My reflection about "The Original Patriot"

I have always had an interest in WWII and I often have the pleasure of hearing many stories from veterans through my work, so when I heard about this book I was immediately interested. Chag Lowry’s book about Native American WWII veterans is an interesting book that is well worth reading. Informative, well written and a true treasure, Chag’s book revealed accounts by a population often forgotten and rarely acknowledged. The stories told in this book were fascinating and truly inspiring. The men and women in this book fought bravely for a country who destroyed their way of life, massacred their ancestors, and repeatedly exploited they’re people. The stories are a true example of resilience and perseverance. The attitudes depicted in this book are inspiring and difficult to truly comprehend. When I think about everything the Native American’s went through, I am amazed that some of these men and women chose the path they did. To answer this question Jimmy James stated it best, “We are people who live in a nation. We have our nation inside another nation. We live with our laws and abide by their laws” (Lowry, 2007). After reading this book I researched Native American Vietnam veterans and found evidence of higher rates of PTSD. I assumed I would find historical trauma to be a factor in the higher rates of PTSD however I did not find a lot of supporting information. It is estimated that over 42,000 Native American servicemen were stationed in Southeast Asia during the Vietnam War. This means that per capita, nearly three times as many Native Americans served as non-Natives. What long-term impact would this leave on an already wounded people? According to statistics reported by the National Center for PTSD, Native American Veterans are significantly more likely to suffer the effects of combat-related trauma than are most other veterans. There may be many reasons for this finding. The first reason for this variance may be the way that Native American cultures view war. Traditionally, the warrior in these cultures has been honored; seen as a person who has sacrificed his physical and spiritual well-being for the better of the community. Warriors were often honored upon their return from combat through the use of herbal remedies and traditional healing ceremonies that were used to cleanse and heal the spirit of the warrior prior to re-entering the community. During the Vietnam War, high levels of political and racial tensions in our local area prevented this from happening. Warriors were often returned home one at a time and were faced with hiding their veteran status for fear of attack or retaliation by those who were not in support of the war. Alcohol is a second factor that has made it difficult for most veterans to recover from their combat-related traumas. Alcohol plays a strong role in the culture of military life. Often equating with status, bravery or manhood, in the context of the war, many soldiers began using alcohol as a form of numbing and self- medication. According to the, Report of the Working Group on American Indian Veterans, Native American Veterans faced high levels of racism within their own units and they were often believed to have keen senses and an innate warrior spirit (Shore H. Jay, 2004). This misconception let to a disproportionate number of Native American veterans being placed in highly dangerous positions in the infantry. On returning home, veterans, who had been forced to use alcohol as a tool for survival and protection from their peers, re-entered tribal communities who were already struggling with their own alcohol-related issues. This made for a dangerous, and sometimes deadly, combination, resulting in an alarmingly high level of abuse, violence and suicide. In the video, “Wounded Spirits, Ailing Hearts, PTSD and the legacy of war among American Indian & Alaska Native American Veterans,” by the National Center for PTSD website, they point out difference in treating Native American Veterans with PTSD (National Center For PTSD). This video is very helpful when working in Native Populations as a non-native. Along with western medicine treatments they state that traditional medicine is the best and most effective treatment. In April of 1998, the Department of Veteran’s Affairs reached a memorandum of understanding with the Navajo tribe. The report they had received in 1992, clearly demonstrated that some of the reasons that Native American Veterans gave for not utilizing VA services were as follows:

• High levels of distrust

• Too much red tape

• They wanted to solve their own problems

• Their issues weren’t serious enough to seek treatment

• Didn’t believe the dominant medical model of treatment would work

• Didn’t know services were available to them
• Didn’t know if they were eligible for VA services

• Geographic/ transportation barriers which limited access to services

In response to these findings, the VA forged an agreement with the Navajo tribe to reimburse them for a portion of the costs associated with the use of traditional healing for their Veteran’s. This is monumental, in that the recognition was made on a formal level that there are many ways in which healing can begin to happen for our warriors. I have always enjoyed hearing stories from the past. Being invited to listen to people tell their stories from the past is a honor and a gift. The stories told in ‘Original Patriots’ are powerful accounts from people who were proud to fight for their country, for their land and their dead. For those of us who are not Native the true magnitude of their sacrifice can never fully be understood.

