April Volunteering

So, we have come to the end of this semester, and the end of the school year. 

This year has been really a fascinating and challenging period. I thought that I had a moderate grasp of pharmacology just from paramedic level education, but after this program I feel like my knowledge base has expanded profoundly from where it was just one year ago. 

I feel much more knowledgable and much more prepared to start medical school next month! Not only because I have a more in-depth knowledge of this one piece of the medical curriculum, but because I feel like I've learned significantly more about the approach to studying for medical school material. The block format, with intensive periods devoted to understanding the minutiae of organ systems and their function, feels much more accessible as a result of the learning expectations of the past 10 or so months. I can't help but feel that having a solid grade from the first semester looked really appealing on paper when submitted with the rest of my application to medical schools, as I was moved from the waitlist to the acceptance list about a week after sending my grades in to the University of Miami School of Medicine. I can't wait to get started in the MD/MPH track there. 

Anyways, to volunteering: in April, I've started to return to my previous levels of physical ability. As a result of spending a good deal of time in physical therapy, I'm able to use my left arm fairly well, but I'm still not quite up to full strength. Even so, I've really been able to get out and do more consistent needle exchange hours. We've had a weekly drop in on fridays for about 3-4 hours, pretty standard distribution of syringes, naloxone and other safer injection supplies. A physician at UM just started a needle exchange in Miami, so I'm really excited to bring some of what I've learned over there and get involved! 

Dr. Clarkson, Dr. Katakam and everyone else, thank you so much for your expertise, your time and attention to detail, and your hard work! I've learned so much from all of you and appreciate y'all for everything I've gotten out of this program. It's been really great to go through this process. 

March Volunteering

(This was saved in draft!! I'm so sorry!)

March has been a challenging month for me. I had surgery on my left shoulder last month, the recovery for which has been surprisingly difficult. Did you know that you can't wash dishes effectively with one hand? And typing, driving, biking, dressing etc, anything that requires two hands has been either shockingly challenging to impossible. It's really messed up my sense of time, as most everything takes twice as long if not longer to get done. Anyway, despite this, I've been still volunteering as much as I can with the New Orleans Harm Reduction Network, going to drop-ins and distributing syringes and other clean injection supplies, as well as naloxone and condoms. It's helpful to be able to be in a stationary place and have program participants come to me, rather than the other way around lately. I've had a weekly drop in, about 2-3 hours each.

More importantly- we took the NBME this month, which actually felt pretty reasonable in terms of how challenging it was. There were very few questions that I had no idea about, and the vast majority seemed totally appropriate for what we've been taught this year. It felt really exciting and relieving to get an exam at the shelf level that was not terrifying! It makes me feel a lot more confident as I'm preparing to start medical school later this year.

Volunteer Hours this month: 10

Total Volunteer hours to date: 22

Februrary

As I've been studying for the NBME shelf exam, I've been really excited at how questions that would have seemed extremely difficult only last year make sense because I have a much more broad knowledge of medications, mechanisms of action, and pharmacokinetics/dynamics. Although there's a lot I need to brush up on, I feel like I'm doing a lot more review than learning new material at this point. It feels really good to be aware of a broadened knowledge base.
In mid-February I had surgery on my left shoulder, and I've had a very difficult time getting around since then. Typing is difficult and painful, the healing process is obnoxiously slow and because I'm still out of work and have had to figure out my days in the context of what hurts the least, I'm struggling a little to keep my days organized in the past two weeks. One thing that I really appreciated about the surgery and recovery was understanding the peri-operative medications being used at the time, and following the surgery I was sent home with a local anesthetic pump to function as a nerve block in my shoulder to keep the pain down as much as possible. That in particular was very cool.
Because of the surgery my volunteering has been limited. I was only able to put on one syringe exchange drop in hours, but it was pretty standard fare- distributing syringes and naloxone, discussing wound care, and teaching how to recognize and treat overdoses.

volunteering time- 4 hours

January Volunteering

It was definitely hard coming back to New Orleans after a nice break which I spent in the Everglades camping, canoeing, and hiking. It was so beautiful! I'd never been there before and was just amazed at the incredible natural beauty and the diverse wildlife. 

