This is the Frontline
From the midwife focused on maternal mortality rates in the Black community to the student providing support for protesters in the streets to the health care consultant turned COVID-19 testing site nurse, the current and future nurses featured here embody the spirit of Penn Nursing’s commitment to social justice and advancing science—and the essence of nursing in 2020.
The Midwife Working to Reduce the Mortality Rate for Black Moms
it’s not often you meet a teenager who knows exactly what she wants to be when she grows up. Even rarer: That she actually does it. But the high school anatomy class that Jatolloa Davis took during her junior year clinched it for her. “I was blown away,” says Davis of the whole sperm-egg-baby phenomenon. The Philly native decided to get her BSN from the University of Pittsburgh, then her master’s in nurse midwifery from Penn. That initial scientific wonderment hasn’t eluded her. “I make sure my patients know how awesome they are…that they’re doing an amazing thing and growing a human.”
But the work she undertakes today goes beyond delivering healthy babies. As a Black woman, she’s acutely aware of the challenges that Black and brown people face when it comes to pregnancies and births. African Americans have the highest rate of infant mortality of any racial or ethnic group in this country, and they are three to four times more likely to die during childbirth or within the first year after childbirth. Davis sees her job as threefold: caring for birthing folks and babies, being an advocate for pregnant people of color, and enlightening medical professionals about racial disparities and biases.
She’s done big things on all fronts. While working in Pittsburgh, Pennsylvania in 2019, Davis co-created a well-regarded anti-racism workshop for midwives, and she is now in talks to roll something similar out across the country. “If you were to check in with any Black or brown person, they would tell you how challenging navigating the health care system is—they don’t feel heard,” she says. “As midwives, our number one goal is to see the whole person and to acknowledge the system wasn’t created for everyone.” One example: There are legit reasons people don’t show up to prenatal care appointments. “Our job is to not make assumptions. Maybe that person had to take three buses or can’t take off work.”
She also believes that people of color will get the best care when they feel comfortable with their providers. Data from 2016 says that 90 percent of midwives are white—this can create barriers to the most culturally appropriate care in many cases. To address that, Davis created a program to get Black high school students interested in nursing or midwifery. “It’s important that the person that’s taking care of you looks like you,” she says.
In 2019, Davis returned to Philadelphia and joined the midwives from Hahnemann Hospital who, since the hospital closed in 2019, now work in the Jefferson Health System. There, she sees pregnant patients in community health centers, in private offices, and in the hospital. “Now we’re able to help teach residents what normal labor and birth—with as little medical interventions as possible—looks like…and to check any implicit bias at the door,” says Davis. “Often, folks don’t think about midwives being on the frontline during a pandemic, but we see it as being at the very beginning.”
The Undergrad Who Helped the Protestors Safely Protest
Melina Lopez’s summer was sidelined by the pandemic. Her internship at Parkland Hospital in her hometown of Dallas was cancelled; a backup plan never came to fruition. When the protests swept the country in the wake of George Floyd’s murder in late May, Lopez was not only moved to participate, she knew she had the time.
However, she was torn. “I was a little hesitant to go out because, you know, we are also in the middle of a pandemic, and it just seemed to be risky,” she says. Lopez’s friends shared a similar sentiment, so they began kicking around ways they could contribute. Inspired by a friend in California, they decided to assemble care kits to distribute to protestors. The women tapped into their own networks, posting on Instagram and Twitter, and quickly raised $400. That was all they needed to get started.
With potential violence, reports of teargassing, and stories about people getting arrested—plus Texas heat and the pandemic—they created a kit that would address as many potential protestor scenarios as they could. They started hitting stores to purchase the obvious: water, snacks, Advil, first aid ointment, hydrogen peroxide, and gauze. They also added helpful resources like Sharpies, so protestors could write vital information on their bodies in case they were arrested or victims of violence caught on camera (like phone numbers and names), and papers with the names of pro-bono lawyers that could be contacted immediately.
Within two weeks, the trio had raised $1,500. They headed to City Hall and area rec centers to distribute the goods. When all was said and done, they were able to hand out 400 kits. (Leftover supplies were distributed to those experiencing homelessness in Dallas.)
The experience was motivating for Lopez, who has aspirations to be a public health nurse. “Being out in the community and seeing the different types of people standing up for the Black Lives Matter movement reinforced that passion,” she says. “These are the people I want to serve with my education and nursing platform.”
