Lott McIlhenny
Board Member
Snow Covers
By Marti Faulkner, RN, Wesley Nurse,
I remember going hunting for rabbits with my grandfather when I was little. He would shoot them; I would get out of the car and get the rabbit to place it in the ice chest in the back of the car. Then we would slowly drive down the road waiting for our next dinner to hop up in our path. Those times were precious to me and I have many memories of harvesting dinner with my grandfather. One memory, in particular, stands out to me the most: We were hunting in New Mexico on some old oil field dirt roads in the middle of nowhere. It had snowed quite a bit and everything was covered with a white blanket. When my grandfather shot the first rabbit, I was surprised at how bright the blood appeared on the snow. I was about 10 years old and decided it was really creepy so I tried to cover it up. I would kick snow on top of the blood, but the blood kept seeping through. I couldn't figure out why, but I worked harder and put on more snow until I couldn't see it anymore. Little did I know that this memory would be very significant to me and the impact that I make on my patients.
Mental health is an issue that often goes unaddressed. During the holidays you see an increase in suicides and the inpatient mental health units tend to fill up. People become impatient with each other and often times feelings are hurt and things are said that can't be undone. I try to think of each person in my life as snow and this is why. The snow sparkled in the sun and was a beautiful cover across the fields. We all know snow is frozen, yet the blood of that rabbit was hot. When I put new snow on top of it, the blood would melt the new snow and the blood would show through. The blood reminds me of an emotional injury, once it's there it burns hot and takes a lot of work to cover up. The new snow being placed on top of the blood reminds me of positive things trying to cover up the hurt from an emotional injury. In the beginning, it keeps melting and the injury shows through. Once the blood is finally the same temperature as the snow, when it has had time to cool off, you can begin to make progress in covering it up. This is when it quits melting the new snow or when a person begins to heal. It takes a lot of rebuilding and positive reinforcement and actions to help someone recover from an emotional injury.
When you are dealing with people that are injured, it may take a lot of snow to make that beautiful fresh blanket be untarnished again. This takes time and patience – that is why it is important for us to build relationships with our patients. When you are dealing with a patient, friend, family member or even a stranger, always think before you act out of frustration or anger. Ask yourself a single question: "How much snow will it take to cover up what I am about to say or do?"
Funded Partner Spotlight: Mercy Ministries of Laredo
Methodist Healthcare Ministries is dedicated to providing access to care to low-income families and the uninsured in South Texas. It's mission of improving the physical, mental, and spiritual health of the least-served is the driving force behind its funded partnerships. For this reason, Methodist Healthcare Ministries has been proud to partner with Mercy Ministries of Laredo, a clinic of the Mercy Health System which also strives to help the underserved through holistic patient-centered models.
"Our missions could not be more comparable. We care deeply about the medically underserved and we are trying to make their lives better," said Sister Maria Luisa Vera, president of Mercy Ministries of Laredo. "Mercy Ministries has been blessed with a 10-year partnership with Methodist Healthcare Ministries."
Mercy Ministries is a mid-level practice that provides primary health care services to unfunded residents of Webb County. Currently, Mercy sees between 1,800 to 2,000 adult patients, primarily Hispanic, between 18-70 years of age. All services are provided to the uninsured on a sliding-scale at 250 percent of poverty, based on income and family size.
"Our main goal is primary health care with a heavy emphasis on prevention and education," stated Elizabeth Casso, vice president and CFO of Mercy Ministries of Laredo. "We want to provide as good a care in this clinic as they could get anywhere."
Since 2007, Methodist Healthcare Ministries has provided Mercy with grants that have assisted their dental, diabetes, and women's health programs. In addition, Mercy's variety of services includes medication assistance, social services, and nutritional guidance, as well as a mobile clinic that travels to 14 Webb County sites (colonias, inner city, and rural areas).
Nearly three years ago, Mercy began to shift its focus to integrated behavioral care (IBH).
"We started looking at how mental health affected our patients and their chronic diseases," said Casso. "We were looking to address the needs of our community and look for solutions; we wanted to help our patients overcome their problems and get better outcomes."
An added solution came in the co-location of Methodist Healthcare Ministries' behavioral health supervisor, Zonia Garza. By being on site, Garza offers Mercy patients support services such as one-on-one counseling to help with issues of parenting, family relationships, depression and substance abuse and referral assistance. Garza is able to assist Mercy through case management and support services that are designed to help people who are uninsured, whose existing coverage does not provide mental health services benefits, are low-income and lack the money to pay for counseling services, or would not receive treatment any other way.
"Having Zonia in our clinic two days a week is an added blessing," said Sister Maria Luisa Vera. "Because Zonia came to Mercy before the start of the Sí Texas Project, we already could envision what was possible if our services evolved into an IBH model."
In 2015, in further pursuit of introducing IBH to patients, Mercy Ministries joined Methodist Healthcare Ministries' Sí Texas: Social Innovation for a Healthy South Texas project, a Social Innovation Fund program that stimulates local solutions to improve both physical and behavioral health together, such as diabetes and depression. Sí Texas focuses on IBH models that are effectively improving health outcomes in communities with high rates of poverty, depression, diabetes, obesity and associated risk factors.
Through the Sí Texas Project, Mercy Clinic enhances its current integrated services, utilizes referral psychiatric services, and incorporates a spiritual wellness component that gives patients the option to augment their counseling through prayer, church referral, pastoral counseling, family counseling, or all of the above depending on patient need. The aptly named, "Sí Three" initiative is based on three aspects of wellness: mind, body, and spirit. The model moves the clinic from its existing co-located model, in which behavioral and physical health services were offered in the same building, to an integrated model in which these services are fully coordinated.
Natalie Burkhalter, family nurse practitioner and Sí Texas project manager at Mercy Ministries, explains, "We wanted to see how the values of our clinic and those three components were driven throughout the clinic so the patient could have complete service – whether it be physical, behavioral or spiritual health, holistically, everything in one. We've even changed our outcome deliverables to be much more evaluative, for the long-term, so we can help as many people as we can."
Three years into the five-year project, with approximately 400 patients participating, Mercy is already witnessing improvements such as better health numbers and patient compliance.
"Our patients are committed to our clinic and to their care. They come because they want to come; they want to get better and maintain their health. Self-management is key to their success and their wellness," said Burkhalter.
Mercy plans to integrate IBH care with all of its patients even after the Sí Texas Project is complete in 2019. According to Casso, the Sí Texas Project has given Mercy many opportunities; it's increased the clinic's capacity and helped evolve the conversation about data, evaluation and outcomes.
"I hope we can help all of our patients stay healthy, and that they can share their health education and teach their families to be healthy too," said Casso. "For example, we offer diabetes classes so patients can learn about their disease and how to manage it. One of our patients' has a husband that's a truck driver. One weekend he wasn't feeling well and was exhibiting symptoms of diabetes. Because of her own experiences as a diabetic, she suspected he was diabetic too, so she brought him quickly to the clinic before he took off on the road again, which could have made his symptoms worse had he waited longer. I think it's great she applied what she learned and was able to help him."
