Home visits bring heart

Guest blogger Will Tucker, one of seven students in this summer’s Community Health Immersion, writes…

Last week I had the marvelous privilege of shadowing Lauren Smith, a Family Nurse Practitioner with Siloam Family Health Center. The experience was an enormous blessing to me and I have rarely seen a more refreshing sight during a home visit. Most of my experience with patient interaction has always been in an office setting and this was actually my first interaction in a patient’s home.

“…I have rarely seen a more refreshing sight…”

Home visits open doors to greater understanding about barriers patients face. Photo credit: medicalhometeam.com

Amazement was my initial reaction as we were welcomed into their homes and I could tell that these appointments were full of purpose and provided insight to a fundamental aspect of Siloam, whole-person care. Chelsea and I were the students able to travel to the home visit that day and we both recorded notes as the patient/practitioner dialogue transpired, some of which was in Spanish.

Walls I anticipated to be up were non-existent in the visits as conversation flowed freely in two languages. I clearly witnessed the value of language that is so applicable in everyday life and is often the form of communication we take for granted the most. Language is a cultural component that conveys along with it meanings for objects or action that cannot be accurately translated, but we were blessed to learn from Lauren its importance in action.

“…not everything can be simplified down to chemical reactions…”

We also learned to focus on other cues a patient may unintentionally give through their environment or behaviors. Through careful observation of many factors in the home a much more thorough understanding of what affects patients on a daily basis is acquired. I have heard it said many times that personal daily decisions will always factor into a person’s overall well being more so than any other factor that a medical professional can assist with and if it were not clear already, I saw with much clarity the truth in that statement.

During each visit I listened intently to the interaction occurring and made various observations about the home and various family relationships that patients had established. I was even fortunate enough to get to read a few jokes in an almanac with the husband of a patient and somewhat dip my toe into the waters of fine trust that exist between patient and practitioner as an observer.

“…I was surprised to find that hope overflowed…”

While I expected home visits to be solemn occasions, filled with despair and hardship, I was surprised to find that hope overflowed and peace persisted despite all opposing circumstances. Emotional & spiritual support was provided by family and friends, physical guidance, emotional, and spiritual support was also supplied by Lauren as she reviewed medicines and plans of action with each patient. But the most important and intriguing facet is that all of those good things were firmly rooted in Christ.

Will Tucker is a rising senior at Union University.

Will Tucker is a rising senior at Union University.

At the conclusion of each visit Lauren sought to pray with her patients and in doing so acknowledged that not everything can be simplified down to chemical reactions, treatments, careful planning, medications to solve this and that problem, but that there are somethings we do not understand yet and may not at all. While I hope that we continue to make great strides in knowledge acquisition, always acknowledging God as its source, I also pray that we never forget the anchor that we have in the love of Christ and its compelling power to peace, understanding, wisdom, and its call to be whole in Him.

Globe trotting by knocking next door

Guest blogger Frances Cobb, one of seven students in this summer’s Community Health Immersion, writes…

“How many servings of fruits and vegetables do you and your family eat a day?

What are the biggest problems for you and your family?

For your community?

Do you exercise?

Has anyone in your family been sick in the last year?

Do you know where to go for healthcare?

Do you and your family have health insurance? ….”

 

These are some of the questions we asked refugee families in our Community Health Surveys (CHS). This summer as part of Siloam’s Community Health Immersion, nine of us went door-to-door completing the CHS among refugee families in the Highlands and surrounding apartment communities. Door Knocking at the HighlandsThrough the CHS we sought to assess basic wellness and identify community-wide issues encountered by the refugees in understanding the American healthcare system and in transitioning to life here in the United States.

When I first heard we would be going door to door interviewing refugees, I think my blood pressure and anxiety shot up. It sounded like an awesome opportunity to interact with the refugees and assess their health across different nationalities within our new community here at the Highlands, however I was mildly terrified of knocking on the doors of strangers and inviting myself into their homes.

