An Alternative to Corporate Health (founded in 2004)
As a follow-up to our earlier post on nutrition in New York City (Feast or Famine) our colleague Renee Shanker sent us an updated list of Farmers’ Markets in the Bronx (see link). For a complete list of farmers’ markets supported by the New York City Department of Health visit this link.
posted by Matt Anderson, MD
For information see
Riker's Island
The June 2009 edition of the American Journal of Public Health contains an article entitled: From Public to Private Care The Historical Trajectory of Medical Services in a New York City Jail” written by Noga Shalev, MD. Dr. Shalev is a graduate of the Residency Program in Social Medicine and this work developed from her 2006 Social Medicine Project. The article describes the evolution of health care services at Riker’s Island.
The Riker’s Island Penitentiary sits in New York City’s East River between Queens and the Bronx, just to west of La Guardia Airport. Riker’s is quite literally an island, connected to the Borough of Queens by a single bridge. It is one of the world’s largest correctional facilities with an average daily census of about 13,000 prisoners. Administratively, the facility houses ten jails that sit on the island and the Vernon C. Bain Center, an 800 person facility located on a barge just off of Hunts Point in the Bronx.
Vernon C. Bain Prison Barge
Dr. Shalev divides the history of health care at Rikers into three periods. From the opening of the prison in 1932 until 1973 medical services were provided by various New York City agencies. During this period numerous reports documented the poor quality of care provided to inmates. It seems clear that the Department of Correction’s concern for security trumped attempts to provide medical care to inmates. As noted in a 1958 report: “The Department of Correction is not now in background, equipment, or personnel capable of giving modern medical care—whether preventative or therapeutic—to the prisoner.”
Attempts to remedy this situation made little progress until the early 1970′s when a series of prison revolts including those at the upstate Attica prison and the Manhattan House of Detention (commonly known as “the Tombs”) led to reforms. This resulted in the second period of medical care at Rikers. From 1973 to 1996 Montefiore Medical Center provided health care under an affiliation agreement with the City. Health care on the island improved and the service was “the first correctional medical program in the country to be accredited by the Joint Commission on Accreditation of Healthcare Organizations” (JCAHO). However this period also coincided with the HIV epidemic and in its wake a resurgence of tuberculosis; prisoners were particularly affected by these twin epidemics. Costs for medical care increased substantially and in 1996 the Giuliani Administration decided to turn health care at the island over to a private contactor. The initial agreement with St. Barnabus Hospital was generally recognized as a failure. Costs did not decrease and there were ongoing concerns about the quality of care. Currently, care on the island is provided by the private, for-profit Prison Health Service, Incorporated. Concerns over costs and quality of care remain. Dr. Shalev characterizes this final period from 1996 to the present as one of “managed care” and the overarching theme of her paper is that health services at Riker’s have moved from public hands (the city) into private hands (for-profit corporations).
Dr. Shalev’s careful historical research, butressed by interviews with Montefiore staff, tell the story of a particular and certainly unique experience in incarceration. But the unique story of Riker’s illustrates the larger themes of how corrections have come to be seen as one more commodity on which profit can be made. And this gives powerful players a vested interests in keeping jails full. The result is a system described by some as a prison-industrial complex, by others as a penal state.
Here is the abstract of Dr. Shalev’s paper:
Over the past 25 years, incarceration rates in the United States have more than tripled. Providing health care services for this growing number of inmates poses immense medical and public health challenges. Focusing on the administrative and financial shifts in health care delivery, I examined the history of medical services in one of the nation’s largest correctional facilities, Rikers Island in New York City. Over time, medical services at Rikers have become increasingly privatized. This trend toward privatization is mirrored nationwide and coincides with the rising prevalence of incarceration.
posted by Matt Anderson, MD
The following letter is from Chhaya Chhoum one of the organizers of the Justice is Healing campaign, an outgrowth of work by Organizing Asian Communities (formerly the Committee Against Anti-Asian Violence):
I want to share some victories we recently had in our Southeast Asian Health Justice Campaign and invite you to a screening of a documentary our Southeast Asian youth made using the theme of justice is healing. Their documentary will be screened as part of the Global Action Project’s end of the year screening on June 18.
