Finding My Niche in Public Health – What I Do in My Day Job

I don’t often talk about what I do – like my paycheck job, the job that pays for food, rent, and children’s college tuition. But today, because it is my biggest and busiest day of the year, I want to talk about what I do. Because I have found my niche — as a nurse in public health working with patient navigators and community health workers.

I have always loved that I am a nurse. I have always worn the title RN or Registered Nurse with deep pride. First because I couldn’t believe I actually made it through school;second because I love the profession. It challenges my weaknesses and gives voice to my strengths.

But though I have always loved being a nurse, I’ve not always been a good nurse. There was the fear factor that I would do something wrong in my early days, there was an insecurity in my skill set, a sense that I still didn’t really know where I fit as a nurse.

While living overseas in Pakistan and Egypt I worked sporadically – private duty cases, teaching childbirth education, and accompanying women during labor and childbirth.

When we moved to the United States I began working as a visiting nurse, going into homes and caring for patients who had just been released from the hospital. I was restless. I knew that clinical nursing was only half the picture of what I wanted to be doing.

It was during that time I made a job change and discovered public health. Public health allowed me to use my clinical skills as well as my creativity in developing programs and presentations to use in communities. I learned more about the big picture of health and why it matters. It allowed me to focus on underserved communities, communities that don’t have as many resources like immigrant and refugee communities, like poor minority communities. I began to understand more about working with people who have the greatest need and where, with the least amount of money, you can make the biggest impact. I ended up specifically working in preventative health screening – breast, cervical, colorectal, and prostate screening. Connecting patients to doctors and clinics so that instead of waiting until a cancer lump grew and the cancer spread, the patient would be screened early; so that instead of coping with chemotherapy and drastic life changes, they would have a minor procedure.

I found my niche in a space where I began educating community health workers and patient navigators, helping them see their natural abilities as valuable and adding clinical knowledge and other skills so they could work in their own communities and effect change. These men and women were bilingual and multicultural, but often without opportunities for higher education they struggled to find a place where those skills mattered.  They are from all over the world and had made their way by various paths to the United States. They hail from Spain and Brazil, Portugal and Dominican Republic; Puerto Rico and China; Bangladesh and Somalia; the Sudan and Haiti. And they are finding their own niche in a country that is far different from the countries and places where most of them grew up.

So today we hold a conference that allows these patient navigators and community health workers to come together and learn, to come together and present what they are doing, to come together and be celebrated, to realize that they are a valuable part of our health care system.

But back to the niche – an amazing thing has happened through this process. I realize that the skills of communicating and negotiating across cultures are used regularly in this job. Those skills I felt would lie dormant and not be used again now allow me to build relationships and connections, encourage and voice understanding of the experiences of both patients and community health workers. Because all of us are outsiders that have gone through the process of adjusting to an unfamiliar world, working to carve out a niche where we can use who we are to make a small difference in the lives of some of the most vulnerable in our communities. 

If you are interested in hearing from some of the people I work with about the amazing work they do take a look at this video that we are showing today at the conference. It’s about 8 minutes long and includes both animation and stories from the community health workers. It was created by my son, Micah.


The Politics of Sick

I sit in a straight-backed chair in the small, sterile examining room at a nearby Urgent Care Clinic, my daughter facing me; her chair softer and more comfortable. A tiny needle from an IV is set securely inside her vein, medicine slowly entering her body, drop by drop by drop. The liquid is deceiving, for though it looks clear it is full of Clindamycin, an antibiotic we know will make her well. Despite the setting we are calm and relaxed – it is a relief to know that we are in a safe place and she is getting good care.

We didn’t know how sick she was. None of us. She arrived in Chicago from Cairo a week ago and came down with a fever and sore throat soon after. My children will tell you that despite (or because of) being a nurse, I am hesitant to go to the hospital, feeling far more confident in the more comforting and lasting value of home remedies and good hot tea than in the sterile but MRSA ridden hospitals of our time. But I also have a sixth sense and though I desperately wanted to be able to home treat, I knew she needed eyes that were objective, a more professional lens.

In a medical system known for it’s bureaucracy we went seamlessly through registration, stopped only by one question: “Do you have insurance?”

And no, my daughter does not.

She has been a student overseas and aged out of the Massachusetts law that says a mother or father can keep their child on their plan until 26 years old.

But. We are in Massachusetts. And so the question didn’t fill us with fear. As first in the nation to undergo tedious and imperfect health care reform we have a system that doesn’t fill us with fear. Yes, there are hoops to hurdle. Yes, it has a long way to go – but when you’re sick and you need care, you show up and a financial counselor walks you through the process, sending your information into a computer system that will come up with an insurance plan you can afford.

At that moment neither of us were thinking about politics, or political affiliation, or socialized medicine, or debates. We were thinking about getting her care, a professional opinion and hopefully medicine so we could be on her way.

When as a nation did we allow politics to co-opt our health, to feed us misinformation about insurance and that terror-producing term ‘socialized medicine’? Truth is the term ‘socialized medicine’ is a made up phrase. It was first heard in the early 1900’s but came into wide use when the American Medical Association fought against a national health insurance plan proposed by President Truman. It conjured images of a hammer and sickle approach to health care that would lead us down the slippery slope to communism. That was in 1947 folks – and it was a public relations coup for in the six and a half decades since that time we have allowed the term to rule us, to be thrown around willy nilly to produce fear and anger, obnoxious and ignorant voices often leading the way.

And as the cry rages around us, people are sick. They are like us. They walk in not knowing how sick they are. They have avoided the emergency room and doctor’s offices successfully, sometimes for years, because they have no insurance. And when they show up, it’s not pretty.

It’s the breast cancer lump that has ulcerated and eaten away the flesh of a breast; it’s the persistent cough, ignored and treated with over the counter cough medicine until it’s so bad that you haven’t slept in weeks; it’s the gnawing indigestion and bloated feeling that you know will just go away only to find that it’s cancer eating away at your colon – fully preventable had screening taken place early in the disease process.

Being sick is not about being Republican or Democrat or Independent or Green Party or Libertarian. Being sick is about being human, living in a fallen world where illness and death and “pre-existing” conditions are a reality. Being sick is not about politics. Being sick is about needing care. Being sick is about the need to be cared for without fear of bankruptcy and debt, without the need to plan a fundraiser to pay the cost of chemotherapy. Being sick will happen to all of us, some time, some way, some how. When will we in the United States get that?

We’re off to the clinic again this morning. And there are still hoops to go through to make sure the insurance goes through. But the hoops are small in comparison and my daughter is slowly getting well.

And today I am all the more committed to doing my part in fighting the politics of sick.

Update: For an in depth look from a woman who was opposed to Universal Health Care, largely because of her stance against abortion, who comes to an appreciation of access for all take a look at this article: How I Lost My Fear of Universal Health Care