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IHSS+ with L.A. Care Infographic

The unique partnership between the Center for Caregiver Advancement (CCA), L.A. Care Health Plan, and SEIU Local 2015 has resulted in a workforce of caregivers who are confident, highly skilled, and integral in their consumers’ overall health and well-being. The numbers in the infographic illustrate the positive impact of this program.

The IHSS+ Home Care Integration Training Program (IHSS+) is a 10-week program that educates and empowers caregivers who provide services to seniors and persons with disabilities through the California In-Home Support Services (IHSS) program. In these classes, IHSS caregivers learn how to take on the enhanced roles of Monitor, Communicator, Coach, Navigator, and Care Aide while developing the skills needed to be integrated into the consumers’ Care Teams.

Close to Home: Caring for Family

For years Melissa Fernandez’s family struggled to find the correct diagnosis for the symptoms her mother was experiencing. When they were finally afforded clarity, they realized that the challenges ahead were significant. A myriad of chronic conditions surfaced that would affect Melissa’s mother’s daily life and severely limit her independence. Once a vocational nurse herself, Melissa’s mother would now need lots of healthcare support. Her mother’s health, coupled with her family’s own career paths in healthcare, steered Melissa toward becoming an In-Home Supportive Services (IHSS) provider.

Photo of Melissa Fernandez

 “Just being able to help is a really rewarding feeling for me,” says Melissa. She is now the primary caregiver for her mother, who has been ill for most of Melissa’s life.

The complexities of her mother’s health conditions and the variety of medications she must take demand that Melissa be adept as a caregiver. And because of the IHSS+ training she received from the Center for Caregiver Advancement (CCA), she feels empowered and grateful to be able to take her mother’s care into her own hands.

“Thankfully because of this training program I’m able to care for her, and not worry about who’s going to care for her,” says Melissa.

Some of the skills included in CCA’s training are CPR, medication adherence, body mechanics, communication across the health care team, and nutrition. Melissa learned how to adapt her mother’s diet to something more appropriate for someone with diabetes.

“I took the training and I’m more educated on certain things such as meals and her diet,” says Melissa. “Now that I’ve taken the course, I try to cook healthier food for her. And I’ll eat it with her […], so I feel like we’ve become closer that way.”

The positive effect of the training is reverberating beyond the caregivers and those in their care. The impact on California’s overburdened healthcare system is measurable.

The largest publicly operated health plan in the nation, L.A. Care, is one of CCA’s partners in providing training to IHSS providers in Los Angeles County. According to an L.A. Care utilization report analyzing the impact of CCA’s training on its members, caregiver training results in a reduction in the number of emergency department visits by 42% and a 60% drop in hospitalizations, saving up to tens of thousands of dollars per consumer for insurers and the healthcare system.

Melissa’s own experience and training helped to familiarize her with her mother’s everyday symptoms and identify emergencies when they happen. 

“She’s had a heart attack before … so it’s very challenging when she has to go to the hospital and she’s being cared for by someone else,” she says.

The training also helped Melissa and her mother adapt to new challenges presented by the Covid-19 pandemic, such as how to maintain her mother’s dental health while she was unable to visit the dentist and how to prevent the spread of infection.

But of the entire curriculum, the most valuable insights Melissa says she learned are ways to help preserve her mother’s sense of self. “We learned how to speak with [the people we care for] and … not make them feel like less of a person. When (my mother) can’t do things, like walk, that gets to her sometimes. I try to build  up her character and self-esteem.”

Caregiver training allowed Melissa to take control of her mother’s health and equipped her with the knowledge to give her the highest standard of care. Without the caregiver training offered by CCA, Melissa, nor her mother, might not be so empowered, or independent.

“There are certain things people don’t realize you need to learn. […] There’s always room for learning, and I think anyone who’s caring for somebody, especially somebody who is sick, should have some sort of training.”

Activities Resource Benefits Residents

Coloring pages, math problems, crossword puzzles – for Tatiana Chavarria, those are more than mere pages she needs to print for her job as Activities Assistant at Vernon Health Care Center — Rockport  in Los Angeles. For the nursing home residents at the facility, the pages are a lifeline.

“They love it. They love to color early in the morning. I have a lot of residents who love math. They like crosswords, puzzles. They’re very active. It’s like school for them,” she says. 

