The end or the beginning...?

As this elective draws to an end, I have to admit that it is bittersweet. As much as I love to cross off another class that is between me and graduation; I do hate to see this elective come to an end. The List of things that caused this month to be a wonderful experience is a long one: The Dominican Republic Trip, The children there in the DR, Being out in the community, Speaking Spanish, Meeting with a Spanish Tutor, Learning about everyday farm life, the laughter, the smell of tobacco and dairy farms, and on and on. Yet the thing that stands out the most for me, about this month, is the way I felt as I left the Dominican Republic and drove away from each farm.... I truly felt appreciated. I think this emotion is what has driven me to this point in my life. It was the appreciation I felt from my patients that propelled me to leave nursing and come to medical school. And it is that same, maybe even more intense, appreciation that I recieve from the Dominicans, farmowners and farmworkers that draws me to settle here in rural NC or in rural Latin America and serve the people that will appreciate me most. So that being said..maybe this is not the end but rather the beginning...

Total number served in Randolph County:
Farmworkers: 92
Farmowners/family: 20
# of farms visited: 13

Total follow up farm visits: 3

Last day on the farms..

Today was my last day on the farms. Today I went to the biggest farm in Randolph County. The have 30 workers so I had to recruit some help in order to see them in a timely fashion. Joyce from the Lation Coalition came out to hand out information on community resources, first aid kits, hygiene kits, english language books, and clinic information. She gave all of this to each worker after they were screened. Dr. Devries from Siler City Community Health Center volunteered to help me with the screenings. She and I worked together to screen the Blood pressure and Blood sugar of all of the workers. We found one uncontrolled diabetic during the screening. I gave him a monitor and showed him how to test with it at home. Dr. Devries called and helped him make a doctor's appointment at the clinic.

I found out at the end of the day that this farm owner actually kept each of the workers on the clock and paid them for the time they spent listening to my talk about heat stroke prevention and while they recieved the screening! I was totally impressed by this! It seems like many of the farm owners consider their workers their extended family. This farm was no exception!

Total number served today:
Farmworkers:30
Farmowners/family: 1
# of farms visited: 1

August 5th- Dairy and Tobacco farm visits

Today was a very full day. I visited 2 dairy farms , 1 large tobacco farm, and then another small farm in the Randleman area. This was my first time during this elective on a dairy farm. I was able to plan my visits in between milkings, so it worked out well with their work schedule. At one dairy, a worker had to leave my talk to go help deliver a dairy calf. When he returned he told me about the delivery while I checked his blood pressure and blood sugar. It was so neat to listen to him talk, you could tell he loved the work that he was doing.

The thing that amazes me most on these farms is the laughter. The farm owners pick at the workers and the workers pick right back. Everyone seems to have a good time even though the work is hard and the heat intense. There were times today that I thought that I may seriously melt. It is just that hot. But how can I complain after one hour of being outside (usually in the shade)? These guys work in this everyday sunup to sundown! So I just keep working, silently sweat, and laugh along with them.

Total number served today:
Farmworkers:27

Farmowners/family: 6
# of farms visited: 4

Hickory Hill Nursery- August 4th

I went to Hickory Hill Nursery today. This beautiful farm is located just outside Asheboro. Interesting enough, many of the plants that are found on the campus of UNC are bought from Hickory Hill Nursery.

I found an interesting gentleman working there on their farm. He has worked for the nursery for many years. He is unable to speak and can only hear very loud noises. He can read your lips if you use simple clear words. He can read in Spanish and some basic English. He communicates with homemade sign language. He is a plumber and a certified electrician in Mexico. I spent quite a bit of time talking the farmowners and with him via written notes. The farm owners asked me a great question. They asked me if there are any resources in our community that could help him be able to speak and communicate better. When he first came to the farm he could barely make a sound...now he has learned to say a few simple words. I wonder what this man could learn if he had speech therapy or a hearing aid. I promised the worker and the farm owners that I would do my best to research the resources that we have here in our area for the hearing and speech impaired. I have placed a phone call to UNCG center for speech and hearing to see what they think about this case. I am curious to hear their thoughts.

Oh and the top picture....my first payment for being a doctor! ha ha The farm owner insisted that I take a plant home with me, a lovely april tryst camellia. They said that is how they pay all of their doctors. As you can see, the farm was absolutely beautiful and the workers and owners were very kind, welcoming, and appreciative.

