by Beth O'Connell
East Tennessee State University: College of Public Health
Cygera, Rwanda

beth HIV class beth dental class

(Above: Beth teaching HIV class, Beth with Dental class)

Final Update from Rwanda

Hand Washing and Safe Water Education

      I have continued visiting individual homes in the village to provide hand washing and safe water education.  Since my last update, I spent three more afternoons visiting homes and have succeeded in reaching all 261 homes in Cyegera  in addition to the previously taught students at Kiruhura Christian College and church in Ruyenzi village.  I am proud to report that total of 1,387 people here have received hand washing and safe water education.  We were initially told by village leadership that there were 256 homes in the village, so I also effectively updated their census information on both number of houses and number of people in Cyegera.

Health Education at Kiruhura Christian College

      Due to holidays and exams at the end of the trimester, my teaching schedule changed several times; however, I rearranged my lesson plans and we successfully completed our public health lessons. The students learned about malnutrition, tuberculosis, sexually transmitted infections, and conjunctivitis, and then wrote a paper on one of these topics to include: definition, causes, consequences, prevention, and a story from related personal experience. They also completed quizzes for evaluation.  The papers and quizzes reflected good understanding of the topics by nearly all of the students.  I discussed mistakes with each student individually who did not receive a perfect score and they appreciated that.  On July 17th, I was honored to attend, by invitation, a meeting of the school administration and parents.

HIV/AIDS Education

On Saturday, July 17, and on Sunday, July 18, two HIV/AIDS classes were held at the church and were open to the public and a total of 110 people attended. Interestingly, many were not members of the school or church, so news had travelled well through the community.  The rapid spread of the disease in sub-Saharan Africa, need for prevention, and methods to prevent the spread were emphasized.   Participants were encouraged to ask questions and they asked many. They are so eager to learn.

Dental Health Education

      Continuing with dental health education I worked with the four employees of the Faith and Hope Children’s Home and also the local church congregation. I gave each of the employees supplies for themselves and their families which will impact twenty people. This is in addition to the students educated previously.  Eighty more participated in this dental education and received supplies at the church. 

Nutrition and Waste-Removal Professional Analysis

      You may recall that while analyzing environmental hazards at the Faith and Hope Children’s Home, I prepared a meal log along with information and pictures on the waste-removal system for analysis by professionals in those fields.   The meal log was sent to a registered dietician for nutrition analysis.  The waste-removal information was sent to a licensed plumber for analysis. I am waiting for their recommendations. I also have pursued information on building raised-bed gardens at the home to help alleviate nutritional gaps. This project is currently waiting for approval by my host organization. I intend to follow through on these unfinished projects even after my official internship experience is over. I feel a personal commitment to them and would like to see the children benefit from their potential.

Conclusion

      I am wrapping up the community and school health education programs and reflecting on my time in Cyegera, Rwanda. Every day has been busy and productive and I will depart knowing the health of the community has and will continue to benefit from my efforts.    I cannot thank Hope Through Healing Hands, the Niswonger Foundation and the ETSU College of Public Health enough for making this opportunity possible - we have definitely made a difference!

 

 

July 22, 2010

Jennifer Hunt
East Tennessee State University
 College of Public Health
Appalachia Region
ASPIRE Scholar/Frist Global Health Leader


            Since my last report, so much has happened! I have completed my survey project of the employees and patients of Rural Medical Services (RMS).  This information will be extremely valuable to the management of RMS in determining the strategic direction of RMS in the future.  I also think this information will be very valuable to the patients of Rural Medical Services.  We received numerous ideas and comments from patients on what they think of RMS and how RMS can strive for improvement in the future.  Overall, the patients and the staff are extremely satisfied with the operations of Rural Medical Services and mostly had only positive comments to make.  Some comments made by both the staff and the employees are worth sharing; they show the perceptions of what a great organization RMS is. 
Comments from the patients:         

  • This place is the best.  Has always taken care of me and found me the best way for me to pay since I do not have insurance.  Thank you.
  • Wonderful staff, very attentive to my every need. Takes excellent care of my children
  • These ladies are the absolute best and most professional women I’ve ever had the honor to know and have came to respect them in everyway.  Thanks for everything ya’ll have done for my family; kids; and myself.
  • Everyone here at the clinic always treats you like family I love them everyone.  They always take the time to see how you are they are wonderful
  • The Nurse Practitioner even called me at home later that night to make sure my child was OK.

