MY FIRST TRIP TO JAIL

I began training on Monday morning regarding counseling and treatment of STI’s (sexually transmitted diseases) when a phone call came from the jail relaying that an inmate wanted to be tested, believing that he might have chlamydia or gonorrhea.  In reviewing his health summary, I could see that he was overdue for Tdap and flu immunizations, so packed them in the cooler to bring along with doses of Ceftriaxone, Lidocaine and Azithromycin.  The Ceftriaxone is a powerful antibiotic that can be painful when received, so is diluted with Lidocaine before injecting.  The Azithromycin is given in pill form.  It is effective against chlamydia and together with the Ceftriaxone and Lidocaine, is effective against gonorrhea. 

The thought of anyone making choices that leads to incarceration always saddens me.  After being admitted to the jail, Liliana, the CNA who is the lead in testing for STI’s, and I were led to a common area and could see several inmates behind thick glass, most likely curious about our visit.  A clean cut and courteous young man was led to where we set up for counseling, testing and treatment. 

After a lengthy interview with the requisite very personal questions, Liliana obtained a urine sample from him and documented his symptoms while I explained the medications he’d be getting as well as the vaccines.  The Ceftrioxone/Licoaine is injected using a larger bore 1 ½″ needle, deep into the dorsogluteal muscle.  Because this young man was not large, I was able to use a smaller bore, 1″needle.  Not wanting his onlookers from behind the glass to observe him lowering his pants for the shot, I asked the guard for some privacy and he accompanied us to a gray, concrete bathroom, staying with us while I gave the injection.  I was glad I was able to use the smaller needle, as just before it pierced his skin, he said, "I've always been afraid of shots."  

I am learning much from Liliana, listening to her interview, hearing her parting words about using condoms 100% of the time and the warmth with which she shook his hand.  I also wished him well with a handshake and heart felt words, hoping to connect on some deep level where the young man who is capable of making wise choices resides.  I don’t know what led to his being in jail, but can imagine it is very disruptive to life in many ways.

We left with the names of two women who he was recently in intimate relationships with and who will receive telephone calls saying that they’d been named as being close contacts to a highly suspected case of the STI’s.  My heart goes out to them as well as one is the mother of the young man’s child and is currently pregnant.  They will both be strongly encouraged to come in for testing and preemptive treatment prior to the young man’s and their test results being returned from the State lab.

Back at the clinic, we packaged up the urine sample, three sputum samples to be tested for TB along with tubes that the nurse practitioner was submitting for testing of some sort and labeled them to be sent off to the State lab in Anchorage.  Liliana will be traveling with her husband for a month, so am grateful to know all of the procedures when I'm given an STI case.  

I was reminded on a very busy day recently by Julie, the Deputy Director of Community Health, who oversees public health nursing here and who has many years of experience in different communities in Alaska, that the nurses in the Barrow clinic are very fortunate.  In many clinics, nurses specialize, so have a focus and knowledge of their specific areas, but don't have an opportunity to learn all of the dynamics of public health nursing as we do here.  Even though the pace is fast, the goals for increasing immunizations rates along with community education and involvement are high and the work load always abundant, I continue to be very grateful for this wonderful opportunity and am encouraged to hear Bertrand's assurances that things slow down in the summer months.