November 18, 2009, 12:42 pm

It Matters Where You Live

cherry_ames_rural_nurseI never read this Cherry Ames book.

It couldn’t possibly be as interesting as working in a hospital!

Nurses were supposed to work in hospitals! Where they would wear their cap! Why on earth would you want to do anything without your cap? Back in 1966 it was the sole reason I was planning nursing school!

(Cut me some slack, I was nine.)

Today, I am in the midst of studying public health. Yes, there is life outside the hospital.

But there was never a “Cherry Ames, Public Health Nurse”. Or so I thought. I was wrong. This is it. Here is the quote from

Cherry, the only nurse assigned to an entire county, uncovers a phony folk medicine production operation using ginseng growing wild in swamp water tainted with harmful bacteria.

Whoa! This was written in 1961 and we have environmental pollution, the potential for infectious disease, pharmaceutical fraud and a million opportunities for patient education! I’d list all the public health nursing interventions involved, but I realize not everyone is as jazzed about public health nursing as I am at the moment.

Thanks to a colleague who gave me an entire collection of the Cherry Ames series, I have this book.

Time to read it!


I actually started this post one week ago – I hate when life gets in the way of blogging. It’s so bad I actually tell myself “I have to blog this!” in my dreams. Not blogging is just not acceptable. It’s like forgetting your underwear, you can’t shake the fact that something is missing! I shan’t allow it to happen again!

I’m not the only one who has been MIA – Change of Shift was supposed to be over at last week, but she is also out of range at the moment!  Hey Emily – make like ET and phone home! Maybe Grand Rounds did her in! Have no fear, the next Change of Shift will be right here next Thursday, so send in those nurse-related submissions!

And if you are in the mood for a great Wednesday carnival, Jenny has Patients for a Moment up at ChronicBabe! It’s a great edition – many, many submissions with fantastic topics. In fact, since I’m sitting here in Starbucks for the first time in ages, I’m gonna read them as soon as I finish this post!


I was part of the USC Annenberg School of Communication and Journalism’s “Health and the Blogosphere” conference/brainstorming session last week.  Bloggers and other health writers were invited to give input on a new professional training program, and I was honored to be a part of that group.

I took away so much more than I contributed. An unexpected focus (for me) was the idea of taking the blogosphere dialog about our own health (“my health”) and expanding that into a discussion about the health of our communities (“our health”).

But haven’t we’ve been doing that for the last year, health care reform having been debated ad nauseam?

Well, no.


We talk about access, the medical home and affording medical care. From screening to vaccinations to treatments for illness and the cost of prescriptions drugs, it’s all about keeping the individual healthy.

We are talking trillions-with-a-capital-T to reform our health care system.

With health care reform, access and education, life expectancy will increase and health disparities will be a thing of the past.



Well, no.

Our health care system looks to remedy problems. Fix them. Change behaviors. Treat illness. Educate.

Reform will mean that everyone is equal. Everyone has access. Everyone covered.

No more health disparities.

A noble and worthy goal.

But it doesn’t address the root cause of the majority of those disparities.


It matters where you live.


All the health care in the world means nothing if your housing is sub-standard, dilapidated and full of lead-based paint.

In neighborhoods full of empty lots and garbage.

All the health care in the world means nothing if you don’t have the means to purchase food (healthy or otherwise) because your job, if you have one, pays nothing and there are no grocery stores in your neighborhood, just liquor stores and fast food joints.

All the health care in the world means nothing if the crime rate in your neighborhood qualifies it as a war zone and you take your life in your hands just walking down the street.

And you can’t get a decent education because what little teaching actually goes on in your underfunded, understaffed neighborhood school is hard to retain when you are going to school hungry. Or watching your back.


It matters where you live.

We will never have true health care reform unless we deal concurrently with social inequities, specifically poverty.

It’s like putting a band-aid on a deficient immune system.

It looks good, but it isn’t really doing much for the patient.


For the record, this is not bleeding-heart “save the world” banter.

I’m not talking hand-outs and welfare that goes on for generations.

I’m talking about providing the basics, the tools that can help raise people out of poverty, the cause of health disparities.

Social justice.

Believe me, I’m all about “pulling yourself up by the bootstraps”.

But shouldn’t we make everyone has a pair of boots, first?


The inspiration for this post is a direct result of a presentation given at USC by Anthony Iton, M.D., J.D., MPH, Senior Vice President of Healthy Communities for the California Endowment: “Beyond Disease: Blogging on Obstacles to a Healthy Society”. Dr. Iton had been the director and county health officer for the Alameda County Public Health Department until September of 2009. I thought this slide was particularly impressive, so I’m including it here:


November 9, 2009, 12:07 am

Domestic Violence – Did I Miss You?

spit:nursepostcard:zwerdling nursing archivesApparently once you remember that tuberculosis is spread by spitting…

You are then allowed to spit.

