Archive for the 'Immigration & Refugees' Category

2014 Einstein Student Run Social Medicine Course

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The Social Medicine Course at the Albert Einstein College of Medicine was founded by a group of 8 students in 1998 and is now in its 17th year. It remains entirely student-run. Course schedules going back to 2007 can be accessed at this page on the Portal.  The talks run from 5:30 to 6:30PM and take place on the 5th floor Forchheimer Lecture Room. They are open to the public.


Wednesday, January 8, 2014
Dr. Robert E. Fullilove
Health and Racial Disparities in New York City

Wednesday, January 15, 2014
Dr. Sunil Kumar Aggarwa
Compassionate Care: Medical Marijuana In New York

Wednesday, January 22, 2014
Dr. Marji Gold
Reproductive Rights and Abortion Care

Wednesday, January 29, 2014
Dr. Oliver Fein
Direct Action: Lessons from the Young Lords Occupation of Lincoln Hospital

Wednesday, February 5, 2014
Mychal Johnson South Bronx Unite:
FreshDirect and its Health and Social Costs in the South Bronx

Wednesday, February 12, 2014

Wednesday, February 19, 2014
Dr. Maria Caban
Harm Reduction and Syringe-Exchange in the South Bronx

Wednesday, February 26, 2014

Wednesday, March 5, 2014
Dr. Mark Heath
Bioethics of Lethal Injection

Wednesday, March 12, 2014
Dr. Rosy Chhabra
Community Based Participatory Research

Wednesday, March 19, 2014
Dr. Danny Lugassy
Healthcare Reform in 2014: Why do we still need Single Payer?

Wednesday, March 26, 2014
Dr. Neil Calman
Segregated Health Care in the South Bronx

Wednesday, April 2, 2014
Dr Aaron Fox
Prison Medicine

Wednesday, April 9, 2014
Dr. Nancy Berlinger
Access to Healthcare for Undocumented Immigrants

Wednesday, April 30, 2014
Dr. Alan Blum
Ending The World Tobacco Pandemic

posted by Matt Anderson, MD

En Foco’s Touring Gallery presents Pete Pin’s Cambodian Diaspora series

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From the Cambodian Diaspora Series

Cambodian Diaspora: Photographs by Pete Pin

April 29 – July 19, 2013 / Reception: May 17, 2013


Born in a Cambodian refugee camp where both parents worked in labor camps, Pin immigrated to the U.S. in 1983. Drawing from the experiences of his family as survivors of the Khmer Rouge regime (1975-1979), Pin photographs Cambodian communities throughout the United States. He documents the struggle and pain of the survivors and the direct descendants of the genocide that took millions of lives. The series is a testament to those who died, and an examination of where future generations are now. In an attempt to understand his heritage, Pin pays tribute to the lives of the survivors.

Pin states, “I have struggled for most of my life to understand the legacy of my people. They are among the most heavily traumatized people in modern memory, the human aftermath of a cultural, political, and economic revolution that killed an estimated two million, nearly a third of the entire population, within a span of four years. That tragedy casts a long shadow on the lives of Cambodians that bleeds generationally, manifesting itself across generations.”

Pin studied at the International Center of Photography and is currently finishing his Artist in the Marketplace residency at the Bronx Museum of the Arts. Pin is also a Season of Cambodia artist, an initiative that  promotes Cambodian artists.

Location: En Foco at Montefiore Family Health Center
360 E. 193 Street, Bronx, NY 10458 t: 718.921.9311
Reception: Friday, May 17, 2013 from 4:30–6pm
Artist Talk: Friday, May 17, 2013 from 6–7pm
Exhibit Dates: April 29 – July 19, 2013
Hours: Monday – Thurs, 8:00am–8:00pm; Friday, 8:00am–4:00pm; Saturday 8:00am–noon


En Foco’s Touring Gallery exhibitions feature presentations by emerging photographers in community spaces throughout New York City, curated by staff or emerging guest curators. Photographers gain professional exhibition experience, an opportunity to interact with local audiences, and are awarded an honorarium. All Touring Gallery events are free and the public is encouraged to attend. Touring Gallery is funded in part by the NY State Council on the Arts, the NY City Department of Cultural Affairs, the Bronx Council on the Arts, the Andy Warhol Foundation for the Visual Arts, and En Foco friends. Special thanks to Montefiore Family Health Center and Montefiore Art for Health, for their collaboration and support.

