Archive for 2008

Society for Community Health Awareness, Research and Action (SOCHARA)

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[This post, by Naveen Thomas, was originally published in June of 2005]

In January 1984, a group of doctors and other professionals who left their jobs in mainstream medical colleges started a community health study-reflection and action group in Bangalore, South India. Community Health Cell (CHC) which grew out of this group, was supported by the Centre for Non-Formal and Continuing Education, Bangalore, till 1990. In June 1990, the project was reviewed and the Society for Community Health Awareness, Research and Action (SOCHARA) was established and registered. Community Health Cell became its functional unit.

As the name suggests, the main aim of SOCHARA was to promote community health awareness, action and research. SOCHARA’s mandate also included evolving educational strategies in Community Health and Development. SOCHARA recognised the need to dialogue and participate with policy makers and implementers to enable the formulation and implementation of community oriented health policies. As a part of efforts to promote community health, SOCHARA also established a library, documentation and interactive information center in Community Health.

SOCHARA consists of 32 members who are distinguished in their own areas of work. CHC, the functional unit of SOCHARA consists of a small core team of 20-25 people, including health and social science professionals, office and library team, research and training assistants, supported by a large informal network of professional associates and friends. The strength of SOCHARA has been its wide network leading to a rich and diverse web of interaction among persons and groups involved in Community Health in India and across the globe.

SOCHARA/CHC have been involved in participatory community health training at middle and grassroots level, primarily with voluntary agencies in South India. On the medical education front, CHC collaborated with the Rajiv Gandhi University of Health Sciences, Karnataka to reorient the vision and mission of medical colleges, to improve their management and to introduce medical ethics, rational drug education and other socially relevant topics in the medical curriculum. In addition, SOCHARA/ CHC were also involved in research on strategies for social relevance and community orientation of Medical Education and follow up initiatives with colleges and universities.

Promotion and awareness building concerning rational drug prescribing, rational drug policy, patents and alternative systems of medicine is another area of SOCHARA/ CHC’s functioning. SOCHARA/ CHC also took an active part in the recent Global Campaign against Indian Patents Amendment (GCAIPA).

SOCHARA/CHC has been providing active support to research and awareness building on environmental health issues including mining, Bhopal gas disaster, etc. The other disasters that SOCHARA/ CHC has been actively involved in facilitating relief and rehabilitation efforts include the Bangladesh cyclone disaster, Uttarkashi, Marathwada and Kutch earthquakes and Tsunami in Southern India.

Over the past two decades, SOCHARA/CHC have been motivating and guiding young professionals who were in the process of reflecting about their personal interest or commitment to community health. They spent 3 – 12 months in CHC where they went through a learning process that was person-centred, with peer support, short assignments, self-study, presentations, writing of reports, etc. Today, over 95% of the professionals continue to work in the area of community health.

A review of SOCHARA/CHC in 1998 and subsequent reviews suggested that CHC expand its training and mentoring role. As a result, a Community Health Fellowship Scheme commenced in April 2003, providing an opportunity for young professionals to learn about community health and its various options by involving themselves in a person-centred, semi-structured training programme. This role of SOCHARA/ CHC is being further consolidated, and CHC is evolving into a research and educational centre in community health, public health and health policy.

The other area in which SOCHARA/CHC has been greatly involved is in building a people’s movement in health. The SOCHARA/ CHC review had also suggested that CHC utilize its network and relationships built over the years to contribute to a mass movement in health. This came true in 2000 A.D., with the Indian Health Assembly held in Calcutta, India and the first People’s Health Assembly (PHA-1) being held in Savar, Bangladesh in December 2000. CHC contributed in mobilizing people and organisations, and in conducting both these assemblies. CHC was also deeply involved in the formation of the People’s Health Movement (PHM) and in drafting of the People’s Charter for Health.

In 2002 two years after the first PHA, PHM secretariat was shifted from GK, Savar to the PHM India region, and CHC was asked to host it on behalf of region. Ravi Narayan is currently the co-ordinator of the PHM Secretariat (Global) based at CHC, Bangalore. The People’s Health Movement has come a long way, and five years after its formation, is getting ready to host the second People’s Health Assembly (PHA-2) at Cuenca, Ecuador in July 2005.

To know more about SOCHARA/CHC, get in touch with us, or email Thelma Narayan, the co-ordinator of CHC.

Naveen I. Thomas, Health Policy Fellow, CHC (June 2005)

Medical Education Conference in Havana: Nov 30- Dec 3 2008

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A conference entitled Medical Education for the 21st Century: Teaching for Health Equity will take place in Havana from November 30 – December 3, 2008. Among the groups participating in this conference are PAHO, ALAMES, the Global Health Education Consortium (GHEC), MEDICC and the Cuban Ministry of Public Health. The deadline for submission of abstracts, which can be done on-line, is June 30th.

US citizens are subject to severe restrictions on travel to Cuba (see a discussion at the following link). Arrangements must be made through Marazul Travel Service. The Marazul website offers specific information on travel restrictions including guidance from the Office of Foreign Assets Control (OFAC) of the US Treasury Department.

it is important to remember that these restrictions are an real and important infringement on the free flow of people and ideas between Cuba and the United States. As the ACLU has pointed out: “There is no reason why Americans shouldn’t be able to practice their constitutional right to travel freely to Cuba.”

Social Medicine Rounds 2007

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Ernie DruckerJanuary 16: 4:30-6pm

Binswanger Auditorium

Ernie Drucker, PhD

“A Plague of Prisons –

The Epidemiology of Mass Incarceration”

America is now in the 30th year of a great epidemic – one of the most devastating in our nations history. It has already stolen more years of life from Americans than Yellow Fever or Cholera did in the 19th century or AIDS in the 20th. But unlike these afflictions, this epidemic is not caused by a deadly new virus or bacteria. It is self inflicted – the result of deliberate social policies. Hundreds of federal and state laws mandate it and the expenditure of a great fortune have financed it – more than $1 trillion in public funds over its 30-year course. This great American epidemic is mass incarceration – a plague of prisons.

Today there are millions of Americans behind bars – over 10 times the number we had 30 years ago – fueled by millions of arrests of the war on drugs, long mandatory prison sentences, and high rates of recidivism. The famous revolving door of the system puts 67% of re-entering prisoners back inside within 3 years of their release. Even a decade after drug use and crime declined sharply (reaching historic lows in 2005) the progression of epidemic incarceration is relentless – in 2006 there were over 1000 additional inmates put in prison each week, reaching 2,700,000 by Jan 1, 2007. Yet, despite its vast scale and profound effects on the lives of tens of millions of American families, this epidemic goes largely unrecognized. Indeed, for most Americans, massive imprisonment is not seen as a problem at all.

Mass incarceration in America disproportionately affects minorities. Only 1% of the country’s white adult male population is in the criminal justice system; but for blacks and Hispanics the figure is 13 %. In most big cities, 50% of all the African American males have been incarcerated in their lifetimes – in Washington DC the figure is over 85%. For the hundred years from the end of slavery to the 1970s, blacks were incarcerated at 3 – 4 times the rate of whites. Today that ratio is 12 to 1; for drug offenses it is 40 to 1 – despite evidence that blacks use illegal drugs at the same rate as whites

And this epidemic has another “hidden” face – an even larger population, none of whom are in prison, but who are powerfully affected – the “collateral damage” of mass incarceration. Tens of millions of children, wives, parents, siblings and other family members of those incarcerated over the course of the 30 year epidemic of incarceration. They are concentrated in the mostly urban minority communities targeted for mass arrests, and while innocent of any crime, they are also punished by the effects of incarceration, just as surely as if they were convicted. In this 30 year epidemic over 25 million American children have been directly exposed to parental incarceration. They are the “innocent” victims of the war on drugs – the children of the “feeder communities” where the epidemic of incarceration affects everyone – more damaging even then the drugs and other crimes that are the rationale for the arrests. In these communities incarceration has become the norm – spawning successive generations of prison orphans and gang members. Over 90% of all the extended black and Hispanic families in the US must by now have had a member incarcerated in the last 30 years.

This presentation will paint an epidemiological portrait of this great plague. The goal is to focus on the scale, structure, and effects of large-scale imprisonment – seen as a public health problem – with measures of disease, disability, and the loss of life that all epidemics bring with them – the closest thing we have to universal measure of human worth. I will also talk about some of the people and programs that are the “plague fighters” – individuals and organizations who are fighting mass imprisonment and beginning to turn the tide of this terrible epidemic.

Note: Mass Imprisonment was also discussed by Robin Steinberg of Bronx Defenders during Social Medicine Rounds of May 2, 2006

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February 6:

Residency Program in Social Medicine

3rd Floor Conference Room

4:30-6:00 PM

Megan Charlop, MPH and David Appel, MD,

Montefiore’s School Health Program:

A Unique Model of Primary Care

The Montefiore School Health Program is the largest school-based health program of its kind in the country, with more than 13,000 children registered in 13 schools in the Bronx – five elementary, one K-8, two middle and five high schools.

All Montefiore school-based health centers provide comprehensive primary care services. The program has a particular interest in improved asthma care. Mental health services focusing on depression, anxiety, bereavement, crisis intervention and family issues are available at each site.

The high school centers offer comprehensive adolescent health care including reproductive health care services that provide pregnancy testing and prenatal care; options counseling; family planning; screening, diagnosis and treatment of sexually transmitted diseases including HIV counseling and testing; and routine pap tests for sexually active girls. A mobile oral health program visits each elementary and middle school program, providing preventive care as well as minor reparative work.

Dr. David Appel was designated one of New York Magazine’s most “Influentials”of 2006. Dr. Appel has been one of the most visible faces and audible voices advocating for children’s access to quality, comprehensive primary care and mental health services in school-based settings. For more information on Dr. Appel, click here. For a brochure about the program, click here.Some articles describing the program are available at the following links:Burden of Asthma in Inner-city Elementary Schoolchildren: Do School-Based Health Centers Make a Difference? Arch Pediatr Adolesc Med. 2003;157:125-129. Impact of Asthma Intervention in Two Elementary School-Based Health Centers in the Bronx, New York City. Pediatric Pulmonology 40:487–493 (2005)

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February 27

4:30-6PM

Rounds in the Community:

Visit to the Ahmadiyya Community Center

Muslim Law and Culture

in the Doctor-Patient Relationship

Imam I.H. Kauser and Dr. Shaded Ahmad will discuss issues related to the medical treatment of Islamic patients. A Halal meal will be served by Imam Kauser’s congregation following the presentation. The Ahmadiyya Community Center is located at 3421 White Plains Road (between a gas station and law offices). This event is a chance to explore many questions related to our practices in the treatment of Muslim patients such as:

1. What is relevant culture/law/expectations regarding female/male dress/undress and touch during physical examinations?

2. What is relevant law during Ramadan and any other designated time in Islam regarding fasting, the taking of medications, water for people who may be frail and dehydrated, etc.

