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12 Years After Fleeing Katrina, Family Displaced by Harvey Seeks New Life in Dallas

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Ashley Aples, left, speaks with his 8-year-old son Zion at an evacuee shelter at Kay Baily Hutchison Convention Center. Mr. Aples fled to Dallas with his family as flood waters from Hurricane Harvey rose around their apartment in Houston.

Flooded homes. People stranded on roofs. Rescue boats patrolling neighborhoods.

Ashley Aples saw the chaos and panic engulf Houston in just a few days, and he knew from experience it was time to flee. He did so 12 years ago when Hurricane Katrina ravaged his hometown of New Orleans and forced him to rebuild his life in Texas.

Now he and his family are rebuilding their lives again – this time in Dallas, with no plans to return to an area facing years of painful recovery from Hurricane Harvey’s historic wrath.

“We’ve seen it before; we know what this means,” Mr. Aples said from the Dallas Mega-Shelter at the Kay Bailey Hutchison Convention Center, where UT Southwestern faculty are coordinating and providing medical care to Harvey evacuees.

By Friday, the medical unit there had treated nearly 200 people like the Aples family, while still awaiting a potential influx of evacuees struggling to escape the floods.

The 35-year-old forklift operator sat on a green cot next to his wife and 8-year-old son, who along with other relatives packed into two cars as floodwaters began to rise around their apartment. They headed north, not sure what they would find.

“My family got what they needed,” Mr. Aples said with a smile, looking across the multitude of volunteer groups spread across the sprawling shelter.

“Some of the worst times bring out the best in us and show us who we really are,” Mr. Aples said of the physicians and volunteers helping at the shelter. “We have individuals here of different faiths and races, all helping their fellow man.”

The Aples family was among the first of a few thousand evacuees expected to seek refuge at the shelter this week after torrential rains from Harvey left much of the Texas Gulf Coast submerged, destroying thousands of homes and killing more than three dozen people.

Inside the medical unit

UT Southwestern faculty, fellows, residents, and students from UT Southwestern Medical School who are spearheading the medical response at the shelter include a wide range of specialties from Emergency Medicine, Pediatrics, and Psychiatry. Caregivers are checking on blood-pressure levels, helping control potential issues such as diabetes, and ensuring evacuees are able to acquire the medications they may have left behind.

Dr. Raymond Fowler, who is directing the medical response at the convention center, said the team has plenty of experience dealing with such situations. He has overseen several similar medical responses to major disasters, including Hurricane Katrina, though he notes this operation is twice as large.

“We’ve gotten pretty good at this,” said Dr. Fowler, Division Chief for Emergency Medical Services at UT Southwestern, who holds the James M. Atkins, M.D. Professorship in Emergency Medical Services. “As soon as we can get them here, we’re ready for our friends in the South.”

The shelter has about 5,000 beds available if needed, and the initial evacuees seeking shelter in Dallas provided an opportunity to test the processes and ready the medical unit, said Dr. Raymond Swienton, Professor of Emergency Medicine, Chief of the Emergency and Disaster Global Health Program at UT Southwestern, and long-standing senior adviser to the state of Texas.

“We are now gaining access to large numbers of people who have been stranded for days in this unprecedented disaster impacting our entire Texas coastal area,” Dr. Swienton said. “We stand ready to provide shelter and medical care to our fellow Texans who arrive in Dallas.”

The medical wing has been bustling this week with volunteers and emergency response crews unpacking food and going over final plans. A pediatrics section decorated with walls of colorful birds and clouds was stocked with formula, diapers, and a box of stuffed animals. One mother sat on a cot in a corner, bouncing a laughing toddler on her knee.

UT Southwestern Pediatrics faculty physicians are staffing and providing support to the pediatric clinic daily to help treat the evacuated children.

“We will provide services as long as they are needed,” said Dr. Maeve Sheehan, Associate Professor of Pediatrics who is overseeing the shelter’s pediatric care with Dr. Halim Hennes, Professor of Pediatrics and Chief of Pediatric Emergency Medicine. “We will also be providing telehealth services throughout the night in conjunction with Children’s Health.”

UT Southwestern pediatric neonatologists aided with the evacuation of neonatal patients as the flooding began, and UT Southwestern pediatric nephrologists are providing dialysis to several displaced children.

Next steps

Outside the medical wing, Mr. Aples sat with his wife and son, listing his next steps: getting a job, finding a home, enrolling his son in school.

“Kids don’t have the same coping mechanisms as adults,” he said, noting one reason why he won’t bring his son back to Houston for anything beyond gathering belongings from their apartment.

“Every time we went back to New Orleans, we saw places from our childhood destroyed. Your mind is fighting itself, looking at the devastation. You have to fight your way out of that box, because that box will put you in a depression.”

