Goodbyes

On the eve of my last day of my practicum, I am finding it hard to say good bye and have closure with the period of my learning and my life.  These last 3 1/2 months have been such a time of growth and learning in a professional way, as well as a very personal way.  I won't go too much into the personal growth, since this is a blog for school, but just let me say that this has been a wonderful chapter in my adult life, and has plunged me forward in the comfort zone of being alone and being by myself, but not being lonely-just more comfortable being alone, and actually craving that type of time.

On the practicum front, I have grown in many ways through the experiences that I have encountered, the teaching and modeling that has gone on, the wisdom of a great mentor, to share his insight and perspective on a situation, the cultural teaching that has opened my eyes to a different way of thinking and a different foundation for beliefs, which has expanded my own.

I have learned from the individuals who have passed through Ward 21, during a time of being unwell, and have been privileged to have some of them take me along on the journey with them, even to the point of being well again, and stable, and discharged to their home or new home.  I have heard many life stories, that have been riddled with challenges and pain, but also of resiliency and growth and strength.

I will miss Ward 21, the staff, the current and past inpatients, the families, my supervisor and colleagues, and the many Psychiatrists that have worked here when I have.  Thanks for such a rich experience.  I am changed.

Maori Health Statistics

This week, I wanted to write a bit about the Maori health indicators and statistics that the Ministry of Health  in New Zealand have posted, and were shared with me at the Treaty of Waitangi Training that I attended. First, some basics: 565,329 people identified themselves as Maori, 14.6% of the total population compared with 434,847 in 1991.  The median age for Maori was 22.7 years-compared to total population median of 35.9 years.  35.4% of Maori are under 15 years old, making that 21.5% of the total population-much younger than the non-Maori population.

84.4% of Maori lived in urban areas and 23.7% said they could hold everyday conversations in Maori.

In the educational realm, 39.9% of the over-15 year olds had no educational qualifications.

This is one of the statistics that really caught my attention:  In 2001, life expectancy at birth was 69 years for Maori males and 73 years for Maori females, while life expectancy at birth was 77years for non-Maori males and 82 years for non-Maori females-an overall difference of eight years for both genders of Maori individuals.  Many of the causes for disability and illness are cardiovascular disease (2 1/2 times higher, cancer (2x more than non-Maori) and diabetes (2 1/2x higher).  Maori had higher suicide mortality rates than non-Maori (over 1 1/2 x).

There is a great focus of trying to change these statistics, and education and services are a priority for many of the District Health Boards, directed by the Ministry of Health.  I wonder how these statistics compare to our Alaska Native groups.  From my own experience, it appears to be some similarities in these groups of first people.  I hope that I can be part of the process to change these statistics for the better.

From the heart

I realized that I haven't blogged in a week.  I have started several ideas, some about entitlement, others about ethics, but today, I tossed them both aside, and wanted to just talk from my heart about the upcoming end of this internship and things that I have learned.  It has been an incredible learning and growing time for me, and I am so thankful for this opportunity.  Today was my formal evaluation with my Field Instructor, Mathew, and my UAA Faculty, Mary Dallas.  I felt that it went well, and it was a great opportunity for me to articulate some of the lessons that I have learned as I have been placed as a social work student full time for past 2 1/2 months.  I have had a great supervisor in Mathew-who has shown me the passion and dedication, along with the ethics and values that are core to the field of social work.  He has modeled for me the example of a social worker in the confines of a institutional setting who has not compromised his own values and goals, which sometimes comes in conflict with the other multidisciplinary teams or partners.

I am thankful for the down to earth quality that embodies the people that I have met here.  The video is of the 2010 World Sheep Shearing Champion, Cam Ferguson, as he competes in a regional shearing competition. It was an incredible community event to witness, and embodies the down to earth core of the individuals here.  I am so lucky.