Reminds me of an incident.

Elderly lady.

Elegant, actually.

Didn’t speak English.

Smiled at everyone she passed.

She smiled at me.

Just before turning her head, clearing her throat and spitting three feet across the hallway.

Then she smiled and continued down to her husband’s room.

I didn’t take it personally. I did, however, feel my jaw hit the floor…

(Postcard courtesy of Michael Zwerdling, RN of the Zwerdling Nursing Archives.)


Emily over at really is CRZE this week! She’s doing Grand Rounds on Tuesday and Change of Shift on Thursday!

Help send her over the edge and get your CoS submissions in! You can send them to me and I’ll forward or send them directly to Emily at “emily at crzegrl dot net”.


Browsing through my October ENA Connection the other day, I noticed the theme was “Government and Advocacy”. Came across an article on domestic violence. It’s a short article, written by Carrie Norman, RN, CEN, member of the Government Affairs Committee. The quotes below are taken from Carrie’s article.

“The CDC estimates that 37 percent of women who sought emergency department care were victims of domestic violence.”

What? 37 out of every 100 women I have triaged?


“Domestic violence victims are more likely to seek treatment for chronic and psychological conditions.”

Okay. But no way have I been taking care of victims of domestic abuse – I mean, hello, wouldn’t it be obvious? The hovering, overbearing abuser who answers all the questions for the patient? The bruises that aren’t explained by the story?

You know, the stereotypical, classic scenario?

“The stress of physical/emotional abuse has been linked to many chronic conditions such as: chronic pain, fibromyalgia, frequent migraines and abdominal and gastrointestinal complaints.”

Well, yeah, I knew that.


I screen them, right? It’s part of triage.

Well, actually I check one of two boxes. Abuse: “Not suspected” or “Yes”.

And unless someone says “He/she hit me”, I check “Not suspected.”

What kind of a screening is that? How can you screen for a problem when you don’t even have to ask the question, you just have to “not suspect” it?


How many women have I missed?

When you came in for the fifth time in a month with abdominal pain for which no etiology could be found and for which you never sought follow up…

Did I miss you?

I’ll never know.

I didn’t ask.

When you presented with migraines on such a regular basis for so many years I got to know you like family…

Did I miss you?

I’ll never know.

I never asked.

When you sat in triage inconsolably sobbing over a skinned knee at 3:00 am because you “tripped in the garden”…

I missed you, didn’t I?

Because I never asked.


“Many women experience some form of violence in their home. I’m here to listen and I may have some suggestions to help.”

Hopefully, there is something we can do immediately.

Or, the patient may not be ready, may not feel it is a safe time to leave.

But, just having someone ask the question and offer resources for when she is ready can let her know she has options.

And give her a sense of empowerment to make the decisions she needs to make.

The bottom line?

Ask the question.

I am.

Should have been doing it all along.

November 3, 2009, 3:53 pm

The Need for Help Hits Close to Home

crime-sceneSam Nouv runs a little donut shop about a mile from my house.

When John was in the hospital, that’s where I bought the donuts for the nurses.

After immigrating to the U.S. from Cambodia in 1987, Sam started working at the shop and by 1990 he owned it (Update via Steve in comments: When he was 13, his parents were murdered by the Khmer Rouge. He spent several years in a displacement camp in Vietnam before finally being sent to the States as part of an entire plane load of orphans).

With the exception of a few holidays, Sam is in the store every morning at 3:30 am and works until 6:00 pm.

Seven days a week.

His wife, Lori, works with him, but she wasn’t there on that Wednesday morning in October.

Thank God.

Somewhere around 4:40 am, the donut shop was robbed. Sam was alone when the assailant entered the shop and he was pistol whipped so badly that he was rushed to Eden Medical Center for emergency surgery to have part of his ear reattached (Update from Steve in comments: “The pistol whipping was so bad that it not only almost severed one ear, but broke the occipital bones around one eye, severely damaged the other eye, and loosened his teeth so that it was more than three weeks before he could eat solid food).

After insurance, the bills for his surgery and health expenses could reach as high as $15,000. Pretty steep for someone who works 15-hour-days to make ends meet. Lori and the kids are trying to keep the shop going until Sam can recover enough to go back to his old schedule.

They need help.

Our friend, Steve Dimick, has helped set up a fund to help Sam and Lori to stay afloat as they deal with their upcoming medical bills. The full story can be found here, at the Castro Valley CARES! website.

Please consider hitting the “Donate” button – and anything, and I mean anything would be appreciated.

Castro Valley is a great community. My husband grew up there, works there and we live so close that it is my community, too. Please consider joining this community, if virtually, by helping Sam keep his business.

They say that charity begins at home. Well, this has hit extremely close to home.

And I want to help make it right.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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