To purchase Chag Lowry's book please visit his website:  http://www.originalpatriots.com/

Bobo, K., Kendall, J., & Max, S. (1991). Organizing for Social Change: Midwest Academy Manual for Activists. Santa Ana, CA: Seven Locks Press.

Wounded spirits, Ailing hearts: PTSD and the legacy of war among American Indian and Alaska Native Veterans. American Indian Vietnam Veterans Project. Retrieved November 13, 2005 from   http://www.ncptsd.va.gov/wsah_bopklet/ws_video.html

Lowry, C. (2007). The Original Patriots. Eureka: Chag Lowry.

National Center For PTSD. (n.d.). Retrieved 2 28, 2009, from Is PTSD different for Native Veterans?: http://www.ncptsd.va

Shore H. Jay, M. M. (2004). The american Indian Vteran and Posttramaunatic Stress Disorder: A Telehealth Assessment and Formulation. Culture, Medicine, and Psychiatry , 231-243.

Footprints

Tonight when I tucked my seven year old son into bed he asked me, "take me to the beach." This may seem like a simple request from a little guy who wanted to go play at the beach but it was much more that that. For the past four months I have noticed my son struggling with anxiety and irritability. More than normal. He also began grinding his teeth at night which may be an indication that he is experiencing some kind of stress or anxiety. He is my sensitive child who is very loving and emotionally driven. He is definitely dramatic. I have been working with him to think positively and have a little perseverance because he often gives up on things if he is not instantly good at the task. This is the complete opposite of my other son who will not give up and is extremely strong willed and determined. I often tell my sensitive child to keep trying, practice makes perfect but it is still a struggle. It can be anything from trying his shoe to riding his bike, he doesn't want to try. Two weeks ago I decided to try a mediation or visualization with him to help him quiet his mind before bed hoping this would decrease his teeth grinding. I began by making sure he was comfortable an then I asked him to close his eyes. I began describing the beach, the warm sand as it tickles our toes, he quietly said," but mom what if there is glass in the sand?" So we moved along the beach with our flip flops until we reached the sand with no glass, and I asked him if he could feel the warm sand and he could, we then ran to the edge of the water and felt the cold wash over our feet, " but mom will the water wash us away?" Assuring him that I would hold his hand we continued on, finally we lay exhausted in the sand feeling the warm sun on our cheeks, he whispers, "but mom we will get sun-burned." I gently remind him that we put on sun screen before we left the house; finally we lay quietly feeling sun as it warms our skin. The next night I asked him if he wanted to go to the beach again and he did but this time I addressed all his concerns so that he could relax and he did. The next night it it was even easier. The thing is tonight he asked me to take him to the beach. He wanted to do the visualization. I hope to keep this going and that it will eventually help him and ease his racing mind so that he can sleep peacefully. The discussion and information provided by Michael in class has been been very helpful. I didn't realize mediation could be done by young children but I have seen that it can and it is helping my son. I appreciate the introduction into different aspects of social work so that we may utilize what speaks to us and incorporate it into our practice, and even into our lives.

