Health Fair, Self Care for Pallium India staff

The concept was simple enough: provide the staff with a measurement of their height, weight, blood pressure, and if they could manage the needle poke, a random blood glucose.

The India Winterim Pain and Palliative Care section students commandeered some tables and blood pressure cuffs. For two Fridays in a row, the staff seemed to enjoy being the patients after all their care of patients during the week.

It was a little puzzling for staff at first that we simply wanted to give them this information for their own health. Each staff member got a card to put in a purse or wallet.

We found some measurements that needed action and we encouraged those staff members to go and get checked out with a doctor.

We also did not realize how painful the needle poke was for random blood glucose. Ian Wallace, now famous on social media for his contributions to Pallium’s healing garden, was clear about how much pain we inflicted.

The Iowa team was thrilled with the humor, fun and good-hearted participation in the first Pallium staff health fair. We hope to keep you all healthy in the years to come.

“You have two ears and one mouth for a reason.” Guest blog from Caprisse Honsbruch

My first home visit was to Palode. My group saw 10 patients with various conditions. There were people with cancer, amputations, stroke sequelae, paraplegia, diabetes, hypertension, and asthma. The age range of the patients were 23-90 years old, and there were 7 men and 3 women.

The experience was not what I was expecting. I was expecting more medical treatment and interventions, but these visits were more check-ups for chronic conditions. There were many social and psychospiritual interventions done, probably because there was a social worker on the team. Some of those interventions included setting a patient up with a way to support the family by raising chickens, making sure the patient’s child goes to school, helping a patient get a disability pension from the government, and taking steps to help the patient rehabilitate their house. That was really neat for me to see because that is not something that a pharmacist is usually involved in. It made me have a greater understanding and respect for what social workers can do. In the future when I’m hopefully a hospital pharamcist, I will go to the social worker because they seem to be able to work miracles for patients’ social needs. Even talking to the patients seemed to brighten their day. I found that interesting because in the USA a doctor’s visit is more like a chore, but in India we were welcomed into the house and treated with the upmost respect by the patient and their family. Dr. Raj said that doctors and health care providers are very well respected in India, and I definitely got that sense in the home visits. There was even an instance in a home of a patient who was very sick that the family insisted that everyone have a glass of fresh squeezed orange juice. I unfortunately didn’t feel comfortable drinking it, because it smelled amazing, but it was little things like that that made me feel very welcomed in the home.

The patient who I connected with the most was a women who was diagnosed with breast cancer 3 years ago, and has since been in remission after chemo and radiation. She has had 2 mammograms since that have been negative, but she is anxious that the cancer could come back. She really reminded me of my mom. She was diagnosed with breast cancer, but has since been cancer free for almost 5 years. Every time she has a mammogram appointment though she is very anxious that they will find a reoccurrence of cancer. She always tells me it not a question if the cancer will come back but when, which as a daughter can be hard to hear. The patient lived in a very nice house with a great kitchen and had a big flat screen TV. So I made the assumption that she was well off. But I learned that you can’t judge a person on material things like houses, clothes, cars, etc. because she was actually in debt. She was staying in her sister’s house, who lived abroad, because she had to sell her house so that her daughter could get married. Because even though dowries are illegal they are still common in Kerala. That took me aback because that is not the culture in the USA. In class we talked about how healthcare puts people in debt but not marriages, so I found that interesting. She was also nervous about her cancer coming back because her daughters are married which means they need permission from their husband to go and help their mother. That also took me aback because the culture again is so different from what I am used to. If my mom needed help because she was sick I would hate to not be able to go because my significant other said no. Finally she taught me that if all you can offer a patient is conversation then that is all right. I’m personally a fixer. If you have a problem, I want to be able to fix it. But sometimes you can’t make everything okay. If a person is dying from a terminal illness, you can’t wave a magical wand and make everything better. But you can listen to them and hear what they have to say. As a future clinician I will work on being better at that. My professors, in my other pharmacy classes have said, that you have two ears and one mouth for a reason. Let the patients tell you what they need. Don’t assume you know what is best based on your personal biases. 

Here are some of Caprisse’s favorite photos.

The best gift a social worker can give: guest blog by Ashley Johnson

Note from editor: Every year the social workers, particularly Sarath Mohan, hope that TEAM IOWA Will include social workers. Our lone social work student this year, Ashley Johnson, from the UI MSW program in Sioux City got to spend time with Sarath before he left for the UK.

