Executive Director
Cynthia is board certified in internal medicine and was a primary care doctor for many years before starting Adult Foster Care North Shore in 2001.
The Director's Corner
December Director's Corner
The Compassionate Friends
They say that the death of one's child is a more consuming grief than can be imagined. they said it is like a hole... a huge hole that can never be filled. They say that the grief comes in waves, that family dynamics change, that some friends fade and others grow closer, that the longevity and the intensity of the grief are hard to explain. They say that the only people who understand are those who have been through it.
In 1968, eleven year old Kenneth Lawley was riding his bicycle when he was struck by a car. He was admitted to a hospital in England where there was another young boy named Billy Henderson who was dying of an illness. They boys died within days of each other. The Lawley family sent flowers to the Hendersons, and, with the help of a Reverend Stephens, the families began to meet. From those roots, the Compassionate Friends society grew.
The vision of the Compassionate Friends is that "We need not walk alone." The Compassionate Friends exists to support families after a child dies. There are now chapters in all 50 states. Locally there are chapters in Newburyport, North Reading, Manchester (New Hampshire), and Boston.
A man whose daughter was killed in a car accident 30 years ago says that his feelings today are as fresh as on that day... the day the world changed. Others say that the grief has no patterns or timetable. People describe feelings of anger, guilt, shock and devastation. Parents, siblings, and grandparents find that friends become uncomfortable around them. Friends are afraid to mention the dead child's name or to speak about their own child for fear of upsetting the grieving family. Others say things in the spirit of friendship that are painful for a grieving parent to hear. One man's friend said, "You need to get over this and move on." The man had to turn and walk away because there was no way that he could communicate to his friend the unnatural and profound nature of his grief.
The Compassionate Friends Society has a saying that those who need them will find them, and those who find them will find comfort.
If you are a member (or a friend) of a family that has suffered the death of a child, the Compassionate Friends is here to help you and provide support for the family. Feel free to contact TCF's National Office at 877-969-0010 or nationaloffice@compassionatefriends.org . You will always hear a friendly voice on the other end of the line.
November Director's Corner
On Being An Immigrant
This story is part of a series on members of our staff who came from another country. Olivier Che joined AFC in 2013.
When Olivier Che was 21, his parents and siblings left Cameroon, Africa to go to the United States. Olivier stayed in Africa to manage the family business (grocery stores and a small book shop) and also to play soccer and continue in school. Olivier was good at soccer ( they call it football), and he was recruited to play semi-pro for the Bestia Football Club in Singapore, Asia. Due to an injury he could not continue to play soccer. Olivier decided to come to the U.S. Back in Africa he used to sit around with his friends and talk about the great democracy. His parents met him at the airport in Boston, and they went to their home in Lynn.
Olivier knew some English from school and from his travels, and there were fellow Cameroon immigrants to advise him. A Cameroon lady got him into the Red Cross training program for Certified Nurses' Aides and then helped him get a job at the Greenery nursing home in Beverly. Olivier had no car, so a coworker would pick him up in the morning, and after work he took the train home. If he worked a double shift, he didn't get off work until 11 PM and sometimes missed the last train. More than once he walked home from Beverly to Lynn (about 8 miles) in the middle of the night.
When the Greenery closed, he went to work at Hunt Rehabilitation Center in Danvers. From there, he was chosen for a Massachusetts Long Term Care Foundation scholarship. He was one of 42 people in Massachusetts to receive the scholarship that year, and he used the money to go to nursing school.
Olivier did not waste much time. While working and going to school, he found time to marry a girl named Jacqueline whom he had met in Lynn. She was from Cape Verde Island (off Africa). They now have 2 children: Olivia, age 7, now in first grade and Jason, age 5, in kindergarten. He also studied to become a U.S. citizen and tried to get used to the American culture.
When he was new to Lynn, he looked out the window and saw kids wearing big jackets in summer. He asked his siblings why the big jackets. He was told that those were the kids who sold "weed and drugs" and to avoid them. Some of those kids also carried guns. Olivier and his brothers had never seen drugs, and to this day, he doesn't know what marijuana looks like. His brothers did not know either.
