2018 Week 5: Healthcare and Health Policy

picture of Reah Vasilakopoulos CIIPREAH VASILAKOPOULOS | BALTIMORE HARM REDUCTION COALITION

“Opioid overdose crisis: Both common and personal” is Slide 5 of BHRC’s opioid overdose response training. Here, I always stop to recognize for our audience how common and personal overdose can be. It can be painful to revisit or discuss such a sensitive topic, and we emphasize everyone taking care of themselves throughout our presentation.

Losing loved ones to overdose is an intimate thing to share with just anyone. Over the course of the last few weeks, I have been surprised and humbled by the openness of many Baltimore residents I’ve met and their willingness to share their personal stories relating to overdose. Many of these personal stories are shared in support of safer consumption spaces (SCS).

An SCS, also known as an overdose prevention site, is a space where people can bring in drugs they’re wishing to use and do so under medical supervision. There are 100+ SCS around the world, in 66 cities, and no one has ever died in any one of them. This is a safe place away from police where people can be brought back from overdose or receive other medical attention, get connected to support services or other resources, and ride out their high comfortably.

As part of my weekly responsibilities, I am helping to staff a mock SCS, organized by the BRIDGES Coalition, every Thursday and facilitate naloxone trainings. This week, I met a man who had lost 15 friends, including his girlfriend, to overdose in the past year. He wanted more naloxone and spoke to me for a long time about how supervised consumption could have saved his girlfriend’s life. I met another man who is known in his community as Mr. Wake Up: he received his title from how frequently he brings people back from opioid overdose with naloxone.

In meeting these two men, as well as many other residents, I can see that so much of the grassroots support we’re looking to build for SCS is already there. Many residents spoke as though their support was obvious, their stories all connecting to the larger theme of lost lives.

They also spoke often about wanting to heal from these traumatic experiences and prevent future ones.

Going into this project, I knew that if we had an SCS in Baltimore, so many lives could be saved. I knew an SCS would act as a statement of compassion for people who use drugs. I’ve come to realize how an SCS could bring not only newfound safety for people who use drugs, but also healing for those who have lost loved ones to overdose. The community support I’ve learned about isn’t about just benefiting individuals, but also the community at large, present and future.

Self-care is important, but so is community care.

 

picture of James Yu CIIPJAMES YU | KESWICK MULTICARE CENTER

The work I did this week has been a culmination of everything I have learned over the past few weeks. I never thought I would learn and experience so much in such a short period of time. The social workers under whom I work entrust me with processing new admissions, doing cognitive and mood assessments, ordering and verifying durable medical equipment, and notifying patients of their insurance coverage and discharge dates. I had sat in on care plan meetings but had never directed them. I had to cover for one of the social worker’s care plans on Tuesday. All I could do was play it by ear and rely on what I had observed. Thankfully everything ran smoothly and I fielded all of the patients’ and families’ questions rather well. On Friday, the two social workers who I usually work with and from whom I take directions were not at work. I had to be comfortable running independently and dealing with any issues that came up. There were also an uncharacteristic amount of new admissions that I had to run through almost entirely on my own. While the day was busy, I definitely found my rhythm and leaned into the pressure rather than back away from it. It made me realize I was capable of a lot more than I initially expected. On Monday I was introduced to the long term care units at Keswick this week so that I could get a taste of the planning that goes into caring for those who can no longer care for themselves and whose families cannot provide the level of support needed to sustain them.

It is well known that assisted living is not the most glamorous lifestyle, especially since the residents are almost entirely dependent on nurses and geriatric nursing assistants 24/7. The staff does the best they can to ensure each resident is happy and healthy but the harsh reality is that while many residents receive the physical support they need, a lot of emotional needs are not met. Many sit alone in their rooms watching television most of the day. They will eat together in the dining area and attend events like bingo but other than that they rarely have anyone to talk to or to listen to. The lucky ones have family who will visit every once in a while, but that is often not for very long and the family is preoccupied with communicating with the staff. I had the opportunity to talk to some of the residents and quite honestly it seemed that having even the slightest human interaction made them perk up, brighten up, and become more responsive to their surroundings. Their state of being seems to be reliant on the initiative of the staff and those o more able body and mind to give them stimulation. I never realized how lonely you could feel in a crowded, bustling nursing home until this week.

I wish I could change this over the next few weeks but it will certainly take a lot of effort to chip away at the existing culture. I would hope that Keswick could bring in volunteers who devote their time simply to talking to residents and giving a chance to socialize and interact with others. This could be something that I take charge of and then present a plan to the staff to make it a reality. I have found a way to make an impact and I will not let it slide.

 

picture of Christina Ambrosino CIIPCHRISTINA AMBROSINO | CHARM CITY CARE CONNECTION

SAVE THE DATE! On the 21st of July, there will be a Community Health Fair at 29th Street Community Center. Bentley, the intern at the 29th Street Community Center, and I have been working on planning this event for over a month now and it’s finally starting to come together! We’ve received over $450 in funding and have been starting to spread the word over social media and around businesses in the area. Approaching local businesses for donations to the fair and allow us to advertise our fair in their building seemed like an uncomfortable, daunting task. Bentley and I were so surprised at the responses we got—so many people went out of their ways to find spaces for the flyers, take our information down to later present to their managers, and even to hand us cash from the register. Only one business (a liquor store) refused to accept flyers at their location. “Now that’s more like what I’d expected this flyering would be like,” Bentley said as we exited the store. The kindness of so many people that hot Wednesday afternoon was truly noteworthy. I can’t wait to go out again this Wednesday to follow-up with some of the businesses and to continue to spread the word. We did have a recent realization, however, that puts a bit of a dark cloud on the whole endeavor. We should have done more research on the timing of this event, because we had accidentally chosen to hold the fair on the same weekend as ArtScape. It’s too late to change the date, so we’re going to make it work! Maybe we’ll attend ArtScape in the morning to pass out flyers and spread the word about the Health Fair. Bentley and I are still taking any suggestions about how to approach this overlap of events, so please reach out to us if you have any words of wisdom!

