My community clinical placement this quarter has me in a county office with Public Health Nurses (PHNs) who work with resident clients on issues ranging from medication management to Adult Protective Service cases to finding housing for homeless citizens. It's a mixed bag out here across the bridge... that's for sure.
I try to err on the side of staying reasonably mum about my impressions and opinions relating to public institutions, places I'm working, and people I'm working with (with obvious exceptions I am WELL aware of thank you very much!!). Regardless, the internet is a very accessible place! So I'll just say this before I launch into what I have been specifically working on: Marin is an enormously wealthy, predominantly white community. Community Health placements are NOT the same as hospital med-surg floors. Thus, the pace... the energy required for a clinical day... the skills one has to draw from... the challenges one encounters... all very, VERY different than my summer on 14 Long. Dig? :)
Every Tuesday and Thursday morning, I wait for my friend Adam's holler from the street to let him into the garage with his bike. We hop in my car and cross the Golden Gate, watching for the glorious spot where the fog line recedes and the sun shines through. And then we do things like... well... meet up with our third half Kate, and show up at St. Vincent's soup kitchen during lunch service. With a bunch of flu vaccines. We set up right there in the cafeteria and two hours later, we walk out 53 flu vacs lighter.
A day later, we were out in the field at a community health fair. Our medication management booth was adjacent to a homeopath who was providing homeopathic flu vaccines. Intrigued as I was by her claims that she could also reverse autism with her elixirs, I did not bite on the homeopathic hook. Adam, on the other hand, abandoned all training, science, and reason he has ever been motivated by and foolishly accepted her tincture tea concoction. Two sips and a burning throat later, he came to his senses and hightailed it out of there. His EXACT words regarding the incident: "It tasted like tingly burning tree bark... It tasted like regret."
One of our favorite experiences was an orientation to Marin City by one of the PHNs who has worked with the community there for-ev-er. Marin City has about 3,000 residents and was initially a shipyard where African Americans from the South moved to work during World War II. The war ended and work dried up, but the community survived. Today it is situated in some of the most beautiful and highly valued pieces of land on the planet, since it overlooks the Bay and is literally 10 minutes from SF. It is filled with a lot of Section 8 housing, is a designated area of gang activity, and doesn't have a grocery store in its vicinity. It boasts the likes of Jack Kerouac, Annie Lamott, and Tupac Shakur as notable one-time citizens. We desperately want to work with the NP at the health clinic there - but it feels like it has been harder than it should to make that happen so I am not overly optimistic at this halfway point through the quarter.
As I said above, we have a number of PHNs that we can connect with to see if there is something we can go do with them. I knew I found a good fit for me with Sean when I saw a full BDU and weapon picture of him in an indistinguishable desert, a huge bald eagle/American flag picture on his computer desktop, and noted he looks like every middle aged detail guy I ever worked with in DC. LOVE IT! Long story short, he works with a community on Richardson Bay called "Anchor Outs" who live on dilapidated boats that they scrape together or buy for 125 bucks. They are totally at the whim of the elements, and have no direct way to get to shore other than inner tubes or dinghies they have. They have a full on community out there though - there are about 100 boats where some people have lived for years. Every winter there are a few deaths due to exposure. There are good guys and bad guys out there, I'm told, and the bad guys live in (drumroll please) THE BARGE. Lots of drugs happening on the barge. The barge is like... the big bully of the neighborhood. Anyway, Sean invited us to the meeting he had set up with the Police Dept's task force on homelessness. In the meantime, we concocted a plan (and YES, Adam, I'm giving YOU the credit!!) to ask the cops to take us out on their boat so we could offer flu vacs and basic health screenings to the Anchor Outs. We met with the PD this week and they seemed amendable to the plan but have some stuff to sort out first. So FINGERS CROSSED that we will actually get a date set for this endeavor and we can suit up in some scrubs and hop on a boat to give some shots! In the meantime, I am practicing the discipline of "letting Marin be Marin."
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