Tatiana can’t sing enough praises for an activities resource subscription that she has access to through her Education Fund. The subscription gives activities assistants at nursing homes unlimited access to thousands of ideas and resources for focused activities, music therapy, humor, games, trivia, art and crafts, multicultural programs, and more. 

Tatiana says the subscription may have given her more ideas and more resources for her day-to-day planning, but the real benefactors are the residents.

“It gives my residents more options to choose what they want to do,” she says. “Every morning, they’re always asking, ‘What are we doing today?’ Now, they are more involved in the activities.”

Studies have shown that recreational activities at nursing homes have a positive effect on residents’ quality of life. Having a choice of activities gives residents a sense of independence, and participating in activities that interest them helps reduce feelings of isolation and depression.

Learn more about your Education Fund benefits.

A Holistic Approach to Caregiving

Nearly five million people across California support family, spouses, and friends with the caregiving needed to live safely in their homes. And those family caregivers routinely sacrifice their earning potential and their own wellbeing to take on that task, while never truly being recognized for their value, nor are they given the proper tools.

Tatevik Kyosayan’s mother was once a caregiver before she began to need support herself. A musician and music teacher by trade, Tatevik decided to put aside her passion temporarily and take up the role of caregiver for her mother.

Photo of Tatevik Kyosayan

Caregiving is so often a burden that many untrained and undervalued caregivers must shoulder in silence, but for Tatevik becoming a caregiver has been a source of personal fulfillment. She has worked as an In-Home Supportive Services (IHSS) provider for 14 years now and currently cares for her mother and an elderly neighbor.

“I stepped in, and I found so much satisfaction in helping elders,[…] because you get to enjoy the work, you get to be very helpful.[…] They need me and they appreciate me,” Tatevik says.

Despite working in caregiving since 2007, Tatevik was open to continuing to build on her experience and skill set. When she heard about the free IHSS+ training offered by the Center for Caregiver Advancement (CCA), she quickly enrolled. She is proof that even when you have over a decade of experience in caregiving, it can still be incredibly valuable to keep learning.

“There was still so much that I’ve learned from here,” Tatevik says. “It’s a very, very, very helpful training, especially for caregivers who actively work full time.”

During the IHSS+ caregiving training, Tatevik learned about personal care, infection control, CPR, nutrition, and medication adherence. The medication adherence module covered in the training introduced Tatevik to techniques and tools to ensure the people she cares for correctly follow their prescriptions and medical advice, which she believes is crucial.

“The most valuable part of the training was the medical point of view and about the medications—the Five Rights,” she says.

The Five Rights are: the right drug, the right dose, the right time, the right route, and the right person. It is a tool to avoid errors with administering prescription medications that Tatevik relies on as a caregiver to the elderly.

Even with the caregiving skills her experience and prior training afforded her, Tatevik says there was a lot she learned through IHSS+, like a holistic understanding of well-being.

She says the knowledge she gained about nutrition and the perspective she gained about protecting the dignity and privacy of those in her care were eye-opening.

“I never had training on nutrition and how to really handle the people who have diabetes or high cholesterol […] The class helped me a lot to provide proper nutrition for myself and my family, and for clients.”

Another crucial aspect of the training, Tatevik says, is learning how to better communicate with the larger healthcare team.

“It’s extremely important training because […] let’s say you have a client who has a nurse coming in. And they ask you [a question] or they tell you a word you’re like, what is that? So at the training, they teach you the wording, important wording. They teach you all that. Important aspects of care in detail. And of course, they teach you about the medication.”

Surveys conducted after training echo Tatevik’s experience. CCA found that 95% of caregivers have more confidence in their ability to talk to the care team of the person they care for after completing caregiver training offered. And better communication among the team results in better care for the individual, and fewer unnecessary trips to the emergency room.

More than helping Tatevik build on her skill set, the training made her feel like a part of something bigger. A community of fellow caregivers that she could continue to learn from and lean on. A sense of belonging.

“When you get to take this class with other caregivers they share their examples and discuss things. This was very helpful,” Tatevik says, “because then they give you their perspective, or some knowledge that I didn’t know or even the book didn’t have.”

Post-training surveys show that 68% of caregivers feel less stressed, depressed, or lonely following the training. This feeling of community is one of the ways that the training does more than improve the lives of the individuals receiving care, but also improves the lives of the caregivers themselves.

