Public health nurse pursues new healthy endeavors

Posted: Sunday, September 12, 2004

Donna Fenske paused to scan through the pages of a medical book before passing it down from the shelf to be packed into one of several cardboard boxes strewn across her office floor. It was a bittersweet exercise marking the end of a career as an Alaska public health nurse.

She'd served the Kachemak Bay and lower Kenai Peninsula region for 25 years, and now she was leaving. During her time in the state job, her kind face and gentle demeanor became well known and much loved and her dedication highly respected among the residents of the Native and Russian villages and within the highway communities stretching north from Homer.

While she is giving up her state job, she is not leaving nursing. She couldn't. It's in her blood. It is who she is. At an age when many consider retiring, Fenske is back in school earning a license as a nurse practitioner, a medical level between a registered nurse and a doctor.

Cleaning out an office after so long forces a career into a kind of misty-eyed perspective. She admits it wasn't easy saying goodbye to familiar surroundings, especially when handing books off the shelf to nurses who have been not only her colleagues, but also her students and friends.

Fenske began her career as a state public health nurse in Homer in 1979. In 1992, she became manager and team leader of the Homer Public Health Clinic, supervising four other public health nurses and a pair of clerks.

Prior to her move to Homer, she'd taught nursing at the University of Alaska Anchorage and Alaska Methodist University Anchorage for more than two years, served as director of the Continuing Education Approval and Recognition Program for Alaska nurses, was a substitute Anchorage school nurse and a staff nurse at Alaska Native Medical Center where she'd began her Alaska nursing adventure after moving from Whitefish, Mont.

She still teaches cross-cultural curriculum classes on the Russian Old Believer culture through UAA's School of Nursing for bachelors' of nursing and graduate students.

Much has changed during her quarter century serving the Kachemak Bay region, including, she said, the focus of the state's public health nursing section. Programs have come and gone, often impacted by political choice or lack of funds. Some changes have been good, others not.

"Traditionally, public health nurses have focused on disease prevention, health promotion and education. That piece is still there to a certain extent, but now the focus is on bio-terrorism and disaster preparedness," she said of some of the most recent administrative innovations. "The piece that's missing is maternal and child health education, where public health nurses reach out to families. Education on parenting was once a focus."

Fenske said the system is in transition as current policy looks to the private sector to deliver medical services currently provided by the nursing section, including in education and child health. She expressed the hope that however those things may be delivered in the future, the clients get what they need.

"What we always felt as a team of public health nurses is that you can reach more people through health education than through any other way. It is necessary to reach people on a one-on-one basis," she said.

Seeing people one-on-one is exactly what happens at the Homer office. Last year, the nurses there saw 3,056 clients in one quarter and well over 12,000 during the course of the year.

The emphasis on health issues has waxed and waned through different administrations, Fenske said. She compared that of Gov. Frank Murkowski to his predecessor's.

"I've seen it come and go, but I think the administration prior to this one had a strong focus in public health and wellness education," she said. "I'm not seeing that now."

Fenske said there had been "a dramatic reduction in funding" that has affected travel, supply and daily work budgets.

"Cutting back maternal and child health programs and the like is taking a step backwards," she said.

There has also been less support for reproductive health programs, not only in Alaska, but nationwide under the current Republican administrations, Fenske said.

"Everybody has felt the budget cutting there," she said.

When Fenske first began working in the Homer area in 1979, nurses did a lot of acute care and often diagnosed and treated medical problems using standing orders.

"We were often the only health providers in the villages," she said.

In the 1980s, the focus shifted to health promotion and "wellness," as nurse practitioners, who had more decision-making flexibility, became available, taking over much of the acute care delivery, she said. The public health nurses continued their focus on health education.

"It's part of our role. As years went by, I saw programs come and go, either because they were not considered important anymore or there was no funding to keep them up," she said.

Sometimes programs changed because they'd worked. Several years ago, the public health nurse program placed a strong emphasis on combating hepatitis B. Still important, the disease is no longer as high a priority largely because so many have been immunized, she said. Among her responsibilities was attending to the medical needs in the remote villages around Kachemak Bay. For her, that became a labor of love and today provides a treasure's worth of fond memories.

"What stands out is that it has always been fun, except maybe for the bad flying weather," she said. "I've enjoyed meeting the different people in the Alaska Native cultures."

 

Photo by Hal Spence

A pilot in her own right, she said she wasn't allowed to fly herself in and out of the villages, and had to travel on a local commuter airline. Villagers often proved eager for medical knowledge, Fenske noted.

"People are generally very interested and they are very open," she said.

