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.