Total number served today:
Farmworkers:3
Farmowners/family: 2
# of farms visited: 1

Randleman Area- 7/29/09 entry

This morning at 6:30 I went back to one of the farms from sunday to recheck the worker who had a Blood glucose (BG) of 300. His fasting BG was 218. I had to tell him that these numbers indicated he is a diabetic. He was devasted, as most of us are when we are told bad news like this. It always breaks my heart to give bad news. I tried my best to answer all of his questions. I taught him how to use a blood glucose machine to check his BG levels at home. We also talked about the "diabetic diet" and how to carb count. He was an incredibly quick learner so this was actually very easy! I went to the local diabetes education program later that day in order to get more information and handouts on diabetes management for him. He went to see a doctor at Siler City Community Health Center the next day.

I went by to see the other 2 diabetic patients on their lunch break to give them a blood glucose machine and show them how to use it. True Track donated some monitors for these patients.

I went to 3 different farms in the Randleman/Archdale area today. Leighanna, from Merce Clinic in Asheboro, came with me to help me out. She shared with the workers a little bit about Merce Clinic and what they have to offer.

Driving back home as images of the farms and the farmworkers flashed in my mind, I realized that I truly enjoyed those hot hours out there on the farm. The workers and farmowners were so grateful for the time I spent with them. They were so thankful for the information, the firstaid kits, the hygiene kits, and the books and tapes to learn English. I realize that this is what I love about working with this population. At the end of the day, no matter how tired, you truly feel appreciated. And that makes all the difference.

Total number served today:

Farmworkers:10

Farmowners/family: 4

# of farms visited: 3

# of follow-up farm visits: 3

Finally out on the farms-- 7/26/09 entry

The Canoy family and their farmworkers (who are like family!)

Some of the items that are given to each farmworker: First Aid kit, Books and cassettes to learn english, resource directory, information about local clinics and the Latino Coalition, also a hygiene kit. (All items donated by local organizations and businesses)

A beautiful tobacco field on the Saunders' farm in Coleridge, NC

My first day on the farms was today! I started out at 3pm and finished up around 10:30pm. I went to 5 different farms in the Coleridge/Ramseur area. I did a Blood pressure and/or a Blood glucose test on 22 workers and 6 farm owners. At each farm I did a quick talk on heat stroke and also handed out the supplies that are pictured above. I also gave 2-3 first aid kits to the farm owners to place on their trucks and tractors so that they can have some first aid kits handy on the field. Today was fun because of the 5 farms that I went to. Two of the farms are owned by my relatives. And the other 3 farmowners are family friends! It was nice to be out and visit with each of them.

During the day, I found 3 workers with diabetes. One of the workers that I tested already knew that he had diabetes. His Blood glucose was controlled but he did not have supplies in order to test his sugar at home. The 2nd diabetic that I found had a Blood glucose of almost 400! He knew he had diabetes but had not been checking his blood glucose. He was only taking a low dose medication that he was given back in mexico and had not seen a doctor to follow up on his diabetes. He had been feeling very poorly and told me that he could barely keep up with the other workers. Now he knew one reason why! The 3rd worker that I found had a Blood glucose level of 300. I told him that I would return and do a fasting Blood glucose level later in the week. I was able to help get an appointment at Siler City Community Heath Center for the two patients with elevated blood glucose levels.

Total number served today:

Farmworkers-22

Farmowners/Family-7
# of farms visited-5

7/24/09 Blog Post

NC East District Wesleyan Women's Conference

Cathy and Me at our meeting place-- "The coffee Break"

Still in the planning phase of my farmworkers outreach project. Monday was my last day in the Hispanic clinic at Moses Cone. The rest of my time was spent calling farms and telling them about the project. I spent a lot of time preparing the talk on Heat stroke. Cathy, my Spanish tutor, helped me make corrections to my handout for the farmworkers. Also this week I worked at gathering all the supplies I will need for my first farm visits that are scheduled for Sunday July 26th.

