A Letter from the Road: A COVID-19 Crisis Nurse from San Quentin Prison Reports

A Letter from the Road: A COVID-19 Crisis Nurse from San Quentin Prison Reports

I’m doing laundry at a wash & fold in front of the house boats of Sausalito. Reminder: buy more scrubs. I’m one mile from from the hotel. Three minutes by car, 10 minutes by bicycle. The views are great. The weather is awesome. I could live here easy. Not on a house boat though.

They have a problem with the mating calls of some kind of small mud fish whose population has exploded. I guess it sounds terrible, like hammers on the hull all night long. Nature.

The hotel is a popular national chain brand in Mill Valley, gateway to Mount Tamalpais, and Muir Woods. It’s just north of San Francisco. I can just barely see Coit Tower. I’m maybe an hour and a half from my home so the commute would be brutal. The state is picking up the hotel tab thanks to a program authorized by the governor. It’s been a godsend.

The hotel is using the pandemic money to remodel. The room is nice, but there are sawzalls and hammers and loud Mariachi music playing during the day. At least I’m hardly ever there. They don’t clean the rooms as often because of the pandemic, but you can get fresh towels and coffee pods at the front desk any time.

The job is tedious, but not difficult. Basically, you make rounds on the prison population two times daily trying to root out COVID patients and separate them. I get there at 5:30 AM. There is a line to get through the gate. I have to sign four different log books in four different areas plus clock in with a time card.

We got a great tour of the prison on day one. The thing I remember the most is when the nurse educator guiding us said, “To everyone else they are prisoners, to us they are patients…all of them.” This dichotomy in mandates between prison staff and medical staff has allowed me to put the job neatly into my bailiwick. Nursing is nursing. The rest of it is for prison staff to handle.

The whole prison is on lock down. It’s quiet in the yards. It’s been grim. However there is hope. The numbers are improving. On my first day, there were over 1,300 patients in isolation. Two weeks later, the number is half of that. Everyone wears a mask. Infection control is taken seriously. Teams of nurses go out twice daily to assess the inmates. Other teams are doing COVID testing. Every staff member gets tested once per week. Cautiously, things are returning to a semblance of normalcy, whatever that means in a prison.

We pair up—an RN and an LVN—and grab our shoulder bag. Inside the bag is an IR thermometer, a pulse oximeter, a BP cuff, disposable PPE, alcohol wipes…sundries. When we get to our assigned area we put on the PPE and each team gets their own guard to keep them safe. “Don’t step into the cell, don’t put your face in front of the food port, don’t walk close to the cells…” Helpful advice and a sober reminder of the overlapping existence of prisoner and patient.

I’ve given careful thought to the nature of the job, the nature of crime and punishment, and the morally ambiguous task of providing competent health care to people who have committed terrible crimes. Thankfully, I’ve never followed crime stories. Having worked in the ER for many years, I’ve dealt exclusively with the aftermath of crime and the amelioration of its physical consequences…as best as can be done anyway. I have no curiosity about death row inmates. I can honestly say that I leave that at the door and look at each person strictly through the lens of health care. Having said that, I can tell from even the most cursory interactions with some of the patients that there are some seriously disturbed people within these walls. I’m happy to move along to lower level offenders.

From the ground, I can say the efforts to control the spread of COVID within the prison have been very successful. Again, I’m just the tip of the spear so the big picture is a little out of my view. But just judging from the numbers of patients I assess daily, things are improving very quickly. I guess that’s the benefit of working within a closed system…it was also that closed system that allowed the virus to spread so quickly in the first place, so there’s that. Wearing masks, social distancing, testing, contact tracing, quarantining…they have brought the cases of infection down so quickly that it’s possible that the job will end early. I’ll be sorry to leave. The pay is…generous.

The best part of the experience has been meeting new friends. Travel nurses are go-getters. I’ve met nurses from all over the world on this assignment. We share a common bond and have moved together from trepidation to confidence in this new role. We share stories in the break room and compare notes on our experience. Several nurses are staying in the same hotel that I am. It’s a great way to meet friends in our new socially isolated world. I hope that I have met lifelong friends here as I have on other contracts. The staff at the prison have been nothing but welcoming, same for my agency. A good experience from top to bottom.

The good news…or bad news depending on how you look at it, is that other prisons are experiencing similar outbreaks and will need COVID crisis teams to come in. There are already jobs being posted for other prisons in California. Susanville, San Lois Obispo, are two that I’ve seen. If you are interested in making some quick money, and are willing to shoulder some risk, I encourage you to contact a recruiter. The turnaround time for me was three days between first contact and clocking in. Be ready to move quickly. Have your documents together. The free hotel program is still in effect so your housing is covered. Stay safe out there.

