An ABCCM Medical Ministry Clinic Experience and Reflections by Dr. Shannon Dowler and Student Nurse Eli Dowler

Dr. Dowler is a volunteer physician and preceptor at the ABCCM Free Medical Clinic in Asheville, NC. She and her son, Eli, recently shared their experience working together and caring for a patient in need in the Spring of 2024:

Shannon: We were supposed to be at the Dominican/Haiti border on a medical mission trip but due to flight delays and cancellations, we were unable to proceed. Eli was on spring break as a junior in the nursing program at Appalachian and I was despondent. We raised the boys actively participating in outreach and service but this was going to be our first mom-son medical experience together. The week before I had volunteered with the ABCCM interprofessional student clinic team and we had taken care of a young man struggling with a myriad of health issues and a strong lack of faith in the health care in the area. He had started uninsured but had recently qualified for Medicaid, but had been treated so badly he was only willing to come to ABCCM, his safe place.

?

Eli: Spring break of my second semester of Nursing School came at a desperately necessary time. I was exhausted, stressed and ready to relax. To be completely honest, my motivation for the medical mission trip to the Dominican was at an all-time low. The prospect of flying to another country for a week of clinical time was sure to be exhausting and I was very much in need of some R&R. However, we were prevented from traveling and wound up back in Madison County; honestly, I was thrilled to sit on the porch and watch the sunset. My mom had different plans - she requested I accompany her to the ABCCM Free Clinic to see some patients and get some clinical time together. I was happy to do it but was pretty unsure and nervous about practicing in an unfamiliar setting (I had only been in hospitals and in-patient psychiatric units).

Shannon: The man I had seen the week before was suffering from a serious wound that had the potential to advance to an amputation and he steadfastly refused to go to the hospital. “They treat me like I’m a nobody,” he shared. “I’m suffering and they don’t care.” He had a farm that he was the sole caregiver of and animals that needed him, and he walked through life a hulking figure in well-worn overalls. That Monday when we were supposed to be in the DR, we popped into the ABCCM clinic to volunteer together. I called the gentleman above to check on him and learned he still had not gone to the hospital and had run out of all of his medications. He sounded hopeless and like he had given up.

?

Eli: We arrived, started seeing patients, and my fears were relieved. I really enjoyed the setting and the large variety of patients that came into the clinic, they all needed care and seemed like people who didn’t often seek healthcare. Towards the end of the day my mom and I were calling patients to check in on various sores, prescriptions, and follow-up appointments. That was educational in and of itself but one case stood out. We were on the phone with a relatively young gentleman who had a flat affect, admitted he ran out of medications but didn’t seem concerned, and had a list of health issues that needed tending to. The most severe of which was his large leg wound of unknown origin. My mother, being the thoughtful and persistent woman she is, decided we would conclude our day with a home visit to bring him his medications and check on his wound.

Shannon: The pharmacy team packaged up his refills, and the nursing team loaded us up with dressing change supplies and vital sign equipment and we made our way to the far corner of Buncombe County to do a home visit. Ready or not, we told him, here we come! When we found his farm, we were greeted by his dog and a braying donkey, but no patient. We poked around a little, a little afraid of getting shot, but he was not home. We parked ourselves on his porch and talked about his story, how healthcare had let him down, and how sometimes we just need to go to the people but that is not the way our system is designed. As we were getting ready to give up, we heard a car coming up the drive and as he got out of his car, it’s clear he expected we would be gone.

?

Eli: That was a new level of nervousness for me, I had never done home care and had never met this patient before. Nonetheless, I put on my clinical face and we went to see the patient. Immediately I was concerned. We were very rural, on a farm, with no one in sight. I was sure something related to our trespassing was bound to occur. We waited, my anxiety continued rising, and eventually he showed up.

?

Shannon: His main excuse for not going to the hospital was his animals, so we offered to feed his animals that week. We had nothing else scheduled! He reluctantly showed us around.? We asked to check his leg and he declined initially but after some aggressive peer pressure, he relented. As we took his vitals and did his dressing change, we got to know him.?

?

Eli: He was not excited to see us. He begrudgingly answered our questions and only because of my mom’s fierce persistence did he show us how to take care of the animals in the case he went to the hospital. The nurse in me was screaming. So many boundaries felt like they were being crossed; between showing up to his home address and hounding him for information I was uncomfortable and felt as though we were violating his already lack of trust in healthcare. But once again my mom was right. He really just needed someone to show up for him and truly show him that they cared about his well being and wanted to ensure that he was going to be ok. When we got around to taking vitals I had another new experience. I couldn’t read his blood pressure, I heard beats at 160, then tried again to 180, and gave up and asked mom to try. Thankfully she recognized that he was just so hypertensive that he needed it pumped up to around 240 to get a reliable reading of how high his systolic blood pressure really was. Immediately I felt bad. Part of the medications he had run out of were his antihypertensives and now his blood pressure was dangerously high and desperately needed medication

?

Shannon: We learned he played chess and piano and was passionate in his love of his farm. He played us songs on the keyboard he had set up in his living room and despite our assurances we would care for his animals, he was not going back into healthcare, regardless of the consequences.? So, we kept going back to him.

?

Eli: This visit continued to prove to be necessary as we assessed his leg and realized how inflamed and infected it was becoming. Again, another medication he had run out of was his antibiotics. Again I felt bad. My fear transitioned to compassion and care as we established rapport and worked towards understanding why he wasn’t seeking care for such a dangerous wound. By the end he was laughing, expressing understanding of our teaching about wound care, and even agreed that he would potentially go to a hospital if it got worse.

Shannon:? There is a happy ending to this story. Working with the ABCCM team, we got him established with primary care and were able to connect with them about his prior experiences. With their encouragement and now coverage with Medicaid, he went to a new wound care facility and slowly is seeing his wound improve. He will not lose his leg and he will not lose his farm.?

?

Eli: This home visit opened my eyes to a world of rural, underserved, and low health literacy people whose past experiences with healthcare have pushed them towards undertreating and ignoring their health out of fear of seeking care from uncaring practitioners. I hope that during that visit and when we returned a few days later he was able to understand that there were practitioners out there that do care and do genuinely want to see them in their best health. That visit was impactful in many ways and I am glad every day that we went to his house.

?

Shannon: There are two other important things to take away. One, we were able to find our own medical mission trip in our backyard and while I taught Eli about medicine, he taught me about dressing changes, and we bonded in our love of medicine and people! Two, there are a lot of people like this gentleman who have been judged and sentenced with poor care in our system today. The role of a medical mission like ABCCM is that chance to help those who have fallen out of care, or simply not had access, find a meaningful way back in through caring and compassion.