 

picture of Luke Bonanni CIIPLUKE BONANNI | SHEPHERD’S CLINIC

This past week went pretty well. We had a going away celebration for one of your behavioral health counselors. At the clinic, we provide counseling services to patients, which is one of my favorite parts of the clinic. Although I have only been at the clinic for a few weeks, I can see the positive relationships that the counselors have formed with their patients. While medical care is obviously an important factor in maintaining and recovering one’s health, it seems like sometimes just having someone to talk to makes all the difference in health outcomes. As I’ve spent more time at the clinic, I’ve realized the importance of patient cooperation with clinic and provider directions. Once a patient leaves the clinic, it is up to them to take their medications, attend their appointments, follow their diet and exercise plans, and advocate for their health. However, dealing with many stressors takes a toll, and likely makes cooperating difficult when a patient has more immediate concerns. The benefit of our counseling services comes not only from bringing about a clear improvement in a patient’s mood, but also from giving patients an outlet to discuss their experiences and in turn give them the confidence and support to advocate for themselves. As our behavioral health counselor said goodbye to his patients, I could sense how appreciative they were. They kept asking him not to leave. Before he left, I had a couple conversations with the counselor, mainly asking him about his work. He told me that most of his work was simply listening, then working with patients to come up with solutions. The greatest lesson I learned was the importance of listening as a care provider. Whether providing counseling services or medical care, listening to patients is paramount. Not only does it help patients feel like they are in control of their own care, it strengthens the relationship between provider and patient, thus increasing patient cooperation.

 

picture of Valeria Hernandez Munoz CIIPVALERIA HERNANDEZ MUNOZ | ESPERANZA CENTER

After triaging a patient, we write candidate conditions on the board for the providers to prepare before seeing a patient. As an undergraduate intern who really doesn’t know much about medicine yet, I often end up writing their main symptoms, or guesses followed by a couple of question marks. This week, I wrote “PTSD?” on the board. “That’s correct,” one of our full staff members, Bill, told me with that smile people give you when there’s nothing left to say.

To anyone reading the board, or even this blog post, with the knowledge that the clinic mainly provides care for people who immigrated from Latin America, this diagnosis would mean that this patient came to the US fleeing violence. But all three incidents he had suffered happened here, in Baltimore. He told me about them with great calm, like they weren’t reason enough to keep him up at night, and Bill took all the time he could to make sure he did everything within his medical and social capacity so that they didn’t.

In the clinic there’s often talk about recent changes in medical culture, most of them resulting from the way in which insurances decompose health care to charge for every step separately. The increase in knowledge has also contributed to the fragmented specialization of fields, perhaps all too fast for the coordination of teams to keep up. The result is a loss in holism in a time where we learn that more and more things factor into our health.

From time immemorial, medicine has been mostly palliative, probably because no deeper knowledge of disease existed to do more. However, addressing the cause of PTSD today would mean tackling social issues beyond doctor’s expertise. The need for cross-disciplinary work goes beyond medicine. It has made me appreciate even more the fact that Esperanza Center also provides legal and educational services. I think that in the future, I would like to work in a similar organization, and one that is founded on collaboration.

 

picture of Isadora Schaller CIIPISADORA SCHALLER | BOONE STREET FARM

During our CSA harvest this week, my supervisor pulled me aside to say that I was becoming a great intern at Boone Street. This small compliment made all of the hard work and early hours feel totally worth the muscle aches and sleep deprivation. I’ve felt a sense of connection with the people on the farm and with the larger community that I am incredibly grateful for. This week was filled with trials and rewards – from staking tomatoes and navigating Youth Worker drama to cooking with vegetables grown on the farm.

Tuesday was a difficult day as we hosted twenty CTY high schoolers as volunteers. While they were hard workers and filled with enthusiasm, they had little awareness of the city and the importance of the social justice issues facing the Baltimore community. This was fairly surprising as they were partaking in a summer-long social justice class. I was shocked that none of the students even knew where they were working, or the importance of an urban farm when serving in a food-priority area. While it is not the fault of the students (rather the program curriculum that is not designed to highlight Baltimore social justice issues), I felt that the students were being done a disservice.

Another difficult aspect of that day was watching the Youth Workers work side by side with the CTY kids. Although they were the same age and laughed about memes together, the kids were world apart. Partaking in CTY requires submitting SAT scores and having the financial means to afford the expensive program, a massive privilege compared to the Boone Street Youth Workers who are struggling in numerous ways. Comprehending the worlds separating the kids was sobering, but I am doing my best to support my crew in small ways. From baking cookies for a birthday, to recommending a friend as a STEM mentor, I hope that even the smallest things I can do will make an impact in their lives (even if it’s just a sugar rush!).

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