Despite her initial apprehension for participating in remote training online due to the Covid-19 pandemic, Tatevik has fond memories for those 10 weeks and the passion her instructor inspired in her class. She hopes every caregiver has access to training like the CCA’s one day.

About the future, Tatevik says she wishes “this training was just across the board, like almost every caregiver. […] The quality of care would be higher, much higher than what it is now.”

Sources

Government of California. “California Master Plan For Aging: Caregiving That Works” Master Plan For Aging, 2019, mpa.aging.ca.gov/Goals/4.

Second Set of Eyes for Care Team

The signs were there, but caregiver Levon Wortham was in the dark about what to do.  Then he signed up for a caregiver training program that focused on caring for seniors with Alzheimer’s disease and other types of dementia or cognitive decline.

Photo of Levon Wortham

“My Alzheimer’s class really did help me a lot because it allowed me to recognize a lot of the issues that I knew were there, but I didn’t have any definition or reason for them,” Levon says.

Levon is part of the first cohort of In-Home Supportive Services (IHSS) caregivers to complete the Center for Caregiver Advancement’s IHSS+ Alzheimer’s training program in Alameda County. 

“So just after taking this class, it really helped me understand how deep the changes (in my care recipient) were. As the dementia started to progress, I started to notice the signs of progression. I realized if I hadn’t taken this class, I would have been in the dark about what was happening to her,” Levon says. Trained caregivers like Levon are pivotal to helping people living with Alzheimer’s remain in their homes. Proper training ensures that the caregiver understands the disease, recognizes areas of concern, and can report to the care team, and knows strategies on how to provide better care.

In California, there are over 520,000 IHSS providers caring for more than 650,000 elderly or people with disabilities in need of home care services. Often, these IHSS caregivers enter the workforce with little to no training or support.

“I go back to my notes from class a lot. And I continue to reflect on the different experiences and different topics we talked about in class. It’s really, really helpful,” says Levon.

The number of people with Alzheimer’s disease and related dementias will double by 2060, according to a study from the Centers of Disease Control and Prevention. And among people 65 and older, African Americans have the highest prevalence of Alzheimer’s and dementia, followed by Hispanics, Native, and Asian populations. By 2060, researchers estimate there will be 5.4 million Black and Hispanic people living with the disease in the US. This reality calls for a much larger, more culturally competent workforce of caregivers with training on how to care for those with Alzheimer’s or other forms of cognitive decline. It will depend on trained caregivers like Levon.

The biggest impact of the training, Levon says, was that it made him a stronger advocate for his consumer. The voluntary 10-week course teaches skills that are crucial to helping people who are showing symptoms of Alzheimer’s disease and related dementia. Embedded in the curriculum are strategies for managing repetitive behaviors, assisting with daily activities such as bathing and medication, and helping to manage hallucinations and wandering.

Because he gained a deeper understanding of what she was experiencing, he adjusted how he was taking care of her. The training expanded his knowledge of the disease, which allowed him to recognize the symptoms and respond in a way that helped him connect with the consumer more effectively. And knowing the terminology and how to speak the language of the care team of doctors, nurses or personal support workers, helped him to become a better advocate.

“The most valuable lesson that I learned during my training, I would say, is just how to be an asset to the care team, because my experience or my witnessing (of the changes in my consumer), and my advocacy are very important,” he says.

Levon spends almost every day with his consumer, so he knows he can be a second pair of eyes when it comes to observing and monitoring her symptoms. He saw himself as a historian of sorts: He took detailed notes – reactions to medication, changes in behavior – and reported all of those to the doctors and the care team. 

“I’ve actually had that response from the doctors that I communicate with that what I report is really helpful to them,” he says. “They think I’m just the smartest person on earth, but I’m really not! I’m just really paying attention and understanding how important it is to be able to relay these things to the doctor for my consumer.”

Backing up his instincts with actual data went a long way into making the care team take him seriously, and to recognize and respect his role as an IHSS caregiver as a critical component of the healthcare system.

“The most rewarding part is just knowing that what I’m doing is actually helping someone who, if I wasn’t doing this, would be going without care,” he says. The reward is in knowing that someone “feels that they are cared for.”

The IHSS+ Alzheimer’s training project in Alameda County is funded by the California Department of Health, in partnership with UC San Francisco and Alameda Alliance for Health.

