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Santa Maria Sun / Cover Story

The following article was posted on October 7th, 2021, in the Santa Maria Sun - Volume 22, Issue 32 [ Submit a Story ]
The following articles were printed from Santa Maria Sun [santamariasun.com] - Volume 22, Issue 32

The Awareness Issue 2021

By SUN STAFF


Domestic violence advocates use self-care to combat burnout and shared trauma

BY TAYLOR O’CONNOR


SELF CARE
Miriam Ceballos has been a DVS advocate for four years and works with three other staff members.
PHOTO COURTESY OF DOMESTIC VIOLENCE SOLUTIONS

Calls about domestic violence crises became a daily occurrence at one Santa Maria shelter in September. 

“We get them all day and through the night; they are emotionally tough, but it’s no comparison to what the victim is going through,” Domestic Violence Solutions (DVS) Lead Advocate Miriam Ceballos said. “My coworkers and I were discussing that this has just been such a yucky month. It’s been intense.”

DVS Director Jan Campbell said that from July to August, DVS Santa Maria had a total of 536 crisis line calls, 400 bed nights, and 299 law enforcement calls. Numbers for September aren’t available yet, but Campbell believes calls continued to increase.

“What hit me is the level of lethality and violence that escalated in the North County area. We got a lot of calls from care providers—Dignity Health and Cottage Hospital-—where people had been hurt. This caused a huge decline in mental health,” Campbell said. 

The numbers raised Campbell’s concerns for advocates experiencing burnout and shared trauma—an emotional and cognitive response people can develop when exposed to others’ hardships. 

“When you’re dealing with people that are in trauma, advocates tend to take on the trauma of the person they are working with through empathy or compassion, but there are techniques to manage that,” Campbell said. 

Figuring out those techniques challenged Ceballos during her first two years working at DVS. 

Ceballos—who’s been an advocate for four years—starting working at Domestic Violence Solutions after working in the banking industry. She made the career change to help others since she had experienced physical, emotional, and verbal abuse in her home. She went to therapy, developed positive coping mechanisms, and believed she was in a good mental state to handle this kind of work.

However, she quickly learned that nothing had prepared her to work with domestic violence survivors. 

Ceballos saw victims of sexual abuse, suicide, and homicide. She visited clients at hospitals and received 2 a.m. crisis calls to come and save someone from their home. 

“I’d come home and bring work with me. I lost my appetite, and I wouldn’t eat dinner. I felt angry and frustrated—there were moments where I would just cry,” Ceballos said. “It was definitely overwhelming and crept over every aspect of my life.” 

In the days following hard calls, she felt like she had just run a marathon, she said. Although she was physically at work, Ceballos said she felt checked out mentally. She put her own emotions aside and pushed through in order to be there for her clients. 

Ceballos’ experience is common, DVS Clinical Director Carolina Najera-Magana said. Advocates are trained to be very empathetic, but the challenge is separating themselves enough to see outside of the clients’ emotions. 

“I’ve seen many advocates who are dedicated, passionate, and love the work, but the job wears on them,” Najera-Magana said. 

This causes high turnover rates for domestic violence advocates, she said. 

“People experience compassion fatigue and then, of course, just the stress levels physically. A lot of people decide this is something they cannot do long term. That is a result of not being able to manage trauma very well,” she said. 

As clinical director, Najera-Magana does clinical counseling and is on call for 24 hours when on shift. Debriefing—with Najera-Magana or other coworkers—is one of the ways that advocates can let go of the trauma, she said. 

“It’s a feeling of, ‘You need to take this, because I can’t take this anymore. I’m going home and I want to leave it,’” she said.

That sharing can lighten the load, and the advocate’s relief is “palpable,” Najera-Magana said. Oftentimes, advocates also need to hear reassurance that they handled a situation well, Najera-Magana said.

“It’s really important for the administration to acknowledge how hard the job is. Personal days are encouraged. If you’ve had a really gnarly day, it’s important to take a day for yourself,” she added. 

Self-care is something Najera-Magana and the administration staff push advocates to do—to take personal days or sick days so that they can take care of themselves. 

Ceballos said she preaches self-care to her fellow staff members and found her own practices.

“When I first started working here, I would not miss work at all because I felt a sense of responsibility, that I needed to be there to help the client step by step. … I understand now that I wasn’t doing myself any good. Now, I really do listen to myself and listen to my body,” Ceballos said. 

She talks about her client calls with coworkers only, and understands more about her own emotional boundaries.

“The clients I shared the most trauma with were Latinx females who experienced domestic violence for decades. There were clients that reminded me of my mother and brought back vivid memories,” she said. “If I had a case that had negative triggers, I would tell my coworkers to work on this case or I would move to work with a different family.” 

At home, Ceballos colors in coloring books or journals to bring down her level of anxiety and quiet her thoughts about clients. 

