What is the cutting edge in Social Medicine in 2011, at least in the Bronx?

The 18 social medicine projects completed by the 2011 graduates of Residency Program in  Social Medicine offer one perspective.  These projects cover a wide variety of topics; three were conducted internationally (Quito Ecuador;  Andhra Pradesh, India; and Rwanda). Among the questions addressed were:

1) Are medical schools and residency programs accountable to the broader society?

2) Does the promotion of Zumba dance in the clinic  improve the health of diabetics?

3)  What are the barriers to reproductive health care among homeless adolescents living in shelters?

4) What is a social medicine doctor?

The abstracts published below represent work by residents in Social Pediatrics, Family Medicine, and Social Internal Medicine/Primary Care. The actual presentations were made during Social Medicine Rounds on May 24, May 31 and June 7, 2011.

 The objectives of this study are to obtain information about where teenagers receive their information about sexual health topics, to obtain information about the use of the internet/social networking, and to evaluate adolescent knowledge concerning reproductive health. Male and female adolescents between the ages of 14 and 21 were recruited from two urban clinics in the Bronx. They were asked to complete an anonymous survey which included basic demographic information, internet availability, a knowledge assessment, and questions assessing sources of information and their usefulness. Participants were also asked specifics about websites/social networking resources utilized. Responses to survey questions were tabulated in Excel and descriptive statistics were calculated.

One-hundred and eighty-nine adolescents were surveyed during their clinic visits. The median percent correct on knowledge questions was 64.7%. The most common sources were medical professionals (93%), mothers (85%), friends (86%) and the internet (83%). Information provided by medical professionals was seen as the most useful (92%) followed by mom (81%), boy/girlfriend (79%) and the internet (73%). The most common websites used were Google (74%), Yahoo (26%), and Wikipedia (26%). The top four search terms were sex, condoms, birth control, and HIV.

To assess the potential of group visits in comparison to individual visits, a Centering Parenting Model of group well-child care was implemented at a Federally Qualified Health Center in an urban primary care setting designated as Patient-Centered Medical Home.

Study participants are parent-baby dyads and are established patients at the Family Health Center. Centering Parenting groups consisting of 5-10 pairs meet at predefined routine well-child visits to receive routine well baby care in a group setting.

The purpose of this project is to provide group well child care as an alternative to individual provider care with the hope of improving quality outcomes and parent satisfaction.

 Background: Cervical cancer is a completely preventable disease. Yet 470,000 new cases of cervical cancer are diagnosed each year and 300,000 women die annually worldwide. The overwhelming majority of these cervical cancer cases occur in the developing world. Pap smears are the main screening test for cervical cancer but many developing countries lack the infrastructure to perform pap smears. To address this need for cervical cancer screening in the developing world, the medical organization Prevention International: No Cervical Cancer (PINCC) developed a mobile service which screens for precancerous cervical cells using direct visual inspection of the cervix with acetic acid (VIA) and immediately removes suspected lesions in a single visit using either cryotherapy or LEEP. This study aims to evaluate the effectiveness of PINCC’s mobile cervical cancer screening program in Andhra Pradesh, India.

Methods: For 12 days in August and in December 2009, PINCC went to a different village each day in Andhra Pradesh, India. Mobile cervical screening using VIA was performed on non-pregnant, non-menstruating women between the ages of 23 and 75 who did not have signs of vaginitis. Pap smears were often performed for VIA-negative lesions, or if the squamocolumnar junction (SCJ) was not fully visualized because it extended into the cervical os. Biopsies were taken of VIA-positive lesions. Cryotherapy was performed if VIA-positive lesions covered less than 75% of the cervix and there was adequate visualization of the SCJ. Women with VIA-positive lesions covering >75% of the cervix received LEEP. PINCC referred all women suspected of having cervical cancer to the local hospital, based on the screening VIA results and biopsy. These women did not undergo cryotherapy or LEEP treatment.

Results: PINCC screened 623 women for cervical cancer during the 24 days that they were in Andhra Pradesh, India. Cervical samples from only 543 women were used in this study since there were missing data for 80 screened patients. Of the 543 women screened, 431 were VIA-negative and 112 were VIA positive. The VIA-negative group included 391 completely normal cervical screening after adequate visualization of the SCJ and 40 women who had to undergo pap smears for inadequate visualization of the SCJ. Precancerous cervical cells were found in 3 of 40 pap smears. Of the 112 participants with positive VIA lesions, 21% had cryotherapy, 27% had LEEP, and 45% were biopsied only without treatment due to either a non-functional cryotherapy or LEEP. Squamous cell carcinoma was found in 1.3% of the screened women. Of all the 112 VIA-positive lesions seen, biopsies found cancer or precancerous cells in 53 women, for a positive predictive value of 47%.

Conclusions: In 24 days, PINCC effectively screened 543 women with the low-cost method of VIA and immediately treated them with cryotherapy or LEEP. The PPV of VIA to detect precancerous cells was similar to other studies involving VIA. Further measures need to be taken to reduce the number of samples with missing data and to ensure operational equipment. A mobile “see and treat” model is a feasible method to address the high cervical cancer rates in the developing world.

The Montefiore Transitions Clinic (TC) was established to provide access to primary care, mental health services and social services for recently incarcerated adults. In July, 2009, we established a TC for recently incarcerated adults through partnership with Bronx Parole Board and The Osborne Association, a local prisoner advocacy community based organization (CBO). Initially, referrals to TC were primarily from parole officers and the overall burden of chronic illness was low. Here we report on the impact of a community health worker (CHW) on patient recruitment and disease severity.

