Neighborhood Matters

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By Sarah Achenbach
Photos by Frank Klein

The health needs are vast, and resources few, for those living in the communities surrounding Hopkins’ East Baltimore campus. Through course work and as volunteers, Hopkins nursing students are reaching out to make a difference.

Jeane Garcia ’08 is one of 10 Hopkins nursing students who provide counseling to patients through HIV Counseling and Testing Training Program. Garcia volunteers at the Chase-Brexton Clinic, one of the three program sites.

There’s a patient that Kaitlin Haws, RN, will never forget. And she makes sure the Hopkins nursing student volunteers she trains won’t forget him, either. Each day at Chase-Brexton Health Services Inc., a Baltimore clinic serving the underserved, HIV-positive, and gay, lesbian and transgendered communities, Haws tests clients for HIV and counsels them on the results, negative or positive. A 2006 graduate of the School of Nursing’s accelerated program, Haws remembers well the first time she had to give a patient a positive test result.

“A young man came in who had been tested before, and the results were always negative,” she recalls. While waiting for the results of the rapid HIV test (typically 20 minutes), Haws did exactly what her training had taught her: She covered the risk factors for contracting HIV, tried to get a sense of what was going on in his life to bring him in that day, and discussed what he would do when he walked out the door—assuming, of course, that the test would be negative again.

“We had a good rapport going,” Haws remembers. “Typically I would have a patient wait in the waiting room while I read the result, but this time I didn’t. I remember looking at the test and seeing two lines, which means it was positive. My heart just dropped and my palms got sweaty. By now I’ve given a lot of positive results, so I can anticipate how a patient might react, but that day it was a matter of me getting out of my own emotion.”

With relationships with more than 100 community-based organizations, SOURCE has quickly become a one-stop volunteer shop for students and faculty and for the East Baltimore community to call for assistance

Haws shared that story recently during an orientation session for a fresh crop of student volunteers at Chase-Brexton: 10 each from Hopkins’ schools of Nursing, Public Health, and Medicine. Each student recently completed training to provide counseling during HIV testing at Chase-Brexton, the Johns Hopkins Hospital Emergency Room, and at Health Education Resource Organization (HERO). The HIV Counseling and Testing Training Program is co-sponsored by the three schools through SOURCE (Student OUtreach Resource CEnter), the tri-school community service and service learning center.

During the 16 hours of SOURCE training, the 30 students learned counseling techniques including how to use verbal and body language to guide clients in the often angst-ridden moments after they receive their HIV testing results. “Our natural tendency is to give a patient information overload, but you need to allow a patient the time to think after getting a test result,” says Jeane Garcia ’08, who, like Haws, enrolled post-Peace Corps in the JHUSON’s Peace Corps Fellows program, the only undergraduate nursing Peace Corps Fellows program in the country. “During the training course, we role-played our reactions to testing scenarios, and it was a lot more difficult and introspective than I thought it would be.”

SOURCE’s HIV Counseling and Testing Program is just one avenue through which nursing students provide health care to those living in the communities near the school, where such outreach is critically needed. “The good news is that teenage pregnancy rates and infant mortality have decreased over the past few years, but the biggest challenges facing this community are substance abuse, violence, and poverty,” says Lori Edwards, APRN, BC, MPH, who directs the School’s comprehensive Community Outreach program. “The community itself says its number one concern is substance abuse. Historically, one out of 10 people in Baltimore is a substance abuser.”

The School’s Community Outreach program began 13 years ago as a way for Peace Corps Fellows to meet their required community service. By the late 1990s, other nursing students were eager to pursue community health volunteer roles in East Baltimore and throughout the city. To meet the demand, Edwards developed an undergraduate elective and pre-requisite for students interested in community outreach: Community Outreach to Underserved Populations in Urban Baltimore.

Edwards estimates that in 2006-07, at least 107 School of Nursing students volunteered a minimum of 5,200 hours at 22 agencies, such as the Refugee Resettlement Center, Tench Tilghman Elementary School, House of Ruth Maryland, Baltimore City Health Department, Hispanic Apostolate, and the Julie Community Center. That’s 9,500 client interactions—all low-ball figures, says Edwards, who is one of two SON administrative representatives on the SOURCE governing boards. Her office works closely with SOURCE to coordinate nursing students’ volunteer interests.

Associate dean Sandra Angell, who earned her nursing diploma from the School in 1969, describes SOURCE as “a great development.” She adds, “It’s really pulled together all three schools on this campus and it’s made it much easier for community agencies that are trying to seek help for their sites.”

With relationships with more than 100 community-based organizations, SOURCE has quickly become a one-stop volunteer shop for students and faculty and for the East Baltimore community to call for assistance, agrees Seth Christman, SOURCE coordinator. And there are real benefits for the students as well.

“Being able to connect students from the three schools gives students a different view of skills in health education and practice,” notes SOURCE’s Christman. “A nursing student might come to the HIV Counseling and Testing Program from a patient-centered approach, while a public health student might come at it from an education perspective. Sometimes the greatest teachers are your peers.”

Working alongside students from the schools of Public Health and Medicine is a big draw for SON students, particularly returning Peace Corps veterans like Garcia. “From my Peace Corps work in Malawi as a teacher and HIV counselor, all the HIV issues of prevention, advocacy and policy interest me, and the interdisciplinary approach of the training invites that,” Garcia says.

When Kaitlin Haws was completing her baccalaureate nursing degree after serving in the Peace Corps in West Africa, she volunteered with the Women, Infants & Children (WIC) program, a nutritional counseling program offered through the Baltimore County Department of Health. “So many people don’t have access to proper health care,” Haws says. “At WIC, we were trying to provide proper nutrition when often the only access for food was the corner store, which doesn’t offer much produce.”

“Being able to volunteer in the community while going to school reiterated for me why I was in nursing school in the first place,” Haws says. “My work brings together therapeutic communication and health education. The most satisfying and challenging aspect of my work is providing a well-rounded approach to health care for the underserved.”

For the newly minted graduates of the HIV Counseling and Testing Training Program, this is at the heart of what they hope to accomplish in their new volunteer role. “Nursing is care and support,” says Garcia. “To be there for someone one-on-one during one of the most significant moments in his or her life, regardless of the HIV test outcome, is amazing.”

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