Digital Doorway

Living with chronic pain is a difficult lesson to integrate into one’s life. Dogged by discomfort, where does one turn to learn to assuage the pain? How does one rise above the waves of physical sensation in order to see beyond the more obvious earthly struggle? Pain is indeed a teacher, albeit an occasionally cruel one, and I tire of its daily presence in my life.

I know that many people live with pain that is much more intense and debilitating than mine. There are amazing and resilient people all over the world who move through their pain with a courage of spirit that I can only imagine. They are my teachers, and I am seeking those who can model for me how to move through the pain, ride the waves, tumble through those terrible waters, and emerge on the other side, freer and more healed than ever.

In the midst of the pain that sometimes grips me like a vise, I hold a vision of a pain-free body, a body that no longer entertains the presence of such an unwanted visitor. I know that that future is mine, that my body will one day breathe a sigh of relief when the pain is released, leaving my body and slipping away like a mist in the trees. That day is coming, and I am giving thanks that, with every passing moment, it is that much closer to fruition.

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Originally published on the Blogger version of Digital Doorway.

Please feel free to visit my new fun blog, "The Adventures of Bob The Nurse "–one more thing for a nurse with too much time on his hands….

Since this is the end of Public Health Week, I wanted to share a link to a site created by the American Public Health Association which is encouraging Americans to make our country the healthiest in the world within one generation. Contrary to popular belief, the United States lags far behind most other industrialized nations in numerous measurements of health and well-being, and it will take concerted effort to turn those numbers around.

Were you aware that the U.S. ranks 46th in terms of life expectancy in the world—far behind Europe, Japan, Jordan, and South Korea?

How is it that a baby born in the United States is more likely to die before its first birthday than a child in any other industrialized nation in the world?

Why is almost 1 out of every 20 adults in Washington, DC—the nation’s capital—HIV-positive?

Why do more than 10 million American children lack health insurance?

How does one American under the age of 29 contract HIV every minute?

These are questions of enormous import and gravity, and even as I write this post, municipalities across the country are laying off Public Health Nurses and decimating the public health infrastructure in reaction to the economic downturn.

Please watch the video posted below, visit the website, and decide if you would like to take action, contact your legislator, or find another way to support public health in your town, state, region, or nationwide. The health of our country has been driven to a precipice that we do not need to collectively drive over. And like the website says, one person can effect change, and the actions of many individuals can potentially turn the tide.

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Originally posted on Digital Doorway’s main blog on Blogger.com .

At a time when it is universally agreed that the fight against communicable and infectious disease is an absolute necessity, right here in New England the city of Worcester, Massachusetts is choosing to dismantle its public health infrastructure, laying off its public health nurses during the celebration of Public Health Week.

Public health nurses provide case management for patients with active tuberculosis, provide crucial surveillance of communicable and infectious disease, and perform a myriad of tasks that help to protect citizens from harm and injury. Worcester’s short-sighted decision is seen as potentially catastrophic, and I share with you below the text of a press release from the Massachusetts Nurses Association:

WORCESTER, MASS — As the City of Worcester prepares to celebrate National Public Health Week, the city manager has recently announced the elimination of nearly all funding for public health services and the layoff of nearly all the nurses who provide public health protection to the state’s second largest city.

The public health nurses serve all the people of Worcester, providing vital preventive services to immunize against, track and manage over 150 infectious diseases, including tuberculosis, hepatitis, salmonella, the flu and West Nile Virus. The cuts in services and staff leave the city vulnerable to the unwarranted spread of infectious diseases. It will also deprive the city’s most vulnerable children and adults of access to immunizations and other health screening services.

The decision by the City of Worcester to lay off all six of its public health nurses, along with the chief public health nurse and secretary for the department, is a shortsighted and dangerous decision that will shred the health care safety net for the city’s 172,000 residents. The layoffs, which were announced last week, will take effect on April 17.

While everyone understands we are in a fiscal crisis, this decision places hundreds, if not thousands, of our residents at risk for harm and leaves the most vulnerable in our city stranded without necessary care," said Anne Cappabianca, chair of the bargaining unit of the Massachusetts Nurses Association, which represents the Worcester public health nurses. "The public has a right to know what they are losing and what they will be exposed to as a result of these cuts."

► A public health nurse is a special type of registered nurse who focuses on providing health promotion and protection to an entire community or population. There are currently six public health nurses serving a population of more than 172,000 residents in the City of Worcester.

► During the past year the nurses investigated 300 communicable disease cases, including tuberculosis cases at local colleges and high schools, requiring tuberculosis skin testing of hundreds of individuals.

