Archive for the 'Alternative health care' Category

What is the single best thing we can do for our health?

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A chance encounter with a neighbor walking his dog, reminded me to post this short video by Dr. Mike Evans, a physician with an interest in Preventive Health. It discusses the health benefits of walking. This an activity that requires no special equipment, no special gym, no coach, and no particular training (past age 14 months). You can watch the video on his website at this link or watch it on You Tube screen below. (If you do watch it on You Tube please skip any creepy Pharma ads).

 

 

 

Street Medic Training: New York City May 19th and 20th, 2012

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Street Medic Training
 Saturday, May 19th and Sunday, May 20th
 8:45 AM – 6:30 PM

 

Street medics are a community of health workers who are specifically trained to respond to the health needs of people at demonstrations, in progressive social movements, and at encampments.

Street medics are called upon to deal with a wide variety of illness and injury: crowd-control, chemical weapons decontamination, weather and temperature-related illness, altered mental status, sexual assault, and handcuff injuries, all in resource-scare, unsecured environments. Street medics also provide preventative care and public health promotion in protester encampments. Street medic care is ethical, empowering, and do-no harm.

Those who already have advanced first aid or medical training will want to take this course as we cover many topics that are specific to protest healthcare. People with no healthcare background will learn valuable skills that can be used anywhere, not just at protests. In this highly participatory training, you will learn to use your skills in complex, high-tension, low-resource situations. Expect to have fun!

Location: Manhattan. Address and subway information emailed upon registration.

Cost: $50 with a sliding scale. No one will be turned away for lack of funds. Please explain your needs when registering. Payment in the form of cash or check can be made on the first day of training on May 19th.

For registration info, please email streetmedicnyc@gmail.com.

If you have further questions, please contact streetmedicnyc@gmail.com for more information.

Instructors from Common Ground Health Clinic, Latino Health Outreach Project, Medical Activists of New York, Black Cross Health Collective, Mutual Aid Street Medics, Katuah Earth First!, Mutual Aid Disaster Relief in Haiti, Mountain Justice 2005 Medics, and The Union of Palestinian Medical Relief Committees (Ramallah).

posted by: Matt Anderson, MD

More Low-cost & Free Health Resources: Acupuncture & Advanced Directives

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Swedish Institute

Low-cost acupuncture treatments

For several years, Manhattan’s Swedish Institute (226 W 26th St.) was the place to go for low-cost acupuncture treatment in New York City.  The Institute’s teaching clinics offer both acupuncture and Swedish massage.  A 13 week course of acupuncture cost $360 ($150 for seniors).

Earlier this week we ran into a colleague,  Dr. Ben Kligler, co-author of Integrative Medicine: Principles for Practice, who informed us that the Swedish Institute has been purchased by the Pacific College of Oriental Medicine.  He recommended the PCOM teaching clinic where acupuncture is provided by interns at somewhat higher prices than the Swedish Institute; see the details on their website. The address of the PCOM is 915 Broadway, 3rd floor.

Both the Swedish Institute and PCOM have interesting websites.  Here is the Swedish Institute’s explanation of what it’s like to experience an acupuncture session.

Advanced Directives

A recent article in The Teaching Physician (a publication of the Society of Teachers of Family Medicine) discussed a new (free) initiative to make it easier for people to both make – and retrieve – advanced directives.  “Information Technology and Teaching in the Office: Advance Directives Online” by Richard P. Usatine, MD, and Craig M. Klugman, PhD, University of Texas Health Science Center at San Antonio was published in the October 2009 edition and discusses Caring Connections (http://www.caringinfo.org/).

Caring Connections was developed by the  National Hospice and Palliative Care Organization (NHPCO) with support from the Robert Wood Johnson Foundation.  The website offers a number of resources for people considering end-of-life care.  The one highlighted in the article was the ability to create and store advanced directives on line.

As noted on the site: “Advance directives allow you to document your end-of-life wishes in the event that you are terminally ill and unable to talk or communicate. ” They generally take two forms. In a living will someone specifies what kind of care he or she would like in future.  A health care proxy is someone who can make decisions for a patient if he or she is incapacitated.

As a practicing clinician I find that there are several problems with Advanced Directives.  First, people don’t fill them out. No one likes to think about their own death. Second, people often turn to lawyers who charge money to complete these forms. This is really not necessary.  The forms in New York State can easily be completed by a family.  [The specifics of advanced directives, however, vary by state.] Finally, there’s no logical, single place to put Advanced Directives so that they are easily retrievable in an emergency.

