The Doctor Answers Questions

Medical Care in Community, Part 2

September 13, 2021 by

People often wonder what medical care is like on our communities. For this two-part series, we’ve asked family practice doctor Monika Mommsen to talk a little about the daily ins-and-outs of medical care on her community. In Part 1, Dr. Mommsen talked about her personal history and views. Here she answers some questions, posed by her daughter Marianne Wright, including some from readers.

Marianne: Where do you practice medicine on the Bruderhof, and what is your clinic like?

Monika: I am based at our small medical clinic at Woodcrest in upstate New York. We have two Physician Assistants, several nurses, and me. Day-to-day administration is done by the head nurse, who welcomes and triages patients, answers the phone, and schedules appointments. The floor nurse welcomes patients, records their vitals, and assists with small procedures. Another nurse manages our little dispensary where we have over-the-counter medications and supplies – everything from Band-Aids to specialty shampoos. She communicates prescriptions to the local pharmacy, which makes daily deliveries to our office. So if someone in the community needs a prescription refill or is requesting an over-the-counter medication or other supply, they will write a note and she will fulfill the request and put the items in their mail cubby by the end of the day. There’s a nurse who transcribes dictation and keeps the charts up-to-date. Our staff is a close-knit team. We enjoy working together and just being together. At 10 o’clock every morning we have coffee together, and if there are patients in the office at that time they’ll be invited as well – it’s especially nice if a mother is there with her baby for a checkup, and we can all take a minute to enjoy the baby. And of course we enjoy celebrating a birthday or special occasion by heading off for an afternoon to swim or enjoy the mountains.

Dr. Monika Mommsen with a new baby Dr. Monika Mommsen with a newborn baby – one of Marianne’s sons – in the Mother House at the Woodcrest medical office.

When I started work in the late 1970s the office was quite simple, two rooms in an old building with one exam room. Today we have a beautiful suite of rooms. When you walk in from the waiting room, there’s a big open nurses’ station, and each practitioner has an office and an exam room. There’s an x-ray unit that we use mainly for chest x-rays and checking for fractures; it’s digital so we can forward x-rays to orthopedic consultants for advice. There is a spacious room for procedures such as sewing up lacerations, applying casts, or removal of masses for biopsies. And if someone presents with heart-related problem or acute injury we can stabilize them before transfer to hospital if needed.

Right down the hall is a dental office run by two dentists and two hygienists. We collaborate particularly about airway issues, which can affect general health as well as dental health. Next door to that is a physical therapist to whom I refer patients either for rehabilitative therapy after surgery or injury, or often for low back pain or shoulder problems. She has been a huge asset and will follow patients with a home health program. Patients have us all easily accessible, and collaboration allows us to provide better care.

Marianne: And just to make it clear, how do patients pay you for all the care you give?

Monika: All care is free because none of us has a salary. Whatever we do and whatever role we play, it’s all part of our commitment to our church, and our commitment to caring for each other.

Marianne: What happens if there’s an emergency?

Monika: There’s a paging system for all the medical staff. If there’s a medical emergency – say trauma, heart attack, or an anaphylactic reaction – the whole staff will drop what they’re doing to help. A week or so ago we had a little girl that had broken out in hives along with some respiratory trouble as a result of a yellow jacket sting. We were available to care for her; thankfully she recovered well. If someone isn’t able to get to our office we have a transport vehicle with the basic medication and oxygen so we can resuscitate on the field if necessary and bring the patient to the office. If needed, we’ll call the local ambulance for transport to the nearest hospital, half an hour away.

Marianne: As a mother of five young children, it seems that when sick children get worse it’s always in the middle of the night. What is the response system for people who would probably otherwise go to the emergency room?

Monika: We have a nurse on call full-time, and even in the middle of the night if it’s an emergency she will go to someone’s house to evaluate the situation, and call one of us providers for recommendations. With children it’s often an ear infection, croup, really severe coughing, or high fevers. Often we can provide medication right away. The next day we’ll see the child in the office for follow up. Parents often call the office in the morning asking to have a sick child evaluated and we try to see them as soon as possible. The clinic, of course, is five minutes’ walk away from most people’s homes.

Marianne: And your clinic staff makes house calls?

Monika: Yes, for a variety of reasons. Sometimes it’s simply monitoring a situation; last year one of the children had a puncture wound from tree-climbing with a risk of infection, and someone stopped by every day to make sure it was healing properly. If a patient is recovering at home from a bad bout of flu, we’ll visit them rather than have them come to the office. If someone is seriously ill, having to get out of bed and come to the office doesn’t necessarily promote healing! We can administer intravenous fluids at home, also IV antibiotics – usually one of the nurses stops by regularly for that. If someone has a serious on-going illness, their primary care physician would visit them at home most days, especially if it’s something where the patient’s condition can deteriorate quickly. That visit keeps a relationship of trust, so the patient knows that their problems are cared for even if there does not seem to be anything acute on that day.

Marianne: And how does this relate to the Bruderhof’s philosophy of life at all stages?