To evaluate the impact of the referral source on the disease prevalence seen at TC, we performed a retrospective chart review comparing patients seen before and after the CHW was hired. Data was available for the first 39 TC patients, of whom 38 were referred by the Parole Committee, and the 30 most recent TC patients, 29 of whom were referred by the CBO through the CHW. Our primary measure of interest is prevalence of chronic disease in TC patients, including HIV, hepatitis C, mental illness, opioid dependence and diabetes. Secondary measures include time from correctional facility release to first clinic visit and insurance status.

With the assistance of a CHW, the TC has reached a population of former inmates with a higher burden of chronic illness. Referrals from a CBO, coordinated by a community health worker, identified a population with a high prevalence of chronic diseases including HIV, hepatitis C, mental illness and opioid dependence. system of facilitated referrals, along with access to health centers where barriers to care are minimized, can help bridge gaps in care for the formerly incarcerated population.

Needs and Objectives: Although weight loss can lead to a reduction in diabetes and hypertension and improve health outcomes, only 42% of obese U.S. adults report that their physicians have counseled them about weight loss. Even when weight loss is advised, most physicians do not discuss specific weight loss strategies, indicating that the quality of counseling may be poor. To address this gap, we adapted, implemented, and conducted a pilot evaluation of a previously developed theory-based obesity counseling curriculum for residents using a 5A’s behavioral change model. In this model, residents are trained to assess obesity risk, agree on mutual goals, advise a weight-control program, assist in establishing appropriate intervention, and arrange for follow-up. The objective of our evaluation was to determine the feasibility and impact of a novel obesity counseling curriculum, which incorporates training and practice in obesity counseling skills, on residents’ self-assessed competency in obesity counseling.

Setting and Participants: Our target audience was 28 interns and residents in the Primary Care/Social Internal Medicine Residency Program at Montefiore Medical Center, Bronx, New York.

Description: The curriculum was delivered 4 times over a 6 month period to groups of 5 to 10 residents during ambulatory medicine blocks. One week prior to curriculum participation, residents completed a previously validated survey with 9 items measuring self-assessed obesity counseling competence, based on the 5A’s model. Each question used a 4-point likert scale. The 3-hour 5A’s Obesity Curriculum included a 2-hour didactic and discussion session on the epidemiology of obesity, 5A’s obesity counseling framework and practical tools for its implementation. Case-based discussions of treatment modalities included behavior change, medication, and surgical options for weight loss. The final hour involved reviewing motivational interviewing (MI) and practicing with a standardized patient. Two months after participation, residents completed a post-intervention survey, and gave general feedback. Preliminary analyses compared median scores before and after curriculum participation using the Wilcoxin test.

Evaluation: To date, 16 residents have completed the curriculum and surveys, with another 10 scheduled to participate. Residents reported their counseling competence in: 1) assessing patients’ stage of change, 2) diet and 3) current level of physical activity; 4) agreeing on mutual goals for weight loss; 5) assisting patients in goal setting for weight loss; 6) responding to patients’ questions about behavior change; 7) offering medication and 8 ) surgical weight loss options; and 9) using MI techniques to change behavior. After the curriculum, there was a significant increase in the median scores from 2 to 3 (2=somewhat able to perform, 3=able to perform adequately) in residents’ report of assessing stage of change, assisting in goal setting, discussing treatment options and using MI techniques. There were no differences in the remaining domains. On qualitative questions, residents reported a high degree of satisfaction with the curriculum and requested additional skills practice sessions in MI.

Discussion: We developed and implemented a novel curriculum for residents to address strategies for weight loss using the 5A’s behavior change model, which incorporated obesity counseling skills practice. Preliminary pre and post curricular analyses showed improvements in several areas of residents’ obesity counseling competence. Implementing this three hour curriculum in a residency program was feasible. Post curricular questionnaires indicated that residents were satisfied with the curriculum, and were eager for additional sessions for continued practice and refinement of obesity counseling using MI skills. Further evaluation, with additional learners, and direct observation of counseling skills is needed to fully elucidate the impact of the curriculum in promoting effective obesity counseling skills.

Chronic malnutrition is associated with childhood mortality and affects up to a quarter of children in Ecuador. In southern Quito, lack of knowledge and poor diet diversification are contributing factors. Existing research has shown health education is a critical component in influencing behavioral changes and local collaborators, such as the Ecuadorian Ministry of Health and community physicians, have identified health education as an area that merits further investigation in their patient population. Hence, the objective of our study was to assess the effectiveness of a health education intervention given at a government-run clinic in Quito, Ecuador.

A 20-minute workshop and pictogram handouts were developed to provide education on the effects of protein malnutrition and highlight locally available protein sources. The workshop was offered daily over a 4-week period and the handout was distributed to a subset of patients after the workshop. Oral questionnaires were developed to assess protein nutrition knowledge, confidence in participant’s own knowledge, and protein intake pre- and post-workshop and at home visits three weeks later. A total of 98 participants completed pre- and post-workshop questionnaires and 57 completed home visit questionnaires. We found that knowledge and confidence increased after protein education workshops with retention at home visits. The utilization of pictogram handouts in educational sessions improved protein intake. These findings support continuing to work with Ecuadorian collaborators to further develop one-time, concise educational interventions to improve dietary behavior.

[This presentation won the Daniel Leicht Social Medicine Award and the Chairman's Research Award.]

Purpose: Seen as a public good, graduate medical education (GME) was financed by Medicare 1965, expecting that this responsibility would continue “until the community bears the cost in some other way”. Over 40 years later, Medicare is still bearing the brunt of GME financing, spending $9.5 billion last year. Many have suggested that academic health centers have become dependent on such financing. We sought to better understand the perceived responsibility of GME institutions in addressing the needs of the nation, and the utility of and most likely methods to measure and compare the social impact of GME institutions.