The employees, while offering numerous suggestions on the operations of the organization, are equally as satisfied with RMS.  From the employees:

Comments from the employees: 

  • Large company now, but still has values and care for its employees as if it were the small company it was years ago
  • Freedom to do my job without being over managed and being able to take advantage of opportunities for projects as I see best meet the goals of my department
  • RMS plays a vital role in the health care of the communities it serves and I enjoy being a part of that.  Also at RMS everyone is treated as an important part of the team regardless of their position.  We are told from the CEO that we are valuable to the organization.
  • To know that we are serving the most needed people.  Particularly for me this service is a ministry, in which the reward is to see the transformation in the life of the people we serve.
  • Ability to offer medical services and care without regard to patients insurance or financial status

 

I am looking forward to presenting my findings to the RMS leadership, employees, and Board of Directors and getting their thoughts and impressions on the information.

This past week, I attended and helped conduct Migrant Field Screenings.  These field screenings are held at various farms throughout the county.  I attended the screening at a large farm in Parrottsville, TN.   The screenings are held outside and the providers use card tables as their desks and migrant workers come to the screenings after work and are seen by health providers.  The workers include office personnel who answer the phones and use computers, workers who are out in the fields harvesting crops to those working in the packing warehouse.    That day at the farm, the providers saw numerous cases ranging from diverticulitis to diabetes. RMS provides all of these services and medicines free of charge to those wishing to participate.  Though I expected to be there just to observe, I was able to participate by taking blood sugar readings.

In addition to providing practitioners and nurses, Rural Medical Services also provides translators to help with the language barrier experienced between workers who speak only Spanish and providers who do not speak Spanish.  After having their vital signs and blood sugar checked, patients were seen by one of three providers at the screening that day.  Students from the East Tennessee State University’s College of Medicine and College of Nursing were on hand to help the providers.   Various medications were also available to the migrant workforce free of charge.    During their session with the migrant patient, providers also conducted patient education on how to better care for themselves during the extreme heat conditions that come from working in the field to stretching exercises for office staff to help avoid developing carpal tunnel syndrome.  It was interesting to see this process in action and how the providers and staff focused on the care of the patient in spite of language and cultural challenges.

 

by Kelsey Neff

July 19, 2010

We’re back on the road again with the Brad Paisley H2O World Tour, with last weekend’s visits to Chicago and Moline, IL!

waterbottle girl

Friday morning greeted us with hot temperatures and even hotter humidity! The severe temperatures didn’t sway the hardcore country fans, or our even more dedicated Water = Hope volunteer crew! We had a great group of volunteers, starting the day with 12 dedicated do-gooders, consisting of three sets of best friends. We had a group of high school students, and best friends, who had volunteered at other similar shows previously, and collected an awesome amount of e-mails and donations. We had Barry, Bob and Betty who went out into the Water World Plaza to talk to concert-goers about Water = Hope. Bob was an experienced campaigner who had volunteered at a U2 show a couple years back with the ONE Campaign, and he impressed us by raising a lot of money to build wells, working so hard we barely saw him! And last but not least, we had a best friend duo who worked together at a school and were on their feet moving for the majority of the night. Everyone did a great job, thanks to all of you for suffering through the heat with us!

threesome girls

We had a great response from fans in Chicago, raising almost three dollars for every e-mail address we collected! People were very interested in our goals and showed their support in many ways. We met a couple people from Texas who wanted to volunteer for us when we head that way in August, and others who grabbed t-shirts for a bunch of their friends and family. The show was fantastic and the crowd was great. Thanks for an awesome night Chicago!