The Traveling Nurse Tackling COVID Across the Country
the idea of being a travel nurse was appealing to Christian Perucho. The New Jersey native had spent over two years working for Penn Medicine at the Princeton Medical Center and was enrolled to start his Nurse Anesthesia degree at Thomas Jefferson University this fall. Why not take this time, before school started, to try something new? “I was curious what the culture was outside of the East Coast and wanted to get out of my comfort zone,” says Perucho. The gig seemed ideal: he signed a three-month contract with American Mobile Healthcare to work in the Surgical/Trauma/Liver Transplant ICU at Stanford University Medical Center in Palo Alto, California.
What timing. He left New Jersey at the end of March, just as COVID-19 cases there were surging. He headed to California, where health care workers were watching what was happening on the East Coast. When he arrived in Palo Alto, half of his unit had been converted into a COVID ICU; eventually it was all COVID, all the time. “I signed this contract with the intention of gaining more experience in surgical-trauma,” says Perucho. “But then I’m like, ‘Okay, this is what we have to respond to now.’”
Perucho worked on a team—one that he was brand new to—that had to quickly adapt and experiment. The experience of what he saw in those first crucial weeks in Princeton helped guide decision making. “I’m pretty thankful we had time to figure out best practices.” Some of the innovative things they figured out: how to use technology (like FaceTime) to virtually bring family members into care decisions and to comfort loved ones; how to jury-rig IV pumps with extension tubing to reduce COVID staff exposure; and how to smartly and safely preserve the life of PPE. He was also able to experiment with medicines and treatments like convalescent plasma transfusions. “Being at such a large teaching and research institution is nice. They have a lot of resources and can quickly adapt,” he says.
When his three months were up, Perucho extended his contract through the summer. “I was pretty nervous before I started,” he says. “I wasn’t only going to a different health care system but one across the country during the pandemic. The whole experience reinforced the value of teamwork, even if you don’t necessarily know any of your team.”
The Nursing Student Helping Spanish Speakers Navigate Health Care
Nurses are drawn to the field to help others. For Vivian Echeverria, it’s more personal. Echeverria—originally from Costa Rica—is a traumatic experience survivor, now a board member of an organization that helped her. The NSC helps immigrants and refugees—some of whom have been victims of human trafficking, torture, and domestic violence—thrive. The Philly-based organization is one of the three largest in the country that does this work. “Because of my challenges and what I’ve been through, I want to help others to recover and get back on their feet,” she says.
While Echeverria is pursuing her BSN, her goal is to be a psych nurse practitioner. The discipline resonates: She had to take time off from school last year when she was diagnosed with PTSD. That’s also what inspired her to join Penn Nursing’s Community Champions program—which connects undergrads with opportunities to make a change in their community while getting real-life experiences—where Echeverria was introduced to Puentes de Salud, a nonprofit that provides health care and educational services (among other things) to the city’s Latinx population.
There, she’s able to use her native tongue to help where she’s needed. One recent assignment: To check in with individuals when the pandemic hit. “Most employers don’t provide medical insurance,” Echeverria says, so when the layoffs came it was critical to make sure people knew they had resources to turn to. But, in the mindset of treating the whole person, she saw something: “I noticed in this extensive over-the-phone survey, none of the questions were related to mental health.” Echeverria huddled with supervisors to figure out the right questions. “We’re able to get more people that need mental health services onto the correct path. There’s just so much more going on than physical issues.” What’s interesting, she discovered, is that it’s taboo to directly ask or talk about mental health in certain Latinx communities, making the phrasing of the question even more important. “In a way, the circumstances helped, because more people were able to access a counselor over the phone or through telehealth counseling,” she explains.
Echeverria is looking forward to returning to school this fall to continue her studies. “After overcoming so much, I am ready to continue to pursue my goals. Nursing is all about caring—I know how important it is to get good quality care, and I want to care for others.”
The Data Expert Enabling a Quick COVID Cure
Becca Nock wasn’t expecting to be analyzing health care data for a living. She was introduced to the field in 2014; it was a well-paying summer job in graduate school. Now, she works for HealthVerity, a Philly start-up that provides critical data to health care companies. If you think of finding solutions to COVID-19 as a speeding car, HealthVerity provides the fuel.
Here’s how it works: HealthVerity connects with partners around the country (from labs to electronic medical records systems to insurance companies) to gather data. Clients like pharmaceutical companies, consulting firms, and government agencies use that data to—among other things—create real-time, virtual studies. “We help companies look into the effectiveness of different drug and treatment options,” says the Houston native.
