No one can ever say Lorraine Freytes backs down from a challenge.
Diagnosed with lupus when she was just 11 years old, the disease has challenged her to keep going despite debilitating symptoms and grueling therapies. Now in her junior year of nursing school at Florida International University with a 3.8 GPA, Freytes has traveled a rough road to get to this point. But, she says, taking the easy route just isn’t her way.
With lupus, Freytes became familiar with hospitals and hospital staff at an early age. A flare up of joint pain and severe fatigue so intense she was unable to get out of bed led to her diagnosis, and physicians and nurses quickly became part of her regular routine. And while they worked to make her feel better and control the lupus, they also, unknowingly, influenced her career path.
At first, Freytes and her family were unhappy with her treatment, overwhelmed by the diagnosis, and frustrated that their voices weren’t being heard by those who headed up her treatment plan. Eventually, her family found a hospital where the staff responded to her, and it changed her world.
“The staff was wonderful,” she says. “They treated me like a person, and I decided I wanted to become a nurse. I loved going to see them, and I wanted to make other kids feel the way I felt when I had to go.”
Freytes says the staff’s compassion gave her a deep sense of relief. “I can’t even describe it, like the butterflies, that someone cared,” she says. “Someone who didn’t even know me. It was heart-warming and incredible.”
As part of her treatment, Freytes received chemotherapy several times a year for several years and so became close to the staff. Her thoughts never wavered. “I wanted to be that person,” she says.
Despite the upheaval, Freytes kept her goals in sight. “I always pushed myself,” she says. “My parents said, ‘Don’t let lupus stop you from doing what you want to do.’” When she couldn’t take notes in class, she recorded the lecture. She wanted to be out in the world. “If I had to hobble out the door, I did,” she says.
As a student, Freytes takes care of herself knowing the rigors of nursing school are extra challenging for someone with lupus. She receives wonderful support from a close network that includes her family and her boyfriend. Sometimes she just has to push through symptoms like severe fatigue, she says, but she also takes care to slow down and rest. “I exercise, eat healthy, and take lots of naps,” she says, noting that her lupus is manageable right now. She hasn’t had an infusion in two years.
Freytes is thinking of a career in NICU or pediatric oncology because she received her own chemotherapy infusions there. “I like that environment,” she says. “I want to give patients hope. I can show them I was sick, too.” She also knows what it’s like to feel miserable from treatments that are helping you and that common link will help her be the kind of nurse she has always envisioned.
After Freytes finishes her bachelor’s degree, she plans to keep going until she has a PhD in hand. “I always tell people to follow their dreams,” she says. “Don’t let things stop you from what you need to do or want to do. You can’t live in a bubble.”
And even when an illness or another of life’s unexpected challenges gets thrown in your path, keep going, she says. “You have to push yourself and you have to try. You just have to do it.”
There are substantial racial disparities in the burden of lupus, according to initial data from the largest and most far-reaching epidemiology study ever conducted on the disease lupus and published recently in the journal Arthritis and Rheumatism. New data from two registries, part of the National Lupus Patient Registry (NLPR), also reveal that black females disproportionately are burdened by lupus, a devastating and complicated autoimmune disease.
An extensive review of records from hospitals, specialists’ offices, and clinical laboratories in Georgia and Michigan showed blacks had an increased proportion of lupus-related renal (kidney) disease and progression to end-stage renal disease than whites, and that black females developed lupus at a younger age than white females. To learn more, visit www.lupus.org/news.
The NLPR is the first comprehensive population-based epidemiology study in lupus, with five registry sites located in Georgia, Michigan, California, New York, and the Indian Health Service. The sites are collaborating to use similar case definitions and data collection procedures to capture diagnosed lupus in these areas and allow more accurate data comparison, critical in assessing this complicated disease. The Georgia and Michigan sites are the first to report their findings.
With a grant and under direction of the Centers for Disease Control and Prevention (CDC) and in partnership with the Georgia and Michigan state health departments, investigators from Emory University and the University of Michigan led this landmark epidemiology study to include blacks and whites of all ages.