In the United States respect for one's elders seemed to be lacking. In Lynn a neighbor family often fought, and the daughter would swear and use foul language toward her parents. When the parents fought, they would also use language that was very disturbing to Olivier. Someone might say, "Damn" on occasion, and use of such a word would indicate western influence.
In Cameroon it is considered disrespectful to look directly at a person during conversation, especially if the person is older. It is preferred that you make brief eye contact and then look aside or look down. In the United States, lack of direct eye contact is considered an indication that you are not telling the truth.
Hand shaking is also different in Cameroon. People of noble birth and traditional leaders usually do not shake hands with anyone. If you meet a person who is older or who is a leader, you would not expect to shake hands unless that person offered his hand first. You would never initiate the handshake.
Olivier found it assuring when he first came to the United States that there were people here from Cameroon who could teach him these things. He now coaches a lot of immigrants. His advice: stay away from the wrong side of the law, go to school and work hard. He tells them that all of the structures are already in place and that all they have to do is use them. He is part of a tight community in Lynn that welcomes exiles.
Olivier and his wife now own a home in Lynn. They brought her mother over from Cape Verde to help with the kids while Olivier and Jacqueline work.
In 2008 Olivier became a citizen of the United States. There was a ceremony at the State House for about 150 people. He felt as though a big weight was lifted off his shoulders. He felt that he was now more acceptable in society. There was no family celebration afterward because he had to go to work. He had called and said that he might be late, but he managed to make it to work on time.
October Director's Corner
Planning a Funeral
The most common reasons for planning your funeral in advance are:
- To make the process easier for your family
- To spend down your money so that you will qualify for Medicaid
- To get what you want
Planning a funeral can be a sensible and thoughtful way to spare your loved ones from painful and expensive decisions.
Your loved ones may feel guilty choosing the cheapest casket ($795) when you yourself would never consider wasting money on a more expensive one. A casket can easily cost $9000. Michael Jackson had the "Promethean" solid bronze casket from Batesville Casket Company ($24,000).
Making a casket is an option that can be both economical and personally fulfilling. You can get a do-it-yourself kit that includes everything you need including rope handles ($600).
The Jewish faith calls for simple and natural caskets with no metal. At a Jewish funeral, metal handles are often removed prior to burial.
If the deceased is particularly large, you may need an oversized casket. Standard caskets are 27" wide. The Goliath casket company specializes in oversize caskets up to 52" wide (starting at $2500).
Prepaying for a funeral is a legal way to spend your money in order to qualify for Medicaid. The money that is paid is put into a trust and guaranteed. The funeral home does not get the money until after the funeral, and you cannot get the money back. In Massachusetts the trust is irrevocable, and the price of the funeral will not change once the money is paid.
According to Kevin Grodin, a licensed funeral director in Gloucester, the average cost for a funeral is about $7500. That includes embalming, viewing, casket and burial. It does not include the cemetery plot.
Burial plots are another story. Catholic cemeteries can cost about $1300 for the plot plus $850 to open and close the grave. City cemeteries are often less expensive. In Gloucester the only city cemetery still available charges $700 per grave plus $850 to open and close the grave.
Cremation is less expensive. It is possible to have a viewing and then a cremation. If the viewing is public the body must be embalmed. The funeral home can use a casket insert for the body so that the casket can be rented and the body removed after viewing.
Funeral directors are licensed professionals who take two years of specialized school and serve a two year apprenticeship in a funeral home. Funeral directors must also pass state and national tests before they can get a license with the state Board of Funeral Directors. Funeral directors can walk you through the planning process and are unfazed by unusual requests.
September Director's Corner
On Being an Immigrant - Pascale Guillaume
When Pascale Guillaume (pronounced Ghee-ohm) was a girl in Petion-Ville (a commune and suburb of Port-au-Prince, Haiti), the country was in chaos. President Jean-Claude Duvalier (Baby Doc) had just been overthrown in a popular revolution, and the country was not a safe place to be. Suddenly Pascale's mother died at the age of 42 of a brain aneurysm, and Pascale, who was still in high school, found herself in charge of the household including her half brother and sister (age 9 and 6).