► The nurses track at least 100 residents each month that may have been exposed to TB and are now living in the community. They make more than 35 visits each month to the homes of those residents with active TB to ensure they are receiving proper care and are taking their medication. In so doing, they prevent the spread of this highly infectious disease while at the same time assist those infected in getting well. Without the services provided by the public health nurses, these patients are less likely to follow their treatments, and are therefore at much greater risk to become more seriously ill, and much more likely to spread this disease throughout the community.

► In preventing the spread of disease, public health nurses are responsible for immunization of vulnerable segments of our population against the spread of disease. For example, more than 2,000 vaccines were administered to children and adults during the last 10 months by the public health nurses.

► The nurses also provide all varieties of childhood immunizations to those who can not afford them, such as children living in family homeless shelters, etc.

► Worcester public health nurses also play a vital role in the city’s disaster response plans. During the ice storm in December 2008, the nurses staffed the shelters at Burncoat High School and Doherty High School to provide care to victims, including fragile elderly residents.

"In addition to the loss of existing services, the elimination of the public health nurses prevents the city from initiating a number of health and wellness programs planned for the recently established wellness clinic in the department. These programs included screening services for diabetes, hypertension, kidney disease as well as obesity.

"In the long run, all of these programs save money and save lives, while increasing the wellness of all our citizens," Cappabianca said. "Those who suffer the most from these cuts are those in our community for whom these services matter most. In abandoning these programs, particularly all our services related to disease surveillance, we jeopardize everyone in our community unnecessarily."

Founded in 1903, the Massachusetts Nurses Association is the largest professional health care organization and the largest union of registered nurses in the Commonwealth of Massachusetts. Its 23,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health care issues affecting nurses and the public.

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This post originally appeared on the main version of Digital Doorway on Blogger.com.

After five days of hearing about emergency preparedness and response at the Integrated Medical Public Health, Preparedness and Response Training Summit , I’m ready to go back to work and hit the ground running. I have my work cut out for me, and this conference fed me ideas and inspiration for how to move my own agenda forward in our town of 30,000.

People of all stripes flocked to this very well-organized first-of-its-kind summit, and we all rubbed shoulders and elbows in dozens of trainings pertaining to emergency response. With visits from the Deputy Surgeon General and other dignitaries, many words were shared about how the United States is now better prepared than ever in terms of having the capability to respond to disasters of many kinds.

As a new public health professional, many of these concepts are relatively new to me, and I certainly do not live and breathe these subjects as so many of my colleagues do. Still, as coordinator of a local chapter of the Medical Reserve Corps (MRC), it is my responsibility to make sure that our town’s readiness to respond to public health emergencies is robust, and my primary goal at this point in time is to recruit members for our MRC, creating a body of credentialed and registered volunteers who can be mobilized at a moment’s notice when the need arises, whether it be to vaccinate elders against the flu or staff a Red Cross shelter during a blizzard.

While "disaster" is one of the operative words in the preparedness world, many MRC’s simply take part in activities that enhance the public health of their communities, and I’m striving to create an active and engaged MRC that does just that. The importance of volunteerism is one of the hallmarks of President Obama’s overall message to the American people, and I plan to capitalize on that message as I take the gospel of the Medical Reserve Corps to medical practices, retirement communities, and civic organizations where interested people are just waiting for a way to give back.

I have many responsibilities in my job as a Public Health Nurse, and emergency preparedness is only one of the hats that adorn my head on a regular basis. This conference was certainly an eye-opener, and I hope that I can translate my new learning and inspiration into action on the ground and a new group of eager volunteers ready to do their part.

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Originally posted on Digital Doorway on Blogger: http://digitaldoorway.blogspot.com/2009/04/emergency-response-and-preparedness.html

Every week, I receive emails asking me to review a product, comment on an article, or react to something happening in the world of health care. From nursing to union organizing, the requests come in fairly regularly.

Not long ago, I was asked by a website called Software Advice (who offer free advice on software to consumers) to examine a new partnership between Wal-Mart and eClinicalWorks. It seems that Wal-Mart, in its infinite wisdom (or lack thereof) has decided to go into the Electronic Medical Record (EMR) business, partnering with eClinicalWorks to sell a $25,000 software and hardware package to physicians at Sam’s Club outlets.

In terms of EMRs, I’m no expert, and while I have used a number of EMRs that were variable in quality and usability, I cannot speak to the quality or usability of eClinicalWorks’ products. However, as a consumer, I know that I have never set foot in a Wal-Mart due to the fact that I am staunchly opposed to Wal-Mart’s labor practices, their dumbed down sales pitch, and their ubiquitous ability to sap the life out of local business wherever they pitch their (ever enlarging) tent.