The Caring Connections site deals with both problems. State specific forms are available for downloading.  The forms come with very detailed instructions.  Once they have been completed users are encouraged to scan them and upload them to a Google Health Profile. This profile can then be shared with the key people who need access to the advanced directives.

One is always a bit reluctant to further promote the Google monopoly on the web, but this is a useful free service.  It is, however, only available in English, a true limitation in an ever more diverse United States.

More free stuff in NYC – medical and not

The Swedish Institute is mentioned in a wonderful book sent to us by a reader entitled The Cheap Bastard’s Guide to New York City. Interested readers of the portal should consider getting a copy at the New York Public Library (of course).

posted by Matt Anderson, MD

A Right to Health, Neighborhood Health Centers in Profile (A Classic Film)

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A friend recently brought to our attention the film, A Right to Health, Neighborhood Health Centers in Profile, made by the Office of Health Affairs of the Office of Economic Opportunity (OEO) apparently in the early to mid-1970’s. This 33 minute film highlights the work of diverse Community Health Centers in the US, beginning with Montefiore’s Martin Luther King Health Center in the South Bronx.

Here is the YouTube feed of the movie:

The film is also available in a better quality download (in 2 parts) from the Prelinger Collection.

We have also posted Out in the Rural, a film about one of the first two OEO community health centers, the Tufts-Delta Health Center of North Bolivar County, Mississippi.  See our media page for a link to this film and the following link for an introduction to Out in the Rural.

A Right to Health is made in the overly somber, paternalistic style of old public service announcements.  Nonetheless, the voice and feeling of the communities manages to emerge. Dr. Roger O. Egeberg, then Dean of USC School of Medicne, introduces the movie stating that it “describes new ways of providing health care for the poor.”  But this is a bit deceptive.  The film describes ways of organizing health care services – community care, comprehensive care, team care, the use of community health workers – that suggest a broader vision of clinical care than just “poor care.”  In fact, the title “A Right to Health” expresses a universal ideal that we have yet to achieve in the US.

Posted by Matt Anderson, MD

Peckham Experiment (1926-1950): Turning the conventional Medical view inside out

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peckhamhealthcentreThe Peckham Experiment (1926-1950) was a remarkable English attempt to rethink the role of health and medicine, an attempt that greatly influenced subsequent thinking about community health.  We recently learned the the Pioneer Health Foundation, which was set up to finance the Experiment, is still in existence and has a very informative website. The wealth of pictures and documents on the site really brings this piece of history alive.

The story of the Experiment begins in 1926 when two English physicans  Scott Williamson, a pathologist, and his (future) wife Innis Pearse set up a small health center in Peckham, a working class neighborhood of southeast London.  Located within a small house, the first Pioneer Health Center was a social club which also provided physical examinations (“overhauls”), day-care, social services, and orthopedic consultation.

Williamson and Pearse were struck by the degree of disease they found among the attendees at the Center.  Quoting from Pearse (see link):

“Suffice it to say that of all those overhauled, only 10 per cent were found to be without any clinically discoverable disorders. There were some 25 – 30 per cent who knew they had some disease; less than one half of these were under medical treatment at the time of examination. The remaining examinees (some 65 to 70 per cent) all had some pathological disorder of which they were unaware, or which they ignored.” (J Roy.Coll. Gen. Pract., 1970, 20, 147)

Findings like these spurred a rethinking of the role of the center. In the words of Mary Langman, the Center’s Founder Secretary:

“Within a few years Scott Williamson shut this venture down; it had become apparent that whatever abnormalities they found were returning in some form even where they had been successfully treated, on return to the same environment as had caused them in the first place.

Something had to be done about that; but what? The doctors could have no control over the working environment, not over the facilities at home. They had little influence over conditions is schools. Their only point of leverage was small – the limited leisure time available to everyone at various time of their day.”

The logical conclusion was to build a new Pioneer Health Center, this in the form a recreation center. The beautiful new center (shown in the image) was opened in 1935 and included a gymnasium, theater,  swimming pool, and school. Nursery facilities were available and a cafeteria served organic food grown at the Center’s farm.  [The PHC website has beautiful pictures of these facilities.]  To join the center one had live nearby (“within easy pram pushing distance”), pay a small fee, and agree to a yearly, family physical examination.

