Monday, March 24, 2008

Career, part 3

One of my partners in refugee work, Lance R. and I had written a print and internet guide to cross-cultural care (the state helped with our efforts). We used that as the basis for a book proposal and in 2004 our book, Refugee and Immigrant Health was published by Cambridge University Press. Again, a practical guide to providing care – in this case, to people from other cultures. Even before that book was out I began working with Tao S. and Carrie K. on a book on infectious diseases of refugees and immigrants. Tao (a pediatrician) and I met through our work with refugees and Carrie (a dermatologist) was a volunteer at Agape. Infectious and Tropical Diseases was published by Elsevier Science in 2006. A distinguishing characteristic of this book is the way it cross-references diseases, symptoms, and geographic areas to help clinicians generate a minimum of differential diagnoses. It also is cargo pocket size, so can be carried into primitive areas. Writing these two books so close together – along with working and volunteering – was very tiring to me. Photo: Vatos in the clinic


A little more on Leslie: Who fights harder for humanity than Leslie? I’m not talking about abstract stuff – feelings and beliefs and so on, nor am I talking about the occasional kindness or being a usually nice person (though she is that). Leslie’s battles are real battles – big battles – for real people and there have been many. I’ll name a few, but far from all: Florence Jessie, Sang Van and her family, Lay Rith and her whole huge family, Yann Sorn, Yuon, Amalia Garcia, the woman with rheumatoid arthritis, Maria de la Cruz, James Smith, the Vietnamese man with schizophrenia, Cesar, the Honduran man with typhus, Clarence W. … And how many 100s of thousands of dollars in medical bills has she gotten forgiven? How many people has she gotten a same day appointment at wherever? I wrote on my website something like, “What is it like to be married to a real miracle-worker?” Well, the answer is that it usually is grand – especially when we’re working together. Of course I don’t think of Leslie all the time as a miracle worker. Sometimes I’m irritated, sometimes upset – but in reality, most of the time feeling happy and grateful. And always loved and loving (except when irritated).

Here is what I wrote about Leslie on the website in about 2004: What does it mean to be married to someone who really does do miracles? I can tell you. We started when we were 16 and here we are today, 45 years later. This from the dedication to my book on palliative care: I lay dreaming that I was in an outdoor marketplace, watching a group of musicians set up to play. One by one they began to tune, softly. Then in a soft clear voice, a woman sang the words, "Who knows ... where the time goes ..." and at that moment I awoke and said, "To Leslie." A true vision. Our life of love and growth. Photo: Leslie in her natural habitat

Leslie had a dream in which she had 20 seconds to say who she is: “wife, mother, daughter, spent my life trying to help other people.”

I went back to school and in 2000 was certified as a family nurse practitioner. I continued teaching community health, and once again, integrated my work with teaching. Teaching and practicing at the Agape Clinic has been a wonderful and rewarding phase of my career. Leslie and I were working together again, and together, we took Agape from a Saturday medical clinic to a Wednesday through Saturday operation with these services …

Agape: Overview of Current Services (2006)

There are a number of free clinics doing wonderful work in the Dallas area. What makes Agape unique (locally and nationally) is the integration of comprehensive services in a medically underserved community, at a very low cost.

Primary Medical Care
The heart of all Agape services (and the means by which patients and community become involved in preventive and other health-oriented services) is primary care for people who are sick (5620 patients treated in 2003). Care includes medications, the average retail cost of which is $45.00/patient. Services are delivered by volunteer physicians, nurse practitioners, and students from Baylor, UT Southwestern, and other schools. Health problems treated at Agape include acute illnesses such as pharyngitis, urinary tract infections, and common skin disorders. Chronic health problems treated at Agape include asthma, hypertension, and diabetes. In addition to treating the more common primary care problems we provide specialty care, including pediatrics, dermatology, psychiatry, and women’s health.

Agape is the only site in Dallas providing immunizations on Saturdays year-round. This matters – a lot – because Texas ranks 46th in national immunization rates and Dallas is ranked even lower than Texas as a whole. Immunizations were in place when we started. Photo: Patients waiting in the hall

Community Health
In 2005 Agape has held five mammogram and other (hypertension, diabetes, asthma, etc.) screening events and is scheduled for a childhood vaccination and screening event. Screening is coupled with health teaching and all patients with positive findings receive follow-up. Through Agape’s partner, Baylor School of Nursing, weekly health-related classes are provided for parents at Zaragoza Elementary School (three blocks from Agape), as well as health classes for Zaragoza students. Baylor students also follow-up on complex patients and provide outreach to more isolated patients. Community partners such as Concilio Dallas offer weekly classes on diabetic self care and how to access CHIP and Medicaid.
Social Services
The health problems of many of Agape’s patients are worsened or complicated by a variety of other issues. From teaching people how to use private insurance to assisting people into the healthcare system, patient advocacy and assistance are key aspects of care at Agape.

Professional Education
Agape is a training/clinical and service-learning site for students from Baylor, University of Texas at Arlington, Texas Women’s University, University of Texas Southwestern Medical School, Dallas Theological Seminary, and other institutions.

Spiritual Care
Spiritual or partially spiritual crises identified and treated at Agape include family violence, poverty, injustice, isolation and a host of other chronic stressors. Through Agape’s partner, Creations of Faith, patients find a safe place for fellowship, prayer, Bible study, and therapy. In addition to care provided through Creations, Agape staff and volunteers pray with patients and give other spiritual care.

Community Development
The recent grant awarded by the Dallas Women’s Foundation brings to fruition ongoing work at Agape to advance the health of the community through community empowerment. Agape has a history of recruiting volunteers from the community served by the clinic (the community served thus becomes the community of solution). The Women’s Foundation grant allows us to train promotoras salud (lay health promoters) from the community to teach and assist patients in the clinic and the community.

Community Partners
Providing comprehensive care such as outlined above requires extraordinary cooperation among different organizations. Agape approaches relationships with other organizations from a working perspective (vs. endless meetings, networking, dialoging, and the like). Community partners include:
- The community itself ... rest of list deleted
So that’s it job-wise for me. Leaving the patients, students, Agape, and Baylor behind and looking to the Winds, Glacier, John Muir Trail, Asia. Life has been much richer than what I wrote above, but this was about my career and it has been a good and rewarding one. Photo: Sunrise, 1/1/2008, Big Bend

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