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Wednesday, March 10, 2010

Walking in the community (fourth in a series)

Read part 3 ...

Read part 2 ...

Read part 1 ...

On Monday morning we split into two groups in order to visit some of the communities served by the local public health clinics. One group went to Chirripos, one of the poorest barrios in San Francisco de Macoris, with a public health nurse named Ramona.

We got a chance to tour the clinic and see what services were offered and what resources were available to serve the community. The clinic was very small and simple, and when Ramona showed us where they keep the medicines, the cabinet was almost empty. She had a list of the services that were supposed to be available at all of the public health clinics around the country, but close to half of them were not available to the residents of Chirripos because they did not have the supplies to carry out the care.

For example, they are not able to vaccinate children at the clinic because they do not have a fridge to store the vaccines. In one room on the outside of the clinic there was the pharmacy, which was full of medicines and supplies but only for those who have insurance.

To many of us the difference in care between those who have insurance and those who do not was stark. The Dominican system of insurance is such that the very poorest are covered by a type of basic public health insurance, and those who can afford private insurance use a completely separate system of private clinics and hospitals. The working poor ( i.e., those who are very poor but do not qualify for the public insurance), are completely lost within the system. Many of the students were able to make comparisons to similar issues with the insurance industry and health care system in the U.S.

After the tour of the clinic we accompanied Ramona on her house visits in the community. We visited houses that were little more than clapboard with tin roofs on unpaved roads. Children were playing in the dirt as street dogs lounged in the sun and neighbors chatted in the street.

The sense of community in the barrio was so powerful and we found that family members as well as neighbors were always present to help care for each of the patients. We visited patients with TB, cancer, and other chronic illness who had difficulty getting to the clinic.

One woman in particular, who had breast cancer, really helped us to understand how the lack of resources affect patients. As we entered her tiny house we had to adjust our eyes to the dim light in order to focus on her face. She was sitting in a chair and slowly began telling us her story. She was poor enough to be on the public insurance, and when she was diagnosed with breast cancer she was able to have a very basic surgery to remove the tumor.

However, the public insurance only covers a small part of the treatment, which is the first surgery. She did not have the money to cover more treatment, and continuing care and chemotherapy or radiation is out of the question. While the surgery may slow the progression of cancer, she will die from the disease because of lack of access to care.

She kept telling us, “I don’t want to die. I have a son who is 17 years old and I don’t want to leave him. Please, I don’t want to die.”

It was very difficult for us to leave her knowing that there was nothing we could do for her.

Ramona vented her frustration at having to tell patients that she didn’t have the answers or access to resources to make them better, but she does her best to remain positive.

“While I don’t have resources, I do have my heart," she said. "I am able to offer emotional support and let the patients know that I care about them and that someone is listening to them.”

While in the United States we have access to so much technology and such a high level of care, we are so often missing that element of human connection.

Although we call it “nursing care” we are so often focused on our skills that we forget to be present for the patient so we can listen to their needs and truly connect, person to person.

Many of us went into nursing because we wanted to care for people, and on Monday we saw such a powerful example of how that can be done. It was such a good reminder of the impact that a nurse can have both on the individual and the community. While many of us came here with the thought that we were coming to help, we are actually learning so much more than we could ever give…

Hasta la proxima,

-- Abby Weil 11N and Hunter Keys 11N, students, Nell Hodgson Woodruff School of Nursing

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