We launched the Southeast Asian Health Justice Campaign in 2007 for improved and quality health services at Montefiore Medical Center, a Bronx-based hospital frequented by local Cambodian and Vietnamese refugee communities who continue to suffer from traumas of war and genocide experienced two decades ago from their homelands. Despite the high population of Southeast Asian patients at Montefiore, lack of translation services and cultural competency and the failure of medical staff to link the community’s prevailing health conditions to traumas experienced two decades ago, have led to inadequate provision of health care. Our demands include quality translation services; holistic care that includes alternative treatments, like acupuncture; integration of social services into the health care delivery; cultural competency of medical staff; and increased community outreach and education. Our Southeast Asian youth have been leading this campaign by organizing the community, mobilizing a broad-based support from different sectors, including elected officials, and engaging Montefiore staff for improved health care delivery.
We recently has a victory in the health justice campaign with Montefiore Medical Center hiring a Vietnamese speaking doctor and providing acupuncture free of charge at one of the clinics! While this is a huge victory, we will continue to organize until other important services, such as translation, are implemented. Thank you for all the support that people have given to us that made this victory possible!!
As part of the campaign, three of our youth members participated in the Global Action Project’s documentary making project to document the Southeast Asian community’s health conditions. Please join us in the screening on *June 18, 2009 at 5pm.*
Featuring youth-produced media exploring the impact of racism on self image, the criminalization of immigrant communities, LGBTQ youth responding to hate violence, the work of youth organizers in the Bronx Southeast Asian community and much more!
This event is FREE and open to the community.
Please come support GAP’s youth producers!
5PM – 8PM
JUNE 18, 2009
66 W 12th Street
Tishman Auditorium
at The New School
The Tishman Auditorium is located at 66 W 12th Street, between 5th and 6th Aves
Directions: Take the 4, 5, 6, L, N, Q, R, W to 14th St Union Square, the F, L, V to 6th Ave – 14th St, or the 1,2,3 to 7th Ave – 14 St
RSVP to media@global-action.org <mailto:media@global-action.org>
Also look out for us on these media outlet in the next few months….
Free Speech Radio News, which is broadcast nationally on the Pacifica
network
Peace
Chhaya Chhoum
–
Chhaya Chhoum
YLP, Program Director
CAAAV Organizing Asian Communities
2473 Valentine Ave. Bronx, NY 10458
Ph. 718.220.7391 ext. 15
cya@caaav.org
chhaya4178@gmail.com
www.caaav.org
John del Signore at the Gothamist highlights Mayor Bloomberg and Governer Paterson’s new Food Retail Expansion to Support Health (FRESH) Food Stores. Stores will be eligible to apply for these grants based on their appropriation of space and resources to providing fresh foods to the communities they serve. This is a welcome initiative in a city with some of the greatest healthy food disparity anywhere. The next step will be alerting grocers in the community to the potential funding available. Many grocers in underserved communities are owned and operated by immigrants who may have difficulty navigating the steps to obtaining these funds. For more information, visit the FRESH website.
Original post here.
“Acting on last year’s study showing that many lower-income neighborhoods desperately need decent grocery stores, today Mayor Bloomberg and Governor Paterson have announced a new program to encourage “the establishment and retention of neighborhood grocery stores in underserved communities in Northern Manhattan, the South Bronx, Central Brooklyn and Jamaica, Queens.” It’s called the Food Retail Expansion to Support Health (FRESH) Food Stores program, and the mayor’s office predicts it will “help create an estimated 15 new grocery stores and upgrade 10 existing stores, creating 1,100 new jobs and retaining 400 others over 10 years.”
To qualify, retailers must meet certain requirements, like providing at least 30 percent of retail space for perishable goods that include dairy, fresh produce, fresh meats, poultry, fish and frozen foods; and providing at least 500 square feet of retail space for fresh produce. Then they’ll be eligible for zoning and financing exemptions, such as real estate tax abatements and sales tax exemptions on purchases of materials used to acquire property or to construct, renovate or equip grocery stores. Some of the funding for all this will come from a new $10 million state revolving loan fund program created for FRESH, and the state also announced the establishment of a permanent farmer’s market grant program, as well as financial incentives for food markets to be green and energy efficient.”