The  Center was seen as a vast experiment to understand what promotes health.  Quoting from the website, it sought “to turn the conventional medical viewpoint inside out – to look at what is biologically right whereas pathology and therapeutics look at what is biologically wrong.”  Its results profoundly influenced thinking about community health.  Here is a brief summary prepared in 1986 of the major findings:

“Basic Concepts and Processes derived from the work of Dr George Scott Williamson and Dr Innes Pearse

1. Health is a positive process and not merely the absence of disease.
2. Health has action patterns and behaviour of its own, and its own laws.
3. The basic unity is the parents and their children.
4. Health is to be seen in the excellent of structure and function – in their individual actions and behaviour of this unity, and in their relationship to each other and the environment.
5. This excellence is established mainly during certain key phases of growth and development, from birth (or before) through infancy, childhood, puberty, adolescence, courtship, mating, parenthood.
6. Each phase has its own developments characteristic of that phase which are integrated into the whole person and the quality and direction of all future action.
7. The potential for this growth and development is inherent in the family and its individual members, and is entirely self-announcing and self-directing.
8. It announces itself in each phase through feelings, appetite, and interest in things pertinent to that particular development, and is characterised by the spontaneous nature of the behaviour.
9. It directs itself through the dedication of the individual or individuals in all the appetitive phases, e.g., in physical achievement or in courtship and marriage.
10. Its completion is accompanied by feelings of satisfaction and fulfilment.
11. The successful completion of such cycles is not only necessary for the acquisition of important skills/capabilities, but also provides a foundation of emotional health and contributes to such qualities as contentment, judgment and courage.
12. Throughout each phase there is a high degree of energy – vitality and drive manifested within the dedication.
13. The emerging skill can only grow and develop if the environment contains the appropriate opportunity/stimulus for exercise and practice.
14. The environment must contain sufficient families to cover the whole spectrum of interests, actions and growth and development, so that each family and its members may find opportunities for its own specific action and development.
15. This population must be one in action, through the full range of phases and interests, and visible and accessible to each member in continuity.
16. This population will develop and exhibit community integration, purpose and achievement in its major and minor actions. What is being manifested is the growth and development of the whole. It is a biological entity in its own right, as well as being the nurtural environment for each individual and family.
17. The growth and development of each family in mutuality with the social whole constitutes biological order.
18. Such a community is cultivable, and is self-sustaining. As was demonstrated by the Peckham Experiment, this is achieved by cultivation of the environment and not by direct cultivation of the individual and family.”
(Compiled by Douglas Trotter and Allan Pepper, November 1986)

The Center was closed during World War II and turned into a munitions factory.  It reopened in 1945 but then closed permanently in 1950 due to lack of funding. The Center apparently did not find favor in the new formed British National Health Service.  The building is now an apartment house.  The Pioneer Health Foundation has remained in business, publicizing the work of the Experiment.  For a fuller overview of the Experiment see the 1985 paper by Allan Pepper at this link.

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The Peckham Experiment is one of the most influential of many attempts to reconceptualize the role of clinical medicine by integrating it with the life of the community and focusing on health promotion by various means rather than simply the cure of disease using medicines.  One is struck by the bold vision represented by the project.  Also in this tradition is the work of Sidney and Emily Kark on Community Oriented Primary Care (originally, A Practice of Social Medicine).

posted by Matt Anderson

Family Centered Maternity Care

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images3Our colleague, Dr. Rebecca Williams, has set up a website exploring Family Centered Maternity Care (FCMC).  Family Centered Maternity Care, as she explains it, is a philosophical approach to prenatal care and delivery providing care to the pregnant woman in the context of her family. FCMC is prenatal care that considers, includes, and fosters the development of families. Historically, practitioners have also promoted natural childbirth.” While the site is primarily towards the teaching and clinical needs of our Family Practice residents, Dr. Williams updates it on a regular basis, making it a valuable resource.

The movement for Family Centered Maternity Care is several decades old.  Interested readers may want to consult Celeste R. Phillips‘ book  Family-Centered Maternity Care some of which can be read on Google Books. Phillips, a pioneer in the field, defines FCMC as “a way of providing care for women and their families that integrates pregnancy, childbirth, postpartum, and infant care into the continuum of the family life cycle as normal, healthy life events.”  She developed the following 10 principles for FCMC:

Principle No.1: Childbirth is seen as wellness, not illness. Care is directed to maintaining labor, birth, postpartum, and newborn care as a normal life event involving dynamic emotional, social and physical change.