Cannabis sativa L. marijuana

Well, this week was an interesting one for me as I thought about the conflict that exists at my internship site, and the conflict of policy and cannabis or alcohol.   I have been aware that the inpatients in the ward, have often used cannabis, while they have been there, but was interested in how they obtained it while residing in the hospital.  I have also heard at numerous ward daily meetings (average 3 times per week) that some of the inpatients on the ward had been using cannabis or drinking alcohol during leave granted or unauthorized leave (AWOL),  I  guess sometimes these substance have been passed through the window of the hospital bedroom, others have picked it up while they have been out on a pass.  On Friday, I had three inpatients request an escort to  go to the bank.  I thought it was interesting that they all needed to go at the same time.  It turns out that they owed money to another inpatient, who had given them some weed.  When the topic came up at the ward meeting, a resident psychiatrist asked the question that I had been thinking...are there any consequences for these actions?  I guess the hospital has a zero tolerance for alcohol and drugs, but if the ward followed the letter of the law, they would be kicking out individuals who may be involuntarily there or could be mentally very unwell, and thus put them more at danger to themselves or others.  It is very interesting and full of conflicts and ethics and complexities that are hard to suss out and figure out.  During supervision, we discussed this and talked about that the dilemma and the difficulty that the hospital staff are put in.  If also is confusing to think about the message that is sent to the inpatients who do not receive any consequences or need to accept responsibility for breaking the rule.  The whole thing is very complicating and difficult for this student to understand.

Here are a few articles/research that talks about cannabis and mental health.  It is definitely connected in some way, and my views have changed after seeing so many individuals who experience acute mental health issues connected to cannabis, among other substances. 

http://www.norml.org.nz/News/nandor_elected.htm

http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1614.2006.01902.x/full

Holidays in NZ

Holiday Beach Bach.  Families come back to the same beach/holiday home for 5 plus generations.

Proud of the fish and Rock Lobster caught on holiday

Launching a boat by tractor at the beach

Kids playing with family at a skate park during school holidays.

Sushi making over the holiday with Jack and Dad/Scott

Kids on  holiday, enjoying a chat!

Holidays in New Zealand are like stepping back in time and grabbing onto the traditional values of family time and relaxing together.  The schools have three two week breaks from school, where families plan short vacations or visits to their holiday baches.  The break over the Christmas holidays, summer, is about 6 weeks, in which many parents take off of work, stores limit hours, and it seems that the country just slows down for family time and holiday.  Many people own these holiday homes/baches and often have had the bach passed down for many generations.  I was able to go on a long Labour Day weekend with the Lees’ who have been coming to the same beach for 5 generations.  They have only shifted homes once, and couldn’t imagine not spending the summer vacation here.  Many barbeques occur, along with the fish frys and sausage sizzles that are so popular.  I am so thankful that some of my family will be coming to join me in this wonderful tradition of sharing quality time together, just relaxing and enjoying each other.

Suicide

Disclaimer:  Contains hard information.  Today, I wanted to put down a few words about suicide.  This week, I experienced  the first professional/work related suicide of a young girl that I was working with.  I had only briefly visited with this young 24 yr old, who had just moved to Palmy 6 months earlier.  She had only experienced one episode of drug induced psychosis four years ago, but he just recently sought out help, because she was feeling some of those feelings and wanted some help.  In the four days that she had been on the ward, she had shown improvement, but had still had enough risks that the doctor wanted to only let her have day leave for a few hours.  She went out on leave from the ward, and was found shortly after from her one friend in town, dead by hanging.  I received the word at work on arrival on Tuesday, after the long holiday.  It was a shock for me, and difficult for me to hear the psychiatrist say that she didn't see it coming, and then we moved onto the next report, just like that.

I have seen suicide profoundly affect the lives of some dear friends and seen the many years of aftermath of fallout from that experience.  Even 40 years after my friends' event, the ramifications are still resounding in the lives of the children and former spouse of the one who died.  The ones who are left behind are tasked to make sense or not of it, and use this to shape their perception, perspective and lens on life and the world.

Hopefully many of my faculty will not be reading this, because there is not one reference in this, just gut reaction and reflection.  I have seen that many times the suicide may be caused by impulsivity.  This could be caused by a previous head injury and the damage to the frontal lobe, or a bad decision, or an accident or by altered judgement by substance abuse or a zillion other things.

In the end, we have a responsibility to let people know that we love them and that we care.  We have the responsibility to let people know the resources available to them, and give them access to those resources.  In the end, the individual has the responsibility to use these resources, choose to live with supports available and to not use anyone else for an excuse or scapegoat or reason.

