Month: June 2017

When I had my phone interview for my assignment in Guymon, OK, I was told the patient population there was very diverse.  Now, I had never been to Oklahoma before, the panhandle was especially foreign to me, but I must admit that statement caught me by surprise.  When I arrived, I was surprised again.  Guymon is home to a very large, very diverse immigrant population.  Seaboard, a pork packing and process plant, has attracted an influx of foreign-born workers into rural America.

One of the teachers I met at the YMCA (I try to join a local gym when I can) invited me over for dinner one evening.  Not only did she teach fitness classes, she also taught at the one of the elementary schools.  She discussed with me how much the demographics of the town had changed over the past twenty years and how those changes impacted the local educational system.  For me in the clinic, we treated women from Guatemala, Laos, Eritrea, Ethiopia, Somalia and Sudan.  Most of us who have practiced in any of the major cities have encountered a growing Spanish Speaking Obstetric population especially, however in Guymon, some of the Guatemalan women didn’t speak Spanish, they spoke Keche, a native Guatemalan language.

In addition to negotiating the language barriers, which at times required two interpreters, each culture approached interactions with medical providers in a different way. Some women embraced the historical patriarchal framework of medicine, they did not participate in decision making, said yes to all recommendations, never missed an appointment and seemed genuinely grateful for the care they received.  Others felt our way of practice was rigid, rejected most recommendations and appeared more bothered with our care than appreciative.  For example, on the first day of my second stint in Guymon I was briefed about the patients due in the next month. One patient, by our dating was at least 2 weeks past her due date and refused any intervention.  She arrived to her appointment with me, I again reviewed our recommendations and detailed the possible consequences to expectant management (i.e. wait and see…).  Her husband responded, “it will be fine, don’t worry.”  So I wrote my note, prayed on it and tried not to worry.  And guess what?  It was fine.  She delivered a healthy baby a week later with no complications.  Will this always be the outcome?  Of course not.  However, it reinforced my role in the situation.  My role was to explain the options and then respect her autonomy.

Today we talk to Megan Furnish, one of the staples of the medical community, a labor and delivery nurse turned midwife in Guymon, OK.

1. Tell us about yourself.

Originally from Walsenburg, CO I came to Oklahoma Panhandle State University (a small college in tiny Goodwell, OK just 10 miles outside of Guymon) and started the nursing program. I graduated with my ADN in 2002. During my time at OPSU, I met my husband Jake of 12 years, whom was born and raised in Guymon. We were married in 2005, at which time I also graduated with my BSN. In 2007, we had our daughter Claire followed by our 2 sons Cooper in 2010 and Colten in 2014.

2. How did you decide to go into Nursing? Midwifery?

Starting college @ 17years old I wasn’t really sure what I wanted to do in life, but becoming a doctor had always sounded like a good plan. So my first year of classes were focused on fulfilling the Pre-Med pre-requisites. During this time, I realized the extensive requirements to becoming a doctor. I could not at the time see how these would fit in very well with my goal to get married and have children some day so I decided on Nursing instead. The 2 year program was appealing & it was along the same line as my original plan. I had no idea what it really took to be a nurse or the in’s & outs of this position.

With this being said, I absolutely hated every part of nursing school except for L&D. I probably would have quit but I’ve never been a quitter so this wasn’t an option. I toughed it out and made it my goal to work anywhere I could in L&D. This proved quite challenging because most hospitals want L&D nurses with prior experience and are very reluctant to take on new nurses in this area including the hospital in Guymon. So I drove 1.5 hours to Dumas TX to get my year of experience then returned to Guymon as an “experienced” L&D RN. I went on to complete my BSN in 2005 while also working full time.

As an L&D nurse I got to see the good, bad and the ugly. I was amazed at the variation of care provided by different doctors but one thing always seemed to be lacking, patient autonomy. Very rarely was the patient asked what they wanted their experience to entail, mostly they were told this is what we are going to do. It bothered me…. a lot. “We are going to break your water now” or “You need an epidural”. So as a nurse I strived to make the patient experience as autonomous as possible yet I could only go so far. You see there is great power in a provider saying this “is what you need”, so I decided to go back to school. With two small children (Claire 3 & Cooper 1) going to Medical school was not an option so an online Masters in Midwifery it was.   Another driver to my going back to school was the constant challenge of maintaining OB/GYN providers in our community. Over my years here we have seen 9 delivering providers come & go.

