HS315 Unit 7 Seminar Reflection Example

People Come Back to Places, Not Appointments: A Unit 7 Seminar Reflection on a Shelter Foot Clinic That Lost Its Patients

[Student Name]

Purdue University Global

HS315: Practices in Public Health

Unit 7 Seminar Reflection

[Instructor Name]

[Date]

The guest, the clinic and its figures are composite; the displacement study, the surveillance study and the reflective model cited are real.

What the Guest Described

The guest ran a weekly foot and wound clinic in the basement of a downtown shelter in a river city about the size of Fallon Springs. Every Thursday from 1 p.m. to 5 p.m., she and a volunteer podiatrist saw anyone who came. In its best year the clinic saw [430] people and dressed [260] wounds. But only about one person in five came back the following Thursday for a second dressing, and the clinic could not tell what happened to the rest. Some, she later learned from emergency department staff, came back to the hospital weeks later with infections that had spread. She said the clinic kept careful notes on every visit, but it had no way to look anyone up afterward, because most patients gave a first name only and had no phone. She showed us the clinic's last annual report, which listed visits, wounds and supplies used and said nothing at all about what happened between Thursdays.

My First Reaction

I typed my first reaction into the seminar chat before I had thought about it: "Seems like the patients needed to take more responsibility for follow-up." I meant that the clinic had done its part, the care was free, and the people who did not return had chosen not to.

What changed my mind was a single sentence from the guest: people come back to places, not to appointments, and her clinic had asked them to come back to an appointment.

What Changed It

The guest explained three things that made Thursday afternoons impossible for many of her patients. Shelter beds in that city were assigned nightly, so someone who slept at the shelter one week might be across town the next. Encampments were cleared every few weeks, and people lost their tents, their supplies and often their medications. And Thursday afternoons were when the day labor office paid out, so some of the people most likely to have foot wounds were waiting in that line.

The second point stayed with me after the seminar. A study of people who inject drugs and live unsheltered in US cities estimated that involuntary displacement through encampment sweeps would lead to substantial increases in overdose deaths and hospitalizations over ten years (Barocas et al., 2023). If clearing a camp has effects that large on overdose, it is easy to believe it breaks the thread of wound care too.

By the end of the session I saw that the clinic had been well staffed and well meaning, and that its design had assumed a stable patient. The one-in-five return rate was not a measure of patients' responsibility. It was a measure of how many people could be in the same basement on the same afternoon a week later.

Turning to My Own Plan

This was uncomfortable, because my Unit 5 plan, Street Wound Care, has the same flaw in part. The van stops are scheduled three days a week, which is good, but the river camp visits are fixed for Tuesday and Thursday mornings, and objective 5 in Unit 6 expects a second dressing within three days. If the camp is cleared on a Monday, the people I most want to reach will not be there on Tuesday, and the plan has no way to find them.

I am revising the plan in three ways. First, each wound kit will hold enough supplies for three dressing changes, with a picture card showing how to do it, so follow-up does not depend on meeting the nurse. Second, the outreach worker will ask each person where they expect to be in the next few days and record it, so the nurse can go to them. Third, the program will ask the city for advance notice of any camp clearing, so that the nurse can visit the day before.

What I Check First Now

Using Gibbs's reflective cycle helped me separate what I felt in the moment from what I learned afterward (Gibbs, 1988). The lesson I will keep is a question to ask of any program design, in public health or elsewhere: does it work only if the person comes back to us at a time we choose? If so, it will fail the people whose lives are least predictable, who are often the people at highest risk. The rise in invasive group A strep among people experiencing homelessness (Valenciano et al., 2021) means the stakes of that failure are not small.

References

Barocas, J. A., Nall, S. K., Axelrath, S., Pladsen, C., Boyer, A., Kral, A. H., Meehan, A. A., Savinkina, A., Peery, D., Bien, M., Agnew-Brune, C., Goldshear, J., Chiang, J., Linas, B. P., Gonsalves, G., Bluthenthal, R. N., Mosites, E., NHBS Study Group, Wortley, P., . . . Xia, M. (2023). Population-level health effects of involuntary displacement of people experiencing unsheltered homelessness who inject drugs in US cities. JAMA, 329(17), 1478-1486. https://doi.org/10.1001/jama.2023.4800

Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Further Education Unit, Oxford Polytechnic.

Valenciano, S. J., Onukwube, J., Spiller, M. W., Thomas, A., Como-Sabetti, K., Schaffner, W., Farley, M., Petit, S., Watt, J. P., Spina, N., Harrison, L. H., Alden, N. B., Torres, S., Arvay, M. L., Beall, B., & Van Beneden, C. A. (2021). Invasive group A streptococcal infections among people who inject drugs and people experiencing homelessness in the United States, 2010-2017. Clinical Infectious Diseases, 73(11), e3718-e3726. https://doi.org/10.1093/cid/ciaa787