Method: Eighteen informants were interviewed via semi-structured interviews done by phone and in-person. Key informants were chosen from salient national agencies/associations after developing a sampling matrix to ensure appropriate breadth of perspectives. Snowballing technique was employed, and informant interviews were continued until saturation of themes was achieved and confirmed via search for disconfirming data.

Results: Seventeen of eighteen informants noted that GME institutions have a responsibility to be socially accountable. Informants’ definitions of social accountability included: training of future physicians, addressing workforce shortages and providing service to the institution’s community. Multiple informants noted barriers to measuring social accountability, though many informants suggested possible tools for measurement of social accountability.

Conclusions: GME is largely seen as a public good, and multiple informants noted that recipients of GME funding should be responsible to their communities. However, time constraints, financial limitations, and curriculum overload limit GME institutions’ ability to be socially accountable. Financial incentives, accreditation requirements and maintenance of mission values can address GME institutions’ responsibility to medical education, workforce shortages and community service.

Prison release rates in New York City correlate directly with poverty rates, and a disproportionate number of prisoners are returning to the Bronx. Recently released individuals attempting to reintegrate into the community are among the most marginalized of populations and have grave health outcomes. RPSM residents provide care for many of these patients who are directly or indirectly impacted by incarceration. The goal of this project was to develop a longitudinal training program in correctional health for family and internal medicine residents. Methods included reviewing existing correctional health training programs, interviews with medical and academic directors, rotations and site visits to correctional facilities and transitions clinics in San Francisco and New York City.

The proposal for a longitudinal correctional health curriculum is comprised of required clinical and didactic components: Transitions Clinic sessions at FHC and CHCC during elective blocks throughout residency as the foundation; health education workshops, targeted outreach and discharge planning at Rikers Island and VCBC; buprenorphine training and case-based discussions with a substance abuse specialist; and cross-track conferences to discuss syllabus readings. Residents interviewed unanimously support a longitudinal model of learning and this proposed curriculum provides an example of a rigorous training program to meet their educational needs.

Description: During the academic year 2010 – 2011 we initiated an iterative educational process to engage residents in a dialogue about SBP. An anonymous web-based survey was sent to all 19 PGY2 and 3 residents asking them how they would handle four common clinical scenarios that occur when the resident is not in clinic or between patients’ clinic visits: (1) following up of critical lab values; (2) scheduling non-routine follow-up appointments; (3) handling urgent care situations when patients call from home; and (4) titrating medications. Each scenario was derived from our clinical experience and piloted with colleagues prior to survey distribution. Results were analyzed and a set of best practices was created. At a program-wide retreat attended by approximately 25 residents and faculty we moderated a two-hour discussion on the survey results, best practices and other SBP topics identified. A second anonymous survey was sent to the same 19 residents assessing the value of monthly SBP meetings.

Evaluation: Seventy-four percent (14/19) of residents responded to the initial survey, with up to 5 solutions given for each scenario. Responses varied by the skill level of the clinic staff member asked to assist with the task, the number of phone calls, emails, and hand-offs required, and the time needed for task completion. Given the heterogeneity of responses a set of best practices, emphasizing non-physician resources, was created and disseminated. Our second survey used a 5-point Likert scale (5=Quite Valuable, 1=No Value) to quantify the value of monthly SBP discussions. One hundred percent (14/14) of responders reported that sessions would be valuables or quite valuable. We then initiated monthly discussions (60-75 minutes) during ambulatory blocks (4-8 residents/month). To date we have held two sessions. Prior to each session we solicit SBP topics and distribute a resident derived agenda. Afterwards, we email key takeaway points and post updates on our program’s searchable website.

Background: Chlamydia and gonorrhea (GC) screening in specific populations, including substance users, is recommended. Entry into methadone maintenance treatment presents an opportunity to screen a high risk population, yet the prevalence of Chlamydia and GC infection in this population has not been well-defined. To address this gap, we began to routinely offer screening to women admitted to our Bronx methadone maintenance treatment program (MMTP).

Methods: A chart review of consecutively admitted adult female patients from June 1, 2010 is underway. Using a structured chart review instrument, we abstracted sociodemographics (age, race, income), substance type, injection use, trauma and incarceration history; HIV antibody status, syphilis titer, and urine GC and Chlamydia results.

Results: Forty-nine women were entered treatment between June and December 21, 2010. Eleven (22%) self-identified as Black, 32(65%) as Hispanic. Their mean age was 40 All had heroin dependence. Thirty-one (63%) reported cocaine use. Twenty-two (45%) had injected. Eleven (22%) had experienced domestic violence and 30(61%) had been incarcerated. Nine (18%) were HIV positive, and five (10%) had serologic evidence of syphilis infection. None of the 46 (94%) women tested for GC and Chlamydia were positive.

Conclusions: Although women entering MMTP are typically considered at high risk for sexually transmitted diseases, routine testing GC and Chlamydia testing did not identify any infections. The HIV and syphilis infection rates we found warrant routine screening, but the absence of GC and Chlamydia in this population does not thus far support routine screening with drug use as a sole risk factor.

Purpose: It is clear that social conditions contribute to ill health. This was described as early as the 19th century by Rudolf Virchow, generally considered the founder of social medicine. Yet, medical training continues to center on the molecular basis of disease. In efforts to create a different model of physician training, the Residency Program in Social Medicine (RPSM) of Montefiore Hospital was founded in 1970 to train a cadre of socially-minded physicians dedicated to providing care for the underserved. The RPSM is a holistic curriculum that encompasses an understanding of social problems affecting the health of individuals and communities and strategies for addressing these issues, while training in community health centers. This study investigates what encompasses a social medicine physician today, and how their practice differs from other primary care doctors.

