During my most recent clinical rotation, I encountered a patient who was from rural Maine and had a slew of health problems that landed him in the hospital. He had chronic kidney disease and was in the hospital for fluid volume overload since he has not been to the dialysis clinic in several weeks. This led to an exacerbation of his heart failure and caused him to have episodes of syncope at home. The person lives in rural Maine and he has to drive over an hour to get to his dialysis appointments. He has a history of hyperlipidemia, tobacco use, alcohol use and hypertension. His insight into his condition is poor and his health literacy was not the best. I feel as if he has not received much education from public health initiatives as they may not have been far reaching enough to influence this man’s life up in rural maine. The access to care is poor as he has to travel really far to his dialysis appointments. He has to travel over an hour several times per week just to stay alive. I cannot really blame him for not going to his dialysis appointments as he would have to put so much focus and energy all of the time in figuring out how to get to his dialysis appointment. The amount of time he must set aside for the appointment itself, the time  to get there and the time to get back to his house must be astronomical. 

I feel as if the health system could have done better through providing more dialysis clinics to rural Maine promoting ample and equal access to dialysis for all who require it. I feel as if the staff at the health system could have done better through potentially setting the client up with social work in order to work out a solution regarding the inequitable access to dialysis clinics. I also feel as if the staff may be desensitized to this sort of problem since they see it so much and just regard it as a normal occurrence, so they don’t feel the need to attempt to do anything about it or change it as a group. It is not just their responsibility however, it is everyone’s responsibility to break this chain of complacency.

I could have done better by mentioning my thoughts on the situation to the nurse, however as a student I feel as if I am there to learn, not criticize or make suggestions as to how the nurse gives their care. The nurse also seemed busy and I didn’t know how much power I had to be able to make a difference in this situation. So I feel as if it may have been a combination of my hesitancy and the system itself.