Abigail Smedly and Tanya Wait, on public health, their path to nursing, and the tangible expression of love.
(Publication Date: 10.04.22)
Overview: In this episode of the We Are Chaffee: Looking Upstream podcast, host Adam Williams talks with Tanya Wait and Abigail Smedly, deeply empathetic public health nurses in Chaffee County, Colorado.
Abigail tells about a life-changing experience that happened in the country of Kazakhstan when she was 16 years old. Tanya tells about how her nursing career nearly was derailed before it began, due to, of all things, a public health crisis.
Adam asks what makes “public health” nursing different from the typical role nurses hold in hospitals and doctors’ offices. And Abigail and Tanya elaborate on the definition of “social determinants of health,” which are at the heart of Looking Upstream's mission.
They also talk about the mobile health clinic in Chaffee County, which Tanya and Abigail staff, mental health and tangible expressions of love.
SHOW NOTES, LINKS, CREDITS & TRANSCRIPT
The We Are Chaffee: Looking Upstream podcast is a collaboration with the Chaffee County Departments of Public Health and Housing, and is supported by the Colorado Public Health & Environment: Office of Health Disparities.
Along with being distributed on popular podcast listening platforms (e.g. Spotify, Apple), Looking Upstream is broadcast weekly at 1 p.m. on Tuesdays, on KHEN 106.9 community radio in Salida, Colo., and can be listened to on-demand via khen.org.
Chaffee County Public Health
We Are Chaffee
Looking Upstream Host & Photographer: Adam Williams
Looking Upstream Engineer & Producer: Jon Pray
Producer & We Are Chaffee Community Advocacy Coordinator: Lisa Martin
We Are Chaffee Graphic and Web Design: Heather Gorby
Director of Chaffee County Public Health and Environment: Andrea Carlstrom
Director of Chaffee Housing Authority: Becky Gray
Note: Transcripts are produced using a transcription service. Although it is largely accurate, minor errors inevitably exist.
[Intro music, guitar instrumental]
Adam Williams: Welcome to We Are Chaffee: Looking Upstream, a human forward conversational podcast based in Chaffee County, Colorado. I'm your host, Adam Williams. Today, we have two guests, Tanya Wait and Abigail Smedly. Both are public health nurses. Both have extraordinary stories of how they became nurses, and both are amazingly compassionate and empathetic. So, naturally that makes them perfect guests for the Looking Upstream Podcast.
(00:37): They have special perspectives in our community, and I think the humanness they show exemplifies not only what we want when we seek care from healthcare professionals, but it's what we need in society at large if we're ever going to heal those social divides we all see and feel right now.
Bridging gaps, creating human connections through sharing stories from our personal experiences, that is a big, big piece of what we're doing with Looking Upstream. The idea is that by engaging in meaningful conversations throughout the community, we're laying foundations to build it up stronger. We are cracking through the shortcut labels and presumptions we so easily place on one another to actually see and hear each other more honestly.
(01:15): Underlying the stories that guests share on this podcast are what are known as upstream health factors. Hence, the name Looking Upstream. Another phrase we often use around the podcast to refer to upstream health factors is social determinants of health.
These are things related to challenges with housing and living conditions, social inequities and barriers, and many related policies and entrenched systems. It's about how those upstream factors lead to downstream consequences on social behaviors and health, and ultimately, the connectedness and wellbeing of all of us as a community. So, again, today, I'm talking with Tanya Wait and Abigail Smedley, who were very helpful in not only sharing personal stories but in providing education.
(01:58): I don't know about you, but I needed to ask what public health even means, what it refers to. Given their subject matter expertise, I took the opportunity to ask Abigail and Tanya to help deepen the definition of that phrase, social determinants of health. That was for me as much as for anyone, but I think you'll find what they say to be useful too. Along the way, Abigail shares about a life changing experience that happened in the country of Kazakhstan when she was 16 years old. Tanya tells about how her nursing career nearly was derailed before it began due to of all things a public health crisis.
(02:32): We also talked about the mobile health clinic in Chaffee County, which Tanya and Abigail staff, and we touch on mental health needs and resources. I also ask both guests to share how they not only sustain the energy and empathy to care for all of us, but for themselves. I love today's conversation.
Abigail and Tanya shared so thoughtfully and at times clearly showed the emotions related to what they were sharing. It's good stuff. So, here we go, my conversation with Abigail Smedley and Tanya Wait.
[Transition music, guitar instrumental]
Adam Williams (03:10): Tanya, Abigail, welcome to Looking Upstream.
Abigail Smedly: Thank you.
Tanya Wait: Thank you so much for having us.
Adam Williams: You are both Registered Nurses, right?
Adam Williams: And you both work in public health here in Chaffee County. Abigail, let’s start with you. To set a foundation for some basic understanding here, for myself as well as listeners, what is public health? What does it mean or encompass?
Abigail Smedly (03:15): Yeah, so public health is its aim is to promote and protect the health of people, the communities that we live in. We have several different programs that do that, focusing primarily on preventive medicine and health equity among our population.
Adam Williams (03:32): Okay. So, Abigail, then how does public health differ from what the typical citizen like myself and presumably nearly everyone listening when we think of going to a doctor's office or maybe a hospital stay? What is the difference?