Monika: All stages of life deserve this level of care. Life begins at conception. We will never entertain abortion, even if we know there may be a problem with a baby. There have been babies with severe abnormalities that mothers have carried to term, and it’s been a very meaningful and deepening experience for the couple as well as for the community, even with the painful knowledge that the child will not live long. And when the child dies, the whole community gathers, and his or her life is celebrated as the gift that it is.

Marianne: So how are expectant mothers and new babies cared for?

Monika: Most pregnant mothers will tell me as soon as they realize they’re expecting. I will see them in the office if there are risk factors or signs of impending miscarriage, but otherwise they’ll be evaluated at twelve weeks. For couples expecting their first child, I’ll make sure the husband accompanies his wife for that appointment. That moment when the parents first hear their baby’s heartbeat is so awe-inspiring. Our office has an ultrasound machine that I use to date the pregnancy and to rule out major problems. Pregnancy care is done in collaboration with an excellent local obstetric group who will see the mother several times during the pregnancy. Babies are delivered in the local hospital, usually by a midwife, but in collaboration with me or whichever doctor has been caring for the mother during pregnancy. Of course some babies surprise us by coming very quickly at home, but in general we recommend to mothers that a hospital delivery is safest. I spend time educating first-time mothers about labor and nursing, and we’ll also discuss the miracle of creation that she is part of – all the intricate ways that God designed to make new life possible.

When a mother goes into labor, she and her husband go to the hospital with her own mother, if possible, or one of our nurses – with COVID we’ve had to make adjustments. I will also accompany them if it’s a high risk pregnancy and there’s worry about the labor or the outcome for the baby. I’m very much in favor of natural birth, but we all have our limitations. Some women will request an epidural, and of course a C-section may be necessary. I think sometimes there’s an exaggerated emphasis on a “natural” process, when really the most important thing is that the mother and baby come safely through the birth.

If a mother has a miscarriage and it’s uncomplicated, we try to provide care without going to the hospital, and then support the couple in grieving for the little life that was with them so briefly.

Marianne: What happens when a mother comes home from the hospital with her baby?

Monika: If all goes well, they’re discharged within twenty-four hours. Next to the medical office is our Mother House. It’s a nursery, dining room and kitchen, bedroom with hospital bed, and bath, and the mother and baby are cared for there for a couple days, making sure that nursing is going well, the baby’s thriving, and the mother has recovered. (Some mothers do want to go straight home from the hospital to their family.) They have their own nurse, and if it’s someone’s first child they’ll get tips from the nurses on bathing, skin care, and so on. The nurse takes care of the baby at night so the mother gets some good nights of sleep. While they’re in the Mother House the community kitchen prepares their meals, and the laundry is washed for them, so it’s like a little retreat for the parents, a time for them to take in this new little person. And of course any older siblings can walk over during the day to visit with their parents and new brother or sister. The whole community celebrates every time a baby is born; sometimes so many people will want to stop by to see the baby through the picture window that we have to enforce strict visiting hours so mom can get some rest! After they go home, one of the nurses visits them daily for the first two weeks. They bring the baby to the office weekly for the first six weeks, to be weighed and to ask any questions. We do all we can to encourage breastfeeding, but we recognize that it’s not always possible, and it’s also often necessary to supplement. Motherhood and nursing are not equivalent. You’re just as much a mother whether you are able to nurse or not.

Marianne: We’ve talked about birth and new life. Can you describe what it’s like in the community when somebody is reaching the end of life?

Monika: End of life is part of the natural cycle. It’s a time when someone is supported by the community and the pastors, and a situation will be mentioned for prayer in church meetings. Nursing care is provided at home, either by one of the nurses or family members who we’ll train in the basics of bedside care. If someone is seriously ill or dying, I or one of the other practitioners will visit them daily. They also have one of the nurses on call. From the medical office we work with whomever on the community is responsible for furniture, to make sure the patient’s house is convenient for care and that they get the necessary equipment – a hospital bed, commode, walker. We’re often helping them rearrange the room. The community will do as much of the practical care as we can, so it’s not up to the family – the kitchen provides meals to eat at home; often an extra person is tasked with helping out around the apartment and taking the trash or picking up supplies. That gives the family the chance to focus on spending time with the sick person.

In the last hours of life, we can provide comfort with pain management or oxygen, but there comes a time when all you can do is prayerfully sit with a person and their family as they make that final journey. I have often experienced things at a person’s death bed that science cannot explain – the room is flooded with peace, and you can see that the person sees beyond our earthly sight.

After the person passes away, the family will prepare the body, bathing and dressing it. They are assisted by someone who has done it before, as well as one of our sisters who is a trained mortician. She works with a local funeral home, but the body stays on the premises of the community. The family decorates the room where the wake will be held with favorite pictures, photos, and flowers – it is simple and natural. Until the funeral the body is never left alone – members of the community sign up to be there for certain hours. Then the whole community gathers for the funeral meeting, and the coffin is carried to our cemetery by hand, and buried by hand by the brothers of the community. After the burial, the sisters and children cover the grave with flowers. We call this “the last service of love” – the last time we can do something to care for someone’s physical body. And as Christians of course we know that it is not really the end.

Monika Mommsen lives with her husband, Marcus, at Woodcrest, a Bruderhof in Rifton, New York.


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