Monday, October 8, 2012

Day 3: Chief Andrew Isaac Health Center, Fairbanks

Today I observed a certified nurse midwife who was fantastic! When I arrived to check in at the specialty clinic in the morning, no one was there yet and the midwife I was supposed to observe is actually not in the office until the end of the week. But the physician I was supposed to follow in the Family Birth Center on Thursday and Friday actually works in both the health center and birth floor throughout the week, so that was nice. I met the midwife and she was just collecting information on her patients for the day. She had a patient load of five, so it wasn’t too bad. She said she has her own way of getting the basics of each person’s history and problem and jots that down on a piece of notebook paper with the labs they may need, meds they are taking, and what the main concern is.

The first two women this morning were coming in for their annual wellness exams, which are very important since many have to fly in from the villages. This is the only chance they have to receive care and ask questions, since many health aids in the villages are not certified for specialty care, cannot do labs, etc. Prenatal visits took place for the third and fourth patients. I asked what rates of prenatal care were, and the midwife told me only 38%. Rates of gestational diabetes are exponential in Natives and Hispanics, which I also suspected already. Thyroid problems were also priority on the list, so the midwife made sure TSH labs were ordered on each patient, since abnormal levels can cause depression and decreased milk supply. STD swabs for Chlamydia and gonorrhea were also done. Those were the two standard STD tests done for each patient, but if they wanted additional swabs for HIV, Hep C, etc., they could ask for those. Domestic violence is also asked about by the midwife for each patient.

I asked the midwife about what effect culture has during pregnancy and birth, and she responded that she tries to keep medical jargon out of conversation. She explains things slowly and thoroughly and allows lots of time for education and questions. She said pregnant women cannot have any interaction with bears—art, real bears, pictures, etc., for fear that they tamper with fertility. That was extremely interesting to hear. The midwife made sure there were no bears hanging on the walls in the clinic. I asked about how common home remedies were and she said it varies between providers and patients. Most don’t see the benefit of taking them for health, only as remedies when something is wrong.

Privacy, dignity, and comfort were promoted with each visit. I was astounded by the midwife’s ability to speak so calmly and confidently and ask so many questions. She was very thorough. The assessments were much more thorough than anything I’ve ever seen done before (including in Minnesota). The assessments were holistic, which is very important to these women because they only have the opportunity to receive care minimally, and specialized care is pretty rare in the villages. The midwife went through a full head to toe assessment with each patient.

The midwife stated the women who come in are usually very young, which I noticed immediately. Teen mothers are common. She stated teens need better rates of prenatal care, good nutrition including folate, to stop drugs and alcohol, and notification for LBW (low birthweight) and developing anemia or HTN. She said they are more likely to deliver preterm babies, have low birthweight babies, or have long labors and that the father is not part of the picture. Babies from teens are more likely to die in the first year of life. She encourages teen moms to stay in school or get a GED.

I really learned a lot in a short period of time. The accountability of the staff together as a team was unbelievable. Everything was exactly on time and the nurse consistently anticipated the needs of the midwife, so labs and admission, etc. were all very efficient. The staff was so open and welcome to me shadowing the midwife and they answered questions and actually relayed information to me and allowed me to be a part of the patient’s care. I really appreciated that since I usually feel in the way and a nuisance! I see myself able to work in this setting…. I was very surprised how “health literate” the patients we saw today were, even the ones from the remote villages. I’m sure up towards the North Slope and in the VERY remote villages, they are not as health literate. The midwife told me this was true of the villages she goes to (she was making a visit to one village next Thursday). The patients were very aware of what issues had been priority at their previous wellness visits, what the results of treatments were, etc. They asked lots of questions and seemed to understand what the components of healthy diets were, exercise, etc. All in all, today was a great experience for me and I am thrilled to be able to scrub in on a C-section tomorrow morning!

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