Search This Blog

Friday, November 25, 2011



Welcome Isabella

At our community health center, each provider has a primary nurse that works with them. There was a time when nurses rotated daily but we found this to be somewhat disruptive. Now, each nurse still has to know how to work with multiple providers and how to manage pediatric and adult patients, but for the most part, a nurse and provider form a team. This works very well for us. The nurse forms a trusting relationship with the patient and parent. There is great continuity if a child is being followed for an illness and also for well care.The provider and nurse over time develop an understanding of how to provide the best patient care. This relationship is such an important one with regard to time and efficiency in the office. In many offices and hospitals, care is very fragmented and one staff member may ask history, another do vitals, another draw labs, another give vaccinations. This may be efficient but I feel something is lost for the patient and the nurse. I love the fact that these are our patients; I love that my nurse takes such pride in taking care of them. The provider/nurse relationship is something to explore when you interview at an office.

The nurse I currently work with is young enough to be my daughter. She had her 21st birthday this fall but has more maturity in 21 years than many get in 40. She chose her career in high school and attended a special program to get her LPN degree during her final years. She did an internship at our health center and because of her clinical skills, her willingness to learn and her genuine warmth, was hired to start as soon as she graduated. We started working together about a year an a half ago.

Sharon has been a pleasure to work with. She is very quick to learn. She will watch me and see all the things I am doing and say " Why don't you let me try and handle that piece, I think I could do that." She is great on vaccines. She knows when I will want a vision screen and when we need a urinalysis. She is the one that is trained on all the new equipment in our office and then she teaches the rest of us.

Sharon also found her soul mate in high school and they married when she was 18. This week, they became proud parents of a beautiful little girl, Isabella. I became just proud, of all of them. Isabella is the third baby born in our health center family this year. We also welcomed Jayson and Victor. They are all healthy. We have so much to be thankful for. Sharon gave me permission to post some pictures.

Sunday, November 20, 2011

Catching Up and Keeping Up


November 20, 2011 CATCHING UP AND KEEPING UP Last week, we took a lovely vacation out to the mountains of Giles County where my husband’s family takes a yearly hunting trip. It is great fun hiking and taking time to watch the sunset. Returning to work is never an easy feat after vacation. The electronic bubbles on our computers are always brimming over with double digit numbers of phone calls, results to be checked, refills. The red exclamation point indicates urgency and these are addressed amidst the heavy flow of patients that always characterizes a post- vacation week. And of course, the hospital is
bustling with new babies.
David and I are also completing our NRP recertification. There is a new edition of this education and it is our responsibility to keep our small unit up to date on all of the changes. We have an excellent nurse manager, Ann, in our maternal child health unit, and we handle changes together. For us, updating NRP involves not only our personal recertification, but solving the logistics of how we will get blended oxygen in our nursery, how we will incorporate an oximeter on the warmer in the OR where c-sections are done, and how we will update the nurses who are still certified with the older version. Ann did a great job and by the time I had a sick baby delivered in the wee hours of Saturday morning, we had new laminated algorithms and normal oximetry charts posted in our resuscitation area.
Our other educational event this week was an update on concussions. Thanks to support from Children’s Hospital of the King’s Daughters (CHKD) in Norfolk, Virginia, our community was able to hear two experts discuss Virginia’s law regarding concussions and the management of concussions. David and our director of nursing at ESRH (Eastern Shore Rural Health) worked very hard in the weeks prior to this presentation to invite all members in our community who deal with this problem. On a rainy Wednesday night, coaches from both counties, school nurses, physicians from our local private practice, our local adult neurologist, pediatric providers, school administrators, some parents and some students, gathered to hear Dr. Ralph Northam and Dr. Joel Brenner discuss concussions and return to play. It was a wonderful turnout and showed the power of community. Our local restaurant provided the space; CHKD provided a wonderful meal and speakers. We were able to discuss the barriers that we face in a small area where we do not have certified athletic trainers in our schools. We were able to work together on ideas for solutions to provide the neurocognitive testing that is important in the management of these athletes.
While we know there is never a dull moment around here, and often feel there is never a spare moment, the beauty of this place will often force us to just witness a special moment. I share two sunsets that opened and closed my week. The first is from Wind Rock in western Virginia. The second is from the overlook on the Chesapeake Bay Bridge Tunnel.

Monday, November 14, 2011

Finding Home


Some people find a job and then find a place to live nearby, but husband and wife pediatrician team, Drs. David and Cathy Riopel, had a different approach.  On a very long trip up the eastern coastline – from Florida to Virginia - the Riopels first found the right place.  They both felt life change when they crossed the 17 mile bridge tunnel span connecting their future home to the rest of Virginia.  The ocean pounded Smith Island on one side. Striper fisherman fished around the nets on the bay side. Bald eagles flew overhead.  The bridge joined a highway surrounded by the vast green of winter wheat. The place felt right but would there be a need for pediatricians?  On the way home they called the local hospital.  They were connected with Eastern Shore Rural Health, a local community health center.  They had never heard of a community health center but instantly felt comfortable with the idea.  The mission to provide healthcare to a whole community was right.  Nineteen years later they still enjoy living, working and playing on the Eastern Shore.