The cost of Medicare Part D

On January 1, 2006 congress and the Bush administration created a new program designed to assist Medicare beneficiaries with prescription drug costs. Never before had Medicare covered prescription drugs and as a result of prohibiting the government from negotiating for the best drug prices on the behalf of the 43 million eligible people on Medicare, the Medicare Part D program was placed in the hands of private health insures. A program that was marketed to help seniors and reduce cost actually penalized the most vulnerable group receiving Medicare benefits, the low income and disabled seniors who previously received Medicaid assistance for prescription drugs at no cost, now have to apply for a subsidy and begin paying for their medicines. This population is referred to as the dual eligible’s; Medicare beneficiaries who are dually eligible for Medicare and Medicaid programs. Medicare handled this transition by randomly assigning dual eligible’s to average cost prescription drug plans, most of which do not cover all drugs used by this population. Let me explain in detail how Medicare part D works so you can better understand the impact of this change on this population. Each state offered private insurers and opportunity to implement a Medicare Part D drug plan. Each insurance company could decide which drug they would and would not cover. They would charge a premium for their plan some of which had deductibles and some did not. The plans offered coverage on specified drugs at a co pay amount. The co pay could be as low as $0 to $30 per drug. Premiums varied as well any where from $5 a month to $150. In addition the plans only cover total drug costs up to $2250, and continue to not cover drugs until the out pocket cost reach $5100. Then the plans will again begin to pay a percentage. This is referred to as the “Donut Hole,” a gap in coverage where plans pay nothing but beneficiaries must continue to pay their prescription drug plan premium. Many people did not realize how this worked and how it would affect them. These plans did not count the cost of the drug at the co pay amount, they added the full cost of the drug, so if someone was receiving a 30 day supply of Prozac and paying $30 and the full cost of the drug was $150 for a 30 day supply then the amount added up would be the full price. Many people take drugs that are over $100 for the full price. This means if a person took 6 different medications with co-pays of $10 and a full cost price of $100, the person would be paying $60 but the amount considered would be $600. This means this person would hit the Donut Hole in only four months. Then they would have to pay the full price of the drug until the dollar amount reached $5100. This affected a population which did not qualify for Medicaid but had been utilizing pharmaceutical programs for their medications. Most brand name pharmaceutical companies had offered free medications to folks who where low income but not eligible for Medicaid, however when Medicare adopted Part D these programs discontinued, forcing people to join a drug plan they could not afford.

The recently passed Health Care Reform bill has many similarities to the poorly designed Medicare Part D program. Although this bill will help many people who were previously without health care, it is not a public option and ultimately puts millions of dollars into the hands of insurance companies. Jon Walker from firedoglake which is a progressive political website writes about this issue in his blog here is the link:
http://fdlaction.firedoglake.com/2010/03/15/democrats-who-once-railed-against-medicare-part-d-now-insist-members-must-vote-for-strikingly-similar-senate-health-care-bill/.
With the bill now in place there are a few improvements for the Medicare Part D program. For seniors, the bill will immediately expand the Medicare drug benefit and, effective July 1, provide a 50 percent discount on brand-name drugs for the low-income elderly and the reconciliation package (a revised section of the bill)would also gradually close the gap known as the "doughnut hole" in Medicare prescription drug coverage, which leaves many seniors to pay the full cost of expansive medications. Ultimately I would have liked to see a public option which would have forced insurance companies to lower their costs. In our current capitalistic society it will be a monumental day when every American can share the same health care coverage, and bills are not influenced by lobbyist with bottomless packets. Here is one more link to another blog from Jon Walker providing some food for thought:  http://fdlaction.firedoglake.com/2010/04/27/reduce-the-deficit-by-expanding-medicare-not-cutting-it/ .

Oscar the Cat

This is an interesting story that made it's way around the office last year so I thought I would share it. In 2007 Dr. Dosa a geriatrician and assistant professor at Brown university publicized and article in the New England Journal of Medicine describing cat named Oscar and his ability to predict death. During the time this article was written in 2007 Oscar had predicted at least 25 deaths in the nursing home where he lived in Rhode Island. Since then he has gone on to predict 50 cases by curling up with a resident in their final hours. I love animals and have seen the power of their presence in patients homes, but I can’t help being a bit suspicious. Maybe the staff is placing the cat into the pt’s bed in their final hours. Dr.Dosa’s book describes an instance when staff place Oscar on a resident’s bed and the cat ran out and went to another bed. The resident that the staff thought needed Oscar died two days later and the resident Oscar visited died that night. Dr.Dosa and the staff in the nursing are convinced of Oscar’s accuracy and even alert family members if Oscar is visiting their loved one. The staff report that Oscar is not a social cat and spends little time with the residents who are not dying. If Oscar is left outside the door of a dying resident he will scratch on the door until he is let in. In Dr.Dosa’s book “Making rounds with Oscar: the extraordinary gift of an ordinary cat”, he offers no scientific explanation for Oscar’s behavior. Dr Dosa suggest that possibly Oscar can detect ketones, the distinctly-odored biochemical given off by dying cells, apparently dogs also have the ability to smell ketones. With no scientific proof one may be skeptical, but as we all know there are many things in life that cannot be scientifically explained.

