Urban Health Scholars 2013 NYC Trip

Welcome to our blog! The Urban Health Scholars are a group of medical students at the Geisel School of Medicine at Dartmouth who are committed to working in urban regions with medically underserved communities. In addition to holding journal article discussions and working in urban areas in Vermont and New Hampshire, our group also has the opportunity to travel to other urban locations to learn as much as possible about the unique features of practicing in an urban environment. We have been lucky enough to get to travel to New York, Boston, Philadelphia, and Miami in recent years (with Chicago on the way!) and subsequently try our best to share all that we have learned with our classmates and other members of the Geisel community. In the blog posts that follow, we hope you will get a taste of what our most recent experience in NYC was like. We would like to give a huge THANK YOU to everyone that made this trip possible, including the Office of Multicultural Affairs at Geisel, our Geisel alums in the city, and all of the wonderful contacts that welcomed us into each of their sites. Thank you, and we hope you enjoy the blog!

Thursday, 1/10: Ryan Community Health Center

To start off our trip, the Urban Health Scholars first went to visit the William F. Ryan Community Health Center on the Upper West Side. As one of four sites for the Ryan Health Network, one of the oldest health organizations in the country,  this Federally Qualified Health Center was a great way to start immersing ourselves in urban health models at the primary care level. We were fortunate enough to get the chance to meet with Dr. Daniel Baxter, the Chief Medical Officer at the Ryan Center. Dr. Baxter took us on a tour of the 35,000 square foot facility, which included an adult medicine walk-in clinic, specialty services such as ophthalmology and podiatry, radiology, and the Women’s and Children’s Center.

In addition to showing us around, Dr. Baxter led us in a very candid discussion about health reform issues specific to urban populations. For example, while there is a huge population of medically underserved individuals in an urban system, there is still a lot of competition amongst providers for necessary resources and services to allow them to keep their doors open. When asked about the future direction of the Ryan Health Network, Dr. Baxter described a path in which the Network will try to balance the fine line of expanding to provide as much health care as possible while still maintaining a high quality of care at each of their sites. As one of the largest  health organizations in New York City, this was certainly a great way to start off our trip and to get all of the scholars excited about the possibilities of working in an urban health care environment!

Friday, 1/11: Bellevue Hospital and NYC Department of Health

We started off the morning on Friday the 11^th with a trip over to Bellevue Hospital, the flagship hospital of the NYC Health and Hospitals Corporation (the integrated health delivery system that serves all New Yorkers regardless of ability to pay).  Bellevue is an incredible hospital, holding the title of the oldest public hospital in the United States.  We sought out Bellevue for its commitment to serving vulnerable populations in New York and caring for a diverse patient population. We started by meeting up with Dr. Paul Testa, Dartmouth Alum and current EM attending at Bellevue, who described his journey from his home in NYC to Hanover for medical school, and then back to NYC again! Dr. Testa introduced us to Dr. Raj Gulati, who led us on a tour of the ER. Since most of Bellevue's facilities are not yet open yet after Hurricane Sandy, the ER is currently operating as a stand-alone emergency department. We felt incredibly fortunate to get the chance to tour this facility, and could not have met a kinder and more welcoming group of physicians, nurses and staff!

The tour included the ER and walk-in services area of the hospital, and we were able to get a feel for how Bellevue serves its complex patient population by posting signs in several languages, and sectioning off areas to cope with volume. The hospital has recently completed a push towards ensuring patients and providers can effectively communicate, installing translation phones in every patient and ER exam room. The staff at Bellevue emphasized the importance of patient education and has taken strong measures to ensure patients receive medical education and instructions in their native language. Dr. Gulati described how Bellevue’s ER meets the needs of patients from the homeless, to immigrants, to inmates and addresses the unique challenges of these populations. Dr. Gulati highlighted how the ER responded to Hurricane Sandy and continued to serve patients after losing power and coordinated among physicians, residents, nurses and medical students to evacuate hundreds of patients.  During the tour we got a real taste of the fast-paced life of an ER doc in a massive urban setting.