Her duties in the villages included administering immunization programs, health planning, counseling and working with village health aides. When necessary, she referred patients to local physicians. Generally, health concerns were much the same everywhere, but data indicate certain maladies to be more prevalent among Natives than Alaska's broader population, she said.

"Stats show a higher rate of diabetes and the health problems brought on by that in the villages," she said. "There is a lot of focus on diabetes prevention right now."

When it comes to healthcare, residents in communities along the highway system, with their hospitals and clinics, often have more choice, she said. But those populations also face medical challenges, including in women's health, domestic violence and substance abuse. No community is immune from these issues, but the availability of health care services can be an important factor in how people come to grips with them, Fenske said.

Homer public health nurses often have had to stretch their budgets and find innovative ways to raise funds for supplies. The constant demand for educational materials from members of the public led her and fellow public health nurse, Bonnie Betley, to established Friends of the Homer Health Center about 10 years ago. The nonprofit group raises money used to purchase educational materials. A March of Dimes grant paid for books on genetics. Another grant funded an education program for adolescent health, decision-making, healthy choices, nutrition and wellness.

"I write mini grants to anywhere I can to get money," Fenske said, adding that were it up to her, the state would have a fund set aside for such purchases.

She has helped develop a program of parenting classes in the villages called "Life With Kids." Again, with close attention to cultural issues, she began by finding out what villagers wanted in such a program. She met with residents, wrote up a proposal and took it to village elders.

"We integrated traditional parenting into the classes and invited them to participate," she said. "We got a good response."

The program currently is in hiatus but will start again and operate in Nanwalek and Port Graham.

The Homer public health nurses also launched what has since become a major event in Homer, the annual Homer Health Fair, now primarily sponsored by Rotary and South Peninsula Hospital. The first Homer Health Fair was held in the office of a local physician. Later, it moved to Homer High School. The public health nurses sponsored it for four years before it grew so large the Rotary took it over. Hundreds come each year.

Fenske was instrumental in helping identify a rare genetic condition called Thiamine Responsive Anemia Diabetes and Deafness, or TRADD, affecting a few members of one of the remote villages. Genetic research conducted through Boston Children's Hospital later resulted in development of a test that can predict carriers. A prenatal test now exists to identify the condition.

She currently is writing her thesis on the treatment regime for TRADD from the nursing perspective.

As a teacher of nurses, Fenske has watched as students grow to realize what it takes to do the job. The most eye-opening thing students see is how dedicated public health nurses are and how much can be accomplished with limited resources, she said. Fenske doesn't consider herself so much a taskmaster as a role model. Among her former students is Betley, a public health nurse in Homer who has worked with Fenske for 14 years.

"She's the reason I became a public health nurse; seeing how hard Donna worked and how people just loved her," Betley said.

When Betley was a student in the UAA bachelor's of science in nursing program, she spent her last semester in Homer working with Fenske, who was her preceptor an on-the-job mentor. Betley worked at South Peninsula Hospital for five years before landing her job with Fenske as a public health nurse, where she has been the past 16 years.

Fenske, she said, has been and continues to be an incredible influence.

"I miss her," she said. "Donna was an inspiration and continues to be an inspiration. You couldn't keep up with her."

Fenske said many of her former students keep in touch, but she regrets not having kept a journal about all of them.

Back in school now, Fenske is in a two-year program to become a nurse practitioner this despite the fact that with her wealth of experience in the field she could teach the courses she is required to complete.

"Nursing is very structured, no matter how much experience you have," she said.

Once she has her degree, she will be allowed to diagnose and treat some conditions and generally have a lot more authority.

"(Nurse practitioners) can make independent decisions to a certain extent," she said.

Public health nurses don't have as much flexibility.

"There should be more," she said. "That was one of the things I commented on during my exit interview."

A life spent delivering healthcare has made her keenly aware that so much remains to be done.

"One thing that concerns me is seeing kids in pain or kids starving or in need, and families, too," she said. "The HIV and AIDS situation worldwide is a worrisome thing. I hope someday to do some missionary work."

Rotary, she said, has asked if she would consider going to Russia. She said she is considering it.

Though she has left the employ of the state, she continues as a volunteer. Meanwhile, in late July, Fenske began working for Chugachmiut and will be working primarily in Port Graham.

"She will be missed," said Sharon Whytal, another public health nurse at the Homer clinic. "It's not even real for us yet that she's gone. It seems like she is just on a longer trip across the bay."

Whytal, who went to work at the clinic in 1995, described her friend and former supervisor as a very compassionate person who gave her workers a lot of freedom and support.

"She would always go the extra mile for all her clients," Whytal said.

Fenske said she is looking forward to her new career and to the continuing opportunity to serve the community, especially those where the need is greatest, among the Native population of Kachemak Bay.



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