The following news (brought to my attention by my dear friend Cristina), from today’s Amy Goodman’s Democracy Now radio show, provides a good exercise in critical thinking: finding the flaws in president Obama’s argument (invalid inferences, false assumptions, etc) that ” it is best to build on the health care system we have”, rather than presumably adopt too radical solutions like single payer (I myself could find four flaws in two minutes! For a fuller argument for why it is misguided at best to build on “the health care system we have” read “Not Change We Can Believe In“).
According to the president, “the vast majority” of Americans get coverage from their jobs, and presumably are satisfied with it.
Another interesting accompanying headline is “Health Industry Says Obama Overstated Pledge to Cut Costs” (surprise surprise!). It looks like, after all, companies “never agreed to specific yearly cuts, but only vague voluntary goals”.
For both clips, click here.
At a town hall-style event in Rio Rancho, New Mexico, Thursday, local resident Linda Allison asked President Obama why the White House and the Democratic-led Congress have ruled out single payer.
Linda Allison: “My question is, so many people go bankrupt using their credit cards to pay for healthcare. Why have they taken single payer off the plate? And why is Senator Baucus on the Finance Committee discussing healthcare, when he has received so much money from the pharmaceutical companies? Isn’t it a conflict of interest?”
President Obama: “If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense. That’s the kind of system that you have in most industrialized countries around the world. The only problem is that we’re not starting from scratch. We have historically a tradition of employer-based healthcare. And although there are a lot of people who are not satisfied with their healthcare, the truth is, is that the vast majority of people currently get healthcare from their employers, and you’ve got this system that’s already in place. We don’t want a huge disruption as we go into healthcare reform, where suddenly we’re trying to completely reinvent one-sixth of the economy.”
Obama did not address the second part of Linda Allison’s question about Democratic Senator Max Baucus, who has excluded single-payer advocates from Senate Finance Committee hearings. Allison says she was partly inspired to ask the question after viewing Democracy Now!‘s coverage on Wednesday of single-payer advocates who disrupted Baucus’s hearing.
We have just published the 12th edition of Social Medicine/Medicina Social, our bilingual, online journal. It is available in both English and Spanish. Our 12th issue captures the stories and struggles of diverse health activists, among them Dr. Walter Lear (shown below):
US Health Activism Collection
Last summer we had an opportunity to interview Dr. Lear (now 85 years old), founder of the US Health Activism Collection. In a wide-ranging interview in his home Dr. Lear discussed his personal background, the origins and purpose of the collection, the impact of the McCarthy period on the US health left, as well as his vision for the future (available at this link). Dr. Lear later added copious footnotes to his interview creating a virtual “Who’s Who” of the mid-20th century US health left.
Dr. Lear also allowed us to make PDF copies of two of the pamphlets in his collection. These are Autopsy on the AMA: An Analysis of Healthcare Delivery Systems in America [1970] published by the Student Research Facility and Your Health Care in Crisis: A HEALTH/PAC Special Report [1972] [Both documents are a bit long and may take some time to download.] Although HEALTH/PAC no longer exists as an organization, there is a HEALTH/PAC website.
Seize the Hospital to Serve the People
We are also publishing a video of Cleo Silvers, a remarkable Bronx health activist who was involved in the takeover of Lincoln Hospital. (For more on this take over see our spring 2007 journal) The video of Ms. Silvers can be seen at our Audio/Visual tab.
Should India Use Commercial Ready To Use Therapeutic Foods (RUTF) For Severe Acute Malnutrition (SAM) ?
Indian Activists associated with Jan Swasthya Abhiyan (People’s Health Movement – India) and the Right to Food Campaign question the value of Plumpy Nut, an Ready to Use Therapeutic Food (RUTF). They argue that locally produced alternatives are cheaper, more acceptable, and serve to strengthen communities. At the very least Plumpy Nut should have been compared to local supplements before being adopted by the government. Available at this link.