One great example: Nock and her team are working with the FDA to figure out which medications are effective treatments for the coronavirus without having to set up a costly, lengthy, in-person clinical trial. “We’re using real-world data with people already experiencing the disease,” says Nock. “Because we have information coming in on a daily basis from labs that were maybe drawn yesterday, we can see how people who are testing positive for COVID are doing on drugs like Remdesivir.”
What’s equally amazing is that Nock is able to account for—in a HIPPA-compliant way—social determinants like race, education level, health habits, and even what a patient buys at the grocery store. “There’s so much data out there and companies are just starting to get used to the idea of using real world data versus collecting brand new fresh data,” says Nock. “But they can see results really quickly and see what is out there—fast.”
Nock credits her success in a seemingly tech career to clinical nursing experience. She works with clients to pull the right data, and it’s not just all line items and numbers. She hopes more nurses get into the field. “I look at the data differently,” she says. “My assumptions of how a patient will look comes from nursing. I have thoughts on how disease prevention and treatments should look.”
The Community Health Nurse Advocating on All Fronts
It’s almost like Tarik Khan has two jobs. Well, more like 10. But he doesn’t see it that way. The Philadelphia native uses his nursing platform to address any inequities he sees, head on. And these days, there are plenty of inequities to tackle.
At the federally-funded Family Practice & Counseling Network in Philadelphia, Khan treats over 2,000 patients—ranging from babies to older adults. As the news of COVID-19 became increasingly alarming, he knew the population he cared for was going to be particularly vulnerable. “In the second week in March, four of my first six patients had COVID-like symptoms. We had five tests for the entire network and couldn’t get enough personal protective equipment (PPE),” Khan says. “I realized our city was in big trouble and sounded the alarm.” That alarm, in this case, was public awareness. He penned an op-ed for the Philadelphia Inquirer, is regularly featured on local news station NBC10, and is active on his Twitter account (@InclusionPhilly; Bio: Nurses will lead us through this crisis), which has over 10,500 followers.
He also helped mobilize a team to bring COVID-19 tests into nursing and group homes—since sending residents to a facility is challenging—and to low-income communities of color that don’t typically have access to testing. (Both efforts are ongoing.) “This is a time where leadership is needed, especially in nursing care,” says Khan. “I wanted to step up.”
Khan isn’t shy about his political beliefs because he knows the kind of care he provides is reliant on who is in charge. He fights for funding for community care centers. “One of the most important jobs is to be an advocate. It’s keeping my foot to the pedal.” He was a part of a Zoom call with Congressional staffers to enlighten them on what was happening in the community in the early days of the pandemic. (Congress wound up giving $1.2 billion to facilities like his.) And he was tapped to be in two commercials produced by Protect Our Care—a progressive PAC dedicated to health care advocacy—that ran in swing states.
For Khan, the pandemic is an immediate concern, whereas the racial inequities he experiences in his field are perennial. He wants to see more people of color in nursing—particularly African Americans—with abundant representation in the highest ranks of the profession. “This is such an important moment for Black Americans,” says Khan. “As an NP, I see so much injustice in health care.” One concrete action he’s taking: Working to bring more diversity to the Pennsylvania Nurses Association. “I’m the only person of color on the board,” says Khan. “When I look at health care, the people making all the decisions—CEOs, VPs, admins—are all white. That’s not right.”
The CDC Nurse Who Worked with COVID Patient Zero
Michelle Holshue was waiting. As a CDC epidemic intelligence service officer—basically, a disease detective—stationed in the Washington State Department of Health this past winter, she knew it was just a matter of time. “We were watching the news coming from China in December and becoming more and more concerned,” says Holshue, who is originally from Pennsylvania. “A novel respiratory pathogen is kind of the worst-case scenario for us in public health.”
Given the amount of travel there is between Seattle and China, it wasn’t surprising that the first case in the U.S. was diagnosed in Washington state. That was on January 21. “In the back of our minds, it felt like it was just a matter of time before we started seeing cases.”
What happened next, explains Holshue, was an immediate response from the state and local health departments, medical community, and CDC. “It was really incredible to see how quickly everyone jumped into action.” Holshue and her colleagues in the state and local health departments launched a massive investigation to identify with whom the patient had close contact. “If the patient went to an urgent care clinic, we figured out how long he was there, who else was in the waiting room, and if he stopped anywhere on his way home.” Holshue’s team followed up with nearly 80 people. The CDC dispatched a group to Seattle to help administer tests to a large portion of the people that were potentially infected.