Pascale's stepfather was offered a government job in Canada, so they all came to Massachusetts where the three youngsters stayed with a relative in Cambridge, and the father went on to Montreal.
Pascale was 23 years old, and she was amazed at what she saw. She had images of the U.S. from what she had seen on TV. She had images of the beauty of Florida and the skyscrapers in New York City. The first thing she noticed in the airport was the lights. She had never seen so much light. It was night time but it looked like day. She was in awe. The little kids were amazed at everything. It was so different.
The little ones had it easier than she did. The adjustment was rough for Pascale. She spoke no English. There was a lot of culture shock. There were people with rings in their noses or eyebrows. Sometimes she would see someone and not know if it was a man or a woman. And everyone was in such a rush. People were always looking at the time afraid of missing the bus or the train or of being late.
Pascale does not remember being afraid, but she was apprehensive about her future. She loved cooking and enrolled in Newbury College where she got a degree in culinary arts specializing in cakes. She tried to find a job in a kitchen but couldn't. People told her that kitchen work was for men. She found that odd. Where she came from, women were in the kitchen.
Her boyfriend moved up from Haiti, and the two of them found work as nurses' assistants. They married in 1989 and had a daughter and a son. Their son was born with Sickle Cell Disease and needed a lot of medical care. Pascale's husband worked constantly and then went to North Shore Community College where he earned a Registered Nurse degree. He kept up the health insurance that enabled their son to get exchange transfusions twice a month at Children's Hospital.
Pascale is grateful that her son was able to get treatment. " I don't know if he would have survived in Haiti," she said. "What i like about the U.S. is that if you are willing to work hard, you'll have a shot at a decent life. In Haiti it is everyone's dream to go to the U.S."
What she doesn't like about the U.S. is the stigma that people put on immigrants "as though immigrants are here to suck the country dry." She said "Most people do not know that if you want to go to college especially if you are older, it is very difficult. School is not the top priority. You have to work and take care of your family. School comes after that."
Pascale finally got a job as food service director at a nursing home in Jamaica Plain. She enjoyed the work and stayed for two years saving all her money so that she could go back to school. She wanted to become a registered dietician, but her husband talked her into becoming a nurse. She went to Simmons College for her R.N. degree. "It was the most rigorous program," she said. It took two years during which time her son continued to receive transfusions twice a month.
Pascale has been a nurse since 2006. Both of her children are grown now, and both of them are registered nurses too.
Her advice to other immigrants: "You have to have a backbone and a dream. You have to be persistent because there will be roadblocks."
The last time she went to Haiti was in 1999, and "That was scary," she said. She couldn't get used to the fact that the Haitians were so laid back. "if you need to do something, it shouldn't take two days to do it. I could see everything they were doing wrong. If a little kid ate a banana and threw the peel on the ground, I would tell him to pick it up. The grownups told me that I was white now (a "blanc"), and they called my kids "blancs" because they didn't speak Haitian. I was ready to leave after three days."
August Director's Corner
On Being an Immigrant - Tom Hoang
This is the first in a series of articles about members of our staff who came from another country.
Tom Hoang was 7 years old when he left Vietnam with his older sister, two cousins, an aunt and an uncle. He is one of six children, and his parents sent him off in the hope of a better life. What he knew about the United States was what he had seen on television. The United States looked like the place to be and full of opportunity.
Nearly two years later (after a year in Thailand and eight months in the Philippines), they landed at Chicago's O'Hare Airport. Tom was then eight. What he remembers is that the airport was huge. An escalator was his first scary experience in the States. He had never seen one. It seemed to pull him up, and he didn't know if he was supposed to hold on or walk or what.
From Chicago, he and his sister flew to Boston where they were met by another uncle who drove them up to New Hampshire. Fortunately, it was springtime, so Tom and his sister had time to get gradually acquainted with the weather. When he saw snow for the first time, the climate shock was complete. Tom started the third grade in a class with 15 students and no other immigrants. He had an easier time than his sister who was 15 years old and started high school. Although the language barriers and new customs were sometimes frustrating for Tom, his sister had it worse. Tom was a whiz in math, and he learned other things quickly. After small schools in New Hampshire, he went to a large hight school in Somerville and lived with his sister who had gotten married. The high school was very big and sometimes he felt lost in the system. He met others from Vietnam, and he had a diverse group of friends from various ethnic backgrounds.
