Volunteer Nurse: A Year of Resistance and Radical Love

JV AmeriCorps member Mary Franz (Boise, ID ’16-17) serves as the Registered Nurse and Outreach Coordinator with Terry Reilly in Boise, Idaho. In our latest AmeriCorps blog, Mary shares her experience discovering the type of nurse she wants to be as she is called to serve, to heal, to advocate, to listen, and to love.

The expectations surrounding a new nurse involve being initiated via night shifts, charting every move you make, and being “devoured” by your elders. There is also the notion that the only “real nurses” are those that work in critical care. This is the standard by which nurses judge each other and are judged in turn. In fact, when you graduate from nursing school, everyone asks you the same question: “Which unit do you want to work on?”

Trying to answer this question throughout my last semester of college, I always found my responses insufficient for two reasons: 1. Not all nurses work on a hospital unit. 2. Nurses do not work for any particular hospital or unit, they serve patients. Service is at the very foundation of who we are as a profession. We are called to serve, to heal, to advocate, to listen, and to love. Those actions are not limited to the hospital; we can accomplish them anywhere.

In resistance to this narrow question, I would ask, “What if I don’t want to be a hospital nurse? What if no unit particularly peaks my interest? What if I don’t want to work the night shift?!”

Hush, you’re a new graduate. You have to gain experience and pay your dues. No one will want to hire you if you haven’t spent time in the hospital.

These pressures from the nursing world were almost too strong to oppose when I graduated last May. My heart screamed “RESIST!” as I scanned the job openings page on the websites for big-name hospitals and medical research centers. Those were the only destinations I could see at the end of the wooded path forged by the new-grad nurses before me, with the lumbering walls of trees on either side asking, “What unit do you want to work on?”

“RESIST!” my heart persisted. I listened. Last May, I stood at the entrance of that path and defiantly turned the other way.

“You’re going to be a volunteer?” questioned onlookers as I packed my bag to become a nurse at a small clinic in Idaho. The idea that I would turn down a hospital position, job stability, and a $50,000/year pay check made me a radical. As a matter of fact, “radical” was exactly the title I wanted to hold when I joined the nursing profession.

Maneuvering through nursing school, I quickly became aware of the enormous injustices in the healthcare system. I saw patients spin through the revolving door of the psychiatric unit and individuals experiencing homelessness sent away into the glacial cold. I witnessed the poor and the vulnerable receive substandard care once providers discovered they arrived without insurance. I interacted with nurses who had become jaded by the flawed systems in place; they no longer felt like they had the power to make change.

In the midst of these ongoing challenges, I found the warm embrace of Public Health. Reading Tracy Kidder’s Mountains Beyond Mountains early on in my education, I was swept away by the radical love of Dr. Paul Farmer:

If you say that seven hours is too long to walk for two families of patients, you’re saying that their lives matter less than some others’, and the idea that some lives matter less is the root of all that is wrong with the world.

Mary Franz (left) with her Boise community mates

It’s a radical notion to walk even an hour to visit a patient. It’s radical to resist the benefits of a hospital nursing position.  It’s radical to think that a nurse can be more than just a bedside caregiver. As I stood in awe of revolutionaries like Farmer, I became more aware of the nurse I wanted to be. I wanted to be a radical. I wanted to be a resistor. I wanted to work for social justice, not a paycheck. Naturally, those desires led me to be a volunteer.

Today, I serve as a public health nurse through the Jesuit Volunteer Corps Northwest AmeriCorps Program at a non-profit, Terry Reilly, which provides access to affordable health care for vulnerable and marginalized people in Boise and  surrounding cities. As a JV AmeriCorps member, I serve a variety of community members including immigrants, refugees, homeless, and low-income families. The majority of my patients do not have health insurance and are receiving primary health care from our organization at a significantly discounted rate.

In comparing my time in the hospital and in the community, I’ve noticed distinct differences in my role as a caregiver. As a public health nurse, I create visions for the long-term health of patients and communities. My goal is not to stabilize or to discharge. It is to empower individuals and communities to make meaningful change and give them the tools and the resources to do so. With this goal, I face extreme challenges because the patients and populations I serve experience disadvantage in ways I am still discovering.

In the United States, gaps in the federally-funded healthcare insurance system and lack of access to affordable private coverage for the working poor have left millions of residents, citizens and non-citizens, without access to health care. When individuals don’t have access to or can’t afford quality health care, many preventable chronic and life-threatening illnesses go undiagnosed and untreated.

“RESIST!” my heart continues screaming. But how do I respond?

