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Volume 29, Issue 7

July, 2018

President's Message                                          

By Nancy Trimble, President

I hope everyone is enjoying the summer months and getting time for fun and relaxation.  Once again we are at that time when transition takes place for the SDAPA Board of Directors.  Louise Papka will be switching from her role as President to the role of Past President.  I will be leaving my role as Vice President/President Elect and move into the role of President.  I want to take this opportunity to thank Louise for her dedication and service over the last 2 years as our President.  She has served many years on the SDAPA Board and will continue to serve as Past President for the next 2 years.  I also want to welcome the people who were elected to positions on the Board starting this July as Director-At-Large: Corey Anderson, PA-C; and Justine Peterson, PA; and Marilyn Ruhlman, PA-C as Treasurer.  We have not been able to fill the position for Vice President, so Corey Anderson has agreed to step into that position until we can get it filled.  I want to thank Corey for his willingness to serve in an additional position on the Board.

I am thankful to have a board that is easy to work with and enjoy being around.  Everyone is willing to do what needs to get done for the benefit of our association and for the PAs of South Dakota.  

Corey Anderson and I had the opportunity to travel to Washington for the LAS meeting to meet with the SD Governor and Senators regarding diabetic shoes and the ability to order Home Health.  Unfortunately, we did not get to meet with the Governor or Senators, but we did meet with their staff members.  Corey did a fantastic job putting forth the case and need for PAs to write prescriptions for diabetic shoes and Home Health.  We discussed the inconvenience and negative impact on patients when they are required to see a physician they have not ever encountered.  We are hoping these 2 Bills can be passed to benefit patients and to move the PA profession another step forward.  The Home Health Bill is currently being considered; however, the Bill for Diabetic Shoes has not yet made it to the floor.  As PAs, we need to stay involved and diligent to move forward.

We were also able to do a little networking and had the opportunity to sit at the table with a former student, Nicole Beuttner, who is serving as president for the Nebraska Academy of PAs.  As a member of the SDAPA and faculty member for the USD PA Program, I was proud to see one of our former students in a leadership role.  Kurt Schmeckpeper, a former student, is the President Elect for Nebraska, and of course, we have former students as board members for our own association and most likely in other states as well.  I certainly appreciate the participation from all our volunteers, and I hope we can continue to encourage these young leaders to take an active role in moving our profession forward and to be an advocate for the patient.


 

 

A Call to Leadership

Earlier this year as Vice President/President Elect, attending the Leadership Advocacy Summit was a new and learning experience for me.  I remember leaving there and feeling inspired about the capabilities we each possess and what we have to offer as leaders in the PA profession and in our communities.

There are so many changes transpiring in our profession such as optimal practice, allowing PAs to write a prescription for diabetic shoes and initial orders for Hospice.  If we believe that change needs to happen and that change will benefit our profession, then we need to work together as a team to stay focused, decide what our purpose is, look at what motivates us, and make decisions about the direction we should go.

The SDAPA Board needs volunteers to fill positions on the board and there are several committees that need help from people who are willing to serve.  These are areas where you can serve in a leadership role; however, the SDAPA is not the only place with opportunity for service and leadership.  As PAs, we serve as leaders in our work place and our communities.  We can make a difference in every aspect of our life.  We have the opportunity to have a positive influence on others, to encourage and inspire others.

 

 

East River CME conference update:

By Leah Mergen, PA-C, Chair

The Sioux Falls CME conference will be held this year on Wednesday, September 5th through Friday, September 7th.   The conference will be located at the downtown Hilton Garden Inn as last year. We have a great variety of speakers this year including one topic sponsored by AAPA and the Epilepsy Foundation.   We have consolidated all our orthopedics speaker/topics for Friday afternoon, so those of you who have a great interest in ortho or are wanting a little extra ortho CME, you won’t want to miss the last day of the conference.   We have several returning speakers and quite a few new faces as well.

We have also scheduled a social hour on Thursday, Sept. 6th from 4:30 – 6:30 immediately following the last speaker of the day. There will be appetizers and drinks and it will be a great time to socialize with your fellow PAs, as well as learn more about opportunities within SDAPA, if you are interested!