 

moline crew

In Moline we met Colin and Erica and their friends who were committed to matching the success we had in Chicago, even though we only had a third as many volunteers. They were energetic and passionate about Water = Hope and impressed us with their results. Moline’s crowd was a touch smaller than Chicago’s crowd, but we still got a really good response from Brad Paisley fans. One fan even looked through her phone and signed her whole family up for our e-mail list; she said she knew that they would want to support this cause. We also had a lot of fans stop by our table and then sent their friends back to sign up as well. The support we felt in both Chicago and Moline was really great; thanks for a successful first weekend back Illinois!

We’ll be back on the road this weekend hitting up Cleveland and Saratoga.

In August, we’ll be in Texas and Florida; visit the Water = Hope website to learn more and volunteer: http://www.waterequalshope.com/

July 8, 2010

by Beth O'Connell
East Tennessee State University: College of Public Health
Rwanda

Beth Oconnell child w soap

(Above: Child with Soap and Water -- Hand Washing Training) 

Health Education Continues at School

                Kiruhura Christian College has continued to allow me to educate all 112 of the students on various health topics. The week of June 21-25, I taught each class about dental health and provided them with toothbrushes and toothpaste. I got this idea from a student who asked me at the end of class one day if I could teach him how to “wash” his teeth. I also gave these supplies to the headmaster, secretary, matron (woman who cares for the girl boarding students), and two teachers who participated and assisted in the education. The handout used is in the appendix below. We discussed both why and how to brush.   These students were also given information on tuberculosis, conjunctivitis, sexually transmitted infections, and malnutrition. Students will write papers about these topics and include how to prevent them. The students of the general paper classes have also been finishing up in-class presentations of the topics they wrote about previously and all of the students are interested in hearing about each of the topics.  This oral presentation also helps evaluate how thoroughly each student understands their topic.

                I taught the students of the biology class about malnutrition June 30 and July 1. In doing this, I stressed the importance of eating food from each category of food as described by the United States Department of Agriculture My Pyramid program. Malnutrition is a significant problem in this village and the people seem to have no understanding of eating a variety of foods, not just a large quantity. I hope that this education at the school will have a ripple effect into the community.

Continued Hand Washing and Water Treatment in Community

                I am continuing to teach hand washing, hygiene, and safe water education in the village. This includes instruction on why and how to do these things and provision of soap and a water treating liquid for each family. I have continued to do this through visiting individual homes and also one group program.  I have reached 192 families of Cyegera with this intervention, 1034 people. There are a total of 256 homes in the village of Cyegera, and I am going to try to reach each of them before I leave. In addition, I also visited a church in a neighboring town called Ruyenzi. The 58 people in attendance that day received the same education and supplies. That is a total of 1092 people educated on hand washing since the beginning of my field experience.  If the people change their hygiene habits and drink safe water in the future, it will have a huge impact of the overall health of the community.

Biosand Water Filtration

                On June 25, I worked with the Rwandese Health and Environment Initiative Project to reinstall one of the biosand filters. Water had not been flowing through it correctly. Replacement of the filtration media, including a better type of sand has fixed the problem. All five filters at the Faith and Hope Children’s Home and the school are working well with flow rates at the standard of 0.7 liters per minute. They began producing clean drinking water on July 4. Some of them which required maintenance will not produce drinkable water until later dates.

Conclusion

                In continuing these two initiatives, I have continued to draw from reliable web sites for sources of information and on assistance from my preceptor, the children’s home administrator, members of the church, and members of the village leader’s staff. Visits to homes in the village have been very productive and are directed by the village leader and church members. Without them, I would have no way of knowing which homes are within the village limits and how to get to them. The administrator of the children’s home has been my translator for all home, church, and the public education sessions. I also continue to look for opportunities to expand my efforts.

July 8, 2010

Brittany Cannon
East Tennessee State University: College of Public Health
Roatan, Honduras

brittany cannon health fair 1brittany cannon health fair 2

For the past week I have been busy both in the community as well as in the clinic, conducting health fairs throughout various communities across the island.   As a result we been able to perform 215 blood sugar tests and blood pressure readings over a four week period.  Seven of the people screened were referred to Clinica Esperanza due to high blood sugar readings. There are a couple more communities that we are planning to go to within the next week or two.