Community Health Centers Offer a Lifeline

Community Health Centers Offer a Lifeline

Community health centers have taken on a big role in the nation’s healthcare as the COVID-19 pandemic has continued to impact the nation. Nurses who work in these centers find their skills in high demand.

According to the National Association of Community Health Centers (NACHC), federally funded centers provide essential access to primary care for people who may not be able to access it through traditional means. Whether there are barriers from language, income, lack of insurance, or transportation, these centrally located health centers remove many of those barriers to care.

Access to healthcare is especially important right now, as the coronavirus is having a devastating impact on communities that are predominantly of people of color and immigrants, and where people live in densely populated neighborhoods and homes. Many of these communities also have a high number of essential workers who must be out in the community daily—increasing the risks to their health and that of those around them. Some community centers provide care for rural areas, where there’s little access to healthcare, but still a high need. The Rural Health Information Hub offers a toolkit for healthcare workers in these areas.

The NACHC states that with the effective preventative care and emergency care, community health centers are able to divert people away from the emergency departments which may be their only viable healthcare option. In addition to healthcare, community health centers also offer or coordinate much needed services such as translation or interpreter services, transportation, and the case management of complex issues and conditions.

Staff also act as excellent community advocates and work to explain, distribute, and educate patients on health conditions, treatment options, home care, and disease management. By doing this, patients and their families can have better outcomes as they know how to manage all aspects of their health. Patients learn about any conditions or symptoms through education provided with a focus of culturally competent healthy practices and behaviors that will work for them.

As an affordable and viable option for approximately 29 million people in the United States, the nearly 1,400 community health center organizations nationwide provide a place where residents go for healthcare delivered by a staff that understands the specific details of their community and how those details can impact their health. Some states have organizations devoted to community healthcare, such as the Massachusetts League of Community Health Centers, that offer more information, resources, and history of these vital centers.

Nurses interested in a career working in community health can find out more through the American Public Health Association, an advocate for providing high-quality and effective public health options. A healthy community allows residents many more options, and community health centers help provide that lifeline.

From pregnancy and neonatal care to addiction or heart disease, community health nurses will see it all in their practices. It’s an excellent role for those who are committed to both lifelong learning and the foundation of a healthy community that is focused on equity.

August Is National Breastfeeding Month

August Is National Breastfeeding Month

August is National Breastfeeding Month and is a good time for nurses to offer support and resources for families who want to make breastfeeding part of their lives.

According to the United States Breastfeeding Committee, “83 percent of U.S. infants receive breast milk at birth, only 25 percent are still exclusively breastfed at six months of age.” And while the benefits of breastfeeding are widely touted by the American Academy of Pediatrics and other organizations, not every family has equal access to resources or has a supportive environment in which breastfeeding can be sustained.

This month calls attention to the disparities that exist and can help families who choose breastfeeding to have better opportunities for education, support, and resources.

On August 27, from 11:30 am to 1 pm EDT, BirthNet will host the lunchtime discussion, Celebrating Black Breastfeeding and How Doulas Can Help. The panel discussion will address using doulas to help families through some of the challenges they find, especially during the times when COVID-19 can bring even more barriers to finding support when they need it.

Most babies and mothers reap health benefits associated with breastfeeding. According to the American Academy of Pediatrics those include some infant and childhood protection against:

  • bacteremia
  • diarrhea
  • respiratory tract infection
  • necrotizing enterocolitis
  • otitis media
  • urinary tract infection
  • late-onset sepsis in preterm infants
  • type 1 and type 2 diabetes
  • lymphoma, leukemia, and Hodgkins disease
  • childhood overweight and obesity

Mothers also find benefits include a faster uterine recovery, decreased bleeding, faster postpartum weight loss, and some risk reduction of ovarian and breast cancer.

Nurses can continue to offer support to moms who are beginning the process or those who want to continue and are having a hard time doing so. While breastfeeding is a natural method of feeding, it isn’t always easy. Frustration, pain, and exhaustion can derail even the most determined parent. But supportive care—from a nurse, a friend, family member, or a professional—can make the path to continue a little easier. When parents find reliable and effective advice, emotional support, and encouragement, they may be more inclined to continue.