The article by Software Advice about these unlikely bedfellows makes a good point that “team members” at Sams Club and Wal-Mart outlets will no doubt be woefully inadequate in their ability to provide adequate information to potential buyers of this software, and physicians who suffer buyer’s remorse after taking home their new acquisition may rue the day they set foot in Wal-Mart to buy toilet paper and subsequently walked out with an EMR they didn’t know they needed.

The Software Advice writers seem to feel that eClinicalWorks’ software is a quality product that can deliver the goods, and I have no qualm with that opinion. But when it comes to Wal-Mart sticking their noses into such a specialized area of health care delivery, my squeamishness meter goes through the roof.

Good luck to eClinialWorks as they partner with a wholesale behometh that has basically co-opted the local store in towns from Canada to Mexico and beyond. Many readers of Digital Doorway most likely are already aware of my disdain for such companies as Wal-Mart, and if I were a doctor shopping for an EMR, I would certainly not plunk down my credit card for a $25K investment sponsored by a retail giant whose reach is already far too long. In the words of someone famous and dead, caveat emptor!

So, my learning curve continues to veer upwards as different aspects of my job ebb and flow. This week, it’s tuberculosis case management.

According to our state Department of Public Health, every patient with active or latent TB who lives in the community must have a nurse case manager, and the local Public Health Nurse (if there happens to be one, that is) usually fits the bill. Thus my work is cut out for me.

Things have been pretty quiet on the TB front in my little town for the last few months, with a few patients finishing treatment and sent on their merry way. Now, without divulging any important details, I will say that a new case has emerged that involves complicated and multiple social contacts, a language barrier, sensitive cultural issues, and the potential for a media and public backlash due to the frequency of tuberculosis among immigrants from outside the United States.

When a new case of TB comes to light and is reported by a medical provider to the state, a great epidemiological and bureaucratic machine is set in motion. There are contacts to investigate, families and friends to test for TB, complicated medication regimens to dispense, and an investigation that can easily consume the time of an erstwhile Public Health Nurse who has many other duties with which to contend. Tuberculosis is serious business, and it is taken very seriously by state and federal agencies that seek to contain it wherever it surfaces. And surface it does.

In these days of global air travel, an individual with undetected (and untreated) tuberculosis can sit on a transatlantic flight for many hours as nearby passengers breathe in the recirculated air carrying the potential for infection. While not everyone on a plane may be at great risk, close contacts who have shared the same air space for a number of hours are indeed suspect, and testing and close monitoring are crucial in order to catch new infections. If the infected individual attends school, works in a restaurant or hospital, or lives in a dormitory in close proximity with others, contact investigations are key to ascertaining who is at greatest risk of infection.

My TB case load has been light these last months of winter, and for that I’m very grateful. Now, an interesting and compelling case begins to draw my attention, and I will be put to the test as I summon my communication skills, cultural sensitivity, and ability to tease out the details of what may be a complex investigation.

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The original version of this post can be found here.

Well, here in New England, the colder days are slowly being outnumbered by the warmer ones, (emphasis on slowly). The mornings can be quite nippy and the nights still drive the mercury down. However, the crocuses are up, the birds are returning, windows are opening and people are out with their bicycles and running shoes in droves.

With my new job being right downtown, I plan to take advantage of the warm weather by doing outreach to local businesses, visiting churches, and making inroads to various groups within our community. I find that many individuals and organizations have no idea what the local Health Department does, and most people don’t even know that our town has a Public Health Nurse. In fact, some nearby towns have no nurse to call their own, so we are especially blessed to have such a well-funded Health Department.

Our Medical Reserve Corps (MRC) chapter has historically been relatively small, usually between 30 and 40 members, only a fraction of whom are actively involved on a regular basis. Although our title emphasizes the medical aspect of our mission, all MRC chapters welcome laypeople and non-medical professionals into our midst, since a diversity of talents and strengths is indeed important in emergent situations. Thus, we are actively recruiting veterinarians, clergy, business owners, IT professionals, HAM radio operators, and any other people who are simply interested in being of service when the proverdial feces hits the fan.

While members of the MRC are all trained to respond to emergencies and lend a hand when police, fire and other entities are overwhelmed (MRC’s have assisted in hurricanes, floods, fires, and other incidents), we also like to do community outreach and emergency preparedness education. Thus, some of my Springtime efforts will include outreach to seniors, church groups, civic organizations (like the Knights of Columbus), and private and public groups of all sizes and persuasions.