Abigail Smedly (03:48): Granted I am new in the public health world, but the difference is that we are focused primarily on the larger picture. We take in all aspects of people's care and how they got there, including social determinants of health. Like I mentioned before, health equity among populations, preventative care. A hospital or a doctor's office is really focused on the problem at hand. You go to a doctor's office for a problem and they address that. I think public health looks at the social structure of health in a broader sense.
Adam Williams (04:23): Okay. Tanya, you can add to that as you feel the need, but I'm also wondering if you can give us an overview then of the work that the two of you do together as public health nurses here in Chaffee County.
Tanya Wait (04:35): Yeah, I think another large part of public health is education. Sometimes that's something that falls through the cracks when you're at a doctor's office or in a hospital. Sometimes the education process of maybe what your illness is or what your diet should be or your medication, sometimes that falls through the cracks. So, with public health, education's a really large part of what we do also. As far as Abigail and I, we have recently started a Chaffee Community Clinic. It's mobile, but we do have two locations.
(05:09): This particular aspect of what Abigail and I are doing is we're trying to reach people who have maybe been marginalized or who don't understand the medical process of maybe going to a doctor and what that entails. People who are experiencing homelessness, maybe they have problems, but they don't know how to get there or they don't have the ability to get there. We're also working with people, like I said, that were marginalized, that maybe don't speak English or who are in the LGBTQ+ community or maybe even women. We're just trying to see all types of people and just try to help them at where they're at.
Adam Williams (05:52): Okay. I was going to ask you about that use of the word marginalized and the word equity has come up. Those sound like pretty key words here of what we're talking about. Is there anything more to elaborate maybe on what it means to be marginalized? What is this equity imbalance we're trying to bring back to that place of equity?
Tanya Wait (06:14): So especially when I say marginalized people, these are people who are in our community, we may see them every single day, but they don't feel seen. They don't feel like they fit into the regular box, especially when it comes to anything medical or even mental health or behavioral health. They perhaps maybe need a little extra hand holding to get through a system that is based on being confused. I will go to the doctor and I'm confused and I'm a nurse, so I can't imagine someone who may be their first language isn't English, how they would fit in.
Adam Williams (06:52): That's definitely understandable to me. I frankly avoid going to the doctor whenever possible. In part, it's because of I don't know where I stand with whatever insurance I have now. That changes over time, over history with changing jobs or who is in what network or any of those questions.
So, I find myself trying to limit how much I go get care. I don't think that's the best way. Preventive approaches are going to take care of us better, which you also mentioned, Abigail. I'm curious when and how and why the mobile health clinic got started.
Abigail Smedly (07:28): Yeah, I think it's been a work in progress for some time, particularly from the work of Andrea Carlstrom, our director, and then Michael Real as one of our partners at public health. I think it came into effect primarily from doing different interviews and surveys to understand the need here in Chaffee County and understanding that there was a need for these marginalized populations that Tanya mentioned and to address some of the stigma they face and the fear they face around healthcare.
(07:59): One of our biggest populations that we also help with this clinic is those individuals who inject IV drugs. So, their entire life revolves around that, navigating that, navigating the stigma from that use. Healthcare, unfortunately, is just another entity that has that stigma in place. So, I think it came into being from recognizing those needs within our county and wanting to try to address them in a different way since the conventional way, as you just mentioned, even for a fairly functional member of society is really challenging.
Adam Williams (08:37): I'm glad I'm fairly functioning. So, I want to step back here. We're going to get further into your work as public health nurses here serving our community, but let's step back first. I want to get to know both of you a little bit more as individuals, get to know some of the history that led to where you are now and why this is important to you.
So, again, Abigail, let's go with you first on this question. You told me before recording today that you had a meaningful experience when you were 16, and that ultimately, it led you at that point to decide you wanted to become a nurse in the future. Tell us about that story, because when you gave me just even a hint of it, I was amazed.
Abigail Smedly (09:17): Yeah, absolutely. Going way back when. Yeah. So, I was 16 or was still going through all of the angst of the emo teenager and ended up getting signed up to go on a service trip to Kazakhstan and I was really excited about it. So, I went with a group of people. We went to the mountains of Kazakhstan and we ended up volunteering at an orphanage there. It was an orphanage that had children from several different surrounding countries. So, Russia, Kazakhstan, Uzbekistan, a bunch of different places.
(09:54): When I was there, it was just this such an authentic experience of joy and love and connection that I can't say that I had felt before. It was so beautiful to be a part of that community and to be a part of serving them, even though what we did was pretty minimal. It was basically just connecting. It was just communicating and connecting with the kids.
When we were leaving, I realized that what I wanted to do with my life is in some way have a tangible expression of love be my career. I wasn't quite sure maybe at that time what that could be, but pretty soon after, I decided to become a nurse because that to me was the way that I could express love tangibly.
Adam Williams (10:35): Okay. I'm wondering, it seems like there might have been probably more than one experience, but maybe if there's a specific experience that you can recall from having been over there when it really maybe clicked for you or felt different for you in that tangible form of love.
Abigail Smedly (10:56): Yeah, I think what felt different for me there was being able to connect with kids who felt unwanted and as Tanya mentioned, unseen. We played tag with these kids. We played hide and seek. We played all of these games.