I hope I don't get in trouble for this, without adding the numerous links to supports and help available, but I just needed to talk.  The debriefing or "resiliency training" that we had as an opportunity to share as involved staff was also a wonderful way to process the experience, and what it means to each of us.  It was humbling to hear the psychiatrist and the numerous psychiatric nurses also question their role and if they missed something or could have done something different.  There are so many people who care, and are interested in helping in whatever way available.  Sometimes it just doesn't seem fair.  It is important to know that there is hope.  Thanks for listening.

What is Wellness?

This past week has really made me do quite a bit of reflecting and thinking about what is wellness, and what is mental health and what is mental illness, and where is the line between them?  What gives some people the training and skills to diagnose and discern the difference and determine a change from one state to another.  I am working daily with about 11 Psychiatrists (which includes the Junior Doctors at this teaching hospital) many Psychiatric Registered Nurses, many "Key Workers"-Clinicians in the Community and one Social Worker, besides myself.  Each person has been specifically trained to identify, assess, diagnose and be a part of the treatment of the individual who is presenting to them.

In the past five weeks, I have worked or met with over 100 different people who have passed through Ward 21, each have a very difficult experiences, and have ended up in the Acute Mental Health Inpatient Unit.  Many have stories that include difficult childhoods, or tragic experiences; others have significant losses or unbelievable histories or present situations.  I have seen doctors adjust and juggle the medications, nurses balance out the time for the individual in leave, seclusion, protection checks, and behavior modification.  I have seen (and been) the social worker negotiating benefits with Work and Income, trying to find accommodations for someone who is at risk for self harm, or needs supported services, but none are available in the community of choice.  Sometimes the best thing for the individual is just not attainable with the current resources, so we settle on second or third best.

Today, I completed a day training in Mental Status Examination, which reinforced the teachings at UAA and University of Wyoming, to take a snapshot of the person at that point in time, and cover the various items to include in this report.  It was interesting to see the video presentation of the interview, and also the amateur assessment that the three groups came up with, as well as the video critique from the Psychiatrist of the Junior Doctor who did the interview.  Many of these assessments were different and that is because each person comes into the interview with their own education and experiences, and prejudices, etc, and the professional really needs to know what is their stuff, and what is the person, who is being interviewed, stuff.

I still don't know what is wellness or what is un-wellness, but I do know that people are doing the best that they can to make an assessment with the information that they have, keeping the wellness and involvement of the individual as the priority.  I also know that many of us are only one incident or crisis away from being unwell for a period.  Life is precious and short, and I am committed to contribute what I can to this world, and to the health and "wellness" of all of us.  I guess that most professionals are just trying to do the best that they can to assist others to wellness and health.  It just makes me more mindful and thoughtful about the assessment and the discernment that is needed when working with others, and importance of assisting and empowering these individuals to find and hold onto the strengths that they hold inside call upon that resiliency to grow or even just survive.

Big week, and hoping everyone has a healthy and good week.

Another weekend visit to the Lee's farm

This weekend was another mental health break for me at the Lee's farm.  It has been a wonderful and magic place for me to de-stress and take some unplugged, down time to do some physical work, and get back to nature.  This weekend, I fed the pig a few times, helped to shear some sheep, found a dead sheep in a paddock and helped to drag it to a place to dispose of her, weeded the garden, drove the four wheeler, so that Greg could drive the tractor down, and helped to put an orphan lamb into the skin of a dead lamb, so that the mama who lost her lamb, but still had milk, would smell the dead lamb skin on the new lamb, and think that it was her baby.



I have found that after a really intense week, working daily with people who are really unwell and in the acute mental health situations, this debriefing on the farm does wonders for my mentally, physically, emotionally and spiritually.  I will head into work tomorrow, anticipating finding out about the individuals whom I am working with.  I'm hoping that the weekend of rest and some medication has given some peace to a few of them.  I find that it is really helpful to see some folks get from this tough space, to a much more stable and healthy place over the course of their stay in Ward 21.  The average inpatient stay is over 10 days, so I have seen many people filter through in my 4 weeks at my internship.