Sources:

Government of California. “California Master Plan For Aging: Caregiving That Works” Master Plan For Aging, 2019, mpa.aging.ca.gov/Goals/4.

“U.S. Burden of Alzheimer’s Disease, Related Dementias to Double by 2060 | CDC Online Newsroom | CDC.” Center for Disease Control and Prevention, 20 Sept. 2018, www.cdc.gov/media/releases/2018/p0920-alzheimers-burden-double2060.html#:%7E:text=Among%20people%20ages%2065%20and,Pacific%20Islanders%20(8.4%20percent).

CNA Apprenticeships Offer Career Pathways

The Center for Caregiver Advancement, in partnership with EmpRes and SEIU Local 2015, has launched the Certified Nursing Assistant (CNA) Apprenticeship Program, which is a paid CNA training program meant to provide career pathways for nursing home workers and address a critical staffing shortage at skilled nursing facilities. The program is sponsored by Healthcare Career Advancement Program (H-CAP), a national labor-management organization, and is registered with the U.S. Department of Labor.

The apprenticeship is offered through CCA’s nursing home program (the Education Fund) and provides workers the opportunity to get paid as nursing aides while they pursue CNA training to prepare for the CNA certification exam. The training is provided at no cost to the worker, and all program-related fees and materials are covered by the program as well. For those who need childcare or transportation, they will receive a stipend to help offset those expenses.

“This program is an investment in the nursing home workforce as a whole, and in the individual lives that provide essential care for vulnerable residents. Apprentices will earn as they learn, and they can look forward to a wage increase once they receive their CNA certification. This will open up opportunities for economic and social mobility for them,” said Arnulfo De La Cruz, Executive Vice President, SEIU Local 2015.

Currently, the CNA training program is available to workers at EmpRes facilities in Salinas and Vallejo, with a few slots open to IHSS caregivers in the area.

“We believe it is a unique opportunity to provide a career pathway for individuals interested in entering into the Certified Nursing Assistant occupation,” said Cindy Cour, Vice President of Human Resources at EmpRes and a member of the CCA board of trustees governing the Education Fund. “Not only does the program provide on-the-job learning and related instruction for the apprentice to master the competencies and become certified, it provides additional support through assigned mentors to ensure success throughout the program and beyond,” said Cour.

A recent study of the nursing home workforce shows that the turnover rate for CNAs can be as high as 129%. One of the goals of CCA’s CNA training programs, especially the CNA certification and apprenticeship programs, is to help skilled nursing facilities address the industry’s staffing shortage and high turnover rate.

“We believe partnerships such as these will improve employee retention and satisfaction, which in turn improves residents’ quality of care. It also provides an avenue for these workers to learn new skills and hopefully open up opportunities that lead to continued career growth in long-term care,” said Cour.

Breaking Down Language Barriers in Caregiving

When caregiver Byeoung Dutt has questions for her care recipient’s doctor, she first turns to Google Translate to help her write down her thoughts in Korean, then English. She does this to overcome some common language barriers in caregiving.

“If there is an abnormal condition in his blood sugar, blood pressure, or overall health, I report his condition by emailing or calling his doctors and nurses,” says Dutt. If her report is too complicated or if her question involves more technical terms, she asks for an interpreter to help her translate the conversation. But there is a difference now in how she communicates with the care team. Thanks to CCA’s caregiver training offered in Korean, her native language, “I have gained confidence in my job.”

Byeoung Dutt

Overcoming Language Barriers in Caregiving

Dutt completed CCA’s 10-week caregiver training for In-Home Supportive Services (IHSS) providers in Los Angeles County. The course covers essential caregiving skills, including medication adherence, assisting with daily activities such as dressing and bathing, proper nutrition, and CPR. To help overcome language barriers in caregiving, this course is taught in several languages: English, Spanish, Armenian, Cantonese, Mandarin, and Korean.

More than a million of direct care workers, or roughly one in four, in the nation are immigrants. In California, almost a quarter of the home care workforce is Asian/Pacific Islander.

“Getting training in my native language allowed me not only to understand 100% of all this training, but also to see the connection between what I learned last week and what I will learn this week,” Dutt says.