When we left, I remember our bus leaving, I tear up even thinking about it because I started to cry because they would chase our bus for a while. I just remembered that feeling of connection and love with them and I just wanted to be able to express that for other people who didn't feel seen.
Adam Williams (11:32): Was it as much that you felt like this was different for them or was it also touching something from your own experience? Did you have that at home and you just wanted to share that, or did you realize, "Wow, there's a connection here that I'm maybe missing at home"?
Abigail Smedly (11:51): Absolutely, yeah. I think it was both. I think it was both for the kids and for me. And then also for that question about my own life, I think realizing that there's more love and connection than maybe we always get growing up and also knowing that any love that I had, there's a way to share that, which I think when you're growing up, it doesn't always occur to you that I could share this part of myself and it helps other people.
Adam Williams (12:21): Travel I think is a tremendous experience for so many things. It's where we learn. You mentioned connection. I know that you've also traveled to India on multiple occasions for similar reasons, helping as a nurse and as a nursing student.
Abigail Smedly (12:35): Yes.
Adam Williams (12:35): Have there been other places that you have traveled or are there others that you would like to go with this service elsewhere in the world?
Abigail Smedly (12:44): Yeah, I mean initially, I wanted to do all international nursing and career, just shifted a bit. I think that I would really love to go back to India. There's some communities there that I would love to go work in.
I was able to visit a farm in Bangalore, India that would primarily house people living with HIV/AIDS and then also had children who has parents had died from HIV/AIDS. I would love to go back there and volunteer time. I think that would be amazing. But anywhere that you can go, I think there's an experience waiting.
Adam Williams (13:18): Absolutely. Tanya, I think there's a story that is a bit extraordinary in how you came to be a nurse as well. Would you mind sharing that please?
Tanya Wait (13:29): I'm a bit older. A lot of people, Abigail included, start their nursing careers as a 22 or 23-year-old. I had a career in dentistry for 15 years, which I loved and I appreciated. I was starting to get a little burned out, which often time happens. One day, I was just there and a little kid goes, "You know what? You're a tooth nurse." At that exact moment, I was like, "You know what? I think I want to be more than just a tooth nurse. I want to be a nurse nurse."
(14:05): So, right then and there, I was 42 years old and I decided I'm going to take a change. I'm going to make it happen. Like Abigail, I want to help people. I want to help them as much as I can. I want to have the autonomy to be like, "I'm a nurse. I can educate you, I can assess you, I can help you." I mean of course, a doctor's going to be included, but I love the autonomy of a nurse being able to do all those things.
Adam Williams (14:35): I happen to know that there's more to this story and we're going to touch in an area that I'm sure we're all completely exhausted with and that relates to the pandemic, but it is relevant in your story because of when you went to nursing school. So, tell us more about that experience and that process from when you decided you didn't want to just be a tooth nurse to where we are now.
Tanya Wait (14:55): Well, I started the ADN program, which is a two-year program. I'm going to see if you all can do math. I started my first year in 2018. So, two years later in May, it would be 2020. In order to get my nursing license, I had to be involved in something called the COVID-19 pandemic. You may all be aware of this in your own lives. It was extremely difficult, extremely scary. I am older and I just wanted to get my career started. I want to do it since my career's going to be shorter than most. I wanted to get going.
(15:33): There was a month there that we didn't think we were going to be able to graduate in time that we were going to... I'm get teared up just talking about that, that we were going to have to wait until the fall. I was like, "I can't wait anymore. I want it now."
So, I actually have a senator friend who she actually called up to Governor Polis. He actually made it so that our clinical hours didn't have to be as many in order to graduate and that saved all of our lives. I tell you all across the nation actually. It was happening everywhere. So, I was able to graduate in May of 2020, pandemic nurse.
Adam Williams (16:14): So, you became a nurse, we're saying, only just a couple of years ago.
Tanya Wait (16:19): Correct.
Adam Williams (16:20): And then you went right into this public health nursing role that you have now. I'm wondering about how that came to be, because again, most of us are going to envision, "Well, this is a person who goes and works at a hospital or they work at a doctor's office."
You have a special role here. I wonder if you were just looking for a nursing job and this was one that was there, if there was something that really drew you to it, if you already had come to understand the distinction between the different nursing paths.
Tanya Wait (16:50): When I first started out, I thought I'm going to work very hard bedside in a hospital so that I could become an ICU nurse someday. That was my original goal. But then when COVID-19 occurred, the thought of being in the ICU with all of these COVID patients was quite scary and overwhelming.
But when I first got out of school, got my license, I actually just applied to public health without having any experience at all for a 20-hour a week position. They hired me as the COVID-19 nurse. Two weeks later, they said, "Would you like to have 32 hours?" And then a couple months later, they're like, "If you would like to be full time, we would love to offer that to you."
(17:34): So, I became full-time COVID-19 nurse to start out and I was working with people who their whole idea is to prevent this disease from spreading. I love the idea of prevention over fixing all day long. So, it became part of me and I consider myself a public health nurse now. I'm so glad I had that opportunity. Most people don't even know what a public health nurse is, and I got to do it right from the ground up to have that mindset of I don't want to just fix problems, I want to prevent them. Part of this podcast is about thinking upstream.
