Chapter 2: Shattering the Glass Floor

Matthew 25:31-46

A little video I threw together of the first day of my Masters of Public Health practicum trip to Panama:  The Panama Canal

From Market to Freezer: The Tradition of the New Mexico Hatch Green Chile Pepper:

Buy, Grill, Peal, Dice, Bag and Freeze.  Simple, fun, and the best way to make your whole home smell delicious!  The local secret to this process is to wear gloves, because the chile oil in these peppers can literally burn your hands!  And now I have peppers for the rest of the year!  Or maybe just for a week…

So I’m playing catch up trying to post all my pictures still from New Mexico!  Above are pictures from my day of home visits on the reservation with Community Health Representative Irene Harley.  This time I drove 2.5 hours North from Gallup at 5:45am to meet Irene at Huerfano Chapter in the Ship Rock Service Unit of Navajo Nation.  That day we went to visit four patients.  Irene had such a lightness and joy to her that it felt like she wasn’t affected by the gravity of her work.  We checked on patients with colds and another with suspected Parkinsons.  On our way back, she told me that she has been a CHR for 30 years!  And with nine years prior working at the Chapter House, serving her community, Irene has dedicated herself to the health and well-being of her community for 39 years straight!  That explains the lightness she gives off when doing her work. 

Our last visit was to a lady Irene worked with to help her build a new home!  This was a patient Irene worked with for a long time, but even with her health managed, her patient fell into a slump.  Irene worked with her week after week, trying to convince her to apply for a housing grant and pick herself back up.  With persistence, the woman gave into Irene’s loving pleas.  She applied for the 1 grant in per Chapter house for a new home and got it!  In addition to that, Irene walked up to one of the key construction workers in town and told him he had to help her patient build her home for her with the grant she obtained.  And with a tangibly simple task of helping her patient build a new house, her patient was able to stand again and be herself again!  Even though she wasn’t home when we arrived, I found myself walking up to a beautifully simple 5 year hold home with a fresh white paint and a nice little garden.  Walking up to that house and hearing Irene’s story of working with this woman, blessed me with that same joy and lightness Irene so beautifully embodied.  

Above are some pictures of Irene’s CHR car that they are provided to make home visits with.  The Health Center sign below that is of the nearest emergency medical center that serves this community.  It was at this health center, that Irene helped helicopter a stroke patient to when she diagnosed his distress on the field some 15 miles away.  The blue and white building is the Huerfano Chapter house that serves as the community center for the community with offices for all local services like Irene’s CHR office.  And lastly, is a picture of Irene and I in front of their CHR event calendar.  

BBQ’d, pealed, chopped, bagged, frozen for the year!  6 pounds of New Mexico hatch green chile peppers!

The Veterans Affairs Wait-List Scandal: A Symptom of a Broken National Primary Care System ~ Warren Yamashita

pm508summer2014:

Sitting here at The Coffee House in Gallup, New Mexico, a small Southwest town with a population of 20,000, it is not to hard to turn the corner and bump into veterans everywhere you go. In fact, many Navajo Indians here have served in the Korean and Vietnam wars. This is a proud American town…

July 11th, 2014

From my little weekend excursions, many know that I am New Mexico right now, but I haven’t yet explained what brought me back this summer.  From my volunteer experience at the Missionaries of Charities’ Soup Kitchen and Homeless Shelter in Gallup, New Mexico, a year and a half ago, I navigated through the small-town “two degrees” of separation to find that Partners In Health (PIH) was working the the Navajo Nation, Indian Health Services and the Community Health Representatives (CHR) program to support and help maximize potential that CHRs offer in improving community health and increasing its capacity resilience. (http://www.pih.org/blog/cope-brings-cross-pollination-to-navajo-nation)

CHRs are usually Certified Nurse Assistants who are native to the communities they serve.  They serve as an extension to the clinic and hospital healthcare systems and prove to be invaluable in crossing the linguistic and cultural barriers that prevent providers from meeting the health goals of their patients.  Not only do they provide medical check-ups, education, counseling, instruction and social support, but they also go the extra step in connecting patients to necessary resources and providing them referrals.  I’ve met CHRs here who helped their patients collect firewood to make sure they literally would not freeze during winter and another who helped her patient receive a new house, which served to revitalize her whole person.  

My work with PIH involves developing a training module and flip book for the CHRs on the topic of “Brain Health”, which will cover topics like Parkinson’s Disease, Alzheimers, stroke, migraines and seizures as well as caregiver topics on burnout, preventing injury, stages of dementia, etc.  Last Spring, I put together a draft module, right before I started my neuro system of medical school!  Since then I’ve been improving the module draft by draft, but last Friday I worked with a group of 7 CHRs from the Fort Defiance Service Unit of the Navajo Nation to elicit feedback from the professionals!  Over a two hour straight feedback session with some group activities to keep us all awake, I came out with a weeks worth of feedback to integrate into the module!  These CHRs were a great group of participants and provided the right mix of serious advice as well as humor to make it a perfect session.  This week I am working to integrate their feedback in preparation for one more feedback session this Friday in the Crownpoint Service Unit.

Spidy Rock! Canyon De Chelly, AZ

Why USC CCTC?: A new Kaiser survey about the need for more insurance educators

Today the New York Times published an article titled “Groups Under Health Act Are Said to Aid Millions: Assisters Helped 10.6 Million With Coverage Under A.C.A.”, in which they described the results of a…

Why USC CCTC?: A new Kaiser survey about the need for more insurance educators

Today the New York Times published an article titled “Groups Under Health Act Are Said to Aid Millions: Assisters Helped 10.6 Million With Coverage Under A.C.A.”, in which they described the results of a…

Why the Myers-Briggs test is totally meaningless

Good article, although I suspect there is some evidence for a degree of validity for the test.  ie) If 50% of individuals score differently a set period of time, then 50% actually continue to score the same. <—that is a degree of validity.  The article itself uses a lack of references to justify its own arguments but rather uses anecdotal and statements of assumption to prove its point.  So although I don’t think the Myers-Briggs test is really meaningless, I do agree with the authors argument that it lacks evidence that merits its wide range of applications and it definitely should not be earning the company over 25 million dollars in profits per year!