Combatting Organ Tafficking
Activists Debra A. Budiani and Kabir Karim of the Coalition for Organ-Failure Solutions discuss the social roots of organ trafficking and consider the implications of a 2008 WHO resolution and the Istanbul Declaration. Available at this link.
posted by Matt Anderson, MD
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
Anyone who has driven across the Whitestone Bridge more than once or twice has probably noticed the large brick building located just east of the highway on the Bronx side. This is the home of the St. Joseph’s School for the Deaf, a school founded in 1869 and which moved to its 10-acre campus in the Bronx in 1913. St. Joseph’s is is one of eleven New York State 4201 schools which are supported by the state to provide educational services to children who are deaf, blind or physically challenged. Social Medicine Rounds last Tuesday (2/10/2009) took us to the School to learn something about deaf culture.
We were greeted by Patricia Martin, Noreen Collins and Roxana Aguilo who were gracious enough to spend nearly 90 minutes talking to us about the school and about the meaning of deafness. Dr. Martin is the Executive Director of St. Joseph’s and has been with the school for seventeen years. Ms. Collins in responsible for pupil personnel services and is the person to call (718.828.9000) for assistance with referrals . Ms. Aguilo is a former student at the school who works there now as a teacher’s assistant. Since she is deaf, she participated in the Rounds through the able translating abilities of Dr. Martin and Ms. Collins.
Dr. Martin began by distinguishing two definitions of deafness. Deafness can be seen as a pathology; this is what we could the “medical model.” In this model the important questions are why it occurred, how severe it is and how it can be fixed. But deafness can also be seen as a culture. From this perspective to have deafness is not to be dis-abled, but rather to be differently abled. To emphasize the reality of deaf culture, Dr. Martin read a poem entitled “Being Deaf” by Dianne Kinnee:
“What is it like to be deaf?”
People have asked me.
Deaf? Oh, hmm… how do I explain that?
Simple: I can’t hear.
No, wait… it is much more than that.
It is similar to a goldfish in a bowl,
Always observing things going on.
People talking at all times.
It is like a man on his own island
Among foreigners.
Isolation is no stranger to me.
Relatives say hi and bye
But I sit for 5 hours among them
Taking great pleasure at amusing babies
Or being amused by TV.
Reading books, resting, helping out with food.
Natural curiosity perks up
Upon seeing great laughter, crying, anger.
Inquiring only to meet with a “Never mind” or
“Oh, it’s not important”.
Getting a summarized statement
Of the whole day.
I’m supposed to smile to show my happiness.
Little do they know how truly miserable I am.
People are in control of language usage,
I am at loss and really uncomfortable!
Always feeling like an outsider
Among the hearing people,
Even though it was not their intention.
Always assuming that I am part of them
By my physical presence, not understanding
The importance of communication.
Facing the choice between Deaf Event weekend
or a family reunion.
Facing the choice between the family commitment
And Deaf friends.
I must make the choices constantly,
Any wonder why I choose Deaf friends???
I get such great pleasure at the Deaf clubs,
Before I realize it, it is already 2:00 am,
Whereas I anxiously look at the clock
Every few minutes at the Family Reunion.
With Deaf people, I feel so normal,
Our communication flows back and forth.
Catch up with little trivials, our daily life,
Our frustration in the bigger world,
Seeking the mutual understanding,
Contented smiles and laughter are musical.
So magical to me,
So attuned to each other’s feelings.
True happiness is so important.
I feel more at home with Deaf people
Of various color, religion, short or tall.
Than I do among my own hearing relatives.
And you wonder why?
Our language is common.
We understand each other.
Being at loss of control
Of the environment that is communication,
People panic and retreat to avoid
Deaf people like the plague.
But Deaf people are still human beings
With dreams, desires, and needs
To belong, just like everyone else.