Hope to see you all there!


AAPA – House of Delegates – New Orleans, LA

By Michelle Hagen, PA-C, MPAS – SDAPA Delegate

In May, I had the opportunity to represent SDAPA at the House of Delegates in New Orleans. It is always very eye opening to be reminded that so many of the issues we face in South Dakota are shared by other states and constituent organizations. 

In Reference committee A there were very few resolutions that were actually pulled for discussion and voting. The LGBT Caucus drafted to amend over 10 resolutions for the same reason, for recognition of non-binary gender identities within current policy. These resolutions were adopted from the consent agenda. The guidelines for ethical conduct of PAs was also amended. The specific language can be seen on the house of delegates web page. 

During my time in New Orleans, I was also able to network with our friend and AAPA Director of Constituent Organizations Adam Peer.   He was very interested in how SDAPA is planning to move forward with OPT (Optimal Team Practice.) I was interested to learn that AAPA was interested in financially supporting our grassroots effort.  Our SDAPA Board of Directors and Legislative committee will certainly have more information regarding this soon!

I look forward to representing SDAPA in Denver in 2019. Please contact me if you have any suggested AAPA policy that SDAPA should be bringing to the national table.

Michelle Hagen PA-C, MPAS

SDAPA Delegate & West River CME Chair

605-209-3853

 

CHIPS:  South Dakota Child ID Program

By Justin Thurman, PA-C

On April 27-29th, several VA employees volunteered their time to help with the SD Child ID Program sponsored by the Masons of South Dakota at the YFS Kids Fair located at the Rapid City Civic Center.  At no cost to families, a child and their family are provided with a photograph, height/weight, audio clip of the child, DNA swab, and dental impression to be kept by the parents for use in the unfortunate situation of a missing child or abduction, essentially having a ‘media ready’ packet.

Volunteers from the VA include:  Monty and Kim Smith, Joan and Bill Patterson, Hondi Dunn, Andrea Casteel, Stacia Shamp, Rochelle Hardesty, Chantal Hardesty, Becca Shamp, Justin Thurman, Ron Johnson, Kim Guilmett, Grayson Nelson (Sturgis High School volunteer at Fort Meade), Sue Matthew and Emma Matthew, and Thea Holt, Hallie Holt, Micah Holt.

•          A child is reported missing every 43 seconds

•          CHIP is provided at no cost, and all items generated are kept with the parents

•          The Masons of South Dakota sponsor SD CHIPs

•          This is the 8th CHIPs event in which VA employees have volunteered

•          Over 20,000 kids have utilized the CHIPs Program

 

  

 

USD PA Program

By Betty Hulse, USD PA Program

While completing the clinical phase of the USD PA program, four of the PA students spent two weeks at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. Here are some excerpts from their reflective papers (Submitted by Betty Hulse, USD PA Program):

Amelia Rew

Our first couple of days were spent in the emergency department. The number of patients that were seen in one day was absolutely staggering and space was very limited. It was clear that a city the size of Kumasi needed an ER 2-3 times that size, but that was not the reality. There were no separate rooms, or even curtains in between patients which meant no privacy.

Because KATH is a teaching hospital there were physicians, residents, and medical students around at all times. We were able to observe as the ER physicians did rounds and even got some practice with EKGs. When a new patient was ready to be seen we would follow the physician or resident as they saw the patient and then discuss the case afterword, which was an excellent learning experience. It was interesting discussing orders considering the resources available. In the US, we are used to having almost every test available, but in Ghana the providers really must use caution because patients can’t always afford the tests and some simply aren’t available. Currently patients are required to pay upfront for everything that is not covered by insurance. The national insurance which most patients had, did not cover all imaging which made things that much more difficult.

