I went out into the community with the public health nurse today. Her job varies from school-based immunization clinics to shingles education at the senior center to house calls for patients with unique situations.
We spent the first hour of the day contacting patients and planning our route. This is no easy task, since phone numbers rarely connect, and the addresses in patient charts are not much more than directions from (sometimes) well-known landmarks.
As we got everything together, the nurse explained that a huge part of her job is based around education. She discusses everything from wound care to refrigerator temperature settings. Here's her library of health education handouts.
We spent the first hour of the day contacting patients and planning our route. This is no easy task, since phone numbers rarely connect, and the addresses in patient charts are not much more than directions from (sometimes) well-known landmarks.
As we got everything together, the nurse explained that a huge part of her job is based around education. She discusses everything from wound care to refrigerator temperature settings. Here's her library of health education handouts.
Our trip today covered a wide variety of situations. The first stop was a well-baby exam for a one week old boy. In other situations, the parents would have brought the baby into the clinic for a quick exam, but this was a very traditional family that was experiencing childbirth the Hopi way. Immediately after the delivery, the mom and baby were driven to her parents house for twenty days of uninterrupted relaxation. According to Hopi custom, the mother should do nothing but relax (and nurse the baby) for the entire period. All of the curtains are drawn, and neither one of them should be in direct sunlight until the sunrise naming ceremony on the 21st day. That was also the case with this family, and there were a dozen family members around (almost all women) to help clean the house and care for the child. The only males allowed in the house were the baby's older brother and the father. I was lucky enough to be granted a health provider exemption.
Some of the more traditional members of the family weren't crazy about me being there, but the bigger issue turned out to be the public health nurse. She is almost 8 months pregnant (and still taking the Jeep out for house calls!), and when she mentioned that to the family, some of them became concerned. According to Hopi custom, babies that are exposed to pregnant women are more likely to be fussy toddlers. The nurse felt bad, but it seemed like the family forgave her.
The next stop was at the home of a Hopi silversmith for a salmonella investigation. He came into the clinic last week with severe vomiting and diarrhea, and needed some pretty intense care. The lab determined that he had ingested some salmonella and was suffering from some food poisoning. The public health nurse was following up with him (as she does with every infectious disease) to see if he was feeling better, and to try to trace the source of the infection. She asked the patient where he got his water from (not always a simple question on the reservation), if he uses a toilet or an outhouse, where he buys his groceries, if anyone else in the house is sick, etc. They eventually came to the conclusion that he probably got sick after eating some pot-luck food at a community ceremony last week. The Hopis still practice most of their traditional ceremonies, and since many of them are to try and bring some rain, we're right in the heart of ceremony season. The health center knows this by the annual spike in food borne illness. We've recently seen a disproportionately high about of infections, cause by some pretty nasty bugs like salmonella, giardia, cryptosporidium and shigella. Many of them come from contaminated food or water, but many of them have no clear cause. In fact, as I type this, health center workers are trying to investigate a possible anthrax investigation. (As an aside, those are a lot more frequent than you'd expect. The anthrax bacteria are commonly spread by sheep, and a lot of people on the reservation keep their own livestock.)
By the way, this is reason #1,452,938 why I love government health care (aka socialized, single-payer, etc.). Could you imagine your local hospital dispatching a team of investigators to follow up after you got treated for food poisoning? You can if you're Native American. It's a well-justified expense if it keeps your neighbors healthy.
By the way, this is reason #1,452,938 why I love government health care (aka socialized, single-payer, etc.). Could you imagine your local hospital dispatching a team of investigators to follow up after you got treated for food poisoning? You can if you're Native American. It's a well-justified expense if it keeps your neighbors healthy.
Our last stop today was to visit an elderly woman with non-alcohol-caused end-stage liver disease. It's a fatal disease, and the woman will probably be passing away very soon. She was very calm--almost to the point of me suspecting depression--but was bravely confronting her situation. With Dr. Phil in the background, she and her caretaker described how she has been doing lately. Everything from bowel movements to skin color was discussed, and the nurse listened empathetically and wrote everything down.
The visit was part of IHS's well developed palliative (hospice) care services. Again, not only is this a wonderful service to the community, but it also saves the IHS a ton of money. The overwhelming majority of US health care expenditures are for people in the last few months of their lives. Everything that the public health nurse can do to make this process smoother (bringing supplies, educating the family about how to prevent bed sores, etc.) gives the patient a higher quality of life during her last days, and prevents the need for costly ER visits.
The visit was part of IHS's well developed palliative (hospice) care services. Again, not only is this a wonderful service to the community, but it also saves the IHS a ton of money. The overwhelming majority of US health care expenditures are for people in the last few months of their lives. Everything that the public health nurse can do to make this process smoother (bringing supplies, educating the family about how to prevent bed sores, etc.) gives the patient a higher quality of life during her last days, and prevents the need for costly ER visits.
Just another day on the reservation.
-M