Principle No. 2: Prenatal care is personalized according to the individual psychosocial, educational, physical, spiritual and cultural needs of each woman and her family.

Principle No. 3: A comprehensive program of perinatal education prepares families for active participation throughoutthe evolving process of preconception, pregnancy, childbirth and parenting.

Principle No. 4: The hospital team helps the family make informed choices for their care during pregnancy, labor, birth, postpartum and newborn care, and strives to provide them with the experience they desire.

Principle No. 5: The father and/or other supportive persons of the mother’s choice are actively involved in the educational process, labor, birth, postpartum and newborn care.

Principle No. 6: Whenever the mother wishes, family and friends are encouraged to be present during the entire hospital stay including labor and birth.

Principle No. 7: Each woman’s labor and birth care are provided in the same location unless a Cesarean birth is necessary. When possible, postpartum and newborn care are also given in the same location and by the same caregivers.

Principle No. 8: Mothers are encouraged to keep their babies in their rooms at all times. Nursing care focuses on teaching and role modeling while providing safe, quality care for the mother and baby together.

Principle No. 9: When Mother-Baby care is implemented, the same person cares for the mother and baby couplet as a single-family unit, integrating the whole family into the care.

Principle No. 10: Parents have access to their high-risk newborns at all times and are included in the care of their infants to the extent possible given the newborn’s condition.

Dr. Phillips currently runs a healthcare consulting company, Phillips + Fenwick, which assists hospitals in implemented FCMC programs.  The company website – www.panf.com – has some resources on FCMC, such as a short reading list.  Of particular interest, is her 1999 article Family-Centered Maternity Care: Past, Present, Future which discusses the history and current of FCMC. Readers may also wish to consult the WHO’s document on Care in normal birth, although this document is now 12 years old.

posted by: Matt Anderson, MD


Health Cooperatives

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A cooperative is an autonomous association of persons united voluntarily to meet their common economic, social, and cultural needs and aspirations through a jointly-owned and democratically-controlled enterprise. Cooperatives are based on the values of self-help, self-responsibility, democracy, equality, equity, and solidarity. In the tradition of their founders, cooperative members believe in the ethical values of honesty, openness, social responsibility, and caring for others. The cooperative principles are guidelines by which cooperatives put their values into practice: 1. Voluntary and Open Membership; 2. Democratic Member Control (one member, one vote); 3. Member Economic Participation; 4. Autonomy and Independence; 5. Education, Training and Information; 6. Co-operation Among Cooperatives; and 7. Concern for Community.

Based on coop principles and values, people create different forms/models of health care cooperatives. One of the most known model is the user/client-owned model. User or client-owned health cooperatives are set up by individuals in the same community to help them meet their own health care needs. Members of the coop determine goals and practices, thereby enabling ordinary citizens to empower themselves with respect to health care. Members-owners each contribute shares of capital and subsequently contribute to operating costs, usually by prepaid premiums and appoint managers to negotiate contracts with health insurance and health care providers. Often these cooperatives purchase and operate hospitals and other facilities, and hire professional and other staff. Services range from simple preventive care and basic insurance to advanced curative and rehabilitative interventions. There are also cooperatives owned by health professionals and pharmacy coops. In fact, cooperatives are being used as the model in the social economy and the delivery of a wide range of social services around the world.

Community Health Centres that follow the cooperative model are non-profit organisations, owned and operated by the members who use their services. Members elect a board of directors who govern the centre. Each member has one vote, regardless of the number of shares held by the member. Members and users are involved in defining the centre’s mission, mandates, goals, and the types of services offered. With the cooperative model, community participation can be facilitated through Board representation, committees of the Board, development of needs assessment, satisfaction surveys, fundraising, volunteer involvement etc. Community Health Centres that are not cooperatives provide similar programs and services as a cooperative, but the level of community membership and control is not as extensive.

For more on Health care cooperatives visit:

— Prepared by Franklin Assoumou Ndong, B.A., M.Sc., Sherbrooke (Québec), Canada, September 2004.