–Dianne Kinnee (Switras)
Dr. Martin went on to describe their work in the school. She pointed out that about 95%of deaf children are born into hearing families. If hearing parents don’t learn sign language, as often happens, this can be very isolating for the deaf child. This is a particular problem in Bronx where many parents don’t speak English. For immigrant parents learning American Sign Language involves communicating in a doubly foreign language. [A universal sign language does not exist; each spoken language has its own way of signing]. The result of this is that even when deafness is identified early on deaf children may not receive a great deal of language stimulation at home.
The school has responded to this challenge by providing programs in which parents can bring their children to the school as early as 8 months of age. Children come to the school on their own starting at age 3 and stay through the 8th grade. The school also offers a 10 session class on Thursday evenings for people interested in learning how to sign. The cost is $50.
Ms. Aguilo then spoke at length about her personal experience. She had been born in the Dominican Republic where there were no services for the deaf. Her mother brought her to the Bronx and she had been diagnosed as deaf at Jacobi Hospital. This was a great blow for her mother. Fortunately, they had a Spanish-speaking counselor at Jacobi who was able to explain the situation in a language her mother could understand. Her mother found learning sign language difficult and so Ms. Aguilo had great difficulty in communicating with her Mom. Ms. Collins mentioned that often parents came to the school requesting that the school tell children about the death of relative or a pet. In these cases the school asked the parent to come in and the school provided translation services.
Ms. Aguilo had been a student at St. Joseph’s and later enrolled at Rochester Institute of Technology where she majored in fashion design. But she was homesick for the Bronx and returned after only a year and a half. Now she was working as a teacher’s assistant. She has three children of her own (“and all of them hear”) and has taught them ASL. Her kids are tri-lingual, speaking English, Spanish (with the abuela) and ASL (with Mom).
The topic of kids lead to a discussion of their use as interpreters. Ms. Aguilo spoke in forceful terms that the American Disability Act gives deaf people a right to a translator and this right should be respected. “Don’t write”, she said. “Don’t ignore our rights. It only makes us angry.” The use of children as interpreter has also been an issue with our southeast Asian patients. For a list of translation resources, see the end of this post. Ms. Aguil0 also spoke about the coverage limitations imposed by SSI particularly in terms of cost-sharing for hearing aids.
Ms. Aguilo noted to us that deaf people can drive cars. Deaf persons had initially experienced difficulty getting auto insurance so they formed their own company. Accident rates are lower for deaf drivers than for hearing drivers.
Finally we touched on the controversy surrounding cochlear implants. A 2005 Scientific American Frontiers program provides an introduction to this topic. The program included a fascinating website that allows one the hear the evolution of CI technology.
To some cochlear implants are the latest medical miracle. But many in the deaf community see it as an attempt by the medical community to eradicate deaf culture. Ms. Aguilo was blunt: “I like being deaf. And cochlear implants say to me that I am not ok.” She did not think they were appropriate for children born deaf. But they were an option for hearing people who were becoming deaf. Dr. Martin stated that the school was neutral with respect to implants.
Interpreting Services
New York Society for the Deaf: 212 366-0075 (9AM-5PM)
Mill Neck Manor School for Deaf Children: 516 512-6222
Deaf & Hard of Hearing Interpreting Services, Inc.: 212 647-1092 (8AM – 5PM, requests for interpreting by appointment; call same number after 5PM for emergency interpreting)
Video Relay Service (VRS): Sorenson VRS 866 327-8877. You need to have either the video number or the IP address for the Deaf person to call in addition to calling VRS.
posted by: Matt Anderson, MD
The Youth Leadership Project organizers
There has been snow continuously on the ground in New York since before New Year, a somewhat rare occurrence in these days of global warming. And saturday, January 31st was a particularly cold night. As one approached the basement of the St. Nicholas Tolentine church, a few brave souls stood outside smoking cigarettes and talking on cell phones.
Inside was the first annual fund-raising dinner of the Youth Leadership Project, a South East Asian community group. A dozen or so large round tables were spread around a long white room. At the tables was a happy crowd made up mainly of Cambodian immigrants. The room was filled with the sounds of people greeting friends. They saluted each other by putting their hands together as if in prayer and making a slight bow. Little kids zoomed in and out from a neighboring “children’s” room, mingling briefly with the adults and then returning. A small bar in the corner did a brisk business while people waited for the evening to start.