Adam Williams (18:13): It is. I think we're going to talk a little more on that later. We're going to go deeper there as well. But first I want to ask Abigail, you've been a nurse for 10 years. You said that you were new to public health nursing, but you've been a nurse for 10 years.
Abigail Smedly (18:24): Yes. Yeah.
Adam Williams (18:25): So when did you come to public health nursing and what motivated you for that or how did that come about?
Abigail Smedly (18:31): Yeah. So, I started my career at a large safety net hospital in Denver, Inner City Hospital. And then I moved out here to Salida and I was a nurse manager, so I was in nurse leadership. Just as Tanya mentioned, I got burnt out from that. I became the nurse manager over the area department that I was in March of 2020.
So, basically entered leadership here at the start of the pandemic, which was pretty overwhelming. I mean I had a great team that I worked with, but I think any nurse will say the last two years was overwhelming. I just felt this lack of connection from my patients. Obviously, I didn't really see patients anymore. I dealt primarily with the other nursing staff, with the doctors and other providers that I worked with.
(19:26): I felt so removed from that story that I shared, that initial connection, that drive to show love to people. I felt like I just made and explained and sometimes had to enforce rules and that really wasn't why I entered healthcare. So, I have my one year anniversary with public health actually at the end of this month.
I decided to move over, because I saw their team, I saw the way their team was still connected to each other and still connected to the work that they did and was really the ones out or part of the people, the group that was out there interacting with people, connecting with their needs. So, I shifted to public health to try to pursue that connection and that original drive that I had for healthcare.
Adam Williams (20:21): Okay. Tanya, let's go back to what you just said, pointing out that this podcast is focused on prevention. We're talking about upstream health factors, which relates to that prevention before things flow downstream to where we currently are. But what I want to ask you for some clarity about is a term that I think, Abigail, you mentioned earlier on, social determinants of health.
This is a significant focus and an area of importance with this podcast. Even though we're doing it largely through talking with people about their own personal stories, we're letting it be a human forward approach. Social determinants is an underlying current in our Looking Upstream Podcast. So, can you help me deepen the definition there? That's also for me as much as it is for listeners.
Tanya Wait (21:10): So a social determinant of health, it could be varied, but it's something that has a major impact on people's health, wellbeing, and then their quality of life. It can be anything from not having stable housing, not having transportation to your medical appointments or to even get to the hospital, racism, discrimination, and violence maybe in the home. Those could be a social determinant of health and also just access to healthcare, access to healthy foods, access to physical activity. That could be something that could be a social determinant.
Also, just your environment. If you live in a highly polluted area, maybe you have polluted water, that could be definitely a problem. I mentioned earlier in America, if English is not your first language, oftentimes, nobody has a translator for that. They're supposed to, but they may not. Also, your education level, your opportunities, your job opportunities, your income, those could all be things that could prevent you from getting the healthcare that you need.
Adam Williams (22:16): Okay. Thanks for elaborating on that. I'm going back in my mind to the word marginalized and equity. So, when I have thought through, trying to guess and anticipate what you might encounter in public health and in the mobile health clinic, I'm just thinking on the human side of this, the emotions that people who are feeling marginalized, who are scared, maybe they're confused, might well come with a sense of loneliness, anger, easily anxiety. We're all feeling that of late for a few years at least.
So, I want to ask just what are you seeing and what is it that people are bringing. Not necessarily just in terms of illnesses on the surface so to speak, but what are you seeing on that human side that you are maybe getting to connect with and help them person to person that probably goes deeper than just, "Well, here's some Tylenol"?
Abigail Smedly (23:21): Sure, I'll start. I think that we're seeing absolutely anxiety, a lot of anxiety, really heightened anxiety. We see a lot of anger from patients or from our clients who have felt, like I mentioned, unseen or unwanted or marginalized. And then we also see I think they come to us with a big sense of community.
I think ironically, our population specifically those who are unhoused have actually maintained their community despite the pandemic. Whereas a lot of us have felt like we've lost it or we're rebuilding it or it's shifting in some way. They have stayed connected, I think, out of necessity and survival, but they do still very much have each other and support each other. So, that's been really interesting to see too.
Adam Williams (24:11): Okay. Yeah, I would have to say that for myself, I feel like I've come to a place after two and a half years of pandemic with I have the security of a home and I have my family. But the amount of isolation that we took on, we had our two sons at home for homeschooling. They just have gone back into school and it took a toll on all of us. So, it's interesting that you point out how those who maybe didn't have some of those, what we would consider the factors of stability-
Abigail Smedly (24:45): Absolutely.
Adam Williams (24:47): ... that they maintained community. In that sense, I'm happy for them to have had what probably led to a level of mental wellbeing in some sense that I now recognize I'm lacking. So, to elaborate there a little bit if we can, Tanya, do you have anything to add in terms of what some of those emotions and human aspects you're seeing? Obviously, without divulging anything that is private or about anyone in particular and breaking laws and just general decency there, what are some things that you're encountering? If there are any examples in a generalized way you can share, I'd appreciate hearing that.