Mr. Aples said he has explained the situation to his son but is trying to keep the mood lighthearted.

Mental health experts at UT Southwestern’s Peter O’Donnell Jr. Brain Institute say that’s generally a good approach to take with children dealing with such traumatic events.

In addition, they recommend showing a calm demeanor around the children. Parents should offer but not force them to talk about the incident. They should also filter some of the news updates children may receive from television or social media.

“This can be overwhelming and scary for kids,” said Dr. James Norcross, Professor of Psychiatry. “But the good news is that kids are remarkably resilient. If you can reassure them, keep them in a routine as much as possible, they will be able to overcome and manage this.”

Mr. Aples is keeping his family’s thoughts positive. He is hoping to get a job as soon as he can and perhaps have the family out of the center in the next few days.

Until then, he wants to spread his message of hope to anyone who needs it.

“I want everyone to really, really just love on their families and be optimistic about the change,” he said, glancing over his shoulder at his son. “We’re going to figure out what we have to do, and the whole family will come together.”

Social Work Helper is a news, information, resources, and entertainment website related to social good, social work, and social justice. To submit news and press releases email [email protected]

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Child Welfare

Parental Medicaid Expansion Translates into Preventive Care for their Children

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When low-income parents enroll in Medicaid through the Affordable Care Act (ACA) state expansion program, their children have considerably better odds of receiving annual preventive care pediatrician visits, according to a new analysis by the University of Pittsburgh Graduate School of Public Health and Johns Hopkins University.

This “spillover effect,” explained in a study published online today and scheduled for the December issue of the journal Pediatrics, demonstrates that the potential benefits of Medicaid expansion extend beyond the newly covered adults.

“These findings are of great significance given the current uncertainty surrounding the future of the ACA and Medicaid expansions authorized by the law,” said senior author Eric T. Roberts, Ph.D., assistant professor in Pitt Public Health’s Department of Health Policy and Management. “Lawmakers crafting policy proposals that could curtail Medicaid benefits or eligibility should recognize that such efforts would not just limit the receipt of health care services by low-income adults, but also by their children.”

The ACA provided states the opportunity to expand Medicaid coverage to all low-income people at or below 138 percent of the federal poverty level. So far, 31 states and the District of Columbia have expanded Medicaid coverage.

Roberts and his colleagues identified 50,622 parent-child pairs from data collected in the 2001 through 2013 Medical Expenditure Panel Surveys, a nationally representative survey administered by the U.S. Department of Health & Human Services that includes detailed information on family structure and demographics, including health insurance status and health care use.

They discovered that children of parents who had recently enrolled in Medicaid had a 29 percent higher probability than children of unenrolled parents of receiving their well child visit, which is recommended annually for children age 3 and older, and more frequently for infants and toddlers.

During the visits, the children are examined for growth and development and given immunizations, and their caregivers are guided on proper nutrition and child behaviors. Studies have shown that children who get well child visits are more likely to receive all their immunizations and less likely to have avoidable hospitalizations. The U.S. has persistently low rates of well child visits, particularly in low-income families.

“There are many reasons that parental Medicaid coverage increases the likelihood of well child visits for their children,” said Roberts. “It could be that insurance enhances the parents’ ability to navigate the health care system for themselves and their children, increasing their comfort in scheduling well child visits. Medicaid enrollment could be a sort of ‘welcome mat,’ in which eligible but previously uninsured children are enrolled after their parents gain coverage. It also could be that parental Medicaid coverage frees up more money to provide preventive services to their children, because even copays can be a deterrent to medical care among low-income people.”

Maya Venkataramani, M.D., is lead author on this research, and Craig Evan Pollack, M.D., M.H.S., is a coauthor. Both are from the Johns Hopkins University School of Medicine.

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Health

How to Develop an Individual Grief Plan

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Story’s Angel of Grief

My Mother always said that my Daddy was “a fool born on April fools”. This was the running joke all of my life.  April 1 came along this year and it was not a joking matter. I was heartbroken and devastated that I could not hear my father’s voice or see his smiling face on his birthday.

Earl, My Pearl, was diagnosed with pancreatic cancer June 20, 2016, after suffering several months of abdominal pain, significant weight loss and limited mobility. He passed away peacefully on September 9, 2016, 4:30 am. This process was very difficult for all of us to watch, yet, we were there every step of the way and handled it a gracefully as possible.

I worked as a hospice social worker for several years prior to my father’s diagnosis. Our journey was still difficult but I was familiar with the language and processes pertaining to the end of life which afforded me the opportunity to assist my mother in talking with our team of doctors and making decisions. She found comfort and security in that and this made me proud. I saw this as an attempt to make this living nightmare a little less scary and slightly bearable.

