Saturday

While spending time in North Carolina I have found that the generosity is highly given and appreciated. Today while we were white water rafting we came across a man who fell off his raft. The tour guide that we had made sure we got him in our boat and taken to safety a little farther down stream. This is just one example as to the generosity that I had witnessed. While I was here in North Carolina I had strived to improve the health and quality of others. For example, when observing the meetings at the recovery center, I made sure to give my advice and encourage and support everyone through the hardest parts of their recovery. I thought that this culture would be able to get healthier if the drugs were eliminated. Unfortunately, the drugs will continue to get worse unless people start getting help for themselves and other people. I hope that all of the great rehabs and help that is available to these individuals improves the drug problems to allow the heritage to be successful in future generations. It is so sad to me to see the Cherokee culture slowly start to die off. In this day and age it is more acceptable than it use to be to mix races. Even though this is a huge success in our world, there is still a sense of sadness to see the culture start to decrease, along with the language. Something that I did this week that was out of my comfort zone would have possibly been the church. Not that I am completely out of my comfort zone, but more of the fact that I am not use to actually going to church masses. 

After reviewing my blog from the first day I feel like so much has changed and impacted me from this experience. I had no idea about a lot of the culture and so much about the healthcare system. I had absolutely no idea about the free healthcare costs and the amount of money that they receive when they turn 18 and the money they receive from the casino. I do feel guilt for what my ancestors have done to the Cherokee and it is so powerful hearing the story and seeing the trails that they had walked on. I am shocked to see the amount of beauty in the area. I also had no idea how bad the drug abuse and alcohol abuse was until this trip. It is really great to see rehabs and other treatment centers working to overcome this issue. 

Friday

After having three days in the Cherokee Health Care System I have learned so much about culture. Everything that we have seen was not what I have expected. I can't believe how much I have actually learned. I thought that the most critical issue that this culture encounters daily is the fact that they all have suffer with some sort of drug or alcohol addiction. There are many prevalent conditions that I have noted in this culture such as diabetes and obesity. These conditions may become the most costly and preventable of all health problems. Diabetes and obesity may be related to genetics, culture or deficient knowledge with their health maintenance. When having a family history of type 2 Diabetes, it may be very difficult to figure out if your diabetes is due to lifestyle factors or genetic susceptibility. However, most of the time I have found that it is a mixture of both, genetics and lifestyle factors. The nurses role in health promotion and health maintenance is evolved around education. Education to the patients allows the nurses to help people; providing nurses the skills and tools they need to positively impact individuals lives. In my opinion and observation the center of the health care system revolves around the nurses and the interdisciplinary team. I thought that this was the center because they are the driving force to keep the health care team going. Today, their was a nurse in the emergency room that I had a great conversation with. He expressed how the team that worked in the Cherokee hospital worked great together and in the long run allowed the patients to be taken care of fast, efficiently and toward the best quality of care. I feel that this is much different than the previous experiences in health care outside of Cherokee. For example, I have never seen teams work so well with each other than I have today in the emergency room. The nurse explained to us that the faster they got the labs, urine samples and everything ordered and sent off to the lab the faster they could open up the bed for another patient, that could be worse off. 

Thursday

I thought that the only children’s hospital in Western North Carolina has compared to previous experiences in health care in many different aspects. For instance, I feel that at Methodist Hospital, the children are constantly sent off their floor for lab, tests and procedures. I thought that it was amazing to see that Mission NICU their nurses draw their own labs, run ABG’s, do circumcisions, laser eye surgery and have portable X-Ray machines come to the children. One huge thing that stands out about this feature is the fact that they are reducing exposure to germs, decreasing risk for a child abduction and make it a lot easier on the infant and the nurses by bringing everything to them, rather than the other way around. Something great that I noticed in the NICU was having the elevator that only staff could use that dropped down to the emergency room and also to the labor and delivery floor. 

There are many different ways that the children and their families adapt to the changes that occur with hospitalization. These changes may affect their health and family integrity as a whole. Unfortunately, some family members may likely suffer with changes in eating, sleeping, activities, family roles and their responsibilities, such as work and taking care of their other children. I have realized throughout the day that the Mission organizations apply family – centered care in many different aspects throughout their hospital. For example, in the pediatric unit there were two different play rooms that were set up for the children. Also, it was mentioned that the X box that was in the play room was mainly used by parents to occupy their time during their long or even short stays. It was nice to see that on the pediatric unit there was a kitchen area set up, along with food supplies and drinks to help the family and visitors to make it a little easier on themselves. 

When comparing the environment in Asheville, NC versus the environment to Cherokee, NC I have noticed a very large difference. However, I thought that both hospitals had their own ways of running things and it was much more focused on the patients and quality of care. I did get the vibe that the Cherokee environment is more focused on the cultural aspect of their tribe versus Mission where it was more focused on the overall care of all sorts of cultures.