She cites the modules on safety and durable medical equipment (DME) as an example. She says that because the course was taught in Korean, “I understood the connection that the medical equipment is necessary to prevent the consumer from falling. I made a connection to the learning before and after, so I understood more quickly and easily.”

Because of the caregiving skills she learned during her IHSS+ training, she now keeps a daily record of her care recipient’s vitals, medications, and general observations about his health and any unusual behaviors so she can communicate any changes and concerns with his care team.

Caregiver skills training helps change the perception of caregivers as an integral part of the care team, and clarifies what caregivers do, she says. “This kind of training is indispensable for a caregiver to be treated as someone responsible for the health and safety of another person, not just a housekeeper.”

Her diligence and professionalism have not gone unnoticed. The pharmacists, primary doctors, and medical staff she talks to have told her that the person she is caring for “is very lucky” to have such a skilled caregiver.

“Because I am taking care of him in a better way for his health and his quality of life, based on that training, I am filled with pride,” she says. She is particularly appreciative that she was given the opportunity to receive training in her mother language as a way to overcome language barriers in caregiving.

The Center for Caregiver Advancement’s IHSS+ Home Care Integration training program is offered in partnership with L.A. Care and SEIU Local 2015.

Turning Care Worker Experience into a Lasting Legacy

CCA board member Joyce Hayashi knows full well the struggles that long-term care workers face every day. She lived it as the caregiver for her mother after she suffered a severe stroke, then later for her sister, Doreen, when she became disabled by muscular dystrophy.

“Many of my contemporaries would not have stopped their careers to care for their family full time,” says Joyce, who quit her job as the operational vice president of a production company to devote her time to caregiving. “But as an Asian American, it’s part of my culture to care for your parents. And as the elder child, there’s an expectation that you would take charge as needed.”

Becoming an in-home care worker was not something Joyce had envisioned, a situation she acknowledges as something most family caregivers have in common. “It was daunting. I had no idea what caregiving entailed. It was something I didn’t know anything about, I had no training. It was unimaginably difficult,” she recalls of those earlier days.

Joyce turned her experience as a care worker into an opportunity to help others facing the same challenges. She joined the union and quickly became one of its most active members. Alongside fellow care workers, she fought for better wages and benefits and advocated for access to training that would lead to improved skills and career pathways.

A few years after attending her first union meeting, Joyce was elected to the executive board as a divisional vice president. She served on the SEIU 2015 Executive Board from 1992 until 2018, and on the SEIU State Council Board of Directors from 2013 to 2016.

Her advocacy for home care workers continues to this day. Aside from her work with SEIU L2015, she has been one of CCA’s stalwart supporters as a board member since 2013.

Joyce currently serves as a member volunteer for the Venice Pioneer Club, providing community support for Westside Japanese seniors. She is also on the executive board for the West Los Angeles Buddhist Temple. She takes pride in her work with the Buddhist Women’s Association as co-chair of its membership committee, in addition to her role as program consultant for Bay Street Arts, the Downtown Los Angeles Artist Space Cooperative.

Since she started becoming involved with L2015, she has seen the labor union’s membership grow not just in numbers but also in diversity.

“At the time I first joined, there were not many Asian Americans who were caregivers in the union. But today it has changed, we have different cultural backgrounds and many different ethnicities,” she says. “It gives a great deal of energy to our movement. That all these different voices can contribute to the cause, to influence others. We’ve learned from each other. We’ve learned to work with each other.”

Finding Creative Ways to Give Care

Lynda Jackson

Watching one of the people she cares for show signs of dementia breaks Lynda Jackson’s heart just a little. The biggest struggle was dealing with the memory loss – they would argue over trivial things, like forgetting where a shirt went or that a question had already been asked and answered.

So Jackson enrolled in the Center for Caregiver Advancement’s caregiver training program focusing on caring for people with Alzheimer’s and dementia. For Jackson, the turning point of the care training was the module on how each stage of the disease affects the brain. “To me, understanding the physical aspect of what’s happening in the brain … and learning and understanding the various phases that they go through … that for me was important,” she says.

Aside from covering the essential skills of caregiving, CCA’s IHSS+ Alzheimer’s training program in Alameda County introduces caregivers to the symptoms and stages of Alzheimer’s disease and related dementia (ADRD), which differ from the signs of aging. To improve the quality of care they provide to adults with ADRD, they learn strategies for responding to common behaviors associated with the disease. These behaviors include aggressive language and repetitive questioning. The care providers learn ways to reduce agitation and anxiety. They learn to recognize wandering, sundowning, and hallucinations.

