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Health Care in Haiti

NP Students in Leogane, Haiti

NP Students in Leogane, Haiti

On January 12, 2010, a devastating earthquake crumbled Haiti. What little there was to what could be called a health care system before the earthquake was crushed, along with a school of nursing that collapsed with its nursing students and faculty inside. Some tried to remain hopeful that this disaster could herald the development of a better health care system with the rebuilding of Haiti and its health care workforce.

While the health care system is still almost nonexistent, the first family nurse practitioner program in the country has opened with the help of an organization called Promoting Health in Haiti, supported in part by Hunter College and its school of nursing. This visionary initiative promises to build a community-based primary care workforce that focuses on rebuilding the health and wellbeing of individuals, families, and the nation.

Last night on Healthstyles, on WBAI (99.5FM), producer and moderator Diana Mason, PhD, RN, interviewed the president and vice president of Promoting Health in Haiti—Carol Roye, PhD, RN, FAAN, and Carmelle Bellefleur, EdD, RN—about their vision for this initiative, the challenges it addresses, and the future of health care in Haiti. Click here to listen to the program anytime:

Healthstyles is sponsored by the Center for Health, Media & Policy at Hunter College, City University of New York.

Celebrating Youth Food Justice in East Harlem and the South Bronx!

Earlier this summer, people from various New York City organizations came together to celebrate youth food justice and community health projects that were created by local middle-and high-school students.  The event, which was held at the CUNY School of Public Health at Hunter College in East Harlem, was co-hosted by the New York City Food Policy Center, the Children’s Aid Society  and MAChO’s Youth Leadership Program.

Art projects such as a rap about healthy eating, a community mural promoting consumption of fruits and vegetables and a cookbook filled with Dominican Republic favorites modified to be diabetic-friendly were just a few amongst the many projects exhibited by the youth.  This event also showcased a photo-based project that I conducted in collaboration with the Children’s Aid Society and youth from their East Harlem Center.   A technique called Photovoice was used, which is a community-based research method that engages people to capture images of their environment.  It provided an opportunity for the youth to record their own stories around important food issues and empower them to promote positive changes in their own communities in East Harlem and the South Bronx.  Check out a previous blog post that talks more about this community engagement technique.

Every single one of the youth’s photos were auctioned off that night to raise funds for an expanded photovoice project this upcoming year, where we’ll be exploring more about community food justice and promoting youth advocacy around these issues.

This Food Justice PhotoVoice Project highlights the potential impact of collaborations between academic institutions and key community-based organizations such as the Children’s Aid Society, in working together to promote positive and sustainable changes in communities.

Stefania Patinella (Food and Nutrition Programs Director at Children's Aid Society) and May May Leung (Assistant Professor at the CUNY School of Public Health) displaying some of the youth's work.

Stefania Patinella (Food and Nutrition Programs Director at Children’s Aid Society) and May May Leung (Assistant Professor at the CUNY School of Public Health) displaying some of the youth’s work.

youth food justice

Participating youth chatting to each other about their own work.

CHMP Welcomes Dee Burton, PhD as Associate Director for Research and Evaluation

The Center for Health, Media & Policy announces the appointment of Dee Burton, PhD as Associate Director of Research and Evaluation.  

Photo Credit: Ernest Cuni

Photo Credit: Ernest Cuni

Dee Burton joins the Center for Health, Media and Policy as Associate Director for Research and Evaluation. Dr. Burton comes to the CHMP from the State University of New York at Downstate Medical Center where she chaired the Department of Community Health Sciences in the School of Public Health.

Dr. Burton’s most recent research focuses on the use of cell-phone technology to deliver longer-term support to highly-stressed populations.  She developed an Open-Slate model of counseling in which counselors are trained to set aside their own frames of reference in order to better understand a participant within the participant’s own context.  Her first study of this model was in an intervention helping Chinese restaurant workers to stop smoking.  She now is developing an intervention using the same Open-Slate phone-counseling approach for HIV-infected people who smoke.  Dr. Burton also is a co-investigator on a study led by Dr. Steven Levine at SUNY Downstate which aims to develop mobile applications to help stroke survivors and their caregivers in the recovery process.

In earlier media research Dr. Burton conceptualized and conducted research on two models of advertising effects that contributed to an understanding of how tobacco advertising can lead to the initiation of smoking.

Prior to returning to New York, Dr. Burton was associate professor at the University of Illinois at Chicago School of Public Health.  She was inducted into the Delta Omega national honorary society for public health in 1999.  She holds a Ph.D. in personality and social psychology from the New School, with an NCI post-doctoral fellowship in health behavior and promotion with a minor in mass media and communication from the University of Southern California.

Calling All Nurse Writers

Theresa Brown, RN, is an oncology nurse and one of the very few nationally prominent nurse-writers in the areas of nursing and health care.  She on the Center’s Advisory Council and this is her first post as a HealthCetera guest blogger.

Being the “nurse who writes” means I work under a misconception. Although a number of physicians regularly opine on the work they do in books, articles in The New Yorker, and my own home base The New York Times, I’ve never heard the MD-writer combination described as odd or bewildering. However, being an RN-writer is seen as unusual, and my admittedly unusual academic background—I have a PhD in English from the University of Chicago —- contributes to the view that I’m an intellectual oddity among my nursing peers.