“Black women had very high rates of lupus, with an incidence rate in Georgia nearly three times higher than that for white women, with significantly high rates in the 30-39 age group,” said Georgia principal investigator, S. Sam Lim, MD, MPH, Emory University, Department of Medicine, Division of Rheumatology. “These are young women in the prime of their careers, family, and fertility. This means a severely compromised future, with a disease that waxes and wanes, affecting every aspect of daily living for the rest of their lives.”
“We found a striking difference in patterns of lupus between the black and white populations, which may help us better assess risk for developing this disease,” explained Michigan principal investigator, Emily C. Somers, PhD, ScM, University of Michigan, Departments of Internal Medicine, Environmental Health Sciences, and Obstetrics & Gynecology. “Not only was the peak risk of lupus earlier among black females, but a higher proportion also developed severe or life-threatening complications of lupus, such as neurologic or kidney disease, including end-stage renal disease. Health care providers caring for this population should be aware of the importance of screening for early signs of lupus, in particular kidney disease.”
“The results just from these two registries illuminate the enormous burden of lupus among young women in the prime of their life,” said Sandra C. Raymond, President & CEO, the Lupus Foundation of America. “But data from these sites represent only the tip of the iceberg. Lupus is a complex and diverse disease that can take many forms. We need a more complete understanding of the impact of all forms of lupus among all populations at risk for developing the disease. The data from the next three sites will help to fill in gaps and document the urgent need to elevate lupus to a national health priority.”
The Georgia and Michigan investigators noted the challenges with diagnosing lupus, stating that likely there remain undiagnosed cases in the community and that applying more up-to-date diagnostic criteria might result in even higher incidence and prevalence rates. The investigators also said they plan to use the lupus patient registries to recruit cohorts for ongoing studies to document the progression of the disease and determine the economic burden of lupus over time, which, according to data already available, is substantial.
“The purpose of the National Lupus Patient Registry is to develop more complete population-based incidence and prevalence estimates and to assess the impact of lupus,” said Charles Helmick, MD, medical epidemiologist, CDC.
“The results of previous lupus epidemiology studies have varied widely for a number of reasons, including lack of representation of populations at high risk, different case definitions, and limited or small source populations. The Georgia and Michigan studies include four counties with a combined population of nearly four million people. The large surveillance population, along with the extensive review of records from many sources, has resulted in the most reliable and up-to-date statistics for lupus,” said Helmick.
In March of this year, model and actress Mercedes Yvette, runnerup in the second season of the reality TV show “America’s Next Top Model,” spoke at a news conference about something that’s extremely important to her. The topic wasn’t fashion. Yvette’s concern is lupus, a debilitating disease that she said is often “overshadowed and overlooked.”
The disorder, formally known as systemic lupus erythematosus (SLE), affects an estimated 1.5 million Americans. Unfortunately, lupus disproportionately affects young women of color, including Yvette.
As a national spokesperson for the Lupus Foundation of America (LFA), Yvette was at the news conference, along with Frances Ashe-Goins, RN, MPH, deputy director of the U.S. Department of Health and Human Services (HHS) Office on Women’s Health (OWH), to help kick off the first-ever Ad Council media campaign on lupus awareness, co-sponsored by LFA and OWH. The theme of the campaign—which includes print, TV, radio and online ads depicting minority women of various races and ethnicities—is “Could I Have Lupus?” There is also a bilingual (English/ Spanish) campaign Web site, www.couldihavelupus.gov, which offers lupus information and resources, an online discussion forum and personal stories from women who are living with the disease.
In addition to increasing the general public’s awareness, Ashe-Goins says she hopes to encourage minority nurses to learn more about lupus and how they can help close the gap of unequal lupus outcomes. “Minority women who are diagnosed with lupus tend to [have a more severe form of the disease than Caucasian women],” she notes.
“It’s important to get the message out to minority communities about what lupus is,” agrees Amy Ma, DNP, APRN, FNP-BC, assistant professor and clinical coordinator in the nurse practitioner program at Long Island University School of Nursing in New York. “We are the front line. We [interact with the patients] more than other health care professionals, so it’s up to us to reach out to our communities with information.”