From there he went to Salem State University that he paid for with student loans, work-study programs, and a job as a security guard. He graduated with a Bachelor of Science degree.
After college Tom ran an after school program for kids in Dorchester who needed extra help with schoolwork. Tom has never been unemployed. he worked his way up to working with state agencies as a care manager with the Dept of Social Services and then with Developmental Disability Services (DDS) for 10 years.
We met Tom through his work at DDS, and he joined our team at Adult Foster Care in 2011.
Tom returned to Vietnam just once in 1994 to see his parents. His parents are now in their 70's, and they still own a store and some rental properties. The country seemed foreign to Tom, and he felt more like a tourist than a native.
Tom's advice to new immigrants is to look forward more than back. He is grateful that he came at a young age because it was easier for him to assimilate. He kept his eye on the opportunities and the better road ahead.
July Director's Corner
Our AFC Family
In the past year we have welcomed several new staff members. You may see them on our website (www.adultfostercarens.com ), and you might meet them at the Wild West party in August. Here they are:
Kelly Beer RN has 24 years of nursing experience in hospice and home care.
Olivier Che RN is originally from Cameroon, Africa. He came to the United States in 2003 and has accomplished a lot in just 11 years.
Bomi Cozzens RN came to us from hospital nursing. She lives in Haverhill with her husband and daughter
Melissa Crowley RN is our newest addition. She has just started doing home visits on her own.
Noella Kloppenberg has 35 years of social work experience in long term care, elder services and hospice. She is now on our intake team.
Siobhan Lucas is also a Gloucester resident. She is working in the office trying to keep up with the masses of paperwork.
Cathy Siegal is now a care manager doing home visits. She recently retired as a special education teacher, and she lives in Gloucester.
We also want to hear about you! You are part of our family. Let us know about accomplishments, transitions, or whatever you want others to know about.
Happy summer.
June Director's Corner
Tuberculosis
Tuberculosis (Tb) is the oldest known infectious disease. It has been found in skeletons from 4000 BC and in Egyptian mummies. Tb usually affects the lungs. It can also spread throughout the body.
Tb is spread by airborne droplets. It is now the second most common cause of infectious disease death worldwide (after Human Immunodeficiency Virus (HIV)).
Tb is caused by a bacterium called Mycobacterium tuberculosis. Up until 1946 the only treatment was going to a sanatorium for the pure air or having surgery. The surgery consisted of collapsing part of the lung so that the lung could rest. One technique, not so long ago, was to insert about 10 ping pong balls at the top of each lung so that the rest of the lung was compressed. When I started medical school in 1976, I remember seeing a few chest X-rays that still had ping pong balls visible.
In 1946 antibiotic treatment came into existence, and streptomycin was used to treat Tb. Since then antibiotic treatment has evolved and so have the Tb bugs. There are now strains of Tb that are resistant to whatever antibiotics we have.
Through the ages tuberculosis has been romanticized in literature. Tb was known as "consumption," and consumptive patients tended to lose weight and become pale. This appearance was often found to be very attractive. Thomas Mann's The Magic Mountain was set in a Tb sanatorium. Mimi in Puccini's opera "La Boheme" died of Tb. More recently in the movie "Moulin Rouge," Nicole Kidman's character Satine died of Tb.
Attempts to find a vaccine to prevent tuberculosis have been ongoing. The Bacillus Calmette Guerin (BCG) vaccine was introduced in 1921. It may or may not be effective and is not used much in the United States. In areas of widespread Tb (Asia and sub-Saharan Africa) the BCG shot is still used.
There is a simple skin test for Tb. In Adult Foster Care our clients and caregivers have the test before enrollment. Thereafter we use a questionnaire to see if there has been a risk of exposure. Exposure risks include jail, travel to Haiti or other endemic areas, exposure to known Tb patients, and symptoms of persistent cough. Please let us know if you think you might have been exposed.