But I am not alone in combining nursing and writing. Many nurses will be familiar with Echo Heron’s nursing memoirs and Carol Gino’s The Nurse’s Story. Tilda Shalof, a Canadian ICU nurse, and Patsy Harman, a certified nurse midwife, are both nursing and writing right now, and Harmon’s new novel, The Midwife of Hope River was just released. Saving Lives: Why the Media’s Portrayal of Nursing Puts Us All at Risk, a polemic by Sandy Sommers, RN, MSN, MPH powerfully argues that media stereotypes of nurses dangerously undermine nursing’s professional legitimacy.

These nurses, and I, all write for the same reasons that physicians do: educating the public about how health care works, outlining ways to make health care better, exploring how hard it is to work in a job that often deals with death, or showing what nurses’ clinical work actually involves.

By writing about nursing (or medicine) we learn about the nature of our roles as caregivers and we communicate the importance of that role to readers. In a recent column entitled “Money or Your Life” I wrote for The New York Times, I argued in favor of the Affordable Care Act by telling the story of a patient who wished for a death panel because he had no health insurance and worried that the care he needed to save his life would bankrupt his family. His choice would have been for the government to kill him rather than for his family to become destitute financing his care. Read more

Nursing Students as Writers

Notebook collection by Dvortygirl
Notebook collection, a photo by Dvortygirl on Flickr.

A new writing course for Hunter–Bellevue School of Nursing graduate students got off to a great start this past Thursday evening. CHMP poet-in-residence Joy Jacobson and I will teach the class for the next four and half weeks of Summer Session II. Our immediate goal is to help the students sharpen their skills in writing—scholarly writing, blogging, and narrative writing—and in on-the-job communication. But we also hope to motivate students to invest more energy in their writing by developing a daily writing practice focused on their clinical and personal experience. We’ll supplement this work by close reading of literary and scholarly texts that deal with the experiences of illness and caregiving.

The combination of reflective writing and close reading is an adaptation of the pedagogical approach used in the emerging field of narrative medicine. The mission statement of Columbia University’s Program in Narrative Medicine provides a good introduction to the aims of this discipline:

Narrative Medicine fortifies clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness. Through narrative training, the Program in Narrative Medicine helps doctors, nurses, social workers, and therapists to improve the effectiveness of care by developing the capacity for attention, reflection, representation, and affiliation with patients and colleagues. . . .

(I wrote a previous blog post about a presentation given by the founder of the Columbia program and one of the pioneers in this field, Rita Charon, MD, PhD. An extensive bibliography with links to several publications by Charon and others can be found here.)

We adapted our guidelines for developing a daily writing practice from Writing as a Way of Healing: How Telling Our Stories Transforms Our Lives, a fascinating book by Louise DeSalvo, professor of English at Hunter and leader of a memoir workshop in the MFA Writing Program. (She also blogs at Writingalife’s Blog.) Anyone interested in writing as a means of exploring the self will find sound advice and much food for thought in this book. DeSalvo writes

This book is an invitation to engage with your writing process over time in a way that allows you to discover strength, power, wisdom, depth, energy, creativity, soulfulness, and wholeness. . . . to use the simple act of writing as a way of reimagining who you are or remembering who you were. To use writing to discover and fulfill your deepest desire. To accept pain, fear, uncertainty, strife. But to find, too, a place of safety, security, serenity, and joyfulness. To claim your voice, to tell your story. And to share the gift of your work with others and, so, enrich and deepen our understanding of the human condition.

These are not mere self-help bromides. DeSalvo draws on a growing body of evidence from research conducted by James W. Pennebaker and others that demonstrates the beneficial psychological and physiological effects of a specific kind of writing about disturbing or powerfully emotional events. According to DeSalvo, Pennebaker discovered that “to improve health, we must write detailed accounts, linking feelings with events [the emphasis is DeSalvo’s]. The more writing succeeds as narrative—by being detailed, organized, compelling, vivid, lucid—the more health and emotional benefits are derived from writing.” (Pennebaker’s Web page at the University of Texas, Austin, has an extensive bibliography of his research, with links to free downloadable files. Click on Publications. He is also the author of Opening Up: The Healing Power of Expressing Emotions.)

DeSalvo and others, such as Sara Baker, who facilitates what she calls Woven Dialog creative writing workshops with patients at the Loran Smith Center for Cancer Support in Atlanta, Georgia, and elsewhere, also note an important caveat: this kind of writing practice, especially at the beginning of the process, can stir up strong negative feelings, particularly among those who have experienced real trauma (for example, those who have survived cancer or violent abuse). It’s important not to push oneself too far; or, as Baker writes: “We must not use our work to retraumatize ourselves or put ourselves in danger.”

Baker encourages imaginative writing—using the tools of fiction and poetry to offer what she has called “an oblique route” that may give a survivor of trauma “more freedom to connect with emotional and often buried truths” than the more direct route of memoir would provide. (Sara Baker blogs at Word Medicine.)

At the first class meeting last week, students dove right into a guided writing exercise called “My Least-Favorite Patient or Colleague.” First, each of us made up a list of nouns or adjectives beginning with the letter ‘B’ that described the person we had in mind; then another list of words beginning with the letter ‘S’ that described how that person made us feel; and a third list, of verbs or verb phrases beginning with the letter ‘T,’ that described what we would like to do to or with that person. Then, based on this material, each of us wrote a simple “list poem”—that is, a poem in which each line begins with the same word or phrase (such as “I remember…”). The last line has to have a strong twist or surprise, something like the punch line of a joke. And to cap it off, the title of the poem is written last (and is often humorous or ironic in retrospect). You can imagine how this little exercise got the juices flowing.

Stay tuned. We may be publishing some of our students’ writing on the CHMP blog in August.

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