Henry, R. (2007, July 27). oscar the cat predicts parients' deaths. Retrieved April 30, 2010, from Washington Post: http://www.washingtonpost.com/wp-dyn/content/article/2007/07/27/AR2007072700578.html

Pet Peace of Mind

 In recent years the interest and study in the field of animal assisted therapy has grown dramatically. Many hospices and acute care facilities are integrating animal assisted therapy into the services they provide. The most common trend in hospice is the utilization of their large patient care volunteer staff to bring animals to visit the terminally ill patients. Many hospices have found this to be therapeutic for the patients by reducing stress and anxiety as well as decreasing depression. Therapy animals can also be a source of comfort for family members following the death of a patient and be a tool in bereavement counseling. Personally I have seen the benefits first hand, one example that comes to mind is a patient who had severe dementia and was extremely anxious. She refused to get out of bed and would not let the nurses help with personal care which she desperately needed. One of the nurses happen to bring in her dog and the woman immediately lit up. She got up and sat for a long time petting the dog and after a while she was able to allow the nurse to assist her, after that the dog became a part of the care plan and visited this patient every time the nurse did. For many patients one of the biggest areas of concern is what will happen to their pet when they die. It is important for the hospice social worker to discuss this with the patient and family and make a plan about where their pet will go after they pass. In addition to this worry patients commonly have a difficult time managing the care needs of their pet. As patient’s decline it is increasingly difficult for them to schedule and arrange vet care or grooming appointments, or keep up with pet supplies and maintenance such as feeding and cleaning liter boxes. A nationally recognized program started in Tulsa Oklahoma by a hospice chaplain and former veterinarian Delana McNac called Pet Peace of Mind helps ease pet concerns for terminally ill patients and their families. Pet Pace of Mind assists hospice patients who are unable to maintain appropriate routine health care and nutrition for their animal companions due to medical expenses or caregiver disability. Locally Hospice of Humboldt has begun a Pet Peace of mind program as well. Pet Peace of Mind allows patients to complete their end-of-life journey without worrying about their pet's current or future needs. Services include providing food and litter, volunteers to help with pet care and grooming, routine medications, vaccinations and routine veterinary visits, boarding or foster care during emergencies and guidance in finding new homes for pets when the time comes.

Hospice of Green Country, Inc. (n.d.). Retrieved April 30, 2010, from Pet peace of mind.org: http://www.petpeaceofmindtulsa.org/

Hospice social work

I thought I might share a little about what hospice is and my role as a hospice social worker. Hospice is a fairly new movement in the health care industry. Originating in the nineteenth century in Dublin, the Roman Catholic Sisters of Charity pledged to provide a clean, supportive environment for care for the terminally ill. In the 1960s, a British physician, Cicley Sauders founded the first modern hospice, St. Christopher’s Hospice in London, England. (Kastenbaum, 2002) The first hospice in America, the Connecticut Hospice, opened in 1974, followed shortly by several others including Yale Medical Center Inpatient Hospice and a hospice program in Marin County, California. Currently hospice is more of a philosophy or program rather than a place. The term hospice comes from the Latin word “hospis’ meaning host and guest. Hospices ran by the Catholic church in the Middle Ages were places that offered refuge to the poor and the sick as well as to travelers returning from the Crusades. The work done by Dr. Saunders in 1967 helped to establish clear differences from the early homes for the dying to a system we now call hospice care. In the United States hospice is primarily a system of care provided in the home however there are inpatient hospices throughout the United States. Currently Hospice of Humboldt is considering building a small inpatient hospice but the process is in the early stages. Hospice emphasizes palliative medicines and supportive services rather than cure oriented therapies and interventions. Hospice is dedicated to symptom and pain management allowing a terminally ill person to die peacefully surrounded by their loved ones in their own home. Today there are over 4850 hospices across the country. The National Hospice and Palliative Care Organization reports approximately 1.45 million patients received hospice care and 38.8% of all deaths in the U.S died under a hospice care program in 2009(NHCPO,2009). In order to receive hospice care a physician must determine to the best of their ability a patient has a prognosis of less than six months to live. Due to the palliative care philosophy of hospice care, the patient would not be eligible for services if they are pursuing aggressive treatments such as chemotherapy. When the patient is done with treatment and does not want to pursue additional aggressive therapies then hospice is appropriate. Hospice is paid by Medicare, Medi-Cal and private insurances and in this area Hospice of Humboldt does not refuse care if someone does not have the ability to pay. Hospice care is provided by a team. Included are the patient, the family, and the health care providers, nurses, home health aides, social workers, chaplains, and physicians. The family or friends of the patient are the primary care providers, hospice does not provide around the clock care (on a regular basis) and we do not have an inpatient hospice facility in this area. Hospice supports the patient, family and caregivers to understand the complexities of caring for a terminally ill person. The multidisciplinary them work together to educate, support and assist through the dying  process. Patients can reside in their own homes, a residential care facility or in a skilled nursing facility.

