June 8

While in North Carolina we provided education to people at the soup kitchen. I educated someone on the importance of smoking cessation and the long term effects of smoking. This person had recently been released from jail and hoped to continue his 3 month strike of cigarettes. He seemed very interested in the information I provided him and asked multiple questions about how quickly his body "gets better" after stopping smoking. Our group also bought a large amount of t shirts, toothbrushes, toothpastes and socks to hand out to the 

local residents of the community. These items will help keep them clean and warm. Those  who received these items were very appreciative and it seemed like we made a big difference in their day. 

           I feel this population is working towards a goal of becoming drug and alcohol free. Multiple locals spoke about how common drug and alcohol addiction is in this community; one person in the community said he lost a friend the previous night to an overdose. This issue is real and relevant in the community and encouraging many people to stop doing drugs and alcohol. As the adult population becomes healthier and sober I believe this will aid the younger generation to follow their footsteps. It will also allow many parents to raise their children again and provide a stable home. Two of the people I talked to at the soup kitchen spoke about how they lost custody of their children due to drugs and alcohol. 

           The trip to North Carolina impacted me immensely. I honestly never realized the barriers to healthcare so many rural communities have. The most eye opening experience was when we toured Swain county hospital. This was one of the only hospitals within an hour driving distance before Mission. Swain County hospital did they best they could provided their resources but they were not able to do much physically for patients. This small local hospital is only able to admit 2-4 % of the people they see in the ER. The rest are either discharged or transferred to another hospital. This made me realize how many people, including myself, take healthcare for granted. Living in an area with multiple different options for hospitals within ahalf hour distance is a huge difference from North Carolina. If I was in a traumatic accident I am confident I could get care in time to save my life. I am not confident in that statement for North Carolina residents. This trip changed my views on healthcare and I realized it is not something I should take for granted and should always ask my patients how accessible their doctors office, pharmacy, appointments are before labeling them as "noncompliant".

June 7

            Today we spent most of our day at the Open-Door soup kitchen. I talked to many people today and everyone spoke about their struggles with drug addiction. Multiple people spoke about their difficultly staying clean from heroin, cocaine and alcohol. I spoke to one person who was released from jail yesterday after being incarcerated for three months due to drugs. He spoke about his struggles obtaining a job, a place to live and a secure food source. He said “just twenty dollars is hard to come by around here”. The person spoke about his trauma growing up and explained the local area has a lot of problems with abuse and drugs. Waynesville has a high poverty rate and the public struggle with common everyday things that many people take for granted such as public transportation and healthcare services.

            The Open Door serves two meals a day Monday through Friday and one meal on the weekend. They average 60 to 100 people a day which helps a huge amount of people in the community. They are also starting to do NA and AA groups on one weekend a month. This will help the locals feel supported and cared for during their sobriety along with keeping addicts informed that the help is always available when they feel ready. Another resource the Open Door offers that I thought was awesome is their prescription assistance. The food pantry ensures no person has to go without their medications due to a financial issue. 

            The biggest healthcare connection in the community is Meridian healthcare. They offer outpatient behavior health services including groups, medication management, referrals and more. They also offer medical assessments. This is great because they work with the Open Door to help patients afford their prescriptions and provide gas cards to their doctors. These two organizations working together aids people to increase their medication compliance and stay healthier overall.

June 6

            Today our clinical group had the privilege of touring Mission hospital. This hospital had a little under 800 beds and served over 30 counties. Many smaller hospitals such as Swain frequently transport patients to Mission because it is a level two trauma center. Swain had about five to six nurses total in the hospital versus Mission which had five to six nurses in each pod. Swain county hospital was very basic and did not have many extra frills. Mission had all the updated technology and was testing new options for a brand-new building. Mission hospital also focused a lot of time and energy on logistics and trends in healthcare. I think this is great and can really help hospitals improve their standard of care. Swain county hospital did not speak much about looking into trends or statistics. 

            People come from all over the Smokey Mountains to Mission hospital for care. Patients get transported from multiple different hospitals through ambulance, car or helicopter. Mission is the only level two trauma center in the Smokey Mountain region so it sees most of the acute patients in the area.

            I was impressed by the organization of Mission’s emergency department. They have a nurse and NP at the front desk to start the assessment process. The NP begins putting basic orders in for patients such as IV, xray, fluids, lab draws, etc. This is helpful to speed up the ER process because once the patient gets roomed the orders are ready for the nurse to begin and the doctor can put in more specific orders once the patient is assessed. Mission hospital also has a separate admitting room for patients in the ER who need watched but do not need a full room to their selves (such as sprained ankle or UTI). This frees up rooms for more acute patients and allows Mission to keep their ER wait time at a maximum of two hours but it normally under one hour. This is amazing for a hospital of this size, around 800 beds.

June 5

            In the Cherokee area there is a huge issue in regards to access to healthcare. There is a local hospital called Swain county and it offers very few services. They do not treat any emergent trauma or severe injuries. This affects patient wellbeing because if someone gets seriously hurt and shows up to Swain county for treatment they will be transported to Harrison hospital. This takes a lot of time and resources and potentially allows the patient to decompensate more. If the injury is severe enough the patient will then get transported from Harrison to Mission. All these transportations add a lot of time onto a patient’s care and could lead to bad outcomes versus just getting treated at one hospital. Today we also learned that Mission Hospital is the only hospital in the area with a Cath lab. Mission is over an hour away from Cherokee so if you are having a cardiac problem and need to go to the lab but five people are in front of you- that causes a serious delay in care and the patient’s wellbeing is at risk.

