Nursing Alumni Make a Difference in Their Community
By Ghada Khouri
George Mason students and alumni have been applying these skills not only in the classroom, but also in community clinics throughout the metropolitan area. Through this practical experience, they help provide primary care to people who need it most--the uninsured.
Since a grant from the Kellogg Foundation established the Washington Regional Academic and Community Consortium (WRACC) in 1996, nurse practitioner students and graduates have trained and worked at six community clinics throughout Virginia and Washington, D.C. WRACC is a collaborative effort among George Mason, George Washington University, Inova Health System, Fairfax County Health Department, and local community-based primary care clinics.
George Mason offers five Master of Science degrees in nursing. Nurse practitioners are registered nurses who have an advanced education and clinical training. They typically provide basic health care services in rural areas and inner cities at low or no cost. At a time when medical care is seen as increasingly expensive and impersonal, nurse practitioners have become an essential element of the medical profession.
Much like the medical students in the hit film Patch Adams, they help treat not only the "disease" but also the "person" through a holistic approach, which takes into account the effects of health problems on patients and their families.
The WRACC clinics are unique in that they serve underprivileged, multiethnic, and largely uninsured communities. "It's a necessary service," says Ann Maradiegue, B.S. Nursing '92 and M.S. Nursing '95, who has been working at Bailey's Clinic in Falls Church, Virginia, for the past two years while teaching at George Mason.
Bailey's is one of only three Fairfax County clinics that provide health services to the uninsured. It serves a largely Hispanic community, which also includes Somalis, Pakistanis, and Vietnamese populations.
"I like the patients," Maradiegue says, especially the children who come to see her for help. She particularly enjoys being able to communicate with her patients in their native language¬Spanish. "Most of them don't speak English," she explains. "And many of them have not had health care for a long time or never, so they can be very, very sick."
Bailey's is one of the most crowded WRACC clinics with more than 100 patients coming through its doors every day with ailments ranging from the common cold to serious conditions that require intensive health care. The six nurse practitioners at Bailey's work as a team in handling patients in a facility with only six examination rooms.
"It's a tiny little building, yet so crowded!" says Maradiegue, who sees an average of twelve patients a day. Despite these pressures, she wouldn't have it any other way. Having lived in the Bailey's area for a long time, she relishes the opportunity to give back to her community.
In fact, her responsibilities will soon be expanded to include teaching a health care seminar at a local mosque and church as part of the clinic's community outreach efforts.
Besides their ability to dispense primary health services, nurse practitioners at the WRACC clinics have special skills that often set them apart from other health care providers.
First and foremost is their ability to provide culturally sensitive care and to identify external factors that may have contributed to a patient's health condition. Rather than treating the symptom, they take a holistic approach to health care designed to treat the root causes of a physical ailment.
Karen Black, M.S. Nursing '97, has been working at Mary's Center for Maternal and Child Care in Washington, D.C.
The center serves the largely Latino population of the Adams Morgan area, which also includes a high ratio of African American families. Although the center is generally less crowded than Bailey's, Black deals with issues all too familiar to her colleagues in Falls Church.
As a family nurse practitioner, she works mostly with children and teenagers afflicted with a variety of ailments and personal matters. Often, she finds herself providing counseling whenever medical problems may have been precipitated by emotional stress or cross-cultural problems.
In fact, being "culturally competent" is an essential aspect of her job. For instance, female patients from most Third World countries, particularly new immigrants, are generally reluctant to openly discuss sexually related illnesses. Putting them at ease is thus crucial to ensuring a proper diagnosis and effective treatment.
It is this ability to understand and communicate with patients from diverse cultural backgrounds that makes all the difference in serving multiethnic communities.
A Holistic Approach to Health Care
Nancy Alsace, M.S. Nursing '94, also a College of Nursing and Health Science alumna, has worked at Bread for the City and La Clinica Del Pueblo, both in Washington, D.C., for two years.
Alsace says the patients who visit the clinics are usually "very complicated." They not only come from various ethnic backgrounds and speak different languages, but they also typically suffer from multiple ailments and socially adverse environments.
"We deal with so many different issues," Alsace says. "It's never just about bronchitis or a little rash." She recounts the story of a female patient who recently checked in with a simple case of hypertension, which turned out to be "not so simple after all." The patient had also run out of food and was worried sick about her daughter's abusive boyfriend. Since stress and nutritional deficiency were having an adverse impact on the patient's physical well-being, they had to be addressed.
As is typical at the WRACC clinics, physicians, nurse practitioners, and social workers came together in dealing with this complex case. As a result, the clinic was able to help the woman secure meal tickets and to address the daughter's abusive relationship.
Other cases that may appear to have simple solutions end up causing unexpected complications for the patient. For instance, a foot infection made worse by tight shoes is not so easy to treat when the patient cannot afford new shoes. "A mother can't really afford a new pair of shoes for herself when she barely has enough to clothe her children," she points out.
Some patients end up aggravating their illnesses by overworking themselves, even when a nurse practitioner or physician has recommended house rest as part of the recovery process. "Most of us have [paid] sick days at work," Alsace notes. "But for many of these patients, not going to work means they won't get paid."
The most difficult aspect of the job by far is the daunting task of raising funds for patients with limited means who require surgery or extensive care. "The hardest thing is when you have difficulty accessing resources," Alsace says. "You know the treatment is out there, but it's very expensive and you can't find anybody to do it."
As a result, a patient may at times have to wait up to three months for a simple procedure such as an ultrasound. The clinic's staff usually manages to secure the funds needed for expensive medical treatment, "but there is no telling when the money will become available," Alsace says. In the worst cases, a long wait could mean a worsening of a patient's condition.
"The barriers to medical care are incredible for the uninsured," says Alsace, who recognizes that frustration often goes hand in hand with helping underprivileged communities. Yet, she emphasizes that the rewards exceed any feelings of disappointment each time a patient is successfully treated.
Making a Difference The WRACC initiative "has opened a lot of students' eyes," says Alsace, whose responsibilities include training graduate nurse practitioner students and residents. "Hopefully, it will get them out working with the community and get them genuinely interested in helping populations that are medically under-served."
Through their experiences, Maradiegue, Black, and Alsace are demonstrating that primary health care is no longer dominated by physicians and that underprivileged patients need community-based personalized care.
Because individuals without health insurance often feel powerless in facing a disease, these Mason alumni agree that one of the most fulfilling aspects of their job is the ability to make a difference in someone's life at a time when they feel most vulnerable.