Despite the
small size of the population and the Zuni Health Center, I believe they are
doing very progressive work through community outreach, population health and
the group practice of medicine. I have
shared just short tidbits of some of the amazing opportunities I had the privilege
of being part of during my short time in Zuni.
My last
morning in Zuni, I had a chance to work with Dr. Chris Piromalli in the group
diabetes clinic. A program truly on the
cutting edge of community medicine; what I believe will be the wave of the
future. Moving towards a model of true
individual empowerment accomplished through education and the synergy of
empathy and understanding that you are not alone in your struggle with chronic
disease by engaging with fellow community members facing similar struggles in facilitated
group sessions. For me it was an
absolute honor to be welcomed by all involved with open arms and I’ll certainly
be a better physician for having had this exposure to this model of care and a
chance to hear the stories of struggle and triumphant with a chronic disease
that easily becomes routine in the lives of a primary care physician. I had the opportunity to witness the
transformation of a patient taking ownership and responsibility to begin
Insulin through the sharing of struggles with his Diabetic peers, a daunting
task for this gentleman that had been refused multiple times in the past. This experience was a wonderful end to an
amazing month here in Zuni. In a similar
vein, I had the opportunity to participate in the joyous class of a group of families
undergoing group prenatal session.
The
opportunity to go with Fred, U.S. Public Health Service Nurse, to the Zuni
Prison to meet with patients that were down and out was enlightening and an
honor. This is certainly one of the most
disadvantaged patient populations out there and to have Fred seek them out to
try to help them in times of need was a powerful demonstration of the need for
reaching out to this community to make a difference in a very challenging time
in their lives. Educational and thought
provoking….
I had a
chance to spend time with the program leaders of DIPS (Diabetes in Preventive Strategy) a program for pre-diabetics that
includes exercise, counseling and personalized guidance to try to prevent people
to progressing to diabetes and Healthy
Living a program for those with diabetes to help support them with exercise
and nutritional support in the community.
Zuni, New Mexico is a trial site for the well-known and published
research trial the Diabetes Prevention Program (DPP) - http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram/
I especially
appreciated this opportunity as it is a goal of mine to one day to work with
and perform outcomes research with similar initiatives.
Of all the
experiences, perhaps the most poignant was an experience I had during a home visit
with the Zuni Home Health Nurse. She is
a truly loving person who cares deeply about her patients. She and her patients were so amazingly
welcoming and friendly; they truly made me feel like an honored guest in their
home. One of her regular patients was a
middle-aged woman with depression and advanced diabetes, our major service to
her was filling insulin syringes and arranging her medications in a pill box
for the week. As we struggled to fill
her pill box with a variety of medications, some weekly, some once a day, some
BID/TID, etc. with some obvious confusion about her actual prescribed doses it
hit me just how real the threat of poly-pharmacy is for so many of our
patients. It was powerful reinforcement
of the need to do a better job of being clear and simplifying prescriptions as
much as possible for my patients. The
patient’s functional status and depression was also a major impediment to her
ability to care for herself, really a lesson in treating the whole person when
formulating a treatment plan for a patient.
This experience made a lasting impact on me and will change my future
practice of medicine for the better.
The experiences
and opportunity to interact with the community and the variety of healthcare
professionals in Zuni have undoubtedly made me a better physician.
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