3. How has Guymon changed since you’ve lived there?

Over the 17 years of living in Guymon, I have watched it continue to grow with unique populations of people from all over the world. More and more restaurants and stores are offering diverse foods, products and supplies. Although I did not live here prior to the packing plant, community members frequently converse about the changes Seaboard has brought. Some embrace the thriving growth while others reminisce of the old days.

4. What are the unique challenges and rewards from working with such a diverse population?

The unique population and differing patient cultures are just two of my favorite things about my job. It is so intriguing to me to learn how women & families experience childbirth differently. They bring extreme variations of beliefs around why things happen and who, or what is ultimately in control. The views of religion, hot/cold, witchcraft and superstitions, just to name a few, are huge factors brought to the table when caring for Non-American patients. Sometimes, these beliefs, conflict with, and even contradict modern medicine proving to be quite challenging and eye opening for our practice.

5. Is there anything you wish you would have known or would have done during your training now that you’re in practice?

Having worked with the diverse population here in Guymon for many years as an RN prepared me well for the challenges I would face as a CNM. I have learned to become somewhat fluent in Spanish which has proven very helpful. If there is one thing that I wish I could have learned, it would be to speak the 25 other languages used in our communities 🙂

Sunsets in Guymon:

*** As part of blogging, I will highlight people and places that have been important to my journey.  Here’s my first “interview”.

New Orleans has been a city near and dear to my heart since the spring break my family drove the ~12 hours from Louisville to visit an aging aunt in Tangipahoa, LA and stopped in New Orleans for a few days.  Though at the time I had sights on attending another college, all roads led back to Xavier University of Louisiana.  I made life-long friends during my time there and gained the foundation I needed to be confident about pursuing medical school.  When one of these life-long friends called me upset and crying during my Emergency Medicine Clinical Rotation in September 2005, Katrina became even more real for me.  She was fortunate; she made it out to her family in New Roads, LA.  But, as the nation watched, many had nowhere to go and no means to get out the city.  When I first started doing locums, I attended a conference in New Orleans, where Lt. Honore, the commander of Joint Task Force Katrina, gave a keynote address in which he addressed the helplessness of the people of the city and lack of infrastructure to support them.

Photos from the NAHSE (National Association of

Health Executives Meeting) New Orleans, LA 2015

My goal here is not recount the events of Katrina, but to set the stage for my interview today.  When we discuss the social determinants of health, one of, if not the most important one is education.  For the past eleven years, my friend whom I mentioned above, has worked in New Orleans as a social worker in a nationally recognized charter school.  She is also raising a six-year old, which also challenges her to exam the school system in a different way.

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1. Tell us about yourself.

My name is Patrice Hammond.  I am married and a mother of a beautiful 6 year old girl.  I’m originally from the small town of New Roads, Louisiana (112 miles west of New Orleans).  My first move to New Orleans was in 1998 to attend college.  I lived there for 4 years and moved after graduation.  I moved backed to New Orleans one week before hurricane Katrina (2005) because the city had stolen my heart. I am a school social worker at KIPP Believe College Prep.

2. You were affected by Hurricane Katrina, how did it change your life personally and professionally?

I didn’t know a hurricane was coming because 2 days prior, no one was really talking about it.  I happened to catch the news on a whim Saturday morning before the storm hit.  I have always been terrified of bad weather.  Once I saw the mayor of the city on TV asking people to evacuate, I immediately packed a bag with two days worth of clothes in it (these things don’t last long right? At least that’s what I thought). I went and filled my car with gas.  The lines weren’t long. I made the 90 minute trip to my hometown with no traffic on the road. As the day went on, the predictions became more dire.  Monday the storm hit.  It didn’t seem to do much damage.  People in the city thought they had dodged the big one once again.  Some hours later the levies broke and that’s when all hell broke loose.  The images of the city whose people I loved were horrific. Cell phones were not working. I didn’t know if my friends were alive.  There was so much misinformation about violence.  In my small hometown, there were rumors of New Orleans “refugees” robbing people and it was a lie.  I went to Walmart to get more clothes because the two days worth that I had packed clearly weren’t enough.  My debit card did not work because the banks weren’t functioning.  Although it seemed like a small thing considering I was alive and safe, I broke down and cried. A stranger paid for my things. Finally, I was able to communicate by text messages.  My friends were all alive, although some were evacuated to different states.  Some lost their homes. Others were not as fortunate.