Chhaya and Khamarin, two of the YLP organizers, started the evening with a brief introduction to the Youth Leadership Project and appeals for help with two current projects. One is the Justice is Healing project (covered in detail in our blog of October 15, 2008); the other is a planned community center (more details below). They spoke in English and then Chhaya’s mother Ousara Phok, got up and translated their speech, a “translation” that involved copious thanks to many of the people sitting in the room.
The speeches were accompanied by a three course meal from Huynh Catering Services. The Huynh family, originally from Cambodia, has a long tradition of catering and Victor, we were informed, “does all the Cambodian weddings.”
With the speeches over, the very serious business of dancing began. Monorom, “one of the best Cambodian bands”, had been invited from Philadelphia and clearly knew what music the audience wanted to hear. Very quickly the dance floor was full. There were several different types of dances. Madison looked something like a line dance and can be seen at this link. Next came the circle dance (ramvong) a slow dance in which the dancers made elaborate movements with their hands as their hips swung slowly from right to left and back. Genders alternated in the circle. It was explained that in the old times unmarried people were not allowed to touch as they danced, thus the physical separation created by the circle. Finally, the Saravan dance which seemed to draw the most enthusiastic crowd.
We found a few minutes to catch up with Khamarin, one of the YLP leaders. He is a 20 year old student at New York College of Technology with plans to become a X-ray technician. He was born in the US and wasn’t entirely sure where in Cambodia his parents were born. His mother, he thought, came from Battambang and his father from a very small village.
Khamarin’s first experience in organizing came in 1999 when his aunt, a YLP
Chhaya and Khamarin
organizer had been campaigning against the welfare reforms of the Guliani administration. (This campaign was the subject of a film “Eating Welfare” made by CAAV: Organizing Asian Communities, the parent of YLP). Khamarin was quite young at the time but could not help being impressed by the fact that his aunt had brought people to the community to help. Thinking back now, he remembers how his elderly grandmother had started doing piecework about the time of the welfare cuts. She sewed small hair bands (scrunchies) in her apartment. He thought she was doing it as a hobby, but later he realized how many women in the community were doing this kind of piece work. “They would do the sewing and then the kids would cut the bands apart and sort them into piles.”
In 2001, 2002 the YLP organized ACE gatherings: Arts, Community, Empowerment. “We would be broken up into little groups and have to cook an entire Asian meal right there,” he said, “You would interact with people who you wouldn’t normally meet.” He learned about “the whole other side of the world.” This led him to training in community organizing and in 2006 he participated in the community health survey that was part of the “Justice is Health” campaign. He would knock on doors and ask questions about health problems and experiences with the medical system. health. He remembered one elderly woman. “My Khmer is not all that good, but it was enough to understand her.” She told him that it had been 5 or 6 years since she had seen a doctor. She had complaints. Back pains, leg pains and recurrent nightmares going back to the war. But it was too much trouble to go to the clinic and have no one there who would understand you. And if she had to take the children to translate, they would miss school.
We discussed YLP’s vision of a community center. The YLP house at 2473 Valentine Ave now serves as an unofficial community center and people gather there for holidays. But it is small for the group’s ambitions. They hope to create a Mekong Center that will serve local southeast Asians, not just Cambodians. It would be place to teach cooking, sewing, gardening, art, and dance. “These are our people’s skills, even though here they are not looked on as skills.” A group of urban planning students from Hunter College had helped them out. As a school project the students had created plans for rebuilding the current house into a real community center. Estimated cost: $2 million. Now it was YLP’s job to figure out what they would do with the plans.
Khamarin said that he had never been to Cambodia. He is afraid of flying. What he knew of Cambodian history he had learned from YLP. His schooling had not taught him much about his parent’s native country.
The Cambodian community in the Bronx has suffered multiple traumas. But this was not in evidence last Saturday night.
posted by Matt Anderson, MD
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