Benefits for all

http://www.workandincome.govt.nz/individuals/

Today, I wanted to talk about benefits a bit, since much of my day is taken up with trying to assist people to apply for or get the documentation needed for benefits.  In Alaska, I am familiar with our National benefits, Medicare, SSI, SSDI, and our state benefits, APA_Adult Public Assistance, TANF/ATAP-Temporary Assistance for Needy Family, but not too much more than handful of other benefits for individuals or families, and we have our 60 month limit for the ATAP.

In New Zealand, they have so many benefits and it has been a very interesting journey to navigate them.  There are benefits for Accommodation Supplement to help with rent, board or cost of owning a house-Housing NZ subsidy, Advance payment of benefit, to pay for school, uniforms, rent, and “Away from home Allowance” if you have children ages 16-17 years old living away from home to go on a training or tertiary/University course, or a Domestic Purposes Benefit, if you are ove16-17 and legally married, or age 18 and over, and raising children, or caring for someone sick or infirm OR a woman alone aged 50 or over.  For someone like Anise, who has had multiple birth, you can have a domestic emergency or need domestic support with things like housework, cooking or childcare.  There is the Training Incentive Allowance for people on Domestic Purposes, Widow’s or Invalids benefits, or Emergency or Emergency Maintenance Allowance, who are training to improve their work skills.

I have helped several people change their “Sickness Benefit” to a “Invalids benefit”, which is for people who have a permanent and severe sickness, injury or disability.  Although the title is not quite politically correct for our people first language, it still provides an opportunity for people who experience a mental health issue, or a disability to receive some financial assistance to live in the community.

One story from my flatmates:  Yesterday, Emma took 9 yr old Jack for a chest X-ray for his bad cough.  She went into the doctors office without her wallet, because she knew that there wan not going to be a cost.  If she had private insurance, she says that she would have to pay about $60-70.  I contrast that with my own visit to Urgent Care in Juneau for my cough the day before I flew over here.  I was charged $287 on the spot, which I may get part of back, but since it is counted toward my annual deductable, I will not get any.  I still don’t know what to make of all of this or the systems that we work within.

Thoughts on Seniors

I was planning on blogging about my impressions about seniors and care for them in NZ, but this weekend in New Plymouth, with old friends, has changed my impression, so this blog will be a significantly different blog entry than I thought it would be.  First off, an observation is that the Maori elders are highly respected by the younger generation, similar to what I have seen in the Tlingit and Haida community with Alaska Natives.  That is very good to see.

I planned on writing about the impressions that I have from trying to find accommodations for people who had experienced mental health issues, and how difficult it was as a discharge planner in NZ to find suitable accommodations for them, when they were transitioning from the mental health unit of a hospital with any history of mental health issues.  I was running into walls in my contacts with  the rest homes in Palmerston North, because they had real concerns about caring for these folks; thus were not keen to even consider them for residency. I was beginning to feel that this country had not done a good job in planning for the bulge of baby boomers that are all beginning to age.

This weekend, I am happy to be visiting my friends in their 70’s who are living in a retirement community in New Plymouth NZ.  It is a very inclusive facility and I see that it has multiple layers of care for the residents, ranging from independent living to skilled nursing help.  I met several residents, and noticed that they were full of life and continuing to living it to the fullest.  I happened to be here for the Oktoberfest Celebration, which included limitless wine and beer, sausages, sauerkraut, a sweet sauce and strudel for pudding (dessert).

The staff were all dressed up in Norwegian clothing, even the gardener, posing as Helga, and an attractive one at that!!!  The wine and beer were flowing, and the residents were wondering if I was a new kid on the block.  Julie and I ended up visiting for several hours, and I had a lovely series of dances with Jack, who lost his wife only a few weeks ago.  He was great at leading, and we both enjoyed ourselves very much.  I had several other residents come up to me later to tell me that I had made his year by our dancing.  To me, I was so thankful to be in the presence of my elders who were so alive and appreciative of living.  I truly wanted to be a bit older to live in this type of grateful community of people.  I am sure that you must have the funds to be be to be in this type of community, that ranges from independent to skilled nursing, but this was the most alive community of older persons that I have ever been in.  It beat my Dad’s Falcon’s Landing hands down.  Sure beat the Oregon senior housing in Eugene, and rivaled the social program at the Pioneer Home in Juneau, and added some uninhibited fun for all. 