That being said, I’ve scored INTJ consistently 6 years ago and within this last year.  However, being an INTJ sucks, for according to Myers-Briggs interpretations, we are one of the rarest personality type (1-2%) and tend to be the most independent/isolative personality type of all 16.  :(

Canyon Duche, AZ with ancient Anasazi pueblo cliff-side homes from ~300AD.

Yesterday I visited, Canyon De Chelly near Chinle Arizona.  At 10 different lookout points, you can see ancient ruins from the Anasazi indians, aka “Ancient ones” from ~300AD!  It was an incredible site to see these homes hundred of feet in the air constructed by these ancient pueblo.  The Anasazi Indians were the ancestors of the Hoppi and Navajo Tribes.  Just looking over this beautiful canyon  and imagining the river that once flowed down there with farms and pastures along the bank was like looking back in time more than 2000 years ago.  

Spider Rock, Canyon De Chelly, AZ

Last Wednesday, I had the opportunity to go on reservation home visits with a Navajo Community Health Representative for the Teesto Chapter House of the Winslow Service Unit.  In 1967, the US Office of Economic Opportunity initially funded the old “Community Health Aide Program”, which was eventually transferred to the Indian Health Service as the Community Health Representative Program, as the first tribally contracted program.  There are over 1,400 CHRs representing over 250 tribes within the United States.  In the Navajo Nation, there are 8 different Service Units, each made up of dozens of Chapters.  Unfortunately, there is too little funding to support the need of CHRs in the communities.  On average, there are about 9 CHRs per service unit and each month one CHR will see over 35 patients on average.  

Leaving at 6:00am, I left Gallup to arrive at the Teesto Chapter House 10 minutes before 8:30am to meet the CHR I would be shadowing for today.  She arrived promptly on time, and we would spend the next 6 and a half hours driving over 50 miles to check on 10 of her clients.  The purpose of my visit was to gain an understanding of the CHR’s work and to learn more about their home interactions for the design and development of a training module I am making for them on common brain disorders, such as Parkinsons and Alzheimers.  In that one day alone, we visited patients who had gall stones, a developmental disorder, dementia, a hip fracture, a tumor, cancer, a blood clotting problem, knee pain, parkinsons, depression, and tons of diabetes!  It was a heavy day, even for a CHR.  Each house, and by house I mean a reservation home, which city-dwellers might be apt to call a “shack”, the CHR would walk to the door, knock, be welcomed in, and greet the client with a good “Ya-ah-te” or hello.  Being bilingual the CHRs are about 35-55 and have the cross-generational experience to be able to relate to both elder and their “americanizing” grandchildren.  While she talked, she took the temperature, blood pressure, heart rate, oxygen saturation, respiratory rate, and blood sugar for each patient.  Since diabetes is so prevalent on the reservation, the blood sugar test became another component of her normal vitals check up.  Unfortunately, I was seeing sugars which were almost all very high, even if some just ate, or didn’t take their medications yet.  Patient’s health literacy varied widely, but was universally low for the “elders” and better for their children.  Often elders with worse conditions would be cared for by their children, grandchildren or contacted home care provider.  Most elders refused to leave their home to go to available nursing homes.  Wanting to stay with their sheep was a common concern for many.  And even for the patient’s family members who struggled to rotate their 24 hour shifts, I’ve heard some families prefer their grandparent to stay in their reservation homes so that money saved from nursing home care can be distributed through the family.  With both pros and cons of all health care systems and community dynamics, I found myself shocked by the disease burden among just 8 patients that we visited that day!  During one visit, my CHR became very silent and let me talk with the family member because her client’s struggle reminder her of personal experiences.  At the end of the visit, I wasn’t sure if it was appropriate to hug in Navajo culture, as I know it isn’t in conservative Japanese cultures, but I gave my CHR a good-bye hug because I was so honored and blessed to have followed her that day.  Without her, many of her clients, who do have access to clinics and hospitals, would be lost due to the lack of their own health literacy as well as culturally and linguistically insufficiencies of their providers.  Even beyond their health care services, the CHRs help connect the broken infrastructure and communication systems that their patients often get trapped in.  Just finding a car to get a ride in to buy the “insure” drink for a patient, fill their water tank, or get firewood for winter can be an impossible mission for some.  Although CHRs are not allowed to transport patients, they find themselves being put in “emergency” or “ethical” situations that call for them to get approval for exceptions to these policies.  My CHR even has had to walk around and pick up firewood for clients on several occasions.  So if I haven’t overwhelmed you enough I should add, that these CHRs attend regular program, case management, and training meetings as well as regular health fairs.  Because of all this, CHRs are at increased risk of burnout and therefore take care of themselves, while having an inner strength that shows itself in the field.  These truly are an amazing group of individuals who are committed to the health and well-being of their communities.  

*Authors Satterfied et al (2002) referenced a study that showed that identification with patients showed greater influence on improving patient behavior than any other factors such as cultural competence, positive relationship, etc.  With my one day anecdotal experience and statistical evidence, I will forever be an advocate of these patient advocates.  

Happy Friday! 

To end my trip last weekend, I drove to El Calderon, a volcano in New Mexico along the continental divide.  When this monster erupted, it created a series of lava tubes that created awesome caves to go caving through.  Here are pictures from my adventures!