If we put together a soundtrack for our trip to Mississipi, it would certainly be an eclectic compilation. Of course it would include some famous Delta blues. But also the whirring of screws driven into drywall and the satisfying clunk of hammers on nails. The pop music streamed from iPods through car radios all the way down I55. The clamor of pots and pans accompanying preparation of meals in the dorm kitchen. But the first single from this hypothetical album has to be one of the beautiful Christmas carols sung by the children's choir at the Tutwiler community Christmas pageant on Tuesday night. We had the wonderful privilege to attend this annual event at the town's community center. We were welcomed by Sister Maureen, who coordinates the classes, after-school programs, and community events that happen at the center. Just watching Sister Maureen for a few minutes, I could tell she was another amazing force for good in her community.
The kids were decked out for the program, half in candy cane antennaes, half in various nativity scene garb. They impressed me with their acting skills during their Christmas skit, but the part of the pageant that has lodged itself in my heart was the singing. Hearing their strong, proud, joyous voices singing carols all together gave me chills. Those songs will be playing in my head whenever I think back about my experiences in Tutwiler as a symbol for the beauty that can come from collaboration and unity. Maybe it's too much import to place on an off-pitch performance of some well-worn tunes. But the meaning resonates and I think it will continue to do so for a very long time.
Thursday, December 22, 2011
Monday, December 19, 2011
While in Tutwiler
Because I (Kirk) couldn't figure out how to post, I'm writing through Kate's account. Indeed our experience has been a journey. It has been a journey to learn about rural medicine, a journey to help build a house, a journey to find ways to serve in little ways with great love. My experience thus far has truly been a blessing. I'm grateful for the second years who paved the way for us, and also very much grateful for the doctors and patients who have allowed us to learn about their lives and perspectives on health and healing. I have had the opportunity to shadow Dr. Traore at the Aaron E. Henry Clinic and Dr. Brooks in the Tutwiler Clinic.
Rebecca, David, and I were the first group to shadow at the Aaron E. Henry Clinic. Before going we arrived at the administration center to have our driver's licensse scanned and turn in other paper work. We thought we would be losing time to be in the clinic, but going to the administration center turned out to be a great experience. We met everyone who makes the Aaron E. Clinic functional, but also met those who participate in providing transportation to the people of Coahoma County. In addition to buses and trolleys that transport the people to and from jobs or other destinations, they also operate a mobile clinic. In brief words, it was like a huge travel bus with three examination rooms, paperwork station, and miniature lab. They would travel across the county especially to schools to provide services to children. It certainly alleviated barriers to access including transportation and scheduling issues like parents not being able to leave work to take children to the doctor.
While at the Aaron E. Henry Clinic Dr. Booker gave us a tour of the facility. It was really nice and I was actually surprised because I expected more basic conditions, but the clinic was very much like Community Health Clinic (CHC) back in Chicago. In working as a phlembotomist at CHC, we use Quest diagnostics for all blood work testing, and the Aaron E. Henry Clinic also uses Quest Diagnostics, not to mention, the doors, hallways, and exam rooms for some reason just reminded me of CHC. Perhaps I just had CHC on my mind because in all honesty many clinics and exam rooms are arguably the same. Regardless, I was just surprised about how new and nice it looked. On the other hand, the Tutwiler Clinic was consistent with my original ideas of what a rural clinic might look like, but what it lacked in technology and new facilities, it made up for with the supportive and loving environment provided by the doctors and nurses.
Today was a special day because Dr. Brooks came to our lodging during lunch to tell us her story, but also give better context to our experiences here. She is a truly remarkable woman. Her words gave a deeper meaning to our our work here with Habitat for Humanity to aid in the project of building a home. She showed us pictures of the homes that she visits and shared stories of the people who lived there. She told us that when someone has a home, it brings a renewed sense of pride and motivation to take care of themselves. Simply having a home improves ones health, but also restores dignity lost to unfortunate circumstances. I felt so moved because she was so genuinely grateful for us being here in Tutwiler. We are only here for one week installing insulation and dry-wall for the house currently being built. In addition to this, we are also shadowing in the clinics to learn about the disparities that exist in a rural health care setting. I feel grateful to be here, to have this opportunity, and to listen to the stories of patients. And for Dr. Brooks to share her feelings of gratitude was indeed inspirational because it reaffirmed that small acts of kindness do make great difference. I feel so blessed and excited to share my experience with family and friends upon returning home.