Armed with a new understanding of the disease, Jackson also listened to her fellow caregivers share their experiences with their care recipient’s symptoms and the different ways they responded. The training helped her get more creative with how she provided care for 70-year-old Grace (name changed for privacy).

“The training program helped me get inventive on how to make their care better, making me more aware of their needs,” Jackson says.

When Grace started forgetting little things, Jackson encouraged Grace to write down her requests either on a tablet or a piece of paper. Now they rely on those notes, clearly written by Grace, to avoid arguments. They do crossword puzzles, read books, go for walks. Grace likes music from the 1970s, so Jackson will sometimes look up artists from that decade and play their songs from her phone. On good days, Grace sings along. On bad days, they will get in Jackson’s car and drive around Berkeley, wondering about each house’s history and the people who live there.

Since her IHSS+ Alzheimer’s training ended in December, Jackson says she wants to keep reading about the disease itself and learning more about the way the brain works. She encourages other caregivers to take the training. “The curriculum is good. It was encouraging and informative. Now I’ve got the knowledge that I can apply to my caregiving,” she says

Grace is like family and seeing her struggle “hurts my heart just a little,” Jackson says.

But her heart is full every day she walks in Grace’s door. “When I come in, she comes and hugs me first thing! I don’t even get to take off my coat. And I think, ‘that’s good, that’s good.’ And I want to hold on to that as long as I can.”

Persevering Despite the Pandemic

Juggling two jobs and school pays off for a nursing home worker

Starting a new career can be overwhelming for anybody, but doing it as a new nursing assistant in the middle of a pandemic presents its own challenges. For Martha Espinosa-Silva, trying to answer the questions from the people she takes care of are the toughest.

“They’re always asking, ‘When can I go out? Can my family come and see me?’” she says. “They’re asking me these questions and I don’t really have an answer.”

Espinosa-Silva is a Restorative Nursing Assistant (RNA) at Centinela Skilled Nursing & Wellness Centre (West) in Inglewood, where she helps residents with rehabilitation and therapy so they can improve their quality of life.

The coronavirus has devastated nursing homes across the nation. In California alone, more than 154,400 cases and 12,998 deaths have been reported at facilities across the state. Starting out as a new CNA during the pandemic, Martha faced long hours and many challenges.

“It’s very tough. We’re there (in the facility) regardless of whatever’s going on. And it’s a lot of things that you have to think about. You’ve got to take care of yourself, your residents and the people around you. And we have families that we go home to, so you make sure that you’re taking the proper steps to take care of them, too. So it’s been tough during the pandemic, but it’s getting better,” she says.

Espinosa-Silva had been working as a kitchen aide before she enrolled last summer in the Certified Nursing Assistant (CNA) and RNA certification courses offered by the Center for Caregiver Advancement (through the Education Fund).

She initially was uncertain if Centinela’s’s staffing schedule would be able to accommodate the days she needed to attend classes. Also, she was already working two jobs, one full-time and another part-time stint at another facility.

However, with support from her supervisor and her Education Fund coordinator, she started her training during the pandemic. For three months, she did not have a day off: She attended her classes on weekends, in between shifts at the two facilities where she worked.

“It was a little bit hard,” she admits about juggling work, her studies and her personal life. “But I was determined that I was going to do the program, that I was going to finish it.”

And she did. She passed her state CNA certification exam and, in August 2020, started working as a CNA.

Receiving her license was a reward for all her hard work and she was ready for her new job. However, she didn’t expect a struggle on her first day: She was so overwhelmed she almost walked away. She was used to staying behind the scenes, prepping meals in the kitchen, and not being on the floor with the residents. Despite the new challenges, she persevered.

“Everywhere you go, there’s something that challenges you as a person and it’s going to make you grow in many ways,” she says.

She found the work of a nursing assistant so meaningful that a few months later she enrolled in the Fund’s Restorative Nursing Assistant (RNA) program to move one more step forward in her career path.

“The certification that I have now, it means a lot. It’s something that is pushing me forward to either being an LVN or speech therapist. I’m holding on to this dream, for my future because I want to stay in the medical field.”

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