Methods: All current residents, faculty and alumni of the Residency Program were eligible to participate in the survey, which was emailed in March 2009. A survey monkey questionnaire was used, and emailed to current department members and an alumni list-serve. The complete survey had seven items that included status (resident, faculty, or alumni); specialty (Family Medicine, Internal Medicine, Pediatrics); questions about the role of social medicine in regards to their practice, how it differs from other primary care doctors, and questions regarding the RPSM curriculum. Demographic data describing the participants was tabulated, and comments were grouped into themes and investigated via textual and qualitative analysis.

Results: The survey was completed by 173 participants. Forty-seven percent were in the field of Family Medicine, 30% in Internal Medicine, and 24% in Pediatrics. Fifty-six percent were alumni, 26% were faculty, and 21% were current residents. There were three main themes that were common to most responses, which were that social medicine doctors 1) have a broad knowledge of the social determinants of health, 2) have the ability to translate this broad knowledge of health into a specific treatment plan, and 3) promote social justice. Within each theme were various sub-themes which provided a richer description of social medicine concepts and its practice contrasted with the practice other primary care physicians.

Conclusions: Social conditions are not separate from medical conditions, an integral concept of social medicine and RPSM. Although this study was limited in that not all potential subjects responded and responses varied greatly in length and description, the concepts of social medicine are clearly central to their practice of medicine. Social medicine is thought to be valuable and essential in the treatment of individuals and communities, and an opportunity for social change. This model of medicine was viewed as fundamentally different from the practice of other primary care physicians. Further research in the practice of social medicine on patient outcomes, and perspectives of patients treated by social medicine doctors could be helpful in substantiating our findings and expanding the number of social medicine residency programs nation-wide.

The Patient Centered Medical Home (PCMH) has received attention as a cost-effective way to address the myriad problems facing the US primary care system. As more practices become PCMH’s, staff must carry out this change, however their perceptions of the PCMH and the change process may not be congruent. We will compare staff opinions of the PCMH transformation at two primary care clinics in the Bronx, NY, using focus groups consisting of providers and support staff, and analyze recorded transcripts for themes. We anticipate the analysis will yield insight into perceptions of the PCMH and the capacities of the clinics to carry out their transformations that will be useful to other practices as they begin their own transformation processes.

 Numerous studies demonstrate the deleterious health outcomes associated with substance abuse and dependence. To intervene early in the course of substance use, Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been advocated by many.Few studies have examined the feasibility of or outcomes associated with conducting SBIRT in hospitalized patients. Although data regarding SBIRT for drug use has been sparse, with the rise in opioid use, abuse, and dependence, many advocate for SBIRT specifically for drug use. We sought to test the feasibility of conducting SBIRT for problematic opioid use targeting patients hospitalized on the medical wards of a large urban academic medical center.

We identified adult patients who were admitted floors of the medical wards and administered audio computer-assisted self-interviews assessing theirof problematic opioid use using the WHO ASSISTscreening tool.Patients were categorized as having no opioid use, or low, moderate, or high risk of problematic opioid use. Those who had moderate or high risk problematic opioid use received a brief computer-based intervention. We found that 42 (56.0%) reported no opioid use, 4 (5.3%) low risk, 26 (34.7%) moderate risk, and 3 (4.0%) high risk of problematic opioid use. Of the 29 patients with moderate or high risk, 19 (65.5%) were interested in referral to treatment and 27 (93.1%) reported that the brief computerized intervention was useful. We question whether our model of conducting SBIRT-with a dedicated person outside of the team delivering health care-is feasible. However, this urban inpatient population seems at significant risk thus more research is warranted on how to best use SBIRT to intervene on problematic opioid users in the inpatient setting.

Zumba Bronx is a reproducible and sustainable form of dance exercise that is built on one of the strengths of an underserved community, the passion to dance. Dance aerobic exercise has been shown to improve participants’ s BMI. The 2010 ADA noted that a 5-10% decrease in weight translates into a decrease in HbA1c. The literature review indicated that successful programs for weight loss have consolidated exercise, diet, and behavior modification plans. In addition, studies have illustrated the utilization of pedometers as a useful tool to motivate diabetic patients to increase physical activity and maintain these efforts. The goal of this social medicine project is to promote physical activity for patients with diabetes at the Williamsbridge Family Practice. The study will utilize this culturally appropriate, and cost-effective form of dance exercise, Zumba, coupled with pedometers, and develop patient centered support that can be incorporated into the FHC and CHCC health centers in the future. The objective of this project is to provide diabetic patients with the tools to develop and maintain a healthy lifestyle.

The purpose of this study was to evaluate whether a dedicated immigrant health session within a larger primary care practice can achieve retention in and quality of health care for immigrants. This was a retrospective cohort study with medical record review of all new patients seen at the OPEN-IT clinic at CHCC from October 1, 2007 to September 30, 2009. The primary outcome was retention in care, defined as at least one follow-up visit within one year after the initial visit. Secondary outcomes included rates of age-appropriate cancer screenings and results of specific screening tests as recommended by the CDC for refugee populations, including Hepatitis B surface antigen, tuberculin skin test, complete blood count, and ova and parasites in stool. Results showed that 79% of patients were retained in care, with no detected difference in retention based on age, gender, length of time in US, or presence of chronic illness. Rates of mammography and cervical cancer screening were 82% and 79% respectively, but the rate of age-appropriate colorectal cancer screening was only 24%. We also found that over a quarter of patients screened had evidence of latent tuberculosis, anemia, and intestinal parasites, although our numbers were small. Our results support the need for clear recommendations regarding immigrant-specific screening. Further work needs to be done to improve rates of colorectal cancer screening within our model and to better understand which diseases need to be screened for in the immigrant population.