During my first day on home visits we saw ten patients throughout what I can only describe as the country/jungle/towns. Finding a patient’s home for the first time would not be an easy feat as I did not see any signs, nor did I remember to look for such things at the time. On the charts they mention home location and additional helpful info, but nonetheless it would be a challenge! For example, after our last home visit of the day trying to get down the hill all the men were out of the Pallium van trying to coordinate a way for our team to stay on the road. It is obvious numerous variables are happening to make sure a home visit happens. That perhaps was one of the first things that surprised me was the energy it took just getting to patients’ homes. I cannot quite imagine during monsoon season. Practicing in the US we have primarily paved roads and access to some degree is available. In my own career the rural areas I have had difficulty accessing and this made me realize the commitment health care often provides to its patients whether it be in India or the US. 

           I tried to stick by Sarath’s side as much as possible on these visits to see what his role as social worker provided during home visits. For a couple of patients, we needed to complete the socioeconomic forms that were not completed yet to better assess what Pallium India may need to provide for a better level of care. At first glance many of the homes looked like they could be considered in the high category of income but when you actually sat down you found out that for one woman, she was living in her sister’s home due to her home being sold for the purpose of her daughters’ marriage. Another patient had 60,000 dollars in debt and no longer had income coming in due to his condition after a stroke. For this patient the Pallium team was getting chickens for him to take care of to use for food and to sell to his neighbors in his community. They had thought about providing him with a goat but ultimately it was decided that chickens were a better economic investment. More examples came into play on how patients were attempting to keep making income to help better their current situation. One man had a dream of selling lottery tickets to provide money and more were making umbrellas to sell.

The last visit was the most striking in the sense of how inadequate the house was the couple was living within. This was the first intake visit so Sarath mentioned that he would be put on a special care team to help start making living conditions more livable. This man was diabetic and an amputee with some skin wounds as well. He was on insulin and there were some conflicting stories on where he was keeping his insulin, but I believe it was being stored in a refrigerator with a neighbor. There was also some talk that it was being kept in some water in their home. This home was rough, there was no real safe roof as it was being held together by logs that did not look stable. They were cooking food from a hole in the ground right by the bed and you could see the ceiling was charred from repeated use. The husband’s wife and mother were there, and they were very kind to Caprisse and I as they kept close to our sides and one pulled me to her and kept looking into my eyes and smiling. It’s amazing the connection you can feel with people without having to exchange words…. That felt like the overall essence of my first day of home visits. What I realized by working with Sarath and the home patients is that I love what I do as a social worker in hospice back at home. I started my medical social worker role for Compassionate Care Hospice just six months ago and I had no idea if my idea of working in end of life care would manifest into a real passion for my work. By this experience I found inspiration from Sarath on how I can work to make my patients quality of life better by how to better communicate and remain focused on income barriers and programs that could help lessen the economic burdens patients may be have. The experience with Sarath and the Pallium team makes me want to be a better social worker at home. A couple of times while walking to the homes I would become overwhelmed with tears as I tried to grasp that I was living this moment and feeling immensely blessed to have the opportunity to witness the lives of these patients. I have had this same feeling practicing at home which made me realized no matter where I am my role as a social worker is where I want to spend my time and energy focusing within. Human relationships are at the core of the social work code of ethics and at the root of my first experience with home visits this is what we focused on and this makes the work so important here and everywhere. Being able to sit down with patients and hearing information that can very often be missed, for example the depression and emotional turmoil that one male paraplegic patient faced was not brought up with nursing/physician and social work provides that platform for patients. A platform to discuss the important emotional turmoil that the disease process brings up for patients and family and that can impact every aspect of the lives of our patients. Our time with this man was not long but it was long enough that he was heard, and I realize now that is the best gift a social worker can give to a patient and family. 
  

 

 

Wellness challenged! Rachel Mullin’s blog on jet lag

 

I knew coming into this trip that jet lag was going to be an experience. I thought to myself that it’d be hard, but it wouldn’t be so bad. I thought I’d be tired, but functional. After all, I’ve worked night shifts that lasted 12 hours. I’ve even traveled internationally before. Fatigue is no stranger to me. After a combined total of 17 hours in flight, I knew this was not a normal kind of fatigue. I knew it was going to be a bit tricky, but I didn’t realize how much I’d be affected by it.

Fuzzy. That was the word I initially thought to use when describing my jet lag experience. The strange thing was that there were times where I wasn’t thinking as much as I was going through the motions. I would get lost in a mind fog and then snap back when I realized someone was saying something to either the group or (more embarrassingly) to me alone. As previously mentioned, I’ve worked long hours on a project before. I understand what it’s like to get lost in thought. The difference between then and now was how quickly I could snap back into reality. I sometimes felt like I was a part of the group but I was not fully present in the group because my reaction timing was slightly off, I found it difficult to come up with responses, and I found myself spacing off several times. This would be a very frustrating occurrence if it happened often and ultimately, I believe it would affect my social health.