Kirk
Rebecca, David, and I were the first group to shadow at the Aaron E. Henry Clinic. Before going we arrived at the administration center to have our driver's licensse scanned and turn in other paper work. We thought we would be losing time to be in the clinic, but going to the administration center turned out to be a great experience. We met everyone who makes the Aaron E. Clinic functional, but also met those who participate in providing transportation to the people of Coahoma County. In addition to buses and trolleys that transport the people to and from jobs or other destinations, they also operate a mobile clinic. In brief words, it was like a huge travel bus with three examination rooms, paperwork station, and miniature lab. They would travel across the county especially to schools to provide services to children. It certainly alleviated barriers to access including transportation and scheduling issues like parents not being able to leave work to take children to the doctor.
While at the Aaron E. Henry Clinic Dr. Booker gave us a tour of the facility. It was really nice and I was actually surprised because I expected more basic conditions, but the clinic was very much like Community Health Clinic (CHC) back in Chicago. In working as a phlembotomist at CHC, we use Quest diagnostics for all blood work testing, and the Aaron E. Henry Clinic also uses Quest Diagnostics, not to mention, the doors, hallways, and exam rooms for some reason just reminded me of CHC. Perhaps I just had CHC on my mind because in all honesty many clinics and exam rooms are arguably the same. Regardless, I was just surprised about how new and nice it looked. On the other hand, the Tutwiler Clinic was consistent with my original ideas of what a rural clinic might look like, but what it lacked in technology and new facilities, it made up for with the supportive and loving environment provided by the doctors and nurses.
Today was a special day because Dr. Brooks came to our lodging during lunch to tell us her story, but also give better context to our experiences here. She is a truly remarkable woman. Her words gave a deeper meaning to our our work here with Habitat for Humanity to aid in the project of building a home. She showed us pictures of the homes that she visits and shared stories of the people who lived there. She told us that when someone has a home, it brings a renewed sense of pride and motivation to take care of themselves. Simply having a home improves ones health, but also restores dignity lost to unfortunate circumstances. I felt so moved because she was so genuinely grateful for us being here in Tutwiler. We are only here for one week installing insulation and dry-wall for the house currently being built. In addition to this, we are also shadowing in the clinics to learn about the disparities that exist in a rural health care setting. I feel grateful to be here, to have this opportunity, and to listen to the stories of patients. And for Dr. Brooks to share her feelings of gratitude was indeed inspirational because it reaffirmed that small acts of kindness do make great difference. I feel so blessed and excited to share my experience with family and friends upon returning home.
Kirk
Color and Contrast: A Day in Pine Ridge
Today was our first day in Pine Ridge and we saw some amazing things--the physical landscape of the reservation is breathtaking in its desolate beauty:
Obviously, scientists and explorers can't just stay on the beaten path...before lunch we climbed the nearby knoll:
And back in town yesterday afternoon I came upon some amazing graffiti art:
The color palate was a crazy contrast from the earlier, muted earth tones:
This one was probably my favorite:
So far Pine Ridge has been a land of fulfilled expectations and surprises, more questions than answers, and a truly novel cultural exposure.
Sunday, December 18, 2011
Monuments and Movement
On Saturday we had the chance to kindle our patriotism while looking over the majestic faces of Roosevelt, Jefferson, Washington, and our own Illinoisan Abe Lincoln. Honestly I was shocked at how moved I was by the colossal monument of American ability and ingenuity.
I was also shocked at both Trent's creepiness...
...and jump-kicking abilities.