Lupus is an acute and chronic autoimmune disease in which the immune system is unbalanced, forming antibodies that attack normal tissue and organs. It can affect virtually every organ system in the body, causing inflammation and tissue damage. Its complications can result in severe health consequences, including heart attacks, stroke, seizures and organ failure. According to OWH, nine out of ten people who have the disease are female, and it is three times more common in African American women than in white women. Lupus is also more common in women of Hispanic, Asian and Native American descent.
The landmark LUMINA (Lupus in Minorities: Nature versus Nurture) study, conducted for the National Institutes of Health by researchers from the University of Alabama at Birmingham, the University of Texas- Houston Health Sciences Center and the University of Texas Medical Branch at Galveston, revealed that African American and Hispanic lupus patients tend to develop the disorder earlier in life than their Caucasian counterparts, often during their prime childbearing years. They also tend to have more aggressive disease activity, more serious complications and are more likely to die from the disease. Hispanic women with lupus have a poorer prognosis overall and are more likely to experience heart disease and kidney damage, while African American patients are more likely to have complications such as seizures, hemorrhages and stroke.
Although there is no cure for lupus, the disease is manageable, especially when it is detected and treated early. But all too often, Ashe-Goins warns, minority patients are not diagnosed until their disease is in the later stages, when it may have already damaged a major organ in their body. “Sometimes it impacts their kidneys, or their heart,” she says. “Or it may impact their neurological system and they have memory loss.”
A Difficult Diagnosis
There are a number of possible reasons why minority women with lupus don’t get diagnosed sooner. One explanation is that early detection of lupus is difficult in general. Different patients exhibit different symptoms and may suffer from them for several years before finally being diagnosed. Some of the more common symptoms include painful joints, extreme fatigue, hair loss, photosensitivity and a so-called “butterfly rash”—a red skin rash that often appears on the nose or cheeks (and sometimes the upper arms, shoulders, chest, hands or face). These indicators can come and go over time, and they can range from mild to severe. Patients usually have to go through several months of testing before learning they have lupus.
Once diagnosed, patients can be treated by family physicians, rheumatologists or clinical immunologists. A range of treatment options is available, including nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease joint and chest pain, corticosteroids to reduce inflammation, and immunosuppressives to restrain an overactive immune system.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), lupus patients can also be treated with antimalarials, such as hydroxychloroquine sulfate (brand name Plaquenil) and chloroquine (Aralen). Although these drugs, as the name implies, were originally used to treat malaria, they have been found to be helpful in controlling symptoms such as fatigue, joint pain, skin rashes and inflammation of the lungs in lupus patients. Antimalarials can also help decrease “flares,” which are instances when lupus comes out of remission, either with new symptoms or recurring old ones.
Socioeconomic factors can also create barriers to treatment for women of color. Lupus medications are expensive. People who lack health insurance— a group that includes minorities at disproportionately high rates—may find it difficult to afford the drugs, so they may forego treatment.
Even if patients can pay for the medicines, they still have to see their health care provider for multiple treatments, even if they are in remission. If the disease has caused organ damage, patients must undergo additional procedures, such as kidney dialysis. As a result, the overall cost of lupus treatment is exceedingly high.
Even though lupus affects minority women at higher rates, health professionals say that at-risk women in communities of color still don’t know enough about the disease.
“In our focus groups [at OWH], we found that women knew about breast cancer, heart disease and HIV/AIDS, but they gave us blank stares when we asked them about lupus,” says Ashe- Goins. She adds that many of the participants knew someone who had lupus but they were clueless about the disease itself.
To fill this knowledge gap, Ashe- Goins developed a lupus awareness program that was initially offered to HHS employees. “We discussed what lupus is, how it’s treated and what lupus patients can do to have a better life. It was highly successful,” she says. “Next, we decided to do a national campaign to warn [at-risk women] about the prevalence of lupus. We wanted to help our young minority women of childbearing age learn to detect the early warning signs.” The result is the national “Could I Have Lupus?” campaign.
