Wagner, South Dakota
Week 1

It has been a great first week in Wagner. The community and hospital staff are both very welcoming. The clinic was pretty busy, and I also had a chance to see some patients in the ED. In addition, I was able to go with the home health nurse this week to an elderly patient’s home that I had seen in clinic earlier. Once there, I visited with the patient about how well he was able to accomplish his instrumental activities of daily living and what could be changed to improve his independence. It was an amazing opportunity to see how differently a patient may function in the clinic compared to their own home environment. For example, while he used a walker in the clinic, he was able to navigate around his apartment with a cane, and I learned that he only uses his walker when out in public (contrary to medical advice). The patient was overall much more independent at home than he had previously appeared in the clinic. This opportunity taught me an important lesson that I will apply to my future geriatric patients. Patients may not always be as dependent, or independent, as they appear in clinic, and taking the time to view them in their home environment is a simple way to gain more perspective.

Week 2
This week in Wagner was very eventful. It began with a cardiac patient who kept slipping into ventricular tachycardia and had to be flown out. The entire nursing staff, ER doctor, and eEmergency worked together to make sure the patient was receiving the best of care. A few days later we had a patient come into the clinic with a tooth abscess. She had literally used her last money for gas to be able to come into the clinic. It was an eye-opening experience about the cost of care, and how even $15 in medicine can be too prohibitive for people sometimes when they are in-between paychecks. Finally, the weeks’ notable events ended with a patient in the ER who had been participating in the Sundance. As part of the ceremony, they sit in a sweat lodge and refrain from food and water. Unfortunately, this occurred during the heat wave, and this patient ended up in the ER with acute kidney damage. It was striking how the ER doctor was able to still respect the patient’s cultural tradition and beliefs and maintain quality of care during the hospital stay, despite how the ER doctor may have felt about what the ceremony participants put their bodies through.

Week 3
It seems that this week was all about community involvement! On Wednesday, we attended a Rotary meeting with Kassy and the hospital administrator. All of the members attending made us feel very welcome, and inquired about our lives and how we were enjoying Wagner. They also responded very favorably to the presentation Kassy gave them, and were vocal about their support for our program. On Thursday, we attended an Intruder Response class in Yankton with one of the nurses and the department manager of the laboratory. It was an eventful morning, and we learned how to respond if gunmen ever come into our hospital. They even taught us how to barricade ourselves and protect ourselves with items that you can usually find in any room, or even with items from our purses. Amber and I were finally able to do our community project Thursday afternoon. We organized an unused/expired medication and used diabetic supply take-back that we hosted at the Wagner police station. Our turnout was not quite as great as we had hoped for, but the police station did agree to set up a permanent location for taking back medications and used diabetic supplies. On Friday, the World Harmony Run came through Wagner, and Amber, Bryan (the hospital administrator) and I took the runners Gatorade and power bars. The runners gave a presentation to the children that were swimming at the city pool, and everyone had a chance to hold the torch that they run with. It was amazing to get to meet people from so many countries all working together for a common cause.

Week 4
My last week in Wagner was probably the most exciting one of all! It started off with my boyfriend proposing to me over the weekend! The nurses and staff shared in my joy, and in our down-time during the week we had fun talking about wedding plans. On Monday morning Amber and I helped teach a babysitting class. I instructed the students in first-aid, and they impressed me with how much they already knew. We ended my lesson with a variation of charades in which one student chose an injury and acted it out, and the rest of the class discussed how to respond. In the afternoon I was able to observe a tubal ligation with one of the surgeons who comes to the facility. It was a great review of my anatomy, and the surgeon and anesthetist were very good about answering all of my questions. Kassy came once again on Wednesday, and Amber and I gave our presentation to wrap up the REHPS program. We had a great turnout, and I was truly sad to see the program end. It was a great experience, and it opened my eyes to various aspects of rural healthcare. I hope that the program continues in the future and introduces other students to the unique and rewarding nature of rural healthcare.