Beyond that, working in town also gives me a route by which to take the “pulse” of the town, talk to people about my work, and enlist community partners in improving public health in its myriad aspects.

Spring has certainly sprung, and I want to take advantage of the pervasive feeling of optimism in the air, reaching out to those who might be willing to contribute to improving the overall health of our community.

I spent today sitting in a conference room with public health nurses, people from our state Department of Public Health, and other professionals who focus their professional lives on the surveillance and prevention of infectious and communicable disease.

As dry as this topic may seem, there is a passion that people in the public health world feel for this work, and many people have dedicated entire careers to this avenue of work. As a newcomer, I listen, watch, and feel my way through this maze of information, and I consider the many decades of human effort that have led us to this point in history.

The 20th century was very much focused on the control and eradication of communicable diseases like polio and measles. We’ve done a pretty good job in that arena, and vaccine-preventable diseases have been on the run for some years, at least in the industrialized world.

Now, multidrug-resistant TB, HIV/AIDS, malaria and other diseases have us on the run, and the fight is raging around the world. Billions of dollars are being spent every year, and philanthropic organizations like The Gates Foundation feed a great deal of private capital into some of the larger public health engines that drive the action.

For myself, I’m a very small cog in a series of multilayered wheels that turn in combinations still beyond my comprehension. While I see my actions as very small when compared with what’s happening “out there”, I also recognize that my interventions on a local scale—counseling a patient with TB, vaccinating a child, preventing illness—are part of a wider web that is made even more meaningful (and, in fact, effective) based on the very small, local actions of a multitude of individuals.

Prevention, surveillance and protection of the public is a year-round and frequently thankless job. Public health happens in the background, if you will, and the public and the media generally only think about such things when something goes wrong. This is understandable, and if the price of such vigilance is relative anonymity in a world made more healthy and safe by their diligence, most public health professionals would probably accept that outcome with a knowing smile.

I am still surfing on the learning curve, gleaning what I can from every day on the job, and relishing the lessons that bring new personal and professional meaning and importance to my work. It’s an interesting ride, and I’m often impressed by the multifaceted nature of the field into which I have so recently stumbled.

Just yesterday, I went to the office of the visiting nurse/hospice agency that I work for as a per diem nurse, and I tendered my resignation.

With my public health nurse position consuming 30 hours of every week (and a large percentage of my cerebellar real estate), my per diem hospice position was so much background noise cluttering my mind and causing me professional anxiety. All of us who work in health care are acutely aware that maintaining a position at any facility or agency means that one has to attend trainings, keep up with changes in policies and procedures, and keep one’s finger on the pulse (pardon the pun) of the organization. As a per diem nurse, this can become quite a challenge when one’s life gets in the way of staying abreast.

In January of 2008, I quit my full-time case management position and entered a period of self-employment, working a number of part-time and per diem positions, consulting gigs, and online writing assignments. That professional juggling act was exciting and novel, but now that I’ve settled into a more or less full-time position in a demanding municipal job, keeping up with other agencies’ changes and demands becomes less and less attractive and more of an emotional and mental drain.

Giving up my position of per diem hospice nurse is a mixed decision, and one that I make quite consciously. Hospice nursing is close to my heart, and is an area to which I would like to return in the future. However, as a per diem who only takes a shift from time to time, I find that making hospice visits causes me considerable anxiety and concern. When one works with the dying on a regular basis, knowing what to say and what to do becomes second nature. The symptom management, the medications, the little tricks and trade secrets all live in a Rolodex in the nurse’s brain and are easily retrieved and shared. For me, those tips and secrets are not second nature, and I am loathe to deliver care that does not conform to a standard of excellence to which I hold myself wherever I work (and I recognize that this is also not in the best interest of the patients and families that I would serve).

As a public health nurse, I am no longer delivering direct care, and I do indeed sometimes miss the direct patient contact and assessment that goes hand in hand with that form of nursing. Less than a few years ago, I was a Nurse Care Manager, overseeing the coordination and care of more than 80 chronically ill patients living on Medicaid in the inner city. That work was a part of my personal and professional identity, and was also great fodder for my writing here on Digital Doorway. But my life has changed, and I have entered a period where nursing has taken on a different veneer, and instead of providing nursing care to a group of individuals, I provide the attention of a nurse to an entire municipality, its residents and its employees.

Letting go of my direct care positions is done with mixed emotions and a great sigh of relief. I have no doubt that my nursing career will take many twists and turns in the future, but for now, I am shedding what feels too burdensome, knowing that one closed door only makes room for ten more doors to open.

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The original version of this post can be found by clicking here.