3. What is the advisable way for a physician to greet/say goodbye/wish good health, etc. to an Islamic patient?

4. Are there cultural and/or family issues we should be aware of related to recent immigrants from Bangladesh/West Africa of Muslim faith?

This Social Medicine Rounds was featured in an article in the New York Times
by Clyde Haberman published on March 6, 2007 entitled: “At Mosque, Doctors’ Ways Get an Update”:

“As the city’s population continues to change, pretty much everyone must come to grips sooner or later with new realities. Exceptions are
few. They most definitely do not include doctors.

“And that is why about 20 attending physicians and residents at Montefiore Medical Center found themselves in a small mosque in the
Bronx the other evening. With not a Muslim in the bunch, they were there for a quickie course on how Islamic law and customs can affect
patient-doctor relationships — from womb to tomb, with much of life’s messiness in between. […]”

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March 6: Global Health Month

Residency Program in Social Medicine

3rd Floor Conference Room

4:30-6:00 PM

Viewing of the Film “Salud!”

Produced and directed by Academy Award nominee Connie Field, the film tells the story of Cuba’s unique and highly effective health system and how it brings its community-oriented and preventive model to medically under-served nations in other parts of the world. The film also takes viewers inside the Latin American School of Medicine (ELAM) in Havana where 12,000 low income students from 27 countries-including about 100 from the USA-receive a free education in exchange for pledging to return to poor communities when they graduate. In this school, as in all other medical schools in Cuba, the goal of the curriculum is to produce doctors committed to public service. The film probes the motivations of the students attending ELAM and traces the opinions and competing agendas that mark the battle for better global health. For more information visit the Film’s website.

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March 20: Global Health Month

Residency Program

in Social Medicine,4:30-6PM

3rd Floor Conference Room

Darin Portnoy, MD, MPH

Medical Humanitarian Aid Organizations:

Present Crises and Future Challenges

Doctors without Borders (www.msf.org) is the world’s largest medical humanitarian aid organization, working in over 70 countries bringing direct medical assistance to populations in need. In more than 30 years of work this group has worked to alleviate suffering and to speak out often and strongly for those that have no voice.

Much has changed since the organization was founded, and humanitarian aid workers now routinely arrive to work in extremely complicated and politically charged environments. Hundreds of international organizations now undertake medical humanitarian work. And while this ought to translate into less need and diminished crisis around the world, this has not been the case.

Using the example of Doctors without Borders and the contexts where the organization is now active, Dr. Portnoy will explain the work of humanitarian aid organizations. In the presentation he will explain how an organization chooses where to work, how it works and how it decides when to leave a particular country. And he will discuss some of the world’s most neglected and underreported crisis and share his impressions of what organizations can expect to confront in coming years.

Dr. Portnoy is an Attending Physician, Montefiore Medical Group Family Health Center and President, Doctors Without Borders/Médecins Sans Frontières (MSF) USA. He has worked with Doctors without Borders/Medecins Sans Frontieres (MSF) for nearly 10 years and since 2004 he has been the President of the US section of MSF. He joined the organization in 1997 as a field doctor and later field coordinator for tuberculosis treatment and control programs in Uzbekistan. After an exploratory mission to Turkmenistan, in 1999, he ran cholera programs in El Salvador. He left for Georgia the following year, coordinating emergency health care for Chechen refugees. In 2003, he worked as a medical coordinator for sleeping sickness and primary health care programs in southern Sudan. And in 2004 he opened medical programs in the isolated northern part of Liberia. He was last in the field just over a year ago, in Nigeria, where he worked with a team to set up MSF’s emergency program to treat a measles outbreak.

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April 17

4:30-6PM

Moses II Conference Room

Walter Lear, MD

Pediatrician Activists

For information about Dr. Lear, please consult our posting: A Visit with Dr. Walter Lear.

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May 1: 4:30-6PM

RPSM 3rd Floor Conf. Room

“How We Get Better:

Family Medicine Residents and Practice Based Learning

and Improvement”

Convener: Victoria Gorski, MD
Presenters: Family medicine PGY-3s

This forum will feature presentations by the four resident/faculty/staff CQI teams of the Family Health Center and Williamsbridge Family Practice. Dr. Gorski will present a brief overview of CQI and its relationship to the ACGME competency “Practice Based Learning and Improvement”. Each team will present its work on behalf of improving tobacco cessation rates or improving parameters of diabetes care at the clinical sites. A discussion will follow on the implications of the teams’ work in fostering clinical quality improvement and resident learning/competency development.

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May 22, May 29th, June 5 4:30-6PM

RPSM 3rd Floor Conference Room

Social Medicine Project Presentations

Dr. Jamal Harris
Quality Improvement: HIV Testing of the Children
of Adult Patients in a HIV Treatment Program

During the summer of 2006, we conducted a quality improvement project to enhance family based care at Sinikithemba, the HIV/AIDS care program at McCord Hospital in Durban, South Africa. The project included revising the family care page with the introduction of an electronic version and a focus on the testing of children. To complete the project we conducted a retrospective chart review, staff interviews, focus groups, and staff trainings.

Dr. Manel Silva
Adolescence: At-Promise Group
Comprehensive health education as a primary prevention for HIV

Dr. Kathryn Scharbach
Development of a Pain Management Curriculum for Pediatric Residents

Inadequate treatment of pain has been a problem in children. Racial and ethnic minorities are at risk for problematic access to pain care and poor pain assessment, and often receive inferior treatment for their pain complaints. The goal of this project was to expand the “Pain Curriculum” for pediatric residents at CHAM. A survey was conducted among Pediatric Housestaff to assess: knowledge about and comfort with managing pain, perceived barriers to pain management, and preference for learning methods. Based on the results of this survey a morning lecture, two case conferences and an EBM session were created – these educational sessions were conducted in collaboration with the Pediatric Palliative Care Service and the Pediatric Pain Service. Finally, a post survey will be distributed to test the effectiveness of a pain management curriculum on improving knowledge & confidence.

Dr. Homer Venters
Bringing Primary Care to Legal Aid:
A Collaboration Between CHCC and the Bronx Defenders

Montefiore Comprehensive Health Care Clinic (CHCC) is located within one block of the Bronx Defenders, a legal aid agency that represents 12,000 criminal defense clients per year. For 2 1/2 years, we have collaborated in assessing the need for primary care services among Bronx Defenders clients. One medical resident has spent over 200 hours at Bronx Defenders helping clients with medical questions and reestablish prior medical care. For those who wish (approximately 1/3 of clients met), appointments were made at CHCC for medical care. This collaboration has joined the resources of two advocacy groups in the South Bronx with the goal of helping legal aid clients when their medical care is interrupted by arrest or other criminal justice system contact.

Dr. Sean Misciagna
My Diabetes Visit Summary: A quality improvement effort
arising from an innovative approach to diabetes as
described by the Chronic Care Model

Historically, medicine has been designed to care for acute needs, and has been poorly equipped to deal with the chronic illness that many of our patients face. Diabetes is an example of this. In order to achieve quality care and improved outcomes, the Chronic Care Model was developed. My Diabetes Visit Summary is an example of a quality improvement effort that supports this model.

Drs. Melissa Tesher and Sarah Siegel
Use of a pocket guide to improve resident knowledge about,
and comfort with, breastfeeding support

Breastfeeding rates are generally lower in poor, urban communities. We evaluated knowledge about, and confidence with, breastfeeding guidance amongst residence physicians serving such a community. We then sought to improve residents’ confidence and knowledge by creating a pocket-sized breastfeeding guide, and evaluated the usefulness of this educational tool.

Dr. Misha Kogan
Spirituality in Family Decision Making in End of Life Care

Purpose: To understand the role of spirituality and spiritual values in family decision making at the end of life. Methods: Researchers observed 24 family meetings between house staff and families of patients who are unable or unwilling to make decisions. Semi-structured interviews were conducted immediately after initial meetings and at set time points including post-death follow-up. Using standard qualitative methods, we examined spiritual themes and functions emerging in family meetings and follow up interviews.

Drs. Carlos Victorica and Angela Vidal
Parenting behaviors of Bronx adolescents,
and the influence of a high school based parenting class intervention on parenting stress

Parenting behaviors and stress in the adolescent parent population can account for significant risk of morbidity to neonates, and has resulted in lower amounts of infant bonding and cognitive scoring. Our original project had hoped to assess the intervention of a physician assisted parenting program at Martha Nielson High School. Unfortunately, after several setbacks, the project was re-directed as a program in “responsible sexuality” at Marble Hill High School for International Studies. The new goals were to qualitatively assess some of the attitudes and beliefs of these adolescents with regards to STD’s, HIV, pregnancy and their management by physicians.

Drs. Ana Matos and Denise Reyes
Voluntary Counseling and Testing
and the HIV Partner Notification Project in Guatemala

The Guatemalan Health Law mandates a system for notification of partners of HIV-positive patients. This project followed in the footsteps of former resident Dr. Amy Miglani and was under the guidance of Dr. Matt Anderson. It included the feasibility of beginning a partner notification system in Guatemala and the pilot of a pre- and post-voluntary counseling and testing questionnaire to assess risk factors, effectiveness, and risk behavior change in patients presenting for HIV testing.

Dr. William B Jordan
HIV Prevention in a Community Mental Health Setting

HIV prevalence is high in the south Bronx and higher among those with chronic mental illness. Past HIV prevention classes for

community-dwelling populations with chronic mental illness demonstrated persistent effects on knowledge and behavior. No programs of this kind exist in the Bronx. This project attempted to demonstrate the feasibility of an HIV prevention workshop for people with chronic mental illness in the south Bronx. Retention rates were improved with incentives. Recruiting new students was challenging. Survey results trended towards improvement in knowledge and self-efficacy, but the sample size was too small for formal analysis.

