June 8

June 8, 2019

This is our last full day here in Cherokee, North Carolina.  I experienced generosity this week through the hearts of some of the wonderful people at Cherokee Indian Hospital.  We were welcomed with open arms and allowed to observe the primary care unit, inpatient unit, and the Emergency Room.  We were gifted the opportunity to watch a live theatre performance of Unto These Hills, a tour through the Cherokee Museum, and a tour through the village.  All of us were lucky enough to be gifted handmade beaded lanyards to hang our badges from and it is something that I will always cherish and remind myself of the generosity shown to us in Cherokee.  This week, even though it was just an observational experience, I learned how a healthcare system can work when it is run for the people that it serves.  We helped the health of others by bringing donations of school supplies, children clothes, and diapers.  The hospital will give these items to the people in need in the community.  This community has begun to trust it's healthcare system but it still has a lot of work to go.  There are still people that are part of the community that do not trust the hospital.  The healthcare concerns for this community are diabetes education and dietary education.  It is important for the youth of this community to also get dietary education and to learn the history of the Cherokee people.  Unfortunately, not all of the youth in the community are learning the ancestral crafts and that means that these unique works of art will not carry on to future generations.  I was out of comfort zone this week while we were observing on the floors at Cherokee Indian Hospital.  It was new and unfamiliar, but I still learned about a wonderful healthcare system.  This has been an experience I will never forget, with people that I will never forget, and I would encourage anyone given the same opportunity to take it as well.

June 7

June 7, 2019

Today was our last day to visit the Cherokee Indian Hospital.  The most critical issues that the culture encounters daily involve the mistrust that occurs with the healthcare system.  It is hard for the people in this culture to trust the system because of all of the awful things that happened to them through the Federal Government healthcare system.  We toured the dental care portion of the hospital today and it is a fully functional dentistry office.  However, it was said that the office does not see the majority of the members of the tribe because of the fear of the healthcare system.  Unfortunately, years ago, Cherokee children were not numbed all the way before procedures and that made those procedures unnecessarily painful.  This has created a mistrust and fear among the older part of the community.  I have observed that some prevalent conditions among the pediatric community here are asthma and obesity.  I have also observed that among the adult community here the most prevalent conditions are obesity and diabetes.  The condition of diabetes is related to the genetics and diet of the Cherokee people.  Unfortunately, a lot of babies in this area are born prematurely and I think that has led to the big number of asthma cases in children.  The nurses at Cherokee Indian Hospital educate the patients about how to handle and prevent illnesses.  There is a native my plate hand out, similar to my plate, that is given to discuss nutrition with children and their families to combat obesity and diabetes.  The nurses in primary care also discuss oral healthcare and they the children toothbrushes, toothpaste, and dental floss during their visit.  The state of North Carolina also has a vaccine program that ensures free vaccines to the children.  This is a great health promotion initiative.  I wish that this model of healthcare, for the people and by the people, could be the status quo across the country.  It is my belief that healthcare is a right for all people and not a privilege.  This is a huge factor with the Cherokee healthcare system, it is the right of their people to receive free healthcare. 

June 4

June 4 2019

The healthcare system in Cherokee North Carolina is run for the people and by the people.  The tribal council works hand in hand with the governing body at the hospital to provide the best care for the registered Eastern Band of Cherokee members.  The members of the healthcare team in the primary care setting at Cherokee Hospital involve pods and in each pod there is a physician, CMA, Nurse/Case Manager, and secretary.  The inpatient healthcare team and ER involve RNs, LPNs, Physicians, CNAs, and social workers.  Anyone can go to the Emergency Room at Cherokee Hospital, but in order to be admitted the patient must be a registered Alaskan Native or Native American.  The tribe pays the healthcare costs for all registered members of the tribe and therefore there is never a charge for the patient, talk about patient centered care!  The culture of the Cherokee Indian does focus on using herbal remedies, but it is said that only specific elders know the exact art of doing it correctly and then they pass it on to the next generation to someone in their family.  For instance, there is a bull nettle root that is used to make teething necklaces for infants that stop them from salivating constantly.  I admire that the Cherokee take care of their own people.

June 6th

June 6th 2019

The Mission Hospital in Western North Carolina, Ashville, is home to the only children's hospital in Western North Carolina.  This hospital serves over 18 different counties.  The fact that this children's hospital is a hospital within a hospital is a unique experience.  We toured the pediatric unit, pediatric ICU, and NICU.  I know that the fact that Mission Hospital services 18 different counties is hard for patients and their families because the patients and families could be driving for hours to come to and leave the hospital.  There is a lodge near the hospital that is has the capability of housing 60 people for the families that have to travel hours to get to the hospital.  The lodge has stocked food and a kitchen for the family to cook in.  This facility applies patient centered care in their primary care facility as well as the hospital.  Reuter Family Outpatient is a wonderful facility that is a one stop shop for the children around and in Ashville.  The clinic even has a behavioral health office, physical therapy, and an office for pediatric assault/neglect.  The facility has started using T.V. goggles for children to watch their favorite movie, as young as three, to keep them distracted during a MRI instead of having to sedate the children.  There are certain procedures that can be done in the office now instead of having to be done over at the hospital and that is great patient centered care.  VCUGs, rectum stretching, and Botox injections for children with Cerebral Palsy are just a couple of the inpatient procedures that can be performed there.  The hospital atmosphere at Mission in Ashville is closer to the hospital system that I am used to back home in Illinois, compared to the hospital atmosphere in Cherokee.  However, Reuter Family Outpatient has a 70% population of pediatric patients that are on Medicaid and unfortunately children in Illinois do not have the opportunity to go to an amazing facility on Medicaid insurance.  I think that the favorite part of my day or the thing that stood out the most to me was the amazing atmosphere at the Reuter Family Outpatient Clinic.  They even have a real bear family that comes to the clinic for the blueberry bushes.  There is a picture of one of the cubs going down the outside slide on the therapy playground.