May Director's Corner
Why is Smoking so Bad? Smoking cigarettes is not only harmful to the lungs, it also clogs up the arteries throughout the body. Smoking can cause heart attacks, strokes, and poor circulation to the legs.
I see people every day who cannot breathe well enough to walk across a room without stopping. I have seen people who cannot chew a whole mouthful of food without being short of breath. Here is a demonstration you might try to see what it feels like to have emphysema (lung damage): take a small caliber drinking straw, close your lips around it, and hold your nose. Breathe through the straw for five minutes.How did it feel? Isn’t it great to be able to inhale air without the straw? The first full breath feels luxurious. Imagine spending your life thinking about every breath.
Emphysema is not a curable condition. Think of a balloon. When a balloon is first blown up, it is springy and taut. After a couple of days, the balloon is saggy and has lost elasticity. The saggy balloon is what a lung with emphysema is like. You can get a new balloon, but you can’t fix the old one. The old balloon does not inflate and deflate easily. It takes more work.
What about poor circulation to the legs? There are people every day having legs amputated because of advanced lack of circulation. Sound unbelievable in Massachusetts in 2014? It’s true. You can open up the arteries and try to replace them only so many times. Once gangrene occurs, often there must be amputation in order to save the rest of the limb. Gangrene looks and smells pretty bad. Gangrene is rot. It is black and foul.
These are some of the many problems that can occur as a direct result of smoking. Clogged arteries also mean less oxygen to the brain. Dementia and strokes result.
Our bodies are a one-time deal. You get one body. You can take care of it or not.
Finally let us mention the effect of cigarettes on your pocketbook. In Massachusetts a pack of cigarettes costs $8.77. If a person smokes ½ pack a day, that amounts to over
$1600 per year. A pack a day costs $3201 per year. That’s a lot of money.
April Director's Corner
Asthma
Asthma is a chronic lung condition caused by inflammation of the airways. The incidence of asthma is increasing in some parts of the world. Perhaps the increase is due to increasing environmental pollutants.
There are different types of asthma. Childhood asthma often has an allergic component such that the airways react with spasm and inflammation when exposed to the allergic trigger. The reaction can be intense and immediate. Adults can also develop allergic type asthma. Asthma is diagnosed before age 7 in 75% of cases. Occupational and environmental exposures are significant problems. Inner city dwellers are hard hit with concentrated pollutants that can cause or exacerbate asthma. Common environmental triggers are dust mites, furry animals, cockroaches, molds, smoke and pollen.
The symptoms of asthma are cough, wheeze, shortness of breath, and chest tightness. In an adult, the diagnosis is not always straightforward. Tests of pulmonary function in which you blow into a tube and your lung function is measured are helpful.
In the treatment of asthma the goals are to reduce the impairment and to reduce the risk of asthma episodes. Asthma is one of the condtions for which patient education and good partnership with medical personnel are important. A person who knows his condtion will know his triggers and what to do and when to get help. People with moderate or severe asthma may have a peak flow meter at home. A peak flow meter is a simple device that you blow into, and you get a number that is the amount of air you are able to exhale. If you know your baseline, you can tell if you are in a stable condition or not.
The mainstays of treatment at this time are inhalers. Many people with asthma benefit from regular use of a cortisone inhaler. The cortisone reduces inflammation, and, by using it in inhaled form, the side effects are minimal. There are also short acting inhalers (for example albuterol) that can be used to treat or prevent acute episodes. Albuterol type inhalers work quickly and may be used as needed instead of every day. For severe attacks of asthma, oral corticosteroids are used. The corticosteroids that are taken orally or intravenously have nasty side effects (diabetes, osteoporosis, increased appetite) if taken for long periods of time so they are best used for just a week or two when necessary.
Avoidance of triggers might include special covers for mattress and pillows to protect against dust mites, staying indoors during periods of high pollution, home air purifiers, removing carpeting from bedroom, removing visible mold and discarding wet carpeting, flu shot, and avoidance of smoke. We cannot cure the condition, but we can help prevent its complications and severity.