My ability to concentrate was shaken. After our second plane from Abu Dhabi into India we had to fill out forms that indicated where we’d be staying, telephone numbers, and our passport numbers. Ann hinted that we might want to take a picture and get our answers in order before we left the plane, so I did. I pulled up a screenshot that I’d taken hours ago but I found that I couldn’t focus on the numbers correctly the first time I wrote them down. It took me two tries to fully get down what I needed to get down, and I actually had someone else from our group to ensure accuracy. I didn’t fully trust that I had done it correctly. I can imagine that someone who had difficulty concentrating on important documents daily would lead stressful lives. Those who undergo chemo may spend a lot of time filling out documents (both medical and legal) so I believe I now have a better understanding about just how difficult that may be to do.

The hardest day for me by far was day two. I woke feeling well rested, excited, and then looked over at my phone and realized it was two am. I rolled away from my phone and closed my eyes, but I couldn’t fall back asleep until five am, when the church bells conveniently woke me up again. My sleep pattern was completely off. By the end of the day I was utterly exhausted, but I knew I couldn’t go to sleep. I didn’t want to. We had a beautiful banquet spread courtesy of lovely people of CET. A wedding reception was concluding next to our table, music accompaniment was playing in the background, and there was a buffet provided. But other than that, I have almost no memory of what happened. I’m not sure that I really talked that much to people. I was focused solely on eating and staying awake. That is the kind of extreme fatigue I was under, and a kind of fatigue I’ve never experienced before. I imagine this may be similar to what chemo patients go through. I’ve read that patients receiving chemotherapy experience great amounts of fatigue. I can imagine that if a patient were to attend a gathering such as a wedding with this fatigue they might be a little sad. While you are supposed to be enjoying the company of others, all you can focus on is your physical needs.

I’ve never undergone chemotherapy or seen anyone in the process of receiving it. As such, I did not have any outstanding biases of my own. I do believe that I had a lack of knowledge, however. It is one thing to read that jet lag is similar to chemotherapy, and another to experience it. Suffice to say, I would hate to experience a year-long jet lag. I feel like it would ultimately affect my emotional, social, and my physical health. In Dr. Raj’s lecture he emphasized the importance of wellness in the form of a Venn diagram. He emphasized that a person should have their emotional, spiritual, social, and physical needs met. In two days I experienced a slight deterioration in my emotional health. A year long experience would truly be awful, and may very well affect all areas of wellness.

This made me think more about how a patient must feel. Let’s not forget, I am a healthy student who was experiencing a temporary state. A cancer patient is not just dealing with tiredness. They may be in significant pain, experiencing other side effects from chemotherapy, having emotional crises, financial crises, etc. I feel like I can better understand a patient now that I’ve experienced one portion of their experience. One stereotype is that cancer patients are extremely fatigued, and perhaps this holds some truth. However, it is difficult to describe how much of myself was affected by a 12 hour time difference. In the future I will use what I’ve learned through this experience to explain the depth of what exhaustion can do to a person using my own experiences.

Meet Dr. Gatha Nair

Dr. Nair is a remarkable co-teacher of this year’s India Winterim course: Pain and Palliative care-learning from each other.  She is currently Chief Resident for the Internal Medicine residency at the University of Vermont. She graduated from medical school in Arizona with a certificate of distinction in Global Health.  She plans to start a cardiology fellowship in the fall.

Gatha joined Pallium India last year in January for a rotation during the India Winterim course.  She served then as a cultural and linguistic ambassador for Iowa students.  She loved the home visits and her energy was infectious.  We asked her to join us this year.

As our teacher, she is exacting in her pronunciation of words in Malayalam, demonstrating exactly where to put our tongues and how to hold our jaws.  She also explains cultural norms, Hindu traditions, and medical facts in ways that have enhanced our experience.  Her enthusiasm, easy laughter, grace and skillful balance of the two cultures melt away the remnants of our jet lag.

She loves to be in Kerala. You can see it in the way she talks to waiters, patients and families, Pallium India Nurses and how she tries to include schoolchildren in our silly antics.

Thank you Dr. Gatha for joining us. We hope to see again in a couple of years. Hope you take a little of Pallium India to your cardiology fellowship in Chicago.