After Mount Rushmore, we headed over to the Crazy Horse carving—an absolutely gigantic monument still under construction more than fifty years after its inception. It reflected another facet of American values; while Rushmore exemplified skill and polish, Crazy Horse showed the individualistic resolve of Korczak Ziolkowski's focus on his passion. Both are impressive testaments to the power of diversity as it manifests itself in our country.
And to learn more about diversity, finally we have arrived on the Pine Ridge Indian reservation. Yesterday marked our departure from the exceptional hospitality of Dr. and Mrs. Statz. Though there were tears and sadness on all sides (just kidding—they were probably super-excited to get rid of our hungry bellies), I was excited to finally saddle up and head for Pine Ridge. Over the last few days in our limited contact with Lakota Sioux I have developed a great deal of questions: what, exactly, are their religious beliefs? How are their traditional healers integrated into the larger structure of healthcare delivery? What is their relationship with the broader American society? While they obviously revere their people who commit to US military service, do they see any tensions in devoting their youth to the institution that has caused them so much pain in the past? Will I get a chance to have any of these insanely complicated questions answered?
We only arrived last night, but already I'm looking forward to today when we get a chance to get out into the field and do what we came here to do: learn as much as we can and start assimilating what we find about the Lakota Sioux into our existing knowledge of underserved medical communities.
historytelling
Our clinical skills course course this term focused on learning to take a medical history. We learned that it takes more than vital signs and physical exam findings to understand why a patient comes in for a visit- we also need to know their backstory. In many ways, taking a medical history comes down to letting a patient be the storyteller of their own past. Yesterday we took a journee (sorry, couldn't help myself) to collect the history of this place where we're spending the week: to hear the stories of Tallahatchie and Cohoma counties. We were graced by the presence of an amazing storyteller- Mr. Bill Sutton. Bill, like us, calls Illinois home, but over the last 2 decades he's spent a remarkable amount of time and energy working with Habitat in the Delta and learning to tell the stories of this place.
Bill first took us to the town of Sumner, a tiny town that played an enormous role in the Civil Rights Movement. The Sumner courthouse was the site of the trial for the two men accused of murdering Emmett Till in an act of racially motivated violence. They were acquitted, but the photos of Till's mutilated body were published and the outrage and sorrow surrounding the situation catalyzed the beginning of the movement. And it happened right here!
Unlike Till's story, many of the stories Bill related wouldn't make the history books. But all the stories, more or less well known, speak to the context of the equal distribution of opportunities and wealth that exist in the Delta today. For instance, we stood on the site of the Friar's Point Coup where violence against freed slaves and sharecroppers cemented a system of economic and social oppression whose legacy lives on 150 years later. And there are enough of these stories to fill a hundred books.
Other sites on our tour with Bill gave me hope that this history of inequity doesn't necessarily dictate disparity for the future. For instance, we saw Habitat chapters across the county that have been changing things for the better for the last 30 years. In the town of Cohoma, we met Mayor Jones and had the privilege of hearing him speak about his dreams for his community: a community center, an after school program, and a revitalization of Main Street.
We watched the sun set over the Mississippi as our tour ended, and I felt hungry for more stories- we're blessed to have the rest of the week here to learn more. I also felt physically hungry (you know I couldn't make it through a whole post without writing about food!). We headed to Clarksdale for ample pizza followed by blues at Red's. If the Delta is "where the blues were born," then Red's is the maternity ward where that baby was delivered, fully formed- wailing, drinking whiskey from a mason jar, and playing a mean guitar. Just amazing, and really beyond description.
We're on our way to Memphis as I write! Stay tuned for a new post following today's adventures.
Bill first took us to the town of Sumner, a tiny town that played an enormous role in the Civil Rights Movement. The Sumner courthouse was the site of the trial for the two men accused of murdering Emmett Till in an act of racially motivated violence. They were acquitted, but the photos of Till's mutilated body were published and the outrage and sorrow surrounding the situation catalyzed the beginning of the movement. And it happened right here!
