June 12th

Sunday June 12, 2016

As I am sitting in the van on the long ride back home I began reflecting on all of the positive experiences we have had over the last 7 days. The 11 of us were given an amazing opportunity to immerse ourselves into the Cherokee culture. When we arrived we were welcomed with open arms by many people who may not have normally been so open with outsiders.

When thinking about all of the generosity we experienced this week I really have to say it began on the first day when we arrived at Cherokee Indian Hospital. On the first day we met the hospitals nursing educator named Kayla. Immediately Kayla treated us with respect and began teaching us all about the Cherokee and the hospital. She took us into a conference room where we sat for at least half an hour talking with her and asking her questions. We then went to the Cherokee Indian Museum where once again we were welcomed by Jerry Wolfe who spoke with us telling us about his history and different stories that were passed onto him by his father.  On the first day of clinical during lunch the director of the emergency department named Victoria came and spoke with us and shared some the traumas she has faced for being Cherokee such as having dentist which were provided by the government slapping her. Throughout the trip we had several more instances that I felt that we experienced generosity. For example, on the last day at the Cherokee Indian Hospital we were invited to two guest speakers. The first guest speaker taught us all about historical trauma and how we need to learn to forgive. We then went to lunch and when we were done eating Kayla told us she had a surprise for us. She took us to the Katua Mound which the Native Americans believe is where they began. This is showing us generosity because this is such a sacred place to them. We next went back to the hospital where we had a class with the healing touch instructor. This was generous because it was teaching us an up and coming type of medicine that is more natural.

 

While on the trip we did not physically do anything to effect the health of others while in the hospital. However, prior to coming on the trip we collected blankets, clothing, toys, and bottles for the young children who come into the ER and are then put into the foster systems. It was explained to us that more often than not that children would come in with nothing and then would not have anything to give the children or the new foster parents and if it would be 3 O’clock in the morning there is no way that the parents would be able to get those supplies for the children because they live in a rural area and do not have access to 24 hour stores. These supplies can make the difference of the health of a child because it could be that one comfort item that they needed to calm them down whether it be a pacifier or a blanket.

I believe that this culture is able to get healthier by continuing the path that they are. The new hospital is doing a good job a focusing on all the aspects of care that are important for the culture. The hospitals had many different things that will improve the health care of the Cherokee. One specific way that the health will be improved is with the alarms that the alert the providers of screenings that the patients need to have that year. Some of the screenings that can be alerted are diabetes, cholesterol, alcohol, drug, dental, mammograms, pap smears, and certain cancers. Other ways that the hospital is able to continue to get healthier is that has a rehab program because the high rate of alcohol and drug abuse. The boundary provides a two-week inpatient detox program along followed by outpatient treatment which focuses on the spiritual and education aspect of healing.

This culture is able to keep their heritage and pass it on for future generations by stories, the museum/play/village, along with the schools. The Cherokee made it evident that they pass stories on to their children from previous generations. The boundary also has several opportunities for the children to participate in culture activities such as working at the “Unto These Hills” and “The Village”. These programs teach others about the history and trauma that the Cherokee endured. The boundary also has a museum that goes in depth from the beginning of the Cherokee to the present day. The Cherokee have also incorporated language classes and history classes specifically about their culture. Another special school the Cherokee offers for children which only speaks to their children in the Cherokee language except for half an hour a day.  This is important because no one really knows the history that happened to the Cherokee and what is taught in school is barley covers what really happened. If they Cherokee do not keep passing their heritage along it will be forgotten.

This week I would say the one thing I did out of my comfort zone was going into a patient’s room where I was not necessarily wanted. It was my second observation day and the nurse had me go into the patient’s room but the patient would not look at me. Even though it is just a part of their culture it still made me feel uncomfortable. 

This experience has impacted me in so many ways so I will just give a brief overview. I am so blessed to have this opportunity to come and learn about a culture that I never would have been able to learn about just by reading a book. This culture has taught me the importance of family and that even when someone hurts you, you can forgive them. This experience has been so much fun and allowed me to make friends with people that I may not have been friends with previously. I now am able to remember not to judge people when you meet them because you do not know what has happened in their past. Also, we are able to recognize a patient in distress earlier than I would have previously!

June 9

June 9, 2016

After visiting the hospital in Ashville I realized there were many similarities and differences from my previous experiences in health care. I used to work at the Children’s Hospital of Illinois so it was easy for me to see the differences. The first similarity I saw was the how they had several nurse’s stations throughout the general pediatric and pediatric icu units. At OSF they also have several nurse’s stations throughout so the nurses are closer to their patients. Another similarity I saw was the nourishment and playrooms. At OSF they also have nourishment rooms and playrooms for the patients and their families so they will be more encouraged to be with their children. Some differences I saw was at OSF they have computers in between two patient’s rooms on all of the pediatric units to allow for the nurse to be able to sit outside of the rooms and monitor their patients without having to be hovering in the rooms. Another difference I found out is that OSF does more inpatient surgeries in their PICU then that at the Ashville Children’s Hospital. 

When thinking of how hospitalization effects children and their families the first thing I think of is child regression and stress. From our pediatric class we have learned that while in the hospital is very common for children to regress in their developmental stages due to stress and from being in an unfamiliar place where they are not comfortable. The affect that hospitalization can have on families’ can be mental, physical, emotional, and financial. 

This organization applies family-centered care in many ways. On the Pediatric floors the families are given one meal to a family member each meal. They also have access to the nourishment center which provides drinks and snacks. In the rooms there are refrigerators, and pull out beds for the family members. On the NICU floor the families have the option of staying in the sleep room which is basically just a bed and a bathroom or they can go to a housing facility that is similar to a Ronald McDonald house (this is set up by a social worker). When we went to the outpatient clinic when you first walked in was a statue of a family but the heads were puzzle pieces to me this showed that the clinic really cared about all of the members of the family and that they are all connected. 

