Frontier Nursing University Courier Program, Lexington, KY
On June 6, 2018, I made the twelve-hour trek from northern Pennsylvania to the rural forested region of southeastern Kentucky. When I first told people that I accepted a public health internship in rural Appalachia it is no exaggeration to say that their mouths dropped open. I received many comments about what I would encounter, and I would be lying if I said that I did not have some of the same doubts and concerns that my friends had. In fact, my stomach was turning the entirety of the drive. After arriving, I was settled into a bed and breakfast that also serves as a historic landmark that marks the home of Mary Breckinridge. Ms. Breckinridge is considered the founder of nurse-midwifery and family nursing in America. She established the Frontier Nursing Service (FNS) in 1925 to provide professional health care in the Appalachian Mountains of eastern Kentucky, one of America’s poorest and most isolated regions. Frontier Nursing Service has now evolved into Frontier Nursing University and helps to sponsor the Courier Program that I participated in this summer. Couriers at the start of the program in 1928 rode on horseback to deliver medicine to local health clinics that did not have access to the supplies otherwise. Sadly, to my disappointment, Couriers no longer ride horses, but we are still expected to serve rural health centers like Mary Breckinridge once did.
The first night of the internship, I quickly met the two other Courier interns before we were ushered to a conference called Diversity Impact Weekend for nursing students, nurses, and alumni of the university. The discussion at the conference reflected on the inequalities produced by the healthcare system and how to be culturally aware and open despite these inequalities. The following week, I began working at my primary site which was Little Flower Clinic and I kept the lessons from Diversity Impact about being culturally open to others in the back of my mind (I was in a little bit of a culture shock from the Williams Bubble) as I started my work there. Little Flower Clinic serves primarily the homeless population of Hazard, Ky. I learned that homelessness does not always mean that you do not have a home, but rather if a patient’s bills are considered more than 60% of their income then they are determined to be financially unstable and could lose their home if their source of income is removed. At the beginning of my shadowing, I rotated around different departments of the clinic, but I took a particular liking working with transportation sector as well as in nursing triage with the APRN Allyson Williams.
The transportation sector of the clinic helps to pick up patients in Perry County for their appointments when they request transportation. Patients also are allowed two “non-medical” visits to Walmart or the Post Office every month. While it may not seem exciting to ride along to go pick up patients, I really enjoyed these trips because I got first-hand exposure to the community that I do not think I could have gotten anywhere else. There is no public transportation in either of the two counties that I worked (Perry County or Leslie County). Public transportation continues to remain a huge problem here, and because the community is so mountainous, rural, and stricken with poverty, those that need health care the most often do not have access to it. I often drove with Jerome, who was a long time member of the community and knows just about everyone and everything here. He was very open to sharing his knowledge of the community with me and answering my never-ending questions. Through him, I learned that the Appalachian people have a lot of pride, for better or worse, and are very connected to their faith as well as their family. He told me that the “three pillars” of the community were faith, drugs, and coal; however, this does not mean that the region deserves the stereotype that it is comprised of uneducated, white, poor, drug addicts. It is a region that has been hit hard by layoffs and pay cuts in the disappearing coal industry which has left an increasing rate of poverty in its wake. However, the people here deeply prioritize serving others who need the extra help, which is something special that I have not encountered in lots of other communities I have resided in. I now realize that is just as important to have knowledge of the social and cultural life of the people in a community as it is to know the medicine in order to be able to treat a patient wholly. This is a lesson that I will carry with me as I pursue a career in healthcare and public health.
When I was not with transportation, I was shadowing an APRN. I was particularly touched by appointments of current Vivitrol patients. Vivitrol is a prescription injectable medicine administered once a month used to block opioid cravings. It is non-addictive and it is not a narcotic. Other current prevalent treatments for opioid dependence include suboxone and methadone. These drugs are addictive as they are opioid-based treatments that help to maintain a level of opioids in the body to manage withdrawal symptoms. Vivitrol is more of a sobriety maintenance treatment that helps to prevent relapse by blocking cravings. I was able to talk to current Vivitrol patients about their experience with the treatment, and in all of the patients, Vivitrol seemed to have a positive effect on their life. The more I learned about it the more passionate I became about conducting educational outreach to people about knowing their options for medically treating opioid dependence. I created brochures for Vivitrol that my clinic now displays, and I also created a flyer comparing and contrasting the different methods of medically treating opioid dependence (Vivitrol vs. suboxone vs. methadone) as well. About halfway through the project I interviewed an amazing woman by the name of Deonna. Deonna had been addicted to methadone, was sent to prison, and then drug court ordered the Vivitrol injection series. After she started the injection series, her life literally turned around. She went back to school, got her nursing license, and then later her first job, house, and car. She told me that Vivitrol, and the counseling that is required with the shot, truly changed her life. I was touched by her story and was more motivated than ever to go share with people this option for treating opioid dependence. I created a presentation and knew I wanted to share it with a group of people that are not always thought of for educational outreach and that could benefit from hearing about their options. After some debating, I decided to see if I could present in the Leslie County Detention Center to inmates. I found the Head Jailer difficult to work with; as he gave me a tour of the facility he often made degrading comments and mocked inmates with mental health problem. I almost didn’t go back; but I realized for the inmates, that environment is their reality not just an afternoon like it was for me. There are not many people who advocate for them and after reflection, I was determined now more than ever to go give a kick-butt presentation. I actually rewrote my original presentation so that I could incorporate aspects on how important treating yourself in both mind, body, and spirit is, and to remind the inmates that they are all deserving basic rights. I think so often the prison population is categorized as “sub-human,” but I am passionate that they are still people that deserve basic rights and respect.
Never in a million years would I have thought that I would ever be in a southeastern Kentucky prison presenting in front of a group of inmates about medically treating opioid dependency. I was able to have Deonna accompany me to the presentation and tell her story which brought an element of authenticity that I could never have generated. I ended my presentation by reminding the inmates that they were not alone and that it is ok to ask for help. I reminded them that they are connected to someone and that an important part of beating addiction is a connection to others. By the end, several inmates were crying and the feeling in the room is indescribable to me. I knew after leaving that facility that I had touched (as well as Deonna) multiple people deeply and may have truly saved a life or several.
I am excited that I was able to have this experience while I still have three more years at Williams. Through my time in southeastern Kentucky, I have gained excellent insight into the roles of mid-level healthcare providers, and how these providers practice in rural and underserved areas. My time spent at Little Flower Clinic and community events gave me increased knowledge of public health problems, particularly the opioid crisis, and the lack of resources to combat them in rural areas. Additionally, I learned that people should not be stigmatized because it oversimplifies and overshadows their reality. At the moment, I am unsure as to what career path I want to take in pre-health, but my time in Kentucky has solidified my interest in public health. Furthermore, I know that what want I do eventually should have a component of service to others as this was some of the most meaningful work I have ever done. I am genuinely and truly grateful to the ’68 Center for Career Exploration and the Class of 1974 for making this summer internship possible.