One thing that stood out to me the most was the healthy, and positive communication at the Children’s outpatient clinic. It was so uplifting to see the community come together and have such a positive place for children and their families that was all donated. It was a beautiful facility and it was set up in a way that makes complete sense. It really pulled on the heart strings when looking at all of the hand prints on the wall in the Reuter’s clinic for children suffering from abuse. I have always been interested in learning more about the communication that the SANE nurse use toward these patients. There are so many different ways that these children use to cope with overcoming the pain of childhood abuse and neglect. It is great to see that this office allows to get the medical assessment, the interviews and also the therapy out of the way, all in one place. 

            

Wednesday

When learning about childbearing practises in this culture I found it sad that the drugs and alcohol do not make much of a change when pregnant. There are a few women that we have encountered that are either hospitalized or in treatment currently. I was aware of the high risk that it can bring to the pregnancy, however I am happy that some are aware to try and want treatment. Some family types that I have observed are both polar opposite. We have talked about families that have really cared for their families and supported them through their hard times. However, we have also seen families who have suffered with addiction themselves and did not support their families. Tonight we had talked about how the tribal and 'white' families were not happy many years ago when the pastor and his wife started dating. The support systems in the community that I have seen are the friends that are made in treatment. I found it very powerful that the bond that these individuals create with each other during treatment. Other support systems are the tribe, churches, the health care staff and also the community in general. I thought it was a great to hear that the church we had visited tonight was go open to taking in anyone who needed someone. Resilience is a person that is able to withstand or recover quickly from difficult situations. When considering the families and how they are able to bounce back from stress, challenges and the vulnerabilities that they face through the Cherokee culture I think about 'their story' and what they have all came across in their lives. The families and the children that are resilient have each other to help them get through their heart times. I have come to realize that the Cherokee individuals are very strong and 'promises' and trust means more than anything in their culture. 

Tuesday

I thought that it was interesting that the tribe and the actual community runs the health care system throughout the community. I think it is great to involve other members of the community to hear what they believe needs to happen to their own health care. The members of the health care team are everyone from doctors, nurses, nursing assistants, dietary, pharmacy, social work and anyone involved with the direct and indirect care of that patient. When someone with a need comes into Cherokee that needs help, they receive the same care that any one else would get. I believe that the similarities that I observed with the organization is the fact that its a goal that everyone should be treated with the upmost respect and quality of care. I think that the differences that I observed is the fact that our culture seems to be more judgmental. I love the feeling in Cherokee that you are not judged and you are just as equal to anyone else. Something that I take interest in is the fact that the herbal alternative medications in the culture have really great outcomes. Walking through the Indian Village a worker had been stung by some fire ants. It was educational to see him use a plant growing right next to where he was sitting called, 'Jewel Weed' to help with the stinging. 

Monday

My first impression of the environment in Cherokee is way different than I had originally expected. I thought that he mountains and the scenery throughout the land is beautiful. Driving down the road or even looking out over the mountains and seeing a beautiful fogof smoke is breath taking. I feel like the most interesting thing that I have learned about the cultures history was a few things at the museum, such as the ‘water beetle.’ I thought that it was amazing that the hospital was able to use that symbolization in the build of the new hospital. Another thing that I had found interesting about their culture is the support that they have toward one another. In this day and age, I feel that it is not something that I see very often. The values and beliefs that are similar to my own is treating elderly people with the upmost respect. I don’t know if it is because my grandparents have always been such a large influence in my life, or if I was just raised to have respect for my elders. One difference that I have seen that may be different from my own culture would be the discipline with the children. Even though I do not have children of my own, I feel like the culture I am from is a little stricter. The cultures heritage is way more integrated toward the children in the community when comparing to the children where I am from. Where I am from we may have learned about our history and culture through school and church programs, depending on the upbringing. However, the children that are part of the Cherokee culture. For example, we were able to see the children actually acting out their history and culture in the ‘Unto These Hills’ reenactment. Their families and ancestors influence their children’s cultural heritage so that their beliefs are passed down through generations. Some common threads in this community that I feel are similar to my own community that I have noticed here would be the fact that there is a lot of history about Native Americans about ten minutes from my house at a state park called Starve Rock. Through the past centuries, Woodland, Hopewellian, and Mississippi Indian cultures have really flourished around that area. I remember going on field trips and visiting Starve Rock and hearing about all of the tribes as a child. 

Sunday

During the next week I am most excited about learning more about why the Cherokee were pushed out of their land and how they got it back. I take extreme interest in how the drugs and alcohol have reached the levels that they have and what the future plans are pertaining to these issues.  My apprehension this week is making a comment and offending someone, unintentionally. When considering the social and cultural environmental influences on children I feel like we learned a lot about how individuals may have to travel hours to reach the Cherokee Indian Hospital Authority. When it comes to children, the parents or the caregivers are the ones they have to rely on for that proper care. If these children and their families are hours away from that care, it really puts a strain on their health.  I feel a lot of empathy toward the Native American people and I totally understand why it would be harder to gain their trust. I feel I can relate to their feelings because it is also hard for me to, “forgive and forget” and I follow a more life motto of, “forgive but never forget.” I do believe that any cultural biases, prejudices, pride and stereotyping need to be put aside, especially in the healthcare settings. The first way to know how to set aside your feelings is by knowing your own beliefs within your culture. Without knowing how you feel about something, it is extremely hard to put your feelings aside and care for the patient with the best quality of care.