taking a urine drug test to test for buprenorphine along with any other drugs, attending group counseling sessions, and individual counseling sessions. Group counseling sessions will include coping skills, stress management, and more. The MAT program at Cabin Creek center will be led by Dr. Sue Westfall and her medical assistant Denise.

Here’s a FAQ page about MAT from the Cabin Creek Website: https://cabincreekhealth.com/medication-assisted-treatment/

Here’s the video from PBS that we watched at the clinic about the physiology of addiction. The documentary specifically discusses opioid abuse in West Virginia.

References

West Virginia Opioid Summary. (2019). Retrieved from: https://www.drugabuse.gov/opioid-summaries-by-state/west-virginia-opioid-summary

by Kishauna Reid

I got the chance to learn from the provider at Mercy Care-Decatur, today. I sat in on all the patient visits to the clinic. I took vitals, discussed the careplan with the provider and reinforced patient discharge teachings when they were leaving. This experience helped me to understand the challenges that come with treating a homeless patient. The homeless patient population does not always have the resources, and sometimes the education, that is needed to address their illness. They face many adversities that hinder their health, however, Mercy Care provides resources to assist patients. Additionally, I noticed that many of these patients also have mental health problems. These patients have so much trauma that they need help to overcome. Mercy Care is a comprehensive facility that provides behavioral health, dental, housing, and pharmaceutical services. Having a pharmacy in-house is beneficial for the patients because they can get their prescription refilled at zero to very low cost. Patients often wait for months before getting their prescriptions refilled because they do not have the means or motivation to refill their prescription. In providing care, the nurses must educate the patients on keeping their follow-up appointments and filling their prescription in a timely manner.   

6/14/2019 and 6/15/19

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. 

6/13/2019

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. 

By Tomoyo Kuriyama and Sarah Anderson

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!

By Rika Win

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 unit.

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 home.