The clinic has been very busy (as always) and for the past two weeks I have been working in triage. Triaging an adult involves taking the patient’s the weight, blood pressure, heart rate as well as documenting the chief complaint for the patients visit. Obviously triaging a child is a bit different and proves to be a little more difficult because it involves getting weight, height, heart rate, and head circumference (depending on the child’s age) as well as temperature from a typically very unhappy child. On average, we see around 35-40 patients per day  and referrals from the community health fairs conducted have been coming to the clinic. It is rewarding to see that the health fairs are beneficial in getting people to the clinic who would not otherwise come in;  I found it especially gratifying to have had the opportunity to triage one of the people I had referred to the clinic at one of the health fairs. I have really enjoyed the patient interaction and know that triage helps make the clinic flow a lot more smoothly as it helps the doctor prepare for the patient he or she is about to see.

In my last update I mentioned doing a nutrition education class at the clinic but have since changed my mind and thought it to be more beneficial to conduct classes regarding child health.  I have been in the process of planning early childhood developmental/preventative health classes in which I will discuss the importance of nutrition as well as other basic issues concerning the developmental stages of children.

A class on prenatal care is currently conducted every Wednesday at the clinic by a local nurse. However, through shadowing the pediatrician here and working in triage, I have come to realize that many women do not know what to do with their child after it is born. Many do not have basic knowledge regarding the stages of development of their children and are unaware of things a mother can do to enhance her child’s health. This will be the focus of my class and I will keep you all posted.

Again, thank you Hope through Healing Hands Foundation … together we are making a difference here in Roatan.

 

 

July 7, 2010

by Jodi Southerland
East Tennessee State University: College of Public Health
Appalachia Region

Jodi Southerland w mealsJodi Southerland w meals 2

Organization: Of One Accord Inc, a local grassroots non profit organization, which provides vital services to disadvantaged community members in Hawkins and Hancock County, TN.

Objectives: Provide supportive services to staff members, build lasting relationships with the community at large and ensure a brighter, more healthful tomorrow for local residents!

Background: Does poverty exist in a land of plenty? Do community members lack vital goods or services such as indoor plumbing, electricity, adequate nutrition and health services? To my dismay, I must answer ‘yes.’ Through my involvement with Of One Accord, interaction with community members and excursions into local communities on the rural roads less traveled, I have begun a journey which I hope will help me to understand more fully the roots of poverty and disadvantage in rural America

Activities: Over the past seven weeks, I have been conducting wellness assessments among community dwelling seniors served by the agency. The purpose is two-fold: 1) develop a client profile which includes demographic data and risk factors that lead to diminished quality of life and poorer health outcomes, and; 2) identify domains in which the agency’s services can be improved or tailored to meet the needs of this population. I also provide health supportive services, education and referrals to seniors through the information provided during the assessments and through my personal observations.

These interactions have led to the development of relationships with some amazing members of our communities, namely, the senior population. The stories of triumph and heartache, grit and tenacity, hard work and determination are too numerous to tell. There is one prominent theme that resounds as these senior residents reminisce and remember yester year: wisdom and the will to live are often developed through hardship and in the face of adversity.

I am also responsible for coordinating activities for our summer volunteer groups. These activities are focused primarily on our older community members and include home repair/renovation projects, house keeping, gardening, hair cuts/perms and visitations. These activities are very hands on and provide volunteer groups with an opportunity to utilize their expertise and skills and improve the lives of our senior residents in real and tangible ways. The agency’s Community Nutrition Program has benefited greatly from the services provided by our volunteer groups. Members assist with food preparation and delivery of both senior meals and youth lunches (Lunch Box Mobile Cafeteria). Volunteers accompany me as I deliver daily meals and a monthly food box to our community-dwelling seniors.

