Seja Jackson, MS, APRN-BC, AAHIVS
St. Francis Hospital & Medical Center
Burgdorf Health Center
Seja Jackson’s primary practice setting is an inner city, community ambulatory care clinic; Burgdorf Primary Care Health Center of St. Francis Hospital & Medical Center in Hartford, lovingly known as “The Burgdorf.” They provide adult primary & specialty care, pediatrics, and gynecology care. The Burgdorf is a clinical teaching site for the University of Connecticut’s medical school. They also provide mentorships for nurses, nurse practitioners, and physician assistants from several other schools. The Burgdorf has a diaper bank, a food bank, and recently their director spearheaded a successful community garden, so that their community, which is located in a food desert, could have fresh, healthy food for much of the year. The Burgdorf has been a trusted, respected, and integral member of the Hartford community for over 30 years, with many staff caring for families for more than three generations.
Seja works with a team of providers consisting of herself, an Infectious Disease physician, a pharmacist, a medical social worker, an LPN, a medical case manager, and a nutritionist. They have approximately 200-250 patients in their caseload. Jackson’s daily patient visit statistics are variable from one to 15 patients per day. There are high no-show rates but also high walk-in rates. Seja says, “We are flexible with our patients, attempting to assist them to accommodate the many challenges they encounter in getting to the clinic and remaining in care. Approximately 50% of our patients are now over 50 years old. This is a shift from years ago when most of our patients were less than 40 years old. There is a preponderance of patients at either end of the age spectrum. We see a large number of young MSM of color at one end and a large number of people over 50 at the other end. We have a high proportion of patients with substance use and psychiatric issues. We have many undocumented patients. Most of our patients qualify for state assistance with insurance and for Ryan White programs.”
Seja has been treating people living with HIV since before the virus had a name, approximately 30 years or so. She attended SUNY at Stony Brook in New York for her BS in Nursing & Psychology, Framingham State University in Massachusetts for her Masters in Counseling, and the University of Connecticut for her Masters in Nursing. She is currently enrolled in University of Connecticut’s PhD Nursing Program with a subspecialty in HIV/AIDS. Says Seja, “I have practiced in many settings during my 40 year career. My preference has always been community based health settings such as the Visiting Nurses, Community Health Centers, or STD clinics. I was a nurse at Fenway Community Health Center in the 1970s to the early 1980s when HIV still did not have a name. I worked at the STD clinic of Boston City Hospital in the 1980s when HIV testing first became available, though there was no treatment. I then moved to Hartford and worked at The Burgdorf for five years, then Hartford Hospital’s ID clinic for seven years, and back to The Burgdorf for the last 13 years, which as I was told on my return, is ‘my home.’”
Seja recalls what motivated her to pursue specializing in HIV care; “Initially, I was motivated by two ideas. The first was when, as a visiting nurse, I became aware that nurses would not go to homes of anyone with that ‘bad disease that gay men got’ for fear of contagion. We actually wore double gowns, gloves and masks when we did give care because we had no knowledge to inform us otherwise. I believed that as a nurse I had committed to give care to all patients, even those with contagious conditions. The second reason was that I wanted to give back to my community and provide care for gay people in a way that, at the time, I knew was not being done in any kind of culturally competent way. I remained in HIV care because I found I loved it and it became a calling for me.”
Seja loves the challenge of working with the various marginalized populations that her clinic serves but sometimes finds those challenges frustrating. Says Seja, “The favorite part of my job is when a patient tells me that I have made a difference in their life, that they don’t want me to retire ever, or when they tell me of their successes such as completing college, having a healthy baby, or becoming clean and sober.” Seja acknowledges that obstacles come in many forms; from external sources such as grant rules or requirements, insurance regulations, and institutional processes or internal sources such as a patient’s inability to maintain adherence, to stop using drugs, or to keep appointments. Seja loves the intellectual challenges that are inherent in the field of HIV medicine. “A former attending physician once told me, ‘If you want to work in HIV you must know medicine.’ I have found that compared with many of my NP colleagues I am, out of necessity, much more knowledgeable about many complex situations. In HIV care we have to become astute diagnosticians, provide skilled physical exams, identify flexible treatment plans and provide intensive follow-up care, all of which makes for an exciting and interesting career.”
Seja motivates her patients to adhere to their treatment regimens by doing “whatever it takes.” She believes that the therapeutic relationship that a provider has with his or her patient is a critical factor in adherence motivation. Seja relates, “Our clinic spends time discussing all aspects of medication prior to starting medication and involving the patient in the choice of the medication. Patients are educated about side effects, correct administration, adherence and resistance. The patient talks with the APRN, the pharmacist, and the social worker before HIV medications are prescribed, identifying potential issues before starting medications. For those patients that are having adherence difficulties, we attempt to identity the problem and help the patient find solutions. If this is not successful, we offer incentives based on individual motivation. In our ‘Your Choice Program’ we have provided concert tickets, gift cards, and financed purchase of a keyboard and a turntable when someone who has extreme difficulty with adherence can demonstrate an undetectable viral load. We also use small, fun incentives such as ‘Winning Team’ trinket gold medals during the Olympics for achieving undetectable viral load. We have a ‘Ladies Breakfast Club’ for pregnant women who are having difficulty with adherence. A nurse brings breakfast to the patient wherever she wants to meet and watches her take her meds while they eat and chat, not only increasing adherence and decreasing transmission to the baby, but improving the relationship with their medical providers. We try to be creative, personally meaningful and very, very patient.”
“I think that one of the most successful parts of our practice is the team approach. This might not be possible in all settings, but when it is possible, it is invaluable. When choosing medication regimens we get input from the various disciplines and we find that we have a more comprehensive process. We share our knowledge and experience. We support each other when difficult or stressful situations occur. We motivate each other to remember why we are involved in this challenging business of HIV care.”
Seja hopes to finish her PhD and be able to teach and mentor students in HIV medicine and nursing. She realizes that, after over 40 years in nursing, she has a wealth of experience and knowledge. Says Jackson, “I would like to share with the new generation of providers. I would also like to do research that makes a difference for people living with HIV, for women, and for the LGBTQ community.”
Seja looks to the future and envisions a very different field of HIV care. She draws hope from cure research and newer injectable treatments. She envisions primary care providers serving as the mainstay for care for people with HIV and that HIV Specialists or Infectious Disease providers would be indicated in complicated or unusual cases. “I have always said that I would be glad to be out of a job if we could end this epidemic. I believe it is now a possibility,” Seja says hopefully.
Having recently started working with the City of Hartford Health Department’s new PrEP program, Seja is busier than ever. In her time outside of practice, Seja enjoys her supportive and beautiful wife, Setoria. They enjoy women’s basketball and have season tickets to the CT Sun’s WNBA. They love exploring new places, especially beaches. Seja has traveled many countries, often by cruise ship. Seja and her wife enjoy dancing, socializing with their friends, and being involved with fundraising for political and social causes.
Asked why she is a Member of AAHIVM, Seja says, “I felt that as a Nurse Practitioner, AAHIVM provided me with the professional credibility I needed to be viewed as a HIV Specialist. I particularly value the credentialing process, for which I had the fortunate experience to participate in the question development process for two years. I have remained a member for other reasons, especially my many years of participation on the NP Committee where I met other NPs experiencing a parallel career path. Several of these NPs are now friends as well as colleagues. I find this organization responsive, participatory, and genuinely committed to the mission of improving HIV care.”
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