Medicines have meaning and these meanings affect both their efficacy and their perception of it. Perceptions about efficacy affect adherence to and retention in treatment. Observations by substance abuse clinicians suggest that patients in methadone maintenance treatment(MMT)hold perceptions about methadone and methadone doses that may not reflect current medical understanding about methadone, including about interactions and adverse effects. Literature about the experience of patients in MMT is sparse, and this study aims to understand the experience with and perceptions about methadone among patients in an urban methadone clinic. Individuals in substance abuse treatment are a marginalized population. It is anticipated that a better understanding of their experience in a particularly stigmatized realm of medical treatment will allow clinicians to better understand their needs, their response to treatments with potential for interaction to methadone, and thereby improve the adherence to and retention in methadone treatment.

 Homeless adolescents experience multiple barriers to contraceptive use and they have high rates of unintended pregnancy and poor birth outcomes. The goal is to conduct semi-structured interviews with homeless female adolescents ages 14-18 at family shelters in the Bronx and to have teen educational seminars at a homeless family shelter. Interviews include questions on demographic data and open-ended questions regarding beliefs about contraception, experiences with accessing reproductive healthcare, future plans, and specific barriers to accessing reproductive healthcare as an adolescent living in a family shelter. Teen seminars focus on pregnancy, sex, and STDs. The purpose of our study is to 1) describe the experience of unintended pregnancy, abortion, and contraceptive use; 2) identify barriers to reproductive healthcare access including contraception; and 3) describe preferences for reproductive healthcare access in homeless teens. This data will generate data for targeted changes in services.

 A survey of pregnant Rwandan women’s use of complementary medicine.

Throughout the years she has been involved in training medical residents and students on refugee mental health in addition to organizing with the Committee Against Anti-Asian Violence (now called Organizing Asian Communities)  in the area of language rights for the Southeast Asian community. She contributed a chapter, on the mental health and resiliency of elderly Chinese  men in Cuba, to the book Community Health Care in Cuba. She is a native New Yorker who grew up in Washington Heights to parents from Puerto Rico and China.

Accessing Health Care: From the Bronx to Cuba

In 2010, Ms. Wong was interviewed for Asia-Pacific Forum, a program on New York radio  station WBAI.  The interview (available at this link) examined barriers to health care access for two different Asian immigrant communities. The first was the Southeast Asian refugee community in the Bronx who have faced challenges to obtaining language access and quality health/mental health care.  (See our prior posts on the Justice is Healing campaign). She then turned to Cuba where she shared her research on health access for the Chinese-Cuban elderly male population in Havana.

La Magia de Cuba

During her visits to Cuba for the book chapter, Ms. Wong produced a short photo-video documentary entitled La Magia de Cuba, for a course on global mental health at the Harvard Program in Refugee Trauma on healing environments. It needs no commentary or introduction. Enjoy:

Ms. Wong is planning to return to Cuba this year to expand her research on elderly Chinese men with a plan to publish a book with Professor Eric Tang, University of Texas.  A fundraising event will take place  later this spring and we will keep readers informed.  She can be reached via email.

posted by Matt Anderson

Coming in from the storm we were greeted by Dr. Thoai Lien who had been expecting us and would be our host.  Dr. Lien informed us that he was an organic chemist and had worked for several years at a pharmaceutical company investigating medical plants.  We learned from him that there were two Vietnamese Buddhist Temples in the Bronx, the Chieu Kien Temple and the Chua Thap Phuong temple located at 2222 Andrews Ave. [There is also a Cambodian Buddhist Temple run by the Khmer Buddhist Society at 2738 Marion Avenue.]

The temple was buzzing with activity as people came and out from the storm.  At the other end of the entrance hall the monk was giving a sermon in Vietnamese in the main shrine; this was broadcast throughout the building.  Dr. Lien noted that during the Lunar New Year the Temple had hosted three days of celebrations and over 800 people had visited.  As soon as our group had assembled, Dr. Lien took us down to the basement where a dozen women were busy preparing food in a tiny kitchen. Half of the basement had been covered into a dining room and we sat down at one of dozen or so plastic tables.  It was time for lunch.

As hot tea and food began to arrive at our table, Dr. Lien explained to us that the Temple had been founded in 2002 by members of the community. They combined donations for a down payment on the property, not entirely sure how they would pay the mortgage.  But they had found a monk, the Reverend Thich Thien Chi, to live in the Temple and had faith things would work out.  Their faith was justified and the Temple had become so popular that they had already paid off the mortgage.  “The Temple belongs to all of us,” he said with evident pride.

The secret to the Temple’s success may lie – in some measure – in Reverend Thien Chi’s unusual talents as a cook.  During the week he prepares food for the weekend.  On Saturdays and Sundays the parishioners warm and serve the food while he gives his sermon and then leads meditation and chants. Dr. Lien emphasized that all the food is given away. Reverend Thien Chi’s philosophy is that by serving vegetarian food, he is keeping people from killing animals and thus spreads good in the world.

The result of all the cooking was a dining room filled with children running about, teenagers with iPods plugged in their ears, and adults of all ages.  There is certainly no denying that the food was excellent.  Over healthy portion of rice we had spring rolls, roasted bean curd, mixed vegetables, and finally no less than three deserts. The desserts apparently were brought by the parishioners and included one custard created from coconut and mung bean.  There is no doubt that feeding people and eating together creates a sense of community.