The role of the social worker

The social work profession helps individuals, families and/or communities enhance or restore their capacity for psychological, emotional, spiritual, social and physical health. Because of these professional values and skills, social workers in hospice and palliative care settings are a perfect and needed addition to the multidisciplinary team. Due to the nature of this service, social workers are working within a mostly “medical model of care”. Social workers help the team to understand the complexities of looking at a patient and their family as a whole interconnected unit. Social workers are strong advocates for self-determination and culturally appropriate care. Social workers evaluate the strengths of individuals and families and understand that good medical care requires that the wishes and needs of the individuals being served are respected which can be a challenge when working in a medical model of care. Social workers within a hospice care setting assist individuals and families with psychological and spiritual stress, financial stresses, ethical dilemmas and problem solving, resource referral and advocacy, advance care planning and grief and bereavement. After a patient is enrolled with hospice a patient focused care plan is generated with a multi-disciplinary approach. Team members consisting of a nurse, a social worker and a chaplain complete a individual discipline specific assessment that are generated into a comprehensive care plan. This care plan outlines the needs and goals for the patient. Social workers are required to complete a psychosocial assessment within the first five days after a patient is admitted to hospice services. This assessment consists of general patient information including ethnic/cultural evaluation, learning barriers, interests and education as well as a mental/emotional assessment looking at cognitive, emotional, coping, support systems and grief issues. Designing a treatment plan and goal setting is very different when working with patients who are dying. The social worker’s goal is to be able to build trust and establish a relationship before the patient passes. Sometimes the social worker may only have the first home visit. During the initial assessment it may be critical to provide as much information and assistance as possible. Funeral and mortuary planning often top the priority list. Preparing the patient and family for the impending death is also critical. Educating the family is the role of all the hospice team members. At times social workers may have to discuss and assist with non-traditional social work tasks, such as assessing pain, assisting with personal care, and assisting with body preparation after death. Knowing how to “meet the patient and family where they are” is very important. It is not our job as hospice social workers to impose any particular agenda. We are there to support the patient and their family’s wishes, and address their concerns be it financial, emotional or ethical. It's like being in the passenger seat, and holding up the map for them, they are in the driver's seat. Understanding the family dynamics surrounding the patient is an important role of the social worker. Oftentimes family members may disagree on the end of life decisions of their loved one. In these cases, we can help educate family members regarding any misconceptions or dilemmas they may be facing during this stressful time. Many times it is just the presence of the social worker and other team members, that offers a sense of support to the patient and family, because they know they do not have to do this alone. During the hospice process families often struggle with self care. They feel guilty taking time away from their loved one. We help them realize that they need to first take care of themselves so that they can be healthy, strong and able to then care for their loved one. Creating a safe place for the patient and their family to talk about death is vital to the hospice journey. It is the social worker’s job to create a safe place for this discussion. Listening is a vital component of a hospice social workers job and just may be the most important thing we do. The  gift of genuinely listening allows the person speaking to see and understand their experience in a different way. I have been invited to listen to many stories that have transported me to different counties, to the beaches of Normandy, to Pearl Harbor, to the commodities line during the depression and thousands of other places. People who are dying often want to know their life had purpose and by sharing their experiences they may feel at peace. There are moments in our job that we sit in silence with the patient and family because there are no words or actions that can take away the pain and reality of the situation, so perhaps the biggest gift we can offer is to stand beside them and not turn away from the pain. There are so many situations, experiences and gifts that are shared in hospice care. To be a hospice social worker is a great opportunity to experience the flexibility, complexities and variability of social work. I often say we wear many hats doing anything from case management, counseling, community referrals, funeral planning, conflict resolution, to being a friendly visitor.

