Land of dreams
February 28, 2006 -- Today the National Public Radio show "Fresh Air" ran a long interview by host Terry Gross with Jeanne Dumestre, a New Orleans nurse practitioner and one of the founders of the legendary local club Tipitina's. The Fat Tuesday interview focuses on the aftermath of Hurricane Katrina, particularly how it has affected Dumestre's patients and her own residential neighborhood. The report is certainly complimentary of Dumestre, an articulate nurse doing "important" work. She offers some good general observations about post-Katrina challenges her mostly poor, mostly African-American clinic patients face. But the show seems oblivious of the fact that Dumestre is a masters-prepared, nationally-recognized expert in the care of HIV-positive women--not just a first-hand witness to the storm's dislocations. Some of the report's language will reinforce stereotypes of nurses as noble helpers, rather than highly skilled professionals. And as far as giving the public insight into the specific practice of a key nursing leader in HIV care in the ravaged area, or the work of nurse practitioners generally, the piece is a missed opportunity.
The 21-minute report is titled "Saving the Heart of the Crescent City." It spends the first few minutes introducing Dumestre and her role in founding Tipitina's, where famous local bands like the Neville Brothers have played. Gross spends a little time on the club. But she soon notes that for over 15 years, Dumestre has "worked as" a nurse practitioner, caring mostly for poor women with HIV at a clinic affiliated with Charity Hospital. Similarly, the NPR site summary says that since 1985 Dumestre has "worked as a nurse," as if she left Tipitina's one day and started nursing the next. The site reports that the move to nursing "came naturally" to Dumestre, and suggests that it resulted from her seeing the effects of AIDS in the city and "the passion of those trying to help." The site says that Dumestre, "working out of" the clinic, has "helped" thousands of outpatients. It notes that in 2005 she won "an HIV Leadership Award for her commitment," and that her work with patients is "changing lives."
It's great that the show gives Dumestre this recognition. And it mentions her award, which was actually given by The Body, the prominent New York AIDS resource group. The group gave her the award not just for her "commitment," but for her (as the name suggests) leadership at the clinic. The clinic offers a huge range of key health services to poor Louisiana women with HIV, from primary care to gynecological care to psychiatric care. But most of the NPR language above gives the impression that advanced practice nursing was pretty much an admirable job that Dumestre fell into, rather than one that required a master's degree and involves high-level expertise. Some of this is pretty obvious, such as the repeated reference to "working as" a nurse, rather than "training" or "practicing." Would the show have suggested that Dumestre simply left the club and starting "working as" a physician? And some of the problem is a more subtle accumulation of connotations from emotional helping words like, well, "helping." Given prevailing assumptions about nursing, these will suggest to most that Dumestre's work is more a noble calling than a skilled profession.
Gross spends about eight minutes on some broad aspects of how Katrina affected Dumestre's work life. Dumestre notes that she hopes her clinic will be able to re-open within a month, though many of her patients have not returned. When the storm struck, Dumestre evacuated to Baton Rouge, where she began working immediately at a hospital and then a clinic there to help hurricane survivors. At some point she returned to New Orleans to live. Her house had escaped the most serious damage because it had been raised as part of a FEMA program. But she continued commuting to work in Baton Rouge, where she was able to reconnect with some of her own patients. Gross wonders if resuming her "important" work helped her cope with her own Katrina problems, and Dumestre says it did. She says the work has always been a good "anchor," that many of her long-time patients have been like family. Gross also wonders if Dumestre lost track of many patients who were "important" to her. Of course she did, and it bothers her, though she will sometimes hear about patients from providers in the places to which they have evacuated.
Dumestre stresses that one key problem is the stigma still associated with HIV. She explains that some of her patients had not fully disclosed their health status to those who knew them, but that they had managed to find discreet ways to get care. Now, with the post-Katrina dislocation, many are cut off from those care systems. They may be reluctant to seek care elsewhere for fear of jeopardizing relations, new and old. Dumestre notes that when she was triaging at a hospital in Baton Rouge right after the storm, virtually no one admitted to being HIV-positive. These are good observations, and very much the kind of thing on which nurses focus.
But rather than continue along these lines and possibly get into some of Dumestre's specific health expertise, Gross spends perhaps the last nine minutes of the report on Dumestre's personal housing situation in the low-lying Broadmoor neighborhood, where at some points there was eight feet of water after Katrina. They discuss the restoration of local structures and services, and the overall redevelopment outlook. These are reconstruction observations that any reasonably articulate New Orleans resident could probably have offered.Of course, it's certainly a positive portrayal of the low-key, articulate Dumestre. Gross calls Dumestre's work "important," and does not suggest that the work of physicians is what really matters, as many Katrina accounts have. We realize that "Fresh Air" has no obligation to go into Dumestre's specific work. And if the entire report had been about Dumestre's involvement with Tipitina's, we would have said nothing. We also understand that Dumestre did not approach the show with talking points. She seemed content to answer Gross's questions, and made no great effort to display her expertise. In fairness, she volunteers few specifics about what she does for patients. This is not uncommon, even for the most senior nurses, who sometimes seem to assume the public knows and values what they do.
However, Gross's strong concern with Dumestre's emotional connection to her patients, and her lack of inquiry into Dumestre's clinical expertise, may imply that Gross doesn't think there's much more than the emotional connection to discuss. Perhaps Gross herself has extensive knowledge of what experienced nurse practitioners do for poor HIV-positive patients. But her listeners clearly do not. And because the report does spend a lot of time on Dumestre's work generally, we also have to note that it blew right by a major expert on areas in which it would likely have real interest. In addition to her deep clinical experience, Dumestre has published lots of AIDS research. Recently, she has been a co-author of "Reproductive Decision-Making Among HIV-Infected Women," Journal of the National Medical Association (Oct. 2005); "Vaginal Swabs Versus Lavage for Detection of Trichomonas Vaginalis and Bacterial Vaginosis Among HIV-Positive Women," Sexually Transmitted Diseases (Apr. 2005); and "Women and Human Immunodeficiency Virus: Unique Management Issues," American Journal of the Medical Sciences (July 2004). It seems pretty clear that Dumestre is not just a noble helper, but a leader in AIDS care for women. We're guessing "Fresh Air" would probably be interested in her expert views of special issues faced by women with AIDS, such as her work on reproductive decision-making, and how the post-Katrina dislocation might affect that going forward. But who knew that a nurse would even have a research focus? And though Dumestre gets plenty of the vague encomiums nurses usually get ("important," "helping"), we hear almost nothing specific about what she has really done to "change lives" in Louisiana, before or after Katrina.
This "Fresh Air" piece is certainly a positive depiction of a nurse, but we doubt it will do much for nursing.
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