Elizabeth Natal, MD
Patient-Physician Perceptions regarding Breastfeeding Counseling at Montefiore’s Family Medicine Community Health Centers

A study looking at what both physicians and patients believe is being done with regards to breastfeeding counseling at the clinics. An important focus of the study was to identify the key periods when patients were making decisions regarding infant feeding practices and the associated influencing factors. Another focus was to identify areas where we can mainstream efforts to continue current successful practices, as well as make overall improvements in less approached areas. The study is a quantitative retrospective study and data was collected through one time patient and physician surveys.

Aaron Fox, MD
Perceptions of health and housing
in an unstably housed HIV infected population

HIV-infected individuals, particularly those with unstable housing situations, have difficulty maintaining adequate access to health care. 14 semi-structured interviews were conducted with HIV-infected residents of single room occupancy (SRO) hotels in New York City. The interviews established detailed timelines related to housing status and health care following HIV diagnosis. For most individuals, diagnosis of HIV was followed by a period of chaos, which often included loss of housing, escalating drug use, and worsening self-care behaviors. Competing priorities negatively affected health care. The need for housing resulted in frequent moves, which disrupted continuity of medical care, and food insecurity impeded adherence with medications. Ultimately, when considering health care for HIV-infected marginalized populations, housing must be addressed as a vital component.

Rupali Kotwal-Doshi , MD
An Intimate Partner Violence Educational Program For Medical Residents

Primary care physicians frequently report feeling unprepared and uncomfortable with intimate partner violence (IPV), leading to low rates of screening and detection. To improve screening rates and comfort levels with IPV, a longitudinal, three-level educational intervention for internal medicine residents about IPV screening and management was developed and implemented. Data from the baseline questionnaire about knowledge, attitudes, and behavior about IPV will be presented, as well as follow-up data from the PGY-3 residents who participated in the first session. Overall, we detected low rates of screening and low levels of comfort with management of IPV among the study participants.

Catherine DeGood, DO
Abortion in Primary Care

A Needs Assessment Survey of Female Patients. A descriptive survey to assess the acceptability and desirability of early abortion provision at a residency-based family medicine office.

Carolyn Chu, MD
Social Medicine In Practice

Development of complementary audiovisual materials for “Social Medicine”, a new online journal devoted to the promotion of social medicine. (www.socialmedicine.info).

Dr. David Herszenson
Health care proxies in the outpatient setting:
Needs assessment and intervention

As our population ages and our ability to prolong life increases, it has become more and more important that those who treat adults in a primary care setting have discussions about advance directives. The health care proxy, the agent who makes decisions on behalf of the patient who is otherwise unable, is considered by many to be the most important component of one’s advance directives. This project includes an assessment and intervention at one of Montefiore’s outpatient clinics in regards to discussion and completion of the health care proxy.

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June 19, 4:30-6PM

Binswanger Auditorium

BCHN: Bronx Community Health Network

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July 3

RPSM goes to the Movies:

SiCKO

Clearview

Bronxville Cinema

Web sites related to the film:

Michael Moore’s official website for the movie is located at MichaelMoore.com

Physicians for a National Health Program created a website devoted to SiCKO which is available at www.sickocure.org.

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Amy Goodman hosted “An Hour with Michael Moore on ‘SiCKO,’ his Trip to Cuba with 9/11 Rescue Workers, the Removal of Private Healthcare Companies & the Healthcare Policies of the 2008 Democratic Candidates” on Democracy Now: www.democracynow.org.

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July 17:

Judy Sheridan-Gonzalez, RN (NYSNA)

Peter Barland, MD (PNHP)

SiCKO:
A discussion forum

3rd floor, RPSM

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August 7:

Dr. Penny Grant,

Methamphetamine labs: effects on children

Binswanger Auditorium

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September 4:

Lois Uttley, MPP,

Medicine and Morality:

The Impact of Faith-based Health Restrictions

on Patients’ Rights and Access Care

Binswanger Auditorium

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September 18, 4:30-6PM:

Linda Landesman, MSW, DrPH

Steven Safyer, MD

The Berger Commission Report:

What has been its Real Impact?

Binswanger Auditorium

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October 2, 2007

4:30-6PM

Camara Jones, MD

The Impact of Racism on the Health of Our Nation

Binswanger Auditorium

Camara Phyllis Jones, MD, MPH, PhD is Research Director on Social Determinants of Health in the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.

Dr. Jones is a family physician and epidemiologist whose work focuses on the impacts of racism on the health and well-being of the nation. As a methodologist, she has developed new methods for comparing full distributions of data (rather than means or proportions) in order to investigate population-level risk factors and propose population-level interventions. As a social epidemiologist, her work on “race”-associated differences in health outcomes goes beyond documenting those differences to vigorously investigating the structural causes of the differences. As a teacher, her allegories on “race” and racism illuminate topics that are otherwise difficult for many Americans to understand or discuss. She hopes through her work to initiate a national conversation on racism that will eventually lead to a National Campaign Against Racism.

Several of Dr. Jone’s papers can be downloaded here:

Levels of Racism: A Theoretic Framework and a Gardener’s Tale

“Race,” Racism, and the Practice of Epidemiology

Confronting Institutionalized Racism

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October 9, 5-6PM:

Nassim Assefi, MD

Why I left Medical Academia and
Global Health to Write Novels”

Binswanger Auditorium

Nassim Assefi (www.nassimassefi.com) is a writer and doctor specializing in women’s health and global medicine. She is the author of Aria (Harcourt, May 2007, and 5 foreign presses), an epistolary novel that explores the trajectory of maternal grief for an oncologist after the death of her only child. She has published a piece in This Side of Doctoring, an anthology of true stories by women in medicine (Sage Press, 2003). She is currently at work on her second novel, Say I Am You, set in post-conflict Afghanistan, where she was a humanitarian aid worker rebuilding health infrastructure for two years and an underground salsa teacher. She currently volunteers in the Women’s Clinic at Harborview, the county hospital affiliated with the University of Washington School of Medicine, where she was once full-time faculty and director of the abortion clinic. Nassim has now left a beloved post in academic medicine and the frontlines of international women’s health (where family planning really does save lives) to write fiction full-time. Come hear why she believes her social justice work is more effectively delivered as a writer and speaker, and why her only aspirations for medicine are now as a volunteer doc.

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October 16, 4:30-6PM:

Robert Ruben, MD

History of deaf culture

and treatment of hearing-impaired populations

Binswanger Auditorium

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November 13, 4:30-6PM:

Dr. Phuong

Health Impacts of Agent Orange

in South Vietnam

Binswanger Auditorium

To learn more about the campaign to clean up Agent Orange in Vietnam, visit the website of the Vietnam Agent Orange Relief & Responsibility Campaign. For learn about Dr. Phuong, click here.

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November 20

4:30-6PM:

Intern Orientation Project Presentation

Binswanger Auditorium

The 2007 Orientation explored the impact of violence on our clinical practices. This was done through indepth discussions of three actual cases. One involved issues of mass incarceration, the second domestic violence and the third concerned a political refugee, Victor Toro (shown above with Dr. Lanny Smith).

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December 11:

New York City Research and Improvement Networking Group (NYC RING) Convocation

Nurses’ Residence, Jacobi Medical Center

School of Social Medicine Genogram

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School of Social Medicine Genogram and Next Generation Medical Education

When Merle Cunningham MD came to visit the School of Osteopathic Medicine in Arizona (SOMA) the other day, the topic got around to the merger of two fine family lines. Merle has been active in Community Health Centers, NACHC, the National Health Service Corps, and health care access in NYC. He has been instrumental working through NACHC and Gary Cloud to help make SOMA a reality.

Forrest Lang MD was the second family line. He took his Social Medicine training to NHSC, Appalachia, East Tennesee State, and the Appalachian Preceptorship. I have the honor of being his adopted mentee. He brought me to TN and helped me to develop the ETSU Rural Fellowship, the Minifellowship, the Rural High School Career Fair, and the initial work toward the Mountain City rural site. One of the Rural Minifellows, faculty that were developing rural programs, was Tom McWilliams DO. His rural program for the Minifellowship was the revision of the Kirksville family practice preceptorship. Much “Social Medicine” type collaboration was involved in the Rural Minifellowship.

Tom McWilliams moved on to develop the first osteopathic school in Arizona at AZCOM and then the new ATSU SOMA, working back with the Kirksville folks. The preferential admissions process used was borrowed from my work which was borrowed from the various interactions with the Rural Minifellows. Tom hired me, Forrest Lang’s mentee, to come to Arizona to help develop this new school. Tom also shares NHSC background and helped recruit Barb Doty who helped found the Alaska FP training program that has top rates of underserved graduates in CHC And Native Consortia practice locations (about 43%). The Minifellowship, like the School of Social Medicine, helped keep ideals and ideas alive to translate them into action.

The School of Osteopathic Medicine of Arizona works with CHCs to funnel in applicants familiar with work with the underserved. SOMA admits medical students with a top priority on service orientation. The top priority is a match to the mission of returning them to CHC locations as long term primary care physicians. After one year at Mesa AZ, the medical students depart Mesa for sites from Hawaii to Brooklyn. The first class will begin in Brooklyn at Sunset Park in a few months. One of the faculty hired here at the same time was a lab tech at Sunset Park, Noel Carrasco, MD. who later did research, U Autonoma De Guadalajara, Neonatology, and Complementary and Alternative work with Andrew Weil.

Just wanted you to know that some epidemics are worth spreading and the School of Social Medicine is one of the best vectors.

When the new medical students arrive at Sunset Park, might just be worth “completing” their training where it began.

Robert C. Bowman, M.D.
rcbowman@atsu.edu

Social Medicine Rounds 2006

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January 17:

Emily Jackson
Rounds in the Community:
“A Visit to the Bronx
Lesbian and Gay Health Resource”

Founded in 1996 by health care practitioners and activists as a source of health information and social services, the Bronx Lesbian and Gay Health Resource Consortium has become the only center for the gay and lesbian community in the Bronx. We will be visiting the consortium and speaking with program developers and community members in an effort to learn more about this unique cultural group in the Bronx.