For me, these last few months have transformed the word “resistance.” It now suggests something resilient and enduring instead of stubborn and short-lived. I am inspired by the ongoing efforts to resist decisions that disregard the dignity of each individual, that treat healthcare as a commodity and not a human right. It’s not enough that my service as a public health nurse opposes the tradition of new-grad nurses entering the hospital. It ultimately needs to respond in resistance to oppressions and injustices facing vulnerable populations. I must remember to not only undo the damage that prejudiced systems perpetuate, but to build something simultaneously. I have to join the collective counter force of both public health and hospital nurses who are serving, healing, listening, and advocating in the midst of uncertainty. I must continue to love.

Real love is radical because it cannot be earned or unearned. It is connected to inherent dignity – to the idea that everyone matters equally. It is invincible because it is determined to thrive no matter what walls are in place, no matter what scarcity demagogues design, no matter what fear they try to sow. Radical love must persist at the center of a nurse’s resistance. It is the driving force to which we accept the night shift, pay our dues, and become a volunteer. Radical love for our patients, our service and commitment to them despite all opposition, distinguishes our profession.

So, what if we asked different questions of new-grad nurses? What if, instead of pushing them to the hospital, we asked, “Which patient population do you want to serve?” Along with this question, what if we challenged new-grad nurses to consider the type of nurse they want to be? “Will you be a resistor? Will you be a radical?” But most importantly, in moments when patients feel hopeless and afflicted, when forces of injustice seem almost too strong, “How will you show love?”

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More than a Number

Corbin Weaver and James Wykowski (Wenatchee, WA, ’13-’14) serve as Community Outreach Specialists at Columbia Valley Community Health. Together, they have enrolled nearly 1000 people into insurance coverage under the Affordable Care Act (ACA) since November. In this post, Corbin and James reflect on what healthy futures in the context of their service means.

James (left) and Corbin at a CVCH event

James (left) and Corbin at a CVCH event

Corbin (C): I have enjoyed the opportunity to walk with patients through a confusing and frequently scary change in the history of healthcare in this country. The message of the ACA has been pretty doom and gloom in the media recently. However, every day I interact with people whose lives are positively impacted by the law. Many have not received healthcare for years because of their financial situation, others had little options of how to take care of their medical needs and were faced with hard compromises regarding their well-being. This changed for many when they became insured in the new system. It’s uplifting to be able to tell a person who has never had insurance that they can now go to the doctor and they do not have to worry about being bankrupted just to take care of their medical needs.

James (J): The biggest shift caused by the ACA is that nation-wide millions of individuals have the opportunity to access free or low-cost health insurance. While I’m incredibly proud of the work we’ve done, it has been and continues to be a long road to health equity. Despite the ACA’s efforts to increase access to health insurance, our patients still face a number of challenges. Not all are eligible based on their immigration status. The application itself requires advanced financial and technological literacy. Patients picking a health plan who have never had health insurance before have to suddenly understand what a premium, deductible and co-pay are, and are then expected to make an educated decision of what plan fits them best. There have been days, weeks, and even months where it feels like there’s a new barrier around every corner.

Corbin at an enrollment kiosk

Corbin at an enrollment kiosk

C: One major challenge of the enrollment process has been fighting perceptions and myths floating around about the changes in the law. There is a lot of fear of the changes that ACA brings, and many misunderstandings. It can be hard to break through those barriers. What is more, sometimes systematic and structural barriers of the application process are frustrating. The system expects people to be able to use computers and the internet. However, this simply is not reality for many of the patients we see. Sometimes the system and transparency seems to break down when it comes to the population living at the margins in society.

J: At the same time, this is a historic moment in history and I’m honored to be a part of it. I’m continually inspired by the tenacity of patients who come back in week after week to see if their application has finally gone through. We’ve had some major ‘wins’ along the way—patients whose lives will be dramatically changed by the ACA—but we’re also beginning to see more and more patients coming in for check-ups and preventative screenings, and that’s really the gratifying piece. Our healthcare system is badly broken. As someone who wants to spend the rest of my life working in this field, it’s encouraging to see the beginnings of change.

C: What I am taking away most from this experience is the importance of being present and caring about the patient sitting in front of you as a person. It is really easy to get caught up in the “numbers game” of enrollment. For example there are “x” amount of uninsured in Wenatchee and we need to see “y” amount everyday to be successful in our enrollment efforts. But in reality, every day real people with real stories and real concerns walk through the doors of the clinic. Those patients deserve care and attention. Many aspects of the whole process are out of my control, and in many ways I sometimes cannot tangibly do a lot for people other than help them fill out an application. However, intangibly, I feel I am there for support and to ease tensions and fears as much as I am there to make sure “x” amount of people in the valley get healthcare by the end of open enrollment. I could not do that if I did not see the people and situations that sit with me at my desk every day.