While COVID-19 was something Holshue had never seen before, she was ready: After getting her master’s degree in public health in 2018, she went on to complete a two-year fellowship with the CDC’s Epidemic Intelligence Service. There, she investigated the spread of several outbreaks, including measles, vaping-related lung injury, and tick-borne illness. “I had a lot of training, but this was obviously different because of the level of concern and alarm and just the world-wide attention,” says Holshue.
Within a few days of confirming the first case, the New England Journal of Medicine reached out to the Department of Health to ask for a case report. Holshue was asked to pen the paper—and was told it was needed in a week. She and her colleagues began working with the patient to get all the facts. “We went over all the information again and again,” she says. “Our number one goal was accuracy. Number two was getting it done as quickly as possible.” Time was of the essence: Other health care providers needed to be armed with information before the inevitable spread. “We were straight forward and objective and recorded what we observed,” says Holshue. The article was published at the end of January and has been cited in more than 1,000 academic papers. It’s been viewed over three million times.
“I think it’s one of those once-in-a-lifetime sorts of situations,” Holshue says, looking back at her experience. “You always hope your work has an impact.” In this way, she hopes more future nurses consider her field. “You have to really think creatively, and it’s challenging every day.”
The Nursing Student Leaving a Legacy of Inclusion
In 2011, when Jason Lee was in the BSN program at Penn, he noticed that some of his Asian schoolmates were transferring out, changing majors, or taking leaves of absence. Lee wondered if it might be possible that anti-Asian bias was a contributing factor for the exodus. Determined to better understand the root of the problem, he teamed up with classmate Therese Parker and distributed a survey to all Asian undergraduate, master’s, and PhD students at Penn. “We wanted to know if people were experiencing any form of cultural bias,” says Lee. The results were profound. Many students had experienced some level of bias or racial discrimination. “Some-thing like 22 percent perceived some cultural bias in the lectures,” he says. Other revelatory responses included students who felt discriminated against and felt uncomfortable due to professor or student comments.
Lee and Parker considered publishing the findings (the Institutional Review Board approved their research) but—after presenting the results to faculty—decided that starting an on-campus group would be a greater catalyst to change. The Asian Pacific American Nursing Student Association (APANSA) was born. “We wanted to provide students with support and help address health disparities within our community,” says Lee. Both missions are equally important in Lee’s mind. “Nurses are the largest workforce in hospitals and the people that interact with patients the most,” he says. “The representation is important if we ever want to recognize and change the disparities in health care.”
Fast forward nine years. Not only is the group still in existence, but Lee was encouraged to see APANSA vocally showing their support of the Black Lives Matter movement in the wake of the George Floyd protests. “One of the other purposes of the organization was to work in solidarity with other campus affinity groups,” says Lee. “Historically, communities of color have been pitted against each other. Young leaders know the cycle must not repeat itself.”
But for Lee, it goes beyond police brutality. The statistics, when it comes to race and health care (e.g., Black women are 243 percent more likely to die from pregnancy or childbirth-related complications than white women), need to be addressed. “Where the medical community can make the most impact is pressing for changes surrounding the delivery of emergency medical services in the field during policing—such as Black Kentucky EMT Breonna Taylor, who went without medical attention for 20 minutes after being shot—and working to root out the inequalities in our health care system,” says Lee.
This past spring, after working at Mount Sinai Hospital in New York, Lee returned to Penn to pursue doctorate studies in nurse anesthesia. He was surprised that his class was over 50 percent students of color. “That’s unheard of in nurse anesthesia education,” says Lee, noting that just over one percent of NAs in this country are Black. He attributes this to a commitment to diversity by Penn and the fact that his program director, Dawn Elizabeth Bent, DNP, MSN, CRNA, is one of the few African American Nurse Anesthesia Program Directors in the country. She, along with assistant director Angelarosa Didonato, DNP, CRNA, helped move the needle forward.
The Consultant Who Dropped Everything to Help Her Own Community
For many people, being a nurse is about so much more than a skill set. It might sound cheesy, but nurses—no matter how long they’ve been working in the field or, perhaps, how long they’ve been doing something else—can’t not do something when they see people in need of help. And when Janelle Mirabeau watched the novel coronavirus sweep across the country, her nursing background instincts took over and compelled her take action.
