Today was our last day at Mercy Care and we spent the day truly observing all the services and did a windshield survey of the surrounding area and neighborhood. There were not many resources or healthy food options surrounding the clinic. The MARTA station was right across the clinic which allowed for more affordable transportation methods to the clinic. The only issue with the MARTA is the reliability because we had one patient tell us that the MARTA went off course due to a track incident which made them late for their appointment. Mercy Care offers in house dentistry, primary care, behavioral health, and pharmacy services. We valued our time in this clinic and it goes to show how much work is still needed within our healthcare system here in Georgia to provide care for all those who need it.
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!
by Julie Pizzat, ABSN ’19
Welcome back to the blog! This is part 2/2 detailing our ABSN journey to Peru.
Day 7: CerviCusco and Pisco
Friday, we stayed at CerviCusco and helped out in the lab as well as the clinic. Since the clinic wasn’t very busy, we were done with Pap smears (“examen del Papanicolau”) and biometric tests by lunchtime, so we headed to La Plaza de Armas to explore some more. We had some great burgers (including veggie options!) at Papacho’s and then stopped by the Museo del Pisco to learn how to make our own Pisco sours. Our bartenders/instructors were very helpful and played fun music while we relaxed after a long week. We headed back to the clinic for dinner and went to bed early to prepare for our big day on Saturday—Machu Picchu!
Day 8: Machu Picchu
Saturday, we were out the door by 6am to take our first bus of the day—our amigo Jesus was back to guide us throughout the day with a new friend, Jennifer, serving as our second guide. We took the bus to Ollantaytambo and then boarded a beautifully scenic train to the town of Aguas Calientes. Part of the Inca Trail parallels the train route, so we saw some hikers along the way, as well as more of the Urubamba River and surrounding mountains. Once in Aguas Calientes, we boarded another bus that took us on a winding and bumpy road up the mountain to the entrance of Machu Picchu. Jesus and Jennifer brought us inside the site and we saw the extensive terraces and remnants of the Inca civilization. We saw various levels of Machu Picchu, from the Inca Bridge to the Temple of the Sun. Apparently, it isn’t explicitly clear why the Incas left Machu Picchu, but some people believe the citizens experienced a natural disaster (such as an earthquake) and saw it as a sign from their gods to vacate the site, even though it was still under construction. We also learned while touring the site that the mountain seen in the background of most pictures of Machu Picchu is called Huayna Picchu (“young mountain”); the mountain, Machu Picchu (“old mountain”), is actually on the opposite side of the archeological site, often behind the viewer. The site sits in the shadow of Machu Picchu, the taller of the two mountains, and that is how the site got its current name. The original Incan name of the site is technically still unknown. Jesus told us all of this and more as we walked around the city and marveled at the architecture and the scenery surrounding us. Once our tour was over, we went to lunch at a nearby restaurant and then took a bus down the mountain back to Aguas Calientes. We had some free time there until our train left, so people split up and explored by shopping or going to the hot springs. Around 6pm we boarded our train home, climbed into our bus at Ollantaytambo, and were back at the clinic by 11pm. It was a long day, but everyone enjoyed the experience of Machu Picchu!
Day 9: Free Day
Sunday was our free day of the trip, and the majority of our group decided to participate in a private cooking class with a local chef in Cusco. The chef took them to the market where they bought the ingredients for their meal and then returned to the kitchen where they learned how to make Palta rellena (stuffed avocado), Lomo saltado (sautéed beef), Pisco sours, and homemade chocolates for dessert.
Another group decided to hike Rainbow Mountain instead, waking up very early (before most of Cusco had even gone to sleep!) and taking a bus several hours outside of town to the trail site. After a challenging hike, they reached the summit and although there was snow on the landscape, it was still a magnificent view.
Everyone met up later for dinner at Limbus, a restaurant/bar with a great view of the city, and went to bed to prepare for our final day of service on Monday.
Day 10: The Final Campaña
Monday, we had our final campaign just outside of Cusco where we once more performed Pap smears, blood sugar, and blood pressure testing for our patients. There was a good turnout and several lucky students held some children while their moms underwent procedures.
After our service was finished, we presented the CerviCusco staff with gifts of our appreciation and took one final group picture. Some people went back to the plaza and San Pedro market to do some last-minute shopping, while others went home and began packing to leave the next day. We had one last dinner together at the clinic followed by a debriefing session to discuss our trip and our group project, and just like that, our time in Cusco was over.
Day 11: Traveling Tuesday
Tuesday was our travel day, and we made our way home starting bright and early. The new volunteer coordinator, Alyssa, saw us off at the airport and was waiting there to pick up the next group of volunteers arriving later that day. We all made it back to Atlanta safely (albeit later than expected thanks to a few delays), ready to get some rest before starting classes again on Monday.