Last Saturday morning was spent at the NC East District Wesleyan Women's Conference. One of the Wesleyan Women's leaders had asked me if I would come do a workshop on missions as one of the breakout sessions. There was a good turnout to the missions workshop...approx 30 women. I shared with them about the missions trips that I have gone on since 1999. I shared in particular about my recent trip to the Dominican Republic. I challenged the ladies to simply consider going on a missions trip in the future. Why? 1) Because it is fun 2) The best way to travel and see the world 3) Helps you become a more "flexible" person in general 4) It can help you become a better missionary here at home. 5) The people you go to serve will end up giving you more than you could ever give to them.

Still planning....

Randolph Co: The most beautiful county in North Carolina

I have to admit throughout my entire medical school experience my southern accent has been a curse! Lets be honest, there is nothing about a southern accent makes you sound smart in morning rounds. Finally, having a southern accent and being from a small town pays off! (The may be the only course in all of medical school that this is the case) I have truly enjoyed talking with the farmers on the phone. There is something nice about telling someone your hometown and then figuring out that we know some of the same people or that they know some of my kin. I have been pleased with their willingness to have me come out to the farms and do some medical outreach for their workers. Seriously though, you have to admit, if you were a farmer and someone from Chapel Hill with a Northern accent called you and asked you if they could visit your farm and talk with your workers, you would say "yeah right!" If you don't believe me just get on the internet and do some research, like I have done in the past week, and you will find what the farmer owners are up against!

Well this has been a busy week of planning for the farm visits. I researched and found almost 40 different farms in Randolph County. There are a variety of farms here in Randolph County: curb side vegtable stands, large produce production farms, Tobacco, Soy, corn, and dairy farms. And I called them all! The rest of my time was spent preparing my talk on heat strokes. I have reviewed some of the case reports of NC farmworker deaths from heat stroke. I may use some of these case reports, if the opportunity presents, with the farm owners. We can discuss in each case what the farm owner or farmworker themself could have done differently to prevent the heat stroke and death. Monday was spent again in the Hispanic Clinic at Moses Cone Family Practice. This has turned out to be a valuable learning experience and a great way to practice my medical spanish. Just curious....do you know how hard it is to do a Nuero exam in Spanish? Well...I do! ha ha Like I said, great practice! Dr. Hale and Dr. Breen are great teachers and very patient with me. Also, I spent 3 hours with my tutor, Cathy, this week. We meet at a local coffee shop and work intensely on my Spanish. (today was the subjunctive tense, yuck!) She actually makes it a lot of fun. She is getting her masters right now in Spanish education at UNCG. She is a great teacher. I am glad I found her. OK that is it for now. I will post more next week!

Also a BIG THANK YOU to Chatham Cares Pharmacy, Chatham Hospital Diabetes Education Program, and True Track Monitors who have donated Blood glucose monitors, strips and other testing supplies so that I can do the medical outreach on the farms!

Getting started...

(Above Picture is of the Latino Coalition in Asheboro, NC- I really like the sign that they have on the door- "Together, we are more")

This week has been very busy. We got back into town around 2:30 in the morning on Monday. I was scheduled to be in the Hispanic Clinic at Moses Cone Family Practice at 8:30 Monday morning. So, after getting a few hours a sleep I headed over to clinic. I met Dr. Hale who will be my preceptor each Monday at the clinic. We saw patients all morning. All of the patients were Spanish speaking. I also presented each patient to Dr. Hale in Spanish. That was a new challenge for me. I loved the mix of patients that I saw: men, women, and children. The more I am exposed to Family Medicine, the more I love it!

I began working on my outreach project that I will be doing in the upcoming 3 weeks. I met with the Latino Coalition in Asheboro and learned more about the services that they offer there. We are going to partner together on this outreach project. They wrote a grant from Rite-Aid pharmacy headquarters. Rite-aid has agreed to supply first-aid kits that we can give to each of the migrant farm workers and also give to the farm owners to have in the field. They are also going to provide book bags and school supplies for 50-75 kindergartners who are part of migrant farm worker families. The Health Department has agreed to help us distribute these as they do the kindergarten physicals this summer. I am busy working on putting together information for the farm owners on heat stroke and exhaustion. I hope to do a quick review of first-aid that they can do in the field if they suspect heat exhaustion or stroke. I also hope to do some education with the farm workers themselves. I am also in the process of checking with different pharmacies and glucometer companies to see if anyone will donate blood glucose testing supplies for me to use for screenings at the farms. I am going to start trying to call the different farms next week to see if anyone will allow me to come out. I am curious to see the response I get from the farm owners.

