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.