Reflection: A picture is worth a thousand words! But stories are priceless. Ms. M is a 69-year-old single woman. She has lived in Hawkins County for approximately thirty years but does not have any family members who live in the state. Five years ago she was diagnosed with cancer and her voice box was removed. She is unable to speak, smell or taste and is required to eat puréed foods. She communicated to me using a note pad. Ms. M is a very strong willed and vivacious woman but she told me that she is often lonely. The inability to speak has all but eliminated her ability to have quality social interaction with others. She does, however, attend community events and religious functions. She is not permitted to drive and depends on friends for transportation. In approximately 6 weeks, however, she will be able to speak for the first time in five years. She had a new medical device surgically implanted in her neck and is currently undergoing vocal rehabilitative therapy with a speech pathologist. Her story has been an inspiration to me. I have made several visits to her home and am always greeted with kindness and warmth. She has also been able to develop relationships with a few of our volunteers with whom she has exchanged mailing addresses.

What have I learned through my interaction with Ms. M and others like her? I have learned that making a positive impact in people’s lives is not as complicated as we may think. A little time, conversation and commitment can go a long way. People helping people, hand in hand along life’s journey! Impacting the world, one person at a time.

July 7, 2010

Building Wells and Writing Senators: Your Support=Lives Saved


Collaboration with charity: water and Living Waters for the World

We are proud to announce that we will be collaborating with charity:water to build three wells in three villages in three African nations: Ethiopia, Liberia, and Uganda. The wells will serve over 1,000 people. The digging of these wells will begin this fall, and we will update you with photos, blogs, and even GPS coordinates so you can follow the development and the life of the villages which will soon have an easier access to clean, safe water.

In the United States, we will be working with Living Waters for the World to install appropriate water treatment systems for families in the Appalachia region. It is estimated that several thousand families within Appalchia are without clean water, either due to lack of reliable water supplies or the fact that their water supply is contaminated. We will commit to ensuring that several of these families will soon have a safe, clean, and a reliable water source for their household needs.

Dear Senators...

Yesterday, we mailed out over 2,322 of YOUR signatures signed at the Brad Paisley H2O World Tour Concerts during May and June for our Senator Paul Simon Water for the World Act of 2009 petition to Senators in Virginia, Missouri, Ohio, Indiana, and Michigan.

We asked Senators Carl Levin (D-MI), Debbie Stabenow (D-MI), George V. Voinovich (R-OH), Mark R. Warner (D-VA), Jim Webb (D-VA), Claire McCaskill (D-MO), Evan Bayh (D-IN), and Richard G. Lugar (D-IN) to sign the Senator Paul Simon Water for the World Act of 2009 as a co-sponsor to advance clean water and sanitation development activities. The Act would provide 100,000,000 people with first-time access to safe drinking water and sanitation on a sustainable basis by 2015 by improving the capacity of the United States Government to fully implement the Senator Paul Simon Water for the Poor Act of 2005.

At the same time, we said thank you to Senators Sherrod Brown (D-OH) and Christopher S. Bond (R-MO) for already co-sponsoring this important bill.

If you would like to call or write your Senator, click HERE to find his/her contact information.

Don't Forget to TEXT H2O to 25383...

If you haven't already, please consider TEXTING H20 to 25383 to donate $10 to go toward building wells in Africa and providing water purification systems in Appalachia. We need your support today. Follow us on Facebook and Twitter, and help us spread the word to raise support and save lives!

Thanks for your action and advocacy for a better, safer world,

JED signature 

Jenny Eaton Dyer, Ph.D.

 

July 2, 2010

by Brittany Latimer
East Tennessee State University: College of Public Health
Namwianga, Zambia

    1.  Learn how to Knit

Most of the older ladies here know how to knit.  I wanted to learn how to knit so I could master this skill during my time here.  Luckily one of my aunts was kind enough to help me get started on this endeavor before I left.  After starting over twice, I am finally making progress and my scarf is coming along quite nicely.  Hopefully it’ll be finished by the time I come back. 

  1. Use your head

A lot of the women here transport their goods on their head.  This is the ultimate etiquette lesson.  The other day when John, Joseph, and I were coming back from Livingstone, we decided to walk the 7 km back to the house.  I had bought some things that were quite heavy so this was not the easiest walk.  After about 1 km, Joseph suggested that I carry the bag on my head.  This worked for about 5 minutes before I convinced them to take a cab. 