People always question why some choose to stay when there’s a prediction of a hurricane. There are several reasons one must take into account: 1) there have been plenty of predictions about the big one coming and it hadn’t, some people were not convinced 2) evacuating is expensive, especially when your entire family lives in New Orleans thus finding funds at a drop of a dime for hotel, gas, food, etc. is difficult in a poverty stricken city, 3) many people travel by public transportation, therefore many people didn’t have a way to leave.

After Katrina, some suggested rebuilding New Orleans was a waste. Some suggested it was a blessing and the city could be “cleansed” of certain residents.  I was not sure of a career path, but I knew I wanted to help rebuild my city.  After all, New Orleans is so rich in culture.  It’s unlike any city in America.

3. How did you find out about KIPP? How long have you worked there?  What do you like best about KIPP?

During the rebuilding process, I searched for jobs to help others find their way back home and came across an ad for a middle school social worker in April 2006.  That’s it! I thought.  It was hard to find an operating school in the city.  If we build schools, families could come back.  I liked KIPP because they were hands on from the start.  We had to go door to door searching for families.  If a house was standing, we knocked on the door to ask if a 5^th grader lived inside. Teachers helped families move into FEMA trailers and participated in the cleanup of destroyed homes.  KIPP has always been hands on with kids and families.  I have been there 11 years.  My students are my family.

4. As a middle school social worker in New Orleans, what makes you the happiest and what makes you the most disappointed about the education system?

I’m happiest when I see students work through struggles and persevere.  My kids have been through things that no kids should have to experience and their resiliency teaches me so much about life and what is really important.  My first class will graduate college next year, most will be the first in their family to graduate. The thought of it makes me tear up.  I’m beyond proud of the work I do.

The most frustrating part of working in the education system is seeing the disparities and segregation that exist within the public charter school system.  Playgrounds at one public school can look completely different from playgrounds at another.  Some schools don’t have school buses to restrict access to those without transportation. Kids are on an unequal playing field and it’s intentional.

5. For those who are interested in changing the state of our education system in this country, how would you recommend getting involved?

Become a mentor.  Volunteer. Donate time or reading books to your local school.  Kids and families are very relational.  If you can volunteer to become a tutor and spend quality time with a kid, even if it’s one hour a week, it could mean all the difference in the world. It could change a kid’s trajectory.

Resources:

https://www.kippneworleans.org/school/kipp-believe-college-prep

http://generalhonore.com/

https://www.nola.gov/nola/media/Health-Department/Publications/Health-Disparities-in-New-Orleans-Community-Health-Data-Profile-final.pdf

http://www.naccho.org/uploads/downloadable-resources/UPDATED-NOLA-Community-Health-Improvement-Final-Report.pdf

Have I expressed my love of travel?  One of the motivating factors in deciding to work as a locums physician was the ability to have more time to travel.  My friends took two international vacations that I had to decline because I didn’t have enough vacation days!!!  Not only was I disappointed, but as a single woman in my 30’s with no children, and adequate resources, I questioned why did I feel conditioned to delay this type of travel to retirement age.  The days of delayed gratification are over.

After choosing to transition to locums, I also made the decision no longer maintain a permanent residence.  I packed up my apartment (more on that later) then headed off to New Orleans.  I had time to hang out with friends, spend time with my goddaughter and attend a conference that I believe will have a long lasting positive influence on my life.  Next, I flew to Nashville to reconnect with mentors from residency and see my Nashville crew.  Afterward, my mother picked me up to drive me to Louisville.  It’s always good to go home and spend time with family.  My dad then dropped me off in Cincinnati so I could catch a ride to Chicago with one of the homies to hang out and then attend the APHA annual meeting.  After a productive meeting, I hopped on Southwest to go back to the east coast to re-pack, network with contacts in DC and prepare for my trip to Anguilla.  Ahh, Anguilla.  I’m pretty sure I belong there.  I’m pretty sure I’ll go back there soon.  I’m pretty sure I have a future life in the islands…

Having a few months off to travel on my own schedule definitely reinforced my desire to incorporate more travel in my life. I had made the right choice… Living La Vida Locums!

New Orleans, LA, Canal Street

Ahh, Anguilla….