Day 8: Recap

This week, I experienced generosity in all encounters. From the start, we were welcomed with open arms. Not only did staff at CIHA welcome us into different settings to observe their practices, but we were invited to some of their most private and sacred places.

While immersed in the Cherokee culture, we were able to improve the health of others through the generous donations we were able to give. They expressed such thanks for the items, and it was very heartwarming to find out how far the donations would go to help children and families. The items are often given to foster families or grandparents who have taken over responsibility of caring for their grandchildren.

With the way the Cherokee healthcare system is designed, this population has every opportunity to be healthier for future generations. Most of the resources they need are so readily available, making it easier for them to take the initiative to promote their health or manage their current conditions. Since being in Cherokee, we have been able to see the vicious cycle that is responsible for this population’s poor health. The main contributors to poor health among the Cherokee is addiction to drugs and alcohol. Addiction has ruined so many lives within this population and change needs to be made for the health of future generations, or the cycle will continue, and individuals and families will suffer.

This week, I stepped out of my comfort zone through being in an environment different than my own. I am such a homebody and I felt very vulnerable being so far from home, amid a culture completely different than anything I have ever experienced. However, I feel that in order to grow and reach your full potential, change is necessary.

Looking back, I remember not knowing what to expect. I was excited to have this opportunity, but I was also very nervous. This experience has changed me in more ways than I could have ever imagined, and it is something I will always carry with me. I have been impacted through meeting so many great leaders who inspire change and have felt refreshed to see a culture put their patients back at the center of healthcare. In my future practice, I will use this experience to be inclusive and understanding towards everyone I meet to provide them with the highest level of care.  

Day 7: CIHA and Cherokee Health

Today, we were back at CIHA for the final time. We began our day in the emergency room, putting the finishing touches on the generous donations we received to be given to children and families in need. It was very heartwarming to see how appreciative they were for the items and to know that they would be making someone’s life a little bit easier.

To finish our clinical day, we were taken to the Kituwah Mound, also known as Cherokee Mother Town. This was where the Cherokee originally settled and is known as a sacred place among their people. It is still used today for sacred ceremonies and has began to be used for new purposes. Often, those struggling with addiction have a very hard time becoming integrated back into society, so they have started a new program called Mother Town. In this in program, residents from the addiction and recovery center come to the mound to work with the land, bringing them back to their roots to help them heal and move forward.

After spending several days in the Cherokee healthcare system, we were able to view several health issues that are prevalent within the Cherokee population. Addiction to drugs and alcohol, diabetes, and obesity were some of the most critical health issues reported by healthcare staff. Healthcare issues within the Cherokee population seem to be most related to culture. In my opinion, one of the most critical issues is substance abuse. To start, the individuals within this population are raised to believe they have no worth, creating issues with their mental health. This low self-esteem combined with trauma and their predisposition to drugs and alcohol contribute to their use. It is very saddening to see the amount of resources they could take advantage of, but don’t because they feel they will never amount to anything, so the vicious cycle continues throughout generations.

One of the main roles of a nurse is to promote the health of individuals and populations. To do this, the nurse must provide individuals with the education they need to help them manage or prevent illness. However, individuals must have the desire to make a change in their lifestyle and feel confident in their ability to care for themselves. This is where the nurse can step in to empower the patient and to provide them with the extra resources or education they may need to be successful.

In this healthcare model, the patient is always at the center of care. Sadly, this is not always the case. As time has gone on, it seems we have lost touch with how to put the importance of caring for the patient holistically as the priority. In providing care for their patients, this culture does something unique. Instead of focusing primarily on their health conditions, such as diabetes or obesity, they place their focus on an individual’s mental health. They feel that if an individual’s mental health is not functioning optimally, none of their other health conditions have the potential to be managed.