Although Cathy was born in Texas and David in Boston, they met in Charlottesville, Virginia where their fathers were professors at the University of Virginia. Both tracked to medical school, but in different ways.  Cathy knew she wanted to work with children in Pediatrics because she had worked at summer camps and a children’s rehabilitation center but David took a bit longer to figure out his direction. David knew he wanted to be physician and help people, but having worked during school with a Family Practitioner, he wasn’t sure if he wanted to work exclusively with children. He completed a combined medicine/pediatrics residency but later decided to practice pediatrics.

The couple trained together at Louisiana State University where one of their work sites was Charity Hospital of New Orleans – the one that you may recall was destroyed by Hurricane Katrina. At the time, the hospital provided healthcare for the underserved.  Cathy chose it because she knew the training would push her. “I was shy and quiet,” she said, “I needed to be in a place where I would be forced to engage. I wanted to train in a place where I would see a high volume and variety of patients.”   David says without hesitation that Charity provided great training for a rural practitioner because there the physician did almost everything.  In addition to the standard resident role, physicians drew blood and labs, performed many procedures, started their own IV’s and learned to “make do” with minimal equipment.  In addition, they were exposed to many different cultural and social backgrounds.

So after residency and a very long trip up the east coast with their 14 month old son in tow, the Riopels landed on the Eastern Shore of Virginia.  After 19 years of both out-patient care at the Community Health Center and inpatient care at the local hospital, they are only surprised that more people don’t want to do this. More than ever, they believe in the community health center mission.  They love life in their rural coastal community surrounded by water and nature and are grateful for the opportunity to work together and to live and work in a close community.   Every day, at school, at the ball field, or at the store, they interact with their patients. Sometimes there is a consult but more often there is a hug and a special feeling of appreciation that keeps them going.

Eastern Shore Rural Health is comprised of five community health centers (CHC’s) from Cheriton’s Bayview CHC to Chincoteague CHC with Franktown, Olney and Atlantic in between.  NINETY PERCENT of children on the Eastern Shore are seen by these five community health centers.  The community consists of professional and agricultural workers with a large number of those who speak either Spanish or Haitian Creole.  There is also a large seasonal migrant population.

 Although their eldest son is now in college and their second son is in high school, the Riopels’ “typical” day once consisted of logistical issues with childcare, sporting events, and with rounds preceding their time in the community health center. They joked that they would often pass on the highway.   Unlike many other CHC”s,  in this community where a close arrangement with the hospital exists,  the CHC pediatricians also consult in the Emergency Room, care for inpatient pediatrics and nursery,  and attend all C-sections. This comprehensive care may be sometimes tiring but the Riopels consider it incredibly rewarding to have attended premature births and then see these at-risk children grow up.
 
David and Cathy are proud that their CHC provides accessible healthcare for ALL without turning people away.  They also enjoy proactive healthcare programs that offer support for teenage moms and breast feeding and allow nursing home visits.  They are thankful to Eastern Shore Rural Health System for the support that has enabled them to maintain an ideal work/life balance.  They consider themselves very fortunate to work in a CHC whose administrators are so dedicated to mission and community.  Their leaders have always been committed to pediatrics even though sometimes this has been financially challenging.

David says, “Being at a place for almost 20 years gets more and more rewarding – especially in a Community Health Center. You have great perspective into the community and really know your patients and families well. Sometimes a well-child visit is like catching up with an old friend.”

 “Like most people,” Cathy states, “I try not to dwell on my age but there is one particular patient that I see every year where I can’t resist a little nostalgia.  She was 1000 grams when she was born and now a healthy teenager and I look at her mother and tell her every year, “ I remember when we first held you and you fit in one hand.”  Surrounded by the water and embraced by the community of the Eastern Shore, the Riopels are home.



Wednesday, November 2, 2011

My beautiful community!







My beautiful community is a great place to live, work, and play! Come join us!













My history with CHC's







I started my career as a Community Health Center (CHC) nurse about 23 years ago. I had worked at the local health department and loved community health nursing. My job with the health department ended due to funding cuts within the state of Virginia. I was heartbroken when I found out my job with the health department was over. Little did I know my career as a community health nurse was far from over…it was just beginning!

When I started my new job…I really did not have an understanding of what a CHC was and it took several years to fully understand the CHC “world”. Some days, I feel as if I still do not fully understand this “world”. The CHC “world” is unique and CHC employees are some of the best you will find anywhere. They are some of the most dedicated, loyal, and hard working people you will find. Once you work in the CHC “world”, it is very hard to leave.

I have lived in the community where I work my entire life. CHC communities are as special as the CHC’s who serve them. I love going to work each day knowing I am taking care of my family and friends. I just helped celebrate my grandmother's 93rd birthday this past weekend! I like giving back to the community who has given me so much. My husband is also from the same community and we are raising our two sons here, as well. I like raising my sons in a small town and the fact that I know most of their friends as well as their parents. It is a lot harder to get into mischief when everyone knows everyone…