Unlike Till's story, many of the stories Bill related wouldn't make the history books. But all the stories, more or less well known, speak to the context of the equal distribution of opportunities and wealth that exist in the Delta today. For instance, we stood on the site of the Friar's Point Coup where violence against freed slaves and sharecroppers cemented a system of economic and social oppression whose legacy lives on 150 years later. And there are enough of these stories to fill a hundred books.
Other sites on our tour with Bill gave me hope that this history of inequity doesn't necessarily dictate disparity for the future. For instance, we saw Habitat chapters across the county that have been changing things for the better for the last 30 years. In the town of Cohoma, we met Mayor Jones and had the privilege of hearing him speak about his dreams for his community: a community center, an after school program, and a revitalization of Main Street.
We watched the sun set over the Mississippi as our tour ended, and I felt hungry for more stories- we're blessed to have the rest of the week here to learn more. I also felt physically hungry (you know I couldn't make it through a whole post without writing about food!). We headed to Clarksdale for ample pizza followed by blues at Red's. If the Delta is "where the blues were born," then Red's is the maternity ward where that baby was delivered, fully formed- wailing, drinking whiskey from a mason jar, and playing a mean guitar. Just amazing, and really beyond description.
We're on our way to Memphis as I write! Stay tuned for a new post following today's adventures.
Friday, December 16, 2011
Community education, LNI, steak&potatoes! Oh my!
Good evening ladies and gentlemen! This afternoon was chock full of Lakota Nation Invitational (LNI) festivities, an annual Native American high school basketball tournament in Rapid City. It's a pretty big deal... http://rapidcityjournal.com/
During the LNI, a lot of teachers, parents, and other community members go to various educational sessions offered between games, and we were asked to participate as presenters—oh, the horror of public speaking (and the horror of being expected to be knowledgeable about medicine)!!! We split up into three groups, focusing on the following topics: alcohol/substance abuse/ASAP, diabetes/hypertension/Mission Nutrition, and mentoring/basic vitals (for the kids who were hanging out around the tournament). For the first two sessions, we spoke to groups of 15-20 adults, giving them a medical explanation of what goes wrong with the body in addiction and metabolic syndrome and how to help themselves and their loved ones avoid these problems. We also ran through the curricula we use in our Prtizker-run outreach programs on the South Side. The ASAP Program (Adolescent Substance Abuse Prevention Program) is an initiative in which we bring healthy and diseased organs to schools to let students see (and touch!) the effects of drugs and alcohol on our bodies. In Mission Nutrition, we teach kids about food groups, serving sizes, and the general awesomeness of fruits and veggies—with many snacks included of course. Being but humble medical students, it was nice to feel like we were able to actually give these community members some valuable and helpful information, and we learned a lot in return. We talked with them about the difficulties of teaching students with Fetal Alcohol Syndrome, understanding the nutritional value of wild berries and buffalo meat, and dissecting the causes of esophageal varices. During these sessions, another inspiration-and-social-skill-
Diabetes/Hypertension/Mission Nutrition Talk
With our afternoon responsibilities safely behind us, we then went to the Rapid City Civic Center, where the LNI basketball action was taking place. Before the games started, the Lakota Sioux honored their female military veterans as well as several tribal members who have made great contributions to the community their female veterans. There was also an opening ceremony and parade—called the Grand March—in which all of the high school basketball teams and cheerleaders gathered on the basketball court to kick off the competition. There was a lot of beautiful dancing and singing...see the photo and videos below! It was really interesting to see the strong patriotism that everyone was showing in light of the really complicated and troubled history of the U.S. Government and the Lakota people. This is something we want to learn a lot more about over the course of the trip!
Native American Drummers at LNI Grand March
LNI Grand March Video
LNI Grand March
The day wrapped up with some serious business dinner provided by Dr. and Mrs. Statz, who are pretty much the greatest parents of all time. Steak and potatoes of epic tastiness and proportions—what else would you expect from the Statz family? Stay tuned for more adventures with Mount Rushmore and high school basketball tomorrow, our last full day in Rapid before we head to Pine Ridge!
