Summer 2008 Internship at Fort Defiance Indian Hospital: The Value of Service through Learning



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Summer 2008 Internship at Fort Defiance Indian Hospital: The Value of Service through Learning

By Tyrell Jim

For the summer of 2008, I was blessed to be a Dartmouth Partners in Community Service participant, serving my internship at Fort Defiance Indian Hospital, a rural hospital that serves the many small communities within the Fort Defiance Agency. Fort Defiance is a small town that sits near the four corners area of the northeastern part of Arizona. It inhabits a population of approximately 4,000 people, most who are full or part Navajo, my own tribal nation. As an intern at FDIH, I worked most of my time in the Pediatrics Outpatient Care Unit. There, I assisted with chart-management, performed as an informant, conducted research, and provided hands-on assistance for the patients. Without this internship, I would still be unsure of my ambitions to become a medical provider. Now, I feel my reasoning for becoming a medical provider has been empowered through this hands-on experience in a hospital setting.

When I reflect back on my internship, I realize that this was a life-changing experience because I learned so much within such a short amount of time, I still feel as though it was just a dream. Although much of my internship benefited my education and persona in some way, there were also the negative aspects that went along with it. However, much of those contradictions helped me in some tiny way that greatly contributed to my learning. It was just like learning from my mistakes. This internship has definitely given me a taste of serving the community, just by being present within the health field. What I had to offer in services balanced the experience with how much I had to learn. This is why I feel that I learned more than I expected about community service and its importance to our global community. In this reflection paper, I will try to explain how this internship has affected me but most importantly, the community.



The Choice

My passion for the health care system first started from my role model—my uncle, who was a laboratory technician employed at my community’s clinic. Observing his service to the community and his enthusiasm while doing it made me want to become something like him, so that’s where my dream for my ideal career started. However, it was until I learned the long, difficult track it would be to become a physician. I started to learn that I will have to sacrifice a lot of free time and fun, money, and security. I started to feel intimidated and somewhat, disinterested with the health field. That all changed in a blink of an eye. My mother, who had the largest impact on my education, died after being diagnosed with liver cirrhosis due to excessive alcohol consumption. It was then and there that I devoted my education to the medical field, not just for my mother’s honor, but to help all other families who deal with similar life-threatening scenarios. It was through this personal life experience did I relate my ambitions to become a health care provider.

Since the beginning of my internship, I did not truly realize how important health issues were to me as an individual. I know I initially wanted to become a health care provider because of my personal life experience; however, just being within the place of the health care system helped me completely realize why I wanted to become a health care provider. For that, I am greatly indebted to Dartmouth for that opportunity. I will shed some light in the following paragraphs about some of those experiences and how they each added more rationale to my ambitions.

The Experience

I was positioned in the Outpatient Care Unit, also known as the clinic at Fort Defiance Indian Hospital. There, I was to offer any support in patient-to-doctor relation management, all in which, of course, I had to do while maintaining strict patient confidentiality regulations. This was extremely important. It also tested and strengthened my organization skills. Through the guidance of my mentors, whom I refer to as the entire Pediatrics team, I quickly became acquainted with the health care community and all the entities that went along with it. From there, I began to understand the entire network which of course, made my services a lot smoother. This opened many doors for my experience.

My job as an intern completely reflected the mission statement of the Indian Health Services, which is a funded health care system under the federal government of the United States. That is, I was there to make sure I assist with proper health care treatment through comfortable communication and service. Importantly, I did not know how to respond to this mission statement until I had the following conversation.