Photo: © Pete Pin, Cambodian Diaspora, 2011. Enfoco, 1738 Hone Avenue • Bronx, NY 10461 • t: 718 931 9311 • f: 718 409 6445 • •


Fundraising Party to Celebrate First Anniversary of Mekong, Bronx’s Southeast Asian Community Organization

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Join Mekong's First Anniversary Celebration on Wednesday, March 27, 2013

Download a copy of the invitation

Peña del Bronx celebrates 25 years of struggle Saturday September 15th

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The 25th birthday party of La Peña del Bronx is a great chance to celebrate, dance and hear some great music!

Magnum Foundation Emergency Fund Interviews Joyce Wong, LCSW & Ousara Sophouk of Montefiore’s Indochinese Mental Health Program

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Joyce Wong, LCSW

Ousara Sophouk










Joyce Wong LCSW , Social Worker and Ousara Sophouk, Family Health Worker at the Montefiore Family Health Center were recently interviewed by Pete Pin for a photodocumentary project – Displaced:The Cambodian Diaspora through the Magnum Foundation Emergency Fund. Mr. Pin, a fellow at Magnum Foundation, spent 5 months last year taking photographs of the Cambodian Bronx community. Joyce and Ousara speak about their 20 years of experience serving the Southeast Asian community in the Bronx. A link to the interview and photographs can be found on the Emergency Fund’s website.

Here is the text of the interview:

In early November, 2011 Pete Pin, EF Fellow, spoke to Joyce Wong, a licensed clinical social worker, and Ousara Sophuok, a Cambodian family health worker who immigrated as a refugee from Cambodia in 1986. Joyce and Ousara work together at Montefiore Hospital in the Bronx, New York where they provide mental health services to the Cambodian and Vietnamese Bronx community.

PETE PIN: Can you describe the clinic and the work you do here in the Bronx?

JOYCE WONG: We have been providing out-patient mental health services for the last twenty years as part of a collaboration between the Department of Psychiatry and Family Medicine. We are part of an urban medical center but we actually modeled our program after the Harvard Program in Refugee Trauma who were pioneers in the identification and treatment of torture and mass violence. With the program, mental health care is integrated in a community healthcare setting as a truly collaborative model of care.

Cambodian refugees were resettled in the Bronx in the mid-1980’s and came to our clinic for healthcare. However, physicians were not equipped to deal with a lot of the medical and psychiatric problems the patients presented. Not only were medical problems associated with lack of access to medical care—as many refugees were living and languishing in refugee camps between five to ten years—but many patients suffered from psychiatric trauma from the Khmer Rouge Regime (1975-1979).

In the mid 1980’s, we partnered with the departments of psychiatry and family medicine at Montefiore and developed a collaboration with a small mental health program to attempt to address some of these problems. At that time non-governmental organizations, especially abroad, addressed the problems of food, clothes and shelter for persons who had undergone mass violence, trauma and natural disaster. But the NGOs did not usually address their mental health needs. My colleagues at Harvard were one of the first to conduct scientific research studies when Cambodian refugees were living in refugee camps in Thailand, and found that high levels of depression existed within the refugee camps. When the refugees were resettled here in the Bronx , the focus on the mental health care needs of refugees was very progressive for that time. It was a holistic approach. This was over twenty years ago.

But how do you present mental health to someone who does not have a western frame of reference or worldview? A lot of the work in the first years was getting to know the community and going out to the community because you’re not going to expect someone to come to your door even if they are living across the street from your clinic. We established a motto of “Eat, Work and Play”: eating with the community, working with the community, and playing with the community. It meant attending weddings we were invited to, attending important religious holidays at the local Buddhist temple, conducting home visits to get a sense of the social issues that the people in the community were facing, walking up and down Fordham Road in the Bronx.

PIN: Were there things unique about the Cambodian community in regards to their trauma and their history that compounded the difficulty of providing services and hindered their ability as individuals and a community to assimilate and to make that transition from the camps to America?

WONG: It was very difficult for Cambodians because during the genocide between one to three million people were killed from a population of seven million. Much of the educated population of Cambodia was killed. Many of the surviving Cambodians that were able to flee and escape to refugee camps were rice farmers who didn’t have high levels of literacy in their own language or education. In contrast, many other immigrant groups came from countries where there was a solid infrastructure, where there’s a high level of educational attainment, and this really influences their experiences when they come to the United States. It affects their ability to navigate in their new home country and what opportunities are available to them on a day to day. The refugees that came to the Bronx from Cambodia were already a disenfranchised community and further marginalized because they were resettled in a physically and economically distressed community. To compound this, not being able to read and write, not having access to resources because of the language was a barrier on all levels: education, work, and health.

