Hannah's journal

This morning, we woke up at the crack of dawn and headed over to Cox Elementary school. During the summer, a special educational program goes on for the children of Migrant Farmworkers. The first thing that I noticed was the smiling faces of the children. I loved their positive attitude. They were so happy to see all of the nurses and waved at us as we passed. As this is the 20th year of the Farmworker Family Health Program, I am sure that the sight of the nurses brings feelings of hope, knowing that they will soon receive new clothes, toys, books and that they will have a fun day of running around the school doing different health activities. We unloaded tons of donations from the vans and the cars and brought them to the gym and a music room designated for donations. After a day of set up, we ended by watching a demonstration by physical therapy of what they do. I thought this was great as it gave me a better idea of what they do so that I can know when to refer to them when I work in the hospital one day. I hope that we have more demonstrations like these from other professions. I think that it will give me a better appreciation for the work of other healthcare providers.

Night camp foot care

On my first time at night camp I did foot care. I had heard from professors and other teachers that foot care was one of the most important experiences in Moultrie. Maeve Howett and Ann Conner spoke to us and had us read their article about intentional touch. They taught us that many migrant farmworkers have left their families behind to earn money for their families that might still be in Mexico or in other Spanish-speaking countries. I talked to a patient that is the same age as my father, but looked about twice as old from the wear and tear of physical labor. Considering the life expectancy of migrant farmworkers, his appearance made sense. I mustered up enough Spanish to ask him about where his family was at the moment. He said that his wife and children were still in Mexico and that he didn’t have other relatives with him. For this man, I believe that intentional touch is especially important because although the man admitted to having friends here, with the idea of Machismo, I am sure that this man and his amigos don’t hug and show physical affection. For this reason, I believe that this man is probably touch hungry. I had the opportunity to challenge my Spanish abilities and talk to this man while I gave him care. I asked him how to say words in Spanish, such as the word for powder that I was using on his feet. He told me it was “talco.” I think that he appreciated my effort to talk to him in his native tongue. I kept eye contact as I massaged his feet with wet wash cloths, lotion and powder. I am glad that I was able to share this intimate experience with my patient and I am sure that he was equally delighted.

June 4, 2013

Goal: get a good start on assessing the community and hopefully talk to some key informants

Morning Assessment:

Nicole Makris and I started out at 8:15am and drove to the city of Adel. We went to a grocery store called Harvey’s. It was an old store that was later bought out by Food Lion. This store had the same basic produce and products as a Publix would have, except there wasn’t a large organic selection. What was once probably a grocery store filled with local products is now bought out by a large corporation that is selling the same basic products as any other store in America. For a small town, this is especially sad because typically rural areas don’t have that much money and it could really be supportive if there was some local business support to pump some money into their local economy.

We also spoke with a police officer named Major Hill who made it quite clear that he wasn’t thrilled to have outsiders in his town. He was very suspicious of our questions despite repeated attempts to explain who we were. We hit the jackpot later when we stumbled upon the Migrant Education project. We met the director, Israel Cortez and the resources manager, Bonnie. This program works through school to train tutors to work with this specific population. The goal of this program is to get these kids to graduate and to pass their standardized tests.  Israel Cortez was the man who wrote the first grant to create a migrant health program, which later became Ellenton clinic. It was really cool to get to meet the man who started it all. Israel Cortez was a migrant farmworker and got to where he was now and is now trying to help others like him.

Night Camp: Foot care again

I was assigned to foot care again, so I could teach the next group how to do it. This time, everything went much smoother. We were able to set up very fast and get right to serving our population. There was one particular patient I had that made a big impact on me. During foot care, I really try to take my time and massage their feet gently and relaxingly. Additionally, I tried to make a lot of eye contact and get to know them as a person. My Spanish vocabulary grew since last night as I began to remember the language, so I was able to communicate with them about their families and what they did during the day and was able to teach them some health tips as well. I learned later after I got back to the hotel from a nurse practitioner who was following one of my patients that I had really made a difference for her patient. She said that her patient was very reluctant to go to foot care because he was afraid his friends would make fun of him. He didn’t think the activity was very manly. After the foot care, though, she said that her patient told her that he was very glad that he went and it was very relaxing. He told her that he would do whatever she said now because he knew that he was going to be taken care of wherever he went. This really touched me that I was able to give comfort to a man who probably had never received this sort of treatment before.

