After having trouble sleeping one night because of concerns for a patient, Malisa Putnam sent an email to the team outlining what she thought could be done to make sure an Amish patient, recently diagnosed with diabetes, had all of her needs met. The email read, “Since I am from the area I am a little familiar with the Amish community. I will talk with them today, but I wanted to give you a heads-up regarding most of the Amish families in the area. Many of these families do not have electricity or running water/indoor plumbing. They do not have phones but will find a non-Amish family nearby and pay to use their phone if needed. These families do not have transportation outside of horse/buggy and have to pay someone to transport them by car/truck if needed. They do not have insurance (as you already know) and do not want to apply for Medicaid. All of these things are dictated by religious beliefs.”

Malisa went on to outline her concerns related to how the family would store the insulin due to lack of refrigeration/electricity, how they would afford supplies and insulin, how they would pay for transportation and doctors visits, how they would be able to call in the case of reporting blood sugars or Ketones, and how she was concerned if a pump was even an option from both a financial and a religious standpoint. She also shared her thoughts on how the team might address insulin storage, putting the family in contact with financial assistance programs, coordinating classes and doctors appointments to lessen the financial burden, and making certain a non-Amish neighbor with a phone was available so they could call the team if needed. She also wanted to make sure the team was careful not to push pump therapy unless it was absolutely indicated and/or the family was open to the idea, as to not cross any religious beliefs.

Malisa ended up taking ownership of this patient and personally reached out to the local pharmacist to arrange to get all of her scripts at cost, as this religious family does not accept Medicaid. She was able to arrange to have two appointments together to reduce transportation costs. This nurse went above and beyond normal duty requirements for this family and their little girl!