Before COVID hit, it had been a while since Mirabeau had seen patients. The Maryland resident has spent the past two years working at PwC, where she travels around the country helping health care clients work through a myriad of challenges. (Most recently Mirabeau assisted a large hospital system with scheduling to make them more efficient.) But she suddenly found herself homebound due to the pandemic, confronted with what former Penn and Christiana Hospital co-workers and friends from nursing school were dealing with. “Hearing the stories of what they were seeing on the frontlines—it immediately sparked something,” she says. Company policy allows clinicians to devote work time to fight the pandemic, so Janelle immediately enlisted to volunteer. By mid-April she was in a Tyvek suit, administering COVID-19 tests in a drive-through clinic located in Prince George County as a volunteer for the Medical Reserve Corp. “It’s something so ingrained in me,” says Mirabeau. “You never really leave it.”
The clinic, which is about 20 minutes from her house, predominantly serves people of color and immigrants with and without legal status. It’s the hardest hit county in the state of Maryland. As a granddaughter of immigrants and a woman of color, Mirabeau saw herself and her loved ones in the people she was serving—and she quickly noticed many people coming through the clinic for testing only spoke Spanish. Luckily, so does she. “I’m able to provide the info they need in the language they are most comfortable with,” says Mirabeau. Being one of only three professionals that spoke Spanish at the testing site was a profound experience. She helped communicate where patients could get test results, when they could safely return to work, and that they don’t have to worry about paperwork—an issue that some feared. She helped craft critical handouts in Spanish, too.
Early in Mirabeau’s career, she had travelled to provide medical care in Kenya, Trinidad, and Guatemala. The fact that the pandemic and its effects were happening at Mirabeau’s own front door has left a lasting impression. She and her sister had been taking regular walks around their neighborhood and realized that there were always a ton of cars lined up on the streets on certain mornings. It turns out that a nearby church gives away food on Tuesdays. People, they noticed, would wait in line for hours. “I see the people who look like me, Black and brown,” she says. “I can’t ignore how much need there is right here in my own community.”
The Acute Psych Nurse Who Pivoted to Virtual Treatments
To set the scene of Weston, West Virginia, where Nicolas Rojas currently works: “It’s an old coal-mining town with two or three restaurants. It’s very, very small,” he says. “It’s in the mountains with limited cellular service.” It also happens to be where William R. Sharpe, Jr. Hospital is located—one of three state-run psychiatric hospitals. “The people we serve come from all around the state.”
Rojas, who is employed by West Virginia University Medicine Health System, moved to the state last year so his wife could finish her dental schooling. Before that, he worked for COMHAR in Philadelphia, an organization that provides—among other things—mental health services for the city’s Latinx population.
When the novel coronavirus went from an outbreak to a pandemic, it presented unique challenges for those in mental health, especially in Rojas’s situation. “We have forensic and civil patients,” he says. “A lot of times the acuity of the illness leads patients to lack good hygiene, present homelessness, or they are admitted directly from jails. We knew we needed to take precautions to keep everyone safe.” However, so much of their care relies on face-to-face interactions. “The patients are in such an acute state.”
The need to move to telehealth was urgent—but rife with challenges. Possibly the biggest one: legislation that limits the use of telehealth services by advance practice professionals. Thankfully, NPs and Physicians Assistants around the nation pushed for quick government intervention, and special permissions were given.
Rojas and his team first tried software on laptops that were brought around to each room. Sometimes he would be working at home, other times he would be at a remote location in the hospital. But they noticed the size of computers could, in some cases, heighten symptoms of paranoia. They had to pivot. Smartphones were less intrusive and easier to use. “A nurse can put an iPhone in their pocket; it didn’t trigger anyone,” says Rojas. It took some time and adjusting, but it eventually worked. Within the first month of implementing FaceTime check-ins, patients became more comfortable, and some were even able to hold the phones themselves. “It helped that the legislation got moving pretty quickly. I don’t know any other hospital that was able to move at that speed.”
Not only did it work, but it was enlightening. “It shed light on what opportunities utilizing technology exist, especially in a setting like this, where there’s limited personnel and a location that’s hard to get to,” says Rojas. “I think it’s really cool for the future in psychiatry.”
He also sees how the whole experience—from quickly adapting to the rural setting to challenging recourses—left him with a changed perspective. “Coming here has help me become open-minded about what barriers people face. It would be a wonderful experience for any current students and alumni.”