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!
Wednesday, January 16, 2013
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 11th
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 2nd 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 4th 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.
Saturday, 1/12: Charles B. Wang Community Health Center
On our last day of the trip, we had the pleasure of visiting the Charles B. Wang Community Health Center located in Chinatown. In addition to learning about the great work done at the Health Center as an FQHC, we also learned about the center's remarkable devotion to the vulnerable population in its community and its vital history of community activism.
The Charles B. Wang story is compelling, in part because it was initiated by members of the community who saw an unmet need and sought to address it. Thus, the Charles B. Wang Community Health Center was born. What initially began as a volunteer-run, free clinic has now blossomed into a Federally Qualified Health Center.
We were welcomed with great hospitality by the medical director, Dr. Perry Pong. He presented us with an unbelievable assortment of delicious food which was very much appreciated by some very hungry scholars.
We were definitely sad to see the conclusion of what had been a very informative visit. Dr Pong's geniality and warm reception was truly appreciated. We wish the center well and hope to be back soon!
Alumni Visits
During our visit, we had the opportunity to meet with several Dartmouth/Geisel alumni who offered great perspectives on their career choices and on practicing in an urban environment. In future visits, we hope to meet even more alumni and to continue to connect members of the Geisel family!
Dr. Jeff Schrager (’90) and Dr. Irvin
Sanchez (’08)
On Friday evening, we had the pleasure
of having dinner with two Geisel (or DMS to them) alums, Dr. Jeff Schrager
(’90) and Dr. Irvin Sanchez (’08). Hungry for some Italian food after landing
back in Manhattan after a busy day in Brooklyn and the Bronx, we enjoyed dinner
and conservation with Dr. Schrager and Dr. Sanchez about their careers and
experiences working in NY. Dr. Schrager, who works as a pathologist at LabCorp,
spoke to us about his work in lifestyle medicine, which utilizes lifestyle
interventions including behavioral, medical, and motivational principles, as a
key component of treatment and management of health. It was interesting to hear
how this work in lifestyle medicine initially grew out of his passion for
public health and preventative medicine, and eventually inspired him to become the
go-to person at his workplace LabCorp, coordinating wellness of his fellow
employees. It was also encouraging to see how very possible it is to integrate
other interests and pursuits into your career, even as a busy physician in NYC.
Dr. Sanchez, a current fellow in
Anesthesia at Columbia University Medical Center, talked to us about the
challenges of practicing medicine in an urban city like NYC. At the hospital
where he works, in Washington Heights, Dr. Sanchez has found that being able to
speak Spanish is key. (Good thing UHS has a Medical Spanish Elective!) He also
felt it served him well during his years of residency training in Dallas. As he
plans his next career move, with considerations of his wife and family, Dr.
Sanchez shed some light on the process of finding a job after (finally)
completing all those years of training. The decisions only get harder, it
seems!
Dr. Heidi Rowen (’95)
We went in already knowing we’d love
Dr. Rowen, an OB-GYN, as coming from the strong praises of Dr. Larry Ham, whom
a small group of us were fortunate enough to meet with yesterday at Bronx-Lebanon
Hospital. Former colleagues at the Women’s Health Clinic, Drs. Lam and Rowen
worked together for years, providing much-needed OB services to the huge
underserved and ethnically diverse population of the Bronx. Dr. Rowen, who
spoke French, was able to serve as a niche provider to the West African immigrant
population in the Bronx as word-of-mouth got out through that particular community,
in addition to the many other groups of women she saw during her 10 years of
practice there. The story of how Dr. Rowen ended up at Bronx-Lebanon Hospital was a
cool one, thanks in part to the National Health Service Corps (which places
primary care providers in areas with limited access to care and also provides
scholarship) and to Dr. Rowen’s insistence on ending up in the Bronx, after
having lived in NYC for her residency years. Dr. Rowen loved her 3-year stint at
Bronx-Lebanon so much, she ended up staying on for years after her committment.
It was amazing to hear her tell stories of just how different and important
cultural beliefs can be when considering health populations as diverse as in
the Bronx. She also spoke about the challenges of serving in an underserved
area, especially in OB. The legal challenges, the language barriers, patient
volume, the work-life balance… Over hot chocolate and spiced apple cider in Le
Pain Quotidien, she also shared her love for Dartmouth and after all her many
years of work, was able to say that the first two years of medical school were her favorite :-)
Along the way...
In addition to the amazing clinical experiences we had in the city, the Scholars also had an amazing time getting the opportunity to bond with one another and immerse ourselves in the city for a few days. Since the trip was comprised of first and second year Scholars, we thoroughly enjoyed the opportunity to get to know one another. Since there is not a lot of overlap between the first and second year classes at Geisel when it comes to coursework and other programming, the opportunity to develop such a close relationship between the two classes of Scholars was truly invaluable.
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| And yet, even in New York, we still found a little bit of home! Yes, we did stop and pose next to a Dartmouth Coach bus that we randomly saw pass us in Midtown Manhattan. And no, not one of us is embarrassed about it! |
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