June 5th, 2013

Goal: Become proficient at assessing vision and become more efficient at doing paperwork

Vision at Cox:

This morning, I did a vision screening for the children. I quickly become efficient at going through the screenings and time flew very fast. My favorite part, though, was teaching the children. While the kids were waiting to get screened at the different stations, I sometimes kept the kids busy by teaching them from the education posters we were assigned to do in class. I taught the kids from the Dog Safety poster. I started by assessing what they knew about dogs. Many of the kids thought that a reasonable solution to being chased by a dog was to run away from it. I am very glad that I was able to educate these kids due to their lack of knowledge about stray dogs and the abundance of stray dogs that roam around in this area. I practiced the “teach back” method by asking the kids questions after I had taught them the information from the board. This further allowed me to see who understood the concepts and who didn’t. I also turned a portion of it into a game where I pretended to do different things as a dog and asked them how they should react to it. I had a lot of fun with these kids. They were so bright and happy. These screenings will catch things that will affect their learning in school, such as vision, hearing, and tooth aches. I hope that their future will become brighter through our interventions at the FWFHP.

Night camp:

Tonight, I was assigned to the hemoglobin and glucose station to screen for diabetes and anemia. I was very afraid at first as I have a phobia of needles and pricking. When I first started, my hands were shaking as I moved to prick the man’s finger. Additionally, there are actually quite a lot of things to keep up with at this station. You have to prick the finger, get the blood into two different machines, make sure not to contaminate the blood and clean up the blood afterwards from the machines before the next patient comes.  I was also shaking because men were lining up and there were only two people doing the screenings. I scrambled to get all of the things I needed prepared and was really afraid I would mess up. The nurse practitioner students and a fellow nursing student, though, really helped me to calm down. They told me that the patients can wait and that it is important that I do it correctly. They showed me how to do it a couple of times in an efficient order, were patient with me, and praised me when I finally got the hang of it. Before I knew it, I was speeding through it. I was no longer afraid of pricking the fingers and the blood after being exposed to it repeatedly. I got really good at getting the blood out and scooping it up into the hemoglobin blood collector thingy.

Also, I decided that I really like doing this work. I like to do things physically and despise the idea of sitting in a chair doing paperwork for the rest of my life. I want to help people and see their faces and know them. I also like feeling physically tired. This is very rare in my sedentary lifestyle within the ivory towers. It feels good for my body to move and to sweat from the labor. I think this probably stems from a primal need to do work. I think I want to do this type of work for my career.

June 6th, 2013

Goal: Become proficient at doing BMIs and taking blood pressures, shadow a student from another specialty

BMI screening at school

This morning, in the reflection in the gym before beginning our day, I realized just how much we nurses have been taught and the value in the information. Many of the students from other disciplines asked questions in reflection that the nurses were able to answer. The nurses gave them a good explanation of why children are working in the fields and why their living conditions are so poor. I think educating nurses allows other disciplines to respect what we do and see that we have something important to say. I was proud of us. Today, I screened for BMIs. I was a little surprised about how many steps it takes to take a BMI. You have to calculate the exact age and use the height and weight to calculate the BMI. I knew this going into it, but I don’t think that I realized how much went into it until I sat down and did it for the first time. After calculating a number of BMIs, I got the hang of it and became proficient at the documentation and plotting the BMI on the children’s charts. A surprising number of children were overweight or obese. By looking at these kids, you wouldn’t think of them as overweight, but that could be because America is becoming fatter, so what is normal to us is no longer healthy. I hope that the counseling by the nurse practitioners to these kids will cause them to make some changes in their diet and sedentary behaviors.

Night Camp: Blood Pressure

Tonight, I did blood pressure screenings. At first, I was having trouble hearing and letting the air out slowly, but after several patients, I got the hang of it. I also learned from Nicole how to educate my patients about salt in Spanish. Every day, my Spanish phrases and vocabulary grows. It is really important to learn Spanish for healthcare professionals, so that the patients can receive proper treatment and an opportunity for education. Without education, the behavior will continue and the condition will worsen. We finished seeing patients at about 9:45pm, so I shadowed a PT and a nurse practitioner tonight. I really liked watching and learning from a physical therapist. She explained the difference between chiropractors and physical therapists. She said that physical therapists take more things into consideration and concentrate on the soft tissues. They treat the person as a whole. After several attempts to get a patient’s back to crack, the PTs realized that the patient was just too tense. They took time and massaged his back with a muscle rub for about 10 minutes. The man’s eyes closed and then you could tell that he was really soaking in the experience. Then, his back popped. These men carry a lot of stress, physically as well as emotionally from isolation from their loved ones that might still be in Mexico. I really gained an appreciation for physical therapists today. I really enjoyed shadowing a nurse practitioner. It is true that nursing is a teaching profession. She got right into the teaching role and allowed Grace and I to learn about what she was doing and she gave us opportunities to assess the patient ourselves. I think it is good that we are going down with these different teams of healthcare professionals. I especially like that the nurse practitioners are here because it gives us nurses something to look up to and hope that we might be one, too someday.