Tonight made me think that maybe they do have an infrastructure in place for many seniors as they age naturally.  It made we want to grow old in community with others, and share the experiences, and embrace new experiences, with time.

I am so blessed and thankful to have older people in my life, and am so thankful to be with others as they gracefully accept the challenges that aging brings with it.  I am thankful for my dear friend, Ramsey, who has Parkinson’s, and so thankful for the lessons of life that he and his faithful and sturdy wife Julie are sharing with me.

Here’s to seniors, elders, and those who have come before them.  May they know the immense impact that they have had on us, and know that the wisdom that they pass onto us is very precious and powerful.  I think that NZ is doing a fine job caring for their seniors, in their hospitals, clinics, residential programs/housing and benefits.

Benefits:  http://www.workandincome.govt.nz/individuals/

Age 65years old or over:  New Zealand Supperanuation, Living Alone Benefit, Extra financial support,

A woman over 50 yes or older alone or partner has died:  Domestic Purposes Benefit, Widows benefit.

Going to hospital or rest home long term:  Residential Care Subsidy, Special Disability Allowance. 

Top Ten Day in My Life

This is my favorite place!

Today at Lochlea Farm, working with Greg Lee on the farm, was one of the best days of my life.  We started the day with some bacon and fresh eggs, both from the farm, and went out with 2 Mums and daughters, backpackers, on an adventure for the day.  We went on the four-wheeler, and went into the paddocks to gather up the ewes and the lambs to accomplish a few things.  We drenched the ewes to keep the viruses away, and we separated all of the new lambs and we put a tight band around their tails, and also a ring around the testicles of the males, after pushing the balls up out of the sac, then clipped their ears to identify them, on the right for a male, or the left ear for the females.  We docked over 424 sheep today!

It was a really incredible process with a harness to strap one in, and then the three of us women each holding one lamb each (and later, just Greg and I) grabbed the lambs and cradled them for Greg to work his magic.  We herded many groups, with the help of dogs, and I got really comfortable in grabbing and pushing these sheep around.  The really aren’t very smart, but when it comes to mothering, they are AMAZING!  In social work, we learn how important the Attachment Theory is, and that early bond and mothering is.  Today, I saw numerous, hundreds actually,  of mama sheep-Ewes, separated from their lambs, for us to do our work, then put back into a huge paddock, and  within 30 minutes, they had found their own baby lambs and were nursing or mothering.  It is really important that if a ewe rejects their child, to “lamb them on” to a different mum that is lactating and can give the important nutrients to the baby.   Greg told me that if a lamb dies, the ewe will stand by her dead lamb fro two days.  Greg can then identify them and can take that lactating ewe and put her in a small pen with an orphaned or rejected lamb, and within a day, that grieving ewe will accept and mother this new lamb.  Isn’t that better than “good enough’” parenting?  I was very impressed.

I am in heaven!

Eating marinated lambs tails

The reunited Ewe and twins

Ellen Lee and Adam Lee

Anyway, the green, the nature, the birds, the people, the soul satisfying  connection is unlike any other for me.  I truly feel like I am supposed to be a farmer, here!

A bit of culture in Wellington last weekend

Last weekend, I was fortunate enough to go to the World of Wearable Arts in Wellington.  It was an amazing event, that showcased so many amazing creations. It was different than our Wearable Arts in Juneau, and was choreographed beautifully, without each piece being introduced, instead it was part of a whole expression.  Quite an elaborate sight!

My friend from Juneau, David Walker was the Supreme Winner in 2009, and his wooden dress was showcased on the program, as well as on billboards and flyers all over the city.  I got to see David for a few minutes at Te Papa, the NZ National Museum, like out Smithsonian, only better!  David took a third place this year in a new category, and it was great to get an Alaskan hug after being away from home for three weeks.

  The city is full of life and energy, and was a great break from the internship and schoolwork.  It was a social weekend, so that makes it social work related, right?  I enjoy the city life, just as much as the farm life.