  1. Master tying a chitenge

A chitenge is a wrap that is worn around a woman’s waist.  They are also used to tie a baby onto the mother’s back.  Obviously since I don’t have any children I was using it for the former reason.  I am not a girly girl, so having to wear a skirt everyday has been quite difficult for me.  I would much rather wear jeans and a t-shirt, however it is very important to respect the culture.  So as they say, “when you’re in Rome do as the Romans do.”  It is very difficult to tie one unless you have some put onto the chitenge.  Unfortunately I found that out the hard way.  The first day I wore one without the ties, the chitenge constantly kept coming open.  The Zambian women can effortlessly tie them without any ties made and a baby on their back.  Maybe I can get some tips from the women and actually master this before I leave. 

  1. Learn Tonga

In the southern region where I am staying Tonga is the main language spoken.  Many people can speak multiple languages, especially since there are seventy-two languages spoken within the country of Zambia.  I can’t talk the talk, but apparently I can walk the walk.  I say this because I’ve already had a couple people come up to me speaking in Tonga, but all I could do was stare at them blankly.  So far I’ve mastered about five words in Tonga, so I have a very long way to go. 

      5.  Start a family

The majority of the people here get married quite young and start a family almost immediately.  Everyone will ask me questions in this exact order.  1) How many children do you have?  2) Are you married?  This nurse Freddie told me the timeline for getting a spouse, which ironically sounds just like the philosophy that most Lipscomb students follow.  For those of you who don’t know what that is, it is to get engaged by your senior year and married the summer after you graduate.  Well I’m just going to have to nix this step because I don’t plan on accomplishing this before I leave.    

Although I am rather far away from my goal of becoming a Zambian and have quite a lot of work to do in the time left here, I look forward to learning more about the Zambian culture.  I love being able to experience another culture from a first hand perspective.  It has been an amazing experience so far and I enjoy every day of it. 

June 29, 2010

John Deason
Lipscomb College of Pharmacy
Namwianga, Zambia
 

john deason dentist office

As time goes on I am getting more responsibilities in the clinic.  As of late, I have been working with a Zambian dentist named Ba Ian (Ba means Mr. or Mrs.).  He is a wonderfully kind and patient man that is very good at explaining his work.  A small skinny man in stature but hold tremendous respect with his patients; always keeping a smile on his facem, he whistles and tells his patients jokes to keep them at ease.  There is much you can take from his patient-provider interaction. 

He allowed me to assist him in his work, which sadly in Zambia is very simple.  If you have a tooth ache, 9 times out of 10 it a cavity (which gets marked down as chronic pulpitis), and a cavity equals extraction.  So needless to say, Ba Ian often refers to himself as a butcher since he mostly pulls teeth.  In helping him, I have actually pulled some as well.  He likes it if I have a rounded view of the job.  It’s actually no where near as difficult as it sounds (as apposed to the old cliché).  Teeth come out rather easily once you know how to pull; granted Ba Ian only gives me the “easy patients.” 

My chief job in his office is to write down the chief complaint with diagnosis as he goes around checking the patients in the room.  Generally he has four to five patients at a time and interacts with them all at once.  As you can guess privacy isn’t as big for everyone here as it is in the states.  Once he has diagnosed everyone, he gives them each a shot of local anesthetic (generally benzocaine or lidocaine) and has them all wait outside.  He calls them in one by one and does what needs to be done, then has them all wait together again as I collect the medicine they need post-op (which is simply and antibiotic and Panadol, what they call Tylenol).  The biggest reason for me collecting there meds (because they could simply walk to the pharmacy themselves) is that he wants to minimize their overall wait time so they can quickly get home without feeling so dizzy or sick.  Since I have instant access to the dispensary and know exactly what he needs, things go much faster and we can council the patients then and there and send them home knowing they got what they needed.

Besides the clinic, I was able to look in on a rare experience that few Americans get to see.  Sadly, the mother of Ba Leonard (the head cook, but also essentially main person in charge of the estate when the Hamby’s aren’t here) passed while we were here.  It wasn’t a complete shock since she was very old, but the parting was still difficult for the family.  Leonard’s son Harold took over in his stead for awhile.  He is doing a magnificent job.  There is no doubt that we are well fed.

