IN THE CLINIC AND ON THE AIR

The week at work was a busy one with beginning to train in the Barrow clinic with one of the other experienced public health nurses, Michelle. It’s interesting to see how she, Joanne and Bertrand have different ways of interacting with their clients, all effective and all giving complete assessments, but bringing in their own unique personalities and focuses.

I have several sets of competency lists that I’ll begin to take with me on each clinical day and will have Michelle, Bertrand and the Nurse Practitioner, Colleen, check me off as I progress in each skill area. So far I feel confident giving adults IM (intramuscular) Tdap and flu immunizations, ID (intradermal) flu shots and adolescents IM Tdap, flu and HPV-4 immunizations. I’ve given children as young as five IM flu shots and nasal administrations of flu-LAIV (live attenuated influenza vaccine) and have given a child a sub Q (subcutaneous) varicella vaccination. I’m feeling comfortable with drawing up the flu vaccine from a multi-dose vial and the others from single dose vials, and reconstituting the frozen varicella with diluent before drawing it up into the syringe. All of the IM shots are given with a 25 gage, 1” needle and administered at a 90 degree angle. The subcutaneous shots are drawn up and given with a 25 gage, 5/8” needle and administered at a 45 degree angle.

An important aspect of public health nursing is continually screening for immunizations that are due and offering them on each visit. A person might make an appointment for only a flu shot for their child, so it’s up to the nurse to examine the health history and see if there are any other immunizations due, and then offer, educate and administer them if agreeable or document the reason if the immunization(s) is declined.

Some parents are agreeable to having their children receive all of their immunizations, but correlate the three dose administration of HPV-4 recommended for boys and girls beginning at age 11 with a sense that it is condoning sexual activity. It’s difficult for them to understand how giving their child the HPV-4 vaccine early in life can help prevent cervical cancer in women later as well as prevent the spread of the human papilloma virus. Other parents are very receptive and want their children to receive the vaccine as early as possible.

I enjoy watching parents with their children and am impressed with how they explain or comfort them during the immunization process. One father brought his seven year old daughter and five year old son in for flu shots this week. He explained to them that he wanted them to stay healthy because Santa Claus was coming to visit very soon. He didn’t think that they would want to be sick with the flu when he came. They understood this logic completely so his daughter happily let me give her a shot and then had fun picking out two Dora stickers. When it was her brother’s turn, he sat bravely in his chair, but had big crocodile tears running down his cheeks as I poked him. I felt like hugging him, told him how brave he’d been and found some car stickers that he accepted through the tears. When I saw him later in the waiting room he was laughing and said, “it doesn’t hurt anymore!” Is so fun working with children and their parents.

The pace was busy with many immunizations being given during the week as well as completing the required charting and addressing reminder cards for future immunizations due. It’s very common for parents to bring in two or three children at a time, so keeping each child’s paperwork separate can be a little tricky.

Effective January 1, the State of Alaska Vaccine for Children Program will no longer supply vaccines for children who are covered by insurance. This will require that we determine eligibility prior to their making appointments--they may have had a change of insurance status between their last visit and their current one so we’re not able to go off of the information contained in their current health history.

Once a week, Edith, an Inupiaq elder, hosts a live talk show on KBRW, the area’s only radio station. The station broadcasts over an area of approximately 88,000 square miles, servicing Barrow and the villages spread out across the North Slope of Alaska. Edith interviews people from various areas within the Health Department, introducing them and their topic, asking them questions and then translating their responses into Inupiat for the many people whose primary language is Inupiat.

Bertrand and I were asked to present a program about infectious diseases including RSV (respiratory syncytial virus), influenza and pertussis (whooping cough). We had developed a transcript in order to provide as much accurate information in our allotted time as possible, allowing for translation time. We covered definitions, symptoms, treatment and prevention for each disease and information on where people could receive immunizations.

It was my first experience being on the radio, so I was a bit nervous as Bertrand and I walked into the radio station. We were 45 minutes early, not wanting to be late and wanting time to orient to where we’d be broadcasting from. We were surprised that there were no people manning the station, but that it seemed to be running by itself. A half hour later, the disc jockey arrived, surprised that we were so early. He had put on an hour long pre-recorded program and had left to run errands for the station. He said that Edith usually arrived two minutes before the program began...I could see after we began that she was a natural and seemed to enjoy being on live radio.

I calmed myself by remembering that there was no need to be nervous…it wasn’t about Bertrand and me, but about the information we were sharing that could help people on the North Slope prevent serious and life-threatening illnesses. I enjoyed listening to Edith translate in Inupiat and was grateful that I had studied my topics well enough to be able to answer the several ad lib questions she asked to clarify certain points.

Next week Edith will be interviewing a counselor from Behavioral Health about depression during the holidays and the following week she’ll be interviewing another counselor about The Gathering Place, a day program for people with mental illnesses.

I was inspired watching Bertrand and Michelle’s involvement in having a six month old boy with a malabsorption disorder flown to the hospital in Anchorage. They worked closely with the Specialty Clinic Coordinator at the Barrow hospital, the pediatrician, the ILP (Infant Learning Program) Coordinator and the Deputy Director of Community Health to ensure that he received the care he needed. Without their intervention and part in this coordination of care, this child might have continued to fail to thrive and the outcome could have been fatal.

I’m finding myself thinking often about how much I love my work here. It's very rewarding and combines a high degree of meaningful human interaction with clients and co-workers. I’m grateful for the years I worked in offices before becoming a nurse--the skills I gained are invaluable in this position.

Like the elders in Wainwright expressed and like my mom, Diane, who was raised in Nome, says often, “Life is good!  Life is good!”  And so it is…