James on the day of his first patient enrollment

James on the day of his first patient enrollment

J: Through it all I’ve learned that change takes patience and time. My service this year barely scratches the surface. Sometimes, being an agent for change means digging deep even when you feel like you can’t give anymore. I’m applying to medical school, and while I’d love to spend the rest of my life working on the clinical side of medicine never having to worry about health insurance again, I know that the experiences I’ve had this year will stick with me forever. Each person we serve is more than just a percentage of the poverty level and a list of diagnoses, and they deserve to be treated with dignity and respect.

 

A Journey of Health

During her time as a JVC Northwest AmeriCorps member, Lindsay Poston served as the Health Clinic Coordinator (Gresham, OR ’10-11) and  Patient Navigator and Outreach Specialist (Portland, OR ’11-12) at Wallace Medical Concern. She is now a 2nd year medical student at the University of Chicago, Pritzker School of Medicine. Lindsay notes that she takes “every opportunity to continue serving and learning about those I came to love in JVC Northwest.” Whether by working on a Lakota Sioux reservation or exploring the impact of homelessness on patients in Chicago, Lindsay is turning her experience as an AmeriCorps member into a lifetime of service.

jvcnw.story.lindsay-1.image9217In September I spent two weeks in Peru, working with CerviCuzco, a women’s clinic that provides free pap smears, colposcopies, biopsies, and oncological surgery to the women of Cusco and the surrounding rural Andean communities. Despite the fact that cervical cancer is entirely preventable with adequate screening, it tragically remains a leading cause of death for Peruvian women. Founded by an American physician and run by Peruvian physicians and indigenous support staff, the clinic provides sustainable and culturally specific services to numerous Andean communities, while training American medical students in hopes of developing global physicians.

Women waiting to be seen at the clinic

Women waiting to be seen at the clinic

Some days were spent in the clinic in Cusco, screening urbanites and tending women who had traveled long distances for more complex procedures. Most days, however, were on the road. On rural campaigns, we would drive hours up into mountain villages to be warmly greeted by a coordinating community health worker . . . and every other woman from the village, lined up for a pap smear. We worked until we’d seen every woman who wished to be seen, and then, as our attending American physicians looked on in horror, we students would risk giardia and campylobacter (intestinal parasites and bacteria) for the luxury of table kinship, of sharing a meal with the grateful women we served before heading back to Cusco for the evening.

In the time I was there, our team screened over 300 women for breast and cervical cancer, identifying those who would require follow-up care for lumps and lesions. We were able to reassure countless frightened women who had watched a mother or sister die of cervical cancer, and for those we could not reassure, we were able to explain and support them through the next steps of arranging transportation to the city, providing further diagnostic procedures, and surgeries as needed.

Lindsay caring for a patient

Lindsay caring for a patient

Having worked in free clinics in the US, I thought I knew what it meant to deliver care in a resource-limited setting. But as I stood in the village square, setting up the camping tent and card-table that would be our clinic walls and exam bed, I realized this wasn’t Kansas anymore. When my wastefulness was censured for disposing of – rather than ­reusing—a bloody table cover, I realized just how resourced my free clinics had been. When I asked about the risk of transmitting blood-borne-pathogens like HIV and hepatitis, I learned that these are cultural assumptions I bring to the practice of medicine, that no one in these isolated communities had ever even been exposed to these viruses, and that we really didn’t have enough supplies to be throwing things away just because they have a spot of blood on them.

Although Spanish is the official language of Peru, the majority of rural communities—and many of the most impoverished urban dwellers – still speak Quechua, an indigenous Andean language. So, while I’d worked with diverse Latino immigrant populations in the US and tried my best to learn some Quechua phrases before going, this was a fresh and humbling experience with language barriers in doctor-patient communication. Even with interpreters, I found myself trying to explain the necessity of continuing care for a pre-cancerous lesion – only to discover that in Quechua, there is no word for cancer. At home, there are few weightier words I can say to a patient. In our culture, it stands for so much. Even when we know nothing of etiology or prognosis, it evokes fear, grief, and the uneasy sense that once that word is spoken, life will not be the same. In Peru, speaking to a woman about her diagnosis, the one word that should have carried all her heartbreak was not just weightless – it was non-existent.

The Salkantay Mountain of Peru

The Salkantay Mountain of Peru

I developed hard skills that will allow me to serve women in my local community and around the globe, I expanded my knowledge of Peruvian culture and language, and I was able to contribute to a sustainable movement addressing a serious need in these communities. In retrospect, however, I’d say the truest value arose from the intangibles and unplannables. It was the things that were not there: a paucity of supplies, a conference interpreter who didn’t show up, a language with no word for cancer.  It was challenging an American photographer who did not even ask my patient if he could take her picture, accepting hospitality (against medical advice), and seeing the challenges of founding and funding an international NGO.  Above all, it was taking the time to hear individual’s stories, no matter how many pap smears still stood between me and lunch.