While we ate, Dr. Lien shared a bit of his personal story. He had stayed in Vietnam for three years after the collapse of the Saigon government in April 1975, while he was in his final year in High School. In 1978 he arrived in the US sponsored by someone in Arkansas. He wanted to go to the University but knew that his English was not that good. He got a job and enrolled part time at a local community college.  He managed to accumulate 68 credits and an excellent academic record. He also benefitted from generous educational benefits for refugees so that he was able to enroll at Columbia University in 1981, graduating with a Ph.D. in organic chemistry. He subsequently went to work for a large pharmaceutical company in Boston but continued to commute back and forth to the Bronx regularly, serving voluntarily as a substitute teacher in the Temple’s Vietnamese language school.

After eating we had a brief tour of the rest of the temple. Services were over so we took off our shoes and entered the main shrine dominated by a large golden Buddha. Behind it was a small room where members of the temple could come and leave the ashes of their relatives.  People were praying here and leaving offerings of fruit and incense.  The wall was covered with photographs of the departed, people of all ages. Down the hall was a private space for the monk and a room where people were praying to “the Goddess.” Upstairs was a happy pandemonium of children just let out from Vietnamese class.  Finally we visited the small garden next to the temple where a smaller shrine was dedicated to storing the ashes of the deceased.  Despite the grey weather this was a lovely spot.

Dr. Lien & Dr. Vanessa Pratomo (DFSM)

As we said good-bye, Dr. Lien told us his dream of creating a nursing home for the community.  He did not want the elderly to be alone at home. He also shared with us that he was a writer; he had, in fact, written a poem about the monk. He shared a story he had written (in English) in the Nguoi Dep Magazine entitled “A Poor Scholar named Hai-Thoai.”  It recounts a tale told to Dr. Lien by his grandfather in which a poor scholar is rewarded for his chastity by aquiring the ability to exorcise spirits; he also marries a princess! The story ends: “In this terrestrial life, if you do things justly, your good deeds will be properly credited. Don’t ever think God is too far away to do you some justice.  He can be by your side if you deserve His help.” This seemed an appropriate thought for a Temple that seems to give so much to so many.

[The original version of this posting contained several inaccuracies. This is a corrected version.]

posted by Matt Anderson

The opening speaker will be Dr. Joia Mukerjee of Partners in Health who will discuss “Social  Forces in Medicine.”  This event will take place at 5:30 PM at the Riklis Auditorium and will be followed by a reception. Subsequent sessions will take place each Wednesday (with one exception) at the 5th floor Forchheimer Auditorium at 5;30PM. Dinner is provided.  All events in this series will be listed at the top of our blog roll.

At last year’s course several local readers of the Social Medicine Portal dropped by.  Please feel free to come, but write to Ms. Karp (see below) so that we can inform security.

The list of speakers and topics is as follows:
Jan 13 ∙ History of Social Medicine ∙ Matt Anderson, MD, MS.
Jan 20 ∙ LGBT Health and Community Organizing ∙ John-Paul Sanchez, MD, MPH
Jan 27 ∙ Race and Health in the Bronx ∙ Robert Fullilove, EdD
Feb 3 ∙ Harm Reduction in the Bronx: Dealing with the Hepatitis Epidemic among IV Drug Users ∙ Donald Davis
Feb 10 ∙ Motivational Interviewing and Nutrition in the Bronx ∙Yasmin Mossavar-Rahmani, PhD, RD, CDN
Feb 17 ∙ The Impact of Hep B on Pregnancy in the Asian American Community∙Tomoaki Kato, MD; Maya Gambarin-Gelwin, MD
Feb 24 ∙ Abortion Care in NYC∙Marji Gold, MD
Mar 3 ∙ Native American Health ∙ Donna Perry, MD *Price Center Auditorium
Mar 10 ∙ Separate and Unequal: Medical Apartheid ∙ Neil Calman, MD and Nisha Agarwal, JD
Mar 16* ∙ Liberation Medicine ∙Lanny Smith, MD, MPH, DTM&H  *Tuesday at 7:15pm*
Mar 17 ∙ Reentry: Old Fears, New Hopes ∙Meekaelle Joseph
Mar 24 ∙ Street Medicine ∙ Jim Withers, MD
Apr 7 ∙ The History and Practice of Community Psychiatry ∙Thomas Betzler, MD
Apr 14 ∙ Nyaya Health: A Case Study in Developing a Healthcare NGO∙ Ryan Schwarz and Bijay Acharya, MD
Apr 21 ∙ Refugee and Asylee care: Human Rights for Torture Survivors ∙ Nicole Sirotin, MD
Apr 28 ∙ Ayurvedic Medicine ∙Bhaswati Bhattacharya, MD, PhD
May 5 ∙ The War on Women: Criminalization of Reproduction in the United States ∙Robert Roose, MD

For any questions or kosher meal requests, please contact Jessica Karp at jkarp@einstein.yu.edu.

Posted by Matt Anderson, MD

Their announcement reads:

If you are interested in growing your own food, or having better access to healthy food, or getting involved with changing current food policies, this is the event for you!  Our expo features groups that can help you do all this and more.  Or if you simply want to come sample free local healthy foods, maybe learn a thing or two, and watch a few great films, you are welcome as well!

Rethinking the way we eat

This event will showcase some of the activism around rethinking the way we produce and consume food.

• Urban Farming, one of the sponsors, is an organization that promotes the use of urban spaces to plant gardens.  They have developed the concept of vertical farming - “edible” food-producing wall panels mounted on walls of buildings, growing fresh produce (without the use of pesticides).”
• Bascom Catering will be providing free, locally-sourced Vegan lunches.
• Short films from the Bronx will be showcased. As an example, this link shows a shortened version of an urban farming video made at the Point.
• Two feature films will be shown.  What’s on Your Plate? and FRESH! What’s on Your Plate? is a documentary that follows two eleven year old NYC girls as they try to figure out how food gets onto their plates.  FRESH! focuses on the efforts of activists across the country to “reinvent the food system.”
• An interactive expo will feature groups from the South Bronx and beyond that grow and supply healthy local food, and fight for change in food policy.