My hospice experience also somewhat prepared me for being around death. I spent time with my Daddy after he passed away and I combed his hair prior to his wake with an unusual calm.  These were tender moments that I will forever cherish.

I faced a dilemma as my Daddy’s birthday approached. My 8th wedding anniversary was a few days prior to Daddy’s birthday.  My husband wanted us to go away to celebrate the weekend of April 1st.  My plan had been to spend the morning at the cemetery with my mother.

After discussing it with my spouse and my mother (my voices of reason) I came to the conclusion that my father would not want me weeping at his grave on his birthday. He would prefer me to go away, live life and celebrate with my husband whom he was very proud of and admired. So, we continued with our anniversary plans although I did not know what April 1st was going to be like.

I was committed to getting through my Daddy’s first birthday in Heaven without ruining this special weekend that my husband had so thoughtfully planned.  So, I allotted uninterrupted time and space for my grief and I planned activities to pull me out of those dark places that have the ability to consume us if allowed.  I planned for my grief.  Sound weird; keep reading.  I hope my experience assists you in your process.

On the morning of April 1st, I woke up, attempted to post a memorial birthday wish to My Pearl on my Facebook page and the tears began.  I went into the bathroom and cried hard for at least an hour if not more.  I wasn’t simply misty eyed or a little teary; this was the ugly cry that people try not to do in public.

My husband tried to console me but I asked him to allow me to handle this on my own.  I allowed the tears and emotions to flow without beating myself up for crying like a 37-year-old baby.  I did not attempt to suppress my feelings which is typically our natural response.  I went through the sadness of being Daddy’s little girl without her Daddy.  I experienced the “maybe I could have done more” routine that we wallow in sometimes.  I felt the guilt of not choosing to be graveside on his 75th birthday.

I felt horrible for abandoning my mother in her grief even though I knew she wanted me to continue with my celebration.  It went on and on and I allowed it until it ran its course naturally. Once I was completely done, I sat in silence for a while then cleaned myself up.  I felt weak, somewhat limp yet refreshed. My husband and I went to a lovely breakfast at our hotel; we changed our clothes and went to the gym together.

After that, I took a long hot shower, allowed myself to air dry across the crisp white comforter on our king size fluffy bed.  I then turned on some relaxing beautiful music.  I did not sleep, I simply allowed myself to be in total and complete relaxation for the remainder of the afternoon.  Our friends met us for cocktails and a show and it turned out to be an amazing and wonderful trip overall.  I planned for my grief, I executed and came through my Daddy’s first birthday relatively unscathed and empowered.

Make an appointment to grieve.

When we go to the doctor, we have an appointment.  You have called ahead, maybe weeks in advance, to make the appointment.  You have your appointment time, you see the doctor to discuss your health, meds, etc within your allotted amount of time (usually not over an hour) you say your goodbyes and you leave.  Think of your grief in that way.

I set my grief appointment for first thing in the morning because we were on vacation. We had nothing pressing planned that morning and we had guests meeting us in the evening. Whatever your day is going to look like, carve out space and time to be alone with your grief and make it happen.

This is important because if you allow the grief to have its way, it will show up throughout the day and consume you for the better part of that day and possibly beyond.  Take control of your grief by making an appointment, letting it present as it may, then, as you do with other appointments, say your goodbyes and leave it.

Don’t take “walk-ins”.

It is very difficult to walk into your doctor’s office and see them without an appointment. Apply this to your grief.  Say you had your appointment, you successfully followed all of the steps and are moving on with your day.  If grief shows up outside of its appointment time, turn it away:  “Look grief, your appointment was 8 am. We saw you and dealt with you then.  I will see you at your next scheduled appointment.” Acknowledge your grief but do not allow it to consume you outside of your appointment.  Commit to having power and control over the grief.

Plan to grieve alone.

Our family members and close friends mean well in trying to assist us in our grief, especially around holidays and special events that we would normally share with our deceased loved one.  Unintentionally, they can often be a hindrance, sometimes a crutch in our process. Additionally, we may subconsciously modify our grief in order to accommodate them and their level of comfort.

This appointment is not the time for such modifications.  Maybe we will cry but suck it up and move forward prematurely because they might feel like we have cried long enough.  Or maybe they, meaning well, will say the cliché things that people say when one is grieving in an effort to help ease the pain and stop the flow of tears:  “it will be ok” or “time heals all wounds” and my all-time favorite “he’s in a better place”.  We know that those things are true.

