So eventually Josh or Melissa will put some pictures on this site, or at least write an article or two of their own. For now, though, you will all just have to settle with reading my analytical masterpieces... and as always, the actual names of people have been removed from this post and in their place you'll find [job title].
Service Learning in Community Development
Reflection Journal 2: 12/08/08
Monday, I arrived at 11 and left at 1, giving me two hours to view operations on a day which I will not normally be present. However, I felt it was important to attend the clinic because of the stark differences between a Monday/Wednesday and a Tuesday/Thursday. [PharmD 2], a pharmacist who spends two days per week at the Idas Valley clinic, was there and taught [my partner] and me how to enter records into the computer using their software system. As she worked with us, I think we both became aware of a situation that we feel could be improved throughout our service-learning. They are presently trying to move all records onto the computers, a daunting, if not impossible, task. Yet they seem to have been making much progress in terms of entering most of the patients into the software. However, most of the computerized records are not fully updated and many do not contain important test results and prescription regimens. As many of the physical charts are in poor condition, there is a possibility of loss or damage to the physical records and without electronic backup, ill effects could surely follow. As these realizations came to mind, I felt slightly apprehensive. If someone’s chart was to disappear for whatever reason, their health could be in jeopardy. It would fall upon the doctor and the patient to remember the complex drug combinations, and any lack of adherence to a regimen increases the chance of developing resistant strains of the virus. Thus, if we could perhaps work with the clinical staff and develop more computer literacy in regard to the medical filing software, it would speed the transition and enhance the effectiveness in using electronic records. This would lead to an increase in security, confidentiality, and kas;a, as well as providing a safeguard against a possible deterioration in the clinic’s ability to provide appropriate medical services to all who need treatment.
Tuesday was spent mostly in Observation again with [Sister 1]; the last hour was dedicated to entering more records into the computer. [Sister 1] has been the person with whom we have had the most contact and I would say that my conversations with her were the most important aspect of this week. We had discussions on topics ranging from equipment at the clinic to weekend excursions, proving our acceptance more or less into this community. She does her best to be encouraging and informative, and I felt secure in my role and confident in my service following my exchanges with her.
A third “incident” happens all the time, and as such, I will not mention a specific example but rather the general occurrences and associated feelings. Each time a patient’s chart is brought to us, we proceed to gather the necessary information. However, due mostly to the language barrier and also to the limited time we spend with patients, it is hard to develop any sort of dialogue or relationship with them. By the time they adjust to us as new staff in the clinic while we are concentrating heavily on doing our jobs correctly, it is time for them to leave the room. I will not say that it is frustrating, but I do not foresee much interaction with patients other than providing a medical service. Thus, any development project will almost necessarily be geared toward the facility and/or staff.
Routine tasks, simple procedures, and busy work all make up a large proportion of my time at the clinic thus far. I would therefore like to make two comments in this regard. The first is my appreciation of the staff who willingly allows us to participate in their daily work, providing us a hands-on yet limited introduction into medical practice. This works well: we have not been thrust into any situation that is in anyway mentally or physically challenging or risky while still having the chance to learn and work in a clinical setting. These baby steps are a highly suitable approach and the set limits give a structured entrance into our future profession. Proceeding, my second thought on these tasks has been that they provide us with sufficient time to acquaint ourselves with the staff we are helping. Between each patient or observation or chart we engage in small-talk that allows us to develop friendships, ascertain the existing needs and goals of this community, and gain practical knowledge in the realms not only of medicine and community development, but also language acquisition and cross-cultural communication.
We are still very much in the critical contact-making phase of development. Learning is taking place on both sides as familiarity is enhanced. As they get to know us and work with us, each staff member shows more interest in our presence as pertains to academic study as well as community development. If this solidarity increases, I predict they will respond well to any attempts at furthering development we might suggest.
Coming from a medical environment where everything is extremely organized and strictly managed, it is slightly unsettling to see such a specialized clinic operate in such a relaxed way. Some sisters often forget to wear gloves, there are occasionally multiple patients in the room simultaneously, and the condition of the charts and lack of electronic data are examples that alert me to differences between the private, sterile environment in US clinics and this government-funded clinic. In no way am I suggesting that this clinic is doing anything 'wrong' or 'bad,' but differences exist and can often impede adaptation of the community development worker. Thus, a healthy realization of the environment in which one works is, I feel, a good way to begin to get to know and accept the community and it will ultimately help them get to know you.
In the previous postings I mention a certain “community” and would like to provide specific qualifiers and contexts to this oft used term, although none are wholly accurate. The physical locale of our SLCD is the Idas Valley ARV Clinic found in the section of town east-northeast of campus. In strictly geographical terms, following this logic, the community is a site housing a pharmacy and a primary care, ARV, and dental clinic and encompasses all those who travel to this place. In a professional workplace classification, it would denote those doctors, nurses, and other trained personnel who work together as a team in pursuit of a common goal (improving the quality of life for HIV victims). It could refer to the fostered sense of kinship between patients and their caregivers, and could also be extended to include all patients who ever attended the clinic. By examining and combining these last two, one could say that the community extends even further to the surrounding township clinics to include patients receiving treatment from the traveling doctors. Community could also refer in a hierarchical way to include the governing body of the clinic, its source of funding (government), and any inspectors assigned to assess effectiveness. My view, though, scales down the scope in this case to those persons with a vested interest in the day-to-day operations of the clinic. I feel this includes the full-time clinic staff, auxiliary workers including doctors, nurses, and pharmacists who periodically spend time there, and also the patients. I hesitate to include a collective “patient” as part of the community, for there seems to be few commonalities between patients other than their present affliction and view of the clinic as a kind of sanctuary, and if such commonalities do exist, this is neither the setting nor is there the desire to create any solidarity amongst themselves. However, they too have a vested interest in the clinic, and it was established initially for patients and could not exist without them. Also, the workers involved directly with these “patients” (such as counselors, reproductive health workers, and the medical staff) lend to the overlapping of various social fields, which ultimately merge into a community field and as such, patients are included when I speak of the “community.” Individually, also, each patient forms relationships in the clinic and are the members who stand to learn and gain the most.
No comments:
Post a Comment