Many patients that we saw needed a higher level of imaging than just an X-ray but that was all they could afford, so the physicians would have to come up with an appropriate diagnosis and treatment with some of the puzzle pieces missing. To my surprise, a majority of the patients that were in the emergency department had actually been seen days before and were simply waiting for a bed to become available on the floor. Some of them had a mattress but no sheets, and a few had a bed but no mattress to lay on. These things were an additional expense that not all could afford. At the end of the first day, we were exhausted and emotionally drained. I wasn’t even sure how to process the amount of poverty and lack of resources that this hospital faced every day.

I was humbled by the kindness and hospitality of every physician we encountered. They were excellent teachers and went above and beyond to get us involved. They had their own students to teach, but they still made time for us and made us feel like a priority. Their knowledge and skills were amazing to say the least and they all had hearts for serving the people of Ghana. Seeing how hard they worked and how much they cared for their patients reminded me of the kind of provider I want to strive to be every day.

Outside of our time at the hospital, we visited Cape Coast, Kakum National Park canopy walk, Mole National Park safari, and Kintampo waterfalls. The Safari was a once in a lifetime experience that was just as cool as I imagined it would be. Seeing elephants that close was simply breathtaking. Every day I was amazed at the opportunity I had to experience such a wonderful country and learn more about their people and culture. Ghana is full of kind and hospitable people and they taught me so much. I know that I grew as an individual just by having this experiencing and being able to learn from those around me.

Rachel Potter

After spending the first day in the Emergency Department, I quickly realized how good we have it in the US. There literally aren’t even enough beds in the hospital (a hospital with 2,000 beds) for the amount of people that need medical attention in this town, PLUS all the people that travel long distances from surrounding towns to be seen at this facility.

The providers who took us under their wing in the ER were incredible. Not only were they extremely welcoming and willing to teach us, they were insanely smart. This is a teaching hospital that is flooded with medical students (mostly from the surrounding area), making it very crowded in all areas of the hospital, but everyone was very accommodating and genuinely wanted to teach us and help us learn while we were there. I spent the majority of my time with the orthopedic/trauma surgery teams. I had just finished my orthopedic rotation in the states before going on this trip, which was a perfect segue into this experience. They were amazing! I spent time with two doctors who were so helpful and wanted me to jump in and participate and do whatever I could to understand the cases and the things we were talking about.

Some of the things I encountered included numerous fractures (all areas of the body, but a lot of leg fractures), osteomyelitis, osteosarcoma, dislocations, leg amputations, Rickets, severe valgus and varus deformities, and SCFE to name a few. There are some cases that I know I will probably never see in the US over the course of my entire career because of the readily available treatment we have here. One of the hardest things to see was small children and young teens with acute injuries and chronic bone conditions that could ultimately result in limb loss or even death. These hit me pretty hard. We just don’t see much of that in the US. The majority (~90%) of fractures we saw were due to people getting hit by cars/vans/busses in the streets, which is also something we do not see very often.

Our group collected medication donations from our churches, family, and friends before heading overseas. I did not count, but I bet we had around 300 bottles of a variety of OTC medications to donate to a variety of places. We took one batch to a local family medicine clinic, one batch to the orthopedic team at KATH, and one batch to the local orphanage. Everyone was extremely grateful, and it warms my heart to be able to do this for them. I hope we are able to make a difference with these donations!

Thank you so much to Dr. Evans and his nephew, Kevin, for being the best caretakers of us while we were there. We felt very safe, well fed, and well-educated about the country and all it had to offer us during our short journey there. Ghana holds a very special place in my heart. I will never forget this trip of a lifetime and I am counting my blessings every single day. 

Haley Jerman - PASII

Ghana has taught me many things over the past 2 weeks. It has pushed me farther out of my comfort zone than any of my previous trips abroad. I’m not an emotional person, and I was nearly brought to tears on more than 1 occasion in the K.A.T.H. emergency room. The ER was completely overwhelmed with very sick people. There were always two beds in a slot meant for one, and there were patient beds in the reception area and hallways.

