As a nurse practitioner for the Pasco County Health Department in New Port Richey, Fla., Pamela cares for nearly 100 HIV-positive people who need assistance but have no health insurance. Once a month, she also counsels HIV-positive inmates on how to manage their medications. Both groups are woefully underserved, which makes the work of Pamela and her coworkers all the more essential.
Although federal funding cuts have sliced away many of her program's services -- dental care, eye care and nutrition counseling have all fallen by the wayside in recent years -- Pamela and her staff doggedly continue to provide a full range of HIV care. Pamela provides one-on-one counseling and medical help to each of her patients, and delivers it with a full heart, intent on making every patient feel comfortable. Building that trust is the first and most important step toward providing effective care to underserved HIV-positive people, who too often find themselves mistreated or entirely ignored by the rest of the country. With compassion and understanding, Pamela works quietly but steadfastly to turn that tide in her community, and improve the lives of some of the people with HIV who need it most.
Can you tell us about the services your clinic provides?
We try to do a total care approach. There aren't many specialty care options available outside of our facility. I try to meet all their needs, but there are definitely times when I have to refer them elsewhere. If they become too ill for us to manage, or if they need surgery, we don't have the facilities for those services. Our HIV care program is funded by Ryan White state funds.
What is your patient demographic?
Our patients are anyone who doesn't have private insurance but is in need of care. We care for the entire underserved population of our county. I see about two-thirds men and one-third women.
What would you change in HIV care?
One of the biggest issues for the underserved population I see here is that a lot of the federal funding is being cut. We used to have funding for nutrition counseling, but those funds have been cut. I have been trying to provide some nutritional information, but I'm not a nutritionist. Other programs have been cut as well, such as dental and eye care.
We need to make classes available for HIV patients involving education and lifestyle changes, similar to diabetes classes or any other education for a lifelong disease. These classes should include the importance of exercise, how to have a better diet and support of smoking cessation. If we were able to give patients more education like this, they would feel better and have more control over their lives. Being able to make better choices will raise their awareness of their illness and their self-esteem.
Can you describe how your work has changed since you started?
Nursing has made me more aware of people's needs and taught me about quality of life. Quality is what life is all about. No one wants to be stuck in a room alone. When I first started out, I thought I could fix people's problems no matter what they were, and now I look at what's best for the person and how it fits into their life.
Not everyone can follow the same routine. Some patients just aren't happy with the meds, and they would just as soon not go through it anymore. Taking the medications is a big commitment; sometimes I just have to respect their decision. They can still come in and we'll support them to the end. I had a patient recently who decided to not take meds the last year of her life. She never felt good on the medication, so we put her in hospice, because without medications she is a more vulnerable terminal patient. She came in every three months, and only got worse, but I had to respect her wishes regarding her own life.
What is the best part of your job?
The sense of satisfaction when I help people out by helping them manage their health issues. My patients are an underserved population and they have many needs.
What have been your greatest successes?
When my kids got older, I went back to school for my master's and became an advanced registered nurse practitioner, which allowed me to be more productive in my career as a nurse. I felt I could do more to help people. I had become frustrated with nursing and working in the hospital, and with this degree I can do more counseling and teaching now. I do a free clinic and other things I wouldn't be able to do without my advanced degree.
What is the biggest problem patients with HIV face?
Understanding that they are living with a chronic disease with many complications and that they must make a lifetime commitment to treatment in order to survive. When they are ready to go on meds (which not everyone is) and if they are committed to living a healthy lifestyle, they will be fine, just like a patient with diabetes. Some people think that when they take the drugs and start to feel better, that they may not really need the pills anymore and that is when they skip doses.
There are also all kinds of cultural issues you have to deal with. You have to deal with religious beliefs -- sometimes your advice is contradicted by a witch doctor who is telling the patient they don't need the medicine. There are other social issues like machismo in Hispanic males. They also don't like to use condoms and don't like to come to the doctor. We have a lot of refugees from all different places: Central America, Africa, Haiti.
What do you think about the prevention efforts associated with HIV?
There needs to be more prevention efforts in the form of public advertising, especially in the schools. They advertise Viagra, so why not safe sex? I live in an elderly community and the school board is pretty conservative. There aren't any needle-exchange programs in town, and you won't ever drive by a billboard and see a message about safe sex. No one wants to be seen getting tested for HIV, because they think people will attach the stigma of the disease to anyone who is tested. This stigma holds off prevention efforts from being more publicized. Florida has a relatively small population, but we are third in the states for HIV infection. Most of those cases come from the bigger cities -- Miami, Tampa, Ft. Lauderdale -- but even in remote areas, where there is probably not a lot of HIV testing, since there is less disease, education is needed.
What counsel or education do you provide your patients?
We mainly discuss the disease, issues of disease management, safety. We have lots of education handouts we supply as well.
What is the key to a good patient/provider relationship?
A rapport is achieved by talking at the patient's level, sitting down and being on their side, smiling and making them feel comfortable.
How do you keep from burning out?
I take time off and go on my boat if I need a break. I can't go out every weekend, but as much as I can.
Is there any other profession you would want to work in?
Other than nursing? Nothing! When I was in high school, I was somewhat interested in music, and I almost majored in it. My mother really wanted me to go into music. I volunteered at a hospital my senior year of high school with an Army/Navy Candy Striper type of group and I really loved it. I realized I wanted to do this for a living.
Who has played an influential role in your professional life?
Dr. N. Fares taught me all about not only HIV, but people. He was the person I first worked with when I started. He's still around, but he's retired. Dr. Lucy Hartley was one of my undergraduate professors as well as a nurse practitioner. She was a role model for me, in that her degree gave her a good amount of functional independence within the profession and I liked that. I knew I wanted to be a nurse practitioner ever since I got my nursing degree.
What kind of community is New Port Richey?
We are outside of Tampa. It's a small town. It isn't tiny; but it isn't a city. We are an elderly retirement community, which means the population is generally naive about HIV.
What do you do in your spare time?
When I'm not spending time on my boat, I judge gymnastics competitions. Some weekends I may judge 400 children. I love sports and my kids were very involved when they were young and I helped back then as well.
Can you tell us about your family?
I have been married for 27 years and have a son, 24, and a daughter, 22. I have 2 golden retrievers. My husband played basketball in college and is very tall: 6'10". I am only 5'3", so we have had an interesting life. Both of my kids turned out tall and athletic.
Can you tell us about a favorite vacation you had?
The best vacation I had was a boat trip we took last summer from Virginia Beach to St. Michael's, Maryland, on a 54-foot boat with my husband, my college roommate and her folks. It was extremely relaxing and beautiful. We thought that we must be missing out on some of the great places in Florida that you can only get to by water, so this trip became the reason we bought one of our boats. When I go on these trips, I'm not a nurse practitioner anymore. I'm away and can relax, so I come back refreshed. The boating trips keep me positive.
What are you reading right now?
I am not reading right now because I have been packing. I am moving to a smaller house on the water since my kids are grown. When I do read, I like mysteries.
What kind of music do you listen to?
I listen to all music. My favorite group is Sugar Ray and I also like John Mayer.