But, I'm back, and it's been an interesting month. I have really great news- I was accepted the University of Miami Miller School of Medicine for their 4 year MD MPH program, where I'll start in June. Suddenly a lot of the pressure is off my shoulders for this program, and I feel like I can learn at a slightly more leisurely pace rather than studying constantly, cramming and anxiously clicking the "end exam" button and looking at my score through squinted eyes. As a result, I feel like I can pay more attention to the larger scope of material in class rather than focus on high value tested topics, and focus on volunteering as well. While Dr. Zhang wasn't able to host any SMNO walks due to his busy residency schedule, I worked with the New Orleans Harm Reduction Network several times this month. I coordinated several syringe exchanges, taught people who use injection drugs/PWID (this is the update from a recent term IDU or injection drug user) how to recognize overdose and use naloxone through a NOHD naloxone distribution grant, and talked to people about their options for utilizing suboxone as a tool to decrease or end injection drug use. To this end, I helped refer clients to some of the suboxone prescribing physicians in NOLA. It really seems like the local political climate is becoming just a little more humane towards people who use injection drugs, although with the nominee for the us attorney general I'm sincerely worried about any advancement in humane, effective and evidence based public health minded national policy regarding this vulnerable patient population.

January volunteering- four 2-hour drop ins, 8 hours total. 

November Volunteering

November was a really interesting month! I had my first ever medical school interview, and we covered some of my favorite material in pharmacology, which is treatment of respiratory pathologies. The weather took a sudden change for cold and rainy this month, which brought with it a huge spike in the asthma exacerbations and pneumonia I see at work, and while I've previously been acquainted with some of the first line asthma medications such as albuterol and atrovent, it's been really fascinating to connect conceptual class material to patient presentations.

Aside from class and work, I've continued to participate in the Street Medicine project with Dr. Zhang, an emergency medicine resident at UMC, and we went out twice this month, four hours each night. The outings consisted of walks around the downtown/French Quarter/ferry terminal area, where many homeless/houseless people stay,  reconnecting with patients recently seen at local hospitals, following up on their discharge instructions and access to medications, continuing care, and offering assessments of chronic or new complaints. One of the patients we met had a low grade fever, a productive cough, and exertional shortness of breath for three weeks, and from class lectures I immediately connected his complaints to discussions of atypical pneumonia! He didn't want to go to the hospital though, so we referred him to Healthcare for the Homeless at the VA clinic.

The second night drew a large group of volunteers, including two Tulane second year medical students, Dr. Nixdorf,  one of the doctors from Healthcare for the Homeless, and a social worker from Unity House. We were able to meet up with many of the folks who stay under I-10 by Calliope and discuss options for getting housed, in addition to checking blood pressures and glucometry.

Besides Street Medicine, I've continued to volunteer with the public health organization Trystereo, distributing clean syringes to local injection drug users and discussing strategies to reduce infections. I recalled Dr. Dery's lecture on endocarditis as I spoke to one program participant about her recent hospitalization for bacteremia. November has also seen a large increase in overdoses among illicit narcotic users, and so I've been volunteering in a campaign to more widely distribute information on overdose prevention and treatment.

Lastly, my project to get an EMT educational scholarship for Sci High students is under way! I met with the careers counselor at Sci High again this month, and submitted a grant proposal to the city vocational education funding source, Job1, and I'm hoping to hear back from them so we can try to get this project under way!

November volunteer hours: 12
Total volunteer hours: 56

October volunteering

October was an easier month, with material that I felt more comfortable with than in previous blocks. I was cleared to return to duty as a paramedic with the city of new orleans after a major motor vehicle collision in February, so I'm still figuring out how to balance my commitments to the city with academics and volunteering. I've definitely noticed that I have a greater awareness of medications and their clinical interactions when assessing patients in the past two weeks. I had a patient with CHF and A-Fib complaining of strange dreams last week and surely enough when I asked him about his medications he said he takes digoxin!