I was able to meet some incredible Ortho Trauma physicians who were some of the best preceptors I’ve been fortunate enough to work with. K.A.T.H. is a teaching hospital, and they teach extremely well. Physicians in Ghana get paid a small fraction of US physicians and often work in crowded rooms without air conditioning, but that hasn’t stopped them from striving to be the best doctors they can be. They not only can recite recent medical literature, but they can treat patients with compassion AND teach a bunch of residents and students at the same time. Their model of education is excellent. They are constantly asking their students ‘why’ to tease out what they know or don’t know, and Ghanaians are superb at arguing it out without becoming offended. The physician and nurses really are doing the best they can for their patients with limited financial resources.

Aside from experiences in the hospital, I learned a lot from our hours spent in the car driving throughout Ghana. People may be trying to scrape a living off selling their product in a small shack near the side of a hot and busy road, but they’re still visibly happy. They may not have much, but they’re surrounded by friends and family. It felt very apparent that we are too focused on material things and are isolated by our own technology and social media in the US.

Ghana is a beautiful country with incredibly kind and caring people. Not only will the memories from this trip last a life time, but I truly believe that this trip will have a lasting impact on my priorities and overall outlook on life. On day 1 in the ER, I doubted that I could handle a career in medicine if I lived in an area as crowded and impoverished as Kumasi. However, over the course of 2 weeks I’ve come to appreciate medicine even more. I’m excited to spend my career improving lives and helping people heal.

While following up on the progress of a 6-year-old boy, we were able to meet the department head of the Pediatric ICU and he shared the following foundation information with us. This foundation helps critically ill kiddos get the care they need when their parents can’t afford it. I thought maybe future PA classes would like to donate, especially if we continue to send students to K.A.T.H for this experience. 

LITTLE STEPS FOUNDATION

Bank: Ecobank

Account Name: Little Steps Foundation

Account Number: 02113114488940601

Swift Code/IBAN: ECOGHAC

Contact: ADABIEA@gmail.com

USA Contact: Lisa Trujillo ltrujillo@weber.edu  

Robyn Green

“We are grateful” were the words that a nurse named Mable chose as we left the ED on our last day at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. In the US, we are used to a particular order of things: patients arrive at the emergency department, they are immediately triaged, and any life-threatening injuries are promptly treated regardless of insurance or financial status.  But in Ghana, this is not the case.  There, patients are treated based on what they can afford at the time of service. 

Of all the patients we saw, there is one little boy who will always stand out when I reflect on my time in Ghana.  He is a six-year-old boy who was hit by a speeding car and had head trauma as well as a hemothorax.  We first encountered him while rounding with the residents during their handoff.  I asked one of the residents why his sheets were all wet, and she told me that he came in with a fever of 103°F and while he is no longer febrile, the family could not pay for a second set of sheets for him to lay on.  They also couldn’t afford the head and neck CT to determine the severity of his head injuries, or the chest X-ray to confirm the placement of his chest tube.

It was without hesitation that my classmates and I decided to each chip in the $30 for him to have this essential imaging done in order to determine his plan of care. Unfortunately, his CT showed a severe skull fracture and some epidural bleeding.  Because of this imaging, he was able to have a neurosurgery consult to determine the next step in his management. We were never able to communicate with the little boy’s father who only spoke the native Twi language, but the gratitude in his eyes didn’t require a translator.

Throughout our two weeks in Ghana we continued to monitor his status in the pediatric ICU, and at the end of our journey he was beginning to show some mild improvements, only to the point that he became responsive to pain. While we don’t have a way to follow-up on his condition, we can at least know that he received the necessary imaging to determine the best plan of care.

KATH has its logistical issues to overcome, of that I am certain. But as I looked around at the staff and healthcare professionals who work much longer hours than I do for far less pay than I can expect as a new graduate, I came to realize just how dedicated they are to their work. They’re fighting an uphill battle the whole way, and it’s that attitude I cannot help but feel inspired by. Despite limited resources, financial barriers to health, and an exhausted healthcare system that they can do little to change, they show grit every day.

“We are grateful” were the words that Mable chose as we left the ED on our last day. Sitting here now trying to pinpoint what it is I’m feeling after having the opportunity to witness this place and these people, I think Mable framed it perfectly: “We are grateful.”

 

 



 

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