During the HHS campaign, Ashe- Goins and her staff found that their target audience, young women, thought the common lupus symptoms of fatigue or a rash were too minor to be taken seriously. The OWH team realized they had to talk about lupus in a way that would grab the young ladies’ attention.
“We told them they could lose their hair,” says Ashe-Goins.
One of the most frequently asked questions she encountered, Ashe- Goins adds, was whether someone can “catch” lupus. “The answer is ‘no,’ it is not an infectious disease,” she says. “However, there is some evidence that in general, autoimmune disorders can be hereditary.” For lupus in particular, says the LFA, a combination of genetics (heredity), environment and hormones is involved.
The Nurse’s Influence
While national media campaigns and informative Web sites can play a big part in increasing lupus awareness, nurses can make an even bigger impact. As a nurse, you have the ability to reach undiagnosed lupus patients that the “Could I Have Lupus?” campaign may not. When patients enter the health care system, the first person they spend time with is usually a nurse. And that means you can play a pivotal role in helping patients receive an earlier, accurate lupus diagnosis.
Lupus Resources for Nurses and Patients Created especially for young women of color, the “Could I Have Lupus?” national lupus awareness campaign, www.couldihavelupus.gov, offers information in English and Spanish about lupus symptoms, diagnosis, treatment, support resources and more. The campaign’s Web site also includes an online discussion forum where lupus patients can ask questions, get advice and share information with peers. For health professionals and organizations, the site provides information about getting involved in the campaign, including free downloadable campaign materials. The Lupus Foundation of America, www.lupus.org, through its network of local chapters throughout the country, provides a wealth of information, programs, services and support groups for lupus patients and their families. Resources available for nurses include continuing education programs, publications, clinical guidelines, conferences and a comprehensive online publication, Lupus: A Patient Care Guide for Nurses and Other Health Professionals, created by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The guide can also be purchased in print or CD-ROM formats from NIAMS at http://catalog.niams.nih.gov/index.cfm. The Association of Rheumatology Health Professionals, www.rheumatology.org/arhp/index.asp, a division of the American College of Rheumatology, offers members and non-members a variety of education programs and resources relating to lupus and other rheumatological diseases, including nurse practitioner rheumatology training programs, advanced practice skills training, audioconferences/Webcasts, and patient education materials in English and Spanish. The S.L.E. Lupus Foundation, www.lupusny.org, a New York-based organization that also has offices in Los Angeles, provides multicultural outreach programs for minority women with lupus, including the Lupus Cooperative of New York City (LCNY), a collaborative network of health and support services for lupus patients and their families in local underserved and inner-city communities. The foundation’s Web site also offers extensive information and resources for patients, in English and Spanish, about living with lupus and managing their disease. The Lupus Research Institute, www.lupusresearchinstitute.org, provides health professionals with timely news and information about lupus research findings, clinical trials and new treatment options. The institute also offers grant funding for lupus researchers. The Hospital for Special Surgery in New York City offers several multicultural outreach programs and support services, including:
“If nurses pay attention to [possible warning signs] in patients as they’re coming in, sometimes they can help the doctor order the correct test,” says Ashe-Goins. For example, if a patient’s creatinine level is very high, it’s a good indicator that she has kidney problems. At that point, the nurse can research a little further to see if the trouble is related to lupus. Similarly, if you discover that autoimmune problems run in the patient’s family, you should consider that lupus could be a possibility.
“Not all kidney problems are lupus, but I’m asking nurses to add that to their consideration,” Ashe-Goins says. “Nurses have time to assess family history, current symptoms and past history. They can help point the patient in the right direction.”
In Amy Ma’s clinical practice as a family nurse practitioner, one of her patients is a Hispanic woman in her early 20s who was recently diagnosed with lupus. “The patient had been complaining of joint pain and a rash. We did some basic blood work, but it was inconclusive. Then we sent her to a rheumatologist,” says Ma, who notes that the entire testing process took months before the patient was diagnosed.