Details: This event is free, but there is a $10 suggested contribution. Food/clothing donations are encouraged.  Childcare will be provided. For more information, contact: Adam, actionatthepoint@yahoo.com

For more information on local food activism, consult some of our earlier posts on food and nutrition.

posted by Matt Anderson, MD

Shah M, Edmonds-Myles S, Anderson M, Shapiro ME, Chu C. The Impact of Mass Incarceration on Outpatients in the Bronx: A Card Study. Journal of Health Care for the Poor and Underserved, Volume 20, Number 4, November 2009, pp. 1049-1059.

2009 marks the 400th anniversary of Henry Hudson’s voyage (let’s not say discovery) up the the river that now bears his name. There will be many celebrations marking this anniversary, but perhaps none as imaginative as the paired conferences organized by the public health communities in Amsterdam and New York City. The first conference was held on April 6th in Amsterdam, the second conference will take place on September 10th in New York. These dates mark Hudson’s departure from Amsterdam and entrance into the Hudson River, respectively.

The joint conferences are entitled the Hudson Year Urban Health Conference in Amsterdam and New York: a Tale of Two Cities in 2009.   We have posted the conference brochure at this link.  As readers can see there is a social medicine focus to the presentations. Here is a description of the conference from the brochure:

Henry Hudson Year
When Henry Hudson set foot in what would become New York, Amsterdam was already a flourishing city. Trade, culture, and social emancipation were the cornerstones of society. The city thrived because immigrants brought their skills and work. Tolerance for diverse religious and cultural backgrounds was born in Amsterdam and was important for the development of New York. In some ways, New York became what Amsterdam once was. Yet both cities have many vulnerable citizens that need care. In this conference, we will take a closer look at the similarities and differences in how they meet this major challenge.

A Tale of Two Cities in 2009
The Hudson Year Urban Health Conference (HYUHC) is a one-day program planned for Monday, April 6, 2009, in Amsterdam and repeated on Thursday, September 10, 2009, in New York. The Amsterdam site is De Duif, Prinsengracht 756, 1017 LD Amsterdam, The Netherlands. The New York site is Columbia University, Department of Psychiatry, 1051 Riverside Drive, first floor auditorium, New York, NY 10032. The two programs will be largely identical, with a local emphasis for each city. After morning workshops for health experts, afternoon lectures will be open to all persons interested in urban health, followed by a reception.  The HYUHC will be organized by the Public Health Service of Amsterdam (GGD) in co-operation with Care and Community Services of Amsterdam (DZS), Columbia University, the Montefiore Hospital of NYC, and the NYC Department of Health and Mental Hygiene.

Themes and Topics
Big cities are inhabited by many groups of marginalized people. The mental illnesses, addiction, and other health problems from which they suffer have an impact on the individual and on society as a whole. Our conference goal is to introduce these problems and to show a broad audience the progress made and the continuing attempts to find solutions. An important purpose is to raise more understanding and tolerance among the people living in these cities.  Each afternoon speaker will present a controversial statement to discuss with the audience. At the morning workshops, health experts will meet and share knowledge to strengthen the already existing work relations between New York and Amsterdam.

At both HYUHC sites, the Dutch photographer Annaleen Louwes will present a series of photographs concerning urban health care in Amsterdam and New York. This visual display will highlight the similarities and differences between the two cities. The organization Niet-Normaal, the Netherlands (www.nietnormaal.com), will invite contemporary artists from Amsterdam and New York to enforce the message of this conference by showing video art works.

Two abstracts

To provide readers of the Portal with  a sense of the conference’s content, here are two  abstracts, one from New York City, the other from Amsterdam:

Chinazo Cunningham, Montefiore Medical Center and Albert Einstein College of Medicine. Title: Sketches from the Bronx–what we see and what we do!

Dr. Cunningham will present two innovative programs that aim to improve access to care among HIV-infected, opioid-addicted, and unstably housed individuals. One program involves close collaboration between an academic medical center and a community-based organization, medical outreach to hotels (that serve as temporary emergency housing), and the delivery of health care outside of traditional medical settings. The other program provides opioid addiction treatment with buprenorphine outside of a traditional drug treatment program. Dr. Cunningham will describe the evolution and sustainability of these programs and present results of program evaluations.

Udi Davidovich, GGD Amsterdam.  Public education on HIV/AIDS by the GGD
Online public campaigning for sexual health: the role of Internet  interventions, their potential and current achievements. Online prevention interventions have been increasingly used by the Amsterdam Health Services to influence health-seeking behaviour and sexual behaviour among different risk groups for HIV and other STD’s. In this presentation we will discuss the present targets, present achievements and the potential of online interventions. The presentation will be illustrated by three ongoing targeted campaigns: an online intervention for the promotion of safe sex among gay steady partners (in www.mantotman.nl), an online internet intervention for the promotion of safe sex and HIV testing among heterosexual youth: www.vrijlekker.nl, and an internet tool for the facilitation of STD screening among gay men (in www.mantotman.nl).

Further Details:

The New York Conference will take place on September 10th, 2009 at  Columbia Presbyterian, 1051 Riverside Drive (& 168th St), Auditorium, first floor, NY, NY 10032.  The morning program (small groups sessions) will run from 8:30-12:00 and the afternoon program (lectures) from 2-5:00. A reception will be held from 5-6:30 PM.  The cost is free. To register visit this website: www.nynjaetc.org

For more information on the NY400 week and the many planned events, check out the official website.

