Nursing apprenticeship

28 Apr 2015 18:03

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Thank God for Mo

Mo saw me come down the road into the Western Shoshone prayer camp in southern Nevada. The incessant dusty spring wind cracked my lips. I was dejected and sore after walking the last eighteen miles of what began as a straightforward freight train ride from Cumberland, Maryland. Later, Mo told me she was about to tear me a new one for being a day and a half late, until she got a good look at me.

"Grace," Mo said soothingly, as she helped me out of my pack and shoes, "Soak your feet. You look like you've been through hell." She got me a cup of water to drink and poured hot water into a foot soak basin. "Rest yourself today; you're going to get a piece of my mind tomorrow."

I spent much of the year I turned twenty finding my way to Mo's field clinics and learning from her. Mo worked as an ER and ICU nurse in a small-town Montana hospital, but what she loved was home care, hospice, and running field clinics for people engaged in confrontational politics. She was a gentle, stable role model in my tumultuous life.

Mo and other health workers mentored me as I learned to organize and manage health workers, do basic assessment, care, and education for physical injuries, and provide individual and community care after sexual assault and mental health crisis. I learned by doing and reflecting. During an E. coli outbreak I learned basic epidemiological methods and aggressive rehydration. After a backcountry suicide I learned basic forensics and camp-wide trauma counseling. After a meningococcal meningitis death I learned to work with health departments to do contact tracing and multi-state health-messaging.

Mo has a humble, quiet determination to be a good nurse and to constantly teach non-professional health workers like me. There is something profoundly moral about her ability to accompany people through the turbulent waters of political upheaval and end-of-life care with her simple, practical toolbox: two pillows, a blanket, some water, and non-latex gloves.

Finding a scope of practice

In the late fall of the year I turned 20, I settled in the inner city of Pittsburgh. For ten months, I did free wound-care and lay social work for a small clientele of homeless white men who drank and black women who rented rooms in abandoned buildings around the projects. The next year I organized a neighborhood lay mental health and substance abuse support network. I identified natural caregivers and got us together for regular continuing education, peer support, and meals. The group continues to meet eleven years later. It never incorporated, professionalized, or had its direction set by funders.

In 2005 I worked with Mo again, in New Orleans, where we were among the organizers and founding staff of the city's first post-Katrina civilian health clinic. Called Common Ground Health Clinic, it is now a nine-year-old Federally Qualified Health Center. During our time there, it was the busiest free clinic in the United States (~22,000 patient visits logged in our first year), and was recognized for its high quality of care.

Mo and I guarded the centrality of health education, creative problem-solving, and home visits during our time at the clinic. We dispatched a volunteer carpenter to build a ramp and make other accessibility modifications to the home of a diabetic man who lost his second leg in the storm waters. We sent brown-bag lunches and cleaned the badly roach-infested home of a World War II veteran who lived across the street. We also visited him with oxygen and the clinic's albuterol nebulizer when his asthma required clinical management.

Enduring friendship

In the years since I left the clinic I continued to do health and mental health work inspired by Mo and other mentors. I have enjoyed a privileged freedom of spirit and a court-side seat to significant historical events, but I have also become frustrated by the small-scale, reactive, and difficult-to-replicate models for health work Mo and I helped propagate.

Mo now trains nurse aides in her valley in southwest Montana. We still talk regularly. How can we scale innovative health initiatives without abandoning people's priorities for those of funders? What makes some practices self-propagate while others die out? How could seeking better health save poor people money in the short-term and the long-term? How can health work strengthen political organization, challenge local inequities, and enter local traditions? These are some of the questions we are asking now.

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