I have included a short video that I found on YouTube that reveals a glimpse into the life of a hospice patient if anyone is interested. I could go on and on about hospice and why I love it but I think I said enough. I feel it is an honor to be able to serve hospice patients and their families during such a vulnerable time.

Kastenbaum, B. (2002). Hospice Option. In Macmillan Encyclopedia of Death and Dying (pp. 437-441). Michigan: Thomson Gale.

 

NHPCO. (2009). The National Hospice and Palliative Care Organization. Retrieved April 2010, from NHPCP: http://www.nhpco.org

Humboldt Made

Last weekend I had the opportunity to attend the red carpet premier of Love Humboldt and Humboldt Made short films at the Arcata Theatre Lounge. I didn't know much about the short films before going, only that my brother-in-law Clint Victorine had a segment about his business Eel River Organic Beef being shown. After attending and finding out the purpose behind this project, I knew this would be a perfect first entry for this blog project which is focused on community globally. That is exactly what the creators of this project had in mind, to produce a series of short films that showcase Humboldt County's beauty and market its unique locally made products which can be viewed across the world via the internet. This premier presented 16 short films directed by Maria Matteoli, featuring Humboldt County and some of it's locally produced products in a visually captivating manor. Ten of the films were 30 second segments about local entrepreneurs and their products. The ten featured  Humboldt Made businesses were, Lost Coast Brewery, Cypress Grove, Loleta Cheese Factory, Sun Valley Floral Farms, Eel River Organic Beef, Riverbend Cellars, Moonstone Crossing, Humboldt Grassfed Beef, Winnett Vineyards and the North Coast Small Development Center. The goal of this collaboration was to market Humboldt County as a brand by focusing on the natural beauty and quality of life that Humboldt County has to offer and the unique products made and distributed in Humboldt, to a larger consumer base. They plan to utilize YouTube, Facebook and Twitter to advertise Humboldt Made products in an attempt to attract people to Humboldt's way of life and the specialty products made here. You can view the short films on http://www.humboldtmade.com/ as they become available. The 16 segments will be released once a week for 16 weeks. You can also view the released segments on YouTube http://www.youtube.com/watch?v=NoDvwzGbjGg and http://www.youtube.com/watch?v=6TYxQvDxlGU.  The first featured segments are five minute vignettes that artistically incorporate Humboldt County's scenery with locally produced products. The vignettes have no dialog and are complimented by a locally produced soundtrack that can be purchased at iTunes.
The spirit of community was alive and well at this premier. The event was free to the community and offered a wide array of foods created with local products by local caterers. The event was packed and seating was hard to find. Not knowing what to expect I was pleasantly surprised by all the stories and success of our local businesses. Most of all I was proud of the work my brother-in-law has done to grow and develop his business. He is a self made business owner who was born and raised in Humboldt County. He grew up in Hydesville and was drawn to agriculture at an early age. He received his degree in ag business with an emphasis in ranch management. He started raising beef and became very interested in the organic market. He worked very hard to get his operation certified organic, which is not an easy process. He is the owner of Eel River Organic Beef and is now featured in a large health and specialty store called Whole Foods which has stores in southern California, Arizona, Nevada and Hawaii. He has successfully taken his local product and marketed to a larger customer base. He has done this by taking advantage of the internet by starting a website to sell his product, http://www.eelriverorganicbeef.com/. You can view his segment featured in Humboldt Made and currently being shown in the meat departments of Whole Foods, at . To everyone involved in this project, well done! http://www.youtube.com/watch?v=1VlJdW-XHlk