Tanya Wait (25:29): Do you mean their needs that are being met or maybe just a generalized feeling of connection?
Adam Williams (25:36): I like the idea of the connection, but also if there was an example of how that came together, what somebody needed maybe that meant to you because it is two ways. You both obviously are very compassionate and empathetic humans and that seems to be clearly how you're approaching each of these individuals that comes to you.
Tanya Wait (25:57): It's funny because we're in it and we see these clients all day on a couple days a week. We're like in it and it could be really busy and intense. We had someone that came from the state to just see what we're doing, hang out, and see things that we were doing. She told us, she goes, "I am so impressed with every single person who comes up.
You're like, 'Hey.' You say their name or you mentioned, 'Hey, how is this going in your life? Did you go and get this taken care of?'" She's like, "You know everything about them." I was all like, "Yeah, we really do. We get to know them very, very intimately." They have a lot of things going on in their life and most of them are so open to tell us, to ask questions, to ask for help. If we ask them questions, they're so open.
Tanya Wait (26:45): She made me realize, I'm like, "Yeah, we have an actual connection with this population, especially the unhoused or the people who are experiencing addiction." They see us as they're part of their community now. That's something that I've really enjoyed, especially in our Salida clinic that we've really built these really close connections. They'll just come up and like, "Hey, Tanya, guess what? I've been 17 days clean." Or they'll be like, "Hey, when I get out of the shower, I have something for you to look at." They're just so open and it just feels really, really good to know that they trust us.
Adam Williams (27:22): I meant to ask earlier toward the beginning when I was asking initially about what public health is and the mobile health clinic, what are resources, maybe a web address, or how can people know where to find you or if they need to sign up in advance or if they can just show up or if there are any costs associated? If we can just get some of that information out right now before I forget again, it would be great.
Tanya Wait (27:47): The best part of our clinic, it is free. It is free. Anything you need from, "Hey, do you need help getting set up with Medicaid?", we can help you get set up for Medicaid. So, then you can go to a provider. You can get some healthcare done that may not be free. So, if you have insurance though, that can help you. We do harm reduction, which is a fancy way of saying we want to prevent drug overdoses.
So, we give Narcan and fentanyl testing strips to test for fentanyl. In Salida, we're able to do a syringe exchange so that clean needles are being used instead of ones that we don't want you to share. We don't want you to use the same ones. We want to keep it nice and clean. Abigail, say some things too, because I've forgotten some.
Abigail Smedly (28:35): That's all right. Yeah. So, the syringe exchange, we actually collect those needles that they're not out in the community and do some other things to try to prevent infectious diseases from occurring. We do STI testing, sexually transmitted infections or obviously infections that you can acquire from sharing needles. We are in Salida from 12:00 to 4:00 on Mondays and then we're at the Methodist Church and then we're in Buena Vista at the community center from 1:00 to 4:00 on Tuesdays. So, we're open both of those days of the week, unless it's a holiday and there's no appointment required or anything like that. You can just show up.
Tanya Wait (29:09): We also have behavioral health navigators who are very important with specific populations in basically doing what we want to call a soft handoff. Anything they may need from mental health to housing to numerous other things that they may need, there's two of them, they can help get to where they need to go.
Adam Williams (29:32): Okay. That would've been a perfect segue for me to ask about mental health, which is what I want to do next, except I'm going to first ask about web address. Is there something clean and simple for that or if it's on the county website with maybe an extension? Okay, that's what it is. You're both nodding.
I am going to go look that up and I'll include it in show notes and have it linked for people where we put show notes at wearechaffee.org. So, now coming back to behavioral, coming back to the mental health, again, just using myself as an example here, I already mentioned how the toll of the isolation, my kids were home 24/7 almost. My wife works at home. I'm at home. That's how we spent all this.
While we have all this amazing fortune, we have this security, we have the stability. We didn't have to worry about affording our groceries or where we were going to sleep at night, but what I learned was the value of social connection, at least on some level. I used to be someone who would joke and say, you can just put me in a cave in a mountain and I'll just go meditate. I don't need the world.
What I found out through this pandemic is that that's actually not true. At some point, I need connection and in fact, that's why I do this podcast. It's about connection with meaningful conversations. I just don't have to walk into a room with 20 people and make friends with all of them at once. I get to sit here with you.
(30:52): So, my mental health, I have noticed, deteriorated, but I didn't understand it in clear terms until my wife, Becca was able to point it out to me. She said, "You're describing depression." It was an amazing aha. First of all, why didn't I know that? Second of all, what do you mean? She said it as if it was obvious. Well, haven't you known that?
So what I want to ask you is about what you are seeing when you identify individuals who come to the clinic and maybe they need help recognizing, "Yeah, I'm struggling with anxiety, I'm struggling with depression," or whatever behavioral needs and they need this help. So, then how do you help them?
Tanya Wait (31:36): The way you're talking, it's interesting. On a personal note, I also struggled, but I am able to reach out and get help. With this particular population that we've been seeing a lot of, it feels like they're already aware of their mental health issues or diagnoses. Have you found that?
Abigail Smedly (32:02): Yeah. I think that a lot of them are aware primarily because they know that's a large factor of why they are homeless or why they struggle from addiction.