The environment of Ashville and Cherokee to me were very similar but yet different. When we went to Cherokee all of the specialty units were held within the hospital itself but they were all grouped together. At the Ashville the pediatric specialty units were also all together but were not in the hospital itself. I believe both the hospital really encouraged family involvement. The one thing I noticed about Cherokee they really brought their culture into the hospital where as at the Children’s hospital it was more kid themed. 

When walking into the NICU there were family stories on the wall after both happy and sad endings. Then seeing the teeny tiny babies, it made me realize how amazing the nurses are to “grow” and take care of the them. This is what had the most impact on me today.

June 7th and 8th

June 7^th, 2016

The last two days have been super busy and eventful! Some of the things we have done were observational clinical, the “Unto These Hills” which was a play about Cherokees’ history, a tour of a replica old time Cherokee village, rafting, and shopping.

The hospital we were at was on the Qualla Boundary which is a territory that the Cherokee had to buy back from the Federal government). The Cherokee prefer that the land not be called a reservation due to the fact that they had to buy the land back from the United States government and it was not given to them. The name of the hospital is Cherokee Indian Hospital. When we had taken our tour Kayla (the nurse educator) explained to us that the way their hospital works is that they have an Emergency Room that will treat anyone who comes in the door. However, if the patient was not Cherokee and they need more care like an inpatient stay then they would be transferred to another hospital. In the hospital they have a 10 bed inpatient unit, a dental office, and several primary care offices. The primary cares offices are composed of 12 teams, 6 pods, and two teams in each pods. Three of the pods were pediatric primary care offices. Other information that Kayla gave us when we went to talk was about how the Hospital is owned and ran by the tribe. The lead members of the hospital have to bring their ideas and budgets to the tribe leaders in order to get things approved.

When we arrived to the hospital on Tuesday we were taken to our assigned pods. The pod I was assigned to was adult regular patients with Dr. Ross. Immediately, Julie, Caity and I could see differences in comparison to the things we were used to. The nurses, doctors, and office staff all left after report and went to eat down in the cafeteria. When they arrived we met the Case Manager, and the Case Managers Support. The Case Manger Support had several different roles one was to answer the phones, listen to all of the messages on the answering machine and calling back those clients. She was also the main person in charge of scheduling. The Case Mangers also had many roles. The role that I found most interesting that she had was to go through the clients charts and see if they had any screenings that they needed to be done. On the charts there is a tab that shows any screenings that the patients need such as immunizations, cancer screenings, retinal screenings, etc. If a person completes all of the screenings every year not only does the hospital get credit but the clients also get a 100$ certificate from the tribe. Because the doctors nurse had gotten injured he had a CMA who was helping him. Dr. Ross only had two scheduled patients so we did not get to see much during the morning half of the clinical. One thing we did get to see was a trigger point injection into an elderly lady’s trapezius muscle. Dr. Ross explained what he was doing the whole time and I really appreciated that because I did not just have to watch something with out knowing what was going on. He then explained to us that he also works in the outpatient drug rehabilitation program.

The major difference that I saw from our culture to the Native American culture was that the primary care providers are with in the hospital which allows for easier access. One similarity was that I saw was that even in the Cherokee doctors’ offices there was lack of knowledge and understanding.

When it comes to complementary and alternative medicines the first thing I noticed while on the adult pod was that one of the doctors had a book titled “Wilderness Medicines” on their book shelves. We then learn while at the Cherokee Village that Yellow root could be used for sore throat and teething. Another alternative medicine that the Cherokee used to use were the sweat lodge. In the sweat lodge the medicine man would roll large heated rock into a clay building. He would then add the herbs onto the heated rocks and the sick person would then sweat out their sickness. When we asked about what their complementary medications were it seemed as if they did not want to talk to us about what they would keep in their medicine bags. 

June 8^th, 2016

So far I have not learned much about Native Americans and their child rearing practices but I will discuss what I have learned. The first thing I found interesting was that when children are born they are placed into their mothers’ clan not their fathers. The children are then put into school just like normal children. The most interesting thing I found about childrearing practices is that the pregnant mothers do not give birth at the Cherokee Indian Hospital but are sent to larger hospitals. This is done because there is a high rate of drug and alcohol abuse during pregnancy so the children are at a higher risk for problems during and after birth and they Cherokee hospital does not have a NICU or a specific pediatric inpatient unit.

The individuals in the community that have much respect and authority are the elders and tribal leaders of the community. From what I have seen it seems to be that everyone looks up to the elders whether they are family or not. When a child is born the mother often looks up to her mother to learn how to care for her child. Also, those members of the Tribal council are highly respected and have much authority because they are the ones who make the decisions for those within the boundary.

The family structures that I have seen are typically like those families that I would see at home but I believe they are closer and rely on each other unlike those families I would see at home. For example, while at the clinic I saw a grandmother and two cousins. However, the two children acted like they were sister instead of cousins. The support systems with in the community are the elders and the family members. If a person is having problems, then they typically will go to either a family member or an elder for advice and to ask for prayers.

When I hear the word resilience and think of from the prospective of the Cherokee. The first thing I think of is how could they not have resilience towards the United States. It was promised that the Cherokee could keep their land by Andrew Jackson but soon the took that land from them and forced the Cherokee to walk hundreds of miles to a land they didn’t know. During the trip several of their people passed away.  If I were a Native American, then I would have get over the historical trauma that was done to my family members. The resilience is passed down from generation to generation by stories. These people with resilience have to adapt and overcome the traumas that had been happened to them.