“Part of the reason why the diagnosis took so long is because the patient didn’t think her symptoms indicated something that could be so severe [as lupus],” she adds. As a nurse, Ma felt compelled to encourage her patient to follow through with the testing.
Once the lupus diagnosis was finally confirmed, the next step was to educate the patient about living with her disease and about the possible outcome. “We didn’t want to scare her, but we wanted to prepare her for something that could be a lifelong problem,” says Ma. “Fortunately, there is a lot of hope for her. She didn’t get a very bad flare and there’s not a lot of severe organ damage.”
Even though this patient’s disease was caught early, it is still important for the young woman to keep coming back for follow-up visits. However, says Ma, “the patient is a busy mother of young children and I’m afraid that she won’t take the time to take care of herself and attend follow-up treatments. It’s kind of hard for her to grasp the whole concept that [her lupus] might go away and come back again, but that’s what we as nurses have to explain.”
“Because there is no cure for lupus, patients must maintain visits with their physician, even if the disease is in remission,” says Eulalee A. Greene, RN, a clinical nurse in rheumatology at the Hospital for Special Surgery in New York City, which offers culturally and linguistically competent lupus outreach programs for the minority communities it serves (see sidebar). Greene acknowledges that many lupus patients may not want to come back for follow-up care because they have a sense of dread after they’re diagnosed. “It’s understandable that patients have fear about the disease. They may fear loss of friends, social life or even [loss of] employment.”
In these instances, it’s important for nurses to assist patients in finding support systems to help them cope. “Patients can find help through support groups in their community and through church organizations. Most of all, they should be counseled to reach out to their family or significant other,” Greene says.
Are You At Risk?
Because lupus disproportionately affects women of color, minority nurses who are female also need to be aware of their own risk for the disease. Loretta Jackson, LPN, an African American nurse in Mobile, Alabama who was recently diagnosed with lupus, says it took months of testing for doctors to figure out why she had extreme fatigue and her kidneys weren’t working optimally.
“My doctors had asked me before if I had lupus and I always told them no,” she recalls. It wasn’t until her physician insisted that she have a biopsy on her kidneys that she received her diagnosis. “I didn’t think I had lupus at first, because I’ve always heard about the butterfly rash [as a telltale symptom] and I didn’t have any rash. But I still had lupus.”
Even though Jackson has been a nurse for 17 years, her family wasn’t prepared for the findings. “When the doctor came into the room, my family asked him, ‘What is lupus?’ And he explained. Then, when he left the room, they turned to me and asked, ‘What is lupus?’ again,” she says.
Since then, Jackson and her family have joined a local support group, the Lupus Support Network, which has provided her with ample information about living with the disease. She says the group has helped her find resources for obtaining more affordable medicine and has educated her relatives about how to care for someone with lupus.
Today, her family members are not only knowledgeable about lupus, they’re her biggest advocates. “Before, my 14-year-old daughter didn’t understand why she couldn’t even hug me because it hurt me so bad,” says Jackson. “Now, she’ll say things like, ‘Mama, have you had your medicine for pain today?’ She’ll remind me to take it easy if I’m pushing myself too hard.”
Although Jackson is currently on disability leave from her job as a nurse, she says she’s managing her disease and still has a good quality of life. “I have lupus,” she declares, “but it doesn’t have me.”
In her mind’s eye, Capt. Mary Lambert can still picture the children walking to school, just as children do in neighborhoods everywhere, talking in small groups as they amble along. Except in this scene, they are walking along streets lined with bombed-out buildings, and at least one child in every group is missing an arm or leg.
Lambert, an African-American nurse and commissioned officer in the U.S. Public Health Service, will never forget this and other surreal scenes captured in her mind from her time in Rwanda. The stark contrasts will stay with her forever: the lush flowers that grew higher than her head and the huge avocados dripping off the trees, versus the devastated cities and war-torn people, many of whom had lost nearly all of their relatives to roving bands of death squads.