June 7th, 2013

Morning: Runner

Today, I worked as a runner at Cox Elementary. I was in charge of leading a class of 12 children to the different screening stations. I started by bringing them to the dental hygienists. The hygienists clean the kids’ teeth, give them a fluoride treatment, and put a sealant on for protection.  While the children waited to see the hygienists, they sat at a table with books teaching about good dental habits and models of teeth that the children could play with. A couple hygienists sat at the table with the kids to teach them how to prevent cavities. They demonstrated how to brush and floss, using the model teeth. Then, they let the kids practice and while they practiced, asked them if they flossed and brushed at home and gave them advice on foods that they should and shouldn’t eat to promote good dental health. The kids had a lot of fun and learned a lot. We praised them when they flossed correctly and we had the kids that were proficient at flossing teach their peers. This teach back method promotes the learning of both the “teacher” and the “learner.” On their own, many of the kids started brushing the teeth of the stuffed animals that were at the table. They would say things like, “we need to brush his teeth, so he doesn’t get any cavities.” This let us all know that they really understood the concepts. After getting their teeth cleaned, they all got a goodie bag with a sticker, toothpaste, toothbrush, and floss in it. These kids really depend on these bags of supplies. Every year, they get a bag of supplies and don’t replenish these supplies again until the dental hygienists come back the next year. After this station, I took them over to the vision, blood pressure, hearing, and BMI stations to get screened.

June 10th, 2013

Morning Hemoglobin, Glucose and A1C at the school

This morning, I was assigned to do hemoglobin and glucose checks with children. I was really nervous because I didn't want to hurt the children. Growing up, I was always the wimpy kid who cried at everything related to "ouchies." (Now that I have matured, I just faint). Because of this, I think it made me more sensitive to their fears. I tried to explain what I was doing and that they would get a sticker and bubbles afterwards. I tried to do it as quick as possible, so as not to build anticipation. I have done the hemoglobin and glucose tests before, but never the A1C test. The rule is that we only stick kids once because many of the children, understandably, are very afraid of the "tiny stick." By just asking the kids to stick out their finger, many of them started to whimper because they remembered what happened to their finger the last time we came. Almost half of the kids I saw were in the 95th percentile for weight. In class, we learned that usually the first generation of workers that come from Mexico are very healthy upon assessment using screens such as BMI, glucose, and hemoglobin A1C. When the second generation comes around, they are generally beginning to take on a more American look, becoming more obese due to prolonged exposure to the diet. In addition, we learned that these farmworkers generally don't have access to healthy food despite working on farms that grow vegetables. They usually have limited access to transportation to grocery stores and end up eating anything that you can buy in a gas station. Because of the one stick rule, we prick their finger once and a "milk" enough blood to go into the hemoglobin machine, the glucose machine (if their BMI is about the 95th percentile), and the A1C machine (if the glucose reading is 100 or above). The A1C machine tests for elevated glucose over 3 months. This part can be tricky as once the child sees blood coming out, you have to keep them still for long enough to get a sample into three different machines. One of the kids I tested was in the pre-diabetic range. It is unfortunate that these people who were once healthy in Mexico are having children that are 7 years old and on the road to diabetes. One of the nurse practitioners taught me how to calm the children's fears by having the child first practice on her. (She secretly disabled the lancet), had the kid "prick" her and put on a Band-Aid. Once the children understood what was going to happen to them and saw the point of view of a nurse, their fears were calmed and they bravely allowed us to stick them. She also taught me some other valuable lessons, like always tell the child what is going to happen before you do it. Otherwise, they may stop trusting healthcare personnel. The nurse practitioners have served as great mentors throughout the stay in Moultrie. I will use this advice for the rest of my nursing career.

