Community Resilience: Prepare for the Really Big One

DSC00963This week’s New Yorker article by Kathryn Schulz, “The Really Big One”, about my beloved Pacific Northwest’s vulnerability to a devastating mega-earthquake and tsunami, has stirred a lot of debate and fear here in my hometown of Seattle. There’s been a run on the buying of ready-made disaster preparedness kits. Companies doing seismic retrofitting of houses are now booked out almost a year. As the article states, scientists report that we are overdue for a large or mega earthquake (9,0) and tsunami (100-ft) that will kill at least 13,000 people, injure 27,000, displace 1 million people, and destroy two-thirds of all hospitals. Everything west of Interstate 5 will be destroyed.

Currently, despite having the technology to install a sophisticated early-warning earthquake system, we don’t have one and we will have to rely on the “cacophony of barking dogs” to provide us with a 30-90 second warning before the ‘real quake’ hits. (Dogs can hear the high-frequency compression waves that precede an earthquake. Yet another reason to love dogs.)

It is clear that our government entities, businesses, hospitals, schools, fire departments, need to do much more to prepare for this disaster. As individuals we can support legislation to require better community-wide disaster preparedness (and support ways to actually fund these measures). As individuals we can heed the public health disaster preparedness advice and keep adequate disaster kits in our homes, school, and worksites. In a previous blog post titled “Be Very Afraid” (November 22, 2014) I wrote: “Or be at least a little bit afraid: not so afraid that you become paralyzed with fear and not so little afraid that you don’t do practical things to better prepare yourself (and your family) in case of disaster/emergency. Aim for being ‘just right’ afraid.” And I recorded the items I collected to make our family’s disaster/emergency preparedness kit–along with the realization that disaster preparedness is not an equal opportunity affair.

But something I have learned from my colleagues in New Zealand who work on post-Christchurch earthquake recovery efforts, is that an equally important part of disaster preparedness at the community level is promoting community resilience and wellbeing. More closely-knit communities–regardless of economic resources–tend to weather disasters better than others. Several of the Christchurch-area Maori marae (communal, sacred land/communities) organized to take in and provide food and shelter for foreign students and visitors affected by the earthquakes before any official government-sponsored program was able to do that. This isn’t to gloss over the very real socio-economic and racial disparities highlighted by ‘natural’ and man-made disasters. The lessons on this from Hurricane Katrina in New Orleans stand as reminders.

I was somewhat skeptical when I first encountered these bright, up-with-people banners (shown in the photo above) I saw in the midst of the still fresh earthquake devastation in the downtown core of Christchurch in 2014. But as I focused more on their messages, I realized they were all about building individual and community resilience. They are part of the All Right? Campaign, a Healthy Christchurch initiative of the Canterbury District Health Board and the Mental Health Foundation of New Zealand. They based their campaign on the work of the UK-based social, economic, and environmental justice think tank, The New Economic Foundation, which developed the evidence-based Five Ways to Wellbeing (with a Kiwi slant below). Now these are some excellent ways to prepare for the Big One.

  1. Connect… With the people around you. With whanau, friends, colleagues and neighbours. At home, work, school, or in your local marae, church or community. Think of these connections/relationships as the cornerstones of your life and invest time in developing them. Building these connections will support and enrich you every day.
  2. Be active… Exercising can make you feel good! Step outside. Go for a walk or run. Cycle. Play a game. Garden. Have a boogie or do some kapahaka. The most important thing is to find a physical activity you enjoy that suits your mobility and fitness. Do it with friends or whanau and you’ll be ticking two boxes… connect and be active!
  3. Take notice… Be curious. Catch sight of the beautiful. Remark on the unusual. Notice the changing seasons. Savour the moment, whether you are walking to work, eating lunch or talking to friends. Be aware of the world around you and what you are feeling. Reflecting on your experiences will help you appreciate what matters to you.
  4. Keep learning… Try something new. Rediscover an old interest. Sign up for that course. Take on a different responsibility at work. Fix a bike. Learn Te Reo or how to play an instrument or cook your favourite food. Set a challenge you enjoy achieving. Learning new things will make you more confident as well as being fun.
  5. Give … Do something nice for a friend, or a stranger. Thank someone. Smile. Volunteer your time. Join a community group. Look out, as well as in. Seeing yourself, and your happiness, as linked to the wider community can be incredibly rewarding and creates connections with the people around you. Aroha ki te tangata, a Maori saying meaning respect for/goodwill towards others.

Superstorm, Super Nurses, Super Inequality

New York City (Manhattan) from Ganrty Park aft...
New York City (Manhattan) from Ganrty Park after Hurricane Sandy (Photo credit: TenSafeFrogs)

Living in the Pacific Northwest with the return of our perpetual grey days and rain, I do not hear the same level of weather complaints as I usually do. In the wake (literal/multiple meanings) of the devastation of Superstorm Sandy on the East Coast, most people here are grateful for our relatively benign weather.

On Monday, when the storm was hitting Virginia, I called to check in on my elderly father, who is now mostly homebound in hospice. High winds and local flooding were affecting his town in Central Virginia, but he had two nurses with him when I called. One was the visiting home hospice nurse who was checking his health status and making sure he had his medications. The other was his caregiver, a retired Emergency Department nurse. She is a no-nonsense person who walks with a cane and has been known to wave it my father’s way when he forgets to take his medicines. Clearly my father was in capable hands. I could get on with my job of grading student papers. I know firsthand what an important role home nurses play in the daily lives of elderly people and their families. And especially so in times of natural disaster.