Posted by Matt Anderson, MD

In the Bronx…

Breastmilk provides babies an immunologic leg up on life. Breastfed babies are less likely to have diarrhea, respiratory tract infections, otitis media, and other infections. During the first six months, the infection rates are lower for exclusively breastfed than for partially breastfed infants. These benefits are not just for infants in developing countries. Health and survival benefits from breastfeeding are also seen in the United Sates. Encouraging our patients to breastfeed will prevent infectious disease and decrease emergency room and clinic visits.

The Montefiore Breastfeeding Committee seeks to increase exclusive breastfeeding rates on discharge from Weiler and Montefiore North nurseries. Please join us in this effort. Participate in Montefiore Breastfeeding programs during breastfeeding week and throughout the year.

The American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetrics and Gynecology, World Health Organization recommend exclusive breastfeeding until six months of age.

Free breastfeeding continuing education credit for physicians, nurses,
and dieticians is available at: www.breastfeedingtraining.org

From: Dr. Rebecca Williams

… and around the World

Its We the People Who Can Bring Change: Lets ACT NOW!!

World Breastfeeding weeks starts on August 1, (1-7 August). The theme is Breastfeeding, A Vital Emergency Response: Are You Ready?

You can find out more, download materials and find events at: http://www.worldbreastfeedingweek.org/

UNICEF and WHO have made statements in support of the week, which is coordinated by the World Alliance for Breastfeeding Action.

UNICEF’s statement notes: “Around 9 million children under five die every year, largely from preventable causes… According to the Lancet, optimal breastfeeding in the first two years of life, especially exclusive breastfeeding for the first six months, can have the single largest impact on child survival of all preventative interventions, with the potential to prevent 12 to 15% of all under age 5 deaths in the developing world… This year’s World Breastfeeding Week provides an opportunity to sensitize policy-makers, donors, implementing partners and the general public to the benefits of breastfeeding, to its particular importance in emergency situations, and to the need to protect and support mothers to breastfeeding during emergencies.”

You can find the full UNICEF and WHO statements via links at:

http://boycottnestle.blogspot.com/2009/07/wbw-2009.htm

It is a government requirement that tins have warnings that breastmilk is best for babies, but Nestlé refuses to translate these into local language, despite requests to do so, because of ‘cost restraints’. It took a Baby Milk Action campaign that led to Mark Thomas highlighting this irresponsible marketing on UK television, to change Nestlé’s minds, and further campaigning to persuade Nestlé to show cup feeding, rather than bottle feeding, in line with government policies. See: http://www.babymilkaction.org/CEM/compfeb00.html

So campaigning works. Now we need to persuade Nestlé to remove the ‘protect’ logo from labels . You can help by sending a message to Nestlé. You will find the information you need to do so on our July Campaign for Ethical Marketing action sheet, which is now available on our website at: http://www.babymilkaction.org/cem/cemjuly09.html

If politicians fulfilled their responsibility to implement the baby food marketing standards adopted by the World Health Assembly, then public campaigns would not be necessary and there would be progress towards stopping the millions of preventable under-5 deaths.

You can help put pressure on politicians by signing the ONE MILLION CAMPAIGN petition. If you have already signed, visit the campaign website to see what action you can take to encourage friends and colleagues to sign up. See: http://www.onemillioncampaign.org

Make an opportunity to call upon companies and your leaders to END ALL KINDS OF PROMOTIONS of Baby Foods by 2015.

2. If you would like to submit the One Million Campaign Petition to your Head of the State, please use the opportunity to do so.

At this link http://www.onemillioncampaign.org/press-release1.aspx you can find the Petition letter, and petition submitted to the President of the World Health Assembly in May 2009.

From: OneMillionCampaign mail@onemillioncampaign.org

Another link http://www.onemillioncampaign.org/doc/draft-letter.doc provides a draft for you to use to write to your Head of State.

CAAAV and NMCIR-Bronx Project have partnered to provide FREE

Immigration Consultation
US Citizenship Application
Low-cost Adjustment of Status
Low-cost Family-based Petitions

Where: CAAAV  Office, 2473 Valentine Ave.
(Fordham Rd. at 188th St.), Bronx, NY 10458
(Available by the BX 12 bus)
When:    Last Wednesday of every Month
(July: Wed 28th, August: Wed 26th, Sep Wed 30th)
Time:  10 am- 2pm
Email: ylp@caaav.org
Phone: (718) 220-7391 ext.16,

For Vietnamese: Minh-Hà, For Khmer: Chhaya

Please note that if you are at least 50 years old and have lived in the US as a legal permanent resident for 20 years or if you are at least 55 years old and have lived in the US as a legal permanent resident for 15 years you are eligible to take the Citizenship Exam in your native language and the exam is oral – not written

CAAAV kết hợp NMCIR-Bronx Project
cung cấp dịch vụ
FREE- miễn phí
về
Tư vấn Luật Di trú
Hồ sơ xin Nhập Tịch
Hồ sơ xin Thẻ Xanh (lệ phí thấp)
Hồ sơ xin Bảo Lãnh Thân Nhân (lệ phí thấp)
Địa điểm:    Văn phòng CAAAV
2473 Valentine Ave.
(Fordham Rd. và 188th St.), bus Bx12
Bronx, NY 10458
Thời gian:    Thứ Tư cuối cùng mỗi tháng
(Tháng 7: ngày 29, Tháng 8: ngày 26, Tháng 9: ngày 30)
10:00 sáng – 2:00 chiều
Email: ylp@caaav.org
Phone: (718) 220-7391 ext.16
Tiếng Việt: Minh-Hà  Tiếng Khmer: Chhaya

posted by Matt Anderson, MD

posted by Matt Anderson, MD