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February 7:

Emmanuel d’Harcourt
IRC : Recent Projects of the
International Rescue Committee
3rd Floor Conference Room, RPSM

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February 21: 4:30-6PM
Jeffrey D. Sachs
“The Millennium Development Goals”
Cherkasky Auditorium

Professor Jeffrey D. Sachs is the Director of The Earth Institute at Columbia University and the UN Millennium Project. He also serves as a Special Advisor to United Nations Secretary-General Kofi Annan on the Millennium Development Goals. The Millennium Development Goals are the internationally agreed goals to reduce extreme poverty, disease, and hunger by the year 2015. Sachs is internationally renowned for advising governments in Latin America, Eastern Europe, the former Soviet Union, Asia and Africa on economic reforms and for his work with international agencies to promote poverty reduction, disease control, and debt reduction of poor countries.

A critique of the Millennium Development Goals was published in the March 2006 Monthly Review by Samir Amin, Director of the Third World Forum in Dakar, Senegal. Amin states: “A critical examination of the formulation of the goals as well as the definition of the means that would be required to implement them can only lead to the conclusion that the MDGs cannot be taken seriously. A litany of pious hopes commits no one.” (See: The Millennium Development Goals: A Critique from the South)

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March 7: 4:30-6PM
Dr. Ron Waldman,
“Pathways to Survival”
3rd Floor Conference Room, RPSM

Pathway to Survival is about strategies to combat child mortality in the world and addressing child mortality issues. It is one on the UN’s millennium program goals. Professor Waldman is a world known expert in refugee health and child mortality issues. He has been serving as a consultant to WHO, government and non-governmental organizations for the last 30 years. He is a prominent member of the Refugee Health Department at the CDC, Chairman of the Emergency Response Committee of WHO and Professor of Clinical Public Health at Columbia University. Since the early 1970’s, he has been involved in many refugee situations all over the world. Professor Waldman has helped to design and perform many studies which have shaped the framework for current guidelines to address current refugees needs globally.

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March 21: 4:30-6PM
Dr. Jennifer Kasper,
“International Child Health”
3rd Floor Conference Room, RPSM

Jennifer Kasper, MD, MPH is on the faculty of the Department of Family and Community Medicine at the University of Arizona Health Sciences and a pediatrician in the Tucson Medical Center Emergency Department. She is the President and CEO of Doctors for Global Health, a private, not-for-profit organization promoting health, education, art and other human rights throughout the world. She is a former Soros Medicine as a Profession Advocacy Fellow who worked with Physicians for Human Rights on immigrant issues.

Dr. Kasper’s domestic interests include child poverty and health; food insecurity and hunger; immigrant populations; and, child rights. She spent nearly two years in El Salvador serving as the field coordinator and community health worker trainer, as well as providing pediatric care. She has also worked in Honduras, India, and Chiapas, Mexico.

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March 30, 2006: 4:30-6 PM
Dr. Judith Cook
“Medical Consequences of the War in Iraq”
Cherkasky Auditorium

Judith Cook, MD is a general practitioner working with marginalized and excluded groups in London, UK. She volunteered with Médecins du Monde, www.medecinsdumonde.org.uk, for projects in Afghanistan in 2002 and Liberia in 2003. She currently volunteers for Médecins du Monde-UK in Project: London, a new initiative to help vulnerable groups access main stream health care services.

Dr. Cook is a member of the board of Medact, www.medact.org, and was involved in Medact’s work on violence, conflict and health, including their three reports on the impact on health of war on Iraq. She has presented on the War in Iraq, both in the UK and internationally.

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April 4:30-6PM
Emily Jackson
Rounds in the Community:
The Bótanicas Tour

Botanicas play an important role in the physical and emotional well being of many of our patients. Explore these centers of healing, spirituality and culture with our guides, trained in traditional herbal healing at the Bronx Botanical Garden. The Garden maintains a research program devoted to Understanding Plants in Human Health.

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April 4: 4:30-6PM
Zach Rosen
“The Genocide in Darfur”
Cherkasky Auditorium

Presenting, after recently returning from Darfur will be Michael Neuman, Program Officer, Medecins Sans Frontieres and Olivier Bercault, Counsel, Human Rights Watch. For more information on Darfur: www.savedarfur.org, www.hrw.org and www.msf.org.

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April 18: 4:30-6PM
Dr. Abraham George,
“Improving primary health care delivery in rural areas of developing countries”
3rd Floor Conference Room, RPSM

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May 2, 2006: 4:30-6 PM
Robin G. Steinberg
“The Bronx Defenders: Building Bridges between Clinicians and Public Defenders”
3rd Floor Conference Room
Residency Program in Social Medicine

Robin G. Steinberg is the Executive Director of The Bronx Defenders, an organization created in 1997 to provide outstanding legal representation to Bronx residents charged with crimes. The Bronx Defenders has developed a relationship with the Department’s CHCC (Comprehensive Health Care Center) Clinic through which patients facing legal problems can be referred to clinic for health care.

Readings & Links: Please visit the library at the Bronx Defenders web-site and read about their model of holistic advocacy.

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May 30, 2006: 4:30-6 PM
Social Medicine Project Presentations (1 of 3)
3rd Floor, Residency Program in Social Medicine
Gerald A. Paccione, M.D.
Noga Shalev, MD
From public to private care:
the historical trajectory of medical services in a New York City jail

This research investigates the historical shifts in health care provision within the correctional setting. It looks at a case study correctional facility Rikers Island in order to examine trends in the bureaucratic and financial arrangement of medical services over the past half a century.

Juliet Widoff, MD
Health Care Experiences of Street-Based Sex Workers in New York City

A qualitative study of the health experiences, perceived health needs and barriers to care of street-based sex workers in New York City.

Manuel R. Esteban, MD and Gunther Groning, MD
Psychosocial Impact Of Erectile Dysfunction In Hispanic Patients
Qualitative study done with male patients from the Family health center
Sharmila Ramprasad, MD
Sugarbusters

Evaluation of the existing diabetes education program to determine if a structured telephone follow up after the 4 week program improved the effectiveness as compared to regular 4 week program without follow up.

Melanie Ukanwa, MD
St John’s Wort and Omega 3 Fatty Acids in the Management of the Depressed Patient: Creating Provider Pamphlets

Depression is Depression is recognized as an important cause of significant morbidity and mortality. Current standard pharmacotherapies, although effective, are notorious for side effect profiles which discourage patient adherence. Via a systematic review of current evidence-based literature and data obtained from need assessment surveys of WBFP and FHC providers, two provider pamphlets were created to educate on the use of the better tolerated alternative medicines, St John’s Wort and Omega 3 Fatty Acids, in the management of the mildly depressed patient.

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June 6, 2006: 4:30-6 PM
Social Medicine Project Presentations (2 of 3)
3rd Floor, Residency Program in Social Medicine
Daniel O’Connell, MD
Cyrus Boquin, MD, MPH
Understanding Adherence to HAART therapy
among Methadone Maintenance Patients

Using an ACASI (Audio Computer-Assisted Self-Interviewing) questionnaire, I assisted on a project led by Karina Berg investigating multiple factors that may affect adherence to HAART therapy among methadone maintenance patients. High rates of self-reported adherence made multivariate analysis difficult, but interesting findings regarding the potential relationship of chronic pain to reduced adherence will be highlighted.

Aisha Mays, MD
Young Mom’s Prenatal Group:
Medicine, Education, and Social Support

An adolescent prenatal group was conducted over 6 months at the Family Health center which was designed to incorporate a supportive alternative to traditional prenatal care along with an educational program to explore participants educational goals, career aspirations, and knowledge of personal rights as pregnant adolescents.

Emily Jackson, MD
Hitting the Streets:
A Resident Inspired and Resident Executed
Experiential Cultural Curriculum

The Bronx is a diverse mix of many cultures, defined not only by traditional means (country of origin, common language, shared beliefs) but also by societal factors (socioeconomic status, lifestyle, living environment). Recognizing that 77% of incoming Social Medicine residents are unfamiliar with and lack ties to the Bronx, and that residents were eager to move out of clinical settings and into the communities where their patients live and work, we developed a series of Bronx “field trips” oriented around this broadened definition of culture.

Sheena Kumar, MD
Nucleic Acid Testing For Chlamydia And Gonorrhea
In A School Based Clinic

The project is a study proving the importance of universal screening for std’s, the study uses urine pcr testing which is less invasive and just as sensitive as the traditional gen probe.

Rebecca Warkol, MD & Mindy Sobota, MD, MPhil
An Intervention to Increase Emergency Contraception Knowledge, Attitudes and Prescribing Practices among Internists at a Teaching Site

We surveyed Internal Medicine residents and faculty at CHCC about their knowledge about, attitudes towards and advance prescribing of emergency contraception (EC). Then we introduced a multi-part intervention comprised of a 45-minute case-based educational session followed by a one-month clinical reminder intervention during which time nursing staff placed pink reminder stickers in all the charts of female patients under the age of 45, NYC Department of Health posters were hung throughout the clinic and a prescription stamp for Plan B was placed in the precepting room to facilitate prescription. One month after the intervention, EC knowledge increased, attitudes about EC remained positive and 95% of participants reported offering to prescribe EC in the prior month compared to 40% before the intervention.

Kelly S. Ramsey, MD, MPH
A Comparison of HIV Health Services Utilization Measures in a Marginalized Population: Self-Report vs Medical Records

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June 13, 2006: 4:30-6 PM
Social Medicine Project Presentations (3 of 3)
3rd Floor, Residency Program in Social Medicine
Peter Sherman, MD
Sharmila Matippa, MD
A study of utilization of clinic waiting time for health education using internet kiosks

A needs assessment done at both Williamsbridge health center and Family health center and a comparison of health attitudes and willingness to use computers as a source of health information if offered in the waiting area of the clinic. Also, done were semi-structured interviews at both sites to get further information regarding the same.

Kelly S. Ramsey, MD, MPH
A Comparison of HIV Health Services Utilization Measures in a Marginalized Population: Self-Report vs Medical Records
J. Lewis, MD, Anne Gordon, MD,
Kristen Wade-Kempiak, MD and Katherine O’Connor, MD
Breaking Down the Barriers to Inhaled Corticosteroid Use Among Caregivers of Children with Asthma

Asthma, a condition that disproportionately affects our patients, has been shown to have better clinical outcomes with ICS use. We previously explored our patient population’s beliefs about ICS and their side effects. Using this information, we designed a brief educational intervention given at various intervals, and assessed whether this resulted in more favorable attitudes toward ICS, better adherence to ICS, and better asthma health outcomes. We hope to identify an intervention that can reduce health disparities related to asthma in our patient population.