Learning about Regional Health Systems
This morning we went out to the Rapid City Regional Medical Center to learn about rural regional health care systems so we would have something to compare to our experience at our urban academic medical center. I realized that something was different when the VP of Medical Affairs (who was also a captain in the Navy and the police force) came in to lead part of our tours.
As we wandered through their newly updated hospital floors, we wondered about the impetus for changing the patient rooms. Patient satisfaction, he said. But if you're the only regional medical center in the area, we wondered, why would you have an incentive to make things better since patients have no choice for where to go? Because the right thing to do, he said, and there are new Medicare incentive payments for hospitals that get the highest patient satisfaction ratings.
I had heard about these ratings before and our own hospital was going through similar discussion to try and figure out how to raise our outcomes in things like appropriate antibiotic prescriptions, prompt removal of urinary catheters and preventing hospital readmissions. But I had never heard -- or may simply just not know -- what efforts are being made to improve patient satisfaction. In reality though, the actual numbers for Rapid City are comparable to the University of Chicago for patient satisfaction. What was most strikingly different was that the board at Rapid City was clearly making capital investments to improve the patient experience on the hospital floors -- moving the nurses out of the hospital wings, incorporating better televisions in the rooms, and so on, whereas I suspect that the changes to improve patient satisfaction in other institutions may be a lot more subtle. So in the end, while all hospitals are being faced with figuring out how to handle the new quality-based reimbursement schemes from Medicare, what each hospital chooses to focus on and emphasize in that effort is going to be very different.
As we walked on to the next floor to see the new e-ICU suites (with the monitors outfitted to allow specialists from Sioux Falls to monitor patient codes), a classmate commented that it wasn't exactly fair for hospitals or physicians to be graded on patient satisfaction since satisfaction can so often be based on such arbitrary things rather than actual improved outcomes of care. And it's true. However, seeing the changes that are moving forward in Rapid City for care that improves the patient experience, I wonder whether what we saw really did demonstrate that the renewed focus on patient satisfaction may do some good for patients, at least in this part of the country.
As we wandered through their newly updated hospital floors, we wondered about the impetus for changing the patient rooms. Patient satisfaction, he said. But if you're the only regional medical center in the area, we wondered, why would you have an incentive to make things better since patients have no choice for where to go? Because the right thing to do, he said, and there are new Medicare incentive payments for hospitals that get the highest patient satisfaction ratings.
I had heard about these ratings before and our own hospital was going through similar discussion to try and figure out how to raise our outcomes in things like appropriate antibiotic prescriptions, prompt removal of urinary catheters and preventing hospital readmissions. But I had never heard -- or may simply just not know -- what efforts are being made to improve patient satisfaction. In reality though, the actual numbers for Rapid City are comparable to the University of Chicago for patient satisfaction. What was most strikingly different was that the board at Rapid City was clearly making capital investments to improve the patient experience on the hospital floors -- moving the nurses out of the hospital wings, incorporating better televisions in the rooms, and so on, whereas I suspect that the changes to improve patient satisfaction in other institutions may be a lot more subtle. So in the end, while all hospitals are being faced with figuring out how to handle the new quality-based reimbursement schemes from Medicare, what each hospital chooses to focus on and emphasize in that effort is going to be very different.
As we walked on to the next floor to see the new e-ICU suites (with the monitors outfitted to allow specialists from Sioux Falls to monitor patient codes), a classmate commented that it wasn't exactly fair for hospitals or physicians to be graded on patient satisfaction since satisfaction can so often be based on such arbitrary things rather than actual improved outcomes of care. And it's true. However, seeing the changes that are moving forward in Rapid City for care that improves the patient experience, I wonder whether what we saw really did demonstrate that the renewed focus on patient satisfaction may do some good for patients, at least in this part of the country.
Subscribe to:
Posts (Atom)