The past 10 days provided an amazing experience of Peru’s culture and history, and the experiences we had here will stay with us for years to come. Thank you to CerviCusco for being so welcoming and educational, to our wonderful instructors – Dr. Phan, Dr. Zhang, and Dr. Thompson – for guiding us throughout our time here, to the Lillian Carter Center for organizing this trip, and to my fellow classmates who made this journey as memorable as the adventure itself.
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.
This morning we headed to a second community called San Luiz, which is about five minutes from Emiliano Zapata Sur. Last year, the group focused on meeting the people in the community but this year, an important objective for us was the community assessment for San Luiz. Taking what we learned from Public Health Nursing, we explored the community limits with Victor and conducted a windshield survey. Along with Victor, other key informants that we interviewed were many mothers who have lived in the community for several years and a woman named Roquel, who coordinates visits with local members, such as Victor. We collaborated with the interpreters and received additional subjective data from the women in the community during our morning walking tour.
During the walking tour, we began to see the stark reality of their living conditions. We were able to learn so much about how cultural, social, political and economic differences structured their lives, as well as how it affected their approach to health care. The homes are temporary structures that were either built from scrap materials the families were able to find, or that had been gifted to them. The materials varied from sheet metals, wooden frames to plastic tarps. We also learned many families did not have permits to build permanent structures and that it would take several years for the government to approve their application. As a result, they are technically considered squatters. They vocalized their frustration at the fact that some of the lots were empty or contained houses that had been abandoned, but yet they were still not allowed to build on that land. Many of the families are close to one another and we could tell there is a strong sense of support for everyone by the way they watched over other families’ children, advocated for the homes in intense distress, and simply from their conversations with each other. Lastly, the families lack access and face numerous barriers to essential resources such as schools, healthcare facilities, clean water, proper hygiene and plumbing, hospitals, costly surgeries, fresh produce, healthy foods, and better paying jobs. Despite these conditions, it was evident that these families worked really hard to make a living and to provide a home for their children. We were amazed to see their craftiness in their decorated homes and gardens of plants and vegetables. With all that they had, they still managed to display a sense of ownership, pride, happiness, and livelihood.
The severe poverty in San Luiz sets people up for an unfavorable environment that creates unsafe conditions, health risks and concerns, and unnecessary struggles. As nursing students and advocates for healthy living, it was clear that Environmental Health and its implications in San Luiz was our main concern. Health starts where one lives, learns, plays and works. Our community assessment shows that the people in San Luiz Community face multiple and complex environmental threats to their health and wellbeing.
The main problem each community member described was the flooding and water damage in their homes during the rainy season. Their homes would fill up to two feet of water and due to the structure of the homes and the surroundings, their only solution was to let it dry. The standing water commonly contains microbial contamination which poses a risk of human exposure and the likelihood of infection. Bacteria, fungi, and parasites quickly harbor these breeding grounds as there is no plumbing system to eliminate the water. Consequently, a high prevalence of illnesses from microbes is present. For example, the most common hospital visits for the children expressed by the mothers were gastrointestinal illnesses such as diarrhea, nausea, and vomiting. These illnesses are compounded by vector-borne diseases from mosquitoes, ticks, and fleas around the community. Furthermore, wet belongings in their homes can lead to fast growing mold that are hazardous to the community members and their pets. Spores can be inhaled through the air as family sleeps together in their unventilated, humid, small home. Because of these findings, we altered our plans for the rest of the week in order to address these environmental health issues.
Another environmental concern is the pollution and the practice of burning trash because there is no waste management system in place. Burned trash piles was common as we walked through the community. It contained leftover food, plastic bottles, plastic food wraps and electronics. This poses a health risk because air pollutants, toxics and compounds released from the trash are linked to lung and neurological diseases, increased risk for heart attacks and some cancers. In addition, shards of glass and rubbish scattered everywhere makes it unsafe for children to play around. We hope in future years to offer support through designing a waste management, composting, and environmental health program.
Multiple and complex environmental factors pose adverse health disparities and wellbeing to the San Luiz Community who are fighting to get ahead for their children and their future. Health concerns of several community members include deafness, blindness, congenital birth defects, cardiovascular diseases, dehydration, and gastrointestinal problems. Emotional distress and stress magnifies the health problems of the community members. These factors are further exacerbated by the social and economic disadvantages that the San Luiz’s children face. Such disadvantages and barriers include poor quality housing with fear of being kicked out, going to school that is several blocks away, playing around in a field of unpaved dirt with pollutants and contaminants, no running water, and having poor access to quality health care all add to the burdens of the community we encountered. It is essential that more support, programs, resources, research and individualized strategies need to be diverted to the San Luiz Community.
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.