Day 6: Mission Children's Hospital

Today, we visited Mission Children’s Hospital. Mission is a 130-bed, only children’s hospital that cares for children until age 18, sometimes longer in special circumstances. Afterwards, we went down the road to visit Reuter Family Outpatient, a clinic that houses every possible service children and their families might need, including orthopedics, endocrine, neurology, and radiology, to name a few. Both the clinic and the children’s hospital service 18 surrounding counties, which blew my mind. Today, what stood out to me most was the obvious love that everyone at Mission had for their jobs. Seeing everyone so excited about being at Mission and wanting more than anything to help the children was infectious.

When looking back at the experience, I can’t help but think about how the children’s hospital here compares to our pediatric offerings back home. I have never had the opportunity to visit the children’s hospital at OSF, but when comparing Mission to Methodist, the size difference is extreme. At Methodist, there are only five pediatric beds compared to the 130 at Mission. The children’s hospital in Ashville also includes several different specialty units, including Pediatrics, NICU, and PICU.

Through touring the children’s hospital, we were also able to see how they are continuously implementing change to promote best patient outcomes. When parents enter the unit, they are required to not only wash their hands, but wipe off their cellphones and place them into a plastic bag to avoid spreading germs. It was also noted that parent satisfaction was decreasing when it came to the way rounding was being performed. In the NICU specifically, the entire healthcare team used to come to the bedside, and it seemed to be very overwhelming for families to have such a large group of people in such a small space. In hopes to increase patient satisfaction, the unit decided they would try something new. Instead of rounding at the bedside, they began bringing the child’s entire healthcare team and the parents to sit around a table to talk, which the parents have seemed to like tremendously.

Hospitalization can be extremely difficult for children and their families. They often have multiple barriers to overcome, including driving long distances to the hospital, having other children they must care for, and balancing their daily life with the desire to be there for their child. To help families during these times, Mission offers a variety of services. Not only do they offer sleep rooms within the hospital, there is a lodge not far from the hospital that families can stay in if they live out of town. The lodge has four different wings, one designated especially for pediatric families so they can be together and bond with one another.

After visiting both Cherokee and Ashville, I feel they were similar, but there were also notable differences. Both towns were very well kept and had numerous restaurants and shops to visit. The population was obviously different, as well as the culture. In Cherokee, the people are given mostly everything for free, unlike the people in Ashville.

Day 5: Kanvwotiyi Treatment Center

To begin our fifth day in North Carolina, we took a tour of the Addiction and Recovery Center that lies within the mountains of the Snowbird community. After our tour, we had lunch in Murphy before heading back to the cabin. Tonight, we attended church service at Macedonia Baptist where we were able to observe family dynamics and Cherokee culture through their sermon.

In this culture, childrearing practices are somewhat different than what we are used to seeing. Addiction is very prevalent within the Cherokee population, causing many of the children to be without their parents. Instead of placing them into the system, they try very hard to keep the children within their families. Sometimes, this means that the children are cared for by their grandparents. This was the common family structure seen tonight at the church. We also discovered that many of the children who were with the parents or grandparents were children they had fostered or adopted.

Within this community, the most respect is given to Cherokee Elders. They are given this respect by other members of their community because of their wealth of knowledge and wisdom. Growing up, they paid close attention to their elders, so they are now able to teach younger generations about the culture and traditions of the past, so everyone looks to them for advice.

The Cherokee people are also known for their high levels of resilience. I feel that this can be most attributed to their self-awareness and knowing who they are and what they want for their lives. This culture is also known for their strength and willingness to always find the best in every situation. Having such a close-knit community as a part of their daily lives also helps to support these individuals in getting through tough times.

Day 4: CIHA

The people of Cherokee always remain at the center of the healthcare system. The healthcare team within the Cherokee health model is set up a little bit differently than what we are used to seeing. On their healthcare teams, they have most of the same team members we are used to seeing. However, the way they work together is different. Working together, you will find the physician, certified medical assistant, case manager, case manager’s secretary, licensed practical nurse, and so on. In our healthcare systems, it is not uncommon to find each of these team members sitting in different places, or even in their own offices. In the Cherokee healthcare system, the entire team sits side by side. In their practices, specifically primary care, are several pods. Within each pod, you will find a team. The CMA sits next to the physician and works directly under their license, continuously reporting to them throughout the day. Sitting directly behind the CMA and the physician are the case manager and the case manager’s assistant. Being together in such close proximity allows everyone to coordinate patient care more effectively.