Next, Dr. Testa accompanied us across the street to the NYC Poison Control Center (part of the NYC Department of Health and Mental Hygiene), making sure to highlight the famous parts of Bellevue hospital along the way. Across the street we spoke with Dr. Silas Smith, Chair of the Disaster Committee and an Emergency Medicine Physician to learn more about emergency preparedness and how Sandy impacted the city of New York. Dr. Smith gave us an in-depth presentation on how the disaster committee made the ultimate decision to evacuate Bellevue and other hospitals during Hurricane Sandy.  We learned how NY hospitals were able to find placements for patients across New York State- no small task! He also described the populations that are at greatest risk during an evacuation including the elderly, young children, homeless, and those who are dependent on medical care.  Dr. Smith led a discussion with us exploring the challenges of evacuating an urban population, such as difficulty notifying populations without access to phone, radio or TV, language barriers, and limited access to transportation. This incredible presentation allowed us to appreciate the complex factors that go into an evacuation order, and the interconnected components that create an effective emergency preparedness plan.

Friday, 1/11: Bronx-Lebanon Hospital Center

After lunch, half of the group hopped on the subway and made their way up north into the Bronx for a visit to the Bronx-Lebanon Hospital.  Bronx-Lebanon is the largest voluntary, nonprofit health care system serving the South and Central Bronx (www.bronx-leb.org).  We met for about an hour with Dr. Larry Ham, Director of Gynecology at Bronx-Lebanon.  Dr. Ham was able to offer a great deal of insight into some of the major barriers to the delivery of care in a patient population that comes largely from a lower socioeconomic class and boasts a large degree of racial and ethnic diversity.  We chatted about a range of topics including the use of translator services at the hospital, some of the cultural beliefs and practices commonly encountered in his patients, and strategies for minimizing patient wait times and improving the patient’s overall hospital experience.  It was abundantly clear that Dr. Ham’s passion for serving in this community has only grown stronger over the years, and that while the patient population has its challenges, he finds his work incredibly rewarding.  He described the joy in helping a woman through her first pregnancy, and later having the opportunity to take care of the baby he delivered.  We all left Dr. Ham’s office with a little extra bounce in our step--knowing that we had just met a really great doc!

Friday, 1/11: Enterprise, Business and Technology High School

After finishing at the Public Health Department, 5 UHS scholars set out to the Enterprise, Business and Technology High School (EBT) in Brooklyn to talk about health careers. First step: get the VOX car out of the garage! You wouldn’t think this would be so difficult, but as it turns out, nothing can be as easy as you expect in NYC… After handing over our parking receipt, we waited while many cars were moved around. We were soon presented with a bright red sports car. Nice, but definitely not the VOX vehicle we brought with us from Dartmouth! After a few more minutes, we got our car back and headed for Brooklyn.

We were incredibly excited for our afternoon at EBT. Asha C. and Emily had worked hard to create an engaging and exciting curriculum that would combine hands-on activities with learning about health careers and issues of urban health. We had almost 90 junior and senior science students attend the afternoon, split into three groups that rotated so everyone got to experience each activity. In one room, Emily taught a mini-lesson about the spine and students got to try out the lumbar puncture simulation. Almost everyone got it on their first try! Joe and Bianca taught a lesson about the skull and concussions, starting some great conversations about the importance of concussion awareness in teen sports. Asha C. and Inyang spoke about the different paths they each took to medical school, emphasizing the variety of different ways to get where you want to be.

Students with Asha C. and Inyang participated in a discussion about education and urban health issues. Students first brainstormed different health careers and were presented with average salary information for some of these, along with the average national values for a college graduate, high school graduate, or person without a high school diploma. The students were able to have a great discussion about the things an education can “buy” you, including financial security, (a limo!) and job security for your future. They also learned about some of the significant health issues facing people living in urban areas. We used maps of New York City that showed diabetes and obesity rates and compared these to a map showing grocery stores selling fresh fruits and vegetables. This, along with other information about asthma hospitalization rates and SIDS rates by race and ethnicity, sparked some thought-provoking conversations with the students. By the end, some students were asking when they should start preparing for MCATS! We had a great time meeting the students and faculty at EBT High School, and are very much hoping to make this annual event for the Urban Health Scholars.