“The people we worked with were so gracious and appreciative in the face of their losses,” she says. “When I came back to the U.S., it was probably six months before I felt I could complain about anything.”
But just as the experience made a lasting impression on Lambert, she ¬in turn left an equally indelible mark on Rwanda. In 1995, Lambert and other American health care professionals spent two months working in the civil war-ravaged African nation. Their assignment: to train 500 people to staff the country’s severely depleted clinics. The training was critical because Rwanda had lost an astounding 80% of its health care work force in the genocide the year before.
“It was one of the most humbling and rewarding experiences of my life,” she says of her work there.
Serving in countries like Rwanda is just one of the many and varied opportunities available to nurses who work in the Commissioned Corps of the U.S. Public Health Service. Driven by their passion for public service, these nurses work on the front lines to deliver health care to the people who need it most, in locations ranging from Third World countries to America’s most underserved racial and ethnic minority communities.
Cmdr. Ana Marie Balingit-Wines, CCRN, chief of beneficiary medical programs, calls the U.S. Public Health Service “one of the federal government’s best-kept secrets” because so many nurses are still unaware of the career opportunities it provides. Under the direction of the U.S. Surgeon General, commissioned nurses wear uniforms and serve as officers. They work for local, state, federal or international health agencies in a wide variety of capacities. They help conduct research, design disease prevention programs, develop creative techniques in medical methodology, improve mental health care, expand health resources and much more.
“If you are somebody who wants to contribute to the overall health of the nation, and even the world, the opportunities are endless,” says Rear Adm. Mary Pat Couig, RN, MPH, FAAN, an assistant Surgeon General and chief nurse officer.
Never a Dull Moment
Lambert feels the variety offered by the Commissioned Corps is one of this career’s greatest assets. “It’s not easy work, but the opportunities are just incredible,” she says. Her service in Rwanda is just one slice of her nine-year career in the Public Health Service. For three years, she helped provide care for some 4,000 seasonal farm workers in migrant camps in eastern Maryland and Virginia.
Later, she worked for the U.S. Food and Drug Administration as a consumer safety officer. There she managed the review process for FDA approval of nicotine substitute products, such as the patches that help people quit smoking. She also worked for the Centers for Disease Control and Prevention in Atlanta, where she helped create training programs and educational materials on immunization. Since November, she has been developing policies on military health issues as director of the Office of Military Liaison and Veterans Affairs.
In addition to their regular jobs working for government health agencies, nurses in the Commissioned Corps also can be mobilized in time of war or national and international emergencies. To become a commissioned officer, nurses must have earned at least a Bachelor’s degree. Salaries are determined on the basis of rank, education and experience. The pay is competitive with the private sector, particularly after the first couple of years, and the benefits are generous. They include free health care, military commissary privileges and a fully funded retirement plan that doesn’t require any matching contributions by the employee.
Unlike officers in the Army or other branches of the military, who are often forced to move from base to base, officers in the Public Health Service Commissioned Corps control their own careers. While they tend to be mobile, because promotions often require moving to another government agency, they have the freedom to choose where they want to go and what positions they want to take.
According to Cmdr. Marylouise Ganaway, RN, chief nurse recruiter, the need for nurses is greatest in the Division of Immigration Health Services and the Bureau of Prisons. Bilingual nurses especially are in demand to provide care for recent immigrants. Translators can always be found, but nurses who share the patients’ language and culture can establish a comfort level and provide care that much more quickly.
Although these are the only two areas that are currently experiencing a nursing shortage, there are still plenty of job openings throughout the Public Health Service. As Ganaway puts it, “We can always use more nurses.”
The Right Stuff
Who is the ideal candidate for a nursing career in the Commissioned Corps? The answer is fairly simple.
“A qualified nurse who wants to make a difference in the nation’s health care,” Ganaway says.
“You have to be hard-working,” adds Balingit-Wines, who entered the Public Health Service 14 years ago after serving as a nurse in the Air Force. “You have to make a lot of sacrifices. You have to want to do good.”