Community Mental Health with Andrew

This past week, I was fortunate enough to spend two days with Andrew, a Massey University Social Work graduate, who let me shadow him throughout his busy days.  He explained that they work with the recovery model, which refers to individuals and families/whanau developing skills and strategies that enable them to realize their potential despite the existence of mental ill health (Mental Health Commission, 1998).  He works with a caseload of about 30 people, and fills his days with phone calls to consumers, documentation, scheduling, visits to the home, calls to pharmacies, and partner agencies.  E likened himself to the the "sheep dog clinician" chasing after things, and rounding things up.

Ome observations I noticed:  In this field, knowledge of medications and their effects on someone is extremely important.  Not only did I see Andrew discuss with a psychiatric nurse and psychiatrist, the side effects he observed in consumers, but he also had to interpret what their advice and implications were.  He also provided a good deal of education about meds to the consumer and family during a home visit because they had questions about the tapering off of one medication and the increased agitation that he felt.  Andrew used the analogy of a car-meds are like air in the tire.  They help the car to go, but you still need petrol, motor, key, etc and they aren't the end all, be all.  I appreciated the analogy, and the message it represents.

I also noticed that Andrew was very organized to clearly present information and updates to the multidisciplinary team about his assessment and the risks that he felt concerning his consumers.  I felt really lucky to get a glimpse into a day in the busy life of this skilled Community Mental Health Social Worker.  I also know that I have lots more to learn to feel more confident in this field.

Social Workers Day in Aotearoa

Today was National Social Workers Day in New Zealand.  Palmerston North celebrated this with a lunchtime gathering of the social workers form the Mid-Central Health District Board (43 social workers in the hospital and associated agencies and services), with 18 of us for lunch.  It was a nice gathering, and nice to visit with social workers working in so many different capacities, pediatric social workers, mental health, disability social workers, geriatric social workers, rehabilitation social workers, community based social workers.  Went for a drink after work with several of them and continued our conversations about the differences and similarities in our world perspectives.  I sensed a bit of pride in stating that your profession is a social worker, and it was nice to be with a group of similar minded people.  They were very interested in my impressions so far, and my thoughts on social work in the states.  Two of the women had done some training in California for a few months, and they had their impressions of our social work system and government funded benefits and such.  I will blog about benefits soon.  It is very different over here, at least the bit that I have been exposed to thus far.  No 60 month lifetime limit on TANF or Temporary Assistance.
It was a nice day to connect to others who are working in this field, and dedicated to social justice and all of the other things involved in this profession.
Thank you Mathew for being a great ambassador and field instructor for me!  Here's a photo of us today.

Today-Powhiri-The formal Maori welcome ceremony

Today was a special day for me at the New Staff Day with Mid-Central Health District Board.  Fifteen of us spent the day learning about the District Health Board that governs the health of all of the people who live in this Mid-Central District of the North Island, covering the needs of _________people.  We learned about the geographic division of the country, and the responsibilities that this Health Board has to the people that live here.  If a resident of Manawatu is traveling to Auckland and needs to see a doctor, the Mid-Central Health District Board will cover the cost!  Wow.

We were welcomed in a "powhiri", pronounced poe-far-aye, which is a welcome ceremony which is performed only in Maori and has strict protocol.  The powhiri is often the first step in developing a relationship with Maori.  First, we were given the instructions and the coaching of the response song that we will call to the other side.  This was new to almost all of us, and it felt very sacred and spiritual to be a part of this.  We were called in and serenaded with a beautiful song, and received into the large hall.  A Te Karanga was a the call onto the room, and the whaikorero-men's speech was structured and showed acknowledgements of their tipuna, and the spirits of the dead.  This felt a bit familiar and like a Tlingit greeting or start of a formal speech, with the mention of the line of ancestry.  We responded with our male representative returning the thanks and welcome, and then with more enthusiasm than talent, we hanuhiri (visitors) women warbled our way through the unfamiliar words, but it was deeply touching.

The final step in the welcome ceremony was the hongi, a tradition symbolizing trust and friendship.  Each guest and host took a turn standing with foreheads touching, and silently breathing in one another's "essence" .  To come so close to strangers and share one's breath was an experience that wasn't too familiar to me or the other American-from California, yet it created a bond and connection with our hosts.  A shared tea and stories followed with our hosts, and it gave a great perspective for us to start our day, and for me to start my practicum.