June 5th

June 5, 2019

Captain’s Log

The idea of family is an essential part of the Cherokee culture, with that being said, when an unfortunate situation arises that involves the separation from a child from their parents the tribe tries very hard to keep the child with family.  Here in North Carolina it is illegal for a Cherokee child to be adopted by a non-Cherokee family.  The unfortunate drug and alcohol abuse circumstances here have put a lot of children being raised by grandparents, great grandparents, or even great-great grandparents.  The individuals that have a lot of respect in this culture are the elders and to be an elder you have to have reached the age of 62 and a half years old.  This applies especially if the person is a female because this is a matriarchal society.  I observed in primary care that a lot of the children that were being seen were there with their grandparents or even great grandparents.  The children here in Cherokee are born at Mission Hospital because there is not an OB unit at Cherokee Hospital.  This is quite a drive for people because it is over an hour away.  The prenatal care can be given at Cherokee Hospital as long as the mother is considered to be a low risk.  The children and the families that have resilience in the community of Cherokee have a strong support system that includes the hospital care offered, the tribe, their own family system, and the ability to come back from tragedies or short comings.  A lot of the people here that are affected by drugs and alcohol are divided from their support system and therefore have less resilience than other people in the Cherokee community.  I enjoyed the tour that we had of the Snowbird Treatment Facility today and I think that it is a great asset to the community members that struggle with drugs and alcohol.  The facility is completely paid for, for the registered members of the Eastern Band of Cherokee.  The facility is secluded because they really want the patients there to be able to focus on their recovery and have the distractions of life get in their way.

June 3rd

Today we went to the Cherokee Hospital, Cherokee Indian Museum, and the Indian Village.  My first impression of the environment in Cherokee is that they want to teach people about their culture and history.  Kayla, the nurse manager at Cherokee Hospital, emphasized that the elders in the community loved to teach interested people wanting to learn about the Cherokee way of life.  I enjoyed meeting Kayla and I enjoyed touring the beautiful hospital.  It is truly a holistic setting that puts the patients need first.   I really liked that the Cherokee people get to be in charge of their health care.  Kayla told us that you had to have Cherokee blood to be treated at the hospital, except in the Emergency Room.  I found most interesting about the culture's history that it is a matriarchal society.  I found it amazing that women were/are treated as equals.  When the British wanted to trade corn and other food they were surprised to find that they had to deal directly with women because women owned the crops in this culture.  I found that the value of family is a similar belief that I share with the Cherokee people.  Kayla told us that when the mother or grandmother becomes hospitalized, that all of her children and/or grandchildren are there in the hospital room with her and that they are rarely every left alone.  I know that I share similar values with that.  The culture is integrated into the children in the community by offering a private school that would immerse them completely into the Cherokee language and culture.  They would go to this school rather than a public school.  The children and the parents have to sign a contract that they will only speak Cherokee in the home.  The Cherokee community is similar to my own community when I was growing up in the sense that everyone knows everyone.  It was said that people would listen on the scanner for medical emergencies of addresses and they would know right away whose house the ambulance was being called to.  People would show up to the hospital in support of the family suffering a traumatic tragedy.  The pictures below are from the Indian Village and show handmade pottery and basket weaving.

June 2

Captain’s Blog Day Two:

Before coming here my perception or knowledge of Appalachia was very limited.  I knew that it was a remote location, but I had no prior knowledge of anything else.  I did find out that Appalachia is a cultural region that stretches from southern New York to northern Alabama and Georgia.  There is also an Appalachian Trail, used for hiking, that stretches from Georgia to Maine.  The Appalachian History Museum was an awesome experience and I would definitely go again.  I loved that the peacocks and other wildlife were very friendly and that you could hear them chattering the whole time we were there.  I also found that the Doc Randall’s Old Medicine Show wagon caught my interest and all of the war memorabilia from the Revolutionary War, Civil War, and World War I were interesting to me.  What also caught my attention was that there was a Dr. Andy Osborne’s Medicine House and the story behind Dr. Andy Osborne is that he spent the majority of his life taking care of the sick and dying people of the Appalachia.  However, when Dr. Andy was dead, the Priest had to provide a suit for him to buried in.  I think that this example speaks a lot about the people in this region because they are selfless, kind, and would give you the clothes off their backs if you needed it.  I think that a highlight of this experience was seeing the surgical and pharmaceutical items from the civil war and knowing that these surgical items were probably used to perform amputations on wounded soldiers to try to save their life.