Night-time: Hemoglobin A1C

Tonight, I did my first hemoglobin A1C tests on adults. This station was set up in a more unique way. It consisted of two pharmacy students, two masters of public health students, a staff member from the Ellenton clinic, and a nurse (me). This was a very interdisciplinary group, but I didn’t really see any attempt to get us to learn from one another except by casual conversations we had and personal efforts to get to understand each other’s line of work. Personally, I did end up learning more about what the different people were here to do, but I didn’t really understand why we were paired up in this way. I really got to practice my Spanish skills here, though. We started out by asking several screening questions in Spanish to each patient. If they got a score high enough, then they needed the A1C screen. I taught patients about eating fruits and vegetables, avoiding greasy and sugary foods/drinks, and encouraged them to keep exercising (these men are fit, but sadly due to the back-breaking labor they do). I learned lots of new phrases and became proficient at working the A1C machines. Something that frustrated me was finding out, after consistently asking the patients about the food served in the cantina, that these people truly don’t have access to fruits and vegetables. They said that there is hardly any fruits or vegetables, only greasy foods such as hamburgers, tacos, and fried chicken. We can teach them until we are blue in the face about proper nutrition, but unless the food served in their cafeteria changes, their food intake won’t change. This is a larger problem that needs to be changed at the top, but those who have power doubtfully have any concern about the nutrition of their workers.

June 11th 2012

Morning community assessment

This morning, we got to meet Sylvia, a regional recruiter for the Migrant Educational program. She also brought along Melissa Gill, a woman who works for the migrant educational program. They are both Hispanic and wanted to help others like them in America. We began by discussing what the major health problems were for the community, which they said were diabetes, dental, cancer, cardiovascular disease, etc. When we asked them what they though the main problem was in this community, they said transportation. There is no public transportation, they only have 2 taxis, but taxis cost money. Additionally, they have to call the taxi ahead of time and request one (all using a language they don’t know well- English. For these reasons, these people have a hard time physically getting to a place where they would get healthcare. They said that the biggest strength in this community is communication. Melissa Gill has special access to the GRITS system, so she is able to keep track of the health records of the population and keep them up to date and help to provide the health care needed in order for a child to be successful in school. After an hour and a half of picking their brains for information, the women took us to two homes of Hispanic migratory families. One thing that we learned that was very important was that Georgia is transitioning from being not only a migratory state, but also a home-based state. Many of these workers are settling down in one area because of reasons such as familiarity with the area, school, and family. One man we talked to explained that his daughter had severe eye problems (he wasn’t able to give us a name for what she had), so he decided that it was best for his family if they stayed close to doctors they knew. (There is one doctor in that area who provides services in Spanish). Additionally, he expressed how grateful he was for Grady hospital. He said that they took his daughter immediately and helped her. He also explained that his younger daughter, who is 7 years old is having a similar problem as the older one. The man had so much pain in his face when talking about the health problems of his family. This man feels very responsible for his family and it is obvious he would do anything for them, which is unlike most American men I have encountered who live selfish lives. He continually thanked us for what we are doing here in Moultrie and said that we were noble to do what we do. He said that he hopes that there will be more access in his area to these kinds of services. Our group talked afterwards and decided that there needs to be more communication between the different groups providing services to migrant farmworkers in order to connect them and their clients to more services. This client didn’t know of Ellenton Clinic or of the services we provide at the different camps during our two weeks here. Knowledge like this could save these families a lot of money on healthcare and provide them with other basic necessities like clothes and toiletries.

Afternoon and Night camp: BMI, ht, wt

This afternoon, we had an ethics seminar about immigration and the relevance to the new healthcare reform act. We learned that we are all really immigrants in America and that it is the Hispanics who are being singled out. The speaker went as far as to compare it to Hitler blaming the Jews for every problem. As human beings, we all deserve access to healthcare. It should be made easier to become a citizen and to receive all the rights of an American citizen, so they can have access to these new reform laws. The speaker brought up an interesting point about how if the migrant workers become citizens and are paid a living wage, the price of vegetables will give up. I suppose that at this point, Americans will have to decide where their values lie and realize that the price we saw on our fruits and vegetables is not taking into account the price on the lives of these workers.

Tonight, my job was to get the BMIs of the patients. However, most of the patients were so muscular, I don’t believe that their high BMI calculations were really applicable.  Later, I shadowed a nurse practitioner who was taking care of a patient who wasn’t able to hear. They did a lavage on both of his ears to remove the wax and then he could hear much better. He has probably gone for a long time thinking that he was deaf when if he had access to a local doctor or nurse practitioner, he could have had this problem solved a long time ago. Then, the nurse taught him how to prevent this problem in the future by using hydrogen peroxide in his ears every once in a while to prevent buildup of the wax. Again, I see that you can’t just fix a problem, you have to fix the behaviors or the problems will reoccur. Patient education and prevention are vital to a healthy population. This reminds me of something that Sylvia and Melissa discussed with us this morning. They said that the government will currently pay for emergency medical care for undocumented migrant workers, but won’t pay for prevention. However, trips to the ER cost thousands of dollars to the US, while prevention and education cost next to nothing. We need to bring America’s focus to prevention. If only we can fight the interests of those who get rich off of the sickness of the people- pharmacies.