When we first set out, I wasn’t quite sure what to expect, but what I encountered behind each door we knocked on was a generous, resilient family working against language barriers, childcare issues, financial burdens, and general confusion in their transition to a new culture.

In that week and half, it was like we were traveling the globe. I spoke with Bhutanese, Burmese, Rwandan, and Ethiopian families within our community. No one refused to answer our questions and many people went so far as to thank us for taking time to listen to them and trying to understand the difficulties they have encountered in transitioning to life away from their home country.

I was so encouraged as a volunteer and future healthcare provider by the generous and helpful attitude of the refugee families I had the pleasure of meeting. By interacting with them in their homes and taking time to sit with them, we were able to gain a better understanding of the health environment experienced by both newly arrived and established refugee families.

Additionally we had the opportunity to observe the aspects of the American healthcare system that cause confusion among these families and ultimately act as barriers to staying healthy.

CHI participants Will Davies and Stewart Goodwin with shoes courteously removed interview Burmese neighbors about their health status.

CHI participants Will Davies and Stewart Goodwin with shoes courteously removed interview Burmese neighbors about their health status.

 

When the Best Medicine isn’t Medicine…

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Kristy Oman, a fourth year Belmont Pharmacy student who recently completed a four week rotation at Siloam

Three learning moments that will influence my future practice are also three lessons to carry throughout all aspects of life, not just in the practice of medicine.

1.  Health literacy does not equate with English proficient. I have encountered patients who did not have high health literacy, both before this rotation and during, who spoke perfect English. I have had the pleasure to meet several patients on this rotation who required a translator, yet were quite knowledgeable about their disease states and medications. As providers, we should be careful not to let the language of the patient influence your perception of their healthcare knowledge or health literacy level.

Lesson one: never judge a book by its cover.

2.  High quality does not have to mean high cost. The care provided here at Siloam is outstanding, and everyone I have met demonstrates compassion and a sincere desire to provide the best healthcare to each and every patient. I have spent a significant amount of time trying to source medications for patients, whether that is from patient assistance programs, Dispensary of Hope, or the $4 generic list at Wal-Mart. There are times when treatment options are limited, but this month I have witnessed first-hand how diligently providers try to access the best treatment options available.

Lesson two: Where there is a will, there is a way.

3.  Treat the whole person. I was sent on a home visit to investigate possible triggers for a patient experiencing exacerbations of asthma. Quickly upon arriving in the home, we discovered a very possible source: mold. After speaking with the patient and educating her, she was surprised and thankful to realize there were things in her environment that were likely making her asthma worse: dust, mold, air temperature changes. Was teaching the patient how to spot mold directly related to pharmacy expertise? Not really. Was it the right thing to do and best for the patient? Absolutely.

 Lesson three: sometimes the best medicine isn’t a medicine. 

Guest blog written by Kristy Oman

Not Translating but Interpreting

Most people aren’t aware that translating is the art of rendering written words into another language. Interpreter in actionInterpreting, however, is an extreme talent where spoken words are listened to, processed, and then shared out loud in a different language.  It is through interpreting (and some translating) that Siloam is able to operate the way it does.  Through the dedication of volunteers, bilingual providers and staff, and with help of a language line, refugees and immigrants can receive excellent health care.

Through my own observation and interaction with interpreters I’ve realized that interpreting takes a lot of patience and amazing listening skills, but also has the beautiful ability to express true living emotion.  This way of communicating, using  an interpreter, is slowly starting to become a part of my daily life.  I am learning how to appreciate the extra time during interpreting to see things in a brand new light.  I have time to let my mind wander and take notice of the patient’s body language, the clothes they are wearing, and any other social cues that I otherwise would have missed.

