For my Alaska clinical, I was placed at the Municipality of Anchorage in the Department of Health and Human Services. I was mainly in the disease prevention area looking into the active Tuberculosis cases, the recent mumps outbreak, and other trackable diseases. The building also offers other services such as: a vaccination clinic, women's health/STD clinic, Woman Infant Children (WIC), and more. I was with different people during my four days: Robin, Drew, Numia, and Leigh.
Monday, March 12, 2018 - Robin (Public Health Nurse TB Case Manager)
My first day was very informative and started with a tour of the facility, and a rundown of how the PHNs are rotated daily through their roles of: case manager, TB clinic, and TB backup. When in the role as case manager, it is their day to make calls to their assigned patients and make sure their bookwork is up to date. Each PHN is assigned anywhere from 5-7 patients typically. When the PHN is in the clinic role, they are taking the scheduled appointments for that day. As the PHN TB backup they are helping wherever they are needed by answering calls, taking emergent unscheduled appointments, etc. I learned that with both TB infection and disease medications, there is such a wide range depending on the patient. Drug therapy can be from twelve weeks to a possibility of two years, and can be taken once a week or every day. Some clients are able to take their medicine on their own, but the majority are under Directly Observed Therapy (DOT) where they either have to come into the clinic or a Municipality DHHS worker comes to them. The reason for a few different options is to do whatever works the best for the client to ensure they are following their orders. There is one client who will have to be on DOT for two years, so they are starting to let her do video DOT, and she records herself taking her medicine and shows it to the workers. Medication compliance is one of their main struggles which can be frustrating since that is a key factor in stopping the spread of TB. The concept of DOT was newer for me so it was interesting to learn about how people handle their prescription. There was one patient that had come in to get his monthly refills for seven months, and on that seventh month he goes, "I should probably let you know, I haven't taken a single one of these pills." I thought this was just mind-blowing that they had been coming in that many times, yet had not put in any effort into taking the medicine, and the amount of money that was wasted. Due to how the TB program works for Alaska, the client never pays out of pocket, since whatever their insurance doesn't pay for the state will cover.
Wednesday, March 14, 2018 - Numia (TB Medication Delivery)
It was an incredible experience to be able to drive around with Numia to deliver medications. We had 10 people to deliver medication to and it took about four hours, with over 200 miles put on the car. These clients were ranging in all aspects of life, age, social class, ethnicity, etc. One of our clients was a homeless man and we had to go to the Brother Francis Shelter twice and call multiple times to try and find him. We finally found him across the street at Cafe Beans (serves free food for the homeless) and as he came out, we could tell he had been drinking which is not recommended as the medicine is already rough on the liver. The homeless client then said, "I ignored you because I am sick of taking this medicine, is it really even working, or are you all just lying to me." It was sad to hear his doubts with his healthcare team, but also upsetting knowing how crucial for him to be taking his medication to stop the spread in the environment he is in. I had never been at a shelter before and I thought it was sad how many people were around outside, but Numia informed me that this amount was nothing compared to the summer. Also, as we were driving around there were a few homeless shelters that I saw strewn throughout the woods. Being homeless can't be easy, but I feel as though it would be even more difficult in an environment such as Alaska. Numia's job takes a lot of patience and it was really nice getting to spend the day with him and getting to know about his past. Since these clients are taking these medications everyday, Numia is able to spend a lot of time with them. He mentioned that in his role, it is crucial to build a trusting relationship with them and be there when you say you are going to be there.
Thursday, March 15, 2018 - Leigh (Public Health Nurse TB Clinic Lead)
We started the day with a meeting with the three PHNs that work with TB, Bruce the TB doctor at the Municipality, and a few people from the state. This collaborative meeting is held once a month to update everyone with where their assigned clients are at for treatment and disease progression. It was about an hour in length and I think the concept is a really good idea to make sure that everyone is on the same page. There are currently 16 people in Alaska being monitored for Active TB Disease. Leigh informed me that the reason Alaska's amount of TB cases seems high and is ranked number two in the nation, is partly because cases are measured by cases per 100,000 in population. Because of this and Alaska having a smaller population than for example California (5.2 cases out of 100,000 in 2016), it seems that their rate is much higher (7.7 cases out of 100,000 people in 2016), comparing this to the national average of 2.9 cases out of 100,000 people in 2016. Leigh said that this is almost a blessing because it allows them to get more state funding. After the meeting, we were assigned to the clinic room where we refilled a few medications, approved a few people for their clearance card, and started a patient on medication for TB Infection.
