Faculty, Students Provide Care after Harvey

Recent graduates Hannah Lovell (from left), Julieta Schmitt and Hannah George, all B.S.N., RN, volunteered in Rockport clinics during their final semester.

By Catherine Duncan

Hurricane Harvey made landfall the evening of Aug. 25, 2017, near Rockport, where maximum sustained winds were 130 miles per hour. The Category 4 hurricane left in its wake massive destruction of homes and buildings in this small coastal town and the surrounding areas.

With less than 8,800 residents and more than 38 percent living at or far below the federal poverty level, local citizens suffered significant loss, including destruction of their homes, no water or electricity, and virtually no access to health care. With a quarter of the population age 65 or older, the lack of health care and medicine soon became a priority for relief responses.

Cindy Sickora, D.N.P., RN, vice dean for practice and engagement in the School of Nursing, said she was contacted the week after Hurricane Harvey by Irwin Redlener, M.D., president emeritus and co-founder with singer Paul Simon of the Children’s Health Fund in New York City. They had previously worked together in her home state of New Jersey following Hurricane Sandy.

“Dr. Redlener said they had heard it was terrible in Rockport, and he was going to come see it. Paul Simon and his wife, singer Edie Brickell, wanted us to figure out how they could help,” she said. “Because I had only been in Texas for 10 months, I didn’t know the coastal area. I asked David Byrd, who is a native Texan, to speak with Dr. Redlener and explain the area to him.”

The next Monday, which was Labor Day, Dr. Redlener flew here with colleagues from Columbia University’s National Center for Disaster Preparedness, and Byrd, Ph.D., associate dean for admissions and student services, “drove us to Rockport where we saw families living in tents. There was one medical tent. We saw firsthand the realities of the destruction and the needs of residents,” she said.

Dr. Sickora said after returning to San Antonio, the nursing team negotiated the details of securing $215,000, with $200,000 personally from Simon and Brickell and $15,000 from the Children’s Health Fund. The grant covered all the expenses required to travel from San Antonio to Rockport and provide health care twice a week including vehicle rental, fuel, mobile unit rental, supplies, vaccines, faculty health specialists, and administrative support for patient and expense record keeping.

A second two-day trip to Rockport with Tracey Smith Page, D.N.P., RN, FNP-BC, assistant professor/clinical, allowed Drs. Sickora and Page the opportunity to interview residents in the hardest hit communities and speak to federal disaster relief leaders.

“We found a picnic table outside a neighborhood’s community center. We surveyed people there to learn their needs. That is where Dr. Page returned to first offer health care services. She took the initiative and ran with it,” Dr. Sickora added.

A team of 15 was deployed in 18 days from the initial contact with Dr. Redlener. “I wish it could have been faster, but we had to get approval from many departments at the university. We had to ensure the safety of our students and faculty,” she said. “In the months since the hurricane, our faculty and students have been remarkable. I am so proud to be a part of this team.”

Dr. Page, who teaches “Population Focused Health Clinical,” said students who worked at the Rockport clinics were in the final semester of earning their Bachelor of Science in Nursing. Volunteering in Rockport was part of the students’ clinical experience for the population health course and “Transition to Professional Nursing Practice Clinical” course.

Rockport Bound

From September 2017 through May 2018, students in these two courses and faculty members drove to Rockport to offer basic health care services. They worked on Mondays and Wednesdays, rotating at six locations and in additional neighborhoods. Services offered included primary health care by family nurse practitioners, immunizations, education, mosquito-borne illness prevention, contraception, wound care, and limited mental health services.

While B.S.N. students usually train at traditional health care facilities during these two courses, students last fall had the opportunity to go to Rockport and help local residents while learning, she said.

“The key to coming to Rockport is that we needed to know the population and what they needed. We kept asking, and it kept changing. We canvassed the communities by going door to door. That way we knew what their health care needs were and how we needed to respond,” Dr. Page said.

The students learned a lot because they weren’t relying on any technology, she said. “They were relying on nursing assessments. We also talked about the holistic approach—the patient’s mind, body and spirit. We identified mental health needs and directed community members to a federal helpline they could call 24-7. For these residents, their entire life is different. Their churches, businesses and restaurants are gone. Some feel guilty if they have their homes.”