Saturday, 1/12: Walton Family Health Center

On Saturday January 12, 2013, the 1st year Scholars traveled up into the Bronx to participate in a healthy eating and diabetes seminar lead by Mariam Wood at the Walton Family Health Center, a federally qualified health center (FQHC).  The center is an expansion of the Institute for Family Health located in the Bronx, NY.  The center focuses on informing and caring for this community through primary care, behavioral health, dental, and diabetes care.  Mariam Wood led the discussion on healthy eating education for diabetic patients.  We practiced some AWESOME role-playing activities using real life scenarios!  Bianca Williams and Asha Clarke practiced a particularly interesting scenario depicting a woman who felt that if her obese daughter were to eat more healthy foods, then people would think that her family wasn't feeding her appropriately.  Asha Clarke (the mock physician) did an excellent job of convincing Bianca (the parent) to allow her daughter to join the volleyball team by utilizing her On Doctoring skills! Superb work, Asha!  Discussions on the effectiveness of educational programs in churches, barber shops, and nail salons catering to the needs of the community's population opened our eyes to the different strategies that can be employed in reaching out to a community. We were informed of the replacement of the old "food pyramid" guidelines with the "food plate" guidelines.  We were particularly impressed by the healthy Mexican plate ideas.  Delicioso!!!


The Walton Family Health Center facilitates this low-income minority community with insurance enrollment and social services.  Free clinics are also available for the uninsured on Saturdays.  This Saturday clinic is operated entirely by the medical students of Albert Einstein College of Medicine, with the help of two attendings, under their Einstein Community Health Outreach Program.  The clinic sees about 30 patients every Saturday and offers a sliding-scale fee payment plan for patients that qualify.  During our visit, we had the opportunity to shadow third year medical students and attending physicians at the clinic for a few patient visits. We were able to experience first-hand the economic, medical, and technological management efficiency that enables a successful clinic to operate smoothly.  Interacting with the students of the Albert Einstein College of Medicine was a lot of fun.  They were AWESOME, very much like our Geisel classmates!

Saturday, 1/12: The Institute for Family Health's Phillip and Sidney Hillman Family Practice

The 2^nd year scholars visited the Phillip and Sidney Hillman Family Practice, a primary care branch of the Institute for Family Health, and a site that we were fortunate to have visited on last year’s trip. We first met with Cristina McGeough, the site's diabetes coordinator, who gave us information on the Institute’s various health care centers, patient populations, and model of care. She was also gracious enough to prepare a brief info session on the nutritional management of at-risk patients from different cultural backgrounds suffering from diabetes. She emphasized the need for providing culturally specific and sensitive dietary recommendations to our patients as a way of potentially increasing patient compliance. We had a chance to role-play specific scenarios where such counseling tools were required, utilizing some of the highly practical educational resources in use at the clinic. She also discussed the "centering" model of group health care in the management of chronic conditions such as diabetes as an effective way of educating and supporting patients with these life-long diseases. One of our Urban Scholar journal discussions at Geisel actually focused on this model of care, so it was very exciting to see it being practiced at this health care institution.

Following Ms. McGeough’s session, we proceeded to the clinic floor, which on Saturdays happens to be the site of the NYC Free Clinic, a collaboration of NYU Langone Medical Center and the Institute for Family Health. At this Free Clinic, run mainly by NYU medical students (in a similar fashion to the Mascoma Clinic locally in New Hampshire), patients from diverse backgrounds receive basic primary care services irrespective of socioeconomic, health, or legal status. There we met with the 4^th year clinical coordinators who are the administrative backbone of the clinic, and the visiting attending physicians who- after giving us a quick overview of the clinic itself- placed us on clinical teams to observe patient visits with the various NYU medical students who were volunteering that day. It was a great experience as it allowed us to observe the outpatient management of conditions which are common to underserved urban populations including Asthma, HIV, etc.