We were invited to the funeral service the following Monday after her passing.  As with many things in Zambia, this service took a long portion of the day.  Throughout the entire time, both in the viewing of the body, traveling to the burial site, and finally laying her to rest, the Kasibi choir (whom I have mentioned in an earlier blog) stayed by her casket and sang church songs in Tonga.  Once the viewing had ended everyone packed into every car available and rode a long way down a rough dirt road to the grave site.  Once we got out (and stretched, since we where in the back of a ford ranger with 9 other Zambians) we walked through a grove of trees and say a large crowd already gathered there singing.  It was simply beautiful.  I’ve said before, everyone in this country was born able to sing and nothing could be more true.  All the men gathered on one side and the women on the other and they formed a large circle around the site.  Every song was in Tonga and in each a four part African harmony.  I’ll never hear the likes of such music again! 

Once the body was buried, which was a task in and of itself since concrete and tin had to be laid upon the casket to prevent any animals from digging anything up, they began speaking in turns.  There was a translator there for our benefit.  The most striking thing said was from one of the church elders.  As he spoke, he said, “Her spirit will not remain on earth as a ghost to haunt us as our grandfathers have taught us.  No, she will go to the place where all spirits go, and that is to heaven with Jesus!  Here at this time you have the choice to accept this or not; accept the truth or choose to believe your grandfathers!”  I was deeply moved at the display of the man’s faith and that here on the other side of the world, God’s people can still be found. 

Once everyone has spoken they began to call those in the family and others that were close family friends to come up and place flowers on the grave.  I was honored to have my named called with the rest of the Americans staying at the mission.  Once the flowers had been placed, a truck (lorry) pulled up carrying a good number of Zambians.  They instantly ran for the grave and began wailing and falling to the earth beating it with their fists.  Some in the crowd joined them.  I had never seen the likes but certainly wasn’t offended by the gesture.  Just as in all other things, it shows the outward expression of emotion that these people display.  I wish more people could be more like that.  It gives great peace of mind to see how someone is feeling so clearly.

After all the wailers stopped, a few personal effects of the deceased were placed amongst the flowers and we parted.  The rest of the day was rather somber.  I was exhausted emotionally along with everyone else and turned in early that night.  I was able to still take in the words the elder said which comforted me greatly.  

The more I see into the lives of these people, the more I find that I love them.  From the kind jokes to cheer a patient to the broken hearted cries in the middle of an African savannah, these people show you sincerely who they are and welcome you into their lives to share in their struggles and joys.  God has greatly touched me with this opportunity to know people so open and kind.  Again, as always, I pray I can do my best to play a role in His great works.

June 28, 2010

Jennifer Hunt
ASPIRE Appalachia scholar
College of Public Health - East Tennessee State University

hunt 2 health fair

Since the start of my internship, I have already experienced so much about health administration from a rural health perspective and have had the opportunity to be involved with some amazing projects that assist the county’s rural population.

My internship is located in Cocke County, Tennessee with Rural Medical Services, Inc (RMS).  RMS has clinical centers located in both Cocke and Jefferson County and serves the surrounding counties.  While the Appalachian region, which RMS serves, is rich in cultural heritage and traditions, it is also often plagued by high levels of poverty and low levels of education.  In April 2010, the Newport Micropolitan Area reported 2,190 people unemployed resulting in a 13.4% unemployment rate, down from the March unemployment rate of 15.7%. According to the most recent estimates from the State of Tennessee, Cocke County has an average high school graduation rate of 61.2%, under the state average of 75.9%; Cocke County also has only 6.2% of the population that holds a Bachelor’s degree or higher.  Cocke County has  a population o 7,426 of 20.6% of its population is below the poverty level.  