Hongi is a traditional Maori greeting, which literally means “to share breath”. Hongi is done by pressing one’s nose to the other person when they meet each other. It is believed that when the two noses meet, people exchange their breath and the visitor becomes one of the local people (tangata whenua).

First week of work!

It has been a really busy and long week, but I am feeling so thankful that I am placed where I am.  I feel like I am learning so much, already, and have a very approachable supervisor, Mathew, who is helping to connect me to the Social Work community in Palmerston North.  He he has many years of experience in mental health social work, and has a vast knowledge of the resources to connect people to, when it is time to help them transition from the ward, into their homes.  The staff here seem to demonstrate a high regard and respect for the consumers that have come into their care.  They take a very holistic approach when helping people while they are "unwell", and seem to look at all dimensions, physical, emotional, spiritual and extended family to help work toward wellness.

Today there was a difficult morning report with a very unwell 20 yr old, who has done some serious self harm on herself, and in the brief time since she had been admitted, she had braided a very dangerous cord that was discovered before she could do anymore harm to herself.  I will be shadowing Mathew as he works closely with the multidimensional team to help her to get in a safer and better place.  I have not worked this intimately with individuals in acute mental health crisis, in a long time.  Each morning, at the 8:30 staff meeting, I walk out feeling a bit overwhelmed at the severity of issues and challenges ahead for these folks.  I then take a breath, look at the huge talented team committed to this Ward, and the individuals who find themselves here, and I feel thankful to be here to learn, and to contribute what I can to the healing.

Maori Concept for the day:  Te Whare Tapa Wha

The various elements to be considered within each Maori approach to wellness can differ. For example Te Whare Tapa Wha model takes into account taha wairua, taha hinengaro, taha tinana and taha whanau.

Lecture at Massey University

Today was a busy day as well, with 3 Multidisciplinary Team Meetings (MDT), my first family meeting with a very skilled doctor facilitating, and an afternoon at Massey University, meeting the faculty in the Social Work Department, and attending a lecture on Ethics in Research, by Dr. Mary Nash.  It was good to be on their campus, and I felt like a dignitary when Kath introduced me around from the University of Alaska.  During the lecture, Dr. Nash often conferred with me on facts, such as the Tuskegee Syphilis Study done from 1932-1972 (without informed consent or good ethics!).  It was nice to hear reference to good old Rubin and Babbie, and to know what she was talking about, and that the UAA MSW generalist program had prepared me with some of the same historical information.  Afterwards, I let her know that I had just survived my Research Methods classes, and can now appreciate the importance of understanding it better.

The MDT's and Family meeting brought to light some of the areas that I have not had much experience to or exposure of during my work in Juneau.  Some of those from today were:  gang affiliation (Black Power, Nomads and Mongrel Mob are the main ones in town), "P" which is methanphetamine , refugee issues and last but not least ECT, that was discussed as a treatment option for a inpatient on Ward 21.  Any insight any of you have on these, or experience with them, please don't hesitate to comment or email me.  Tah.

Each day, I learn how much I don't know.  I am so thankful to be here though and soak up what I can.
Maori Word for the day: Tangata Whaiora- which is the preferred word for consumers in NZ
Cheers- Photos soon!

First Day at Ward 21

Whew!  My head is so full of information and observations of my first day at Ward 21, Acute Inpatient Mental Health Services.  I have so many thoughts and observations that are swirling around in my head.  After a tour of the facility and introductions all around, I attended my first Multidisciplinary Team meeting with professionals.  I will be attending seven of these meetings per week, each with a different composition of team, MD, Psychologists, Psychiatrist, Occupational Therapists, RN's and more.

I am so excited to have begun working in this environment, and to finally meet Mathew, my supervisor, who is a well respected Social Worker who has worked in this field for over 20 years.  He has a great sense of humor/humour and there seems to be quite a bit of teasing and joking that is used in this workplace.  I am the one with the "accent" and have heard even more commentary on our former governor, and am finding that my political views appear to be in line with the social workers and residents that I have come across.

Maori Word of the day: whanau, which means family-and there are many definitions for family in Maori-extended family network.