            My biggest take away from today’s Wilderness First Aid course was the importance of teamwork and communication. During each scenario communication was a huge factor in treating the injured person. Communication could be to the patient, to the 911 dispatcher or to other team members on what needs done. This course will help me take care of patients back home because it re enforced my need to always communicate thoroughly and explain exactly what I need. It also gave me different ideas on how to treat injuries or illness without the use of modern medicine. The idea of rubbing honey on someone’s gums when a diabetic is unconscious and hypoglycemic is such a simple idea yet I had never thought of it. It is always taught to give 15 carbs or start giving D5 IV. I enjoyed this course because it gave me new ideas and made me think of creative solutions (such as using sticks to stabilize a person's broken leg). 

June 3

JUNE 3rd
Upon arriving to Cherokee, I was surprised by the number of nice cabins and businesses. When learning about the area in class we spoke about the high poverty levels and poor condition of housing- this was definitely evident at times but the amount of nicer homes was a bit surprising as well. I honestly did not know Cherokee was such a tourist-y town. It is filled with gift shops, museums and restaurants. 

I think the overall preservation of history in the Cherokee culture is amazing. They take great pride in teaching others about their culture and hold a high level of respect for the people who embrace their traditions. The Cherokee culture is matriarchal. I found this fact very interesting because this is so unlike any other culture. I like that Cherokee Indians have a long history of respecting women and ensuring that all people are treated equal. Women worked the field but also owned the crops and were in charge of keeping or trading them. Women in the Cherokee culture have influenced a huge amount of their history and take great responsibility in keeping their independence.

 Today we were also able to tour the Swain County Hospital. I was looking forward to this because I had never seen a rural hospital and expected it to be much different than Methodist. Services at Swain County Hospital include acute care (in some cases), rehabilitation, prompt care services and pain clinic. They are also recently obtained a grant to open a ten-bed behavioral health unit. This is an amazing opportunity because there is a great need for inpatient care for these people. The hospital also offers tele health for patients when needed, such as a psychiatrist when a behavioral health patient is in the ED. There are workforce shortages in every community; however, Swain County Hospital suffers from a different type of workforce shortages. They have a high employee retainment however when one person calls in it is detrimental for the entire hospital. They typically have five nurses for the entire hospital and 1-2 CNAs. The nurse on the medsurg floor said many employees have stayed the night at the hospital during bad weather because they knew they would be able to make the 1 hour+ drive home and back safely. These are such simple things people take for granted in the Peoria area. I have never thought about staying at the hospital in fear of my safety driving to or from work. Swain County hospital also offers a grant for nursing student who sign a two-year contract with their hospital. This is a great opportunity to get new nurses, put a priority on education and focus on the future. This program is also a long-term solution to trying to fix their nursing shortage and having more options for employees.

            The biggest healthcare service that is difficult to access is primary care. There are many areas of North Carolina with no healthcare at all. So, if someone has to decide between a critical access hospital and a doctor’s office the hospital will always will. These critical access hospitals are great but there is very little focus on primary care. The main goal is to treat patients and hope they will stay healthy outside. Swain County hospital, specifically, is working to lessen this burden on the community by having a prompt care service as part of their building. It offers well child checkups, adult well checkups, vaccines and lab draws. 

JUNE 2

     After checking out of the hotel in TN, we drove about 15 minutes away to the Appalachia Museum. I thought this museum trip would be a big building with a tour guide but it was actually the opposite. As the bus pulled up to the museum I saw multiple peacocks walking around plus a few cats. My first priority was to pet the cats.

After buying the tickets we were able to walk around to see over 30 small houses, workshops, churches and more. It was filled with historic artifacts dating back as far as early 1800s. I found the history of healthcare very interesting. For example, to treat coughs, lung inflammation, hemorrhage, asthma or tuberculosis the plant, Comfrey, was used. It was said to “clean the blood”. Respiratory diseases spread quickly in the very small houses with large families especially with the less than sanitary conditions. However, these small houses were all many people could afford or build back then. Tuberculosis is also common in prisons. Jail/prison cells were even smaller in the 1800s; four people fit one room with only enough space for a small walkway between them. I also thought Dr. Odie Miller’s statements were interesting. It is crazy to see how far the world has come in the past hundred years. In this time, the idea of keeping a baby healthy by bathing them daily was not common sense to the public. This is obviously much different from the current day. There are strict standards for someone with a respiratory disease such as tuberculosis such as isolation, testing, medications and more.

The Appalachian communities have a strong sense of family and are hard workers. In the museum there were many biographies under pictures and every single one included a story of the person’s strong dedication to work. Not only did the Appalachian residents work day jobs mining, sewing, wood-working, etc but they also managed farms, animals and large families. In the current day, you can see this kind of hard-working dedication in some families however it is far less common. Although they lived difficult lives in the Appalachian area I like to think it was a simpler time. Their days were spent working and surrounded by family.

June 1

 
   On day one of our travel course we drove to Powell TN- about eight hours away from the college. It was a long trip but we made great time thanks to Amy's driving. I am looking forward to checking out the cabin tomorrow, hiking in the Appalachia area and touring the Cherokee hospital. I think the Cherokee hospital will be a totally different environment than what I am used to at Methodist.
     In regards to apprehensions, I think interacting with the community at the soup kitchen could be a nerve-racking experience. After learning more about the people, culture and area at the museum tomorrow I think I will feel more comfortable and actually look forward to spending time at the soup kitchen. I hope the community is open to talking to our group throughout the next week and we learn a lot from their stories.
     Everyone has biases and when working in healthcare it is especially important to keep these in check while interacting with the community. I am curious to learn more about the Cherokee's views on how the trail of tears still affects them in the current day. Cherokee Indians receive large sums of money throughout their lives yet so many still live in poverty. I hope to learn a lot more about their values and culture at the tomorrow in order to better understand their views on life. The North Carolina trip is off to a great start and I'm looking forward to starting the NC portion of our trip tomorrow.