I went on a house call in which the language line was used to interpret our conversation with “Arun,” a Burmese man struggling with severe depression.  He has been suffering from very bad headaches and numbness since leaving Burma via Malaysia, and eventually arriving in the United States.  He is disappointed in himself for not being able to keep a job and feels he is missing out on the opportunities he thought America would be able to offer.  This is extremely hard for him to deal with, as he is not able to support his wife who is still in Burma.  We began to wrap up the house call by praying for him and we also invited the interpreter to pray with us, as well.  Although our interpreter did not pray, her voice became more somber and worked harder to mimic our inflection throughout the prayer.  We do not know our interpreter’s story, her religion or even her name but I do know that by communicating with Arun, we also impacted the interpreter’s life.

The bible is translated into many, many different languages and even more versions.  In its simplest sense it is God’s living word translated for us all to read.  It is these very words, God’s words, that bring us hope when we have none, share his never ending love and grace when we don’t deserve it, and gives us strength when we are at our weakest.  I feel that as Christians we should be God’s interpreters and just be still and listen to what God has to share with us and relay that message through our actions.

Madison Brown - CHI 2013 participantMadison is a participant in Siloam’s Community Health Immersion.

The Doctor is In…house calls on the CHI

Finally, after tromping around the largely-refugee complex in sweltering summer heat, we had found it: the residence of Siloam patient “Subba,” our first home-visit of the day.

Doctor Bag

Dr. Kristin Martel had briefed Caleb and me with some basic information about the patient, a 40 year-old Nepalese female with serious, debilitating depression that was beginning to manifest in bodily (specifically joint) pain. As we approached that unremarkable apartment building, though, I couldn’t shake the feeling that I was woefully unprepared for this – my first home-visit. I was excited to observe an aspect of medicine largely lost to the American healthcare system, but what would it be like, I wondered, to enter the home of someone suffering from severe depression? How could I hope to do or say anything even remotely helpful?

When Subba didn’t answer Kristin’s persistent knocking, I began silently hoping that she wasn’t home so we could skip this whole affair. We waited for a few minutes, and eventually, a Nepalese man named “Poorba” came down the outdoor stairway. Kristin asked Poorba if he knew Subba, and he quickly went back upstairs and returned with Subba’s mother-in-law. She opened the apartment door for us, retrieved Subba from a back room, and invited us to sit with them indoors. Poorba accompanied us as an interpreter.

At first, our interactions with Subba didn’t seem to suggest that anything too out-of-the-ordinary was happening in her life. She didn’t smile and didn’t make eye contact with us, but then again, we had just barged into her house.

After a few minutes, Kristin asked about the medications she was taking. Subba continued staring at the floor, softly rubbing her elbows and knees. She told us that they hadn’t done anything for her pain, which was getting to be so severe that she couldn’t even leave the house anymore. We tried a few other avenues of conversation and eventually came to the topic of her husband.

“How is your husband doing?” Kristin had asked. “Does he work a lot?” My heart fell as I saw tears begin streaming down her face. Kristin moved next to her, put a hand on her back, and gently prompted further. Subba told us that he – her only source of income and support – was in the hospital, undergoing some sort of heart surgery. She felt alone, isolated and unsupported, in her pain.

The sorrowed stillness stretched for what seemed to be an eternity. The silence was broken by Caleb, who lightly inquired about a doll he saw propped up on a nearby table. Her face lifted slightly as she answered, “It’s mine.” She took us back to her bedroom and showed us a few other dolls and stuffed animals, of which she seemed proud. Any happiness they might have elicited sadly fled, though, when we asked about the great view her window afforded her of a children’s playground. The view only deepened her pain, for it reminded her of her longing to be outside.

It seemed that our time at her home would soon be wrapping up, so we prepared to finish with a brief prayer. Before we circled up for the final prayer, though, Kristin inquired about a piece of paper taped to the wall next to Subba’s bed. One of the pictures on the sheet of paper triggered memories of an Eastern Religions class I had taken in college, so I wasn’t surprised to hear the mother-in-law tell us that it was a Hindu prayer. And in that moment, God made His presence known by sealing me with a question I knew I had to ask: “Do those gods answer your prayers?” She said no, they don’t; she prays, but she still feels alone. And there it was, as simple as that – a door to hope. God’s Spirit moved, and we told her why we hope and pray in the name of Jesus.