In other words, this career is best suited for nurses who have a true passion to serve the neediest of underserved areas and are willing to boldly go to places where other nurses may be reluctant to work—from Micronesia to federal prisons to Mexican border towns.
Ever since she knew she wanted to be a nurse, Capt. Evangelina Montoya, RN, MSN, yearned to use her education and skills to help people with limited access to health care. Montoya grew up in a migrant farming family in Visalia, Calif., and knew first-hand the struggles of those without good medical resources. “I recall, as a child, the isolation and the financial burdens my parents endured,” she says.
After graduating from nursing school, Montoya worked in a hospital on an Indian reservation in Arizona. Despite her nearly lifelong desire to serve, she admits that the adjustment was difficult at first. Having completed her nursing degree in Denver, Colo., she had grown accustomed to the comforts of living in a big city. She also had to learn how to speak the tribe’s language so she could communicate more effectively with her patients.
“I had never lived on a reservation,” she explains. “Once I got there, I was in culture shock.” Although she believed her nursing education had prepared her to be culturally competent, she soon realized she had a lot to learn about working within a culture different than her own—for example, how to collaborate with the tribe’s medicine man in the treatment of patients.
Another tough challenge in Public Health Service nursing, says Francess Page, RN, BSN, MPH, is “recognizing that you can’t reach [every person in need] all the time, even though you’d like to.” Page, who is African American, entered the public health arena after working as a nurse in hospitals and seeing patients suffering from conditions that could have been prevented.
Driven by a passion to educate people so they can live healthier lives, she has played a major role in national AIDS prevention programs. Today, as director of policy and program development for the Department of Health & Human Services’ Office of Women’s Health, she continues to work on the AIDS awareness front, along with coordinating prevention and education efforts on such issues as lupus, domestic violence and minority women’s health.
Despite the hard work and the steep challenges, a career in the Public Health Service Commissioned Corps can offer profound rewards—whether they’re achieved directly, by treating patients, or indirectly, by shaping health policy. Page, for example, was instrumental in the effort that led to the creation of a national domestic violence hotline. She also helped establish a national nurses’ summit on violence against women and recently helped put together a national working group on lupus that is providing education about that disease to federal employees and the public.
Montoya, who is now a public health analyst for the Division of Community and Migrant Health, helps develop health care policies for migrant farm workers. She also works in a number of local clinics, to keep informed about what’s happening on the front lines of her field. “I feel I am giving back to the community,” she says.
In addition to her five years of working on Indian reservations in Arizona and New Mexico, Montoya has also served as an occupational health consultant and traveled internationally. In 1995, she went to Mexico as part of a World Health Organization delegation to help that country create a national health care plan. Three years later, she traveled to Chile as part of a delegation on nursing practice models.
Balingit-Wines says her work at the Alaskan Native Medical Center in Anchorage was one of her most rewarding nursing experiences. Many of her patients lived in such remote areas that their only access to health care facilities was by plane. Yet despite the isolation, the population faced growing problems of coronary heart disease and diabetes due to increasingly Westernized diets. Balingit-Wines, who is Filipino, says the fact that she physically resembled her Alaskan Native patients helped establish an immediate comfort level. “Just to hold a hand and see a familiar face meant so much to them,” she recalls.
Capt. Ernestine Murray, RN, BSN, MAS, has worked in a wide variety of positions during her 20 years as a commissioned officer. Murray, who became a nurse after a career in business at Lockheed Martin, worked as a critical care nurse at the Public Health Service Indian Hospital in Tuba City, Ariz., caring for members of the Navajo and Hopi tribes. As a nurse consultant and scientific reviewer for the FDA, she helped develop educational programs aimed at reducing complications associated with the use of medical devices. She also worked as a cardiovascular and surgical intensive care nurse at the National Heart, Lung & Blood Institute.
Currently, she is a senior health policy analyst for the Agency for Health Care Research and Quality. She is involved in the agency’s Center for Practice and Technology Assessment, where she develops and implements clinical practice guidelines and evidence-based reports on health care.