Catalina Island

Today was spent relaxing on Catalina Island, a beautiful island off of the coast of La Romana. My favorite part of today was teaching Mary and Kendra how to snorkel. Mary got her mask on, began to get the hang of breathing through the tube, when she finally put her head under the water she began shrieking because a big school of blue tropical fish were right beneath us. It was so neat to see different ones on the team experience this for the first time. God’s creation is so beautiful and amazing!

Thursday July 2nd--It was the best of times...it was the worst of times...

It was the best of times it was the worst of times…..Today started off a little rocky. First I woke up at 2:00am with body aches, fever, and nausea. After a couple of doses of pepto-bismol, tylenol, and motrin I felt a little better by the time the sun rose. I decided that I was going to go out to help out in clinic anyway. After all it was our last day of clinic and I didn’t want to miss anything. We got there and because of some miscommunication they did not know that we were coming. Therefore they had not advertised the free clinic in the community. We decided to set up clinic anyway. I spent most of the day with my eyes closed, resting, trying to control the dizziness and nausea on a portable cot that many sick Dominicans had laid on before me. Oh and by the way, there was not bathroom at this location. The neighbors kindly offered up their restroom for the team to use if need be. Michael went over to check it out and decided against the offer…you had to wade through a few inches of excrement to get to the “toilet.” But even though it was the “worst of times” the day turned out to be “the best of times.” Our van turned and began to creep down a long dirt road with deep potholes that very few American have ever been down. Little children began to run out of their homes waving to us. They jumped up and down, screaming “yay”! I asked the Dominican interpreters what they were so excited about. They said “You!!! The only time that these kids see Americans is when someone is coming to help them or to play with them.” They all came around and watched us set up for clinic. Even though no one knew ahead of time that we were coming, the word traveled fast and we saw almost as many patients with less people! Four of us were sick that day. I saw just a few patients in the morning. One of my patients was a lady that I diagnosed with Type 2 diabetes. I was able to do some diabetes education with her. (Are you proud Doris?) Then, we had 2 children from 2 separate families come into the clinic within 10 min of each other. Both of them unresponsive except to painful stimuli. David quickly assessed both of them and had me to give rocephin and start an IV in both of them to bolus them with fluid. They began to perk up some after this and we had their parents take them directly to the hospital. The amazing thing is I felt terrible the entire day except for when I was taking care of these children. Some say it was adrenalin, Michael’s mom said I was just faking all day, but I know it was God that placed me, an X-ER nurse, there in that village today. I know it was His divine providence that we were scheduled to have clinic there, even though the town had no idea that we were coming. Oh, on another positive note…Michelle and Jeff designed a toilet for us to use. (See picture). And the day ended perfectly with Dr. Yelverton (also an artist) drawing faces on blown up gloves and giving them to the children. Also, Shadrach, our interpreter, gave out all the extra food that we had left over from lunch to the children, who were so appreciative. Some may say that it was truly the worst of times….but to the team it was the best of times…the best day of the entire trip.

Being ministered to....

Today's clinic ran smoother than ever. We have learned over the past few days how to work well together as a team. One patient that stood out for me today was a lady that has had chronic osteomyelitis for approx 25 years. When she was 20 years old the doctors said that she would die from this bone infection. She said that she has had multiple surgeries and has been on antibiotics for many years. She said that she gives all the credit to God because according to her doctors she should be dead. This same lady had a daughter that was deaf. She had never had the opportunity to go to school because she had this special need. There are no resources for a child like this. So, she and her mom communicate via a sign language that they have created as she has grown up. She was so grateful and did not complain about her life situation. I had come to minister to her but instead she ministered to my heart. What a good example she is for me.

Above are pictures from clinic today. One thing I learned today...It is very hard to teach a kid how to use a albuterol inhaler IN SPANISH!!!!! Oh well we got the job done. See the picture above.