Arrival in New Zealand

After a 12 hour flight from LAX, I have now rested and enjoyed reacclimatizing to New Zealand and getting used to the wonderful little things that are unique to my NZ; such as the toilets that have both a half flush for a pee and a full flush for a poo, walking down the sidewalk needs to happen on the left side of the sidewalk, or else you keep bumping into people and end up like a spawning salmon, ...........I promised to try to keep this on the social work aspect, but forgive me for throwing in a few "Margie-isms"  because I just can't help it.

I have had quite a bit of thinking time on the bus ride  to Palmerston North and many things have crossed my thoughts during this 10 hour ride.  I picked up a NZ Herald newspaper, and there were articles about social issues all over the place.  I decided to look at the paper with a critical eye, as taught in our early classes, and take note of issues related to social work.  There were many articles about the week old Christchurch earthquake, and the increase in heart attacks or the 500 professionals going down to assist and relieve the exhausted healthcare workers in Christchurch.  During a conversation with an elderly man about the devastating earthquake, he explained that "In this country, we take care of our own." And I sensed that there was a lot of National pride behind that.  It does tend to appear that they have quite a bit of positive, sustainable things happening in this country.

My thoughts jump to the sustainable issues on these two islands.  In most of the grocer stores that I have been in, the produce is labeled by where the produce was grown and how many kilometers away that was.  Contrast that with the produce that we get in Juneau, that only looks like a red tomato, but tastes like a flavourless (I put the u in there because that is how they spell it here) mealy mush. I will take exception for the garden grown items that a few of you in Juneau produce.  The reduce, reuse and recycle efforts here seem to be quite high, with many participating.  Even the food courts had several workers sorting the trays for recyclables and minimizing the waste.  I will have to see what they do with their waste, burn it, bury it, ship it out or how they dispose of it.

I had a conversation with woman in the yarn store about American politics, and she shared that she  follows it closely as a “hobby”.  When I said that I was from Alaska, she stated "Oh, Sarah Palin's home", and she is  “Quite amusing actually".  She felt that Sarah has been quite interesting to watch, and is a hoot-but can’t believe that Americans take her seriously.  She quoted several different amounts of dollars spent by her on the campaign trail for shoes, and “Girdles”-new items for me.  I shared a bit of my own personal thoughts on our former governor, and I'll just leave it at that.  Delightful and perceptive woman.

Preparing for social work internship in New Zealand

Many things have entered into preparing for this final internship in my Concentration year of my MSW program through UAA. I knew that I wanted to do my final internship in a block format, to really immerse myself into an agency to best focus on the learning and service. I looked at options available and I decided to follow my heart back to New Zealand, where my family lived for 11 months in !997-1998.
I began by corresponding with Universities in New Zealand, Schools of Social Work, to see if they might be able to assist an international student from Alaska, to connect with an agency, connect with a agency representative as well as a supervising MSW with the appropriate degree.  Massey University , in particular, Kathryn Hays contacted me and we began a year long journey to try to work out the logistics for this practicum experience.  Through many emails, faxes, background checks, liability insurance, University requirements and forms, we have finally arranged it all for  me to do my practicum in New Zealand.

I am anticipating a big growing experience and a chance to taste a bit of social work in a mental health unit in a hospital setting.  I chose Palmerston North as a potential internship site for the following reasons:  Location, responsiveness to my request, access to former friends by riding a hour and a half by public bus ride, and the cultural aspects that it offered to me.  Just for a bit of personal history, I have traveled to NZ three times in the past with my former husband, and my children.  Once, for a quick three week taste of both islands, with only backpacks on our backs. A second time, for six weeks traveling by motorhome and camping, with spouse, and my two year old Katelyn, and pregnant with my second child.  Finally the third time was for an extended time, which took faith and commitment to quit our jobs in Alaska, and bring our three children, ages 9, 7 and 3 on an adventure in this small but wonderful country, and joined by Jane for several months of this trip.

 I am now returning alone, for 3 months to work in acute acute mental health unit of the Palmerston North Hospital, but furthermore, I am here to learn all that I can about this wonderful country and culture.
This blog will mainly focus on the social work aspects of this trip and the country.  Please be patient with me as I try to write my first blog.