However, do we want to hear those things in our time of grief?  NO!!!  We are thinking “it won’t be ok because I can’t live without him”, “nothing will heal these wounds” and “the best place is here with me”.  None of those clichés are needed or welcomed for that matter, at this point in the process.  Again, you have to allow space and time for this process without guidance from well-meaning family members and friends.   It has to run its own natural course.  Friends and family have a more appropriate role in the next steps of this process.

Plan activities that you enjoy.

I knew that if I had grieved and simply remained still, I would have wallowed in a sad, hurtful place all day.  Therefore, I moved on to an enjoyable breakfast then a workout with my husband to take my mind to better places.  It’s not that you’re getting busy to suppress your feelings. Because of your grief appointment, you have dealt with your feelings and emotions head on and very appropriately.

You’re merely creating a beautiful welcomed distraction in order to move on with your day.  After the grief appointment, it is imperative to get up and get busy living.  This has to be planned for and executed.  At this point, your family and social support system could play a huge, meaningful role without hindering your process.  Remember, do not take walk-ins!

Take some time for relaxation and self-care.

My self-care was a long hot shower followed by resting to nice music.  Your self-care may look like a spa day, a long jog through your favorite park, a scenic hike, cooking an elaborate meal or a shopping trip.  Whatever makes you feel well, do it!  Think of this as a special gift from your loved one on this special day; it’s your reward for bravely facing your grief and taking control of your grief process.  I firmly believe that the ones that we loved and lost enjoy seeing us live happy and well despite their absence.

Be Grateful.

My father was here for all of my major life events: all of my graduations and performances, he moved me into my first apartment, he walked me down the aisle at my wedding, he was there during my pregnancy and formed a sweet relationship with my daughter…with all of that being said, how can I wallow in sadness?  I am so grateful for having a father that was present until he passed away.

Others have not been as fortunate and I acknowledge that. For that reason, I choose on his birthday, holidays and any day of the week to be grateful for him and his life rather than focus on his absence.  I am also grateful that he did not suffer long after his diagnosis.

As a hospice social worker, I saw patients and families suffer months and months; having their hopes of recovery dashed with the horrible news that their cancer had spread and there were no further options.  This was not our case.  We had our ups and downs but God was merciful and ended my father’s battle 3 months after he was diagnosed.  For that I am grateful. My gratitude list could go on and on.  My point is that in our sadness and on those birthdays and holidays, we have to immerse ourselves in gratitude in order to make it through.

The preceding technique is not the catch all or fix all for your grief issues around holidays and special occasions. This is merely a formula that worked for me and I was compelled to share it with the hopes of helping others.  If you are experiencing complicated, ongoing grief issues, please, seek help from a mental health professional.

Individual sessions, grief support groups, and other therapeutic interventions to deal with grief may be necessary depending on your individual needs.  Remember, death is inevitable for all of us.  However, being proactive in our grief process and planning for the same may assist and make facing holidays without your loved one bearable and beautiful.  It happened for me; that’s my hope for you!

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Aging

Social Workers Can Now Learn Medicare Online and Earn Continuing Education Hours

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Social workers can now earn continuing education hours while they learn Medicare at their own pace, anytime and anywhere with Medicare Interactive (MI) Pro, an online Medicare curriculum powered by the Medicare Rights Center.

MI Pro provides the information that social workers and health professionals need to become “Medicare smart,” so they can help their clients navigate the Medicare maze. The online curriculum contains information on the rules and regulations regarding Medicare—from Medicare coverage options and coordination of benefits to the appeals process and assistance programs for clients with low incomes.

“For over 25 years, social workers have been turning to Medicare Rights’ helpline counselors for clear and concise information on how to help their clients access the affordable health care that they need,” said Joe Baker, president of the Medicare Rights Center. “Now social workers can enroll in MI Pro and learn—or enhance—their Medicare knowledge at their convenience while fulfilling their continuing education requirements.”

The Medicare Rights Center, a national nonprofit consumer service organization, is the largest and most reliable independent source of Medicare information and assistance in the United States.

Licensed Master Social Workers and Licensed Clinical Social Workers can earn continuing education hours when they successfully complete any of the four MI Pro programs: Medicare Basics; Medicare Coverage Rules; Medicare Appeals and Penalties; and Medicare, Other Insurance, and Assistance Programs. Each MI Pro program is comprised of four to five course modules.

All MI Pro programs are active for one year following registration.

MI Pro courses are nominally priced. Additionally, social workers who purchase all four programs at once will receive an automatic 20 percent discount.

Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives.

Available only through the Medicare Rights Center, Medicare Interactive (MI) is a free and independent online reference tool that provides easy-to-understand answers to questions posed by people with Medicare, their families and caregivers, and the professionals serving them. Find your Medicare answers at www.medicareinteractive.org.

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