Tanya Wait (32:11): Exactly.
Abigail Smedly (32:12): So, it has probably been told to them multiple times. I think they're aware of those issues. I wouldn't say they always have the ability to understand how those come together and impede their ability to find stability in life.
Tanya Wait (32:28): Which is where we come in, where we can be the connectors to help them get the help that they need. That is a big part. We are not mental health professionals at all. That's not our background, but we can help connect them to places like Solvista or counselors or group therapy or maybe AA or Narcotics Anonymous, things like that. We can help be the connectors.
Adam Williams (32:57): Okay. It sounds like you're describing that the parts of the communication that you come into contact most with then are those who struggle with addictions, don't have a place to live that's stable, things like that. The public health opportunities, including the health clinic that is mobile between up and down the county, that's available to all of us, but so many of us have the fortune of having insurance, we have employment, we have that stability. So, we don't use those resources necessarily.
I'm just trying to think through this and process in my own mind here and what I'm learning, because this is educational just for me as I think about, like I've already said, I struggle with using the system and then I'm not likely to go to the mobile health clinic.
There's not a particular reason other than I probably already have such an entrenched thing of there's nothing that I see wrong enough with my health that I need to do that, but I don't know. I don't know if there's a question in here. Maybe it's giving you a thought, but I'm thinking out loud and just the ways that you're probing thoughts for me.
Tanya Wait (34:05): Well, this is part of the mobile clinic idea for me is that if the opportunity arises and we're there and someone says, "You know what? Today's the day. I'm going to go. I've been having these heart palpitations, I'm going to go see this clinic because it's right there." An opportunity knocks. Come on down. You know what I mean? Those are also people that we see a lot. I mean, someone will just come by. I want a COVID vaccine. There's other reasons behind the clinic also. That's one of our goals too, is being just jaded from the medical community or medical process. We want to try to smooth that out. We want to try to make it more for everyone.
Abigail Smedly (34:51): Accessible.
Adam Williams (34:53): Not to put you on the spot with this, but just with your insights then, do you have thoughts on how to smooth that out in a bigger way? Obviously, you're already participating in what you feel like is a good set of tools for doing that, but I think there's so much confusion around for all of us care in this country.
Tanya Wait (35:12): I think compassion training, empathy training is something that could help a lot with people who are in the hospital or in a clinic because they're probably burned out too. Everyone's so scared. Everyone's so fearful and has been for the last couple of years that they're just over it.
They're over dealing with people who are coming in and angry at them. They're over people coming in and wanting stuff done right now. I think everyone needs to maybe brush up on some compassion and empathy training, which there are things out there for that. What do you think, Abigail?
Abigail Smedly (35:49): I totally agree with that. I think that understanding how to provide care for people knowing your own need for care is really, really important. I think a lot of people in the medical world have pursued more self-care and more boundaries in their life, but I think that's needed. And then the big part that we do is navigation and I think an emphasis on patient navigators or patient educators so that there's a more tangible way of answering questions quickly. There's a better way of explaining.
Like you mentioned, well, I'm just going to wait until I'm sick enough, until I need to go. You may not even know the resources out there to prevent you from getting to that place. So, if there were more focus on that to give people what they need ahead of time or explain what is available to them when they're ready, I think that would be helpful.
Adam Williams (36:42): I love the compassion and empathy answer and the risk of taking us off into some other territory here where we're trying to solve the entire country's problems.
Tanya Wait (36:53): I'm up for it. No, I'm just kidding.
Adam Williams (36:54): I think that's an answer for awful lot of things that we're seeing societally. I had mentioned to both of you before we started recording that the word pandemic for me has become a euphemism. In my mind, it speaks to issues that we're dealing with socially and politically and all of these things that we feel have got all of us so anxious. We're feeling so many emotions. So, I can only assume that that's what you are feeling as well and the people who are coming to you. So, how is it that you're dealing with that extra level of stress on what already is, I assume, a stressful job?
Abigail Smedly (37:28): I think for me, this is Abigail, I've released the need to fix it. I think this job and the community clinic has allowed me to show up for people where they're at, instead of where I would like them to be. I think as a nurse, we're good at seeing people's potential, whether that's in their physical health or their mental health. We want them to be better, but that can really burn you out when there's a lot of reasons why people don't get better including themselves.
So, I think I've released the need for them to necessarily get better and instead, I would like to be with you here today and just sometimes leave it at that. Some of our clients or some of my personal relationships, whatever that might be, people aren't able to move to the layer of healing that you would like for them. It relieves the pressure and the stress and some of the emotions for yourself if you can just acknowledge that being there together in that connection, that's enough.
Adam Williams (38:37): I think that's an amazing answer. Thank you, Abigail.
Tanya Wait (38:41): Yeah, Abigail, thank you.
Adam Williams (38:43): It leads me to a question that I have for both of you about compassion and empathy, because it seems like it's just so at the core of who you are and what led you to this career path and to how you are functioning and serving in the community.
I think it can be hard to be someone who is empathetic, someone who carries that maybe more than someone else who finds that a little easier to brush aside, say, disagreements or some moment of tension or a negative interaction. Do you find that it helps it to be easier for you, sometimes more difficult because maybe you feel more of the emotional pain and challenges that the patients are bringing to you?