Holistic care

(Top picture- me interviewing patient Bottom picture- our pharmacy)

Today we went into Santo Domingo to do a free clinic. The population here was very different when compared to the population we worked with yesterday. Most of the patients here in the city had actually seen a doctor during the last couple of years. Since they have some access to care their complaints were more focused. When we asked them to follow up with their primary care doctor in a couple of weeks, because we changed or added a medication, we actually had hope that they had the resources to do so. I did not have one patient in clinic yesterday that actually had a primary care doctor. When I asked, they looked at me like I was crazy. A family doctor that they could see on a regular basis to care for their family was not a concept that they are familiar with. One of the highlights of today was teaching Mary, an ER nurse tech at Randolph Hospital, how to give IM injections. She has held many patients for me as we have worked together during the past years in the emergency department. This time I was holding the patients for her! She was so excited to learn and she did a great job! Another highlight today was a couple of patients today asked me to pray for them. I love the idea of providing holistic care for my patients and today I feel like I did just that. Although it is more difficult for me to pray in Spanish, my patients were very grateful for the time that I spent with them. Oh yeah, during lunch we had to run to the supermercado to buy more sandwich bags to dispense the medications in. I found the candy section in the store and asked a Dominican woman on the same aisle where the best Dominican candy was. She showed me some of her favorite candies. We bought some for the group to try for dessert. Tomorrow we go back out into a small village.

First day in Clinic

Today was our first day in the community. We set up clinic in a small church. The church pews worked perfectly as exam tables! My mom managed the pharmacy and did an incredible job. Suki, Kendra, and Adia helped mom count, package, and label all of the medications. Michael, Dallas, and Mary worked in Triage. Jeff helped out in different areas of the clinic, wherever we needed him. Michelle, David, Faith, Bob, and I all were the providers and we examined each patient. We saw approx 150 patients today. We worked hard, but had a great time. We treated a lot of patients for parasites, scabies, pinworms, and fungal infections. These are things that I haven’t seen very often at home so it is good to get to learn more about them. I had one 10 year old girl that had a history, since age 6 months, of multiple urinary tract infections. She has 4-5 UTI’s each year. This, of course, is not normal in a 10 year old little girl. If she were in the states she would be referred to an urologist in order to search for a reason or source of the infection. But here, due to her limited resources, she can not obtain this level of care. So, she continues to struggle with this problem. It frustrates me that I can’t do more. On a positive note, the children were so much fun to watch and were so excited to get a tube of toothpaste and a toothbrush! I have never had a kid in the states beg me for a toothbrush or toothpaste. They were anxious to get dental varnish and practice brushing their teeth. The dental hygiene students stayed busy the entire time. Children continued to show up all day once they heard that we had toothbrushes and toothpaste.

Getting ready!

Today is Sunday 6/28/09, this morning we went to a Dominican Church. In the past, my favorite part of being in church down here in the Dominican has been listening to the little children around me sing. This church service was no different. They knew every word to every song, sang loudly as if with every ounce of their being, and had a big smile on their faces. We adults could learn a lot about how to worship in church just by sitting back and watching these little ones. The rest of the day was spent packing and preparing for our first day of clinic. The team worked together for 4 hours in order to get everything prepared. Everyone is very excited about going out to the villages.

Trying to be flexible and positive...

So I have not slept in 36 hours except for a quick nap on the plane. We had a little mix up with Delta airlines. They changed our flight from 7:15 am departure to 6:00am without letting us know. So, in the middle of the night after having talked with Delta airlines extensively on the phone, and after Delta apologized, we still had to call everyone and tell them to be at the airport at 4am. Oh well, there are only so many things within our control. We just got here to the Dominican Republic. We all arrived safely with all of our luggage. We have had a lot of fun so far just helping 1/2 of our group go through the process of customs for the first time! Everything went very smoothly. Tonight we rest and tomorrow we will start planning and preparing for the rest of the week.

A day in the life...

This Saturday will be my first day as a 4th year medical student. (Woo-Hoo!) I am starting off my last year of medical school by doing a unique elective in international family medicine. My first 9 days will be spent in the Dominican Republic working in medical outreach for the sugarcane village farmworkers in small towns close to Juan Dolio. The last 3 weeks will be spent working with farmworkers in Randolph and Guilford Counties here in North Carolina. I will be doing medical work with an organization called the North Carolina Farmworkers Outreach. I am very excited about this elective and all that is in store for me this month!

I have entitled this blog "A day in the life." I hope this blog will give you a glimpse of "a day in the life" of farmworkers here and abroad and the barriers that they face. Also, I will share personally the things that I experience during the upcoming month so you can have a view of what "a day in the life" of a 4th year medical student looks like as well.