My first day at Rural Medical Services (RMS), I was able to attend the both the monthly staff meeting and the Board of Directors meeting.  The staff meeting included all providers from each of RMS’s five clinical centers, along with the CEO, CFO, Operations Director, and the Human Resources Director.  Although RMS is a health system, the clinics are run with an element of autonomy at each center (the CEO jokes that he calls each center his “little fiefdoms”).    In addition to clinical responsibilities, providers are charged with the administration of their clinics.  Reports were given from the Medical Director, the CEO, CFO, and Operations Director.  Following these reports, a roundtable type discussion was held that let each provider from each center discuss any topics with which they were concerned.  An interesting topic that was discussed at the meeting was the passage of the new health care reform bill.  The CEO, as well as other providers, voiced concerns about the impact to their patient population as a results of the bill’s passage.  RMS experienced decreases in patient population with the changes in TennCare, RMS  and is concerned about the effect this bill may have on their patients.   It was stressed that RMS must continue to strive to be patient friendly.

The Board of Directors consists of two representatives from the patient population from each center, the CEO, CFO, Human Resources Director, and the Operations Director.  The Board meeting is run similarly to the staff meeting, but in a more formal matter with a call to order, motions, quorum, etc.  At the first Board meeting, provider patient-visit goals were discussed as well as the bid process for remodeling the Newport Center. It was interesting to learn about the bid solicitation process RMS must go through in order to remodel a facility. 

Another interesting administrative aspect that I was able to participate in was the walk-through of the Chestnut Hill Center remodeling project.  The Chestnut Hill Center is located in Jefferson County, TN across from Bush Brothers, Inc.  In May 2010, Bush Brothers, Inc. bought the facility that housed both the RMS Corporate Office and the Chestnut Hill Center.  As part of this purchase, Bush Brothers offered to relocated the clinic to an old school house located approximately half a mile down the road from the current RMS facility.  Bush Brothers, Inc.  agreed to pay for renovation of the old school to convert it into a brand new health center facility for the patients of the Chestnut Hill.  The new center will contain 7 examination rooms, a nurse’s station, 3 doctor/provider offices and lounge, a clinical laboratory, patient waiting room, billing center, and a procedure room.  RMS will lease the building from Bush Brothers, and Bush Brothers (in addition to paying for the renovations) has forgiven the first year lease payments for the facility.  RMS and Bush Brothers has a long standing relationship in the community and Bush Brothers viewed this remodeling project as a way to give back to the residents of the Chestnut Hill community.

The second week of my internship included helping with the annual RMS Health Fair held at the Lincoln Ave Baptist Church in Newport, TN and La Gran Commision Baptist Church in Morristown, TN.  These health fairs bring a number of services to the community that they would not otherwise have access to such as lab work, physical exams, pap smears, prostate exams, mammograms, eye exams, bone density scans, spinal screenings, and hearing exams in addition to health resources from other area organizations.  All these services are provided free of cost to the community!  Although the fair didn’t start until 9am, many people were waiting in line as early as 6 am to make sure that they could be seen and it was apparent that many of these people relied on this health fair to receive their health care. 

My main project for the summer is to conduct both patient and employee satisfaction surveys.  The patient survey asks a variety of questions to determine the overall patient satisfaction with both their respective clinical center and the RMS system as a whole.  For example, one question asks patients to assess the level of satisfaction of the centers was “Please rate the treatment received at this facility.”  Patients completing the survey rate their level of satisfaction on a scale of one to five, with one being very satisfied and five being very dissatisfied.
           

I have been collecting the surveys periodically since the start of my internship, but the final collection date will be July 1, 2010.  I will record and analyze all the data and will present my findings to both RMS staff and the Board of Directors in a PowerPoint format.  I will also include an analysis of the rating percentages for each facility on a separate handout sheet.  The purpose of this survey is to help the community by showing RMS and the centers what the patient population perceives as most important and will in turn to use this input to identify and implement quality improvement initiatives.

The employee survey is set up in a similar manner, with the goal of the survey being to assess the employee satisfaction at RMS.  I will begin collecting and inputting this data during the week of June 27th, 2010 for a presentation to the staff and Board of Directors at their monthly meeting.  I think that this employee survey will be extremely beneficial to RMS because they have never done an employee survey and it will provide a good indication of the overall morale of the staff. I am anxious to see how my presentation of the survey results to the staff and Board of Directors will be accepted.  I hope the results will encourage staff and providers reevaluate reconsider how things are running administratively within their center.

Subscribe to our newsletter to recieve the latest updates.