When someone comes in with a need, they are immediately triaged. The triage system that has been implemented at Cherokee helps staff to identify the severity of an individual’s needs and the steps they should take with the patient in their care plan. It is also important to know how Cherokee an individual is to determine the amount of care they can receive. If they are not from a federally recognized tribe, they can be treated in an emergency, but then they will be transferred to another hospital once they are stabilized. The Cherokee Indian Hospital Authority does not have specialty care units, such as cardiology, neuro, orthopedics, or respiratory, so it may be necessary to transfer someone anyway, depending on their status.

I also found it very interesting to hear about some of the complementary and alternative medicines used within this culture. Within the hospital, there is a complementary inpatient clinic, where patients can receive services such as acupuncture and chiropractic care. It is also common for this culture to use natural remedies to prevent or cure different health issues. There is a root found in nature called the bullnettle root that is used to help infants and children through the teething process. The root is taken from the ground, made into a necklace, and placed around the neck of a child to help dry up secretions and relieve pain. It has proved to be extremely effective and is sometimes left around the child’s neck for several years.  

Day 3: Hospital Tour and Museum

Upon arriving in Cherokee, my first impression was that it was beautiful. Apart from the natural beauty, it was evident that the Cherokee people take pride in their homeland and work hard on its upkeep. Scattered throughout the town were lots of local shops and eateries, and several tourist souvenir shops. We began our day by taking a tour through the Cherokee Hospital, followed by visiting a local museum.

I found it most interesting that this culture was founded on the basis that women were the leaders of the tribes. Throughout history, and even still today, men were typically the ones who led and who were looked to for advice or decision-making. Thankfully, that has changed significantly over the years with the help of women like the Cherokee paving the way.

The Cherokee people are a group of individuals who rely strongly on their values and beliefs. One value they seem to hold of utmost importance is family. Like the Cherokee, my family has always been one of the most important things in my life. I look to my family in good times and in bad and know I can always count on them to have my back.

Integrating their heritage into the children of their community is also something that is important to the Cherokee people. Over the course of time, they discovered their culture was being lost through the generations, especially when it came to their language. They decided to develop language schools, where children attend school just as they normally would, but the curriculum is more language focused. The parents are also involved in this process, as many of them also do not speak the native language of their ancestors. When signing their children up for the language school, the parents are required to sign a contract, stating they will only speak the Cherokee language, even in their homes.

When I look at this community, I can’t help but to think about how it compares to my hometown. I feel they are similar in the fact that my hometown is also a very tight knit community. Not only does everyone know each other in some way, but whether you speak on a regular basis or not, you know you can always count on our community to rally together in times of need, just as the Cherokee people do.

Day 2: Museum to Cabin

Today, my classmates and I visited the Museum of Appalachia before traveling to our cabin in North Carolina. At the museum, we were immersed in the culture of Southern Appalachia through viewing artifacts that belonged to many different Appalachian mountain folk. As we traveled through the museum, we were able to develop a better understanding of what life was like for people during this time.

Before visiting the museum, I had some preconceived notions about how the Appalachian people lived. From being taught about this group in my younger years and through my recent research, I have learned how they are a group of people who live simply and primarily off the land. However, I don't believe I fully understood the magnitude of this concept until I was able to walk through the village. The cabins they lived in and raised large families were smaller than the living room in my apartment. If there was something they needed, they made it instead of going to the store. To me, this is also something that makes this culture unique. Today, we are so dependent on technology and receiving instant gratification, that I believe many of us might not know what to do if we were to become trapped in this type of environment.

One of the most interesting artifacts I encountered was Dr. Osborne's 'Medicine House.' This was a tiny doctor's office in which he spent most of his life, caring for the sick and dying, no matter the time of day. If an individual was too sick to travel, Dr. Osborne would travel to them by horseback. It was said that he never charged his patients for his services, but those who could afford to pay did. This stuck out to me most, because it was evidence of just how much healthcare has changed over the years.