By Cathi Ruiz
I live in a small community in Tuolumne County, CA. Being nestled in the foothills of the Sierra Nevada Mountains has kept our community beautiful and free from progress and growth. Yet the demands of a chaplain to provide spiritual care services within our population — rural, poor, homeless, addicted, isolated, with a high suicide rate and mental health problems — helped me to reestablish and recreate my marketable skills. (Yes, the “M” word.) It has been a worthwhile challenge of self-reflection and action.
I have been working as a chaplain counselor at a local Native American clinic for the past 15 months. I assumed that the skills I learned over the last 10 years would be sufficient in providing spiritual care and counseling to my patients. But not surprisingly, the patients needed to go deeper. My task is to weed through a menagerie of traumatic events of addiction, sexual assault, domestic violence, depression, anxieties, mental health, and co-morbidities of complex health issues to help identify their spiritual pain. Their feelings of guilt and shame arose quickly as their willingness to resolve their pain came to the surface in discussion.
In a hospital setting, I often referred the patient to a social worker or the palliative care team for more resources. In a rural clinic, our resources are somewhat limited. I found that the patients at the clinic are educated about their wellness or lack of it. They expect the chaplain and the entire clinical staff to have a basic knowledge of trauma. If I engage in conversation, providing additional knowledge of the subject, in return they will share their specific traumatic event. This begins our dialogue of spiritual pain.
I began my new education by better understanding the population of Tuolumne County, and participating with other organizations that serve my patients: mental health, action agencies, hospital, faith community, hospice, drug dependency court, local attorneys, child welfare department, Salvation Army, local jail and domestic violence agency. I immersed myself into knowing a little about each agency and who to call.
During these months, my continuing education consisted of webinars, seminars and conferences about trauma-informed care and self-care techniques. Trauma-informed care is heard continuously in Tuolumne County by the agencies that participate in my patients’ world. This approach aims to “engage people with histories of trauma, recognize the presence of trauma symptoms, and acknowledge the role that trauma has played in their lives.”
The local domestic violence agency told me about an ACE (adverse childhood experience) study that classified 10 types of childhood trauma. Five are personal and five relate to other family members: a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment.
I use the ACE 10-item questionnaire during my first session with patients from the clinic. Their answers show the fundamental elements of their trauma during discussion. This is the link that helps to bridge their situation with my skills as a chaplain to begin the healing process.
In addition, the self-care classes I attended provided techniques I could share with my patients. These techniques reduce stress and deliver a different focus to prayer life that engages all senses in connecting to God’s grace. I discovered that yoga is one way to assist with post-traumatic stress disorder. It can also help with addiction and anxiety disorders. Adding prayer and meditation enhances breathing, relaxation and a focus on a peace-filled environment.
My spiritual care education consists of the skills, abilities and knowledge I began acquiring in CPE. My continuing education is focused specifically on the needs of the patient at the clinic. My patients are over 50 and live with chronic pain due to trauma as a child. They are now open to spiritual counseling because their health issues are becoming a roadblock to everyday activities. Spiritual counseling has helped them to identify the guilt/shame they perceive as their fault in the traumatic experience.
A chaplain can provide enormous value to a patient in a clinic: reducing their flight-or-fight mentality, reducing depression, providing techniques for self-reflection and self-care, reducing physician visits, and reducing stress that may affect health issues such as diabetes, headaches, and chronic pain. A chaplain can provide positive alternatives to violent relationships, and establish a plan for those who are suffering from self-doubt. It is a choice of all chaplains to continue their education and learn more about the challenges that face the population in which we serve. Is it not the choice we made when called to become a chaplain?
While recreating my skills through continuing education, I also intend to voice a strategy to help healthcare professionals re-think the value we as chaplains can provide in our community. I continue to learn and grow and serve our patients in Tuolumne County with integrity and respect. I will continue to market the many arenas where chaplains can establish a presence as a valued member of any team.
Cathi Ruiz, BCC, is the chaplain counselor at Mathiesen Memorial Health Clinic in Jamestown, CA.