Today we worked with the community of San Luis to try to prevent future flooding of some of the most devastated houses.  We were trying to help with the environmental hazards that are associated with standing water- such as providing a vector for disease and a breeding ground for pests. To help, we spent time using dirt to fill in the floors that were wet from the flooding rain. We also used rocks that were already around the houses, along with gravel we found, to create a barrier between the ground and the holes in the wall to prevent water from entering that way. Everyone had their own jobs, whether that be loading the wheelbarrow, ensuring everyone was hydrated, or carrying buckets of dirt for the community to place where they thought was best. The members of the community had expressed the day before how the flooding had severely hurt their self-esteem, but we hope that by helping them that they are empowered a bit more. In the afternoon, we attempted to teach our community partners the modules we had prepared, but it began to rain too hard to teach. However, we finished the community assessment we had started earlier, getting the chance to ask our community partners questions about things we had not gotten answered.

The question of how much to help is always a complicated one. Meeting physical needs like this was never really the intent of this trip but we knew that basic physiological needs have to be met first before anything else. With people’s houses being basically destroyed, there’s no way we could try and teach about oral health or composting and ignore those needs. So, we decided to help. Being a nursing student, I automatically default to wanting to help as much as I physically can. But, I’m continually learning that taking a step back and letting people do things on their own is sometimes just as powerful and impactful. Because of our short time there, we weren’t able to do as much as I’m sure a lot of us would have liked to. I do think we were able to meet some immediate needs and provide the community with the materials and hopefully the motivation to finish the job themselves. I’m proud of the work we were able to do today and am leaving feeling ever thankful for the opportunities we are afforded here at Emory and in the United States.

by Kishauna Reid

“Like the lotus flower that is born out of mud, we must honor the darkest parts of ourselves and the most painful of our life’s experiences, because they are what allow us to birth our most beautiful self.”  This quote by Debbie Ford stood out to me today as I encountered a patient that said he was “spiraling out of control” and needed help. It was very insightful working with the psychiatric registered nurse at Mercy Care, today. In order for a patient to be admitted to the behavioral health program at Mercy Care, he/she must first complete a nursing assessment to determine medical stability and readiness to receive treatment. I assisted with the nursing assessment of this particular patient getting renewed for the behavioral health program.

During this assessment, we performed a systematic review of systems, a urine drug screen, and spoke to the patient about his challenges. The patient’s willingness to start treatment showed his perseverance through adversities. Although he knew it would be challenging, he was still willing to continue treatment because he was confident that treatment was the best thing for his health. Individuals that have mental health disorders may have many painful experiences in their lives, and when they choose to seek treatment, they can begin to let those painful experience birth something beautiful. Mercy Care’s behavioral health program includes counseling and group therapy sessions, such as substance abuse and anger management groups, case management, psychiatric visits and many other resources for the patient.

Welcome to our final blog post from Courtney and Abbie. Over the past week we have had the privilege to learn about and interact with vulnerable populations in our backyard of Atlanta. We began on Monday by teaming up with Catholic Charities Atlanta to learn about the refugee resettlement process in the United States. We went to Clarkston to move in furniture and set up an apartment for an Eritrean single mother and her five children. On Tuesday, we went to Grady’s dialysis clinic for immigrants with end-stage kidney disease. We were able to speak with patients about their life stories, current medical condition and educate them about their disease and how to manage it. On Wednesday, we went to Clarkston Community Health Center to do patient education on colorectal screenings, help organize the clinic and price out traditional grocery lists for refugee families to get a glimpse into their financial situation. On Thursday, we went back to the dialysis clinic at Grady to learn more about the dialysis process and update patient information packets so they can better understand their disease. On our last day, we got to tour and prepare lunch at Good Samaritan Health Center for the homeless population in Atlanta.

Abbie’s favorite part of the entire immersion was interacting with patients, gathering histories, doing a grocery store assessment and updating new patient education packets. Courtney’s favorite part of the entire immersion was exploring different parts of Atlanta and interacting with populations with interesting stories and backgrounds.

