PH NURSING, WEEK 3...INTERESTING, REWARDING AND FUN

I was able to wrap up the second Pertussis contact investigation early Monday putting multiple charts and approximately 20 documents related to the case into Liliana’s bin for data entry.  Liliana is from Cuba, has a strong accent and is very assertive in a kind way about making sure things are precise and accurate.  I appreciate this about her and watching how she corrects people is instructive and always makes me smile.  She’ll come in and say, “Baby girl…look, we have a problem here.  How many times I tell you you have to use blue ink on these, huh?  You cannot use black ink!  I keep telling you until you get it right, OK?  It is no problem, but I will come find you every time and some day you will not use black ink, I promise you that.”  I am very sure that she is right.  I think I only forgot twice, but I’m committed to sadly giving up my fine point black pen and being compliant, only documenting in blue from now on, although I’ll miss her funny, good-natured tirade-like visits. 

Liliana is an avid knitter, turning out a scarf a day—the ruffled, multi-colored ones that look complicated to create.  She arrives in the lobby where we gather for lunch daily with a new different colored one that she’s working on.  She’s up to close to 30 now and will sell them at the upcoming Christmas bazaar.  I’m wondering if she’ll have any left though as there are many people stopping by for pre-sales, saying, “I want to buy the purple one”, etc. 

While knitting on Friday, she recounted her 12 years of volunteer work as an ambulance driver for the fire department.  She was trained as an EMT and became a crew leader, supervising seven other people.  I can just hear her giving them instructions---“Baby boys and girls….” She said that many of the calls she got were serious and legitimate requiring transport to the hospital and then possibly having the person medevac’d to Anchorage where there is a larger hospital and physicians with more expertise in treating trauma and serious health problems.  A lot of the calls had to do with alcohol though and impaired judgment.  She said that there were many times when she arrived to find a person so impaired that they couldn’t get to the cupboard to get their own band aide.  She was assisting with a stroke patient one day when the fire chief received a call that someone had cut off their finger.  He asked Liliana to go, reminding her to bring ice to put the detached finger on and to transport the patient to the hospital to be medevac’d to Anchorage.  She arrived to find an inebriated man with a tiny cut on his finger, got him a band aid and went back to help with the stroke victim.  She was not too happy about this. 

Liliana also gave me the tour of the building, showing me where all of the fire extinguishers and alarms are located.  We went upstairs to where all of the things associated with the running of the building are housed as well as the door to the roof.  She said that on November 21, all employees in the building meet on the roof to ceremoniously say good bye to the sun for the next 67 days.  It will be interesting joining them this year.  I don’t think that I could have imagined being here this time last year…it does feel like home though. 

I was very happy to begin training with Joanne this week, accompanying her during appointments with people being cleared for work by TB screening, mothers and/or fathers with infants, toddlers, children and adolescents receiving immunizations or in for well-child checks.  I weighed and measured each client and watched Joanne as she did immunizations and well-child checks.  Later, I was able to greet clients in the waiting room, take them back, weigh and measure them and begin educating about vaccines until Joanne joined us.  I’ll work with Joanne for one more week, then for two with Bertrand, and three with Michelle interrupted by a trip to Kaktovik with Bertrand in early December.  The goal is for me to be working with clients in Barrow by myself by the first of the year and eventually in what they are calling “my village”, Kaktovik.   I’m loving this pace of progressive learning and appreciate their determination that I develop consistent habits that I’ll be grateful for in the future (i.e. when giving a six month old their immunizations, Pediarix, a combination of Hep B, DTaP and IPV) and Hib are given on the right vastus lateralis (thigh) while PCV and a flu shot are given on the left thigh.  There’s no biological or medical reason for this, but having a consistent system and sticking with it will decrease confusion.  From their perspective, they have a very good reputation to keep up in the community and want to make sure that I’m confident and competent before working on my own.  There is a high degree of trust in the staff at the Wellness Center and it’s my goal to earn this trust as well.  I’m grateful to have been hired--along with being new to public health nursing, I’m not far from the beginning of my nursing career.

I’m currently reading and actually enjoying “Epidemiology and Prevention of Vaccine-Preventable Diseases” published by the Centers for Disease Control at the US Department of Health and Human Services.  It’s fascinating relearning at a deeper and applicable-now level about immunology, the various types of vaccines, their mechanisms of action, and their importance.  It will be a while before I am able to memorize the immunization schedules and single and combination vaccine names, but I have a laminated chart with multiple foot notes related to each vaccine that will help me keep on track.  There is much to learn including safe handling, sites of administration, needle size and length, temperature control, and of course associated documentation and of course, of course, in blue ink…unless I want an entertaining visit from Liliana. 

One afternoon I was let loose in the exam room I’ll be using, cleaning and organizing, making sure that I have a good stock of stickers, bubbles, toys, band aides, toothbrushes, several sizes of stethoscopes, referral forms, developmental screening tools and assorted brochures on dental health, pregnancy, breast feeding, infant nutrition, tobacco cessation, TB, poison control, emergency situations and childhood illnesses.  I also reviewed the wall posters having to do with childhood literacy, developmental levels, hand washing, nutrition, etc.  I felt like a teacher with my own classroom and can envision having my own clients soon, assessing, vaccinating, and educating about all of the above topics.