It was on my first day, when I talked with my supervisor, Douglass Esposito, about some of the jobs I could possibly do. We spoke one-on-one for an hour or so about some of the health care issues that mattered most to me. I asserted my opinion about alcohol and drug problems facing society today, especially with the tribal society, which of course reflects back to my personal life experience. He utterly agreed with my concern; however, he also felt that if I wanted to do something for change, in which I was desperate to find, I should be looking at the issues that still need attention. For that matter, he turned my attention to one of the issues facing the Navajo population in the surrounding communities—that being teenage suicide and all other factors that were included in it. That conversation was extremely pivotal because, now, I wanted to do that little project. I wanted to assist with suicide issues that face society in my surrounding area. With the guidance of Esposito and some of his attendants, which included physician assistant, Kate Porterfield, I looked at suicide data for two nearby communities: Navajo, New Mexico and Fort Defiance, Arizona. Through surveys conducted at each middle school in both communities, I found that approximately 5% of students in the middle school had experienced suicidal thoughts all ranging from external factors (e.g. family deaths, divorces, bad grades in school, sexuality, etc.). Those results I found not only surprised me, but depressed me at the same time.

After conducting my research, I looked to seek suicide-prevention programs that were owned and occupied by the Navajo Nation government. The Navajo Nation did have a program, but to my surprise, its infrastructure needed more attention and work, meaning the programs were ineffectual in many ways (e.g. lack of publicity). Upon this discovery, I conversed with my supervisor about some of the service I could do to improve the suicide-prevention programs on the Navajo Nation infrastructure in any way possible. His reply was stressful but nonetheless, true. He simply said there was nothing I, only a first year intern, could do because the lack of infrastructure was a problem that needed to be dealt with through the state of Arizona, and possibly through the federal government. Because of that, I had to regretfully leave the project undone. Though, I do not feel unsuccessful whatsoever. My work in uncovering an important psychosocial issue has contributed to the continual conduction of surveys for teens who visit for treatment. This, in hope, will give a more effective count of suicidal thoughts in the teenage community that could be put forth the efforts of rebuilding an effective suicide-prevention program on the Navajo Nation.

Another defining part of my internship was being a mentor and a leader of a service-learning trip conducted by two environmentalists, Gino and his wife, Molly. On this camping trip, I was to answer any questions about the Navajo culture and geography, since I was well-educated in both areas and being that I grew up there my whole life. The group I was a mentor for consisted of teenagers that came from all parts of the country, all non-Native American high school students. I would have to say, these students were very interested and awed by traditional customs in which my people carry out. Therefore, I felt obligated to serve them knowledge and service in the best manner I could. There were two major objectives for the camp—to clean and revive ceremonial grounds, which included digging a canal for a water route that would replenish the grounds, and to put hands-on assistance in a puberty ceremony that would offer an understanding of the cultural ceremony. Aside those two main objectives, there was also traditional knowledge taught and learned about environmental sustainability. For instance, our lead environmentalist, Gino, taught the group how to put “dead” tree bark into soil and thus, sustain what we call environmental waste. Little informative efforts like these were helpful in giving those high school students the inspiration to become leaders and advocates for the global community.

Through this short camp, I achieved leadership skills along with learning about the educational ambitions of each of the students. It was interesting and fun to engage with a group of students who felt that even my fractionated efforts through community service, differences in our global community could be made. Just being with those students for the few days we had did I learn that I had much to offer because it was through my services that they learned something new about sustaining good character and service. It was an amazing experience I will never forget and I am still in touch with those students who I now call my friends in heart.

There, unfortunately, were times when there were no patients to be seen in the clinic. Therefore, I reached beyond the clinic to Public Health Nursing and asked what I could offer through my services that would represent community service. Through this, I was delighted to have been part of the field nursing team, a group of nurses that make home-visits to patients who are unable to make it to the hospital. Through this opportunity, I was again, tested on my communication skills. Most of the patients were elderly who were monolingual Navajo speakers, therefore, I had to speak my native language the best I could. Additionally, I was taking blood pressure, temperature, and weight.

