Sunday, December 8, 2013

Zuni IHS Community Experiences

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) -
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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