Social Determinants

The students were able to see firsthand social determinants of health, a significant topic in the two courses’ curricula. On a one-on-one basis with patients, they saw how their health is affected by the lack of access to food, sewer, water, and even a roof over their heads, Dr. Page explained.

“The students learned how to care for patients who are living in tents or in their cars. These patients don’t have a refrigerator for storing medicine. They don’t have basic living conditions,” she said. The students also learned that patients may have health issues that would usually be minor but in these circumstances can become major.

“These patients can’t wash their hands regularly. They don’t have sewer access,” she said. “We saw a lot of minor abrasions that evolved into major infections, such as staph or cellulitis. The students saw all of this and learned how to be better nurses.”

Wendy J. Lee, D.N.P., FNP-BC, FAANP, RN, associate professor/clinical, said she worked twice a month at the Rockport clinics with undergraduate and graduate students.

“I learned how severe the devastation is and how slow the recovery is. I saw residents who had physically stressed themselves as they cleaned their homes, businesses and yards. The elderly were especially prone to injuries during this terrible time,” she said. “The consequences of this devastation are impacting their health.”

School of Nursing faculty and students have been providing health care to everyone who needs it here, she said. “I have been coaching the nurse practitioner students who have been working here. They take health histories, and I help them develop treatment plans. This is a great experience for our graduate students. This is what they will be doing day to day.”

Dr. Lee explained the undergraduate students are honing their skills taking vital signs, giving vaccines, talking to patients, and counseling them.

“The students get to sit and talk to the patients. The residents really appreciate being listened to. It is about counseling and talking to people—not just giving medication. Just to feel acknowledged is essential,” she said.

Birth of Mobile Unit

Photo of the School of Nursing mobile unit for hurricane relief
The hurricane relief funding allowed the nursing school to rent a 41-foot mobile unit customized with two fully equipped exam rooms, a reception area, and a wheelchair lift.

The hurricane relief funding allowed the nursing school to rent a 41-foot mobile unit customized with two fully equipped exam rooms, a reception area, and a wheelchair lift. The mobile unit, which is the equivalent of a primary care office, is being used throughout the coastal area to provide a variety of health care services to local residents. “The mobile unit has running water, a bathroom, a refrigerator to hold vaccines, and exam areas for performing health screenings and monitoring vital signs,” she added.

This unit is important to have especially during the colder months, she said. “We can’t provide health care services in a parking lot when it is cold and raining. This unit allows us to bring all those services inside.”

In early 2018, the services provided in the mobile unit transitioned to educational and mental health counseling, Dr. Page said. “With the colder weather, the coastal residents use alternative heat sources. We counseled them on using carbon monoxide and smoke detectors regardless of where they are living. We don’t want anyone to lose his or her life while trying to stay warm.”

Beverly Gail Hutzler, RN, alternate-entry B.S.N. to M.S.N. student in the Family Nurse Practitioner Program, administers a vaccine to a patient at the mobile clinic in Rockport.

One of the nursing school’s partners has a mother’s group that requested assistance in learning how to help children after a natural disaster. “There is a book approved by the American Psychological Association that explains how to help children dealing with the aftermath of such a horrible experience. We will get the book and work with these mothers,” she said.

The mobile unit has proven to be a critical resource for, not only the provision of care in austere environments, but also a learning laboratory for faculty and students engaged in population health clinical activities. While renting was necessary due to the urgency following Harvey, the School of Nursing actively seeks philanthropic funding to purchase a permanent mobile unit to achieve its mission of promoting health as an act of social justice. Dr. Page said, “This mobile unit is the foundation for future outreach. It gives us the knowledge and experience to move toward a permanent mobile unit that can be used when it is needed by the underserved and those in crisis. This is just the beginning of our next chapter.”

To learn more, please contact Melissa Mireles, director of development, at 210-567-5534 or mirelesm4@uthscsa.edu.

Four nursing students help at mobile clinic
Wendy J. Lee (second from left), D.N.P., FNP-BC, FAANP, associate professor/clinical, reviews paperwork with a patient at a mobile clinic set up in the parking lot of a closed H-E-B grocery store in Rockport. Tracey Smith Page, D.N.P., RN, FNP-BC, assistant professor/clinical, oversees the mobile clinic that was an excellent learning experience for Brianna Hatfield (far right), B.S.N., RN, and other final-semester students.

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