I worked on Halloween, which was an extremely busy day, and made my 26th birthday on October 29th.

I made it out to two nights of Street Medicine New Orleans (10/12 and 10/26) with Dr. Zhang and a group of residents, medical students, social workers and housing workers, where we made rounds of the CBD, French Quarter and nearby areas to try to encounter houseless people and offer them resources and medical care. We had meaningful conversations with about 12 people each night, on topics regarding accessing further care via referrals to Healthcare for the Homeless, getting sheltered or housed through Unity, and obtaining medications through the UMC pharmacy. I mostly checked blood pressures and blood sugars, and was able to connect a few people to needle exchange resources via New Orleans Harm Reduction Network.

Lastly, things are coming along with this scholarship program I'm working on setting up to enroll Sci High seniors in an EMT class at Tulane. We're applying for a grant from Job1, a municipal vocational education fund, the department heads at NOEMS approve of the project, and I've met with staff at Sci High on separate occasions, and they are very excited! More updates to follow, and I'm hoping to have a viable program with 6 Sci High seniors enrolled in this class by January 30th.

Total hours: 4 per night at SMNO, 2 hours with sci high EMT education organizing- 10 volunteer hours in October.

September Volunteering

9/31/2016

September was a very busy month with a lot of challenging classwork and studying for exams. I felt particularly challenged by this last block, which covered an enormous amount of material, and I dedicated a large amount of time to studying. I also had to take some time away for a family medical emergency which is unfortunately still unfolding. 

However, I was able to volunteer some time in September- I’ve been working with the community public health organization, the New Orleans Harm Reduction Network for over a year, and I put in two four hour days of time with them this month. NOHRN is an organization dedicated to HIV/AIDS, Hepatitis, and opiate overdose prevention, and utilizes the principles of harm reduction to deliver resources to an underserved and often isolated patient/client population. These resources include clean syringes, naloxone, HIV and HCV testing, as well as education and referral to further resources. With Dr. Kantor of the New Orleans Health Department authorizing a standing order for the organization to provide naloxone, we’ve been distributing the life saving opioid reversal medication to chronic users of opiates.

On behalf of the NOHRN, I also provided an overdose recognition, prevention and treatment workshop for members of a soup kitchen organization in New Orleans; Community Kitchen. Because Community Kitchen often distributes food in areas with high densities of IV drug users, members have often been the first to notice and call emergency services for people who have overdosed. Given this proximity, they reached out to NOHRN and asked for us to provide a workshop for soup kitchen volunteers and other interested parties. Other volunteers with NOHRN and I spent about 2 hours discussing signs and symptoms of opioid overdose, as well as emergency first aid in those situations.

I was only able to join Dr. Charles Zhang on his Street Medicine walks one night this month, but we had several meaningful encounters with homeless patients who live in the area around the French Quarter. I distributed hygiene supplies and discussed infection prevention through the use of clean socks with one fellow who had a small abscess on his foot, and the doctor provided him with some antibiotic cream. We were out on the street walk for about 4 hours.

Lastly, I’m extremely excited to discuss a project I just started working on! 

I’ve been an instructor at the Tulane University Trauma Education Institute for some time, and we teach a semester long EMT class twice a year. I’ve been inspired by the graduate Med-Pharm student involvement at Sci High, and so I spoke with the principal (Ms. Chana Benenson) and the careers counselor (Ms. Jennifer Naum) about increasing access for Sci High seniors who are interested in careers in medicine, nursing, public health, to get involved with EMS education. They were excited about the prospect, and now I’m working on writing grant proposals to build a scholarship program for students to get into the course at no cost to them.

Total volunteering in September: 14 hours.