Facts our group found most interesting/What our group enjoyed doing:

• Chronic Kidney Disease of unknown etiology(CKDu) is hypothesized to be the first chronic disease that could be caused by climate change
• Learning the importance of dialysis and its process
• How to work with interpreter services while still engaging with patients
• Showing compassion to all because you never know what someone has gone through
• Importance of establishing a therapeutic relationship
• Health Care services available to the underserved population
• Touring Good Samaritan Health Center and seeing all the resources they offer from their own food gardens to their fitness classes
• The process of interviewing patients in general or for a research project
• Hearing the life stories from the patients
• Learning the history behind Ponce de Leon and how it was the street that was the divide for segregation

That’s a wrap from week 1! Thank you to our clinical instructors and clinical partners we worked with throughout the week! Stay tuned to read stories from our week 2 classmates!

Flexibility was the word of the day for us on our fifth day in Mexico. Thursday started out like the other days, breakfast first thing before loading onto the bus to head into the community. Today Victor took us to the cemetery to learn a little more about the culture and history of Merida. It was shocking to see how different cemeteries are Mexico; they are bright and full of color. Our translators explained to us that in Mexico death is not feared but celebrated.

After our stop at the cemetery we continued on to San Luis, one of the neighborhoods in the south part of Merida that we had been working with during the week. The plan for the day was to work with community leaders to edit the health education modules we had prepared back in Atlanta, with the hope of teaching the community members later in the afternoon. When we arrived at San Luis one of the community leaders, Raquel, met us and told us how the rain the previous night had flooded many of the homes in the community. The mothers were currently trying to salvage their homes from the damage done by the rain and flooding.

Knowing that the mothers were focused on their homes we regrouped and decided to reassess the community to see what needs we could help meet in this moment. We sent part of the team on a mission to gather supplies while the rest of the team walked around to assess the community. Even with their homes completely flooded the people of San Luis graciously welcomed us, inviting us into their homes showing us the impact of the rain. After seeing the homes we saw that a lot of homes had deep pools of standing water that could cause a lot of health issues for the people. We decided to use our resources to provide gravel, tarps, shovels and other items that could hopefully prevent water from flooding in the homes. Our plan moving forward is to work with the community to remove some of the standing water and hopefully start creating some type of system that could prevent flooding in the future.

Though this day looked a lot different than what we had planned, it was truly an eye opening experience to see what the people of San Luis struggle with in their day to day. We were able to work with the community to come up with a solution to the problem they were facing today. It was just us nursing students coming in to fix a problem, it was all of us, students, faculty, translators, community members and partners, working together to move this community forward.

We started our third-morning sharing breakfast around a long table at our hotel restaurant.  On this morning we had a slower than usual start as we were scheduled for a lecture at the Comisión de Los Derechos Humanos, to be given by professor Adrian Verde Cañetas.  The talk was described to be one that discussed the architecture of Merida, but it ended up being much more.  Professor Canetas described the modern history of how the city of Merida came to be organized.  Present day neighborhoods were once haciendas, or ranches, that was owned by one wealthy family and farmed by endured servants.  As the source of economic power in the region shifted from agrarian to industrial, the haciendas were sold in parcels to new landowners or the city of Merida.  Those subdivisions became neighborhoods built with houses purchased by families of relative means. Our group learned that during this shift the economic power of Merida became firmly held by citizens who live in the north, while the poor neighborhoods reside in the southern part of the city, especially those located near the airport.  These communities would be the ones we worked with during our week in Merida.

A history lesson may seem superfluous to the work performed by nurses, but such knowledge is essential to providing respectful and competent care.  In learning about the economic scope of a region, a nurse can better decide on the necessary resources needed in disadvantaged communities.  In understanding a fraction of the economic upheaval propagated by the wealthy class, a nurse is better able to navigate the social mores of a city.  When outsiders come to help, they must be responsible for educating themselves on the history of an area because they will provide better care.

The remainder of our third day was spent teaching the various health modules to our group had created to the community leaders of Emiliano Zapata.  Our goal for the projects was to help local community leaders educate other residents of Emiliano Zapata on the following topics:  Dental Health, Talk with Me Baby, Preventing Child Sexual Abuse, and Environmental Health and Composting.  Some of the module content was created during the weeks proceeding the trip, but many of the groups finalized their modules after conferring with local community leaders.  The perspective provided by the community leaders assisted our group in creating content directly relevant to the community members.  With the help of the translators, we presented our materials to the adult leaders, who followed up our presentations by teaching the modules to children within the community. 

Today we observed in the clinic and behavioral health. We saw how many barriers our patients faced and the amount of compassion the staff has. The Mercy Care teams functions off of compassion and critical thinking skills.

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