March Director’s Corner
Dealing with Aggressive Behaviors
Our lives are full of personal interactions, not all of them pleasant.Recently someone was shot in an incident of road rage with a stranger.Of course we do not know what happened, but it is likely that loud and insulting words were exchanged.And it is possible that if one of the people involved had remained calm and followed the suggestions below, there would not have been a killing.
What do you do with someone who is out of control?
Our care manager Katia Cuevas found a book called Mental Health First Aid, and it is full of practical information.
Here is what Mental Health First Aid recommends:
First and foremost, if you are in physical danger, leave and /or get help.And stay calm.
If the situation is not dangerous, try to settle things down.Keep your voice soft and your speech slow.Reduce external noise (turn off the TV).Do not aruge or make threats
The person may overreact to any negative words.Use positive suggestions such as “stay calm” instead of “don’t fight.” Instead of saying, “Stop what you are doing,” try something like, “Let’s talk about what is the issue.” Let the person move freely.Do not try to restrict his or her movements.
Use calming body language and remain still with arms at rest and hands unclenched.Avoid fidgeting and sudden movements. If possible, sit down in a relaxed posture.
Be aware that involvement of law enforcement may exacerbate the situation.Even the threat of police involvement can escalate things.
Many of our families have mentally impaired clients whose behavior can be volatile.We have many clients with autism and other mental conditions, and it has been a good education, for me, to watch parents who have learned through experience to do all the right things.It can be like watching a choreographed dance from onset of outburst to comfortable and well-known response to restoration of balance.In some cases, the behavior occurs many times a day.It is a joy to watch the patience and stamina of a loving caregiver.
January Director’s Corner
Schizophrenia
Schizophrenia is a chronic incurable mental illness that affects 1% of the population.Typically it begins gradually in late adolescence and progresses with disordered thoughts, hallucinations (often auditory, i.e. hearing voices), delusions, and sometimes paranoia.It was first labeled as “dementia praecox” in 1887 by Dr. Emile Kraepelin who thought the illness was an early form of dementia.In the 1900’s the term schizophrenia was applied.Many famous and brilliant people have been diagnosed with the disease.Albert Einstein’s son Eduard was a not uncommon case of a gifted you who was considered to be extremely intelligent who was diagnosed at age 20.The movie “A Beautiful Mind” tells the story of mathematician John Nash who lived with the disease and continued to do great work.
Schizophrenia affects one’s ability to communicate and relate to others.Those afflicted often have trouble maintaining the daily routines of life.Things such as self care, jobs, and relationships suffer due to the mental disability.Schizophrenics are prone to isolation whether by choice or due to aberrant behavior.A whopping 80% of schizophrenics smoke, and drug and alcohol abuse are also more common.Schizophrenics are usually not violent.
Before the days of effective medication, people afflicted with schizophrenia were kept in institutions.Treatments included shock therapy (with insulin or ice baths or electricity), surgery (frontal lobotomy, i.e. removal of part of the brain), and psychoanalytic or behavioral therapy.
In 1952 the drug chlorpromazine (Thorazine) was found to have a profound effect on schizophrenics.Chlorpromazine seemed to be able to calm people and enhance abilities to communicate and understand.Chlorpromazine was the first antipsychotic drug, and it began to be used a lot.Over the decades, the drugs have become more sophisticated and have fewer side effects.The drugs do not cure the condition, however, and, in order for them to be effective, they must be taken regularly.
In my family we had to learn how to relate to my sister when she was diagnosed at age 20.She had been a smart, lovely, artistic girl who became paranoid and irrational.Over the years, I have dealt with hundreds of people with psychotic illnesses, and I have learned to be comfortable around them.As with any illness, most of those who are ill respond well to open and friendly communication.Those with schizophrenia may deny that they have a mental condition, and denial may make communication frustrating.In my opinion, isolation is the worst enemy of the mentally ill person.Simple routines and stable relationships with other people are extremely important.
In Gloucester there is the Cape Ann Social Club that is composed of mentally ill patients of all ages who get together for meals and other events.The club motto (which I love) is “togetherness is everything.”