Everyone was very welcoming and nice at the Municipality, and they are very dedicated to their work and improving the lives of the residents in Alaska. They cover such a wide range of health, and focusing on preventative medicine is crucial.
Monday, March 12, 2018 - Robin (Public Health Nurse TB Case Manager)
My first day was very informative and started with a tour of the facility, and a rundown of how the PHNs are rotated daily through their roles of: case manager, TB clinic, and TB backup. When in the role as case manager, it is their day to make calls to their assigned patients and make sure their bookwork is up to date. Each PHN is assigned anywhere from 5-7 patients typically. When the PHN is in the clinic role, they are taking the scheduled appointments for that day. As the PHN TB backup they are helping wherever they are needed by answering calls, taking emergent unscheduled appointments, etc. I learned that with both TB infection and disease medications, there is such a wide range depending on the patient. Drug therapy can be from twelve weeks to a possibility of two years, and can be taken once a week or every day. Some clients are able to take their medicine on their own, but the majority are under Directly Observed Therapy (DOT) where they either have to come into the clinic or a Municipality DHHS worker comes to them. The reason for a few different options is to do whatever works the best for the client to ensure they are following their orders. There is one client who will have to be on DOT for two years, so they are starting to let her do video DOT, and she records herself taking her medicine and shows it to the workers. Medication compliance is one of their main struggles which can be frustrating since that is a key factor in stopping the spread of TB. The concept of DOT was newer for me so it was interesting to learn about how people handle their prescription. There was one patient that had come in to get his monthly refills for seven months, and on that seventh month he goes, "I should probably let you know, I haven't taken a single one of these pills." I thought this was just mind-blowing that they had been coming in that many times, yet had not put in any effort into taking the medicine, and the amount of money that was wasted. Due to how the TB program works for Alaska, the client never pays out of pocket, since whatever their insurance doesn't pay for the state will cover.
Wednesday, March 14, 2018 - Numia (TB Medication Delivery)
It was an incredible experience to be able to drive around with Numia to deliver medications. We had 10 people to deliver medication to and it took about four hours, with over 200 miles put on the car. These clients were ranging in all aspects of life, age, social class, ethnicity, etc. One of our clients was a homeless man and we had to go to the Brother Francis Shelter twice and call multiple times to try and find him. We finally found him across the street at Cafe Beans (serves free food for the homeless) and as he came out, we could tell he had been drinking which is not recommended as the medicine is already rough on the liver. The homeless client then said, "I ignored you because I am sick of taking this medicine, is it really even working, or are you all just lying to me." It was sad to hear his doubts with his healthcare team, but also upsetting knowing how crucial for him to be taking his medication to stop the spread in the environment he is in. I had never been at a shelter before and I thought it was sad how many people were around outside, but Numia informed me that this amount was nothing compared to the summer. Also, as we were driving around there were a few homeless shelters that I saw strewn throughout the woods. Being homeless can't be easy, but I feel as though it would be even more difficult in an environment such as Alaska. Numia's job takes a lot of patience and it was really nice getting to spend the day with him and getting to know about his past. Since these clients are taking these medications everyday, Numia is able to spend a lot of time with them. He mentioned that in his role, it is crucial to build a trusting relationship with them and be there when you say you are going to be there.
Thursday, March 15, 2018 - Leigh (Public Health Nurse TB Clinic Lead)
We started the day with a meeting with the three PHNs that work with TB, Bruce the TB doctor at the Municipality, and a few people from the state. This collaborative meeting is held once a month to update everyone with where their assigned clients are at for treatment and disease progression. It was about an hour in length and I think the concept is a really good idea to make sure that everyone is on the same page. There are currently 16 people in Alaska being monitored for Active TB Disease. Leigh informed me that the reason Alaska's amount of TB cases seems high and is ranked number two in the nation, is partly because cases are measured by cases per 100,000 in population. Because of this and Alaska having a smaller population than for example California (5.2 cases out of 100,000 in 2016), it seems that their rate is much higher (7.7 cases out of 100,000 people in 2016), comparing this to the national average of 2.9 cases out of 100,000 people in 2016. Leigh said that this is almost a blessing because it allows them to get more state funding. After the meeting, we were assigned to the clinic room where we refilled a few medications, approved a few people for their clearance card, and started a patient on medication for TB Infection.
Everyone was very welcoming and nice at the Municipality, and they are very dedicated to their work and improving the lives of the residents in Alaska. They cover such a wide range of health, and focusing on preventative medicine is crucial.