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Summer Series on War and Health

“War has an enormous and tragic impact-both directly and indirectly-on public health. War accounts for more death and disability than many major diseases combined. It destroys families, communities, and sometimes whole cultures. It directs scarce resources away from health and other human services, and often destroys the infrastructure for these services. It limits-and often totally eliminates-human rights. War leads many people to think that violence is the only way to resolve conflicts, a mindset that contributes to domestic violence, street crime, and many other kids of violence in the world. War contributes to the destruction of the environment. In sum, war threatens large elements of the fabric of our civilization.”

– From the Preface to War and Public Health, edited by Barry S. Levy and Victor W. Sidel, Oxford University Press, 1996 (updated January 2000)

July 11, 2006: 4:30-6 PM
Vic Sidel
“All’s Quiet on the Western Front” [Film]
3rd Floor Conference Room, RPSM

“One of the most powerful anti-war statements ever put on film, this gut-wrenching story concerns a group of friends who join the Army during World War I and are assigned to the Western Front, where their fiery patriotism is quickly turned to horror and misery by the harsh realities of combat. Director Lewis Milestone pioneered the use of the sweeping crane shot to capture a ghastly battlefield panorama of death and mud, and the cast, led by Lew Ayres, is terrific. It’s hard to pick a favorite scene, but the finale, as Ayres stretches from his trench to catch a butterfly, is one of the most devastating sequences of the decade.” from The New York Times Movie Reviews.

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July 18, 2006: 4:30-6 PM
“The Impact of the Iraq War on Clinical Practice in the Bronx”
Binswanger Auditorium, Montefiore Hospital

This rounds will be devoted to several ways in which the Iraq War has affected our clinical practices. Four case scenarios will be discussed which raise questions concerning the impact of the war on soldiers, their families and their communities.

For an editorial related to this topic please see Social Medicine, the Department’s academic journal, Volume 1, No. 2, August 2006.

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August 1, 2006: 4:30-6 PM
Dr. Vic Sidel
“War and Public Health”
Binswanger Auditorium, Montefiore Hospital

War and Public Health , a book co-edited by Victor Sidel and Barry Levy, was published by Oxford University Press in 1997 and then in an updated paperback edition by the American Public Health Association in 2000. A fully-revised second edition will be published by Oxford in 2007. The relation to social medicine of war and its primary, secondary and tertiary prevention will be discussed in the presentation.

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August 15th, 2006: 4:30-6:30 PM
Emily Jackson
“Green the Ghetto Toxic Bus Tour”
Sustainable South Bronx

The “Green the Ghetto Toxic Tour” will tour explore the community in and around Hunts’ Point, both evaluating the clustering of polluting facilities within the neighborhood, as well as the work that has been done and is ongoing to create sustainable development projects for the South Bronx that are informed by the needs of the community and the values of environmental justice. Our tour will be led by Marta Rodriguez, the Sustainable South Bronx Community Outreach Coordinator and resident of Hunts Point, as well as several community members.

Information about the Sustainable South Bronx can be found at www.ssbx.org. Majora Carter, the founder and Ex. Dir of SSBX, won the Mac Arthur Genius Award last year.

The Environmental Justice Movement has been developing for several decades in New York City and has become remarkably strong, effective and diverse in recent years. Organizations that historically have been leaders in the movement are The West Harlem Environmental Action and New York City Environmental Justice Alliance (NYCEJA)

A slideshow of the tour is available by clicking here.

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September 5, 2006: 4:30-6 PM
Dr. Peter Sherman
The Effects of Domestic Violence on Families
Binswanger Auditorium, Montefiore Hospital

Dr. Peter Sherman is the Director of the Residency Program in Social Pediatrics at Montefiore Medical Center. He has lectured locally and nationally on issues concerning underserved children including; the health of homeless children and the impact upon children of witnessing domestic violence. He serves as co-chair of the Ambulatory Pediatrics Association’s Serving the Underserved Special Interest Group.and co-chairs the AAP Section II, chapter 3 Committee on Child Abuse and Domestic Violence.

For resources on domestic violence consult:

National Domestic Violence Hotline: 1-800-799-SAFE

American Bar Association Commission on Domestic Violence

The Feminist Majority’s Domestic Violence Information Center

The Family Violence Prevention Fund

US Department of Justice

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September 19, 2006
4:30-6PM
Dr. Ruth Macklin
Binswanger Auditorium, Montefiore Hospital

Dr. Macklin will discuss cases provided by the Department illustrating ethical conflicts faced in providing clinical care. Information about Dr. Macklin can be found at the AECOM Website.

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October 3, 2006: 4:30-6 PM
Bill Difazio
“Ordinary Poverty: A Little Food and Cold Storage”
Binswanger Auditorium, Montefiore Hospital

Bill Difazio, a Professor of Sociology and producer of the WBAI progam City Watch will discuss issues of urban poverty. He is the author of several books, including: “Ordinary Poverty: A Little Food and Cold Storage“.

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October 17, 2006: 4:30-6 PM
Oliver Fein, Henry Kahn,
Fitzhugh Mullan, & Harold Osborn
“Lessons from Lincoln”
Cherkasky Auditorium,
Montefiore Hospital

On October 17, 2006 the Department of Family and Social Medicine is honored to present “Lessons from Lincoln”, a panel discussion with former members of The Lincoln Collective. The four speakers are Oliver Fein (chair of the NY chapter of Physicians for a National Health Program)Henry Kahn (founder of the Dekalb Grady Neighborhood Health Center in Atlanta, board member of Georgians for a Common Sense Health Plan), Fitzhugh Mullan (noted pediatrician and historian, author of “White Coat, Clenched Fist”), and Harold Osborn (leading NY emergency medicine physician, founder of The New Dawn Foundation). The panel will explore how the unique social and political environment of the Bronx became a rich environment to cultivate medical activism efforts, and how today’s health care workers can continue to fight for health as a human right.

The South Bronx of the 1960s and 1970s was seen an “urban catastrophe.” Concurrent declines in housing, job markets, government investment, and community identity forced inhabitants to live in conditions of neglect and devastation. Waves of arson spread across the borough during this time leaving scars that can still be seen today.

By the summer of 1969 the Young Lords Organization had been drawn to this urban wasteland. The Lords recognized that inattention and unresponsiveness had become common practice in many Bronx systems. Local institutions no longer cared for or served the communities they had initially been created for. As a group committed to preserving human rights and supporting the liberation of Puerto Ricans, the Young Lords swept into New York City to bring attention to the deplorable economic, social, and political conditions that were occurring in the South Bronx. In these efforts they were joined by the Black Panther Party.

At the same time, several physicians in training were becoming increasingly frustrated with traditional medical education. A small but visible group of students had become proponents of the civil rights movement and were forming organizations to promote social justice through medical activism. One such group was the Lincoln Collective: a novel training program whose members (medical residents at Lincoln Medical and Mental Health Center in the Bronx) wanted to practice community-oriented medicine with a focus on commitment to service and positive community impact via a collectivist model.

These three groups (Young Lords, Black Panthers, and The Lincoln Collective) turned their attentions to Lincoln Hospital -one of the poorest, most overburdened, and least-staffed hospitals in New York at the time. Patients referred to it as the “Butcher Shop.” The horrible health conditions faced by residents of the community were exposed by these three groups to a city that had been all too content to ignore the South Bronx. What followed in the next several years were multiple direct actions of protest: strikes by mental health workers, efforts to install a community presence within the administration, and reforms directed to ensure patient rights.

Early one morning in July of 1970, a group of Young Lords and its partner organization, the Health Revolutionary Unity Movement (a citywide radical union of black and Third World health workers), stormed the hospital and took it over. They demanded that Lincoln “return the hospital to the people of its community. The group called for numerous changes including new medical facilities, door-to-door preventive health services, drug addiction treatment programs, health education classes for patients and workers, childcare and senior citizens’ services, a permanent 24-hour grievance table, and minimum wage for all hospital workers. A Puerto Rican flag hung from a window and declared “Bienvenido al hospital del pueblo” (Welcome to the People’s Hospital). After negotiations with hospital and city management the protest ended fairly peacefully, if not successfully. Unfortunately more had been done to publicize Lincoln’s dysfunction than would be done to effect any lasting improvement in the community’s health.

For information on the take over and Lincoln Hospital today:

“Lords Liberate Hospital” The Old Mole (1970)

Lincoln Hospital Today

Lincoln’s ER

For information on the Young Lords and Black Panther Party:

Latino Education and Network Service (LENS)

Young Lords Internet Resource

Huey P. Newton Foundation

Disinfo.com (This article includes a number of Black Panther links)

Dr. Oliver Fein:

Currently, Professor of Clinical Public Health in the Department of Public Health at the Weill Medical College of Cornell University. Dr. Fein is active in Physicians for a National Health Program.

Dr. Henry Kahn

Dr. Kahn is a board member of Georgians for a Commonsense Health Plan and founder of the Dekalb Grady Neighborhood Health Center in Atlanta

Dr. Fitzhugh Mullan is on the Faculty of the George Washington University School of Public Health and Health Services. He is the author of Big Doctoring in America: Profiles in Primary Care and White Coat, Clenched Fist: The Political Education of an American Physician which will be republished in a new edition this fall by University of Michigan Press

Dr. Harold Osborn worked as Director of Lincoln’s ER. He works currently with The New Oaks Foundation.

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November 7, 2006:
Alice Fornari
Hunt’s Point Walking Tour

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November 14, 2006: 4:30-6PM
Intern Project Presentation
Binswanger Auditorium

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December 5, 2006: 4:30-6PM
Pat Beresford
Foster Care in New York City post-Nixmary

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December 19, 2006: 4:30-6PM
Cristel Brellochs
“Reaching NYC’s Uninsured: The City’s
Strategies and Approaches to expand Health Insurance Access”

Cristel Brellochs is the Deputy Director of the Human Resources Administration’s Office of Citywide Health Insurance Access (OCHIA). Ms. Brellochs will discuss the Mayor’s HealthStat Initiative which seeks to connect New Yorkers to public health insurance through the collaborative effort of 14 City agencies, 17 health plans and community-based organizations throughout New York City. She is also involved in OCHIA’s initiatives to promote affordable health insurance coverage for small businesses and working individuals.