I was pleased to see the NYT article “Enduring the storm for homebound patients” by John Leland (11-1-12). He highlights the essential work of the 5,000 nurses, aides, and social workers through the NYC Visiting Nurse Service who have been out providing services to patients around the city during the storm. He quotes nurse Allison Chisholm as saying, “…it’s something you have to do as a nurse. (…) I don’t see this as being a hero. I have a conscience. I have to sleep at night.” Mr. Leland quotes an elderly male patient exclaiming how he can’t get over the nursing service. His home nurse seems to have climbed fourteen floors in the dark to change the dressings on his leg wounds. And this patient adds that he can see how expensive the home nursing care must be. (Presumably covered by Medicare). But Mr. Leland follows with a quote from another elderly patient (a non-retired social work professor) who says, “This service saves a fortune because we don’t have to be in hospitals. They don’t pay these people enough.”

Indeed, that was something that was bugging me about the coverage of Sandy that I have been receiving: not enough attention to the consequences of extreme economic inequities being played out. (The residents of lower Manhattan being referred to as “The Dark People” for one thing.) I am sure that altruism and duty have been major motivators for the visiting nurses, aides and social workers who have provided essential services to people across the socio-economic spectrum. But they—and especially the home health aides who make minimum wage or just above—depend on the income from their jobs to feed, house, and clothe themselves and their families. They simply cannot afford the luxury of taking the day off.

David Rohde wrote an article on this for The Atlantic. In “The hideous inequality exposed by Hurricane Sandy” (10-31-12) he points out that income inequality in Manhattan rivals parts of Sub-Saharan Africa, and only Sierra Leon and Namibia have higher income gaps. I have walked the length of Manhattan many times, but until now had not realized how all of the major public hospitals are located in low-lying, flood-prone, power-outage areas.  The Manhattan skyline was forever changed with 9-11; the Manhattan skyline of light/dark, haves/have nots is perhaps forever burned into our national psyche. Now, to do something about it.

Dear Nursing Grads: Please go directly into Community/Public Health Nursing

First District Nurses in Melbourne
First District Nurses in Melbourne (Photo credit: Wikipedia)

That is, of course, if you are at all interested in this type of nursing work. Please do not believe anyone (and especially not your nursing professors who have probably not worked as a nurse anywhere since the 1970s) if they tell you to first work as a nurse in a hospital to “get experience.” That simply is not true. People can and do hire new grads for community/public health nursing. Hiring decisions for these sorts of jobs have more to do with the individual applicant—with his or her personality traits (flexibility, patience, humor among others), understanding of (or interest in learning about) community resources, passion for patient/community education and empowerment, and a personal value placed on prevention vs. costly curative/acute care. In your resume and interview remember to include any relevant work (including volunteer or service-learning before or during nursing school) experience in health and social service provision in the community. Do your homework before an interview—including making sure you understand important terms used in the job description. For instance, “harm reduction” does not mean sitting close to a door to escape from a potentially volatile patient…

Non-hospital places to consider when job-hunting: public health departments, community health clinics, nurse-managed community clinics, Health Care for the Homeless clinics, migrant health clinics, Indian Health Service clinics, home care/hospice agencies, nursing homes/long-term care facilities, school-based clinics (and school nursing in general), and occupational health clinics (including perhaps jail/corrections health care?). Similar to hospital residency programs for new nursing grads, some health departments and community clinics are piloting paid internships for new grads/new hires. Health departments in Wisconsin and North Carolina have examples of these.

And despite setbacks/job losses brought on by the recent Recession, health departments and community health programs are hiring nurses. And if the Affordable Care Act survives the caprices of the US Supreme Court, health care reform promises to bring a substantial increase in public health/community nursing jobs—or as the Future of Nursing IOM report states, it promises “to return the profession (of nursing) to its roots in the public health movement of the early 20th Century.” (pg 24).

If you are wondering whether going directly into public/community health nursing after graduation precludes you from ever getting a hospital job in the future—that is not the case either. Especially now with hospital systems’ focus on health care transitions, patient education, and patient care management/coordination, having had previous experience in public/community health nursing is an advantage. Hospital units always do additional training for any/all new hires anyway, so you can get back up to speed on the relevant patient care equipment, meds, etc.

Meanwhile, how to find jobs in public health/community health nursing? Like with any job search, working your personal contacts is important. Ask your community/public health nursing professor or clinical instructor (a fair number of students asked me–hence this blog post response). In the Pacific Northwest, here are places I recommend looking for jobs:

University of Washington School of Public Health online Job Postings (search with ‘nursing’ and there currently are six listings, including some cool-sounding Public Health Nursing jobs in Eugene, Oregon).

Public Health—Seattle and King County online Job Postings (some amazing ones currently for the Nurse Family Partnership among others—and yes, they do and have hired new grads).

Washington Association of Community and Migrant Health Centers online Job Postings.

And–thank you Paula for these suggested sites:

Washington State Public Health Association “New Job Opportunities” online postings

American Public Health Association online careers search (this one requires you to create an account but you don’t have to be/become an APHA member to do so. You can then upload/post your resume if you want–is easy to use and a relatively sophisticated job search system.)

Happy job hunting!

~p.s. For those of you who would love to go right into public/community health nursing but find yourselves in a hospital or other setting instead–don’t despair of ever being able to transition back into the community. Just try to find opportunities to volunteer in a community setting, doing health/social services sort of work. That will help you build your resume and skills for making the transition back out of acute care.