As a nurse, even if you aren’t an ob/gyn specialist, you can help support families who want to breastfeed by helping them find resources within your organization. General supportive conversation if they are finding breastfeeding more challenging than they realized or guiding them toward breast pumps, pillows, nursing clothing, salves, or support groups can sometimes be all that’s needed.

As a professional, you can also advocate for breastfeeding rights including workplace rights for working parents, equal access to resources and support, and general acceptance of breastfeeding.

The Healthy Newborn Network offers a Breastfeeding Advocacy Toolkit that offers ideas on everything from funding to workplace policies aimed at making breastfeeding easier and more sustainable for many different lifestyles and scenarios.

Celebrate and support families this week during National Breastfeeding Month.

Black Men and the Dilemma of Wearing Masks During the COVID-19 Pandemic

Black Men and the Dilemma of Wearing Masks During the COVID-19 Pandemic

On April 3, 2020, the Centers for Disease Control (CDC) made a statement encouraging all Americans to wear cloth face coverings upon leaving their homes. In response, Black men have expressed their concern about such a recommendation. Their concern is based in that wearing masks could expose them to racial profiling and harassment from law enforcement officers. An example of such concern can be seen in the Twitter posting of Aaron Thomas, a Black man living in Ohio: “I don’t feel safe wearing a handkerchief or something else that isn’t CLEARLY a protective mask covering my face to the store because I am a Black man living in this world. I want to stay alive but I also want to stay alive.” Such a tweet has been reposted more than 18,000 times since its original posting.  Based on his statement, Thomas has decided to not wear a mask so that he can “stay alive.”

This concern has not been unwarranted. A month before the CDC provided its recommendation, two Black men posted a video of themselves on YouTube being escorted out of a Walmart in Wood River, Illinois by a police officer for allegedly “wearing surgical masks.” One of the men stated that: “[The policeman] followed us from outside, told us that we cannot wear masks. This police officer just put us out for wearing masks and trying to stay safe.” The chief of the Wood River police, Brad Wells, stated later in a news release that the police officer in the video “incorrectly” told such men that a city law prohibited the wearing of masks. Chief Wells went on to state: “This statement was incorrect and should not have been made. The city does not have such an ordinance prohibiting the wearing of a mask. In fact, I support the wearing of nonsurgical mask or face covering when in public during the COVID-19 pandemic period.” As a result of the two men filling a complaint, Chief Wells told The Washington Post that an internal investigation of the incident has begun with the assistance of the local NAACP branch.

Georgia Senator, Nikema Williams, wrote a letter to the state’s governor urging him to temporarily suspend the mask laws. She explains why in her letter, stating that her husband, who is African American, 6’3”, and weighs 300 pounds: “was telling [her] how uncomfortable it was to wear a mask in stores because folks get intimidated and look at him like he’s up to no good.”

Black men have also experienced racial profiling when not wearing a mask. In April of 2020, a video from Philadelphia filmed a Black man being removed with force by four police officers one day after the city’s transportation authority required all riders of buses, trolleys, and trains to wear face coverings. After the incident, the transportation authority made an announcement deeming face coverings no longer required for riders.

Therefore, it has been found that both Black men who follow and do not follow the CDC recommendation to wear a face covering have experienced episodes of harassment. Blacks are already at an increased risk of contracting the virus, but now Black men in particular are faced with the dilemma to wear a mask to save their lives from either racial profiling or the raging COVID-19 pandemic.

Like several senators, the NAACP has also made a statement urging states to indefinitely stop their mask laws. Marc Banks, the NAACP’s national press secretary, stated: “No person should be fearful of engaging in lifesaving measures due to racialism.”

Melanye Price is a political science professor at Texas’ Prairie View A&M University. She tells The New York Times that the well-intentioned recommendation to wear masks or bandanas actually can put African Americans at greater risk of racial profiling. According to Kevin Gaines, a professor of civil rights and social justice at the University of Virginia, Black men are already being profiled by the police on a regular basis, but wearing masks heightens such risks of profiling. The initial assumption is not made that Black men are wearing masks to protect themselves and those around them from the threat of the virus. However, in contrast, it is assumed that they are engaging in some type of ill will like stealing or other crimes.

As a result of the risks of racial profiling, some Black men have changed their style of dress in an effort to appear less threatening. STAT correspondent Usha Lee McFarling reports that Black men have attempted to “tone down their appearance to lower suspicion.” Examples of such “toning down” comes in the form of wearing college T-shirts and “dressing like prospects, not suspects.” This has even been found in their choice of mask colors and patterns, choosing floral prints or plain white masks over others.