At Social Medicine Rounds Ms. Brellochs will provide background on the situation of New York City’s uninsured and discuss on-going efforts and challenges in expanding access to public and private health insurance coverage for children, families, working adults and small businesses.

For more information visit the Office of Citywide Health Insurance Access at:

http://www.nyc.gov/html/hia/html/public_insurance/enroll.shtml.

Che Guevara, MD

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[This posting was originally published in November of 2004]

A new invitation to appreciate Ernesto “Che” Guevara-physician, writer and revolutionary-has appeared with The Motorcycle Diaries, directed by Walter Salles. The movie adapts Che’s journal notes during his 1952 “concientización” journey as a 23 year old medical student through Argentina, Chile, Peru, Colombia and Venezuela accompanied by his biochemist friend, the 29-year old Alberto Granado. In a New York Times Op-Ed piece, Che’s daughter, Aleida, herself a Cuban pediatrician, says this about her father’s diaries:

“His awareness grows that what poor people need is not so much his scientific knowledge as a doctor, but rather his strength and persistence in trying to bring about the social change that would enable them to recover the dignity that had been taken from them and trampled on for centuries. With his thirst for knowledge and his great capacity to love, he shows us how reality, if properly interpreted, can permeate a human being to the point of changing his or her way of thinking. I was only 6 when my father died, 37 years ago today, so I have few memories. I got to know my father only as I grew up. My mother, Aleida March, loved him very deeply, and shared his ideals, which she passed on to her children. What I remember most is my father’s great capacity for love.” (October 9, 2004)

If you love the people of Latin America; if the Andes, the Atacama and the Amazon inspire you; if you want to perceive a medical student who has is not afraid to speak his mind and act to healing, in a way that changes others around him (getting a whole community to accept the humanity of the lepers in their midst, literally, for instance); you will appreciate The Motorcycle Diaries. You may want to read the book for yourself-a quick and good read, in Spanish or in English translation. And, you might then want to learn more about the rest of Che Guevara’s life.

There are several large biographies. I recommend three and mention another with reservation. Both Che, Ernesto Guevara, A Legend in Our Century, by Pierre Kalfon (674 pages, translation from the French) and Che Guevara: A Revolutionary Life, by Jon Lee Anderson (831 pages, in excellent English) are well-written, fair and informative. A third, Ernesto Guevara, also known as Che, by Paco Ignacio Taibo II (852 pages, translated from the Spanish), is also very good-but the unbridled admiration of the author gives a one-sided portrait of the man. Finally, La Vida en Rojo: Una Biografia del Che Guevara, published later in English with the title Compañero, by Jorge G. Casteneda (560 pages), is also well-researched. Yet it is written with obvious and bitter Che-envy and could better have the title Let’s Trash Che.

Che, the man and the life he led, are not simple. The young Che thought Gandhi’s non-violent tactics were effective, and he writes of Gandhi with admiration. Later Che came to feel active opposition, including armed struggle, as a necessary step to confront structural violence and oppression. He came to this conclusion by fire, so to speak. On another trip through the Americas, this one including Bolivia, Ecuador, Panama, Costa Rica, Nicaragua, El Salvador, Guatemala, Mexico and Cuba-and onto the rest of his life-Che experienced first hand the United States Government view of what to do about a people who have a different agenda than corporate wealth and US Government control.

In 1954 President Arbenz of Guatemala, elected in free and fair elections, perceiving that the people in his country were starving, and that one landowner-US-based United Fruit Company-routinely left millions of acres fallow (about half their vast holding), put forward a very modest Agrarian Reform proposal. The United Fruit head lawyer, John Dulles, was alarmed. He discussed things with the head of the US CIA, conveniently Allen Dulles, his brother. (Flown into Dulles Airport in DC lately?) A coup was quickly arranged. Arbenz-who refused to give arms to his supporters-was easily removed, and a military dictatorship begun that would last into the 1990s and be responsible for an estimated 200,000 murders of Indigenous Guatemalans.

Che was there during the coup, and the unfortunate lesson he learned in Guatemala was alas crystal clear. The only voice the US Government would listen to when itself engaged in and supporting violent oppression is the voice of violence itself. (A partial list of dictators supported by the US Government during that and subsequent times: the Somozas in Nicaragua; Stroessner in Paraguay-who made his country welcome to Nazi war criminals; Marcos in the Philippines; various military juntas in Argentina, Brazil, and Uruguay; Papa Doc then Baby Doc in Haiti; Batista in Cuba; and these are just the ones practically everybody knows about. Pinochet came later, put into place by the US Government in a coup that killed public health physician and the democratically elected President of Chile, Salvador Allende, on 11 September 1973. Pinochet immediately, again with CIA assistance, rounded up ten thousand Chileans and international volunteers, putting them into the Santiago soccer stadium and killing them, see the moving movie Missing for what happened to the son of a US Congressman then.) Alas that Che had evidence then on which to base his preventive-violence perspective. What conclusion would he draw from looking at the world today?

Che led a life of actively making a difference, of exchanging a privileged potential for work with the poorest of the poor in changing their own lives toward becoming more just and human. He was among the architects of the Cuban Health System, where infant mortality and other health statistics are similar and sometimes better than those of the United States, certainly neighborhood by neighborhood, at a fraction of the expense. The sacrifice toward social justice is the main reason I personally find Che such an inspiration. Che’s leadership continues to spark the imagination and convictions of persons around the world. Some persons lament the “commercialization” of Che, whether the t-shirt worn by someone who does not know about his life, or other aspects. But I think of these things-whether a t-shirt image or a well-made movie-as being subtle introductions to the spirit of Che, to the positive, inspiring aspects of his life, which endure. As Eduardo Galeano, Uruguayan, said:

“A large part Che Guevara’s strength, I think, of this mysterious energy that goes so much further than his death and his errors, comes from something very simple: he was a rare kind of person who said what he thought and did what he said.” From “Celebration of the marriage of words and action,” El Libro de los Abrazos (The Book of Hugs)

Wherever we are living today, whether in the United States or another country, if we have eyes to see we know that most people in the world do not currently have lives of human dignity and social justice. Realizing this, opening ourselves to the cognitive dissonance that living and knowing can produce, what-if anything-will we actually do?

And, so, as Che said in a letter to his children, on his departure to the Congo, I leave you with his invitation:

“Above all, try always to be able to feel deeply any injustice committed against any person in any part of the world. It is the most important quality of a revolutionary.”

Lanny Smith, MD, November 2004

There are many Che-related websites. The text of this speech “On revolutionary medicine” can be found at the Che Guevara Internet Archive. The Wikipedia entry on Che is a bit dry but has many links, including CIA documents on his death and the first chapter in Jon Anderson’s book. You might also want to visit the Biography Project. One of the largest Che sites is www.che-lives.com. For those interested in medical solidarity with Cuba we recommend visiting Infomed and MEDICC, Medical Education Cooperation with Cuba.

Salvador Allende: Chilean President, Advocate of Social Medicine

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In the 1930’s Salvador Allende, a public health physician, served as Chilean Minister of Health. He produced an analysis of the social origins of disease and suffering in Chile, La Realidad Medico-Social Chileña, arguing that the solution to health problems lay not simply in improved medical care but also in better sanitation, housing, nutrition and working conditions. Echoing Virchow, Allende wrote: “[I]t is not possible to provide health and knowledge to a malnourished people, dressed in rags and working under merciless exploitation.”

These ideas were eventually embodied in the political program of the democratically-elected Unidad Popular government in Chile. Allende served as President of the Unidad Popular government from 1971 until his government was overthrown in a US-sponsored military coup on September 11, 197. Allende died in the coup which broke Chile’s long tradition of democratic government and initiated a long period of military dictatorship under General Augosto Pinochet.

Allende’s most famous document on Social Medicine is La Realidad Médico-Social Chilena (Chile’s Medical Social Reality which was published in 1939. Selections of this document were in 2006 in Volume 2, No 3 of of Social Medicine (English) and Medicina Social (Spanish) along with an introduction by Claudio Schuftan; the Spanish site also contains the original health platform from one of Allende’s presidential campaigns. The original version of La Realidad Medico-Social Chileña can be found (with a bit of searching) at the very rich Archivo-Chile.

For more information on Allende in Spanish consult the Salvador Allende archives run by the Partido Socialista. Salvador Allende: Chile’s Voice of Democracy offers English translation of some of Allende’s writiings and speeches.

To read documents related to US involvement in the 1973 coup (“the Latin American 9/11”) visit the National Security Archive website. Wikipedia offers a more general view of this “watershed event in the history of Chile and the Cold War.”

University of New Mexico's Latin American Social Medicine Project

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The University of New Mexico has developed a unique database of publications pertaining to Latin American Social Medicine. In collaboration with the University Health Sciences Center (Centro Universitario de Ciencias de la Salud – CUCS) of the University of Guadalajara (Universidad de Guadalajara) (Mexico) they are cataloging key texts (books, chapters, articles) that relate to Latin American Social Medicine. They index texts originally published in Spanish, English and Portuguese. Structured abstracts are then prepared in all three languages and made available on their website.

A search through the website for “Juan Garcia” brought up six of the key articles written by Juan César García, one of the principal thinkers in LASM, each with an English abstract. The database is currently the only English-language resource that will allow access to these materials so easily.

Albert Einstein College of Medicine Social Medicine Course

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The Social Medicine Course at the Albert Einstein College of Medicine is celebrating its 10th birthday in 2008. It was founded by a group of 8 students in 1998 and remains entirely student-run.

Why a course in social medicine?

Traditionally, the preclinical science curriculum of medical school has left huge gaps in medically relevant, but “unscientific,” topics. Specifically, social factors such as economics, politics, race, and other issues related to healthcare disparities are often minimally addressed. The Social Medicine course aims to inform students about current issues in medical ethics, health economics, health policy and various other topics dealing with health and disease from a socio-economic perspective. The course is offered annually and has been very well attended in recent years. It runs in the spring semester for 12-14 weeks. Students design the curriculum each year, and the lectures are given by faculty and invited speakers. Topics covered in the course have included: the practice of social medicine, correctional health, community-based clinics, the ethics of stem cell research, medical waste, drug policy in the US, no free lunch, healthcare for people with disabilities, the politics of abortion, gun violence, elder abuse, race/ethnicity and unequal treatment, refugee health, liberation medicine, war as a public health problem, and more.

For more information on the 2008 course, please contact the organizers: Laureen Ojalvo and Carolyn Saylor. What follows is the 2008 schedule (which can also be downloaded here).