There is this experience I want to talk about that really inspired me in many ways about service and relating one’s self to others. I think relationships between those serving and those receiving are extremely important; therefore, I feel I should shed some light on this idea. One Thursday afternoon, when the clinic was nearly unoccupied, I decided to go out in the field with R.N. Linda Curley. We were talking about the importance of relating to the patients, and she told me that I should honor those who receive the gift of service because without them, we would not have the passion to carry out genuine deeds like community service. I thought about it the whole time while we were on the dirt road, and I asked her what she meant. She told me that community service is like a mother-to-daughter relationship. You do it carefully and with great integrity to get the best out of it. In her continued lecture, she told me how to politely address the elderly when I greet them. Her theory was that if you address them as “grandma” or “grandpa”, and not by their names, they feel more at ease when they receive health services. Finally, it clicked in my mind those relationships were actually entities that made services easier to do, thus make community service possible. It’s deep in understanding, but I took it as knowledge. Now, I have a different look on community service because I am not just there to serve though “give”, but to make unforgettable relationships that would put forth the inspiration to do community service more and passionately. This part of my internship was a highlight to learning and serving the community in a mature manner.

The Challenge

Day one was and expectedly, the most challenging day of all. I had to meet and greet my supervisor, whom I at first found very daunting. Then, I had to make myself comfortable with my surroundings, which included both work and co-workers. But let me first explain why meeting and greeting has and always been a challenge for me.

As I see it, we learn something new everything from our environment, through observations and practice. The observing part I totally have control on, it is, however and unfortunately, the practice part I still have problems with.

Through observations from everyday life, I have learned that majority of those who succeed in a career are those who are not afraid to speak out loud; those who are not afraid to commit themselves to risks. Personally, I think feeling embarrassed and humiliated is a huge risk for me. Unfortunately, that is the major problem I have come to learn about myself. I personally feel that if I am too assertive, I may say or act in a way that may make the entire situation uncomfortable, leaving myself feeling embarrassed and humiliated. That is one risk I have not been willing to make. If this makes it any easier to understand, I am not as outgoing as most successful people. I refused by choice, to be less assertive. But fortunately and thankfully, most of that has changed throughout this internship.

Let me reflect back to day one. As I have said, meeting and greeting was challenging enough that I really couldn’t do it all in one day. It took me literally three weeks to feel comfortable with my surroundings, let alone, start realizing that I was there working for a purpose. After this long time to actually realize that my problem of being comfortable in my surroundings was all a result of not being confident and assertive, I talked about this issue with my mentor, Robert Allan. Robert, who I found very helpful as a resource, helped me find my way to be more assertive and confident when I established myself in the health community and let alone, when I started working myself into my project. Through his guidance, I made my way though my project a lot easier by being more confident and assertive when I was to communicate with my supervisor and co-workers. It was then and there did I learn that assertiveness and confidence opens a lot of doors for great opportunities. I learned that all I had to do was reach out and beyond for them without being afraid of humiliation and embarrassment. Even now, on campus, I feel a greater strength in confidence when it comes to asserting my ideas in class and in the larger community. For this, I greatly appreciate this internship because it made me realize one of my greatest weaknesses.

Another challenge was adjusting to a more professional level as a student, that meaning that I had to face the realities of life as a worker. Some of those included having to pay for gas, food, waking up early, being on time for work, and even being open to disappointments. Unlike having it easy as it was in high school, I got my first actual taste of being independent in the community. I again, thank this internship for opening my eyes to what I will be facing later down the road after completing college and graduate school.



The Continuous Service

In the light of this internship, I have been changed in many ways: intellectually, personally, emotionally, socially, and spiritually. I have to say, this internship was, by far, one the most amazing community service projects that I have done. This project opened my eyes to the understanding of the struggling world we live in. It made me realize that a helping hand really regenerates another person’s hope for the world. Through this internship, I have realized, I have given with passionate thought, and have learned the reality of being a member of the global community. I feel that every cent given to me through Dartmouth was not a waste, but a contribution to the community because I served to the best I could. Best thanks and wishes for the Tucker Foundation for providing me the opportunity to serve the community.

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