Walking the Labyrinth: Promoting Well-Being, Building Community

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On April 29th “Social Medicine Rounds in the Community” took us a few blocks from the hospital to the Ampark Community School, an elementary school that is part of the New York City School System.

We were greeted by the school’s Principal Betty Lopez Towey, a certified labyrinth facilitator. She is pictured here standing on the labyrinth. An energetic and enthusiastic woman (the perfect mixture for a grade school principal) she took us upstairs to a large room where the school’s labyrinth was laid out on the floor. For the next 45 minutes she taught us about labyrinths.

Labyrinths are increasingly used around the world to create spaces where people can meditate through walking. They have been constructed in a variety of settings: schools, churches, parks, forests, health care facilities, even prisons. The action of walking the labyrinth is designed to promote well-being, emotional, spriritual and physical.

The first labyrinth in a hospital was built in 1997 at the California Pacific Medical Center. We were fortunate enough to see a brief video clip of a stroke victim describing how the labyrinth helped her recover her sense of balance. [Unhappily, the CPMC website doesn’t have a picture of their labyrinth, but we found one at this link.] Kaiser Permanente installed a wall-mounted finger labyrinth at their Walnut Creek Hospital in 2001. Labyrinthenterprises.com has a listing of well over 100 hospitals with labyrinths

Of course, the best part was actually getting to walk the labyrinth. As someone who has meditated in the past, I was struck by how easily my mind began to focus on the simple act of putting one foot in front of another. After a few twists and turns I had no idea of where I was in the labyrinth. I knew where I was going – first to the center and then back out – but I had no idea exactly where I was on that journey. This helped me to focus on the mechanics of my steps, in much the same way that quiet meditation involves a focus on breathing. The sense of disorientation was heightened a bit by occasional very sharp turns at a time when one’s concentration was focused on the feet. A hint of vertigo. But the overall effect was of feeling at peace.

When we left the School we discussed taking the TV out of our waiting room and installing a labyrinth. Or perhaps labyrinths of paper, wood or stone on which the anxious (and the not so anxious) could gently trace their finger, finding a spot of peace in a chaotic world.

Some labyrinth websites:

Labyrinth Resource Group

Veriditas

Labyrinth Enterprises

The Labyrinth Coalition

Gesundheit Institute: The Power of a Positive Model

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The Gesundheit Institute was founded in the 1970’s with the idea of creating a free silly hospital in Hillsboro, West Virginia. This vision was the dream of Patch Adams, a story dramatized in the 1998 Hollywood movie, Patch Adams. But this is more than a Hollywood tale.

While the hospital has yet to be built, Gesundheit serves as a model for a different, positive vision of health care; see, for example, Re-Designing the US Health Care System: Think Universally, Design Locally by Dr. Susan Parenti. Today this vision is embodied in a variety of programs hosted at the Institute:

The Institute sponsors a variety of workshops, such as Thinking Outside the Box 2008: Re-Design Our Health Care System which will take place from August 6-11 2008, at the Gesundheit. The aim is to seed a variety of designs of projects at the local level, that will fundamentally change the health care system for the better.

There are also clown trips. The 2008 trip will travel to Italy and will “spread joy” through clowning in hospitals, nursing homes, disabled centers, prisons for young people, and on the street. The Institute also offers speakers and individual workshops.

What follows is the report to the Portal from Portal Editor Michelle Yu who went to the Gesundheit Health Justice Gathering in 2005: “Wild wigs and clown noses, talks by Patch Adams and his team of doctor-dreamers, imaginations that span the sky, sunrise hikes in West Virginia hills, nonstop music and dance, organic nourishment, and most of all, inspiration to change the world of medicine! If any of the above pique your interests, read on, dear friends! We are looking for 30 heath justice activists nationwide to join together for an inspiring and unforgettable gathering at Patch Adams’ Gesundheit! Institute in Hillsboro, West Virginia. The first gathering in January 2005 featured workshops on Building Novel Model Health Clinics, Coalitions, Liberation Medicine, Greetings, Medical School Curriculum, and much more. Patch Adams, Susan Parenti, Lanny Smith, Andrew Ziwasimon, and other fantastic doctors and spirits participated and presented, and we’re looking to have a similarly brilliant line-up this year. Students and past participants organize the gathering each year, and the experience is unrivaled in your medical education. For questions or information, write to Michelle Yu.”




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