“With each job, I gained valuable experiences and wonderful memories,” Murray emphasizes. As an African American who grew up in Maryland during the time when schools were being desegregated, she thought she had been well exposed to disparities in equal access to basic human services. And yet, she says, the work she did on Indian reservations gave her a new appreciation for the stark needs that still exist.
“America’s health care system cannot be considered effective until those who have the least have the same access as those who have the most,” she maintains. “But through working in the Public Health Service, you feel your input helps chip away at that lack of access.”
Opportunities for students
Nursing students can earn money and get valuable experience through two programs offered by the U.S. Public Health Service Commissioned Corps, as well as a related federal program called the National Health Service Corps.
In the Public Health Service’s Junior Commissioned Officer Student Training and Extern Program (Junior COSTEP), students are commissioned as junior assistant health service officers. Nursing students can earn about $2,300 a month working for public health agencies on assignments ranging from 31 to 120 days. Students are not obligated to go on to a career in the Commissioned Corps after they graduate, but if they do, they receive credit for their time in the program for pay and retirement purposes.
For students in their final year of undergraduate or graduate school, the Senior COSTEP offers a competitive financial aid program in exchange for an agreement to work for the Public Health Service after graduation. As an active-duty officer during their senior year, students are paid about $2,300 a month and receive uniformed services benefits. When they graduate, participants are promoted according to their degree and professional experience. A nurse with a Master’s degree, for instance, would be promoted to a junior lieutenant with a $2,700 monthly salary, plus benefits.
To learn more about these opportunities, go to the student page on the Commissioned Corps Web site. Applications for both programs are available online, or by calling (800) 279-1605; if you are located in Maryland, call (301) 594-3453.
Meanwhile, nurses in certain specialties can apply for scholarships and educational loan repayment assistance through the National Health Service Corps, a program sponsored by the U.S. Health Resources and Services Administration (HRSA), Bureau of Primary Health Care. The program works together with local communities to place health care professionals in rural areas and inner city neighborhoods where the need for health services is greatest. Unlike the Commissioned Corps of the U.S. Public Health Service, however, members of the National Health Service Corps work for the community agencies, rather than the federal government. They are not part of the government’s uniformed services.
The scholarship and loan repayment programs are highly competitive. In exchange for the financial assistance, winners agree to work in two-year residencies in underserved areas.
The scholarship program is open to students studying to become nurse practitioners or nurse-midwives; the loan program is open to primary care certified nurse practitioners, certified nurse-midwives and psychiatric nursing specialists. For more information, see the NHSC Web site, or call (800) 221-9393.
While efforts to close racial and ethnic health gaps in such areas as cancer, diabetes, HIV/AIDS and cardiovascular disease are frequently in the national spotlight, lupus is one minority health disparity that has received relatively little attention. Yet this serious arthritis-related disease, which primarily affects women ages 15 to 45, is three times more likely to occur in African-American women than in their Caucasian counterparts.
The Arthritis Foundation estimates that as many as one in every 250 black women has lupus–and many of them are not even aware that they are living with the disease. In addition, some data suggest that the illness may also occur more frequently in Asian and Latino populations than in whites. While the cause of lupus is unknown, recent research suggests that it may be an inherited condition.
Lupus, which affects nearly 250,000 Americans, is a chronic, sometimes life-threatening autoimmune disease in which antibodies attack the body’s own tissue. It can involve the skin, kidneys, blood vessels, joints, nervous system, heart and other internal organs. Symptoms vary, but may include a skin rash, arthritis, fever, fatigue, anemia, hair loss, ulcers in the mouth, and kidney sediment. The good news is that lupus, once it is diagnosed, can be controlled with medication and exercise.
Because early detection is key to successful treatment of lupus, the Arthritis Foundation offers a number of resources for increasing minority women’s awareness of the disease, its symptoms and the importance of seeing a doctor if they are experiencing signs of the condition. These educational materials include a free booklet, a fact sheet, lists of lupus support groups in various parts of the country, and an online discussion forum for lupus patients. To find out more, contact the Foundation at (800) 283-7800 or visit www.arthritis.org (search for “lupus”).
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