Tanya Wait (39:29): Yeah, I don't want to call it a detriment, but for me, sometimes my empathy and my compassion can really get to me and I need to check myself and be like, "Tanya, you don't need to go home crying today because someone who you saw really affected you. You have to be able to disconnect but still be able to keep that compassion part." It is very difficult for me sometimes.
I'm so lucky that I have a great team that I work with, because they can be my sounding board. Also, at home, I have a very supportive family. So, I know that I sometimes need to be more like, "I can't fix this. I'm still here. I'm still helping. They're going to come back and everything's going to be okay. I don't need to take it so personally if they have struggles. It's not on me."
Adam Williams (40:20): Tanya, do you have a sense of where that depth of compassion comes from for you? Were you raised in a family where that's just what everybody was? So, nature versus nurture. Where did that come from?
Tanya Wait (40:31): It's interesting. My parents are very caring people, but also, I grew up in a family where we talked about nothing. If you had an emotion, you have it and then we're not going to talk about why that emotion occurred. There was no mental health, there was no therapy, there was nothing like that.
If something bad happened in the family, we're just not going to talk about it. So, for me, I think I'm an anomaly. I thank my education and the friends that I made throughout my education and my life for helping me see the compassion and the empathy that the world needs. I think a lot of my friends are that way.
So, I think that I was like, "Yeah, this is me. This is why I'm so sensitive. This is why I cry at everything because just deep down in my soul, I have that." But it definitely didn't come from a family upbringing. It just came from inside I think. I don't know if that's a diagnosis, but I may have just diagnosed.
Adam Williams (41:30): Abigail, do you have a sense for that? Obviously, you shared this story when you were 16 and that touched you in such a life changing way, but do you have a sense for that depth of empathy and compassion that you carry and where it might have come from and how that affects you when you go home at the end of the day?
Abigail Smedly (41:52): Yeah, I think that's a great question. That's a big question. I would say I grew up in a family where that compassion was probably lacking. So, whenever I saw the contrast, it was really intriguing to me and I liked that contrast of, "Ooh, I like that way. That seems like a better way." So I think throughout my life, I've pursued people who show me the contrast and then have shown me so much love and compassion and taught me how to do that well, because I don't know that that's something that I innately necessarily knew how to do. I think how I managed to be empathetic at work, I mean, I say I've released the need to fix it, but that depends on the day.
Adam Williams (42:41): Sure.
Abigail Smedly (42:44): I think that some of the experiences in my career as a nurse really, really wrecked me and felt really hard and people's lives can be really sad. It ended up killing that empathy part of me. But as I spent time recovering and spent time with my own mental health, I think that I learned a way to be empathetic that's not necessarily just giving all of myself all of the time. So, at our clinic, I've learned the boundaries that I need that aren't shutting down, but rather necessary in order to continue providing empathy.
I think Tanya and I do a really good job. There'll be days where I just can't talk to a certain someone that Tanya can or there's days where she can't deal with this nonsense over here but I can. So, I think having a team where you're allowed to speak your emotions and allowed to say when you don't feel empathetic, like you mentioned, we're allowed to be human. I think sometimes in healthcare, you're not allowed to be human. That makes a big difference.
Tanya Wait (43:58): You have to be the caregiver every single time. I'm the one that's supposed to care for you, but we need to care for ourselves too.
Abigail Smedly (44:04): Right. It's normal to run out of empathy.
Adam Williams (44:08): I think between what you both just said there though, you both on some level might have learned this behavior and this practice and that might bode well for all of us. If we go back to the fact that we're all struggling right now, I think we're all feeling some pain, anxiety, stress, anger at whoever all we direct that at.
But this shows that we are capable when there's a will for it. I think when there's a curiosity, I think that's also a really key word, is when you're curious to know about somebody else's experience, about their existence. Their life is different than yours.
Instead of brushing it aside when they tell you a story of sadness, difficulty in their life, what their challenges are, we can accept that. We can accept it as truth and be there for them and have some empathy. Or if we aren't in the mood or maybe haven't learned that practice, we tend to brush it off and say, "No, no, that can't be true. How can your life be different than mine?"
Abigail Smedly (45:07): Absolutely.
Tanya Wait (45:08): Having that passion for the curiosity. I think passion is a big part of what guides me in my practice is I have a passion for this. I want to see people succeed. I want to help people. I have a huge passion and try not to lose that passion for whatever you find interesting.
Adam Williams (45:25): Try not to lose it, but surely, I mean, are there challenges? Abigail, if you want to answer this, either one, but it would seem like you just have such a challenging job. So, I love so much of what I'm hearing from you because you keep going to the well and finding more compassion, it sounds like.
Sure, you're human, so you're going to have those moments. You made me think of myself as a parent when you're like, "You know what? I can't deal with this one today." I'll go to my wife and say, "I need you to talk to him because I'm not there right now." There are those moments and I'm in awe of how much you two encounter and face and help in our community.
Abigail Smedly (46:08): Thank you. Yeah, I think I have learned, especially with the pandemic, to take up space, that I need to take up a lot of space. So, I have strict boundaries about when I leave work after those clinics and what I do with my time afterwards. I try to do the things, go to yoga or meditate or allow myself to feel my feelings afterwards, because we're meant to affect each other. That's part of being human. So, I think as Tanya also mentioned, it's education. This is why people behave the way they behave. This is how addiction works.