Wednesday, January 9, 2008
Matthew R. Anderson, MD, MSc, Irwin Redlener, MD,

Carol Harris, MD and Victor Sidel, MD:

“OPENING SESSION: Social Medicine Practice on the Community, National and Global Levels”
The kick-off session for the 2008 course is an introduction to and celebration of the practice of Social Medicine. This event will be chaired by Dr. Victor Sidel who has been the faculty mentor for the course since its inception. The night begins with Matt Anderson, MD from the Department of Social Medicine at Montefiore Medical Center. His title is ‘Introduction to Social Medicine.’ The evening continues with a presentation by the President of the Children’s Health Fund, and Associate Dean for Public Health Advocacy and Preparedness at the Mailman School of Public Health at Columbia University, Irwin Redlener, MD titled, ‘A Failed Recovery: Stranding Children and Families in the Aftermath of Hurricane Katrina.’ The last speaker for the evening is Carol Harris, MD who directs the Global HIV Medicine Institute at AECOM and will discuss ‘Through the Wardrobe Door from Bronx to Africa.’
We welcome all to join us at the conclusion of this session for a reception outside Robbins Auditorium.

Wednesday, January 16, 2008
Robert Fullilove, EdD:

“Race and Health”

Associate Dean for Community and Minority Affairs, Mailman School of Public Health, Columbia University


Dr. Robert Fullilove teaches courses including Race and Health in the Department of Sociomedical Sciences. Dr. Fullilove is a civil rights advocate, a community organizer of over 40+ years, and a researcher who has been involved with IOM studies on minority health, substance abuse and addiction, HIV/AIDS, TB. Dr. Fullilove brings his work to AECOM in this talk discussing the public health impact as it involves race and racism.

Wednesday, January 23, 2008
Gal Mayer, MD:

“The Medical Care of Transgender Patients”

Medical Director, Callen-Lorde Clinic
Gal Mayer, MD, is Medical Director of the Callen-Lorde clinic (www.callen-lorde.org) in Manhattan, serving New York’s LGBT community. He is an AECOM graduate. This session will focus on the concepts of what is transgender? what is gender? what do all the words mean? what pronoun do I use? How do I stay respectful?

W ednesday, January 30, 2008
Len Rodberg, PhD:

“Presidential Candidates’ Proposals for Universal Health Care”

Chair, Professor, Urban Studies Department, Queens College
Leonard Rodberg teaches the Department’s undergraduate and graduate courses on using the computer in urban analysis, as well as courses on the urban economy and health care policy. Rodberg is also Research Director for the NY Metro Chapter of PNHP. Rodberg, a theoretical physicist by training, is the Chair of the Department. He has a background in public policy and the social impact of technology. Rodberg has worked with the Office of Community Studies in developing Infoshare Community Information System, a computerized data base system that allows community groups, non-profit organizations, and others to access demographic, health, and economic information about New York City. The Infoshare system and databases are now on the web, at www.infoshare.org,and are in use by organizations and individuals throughout the City and State.
Talk: The Presidential candidates have each put forward their proposals for “affordable quality health coverage for all.” Many of these proposals share a common set of elements. What are those elements? What is missing from these plans? Are they politically “realistic?” Will they work?

Wednesday, February 6, 2008
Irene Soloway, RPA and Donald Davis, VHIP:

“Harm Reduction in the Bronx: Dealing with the Hepatitis Epidemic among IV Drug Users”

Viral Hepatitis Intervention Program, AECOM
VHIP is a government-funded harm reduction program geared towards education and prevention of viral hepatitis in the Bronx community. It is primarily run by NYHRE (New York Harm Reduction and Education) and AECOM faculty (Dr. Alain Littwin and Dr. Melissa Stein of the Department of Medicine.) Students are closely supervised by AECOM faculty, Irene Soloway and NYHRE supervisor Donald Davis, as they assist in giving vaccinations and phlebotomy, as well as providing health education and counseling to program clients.

Many of these clients participate in the syringe exchange program located next to the VHIP tent. New services are always being introduced, including rapid HIV testing and student-run group counseling sessions.

Wednesday, February 13, 2008 – ***7:30pm – 8:30pm***
Lanny Smith, MD, MPH, TM:

“Liberation Medicine”

Clinical Faculty Residency Program in Social Internal Medicine and Primary Care at Montefiore
“In September of 2000 I joined the Residency Program in Social Medicine, clear that here is an environment within which it is possible to promote social justice through teaching and example. I continue in my volunteer position as Liberation Medicine Council and Member of the President’s Council of the International Humanitarian and Solidarity Volunteer Association Doctors for Global Health, DGH (www.dghonline.org), an organization I helped to found in 1995 which does concrete, positive work in social justice in El Salvador, Chiapas, Uganda and many other countries, including the USA. Among my responsibilities in the Residency Program in Social Medicine is teaching the core seminar in Liberation Medicine, “the conscious, conscientious use of health to promote social justice and human dignity,” a course which draws significantly on the Health and Human Rights Movement as well as the legacy of Community Oriented Primary Care, (COPC). I am also part of the group teaching Health Educators at Highbridge Community Life Center in the South Bronx. I serve as faculty mentor in International Health Electives for AECOM students and am on the Governing Council of the International Health Medical Education Consortium, IHMEC.” – quoted from faculty webpage at the Department of Family and Social Medicine.

Wednesday, February 20, 2008
David Bell, MD, MPH:

“Young Men’s Sexual Health and Reproductive Rights”

Assistant Clinical Professor of Pediatrics and Assistant Clinical Professor of Population and Family Health, Columbia University
“Dr. David Bell is an adolescent medicine physician and works primarily with ages 12-24. Dr. Bell is the medical director of the Young Men’s Clinic and the School-Based Clinic Program. The Young Men’s Clinic is a unique adjunct to the Center’s Family Planning Clinic. The school-based clinic program consists of 3 middle schools, and 2 high schools in upper Manhattan. Both are direct service components of the Center for Community Health and Education within the Mailman School of Public Health. He provides direct patient care for adolescent and young adult males and females within the Young Men’s Clinic and the Family Planning Clinic. He supervises mid-level practitioners at the school sites, as well as residents and students in the Young Men’s Clinic. Dr. Bell is currently on the board of directors for the Guttmacher Institute. He has consulted for the federal Office of Family Planning, and assisted with trainings on male health with Federal OFP Regions I, II, IV and VI, as well as with Engender Health (formerly AVSC). He has appeared on MTV, BET, and CBS, promoting male health issues. Dr. Bell completed a three-year adolescent medicine specialty fellowship at the University of California, San Francisco School of Medicine.”

Wednesday, February 27, 2008
Neil Aggarwal, MD, MA:

“Abusing Psychiatry: The Role of Psychiatrists in the War on Terror”

Yale Department of Psychiatry
After graduating from Case Western Reserve University with degrees in business and medicine, Neil enrolled at Harvard where he studied religion and anthropology of South Asia and the Middle East. He is interested in cross-cultural and international psychiatry of these regions, psychiatric anthropology, and the role of religion in healing.

About the Talk: I titled the talk “Abusing Psychiatry” for two reasons. The first is an attempt to be clever. The second is because it’s a play on words which actually reflects a professional tension that I’d like to explore regarding the role of psychiatrists in the War on Terror. I’d like to briefly review the literature within bioethics, medicine, and psychiatry to see how people have conceptualized the participation of psychiatrists in the War. Then I’d like to counter this literature with several key authors from anthropology and philosophy in order to help expose many of the assumptions medical professionals take for granted. I seek not to offer any final answers or to adjudicate between these divergent schools of thought, but rather to stimulate critical discussion on how we perceive our professional responsibilities. These questions require us to probe ourselves and for this reason, I don’t want to offer any solutions.

Wednesday, March 5, 2008
Allan Ross, MD:

“Public Health and Pediatrics in Kosovo”

Assistant Professor of Clinical Pediatrics, Columbia University
Dr. Alan Ross completed medical school in San Antonio when he was fifty. He had studied and taught Slavic studies for twenty years before that and, as part of his training, had spent a year in Tito’s Yugoslavia . He learned Serbo-Croat in Belgrade and made lasting friendships there. He and his wife met their first Albanians-not in the Balkans but at Albert Einstein and its affiliated hospitals. In order to learn some Albanian (she did, he didn’t!), they spent their honeymoon in Kosova in 1986. After the abrogation of the province’s autonomy by Milosevich, five years later, Dr. Ross began to devise public health programs for the area: these included a vaccination program in 1991, a TB campaign in 1994, the despatch of neonatal assistance teams to vulnerable children born in hospital, at home, and in an illegal private birthing center in 1996 and, when the rebellion began, the reorganization of a clinic for children driven out of their villages by the police. He gained -and lost- many friends during that time, most,but not all, Albanians, and it is in their honor that he reads these stories tonight.

Wednesday, March 12, 2008
Sheldon Tepperman, MD:

“Gun Violence”

Chief of Trauma and Critical Care Surgery at Jacobi Medical Center
Dr. Tepperman has firsthand experience with the devastation that gun violence can have in the Bronx. He is not only involved in the medical care of gun violence victims and their families, but he is a dedicated activist for legislative change and sits on the board of New Yorkers Against Gun Violence. He gives a riveting talk describing not only the impact that gun violence can have on our community, but several measures that can be taken to curb the illegal sale and use of guns.

Wednesday, March 19, 2008
Gary Kalkut, MD:

“Correctional Health at Rikers Island Health Services”

Vice President and Senior Medical Director, Montefiore Medical Center
Correctional healthcare is a challenging but rewarding area of medicine to which physicians receive little exposure. Dr. Kalkut, an attending physician from the Department of Medicine at Montefiore, will share his experiences and anecdotes as a physician at the maximum security Rikers Island Correctional Facility in NYC, which was a Montefiore facility until 1998. He will also talk about correctional healthcare as primary care for a needy population, with strong public health, social, and political implications.

Wednesday, March 26, 2008
Karen Hein, MD:

“Impact of Conflict, Tsunamis and HIV on Children”

Clinical Professor, Department of Pediatrics and Department of Epidemiology and Population Health, AECOM
“Karen Hein, M.D., became President of the William T. Grant Foundation on September 8, 1998. Dr. Hein was the Executive Officer of the Institute of Medicine (National Academy of Sciences) from December 30, 1994 to June 30, 1998. Dr. Hein is Clinical Professor of Pediatrics, Epidemiology and Social Medicine at Albert Einstein College of Medicine in New York. From l993-l994 she worked on health care reform as a member of the Senate Finance Committee staff in Washington, D.C., drafting legislation related to health benefits, workforce, and financing medical education and academic health centers.