Afterward, we asked if we could pray for her in Jesus’ name, and she invited us to do so. God demonstrated His wisdom and faithfulness when Poorba – this random guy we bumped into while waiting at Subba’s door – told us that he was actually a pastor and would be happy to translate our prayer. We prayed over her, for the alleviation of her pain, for the health of her husband, and against the spiritual darkness that might seek dominion over her house. Her mother-in-law led us into a second room, and we prayed again for the household.

Leaving her apartment was one of the most saddening yet hopeful experiences I’ve ever had. My heart went out to this poor woman who longed for love, support, and alleviation from her emotional and physical pain. Yet as we left, I knew that God was present and that He would finish the work we had seen Him begin. I may never know the end of her story – whether or not she experiences physical healing and spiritual liberation – but of this I am certain: He heard our prayers that day, and He will continue to relentlessly pursue the heart of His beloved child.

Doezal, James- CHI 2013James is a participant in Siloam’s Community Health Immersion.

House Calling

While being at the Siloam clinic, I have been privileged to experience what a house call looks like.  House calls have been lost throughout the evolution of medicine.  When I was younger, quite frankly, I thought that house calls were inefficient and a waste of the physician’s time.  I used to think that pumping through patients was the way to best use the physician’s time.  It makes perfect sense to have everyone come to the doctor because it eliminates the drive time of the doctor and allows them to stack patients so that they can see many throughout the day.

However, even though there are apparent disadvantages in doing house calls, there are significant advantages in doing them.  For instance, the physician can take time with the patient without feeling rushed.  This helps both the patient and provider to feel more comfortable in discussing the issues and ultimately leads to higher caliber care.  On top of that, it allows the doctor to see the environment that the patient is in that can also contribute to health concerns.  This practice is also a foolproof way to make sure that the patient is using their medication correctly because there is no way that they can forget to bring their medication to the appointment.

From a practical standpoint, it may not seem that house calls are a logical way to use the caregiver’s time, but I feel that medicine is far more than practicality.  House calls force the provider into spending quality time with their patients.  This ensures a more holistic visit for the patient and ultimately an overall feeling of being cared for.  The time that I spent doing house calls with various doctors showed me how medicine used to be practiced and that there is a place for this type of care in the world today.

Home Visits

On Wednesday, I was able to participate in my first house call, with Dr. Henderson. When we got to the church where we were supposed to meet the interpreter and then go from there to the patient’s house, there was a misunderstanding and the lady whose home we meant to go  walked in. After some confusion and talking back and forth through the interpreter, we were able to communicate our desire to talk to her in her own home. She cheerfully invited us and so we piled into the cars to head for her apartment.

As I watched this happen, I wondered why it was so important to Dr. Henderson that we go to her home. She was there, we were there, it made more sense to just treat her there as she was expecting us to. We went through an awful lot of hassle to drive a few miles down the road to do the exact same thing.

Once we got in the apartment, took our shoes off,  sat down on the chairs the family pulled out for us, and started talking to her, I realized why the doctor cared so much that the visit be in the patient’s home.  Sitting in her living room, we were able to hear about her family, we saw pictures of them on her walls and heard stories of the major moments in her life they depicted. We were able to get a better feel for her diet. We saw exactly what and how much she was eating. It gave us a much bigger  sense of who the patient was as a whole, not just as a list of symptoms. It was personal, conversational, and relaxed. The patient felt heard, and the doctor was able to better judge where she was.

I saw that the point of the house call was to invest more in the patient. A doctor could address the patients concerns more easily and more quickly in the clinic. A house call isn’t about efficiency. It was about getting to know her, to step into her life, and to take the extra step in caring for her as a person. There is an added element of love in being willing to drive the extra miles, take your shoes off, and listen for awhile that often gets left out of a standard office visit.