NR725A_WongPa_wk16_SL Blog Entry#2

The under/uninsured, working poor, and indigent population I served at the St Vincent de Paul Free Clinic, have their basic and some preventative healthcare needs met. The services provided by the clinic addressed urgent needs such as wound care (suturing and monitoring for complications), cold and flu treatment, hypertension management, diabetes management, and well child care. Unfortunately, the healthcare needs of these populations require more than the clinic has to offer. For example, hypertensive or diabetic crises require more in-depth resources in an in-patient setting for treatment and management which in turn require hospital admission. Without health insurance, many of the patients served by the clinic will put off admissions due to lack of money and insurance until they are physically overcome by the disease or illness progression. In fact, one of my most challenging things happened when I encountered a 23-year old male patient who was experiencing left-sided abdominal pain for two weeks without relief from over-the-counter medications. Subsequently, a CT-scan revealed intestinal cancer but the patient initially refused more diagnostic testing and treatment because he could not afford the cost of treatment. Although I counseled him about the gravity of non-treatment, he still refused. I involved the social worker and the clinic physician in a discussion about this case and fortunately the social worker was able to enroll this patient in an emergency temporarily funded state health insurance program for just these types of patients. After several attempts to contact the patient, we were able to secure a referral to oncologist who managed the patient as an outpatient through his initial phase of treatment. At this writing, I have lost contact with this patient for follow-up.

Services such as the St Vincent de Paul Free Clinic (SVDPFC) is a necessary fixture for this community as well as communities across the nation. This facility acts as a safety net for those who cannot afford insurance and those who are deemed ineligible for insurance. Additionally, services like the SVDPFC extend their human caring to undocumented immigrants who are suspicious and cautious about seeking health care (especially preventative care). In these uncertain times and decreasing financial support for charities, the SVDPFC needs more facilities like themselves to accommodate an increasing number of people requiring their services. In fact, Maricopa Health System (a county-run agency) has decreased the number of clinics county-wide and has started to require residency documentation in order to use their services. The means to provide more services such as the SVDPFC and diminishing rapidly without an alternative solution therefore I fear the Free Clinic will be overwhelmed if the Affordable Healthcare Act of 2010 (AHA) is repealed by the Supreme Court. With this in mind, I am obligated as a member of my community, as a professional nurse, and as a Christian to continue my services with SVDPFC in order to promote the common good, care of the less fortunate, and the infirmed.

Throughout my service learning at the SVDPFC, I have learned that I have deep inspiration for political and social advocacy. I have attended several community action boards with State legislators concerning cuts in Medicare funding and have worked diligently to provide quality nursing care to the underserved and vulnerable populations within my community.  Additionally, I have gained insight to fragmentation of community resources for the under/uninsured, the working poor, and the indigent populations within society.  Furthermore, I have gained compassion, sympathy, and empathy for those who are less fortunate and fear for their safety.

Last Words for the Semester:  "When a poor person dies of hunger, it has not happened because God did not take care of him or her. It has happened because neither you nor I wanted to give that person what he or she needed." --Mother Teresa

NR725A_WongPa_W8_SL_ReflectionsBlog1

“Never doubt the power of a small group of committed individuals

to change the world; indeed, it is the only thing that ever has.”

Margaret Mead

As part of the Society of St. Vincent de Paul (SVDP), The Free Medical and Virginia G. Piper Dental Clinics offer medical and dental care for the working poor, the uninsured, and the homeless population in the surrounding Phoenix metropolitan area. The funding for this service is derived from a perpetual grant from the Virgina Piper Foundation and the Society of St. Vincent de Paul. I believe that SVDP has internalized the building blocks of Catholic social teaching :  preservation of human dignity, respect for human life, association, participation, protection of the poor, solidarity, stewardship, subsidiary, human equality, and “the common good” (Byron, 1998, p. 2 - 6). My service learning experience is working as a RN in the evening health clinic providing nursing care to pediatric and adult populations requiring medical treatments and nursing interventions. The rationale for choosing this site and this environment for my service learning experience is three-fold:  St. Vincent de Paul mirrors my values and beliefs; I can use my professional skills and experience to make a difference in people’s lives; and I can ease the suffering of the citizens within my community.

My role at the Free Clinic is as a staff registered nurse (RN) working with a compassionate group of healthcare providers which includes nurse practitioners (NPs), physicians, social workers, physician assistants (PAs), and registered  dietitians. In the clinic, I administer medications, apply splints and casts, obtain vital signs, create referrals, and document the encounters. I have worked 2-3 hours per week on the evening shift (the busiest part of the day) providing nursing assessments and interventions—that’s a total of 12 hours as of this posting. For example, a middle aged indigent man with diabetes and a gangrenous left foot came in for evaluation. While cleansing the foot and the associated ulcer, I was able to assess the foot for the absence of pedal pulses and capillary refill. Additionally, I was able to solicit a detailed medical and psychosocial history which included moderate bipolar behaviors and schizophrenia.  Furthermore I will able to ascertain that he was a Vietnam-era veteran. Through the use of the social worker and the Veterans Administration, we were also able to get this patient a referral for behavioral health, a hospital to perform the amputation, and a prosthetic device, as well as a post-operative rehabilitation plan. This was just one encounter of many in which the opportunities to make a difference in people’s lives are limitless yet realistic. In fact, I have been asked to help with the community diabetes outreach program and the pediatric dental caries prevention program. Just recently, one afternoon, we went the local mall for a few hours and provide fluoride teeth painting to children 3 – 5.  My long term plans include assisting the manager of the Free Clinic in performance improvement projects such as patient wait time reduction, referrals processing, and cost containment issues. Additionally, I would like to do more community projects such as diabetes teaching and exercise.

I would like to leave you with an inspirational quote that sums up my passion and service learning experience:

“Far and away, the best prize that life has to offer is the chance to work hard at something worth doing”—Theodore Roosevelt

Byron, W. J. (1998). Ten building blocks of Catholic social teaching.  America, 179(13), 9-13.