“I go home and tell myself, ‘I did everything I can. Now, it’s time to take care of me,’” she said. 

September, though, presented some challenges for Ceballos’ boundaries. 

“Even though I do practice healthy coping mechanisms, there are moments where I revert back to those old habits—where I want to take the lead on difficult cases because in my mind I want to protect the other advocates. I don’t want them to go through that and experience the trauma, but it’s not good for me to take all of that in,” Ceballos said. 

When feeling burnout this past month, Ceballos said she took time off to physically and emotionally repair herself.

“I want to be emotionally healthy so that I can be present at my job and be the best advocate I can be for my clients,” she said.

Reach Staff Writer Taylor O’Connor at toconnor@santamariasun.com.


Doctors say a drop in breast cancer scans last year could have repercussions on diagnoses for years to come

BY MALEA MARTIN


GET SCANNED
This 3D imaging machine at Selma Carlson Diagnostic Center in San Luis Obispo is used to detect breast cancer.
PHOTO COURTESY OF TENET HEALTH CENTRAL COAST

While breast cancer comes as a surprise to most who are diagnosed, some patients know their risk ahead of time.

This is the case for a patient of Dr. Colleen O’Kelly Priddy, a breast surgical oncologist and the medical director of Mission Hope’s breast center in Santa Maria. The patient carries a genetic mutation that significantly increases her chances of breast cancer, so she made the choice to get a precautionary mastectomy.  

“She was scheduled to have her regular screening mammogram, and then right after that she was scheduled to have her prophylactic mastectomies,” O’Kelly Priddy said.

But when COVID-19 hit, everything got pushed back for several months.

“Once she finally went back in and got her mammogram, she actually had a cancer,” O’Kelly Priddy said. “Instead of being able to just have her risk-reducing mastectomies, she ended up having to have chemotherapy, then have the mastectomy, and then have radiation afterwards. It turned into a much bigger deal.”

While the genetic mutation that this patient has is rare, it is highly recommended that every person with breasts over a certain age get screened annually for breast cancer. But scans on the Central Coast plummeted last year, and now doctors are seeing more late-stage diagnoses as a result.

“I have seen this in my own practice with delay in diagnosis due to COVID illness and women not coming in last year for mammograms or exams,” said Dr. Rosa Choi, breast cancer surgeon with Ridley-Tree Cancer Center. “I did as much telemedicine last year as possible and picked up cancers when women reported having lumps.”

Prognosis for breast cancer tends to be better when it hasn’t spread to the lymph nodes yet, but Choi said the medical community is seeing more of that.

“Reports from [the] United Kingdom and Canada suggest that there is a six-month delay in diagnosis with women coming in with larger tumors and more node-positive disease,” Choi said. “This may translate into [an] increase in breast cancer mortality by 30 percent in the next five to 10 years.”

Kitt Kelly, oncology patient navigator at Sierra Vista Regional Medical Center in SLO, said he has anecdotally witnessed more patients with late-stage breast cancer.

“There is no escape of accepting that, without screening, all the findings are later than they should be,” Kelly said. “If you have a breast cancer that’s growing, and you wait 18 months, you’re already way behind.”

With early findings, the chance of curing breast cancer is 94 percent, Kelly said. But with a late finding, chances of curing it drop rapidly, “with a lot of suffering along treatment.”

“This is not something that needs to happen,” Kelly said. “This is something that would not happen if the person [got their annual mammogram].”

Even before March 2020, doctors faced barriers in getting people to come in for their annual scans. The pandemic only compounded those challenges.

“When life is good and busy, and people are healthy and asymptomatic, they tend to put screening at the bottom of their list,” Kelly said.

Others avoid their annual mammograms because of radiation concerns.

“I reassure women that the dose of screening mammogram is equivalent to three months of ambient radiation from the environment, so it is safe to get mammograms every year,” Choi said.

Income can also discourage someone from getting their annual screening, but Kelly emphasized that most medical insurance covers mammograms, and for those who are uninsured, there are options.

“Throughout the entire state of California, there is a program called Every Woman Counts,” he said. “It’s run by Medicare. You can walk in or make a simple appointment and get your mammogram, and your care would be the same standard as those who have insurance. People think that because it’s free, and without a written order by a primary care physician, that somehow they will get a lesser care. That’s not true.”

According to the American Cancer Society, breast cancer screenings are optional from ages 40 to 44. Once someone turns 45, scans are recommended every year. For ages 55 and older, mammograms are recommended once every two years, though annual screening is still an option. 

Staff Writer Malea Martin can be reached at mmartin@santamariasun.com.










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What do you think about a farmworker resource center in Santa Barbara County?

It's a great way to create a network of collaboration and reach people in need.
It's been needed in the county for a long time and should have been made earlier.
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