Dr. Hein graduated from the University of Wisconsin (l966), attended Dartmouth Medical School (l966-l968) and received her medical degree from Columbia University, College of Physicians and Surgeons in l970. She was one of the founding members of the Dartmouth Medical School Board of Overseers (1973-1978).

During the past 25 years, Dr. Hein has assumed a variety of roles related to health policy through her activities in program development, teaching and clinical research. She directed a model program for health care of juvenile detainees. In l987, she founded the nation’s first adolescent HIV/AIDS program. She worked closely with the Board of Education to expand AIDS education to the million students in the New York City public school system. She has written over l50 articles, chapters and abstracts related to adolescent health, particularly focusing on high risk youth. Her book entitled, AIDS: Trading Fears for Facts, has sold over 100,000 volumes.

Dr. Hein has served as a consultant or advisor to many city, state and federal health organizations. She was President of the Society for Adolescent Medicine in l992. She has been a recipient of several awards including an Assistant Secretary for Health Award (DHHS) in l989, Health Care Financing Administrator’s Award (HCFA) in l993 and Stewart B. McKinney Foundation in l994 for leadership in the HIV epidemic. She is currently on the editorial advisory boards of 3 journals, a member of the Board of Directors of 7 national organizations (and Chair of the Center for Health Care Strategies).” – From David A. Winston Health Policy Fellowship

Wednesday, April 2, 2008 Sarah Woodward:

“Health Care in Nueva Vida, a Nicaraguan Hurricane Mitch Resettlement Community”

Center for Development in Central America, Ciudad Sandino, Nicaragua
Sarah Junkin Woodard comes to us from the Center for Development in Central America (CDCA), the Nicaraguan project of the non-profit, faith-based organization, the Jubilee House Community (JHC). Before moving to Nicaragua in 1994, the JHC operated shelters for the homeless and battered women in Statesville, NC, including facing issues of limited health care for the poor. Working in Nicaragua since then, the CDCA seeks to respond to human needs created by poverty in a nation where 45% of the population lives on less than $1.00/day, one of the poorest peoples in the western hemisphere, and where simply the lack of clean water impacts health on a daily basis. The CDCA is working to help communities become self-sufficient, sustainable, democratic entities, focusing its work in the areas of sustainable economic development, organic agriculture, appropriate technology, education, and health care. Donations of medicines and medical expertise help to defray the expense of running a full-time clinic. Sarah says, “The CDCA has been called to work with, and speak on behalf of, the poor in our area of Nicaragua, and to share their lives and stories with folks in the U.S., to bridge the gap between us and our neighbors.” Proceeds from craft sales go to the operating expenses of the project.

Wednesday, April 9, 2008
Julio Rivera:

“HIV Treatment Adherence at Lincoln Hospital”

Senior Associate Director, HIV Services Department, Lincoln Medical and Mental Health Center, Bronx, NY
Dr. Rivera currently leads the Treatment Adherence Pilot Program at Lincoln Hospital. The Treatment Adherence Pilot Program will enroll 40 HIV-infected individuals already enrolled in the Immunotherapy Clinic who are on or are in the process of being placed on single-dose, daily anti-retroviral (ARV) medication. The 40 patients who be those who have shown themselves to be non-adherent or poorly adherent to their ARV medication regimen. They initially will be assigned to one track, which requires them to receive a weekly visit from a member of the Treatment Adherence Pilot Program health education staff and to present themselves to their medical provider once a month for a medical evaluation.

The patients will be tracked throughout the duration of the Program; it is expected that 10 of the 40 patients will become seriously non-adherent enough to their medication regimen to justify they being transferred to a second track, the Directly Observed Therapy track. Patients in that track will receive daily visits from a member of the Treatment Adherence Pilot Program health education staff, who will observe the patients take their medication and provide them the education and encouragement needed to have them return to becoming adherence to their medication regimen. The patients will also present themselves to their medical provider one a month for a clinical evaluation.

The primary goal of the program is to reduce HIV-related morbidity and mortality, the secondary goals being to identify barriers to patients becoming and remaining adherence to their medication regimen; to reduce hospitalization rates of those patients participating in the Program; to reduce their number of opportunistic infections; to reduce their emergency room visits; to increase their ARV adherence rates; to improve HIV viral load suppression rates and CD4 counts; to educate patients about medication side effects; to build patient trust in the Treatment Adherence health educators and medical providers; to empower patients to become better informed about and involved in their medical treatment plans; and to increase weight gains among those with previous weight loss associated with their treatment regimen.

Please Note: Image from the article “Lincoln Hospital: The Decline of Health Care” published in the Social Medicine Journal (http://www.socialmedicine.info) Volume 2; Number 2; 2007.

Wednesday, April 16, 2008
Oliver Fein, MD:

“Time for National Health Insurance for the US?”

Associate Dean and Professor of Clinical Medicine and Clinical Public Health, Weill-Cornell Medical College
Oliver Fein, MD Dr. Fein is a practicing general internist with experience in health policy and an interest in access to care, health system reform and global health education. He is currently Professor of Clinical Medicine and Clinical Public Health and Associate Dean for Affiliations at the Weill Cornell Medical College of Cornell University. As Associate Dean for Affiliations, he is responsible for Weill Cornell’s domestic affiliations and the Office of Global Health Education. He also coordinates the David Rogers Health Policy Colloquium, a weekly interdisciplinary health policy forum at Weill Cornell.
In 2004, Dr. Fein was elected to the Executive Board of the American Public Health Association (APHA). He is Chair of the New York Metro Chapter of Physicians for a National Health Program (PNHP) and was elected President-elect for 2008. He is also on the national board of the Global Health Education Consortium. He is a fellow of the American College of Physicians and serves as Chair of the Health System Reform Committee of the Society of General Internal Medicine (SGIM). He is on the Editorial Board of the journal Medical Care. In 1993-94, he was a Robert Wood Johnson Health Policy Fellow in the office of U.S. Senate Majority Leader, George Mitchell.

Talk: The US spends more on healthcare than any other country, yet there are now over 47 million Americans without health insurance. Furthermore, the US has the shortest life expectancy and highest infant mortality rate among developed countries, and over 18,000 people die each year due to lack of insurance. Countries with single-payer systems have longer life spans, less infant deaths, and spend far less on healthcare that covers all of their citizens. Is single-payer National Health Insurance the solution for this country? What are we waiting for?

Wednesday, April 30, 2008 [POSTPONED UNTIL WEDNESDAY, MAY 14]
Victor Sidel, MD:

“War and Public Health”

Distinguished University Professor of Social Medicine at Montefiore
“Dr. Sidel was one of the founders of Physicians for Social Responsibility (PSR) in 1961 and was its president in 1987-88. In 1980 he was one of the founders of the International Physicians for the Prevention of Nuclear War (IPPNW), the recipient of the 1985 Nobel Prize for Peace, and was its co-president from 1993 to 1998. He has spoken and published widely on the economic, social, environmental and health consequences of the arms race, on the risks posed by the proliferation of nuclear, chemical and biological weapons and on the diversion of resources and the curtailment of human rights entailed in responses to the threat of bioterrorism. Dr. Sidel is co-editor with Dr. Barry Levy of War and Public Health (Oxford University Press, 1997; updated paperbound edition, American Public Health Association, 2000) and of Terrorism and Public Health (Oxford University Press, 2003).”

Wednesday, May 7, 2008
Dahlia Wasfi, MD:

“The Human Toll of the Iraq War”

Global Exchange Activist
Please join us May 7th for the closing lecture for this year’s Social Medicine Course! This year 2008 is significant in many ways. Not only does it mark the 10th anniversary of Einstein’s Social Medicine Course, but it also marks the 5th anniversary of the Iraq War. Our closing speaker, Dr. Dahlia Wasfi, will discuss the health consequences and the human toll of the Iraq War, speaking from personal experience during her extended stay in the country.

As future health professionals who may encounter war veterans and their families, as well as immigrants and refugees fleeing from war-torn countries, how can we provide optimal care to our patients? As public citizens making informed decisions this election year, what critical issues should we be aware of as we choose government officials who will guide the future policies of this country? What is our role as physicians and citizens in addressing both health and social issues? Join us May 7th to discuss these and many other issues, and have the rare opportunity to hear from Dr. Wasfi as she provides first-hand accounts and attempts to put a human face to the atrocities of war.

About the speaker: Dr. Dahlia Wasfi was born in 1971 to a Jewish mother and Iraqi father. She spent her early childhood in Saddam Hussein’s Iraq until she returned with her family to the United States in 1977. Dr. Wasfi graduated from Swarthmore College in 1993 with a B.A. in Biology, and from the University of Pennsylvania School of Medicine in 1997. Her latest trip to Iraq was a 3-month stay during the spring of 2006, when she traveled to see her family in Basrah. Based on her experiences, she is speaking out against the negative impact of the U.S. invasion on the Iraqi people and the need to end the occupation.

There is also more information on the following websites:
http://liberatethis.com
http://www.globalexchange.org/getInvolved/speakers/124.html
http://www.youtube.com/watch?v=colcD8UVr90&feature=PlayList&p=F2CE027D408BB226&index=0

No Free Lunch: Saying No to Drug Reps

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Under the banner “Just Say No to Drug Reps” the No Free Lunch campaign challenges doctors to give up their dependency on drug companies.

The site uses a alcoholism motif, beginning with a modified CAGE screening test:

  • Have you ever prescribed Celebrex?
  • Annoyed by people who complain about lunches & free gifts?
  • Is there a medication loGo on the pen you are using right now?
  • Do you drink your morning Eye-opener out of a Lipitor coffee mug?

Two or more “yes” answers may indicate a problem. But fortunately the campaign can help you with your dependence problem.  Visitors can take a pledge to abstain from accepting gifts from drug companies and be listed on a “drug free doctor” database. There is even a “pen amnesty”!

No Free Lunch is the brainchild of Dr. Bob Goodman, a New York internist.  Among the other resources on the site are:

So, it’s really not all that complicated to deal with drug representatives. Just say no.




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