Vickie Mays, a professor of heath policy and management at UCLA, has been attempting to track situations in which Black men wearing masks have suffered harassment. Mays tells STAT that Black men should wear masks despite the risk of racial profiling in order to, foremost, protect their health. However, she suggests that such masks not be dark in color or “ominous looking.” Instead, she suggests they be bright in color or have traditional African prints. Mays also urges health officials to swiftly procure professionally-made masks for Black communities just as they would any other commodity like food or water as this population has been reportedly experiencing greater rates of COVID-19 infection than non-minority groups.

OMH Announces Upcoming Virtual Symposium to Advance the Response to COVID-19

OMH Announces Upcoming Virtual Symposium to Advance the Response to COVID-19

OMH Announces Upcoming Virtual Symposium to Advance the Response to COVID-19The HHS Office of Minority Health (OMH) is hosting a virtual symposium on Thursday, September 17, 2020 to highlight state, tribal, territorial and community-based efforts to address COVID-19 among racial and ethnic minority populations. The Advancing the Response to COVID-19: Sharing Promising Programs and Practices for Racial and Ethnic Minority Communities virtual symposium will feature national, state, tribal and local experts leading these efforts and is developed for public health leaders at all levels and community organizations confronting the pandemic.

According to the Centers for Disease Control and Prevention (CDC), a history of systemic health and social inequities have put racial and ethnic minority groups at an elevated risk of contracting COVID-19 or experiencing severe illness, regardless of age. CDC data suggests the prevalence of diabetes, cardiovascular disease and other underlying conditions also contribute to disparities in health outcomes within communities of color.

The OMH virtual symposium aims to support the dissemination of promising practices, programs and strategies for combating COVID-19, especially in racial and ethnic minority communities.

Stay up to date on the virtual symposium by signing up for OMH email updates and by following us on TwitterFacebook and Instagram.

Spread the word and help connect others to this event.

ANA Speaks Up about Recent Supreme Court Ruling on Contraception

ANA Speaks Up about Recent Supreme Court Ruling on Contraception

The Supreme Court of the United States recently ruled to strike the Patient Protection and ACA’s requirement for health insurance plans to cover the total costs of contraception. The American Nurses Association (ANA) released a statement about their disappointment in this ruling.

We interviewed Cheryl Peterson, MSN, RN, the ANA Vice President of Nursing Practice and Work Environment about ANA’s stance and what this ruling means for the nation.

Why is ANA disappointed in the recent ruling of the Supreme Court to strike down the Patient Protection and ACA’s requirement for health insurance plans to cover the total costs of contraception?

ANA firmly believes all people have the right to determine how and in what form they receive health care. This recent decision from the Supreme Court affects millions of women and health care consumers who have depended on this mandate to offset some of the costs of reproductive health care. For some people, contraception can be a considerable expense. During this COVID-19 pandemic, many people are furloughed or receiving a limited income. Therefore, they may have no choice but to go without contraception health services.

Why is ANA taking a stand on this?

The American Nurses Association (ANA) has advocated for not only nurses, but for quality health care of all people—for decades. With regard to the recent SCOTUS decision on the ACA contraception mandate, we must ensure that all women and health care consumers are provided equal access to quality health care and are provided the proper counseling. All patients have a right to make their own decision about their medical care and treatment.

What do you think is going to happen to the women who counted on this coverage? Why? Do you think this may result in more unplanned pregnancies?

Unfortunately, many women are already facing tough economic challenges due to the COVID-19 pandemic. These women might have to compromise other necessities to obtain contraception coverage or may even have to sacrifice their own reproductive health because they simply don’t have the financial means to obtain these health services. The latter scenario could possibly lead to unplanned pregnancies.

What can be done to help them? What can nurses do in their proverbial “own back yards” to help these women?

Nurses can use their voices to educate women on what their best options are for affordable, quality reproductive health care, which includes contraception and contraception counseling. Nurses can also provide insights and advice on types of contraception for women with particular health needs and concerns.

What kind of challenges is the Supreme Court’s ruling going to cause?

Decisions regarding reproductive health and family planning are inherently personal. The outcome of this ruling jeopardizes a women’s ability to collaborate with her trusted primary health care provider or see the same practitioner for follow-up visits. In addition, this could result in reduced access to crucial and medically necessary health care services and the further exacerbation of health disparities.

Are there any other places that may cover the cost that remains for contraception?

Title X family planning programs have a decades long history of bridging gaps and providing comprehensive family planning and preventive health services to individuals needing access to these services.