The main issue this culture seems to struggle with on a daily basis is substance abuse. First, it was mentioned that interstate 40 runs through Cherokee which is a good route for drug dealers to sell their product. Also, with the per capita system used, enrolled members can receive thousands of dollars twice a year. On an enrolled members 18th birthday, they gain access to possibly more than $100,000. Kayla mentioned that June and December are the worst months for drug overdoses and are also the months of the per capita payout. While substance abuse seems to be one of the main issues in Cherokee, healthcare workers here do not feel it's worse than other areas of the country.
Another health-related issue this culture faces is diabetes. When observing at the Indian Care Clinic (ICC), it seemed like they asked every patient if they had any history of diabetes. This was also an issue at times with patients in the hospital as well. Lastly, access to care is likely an issue in some areas. The mountainous area likely makes it difdicult to travel for some individuals. It was also explained that some would no-show appointments, which was observed during my visit to Analenisgi. It was not clear what the reasons for missing appointments was. One explanation during our time at Cherokee is that their healthcare system had been government run until 2002. Because the Cherokee want to be self-sufficient and independent, some individuals may be skeptical of the healhcare system still.
In terms of the nurse's role in all of this, education will be one of the more important parts of health promotion and maintenance for this culture. First, in this culture, it is important for members of the Cherokee to know the US government is not involved in their healthcare at all as this could be a sore spot given our histories. Also, educating on constructive habits, especially when getting per capita so as to avoid substance abuse. The nurse also can look at issues individuals may have related to access to healthcare and work with individuals to help them to keep appointments. This could include public transportation or clustering all appointments at the same time at the hospital.
Because of the need for patients to take an active role in their own health, it would only make sense that the person receiving care would be at the center of the healthcare system. If the patient does not show up for apppontments, all the other healthcare professionals miss an opportunity to provide care to that individual.
Overall, the observations at Cherokee hospital were quite different than what I have seen in other healthcare settings. The main difference for me was that the hospital provided mostly outpatient services or emergency care with only 20 total inpatient beds. Also, having as many services as they did within the hospital was much different than what I have experienced in a hospital setting.
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