So, when you learn and educate yourself more, it's easier to understand people and it's easier to understand why they impact you the way they do. I mean even down to this person shared this story today and I can see where that triggered my trauma or I can see where that triggered my story, so now I'm going to tend to myself and then I'm able to meet them again, if that makes sense.
Adam Williams (47:13): It does make sense because another connection for us here is that you are setting aside time to be able to deal with this. I've already referred to mental health challenges for me of late and I'm an army veteran. So, I use the opportunity, the resource to work through the VA. I've been talking with a therapist there of late, who one of her tools that she has recommended to me is what she calls a worry hour so that I will take that space and sit there.
So, all the things that might be nagging on my mind and I'm spinning on these mental loops all day long, she's suggesting, what if I take an hour, whether that's not necessarily daily but whatever I need, to focus on it. Let myself have the space to feel what I have to feel, feel what's been triggered, what I'm worried or upset or angry about. So, it sounds like that's something similar that you're doing.
Abigail Smedly (48:05): Yeah.
Adam Williams (48:06): Okay. This brings me to, I guess, a question that I'm going to wrap up with that you're already getting into this space there talking about self-care. So, Tanya, I'll point this to you. You both must deal with so much. So, I am wondering how you recognize what you need, maybe how you spend some time. Abigail shared some of that. Do you binge on Netflix? Do you go for a hike in the woods and scream at the trees until you can't anymore? What does it look like for you, Tanya?
Tanya Wait (48:40): Yeah, I love my home and so I'm very lucky that I have a stable home. So, that right now has become my self-care. I garden, I cook, I clean, which I know that sounds crazy, but it brings me joy. I spend time with my family. I play games. Believe it or not, talking about my day is extremely important in order to get over it, if that makes sense. If I don't talk about it or even if it's something happy or sad, I need to talk about it. So, I do that also sometimes just to myself, sometimes to a therapist, and sometimes to my wife, which is lovely and I feel bad for her, but she handles it like a champion. But yeah, that's what I do for self-care.
Adam Williams (49:27): I understand that because I do the same with my wife and she tends to be someone who does not just dump it all out. She tends to process it internally. She'll come talk when she's ready. Whereas she's the one person that I am so talking with. Being on the podcast, notwithstanding when I say lots of words, I've described myself in the beginning of our transition to this podcast a few episodes ago as I think a decently functioning introvert. I don't go put it on all kinds of other people, but at home, that's where that is. Sometimes I'm like, "Oh, okay, thanks for tolerating this. I'm sorry."
Tanya Wait (50:09): Yeah, I'm the exact same, Adam. I feel bad for people that are really close to me, because everyone else is like, "Tanya is so up and happy. Ooh, ooh, ooh." I'm like, "We should come home after a Monday, Monday night because it's not all happy."
Adam Williams (50:22): Right. So, I want to thank you both for everything that you're doing for the community, but also then coming in here talking with me, sharing some stories from your personal background, sharing some insights about public health in Chaffee County. I think I've expressed that it's been educational for me throughout and you've given me a chance to air out some thoughts that may or may not have stayed on track with whatever our subject really was today. But thank you very much for coming in here and talking with me.
Abigail Smedly (50:55): Thank you for having us.
Tanya Wait (50:56): Yeah, thank you so much.
Abigail Smedly (50:57): Thanks.
Tanya Wait (50:58): Very conversational, which I appreciate. Thank you.
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Adam Williams (51:14): That was my conversation with Tanya Wait and Abigail Smedly. If what they shared here today struck a chord with you, you can email comments to Lisa Martin, one of our producers, at lmartinatchaffeecounty.org.
We also invite you to rate and review the We Are Chaffee: Looking Upstream Podcast on Apple Podcasts, Spotify, or whatever platform you use, assuming it has that functionality. Taking a moment to rate and review is very helpful to shining light on the work we're doing with this podcast. It lets the digital algorithmic powers that be know that we're up to something good here. It'll push it forward and help others find us and be able to listen.
We also welcome your spreading the word on your social media pages and telling your family and friends and coworkers about Looking Upstream the old fashioned way, word of mouth.
(51:56): Once again, I'm your host, Adam Williams. Jon Pray is engineer and producer. Thank you to KHEN Radio, where we recorded today's conversation in Salida, Colorado; Heather Gorby, for graphic and web design; Lisa Martin, producer and community advocacy coordinator for the We Are Chaffee Storytelling Initiative; Andrea Carlstrom, Director of Chaffee County Public Health and Environment; and Becky Gray, Director of the Chaffee Housing Authority.
(52:19): The We Are Chaffee: Looking Upstream podcast is a collaboration with the Chaffee County Departments of Public Health and Housing, and is supported by the Colorado Public Health and Environment Office of Public Disparities.
You can learn more about the Looking Upstream Podcast and related storytelling initiatives at wearechaffee.org, and on Instagram and Facebook at We Are Chaffee. Lastly, thank you for listening. And until next time, as we say at We Are Chaffee, be human, share stories.
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