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Impossible Dream?

My father, Richard Slepin, was a bit of a madman. Born in 1923 into an affluent Jewish family fraught with secrets and emotional drama, the resultant blurred boundaries influenced every part of his life. His chaotic childhood and unbridled brilliance yielded a kind-hearted, scattered, undisciplined, misdirected adult. He had a genius IQ, a kind and generous heart, a wildly funny, intelligent, and deeply thoughtful sense of humor, and a crippling lack of self-confidence. Of the approximately 6 years of my childhood spent in the same household as him, I witnessed and absorbed many of his ways.

He loved music. Mostly classical, show-tunes and opera, all of which played on his turntable on regular repeat rotations. A favorite of his was the score from the musical, Man of La Mancha. This score was my introduction to Cervantes' story of Don Quixote, the main character whose glorious quest was to "march into hell for a heavenly cause." Quixote's escapades included fighting windmills he perceived as dragons, making a tired, past-prime workhorse his noble steed, and falling in love with Aldonza, the local whore, renaming her Dulcenea, the princess of his romantic fantasy. Daddy, chasing his own windmills, wrote letters to editors and elected officials, justified stalking pro-golfers at the local country club, considering this a viable marketing approach for his certain-to-be-blockbuster golf instruction book, and sought to right social injustices. There were so many more causes, none of which he ever brought to fruition. He was 100% quirky.

These days, I live a quirky life, most definitely a departure from my days of "falling in", ascribing to a conventional recipe for success that included being in the Junior League, being a "lawyers wife", getting a graduate degree in nursing, and any other number of iterations of myself. I now live full time in an Airstream, aka the HepCarestream, and travel all over northern California, working with communities to help them develop strategies to eliminate hepatitis C (HCV). The intersection of my nursing background, the loss of my brother to addiction and end stage liver disease as a result of HCV, and my own survivorship of HCV all converged, thus creating an exclusive vantage point from which to address the epidemic at the local level.

Mostly, I love the work and the experience. I'm untethered to a brick and mortar home and this mobile living situation provides the opportunity to conduct informal ethnographic research where I am positioned to observe and interact with local communities in their real-life environments for extended periods of time. In this way, I help communities take steps toward solutions, even if they're baby steps. I've met so many interesting people, yet at times, this lifestyle can be lonely, Many of the counties I've worked in are, culturally, worlds apart from most of the urban and/or suburban places I'm accustomed to. I've had to stand up to the challenges of solitude and accept them as the dues I'm paying toward building nurse-led, sustainable solutions. These solutions will be in service to building an infrastructure that will support elimination of HCV by the year 2030.

Nurses bring a lot. We certainly need physicians and other allied health professionals as our partners for collegial broader thinking, for community of practice, and fulfillment of legal directives. But even without these partners, nurses move mountains. The basis of nursing practice is what we call the nursing process. In this process, we assess a situation, often quickly, and work with the resources on hand toward a solution. In this context, nurses get things done. When we meet barriers, we find ways over or around them at the fullest of our potential.

Virginia Henderson, a nursing theorist, defined the essence of nursing as follows:

"nurses assist individuals, sick or well, in the performance of those activities contributing to health, its recovery (or to a peaceful death), that they would perform unaided if they had the requisite strength, will or knowledge."

After 21 months of being on the road, the vision for my work has evolved and sharpened into building a nurse-led model of care delivery geared toward providing services to marginalized people, meeting them where they are. In this model, I intend to build services in rural syringe exchange programs where consumers can be treated for HCV, receive culturally appropriate education, and ultimately make choices for themselves in the context of harm reduction.

Determining what might be feasible in very rural areas required unconventional measures. I had to chase what some may think of as windmills. Yet, I know they are not windmills. Rather, they are problems that can be solved through a nursing lens in service of a cure for HCV. I started with an idea to get out into rural areas and help them become aware of the HCV disease burden in their geography, and then to take action on that awareness. Along the way, I've observed from an ethnographic vantage point and have learned many lessons that have laid a foundation for finding viable, community specific solutions.

I sometimes worry, particularly in light of my father's life, that I appear as Don Quixote; a windmill chaser. Yet something deep inside me tells me that the windmills I fight ARE dragons, and with innovation, nursing leadership, and funding, my impossible dream might just not be.

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