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.

Impacting Lives – Helping Others

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Residency can be a daily grind of paperwork, conferences, and constant pages, running from patient to patient, to the point where a feeling of disillusionment can come over you at times as medicine just doesn’t seem all the grand things you thought it would be. Siloam is a place that reminds me of the excitement I had when entering medicine with the simple hope of impacting lives and helping others.

During my time at Siloam I was able to sit and just listen, which is so enjoyable as I am usually stretched thin for time. And I learned so much by just listening. One patient told me that her dizziness was cured by drinking water that had been boiled with garlic, which she said was a common remedy people have used in her family for years.

Another described to me the overwhelming feeling of confusion when going to a drug store and seeing 30 different name brands of ibuprofen in a foreign language and not knowing which is better or which one he should get; he wanted a prescription for ibuprofen so he could bring it to the pharmacist and have her pick it out for him.  These views into what it is like to wade through the healthcare world from a different background were interesting and enlightening.

It was also a good experience to work in a setting where I had fewer resources immediately available and so had to think broader and utilize a good thorough history and physical to guide decision making. I am so used to ordering a litany of labs and imaging without thinking of the cost, but when the patient before you will have to pay for any testing you order, it makes you think harder about what is really necessary and be more judicious.  We should do this all the time but we certainly do not.

I appreciated being part of a place where kindness and compassion infuse the daily work and the patients feel like they have someone who cares about them. At every step the patients are greeted with smiles and concern and open ears and hearts and I think this impacts their health and well-being in as much a way as the practice of medicine does. It is a beautiful reminder of the initial intent we all have when we choose to go into a field of service, but that can get lost in the years of training under layers of jadedness.  It’s nice to know the ideal still exists.

Guest blog written by Dr. Stacey Tillman.
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Dr. Stacey Tillman-
a Vanderbilt internal medicine resident
who recently completed four weeks of training at Siloam.

 
 

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.

Redefining “Home”

Today we saw a mouse run through our apartment.

A room with a view at the Highlands Apartments.

A room with a view at the Highlands Apartments.

Lounging on the couches while discussing evening devotionals, the freeloader whipped its rent-free little body out under the hall closet door and into the darkness of the tiny bathroom. As one may expect, a lot of time was spent dramatically gasping and speculating on how to deal with the creature, giving it ample time to run away and haunt our dreams all night.

These past few weeks have been full of challenges; dealing with unwelcome mice gnawing through the shiny bags of pasta in the pantry being only the most recent one. In many ways these challenges have been conducive to personal growth: I’ve learned to live on a food stamp budget ($1.90 a meal), to acclimate to the Nashville heat, to become comfortable around those with whom I don’t speak the same language. I could not be more thankful for the way these challenges are opening my eyes to the true world around me.

Although I’m incredibly grateful for this opportunity, sometimes I find it difficult not to nostalgically long for home, for the comfort of the soft hands of loved ones, the rock-solid mattress of my childhood bed, the beauty of a Lake Michigan sunset studded with so many stars the sky never darkens. For me, this week, the mouse was just another reminder in the seemingly millions I’ve been encountering over the last few weeks telling me that this place is different. Nashville, Tennessee is not home.

I spent the month of May studying abroad in Vienna, Austria, which means it’s now going on seven weeks since I’ve been home in Michigan. Last Monday I was beginning to let homesickness overwhelm me. That morning I accompanied Rebecca Swift, Siloam’s Behavioral Health Consultant, as she spoke with incoming refugees about their transition to America. The stories that were told that morning were heartbreaking. “Abdi” told the harrowing story of his escape from Somalia, a trip that involved driving across the Sahara desert, captivity, and several gunshot wounds which adorned his chest.

Abdi’s escape also separated him from his brother, the only family member to survive the violence in Somalia. “Diego,” a refugee from Cuba, had to leave his wife and two daughters behind as he fled to American soil. He hopes they will be able to join him in this country soon. After the death of her husband, “Hagar” was continuously sexually harassed by men in her community and forced to flee her homeland of Egypt, leaving her two sons behind.

As story after story was told I found my heart constantly tried and humbled by the grit and boldness of the refugees. They were facing a reality in which they could never return home, yet an Iraqi woman told me the day she moved to America was “the best day of [her] life.” I found contagious hope in the refugees last Monday that one rarely experiences in America. The example of these wise individuals gave me new appreciation for Psalm 90, “Lord, you have been our refuge in every generation” (HCSB). Our home is in the Lord—and even when there are mice, language barriers, and family thousands of miles away, the beauty of that promise will never cease to be true. For that, I am thankful.

Claire Johnson - CHI 2013 participantClaire is a participant in Siloam’s Community Health Immersion.

Living Cross Culturally

Living cross culturally is always an experience. The language barrier alone presents a huge hurdle to effective communication. Even more than that are the unspoken rules we may or may not be aware of as we enter someone’s home during a home visit, for a survey, or for a  party.

Through my time at the clinic and time spent in a community largely composed of immigrants, I’ve learned a lot about life in different countries and heard some incredible stories. Everyone has something different to say and a little different take on life.  I’ve met people from all around the world and from diverse backgrounds, and varying experiences.

Despite all the obstacles, people are people. We all have the same basic struggles, we all have the same kinds of wants. It’s easy to assign  someone  who looks so different, doesn’t speak my language, and has such a different world view, to a different category.  Really, we have plenty in common. We are all made in the image of God, we are all sinful, and we all need God’s grace.  I’m thankful for the opportunity to work with so many different people and to learn so much from them.

Cross cultural experience

Most, if not all, of my close friends and family know how much I love soccer. It has been an integral part of my life since my freshman year of high school. Interestingly, soccer is proving to be a valuable asset during my first week in the SMI.

I have created relationships with many of the kids just by playing soccer with them on the local field. It is fun to see how a sport can bridge the cultural gap and allow people of different ethnicities to interact and even form friendships. It is through this international sport that I have come to meet some unique and unforgettable people.

On the soccer field, I am learning to appreciate things that I used to take for granted…like the amazing impact a smile on someone’s face or someone’s laugh has.  Smiles and laughs translate across language barriers just like soccer. I hope that my smile and laughter will impact the lives of the children whom I encounter through my favorite sport as I work this summer in the SMI.

-Cameron Michael

House Calls

House calls are an aspect of the medical field that I thought had been buried in the history of medicine. At Siloam Family Health Center, I discovered that this practice has not been put to rest, yet. The past week, I embarked on a local house call with Dr. Henderson to visit a patient of the clinic. At first, I was really nervous because I was not sure what to expect.

I did not know the patient and was not sure if we would encounter any language barriers. I secretly hoped it was somebody who spoke Spanish because I knew I could help interpret. In part, I was just terrified that we would not be able to communicate and help the patient. I was also afraid of how the patient would react to the fact that we were invading her home.

The patient did not speak English or Spanish – she spoke Karen (a tribal language of Burma). My worries increased as we struggled to find an interpreter for the patient; however, we were able to locate someone to interpret relatively quickly. I could not help but be amazed at how great God’s timing is in both our professional and personal lives.

As we entered, the family was surprised to see a doctor walk in with three students following him. Once in the patient’s home, we were welcomed with open arms. It must have been odd for them to see strangers come into their house and sit down around the living room. I noticed that by seeing the patient in her own home we instantly bonded with her. We entered the world of the patient which opened our eyes to issues the patient faced.

Time started to matter less while the interests of the patient became our main priority. I felt like I was not a stranger anymore but a friend of the family. It was here that I began to see what it really means to care for a patient.

-Alonso Cortez