PIN: Sarah can you discuss your work in the community and how you became involved in the clinic? It’s important to stress to readers that you are yourself a member of the Bronx Cambodian refugee community, that you immigrated here under the exact circumstances as the people you have been providing services to.

OUSARA SOPHUOK: Joyce Wong had mentioned that during the war a lot of educated individuals were killed and the majority of our patients, especially the ones that came for care at our clinic, didn’t have a lot of formal education, including myself. During the war I didn’t have a lot of education, I only finished a few years in school. I escaped to a refugee camp where I studied English for six months. When I arrived to New York there was a temple three blocks from this clinic I went to regularly. That’s how the community got together. I arrived 1986 and I went to the temple where they had a Cambodian women’s program where I studied English.

One day there was a person from Adelphi University who was recruiting people for training in human services and a job program. They wanted us to go for field placement. At that time I didn’t know what I wanted so I said, “I want to work on something that relates to the community and I can help people” although I could not even help myself at that point. It was what I wanted to do, so they said “Ok you can do your field placement at the temple.” When I was doing my field placement my English was not great and I was so nervous to be doing the work. Then I looked at the people that were going to the ESL class at the temple, and I realized I knew more English than them because I studied it in the refugee camp. I said to myself, “These community members need more help than I do.” That’s what gave me a lot of courage to go to school. I went to the training for six months and at the time when I graduated from the program they were looking to hire someone to work in the mental health clinic for Cambodian and Vietnamese refugees at Montefiore.

I grew up in a family that served the community, which is where my desire to help others comes from. My father used to be a Buddhist monk in the Bronx temple and we went to the temple all the time. We prayed and ate together there so I really knew the community before I started working here. Like Joyce had mentioned, we had to eat and play so I went to the temple and I recruited people. I explained to them what I was doing and the services we had here. The people trusted me because my father was the monk in the temple and people trusted him.

PIN: When you approached people to talk about the services here, how did you phrase it, how did you talk to people? You obviously played a very pivotal role in the outreach.

SOPHUOK: At that time it was very difficult to translate from English to Khmer. The word psychiatrist, psychiatry or mental health literally translates to “crazy.” It’s a very strong word so I used the word “emotional health.” Instead of physical health I said emotional health and I explained to them that we have the clinic here and the doctor will take care of your physical health and we will take care of your emotional health. You have to educate the people that emotional and physical is the same, that they’re very connected to each other. This is critical because we went through a lot of trauma during the war.

At first, it was difficult for people to understand. Traditionally we didn’t talk about mental health and our feelings; we always suppressed this during the war. You didn’t say anything during the war, you kept everything inside to survive; you acted as if you were dumb. There’s a Cambodian word a ting mong meaning a scarecrow on the farm. We called ourselves a ting mong because we acted as if we didn’t know anything. We hid our intelligence to survive.

WONG: The Khmer Rouge had a slogan: “To destroy you is no loss, to keep you is no gain.” If you’re constantly told that you’re not of any value and disposable, something happens to your psyche which has ramifications for survival at that time but also psychological consequences in the future.

PIN: Is this something that you see manifesting itself decades after?

WONG: It was a coping mechanism during the war for survival, but as you said it had repercussions for the future. The a ting mong mentality became so ingrained during the genocide and the refugee years, that even after immigrating to the U.S. many Cambodians continued to wear that cloak. If you don’t bring the trauma into consciousness, then it continues to manifest itself and weigh on you every day.

PIN: You carry the weight of that with you. For me I think that’s very critical, the residual affects of trauma; that’s something the academic and resettlement community doesn’t widely recognize. There hasn’t been a lot of work on residual trauma, and this perspective is brand new in regards to the need to provide holistic, culturally sensitive mental health services to refugees that takes into account their unique circumstances.

SOPHUOK: We had to get people to understand that the clinic was a very safe place to talk about our emotional health. I had to convince them that if they said something wrong here they were not going to get killed and that here in the clinic we take care of their emotional needs. And then the people started to open their minds a little bit and began to trust us. After a few years, the program expanded by word of mouth, the doctors, and self referrals.

PIN: Please describe the community within the first year or two here in the Bronx, how their experiences were, even your experience, during that transition in the first several years of resettlement?

SOPHUOK: It was very difficult even for myself. I encountered a lot of difficulties even though I spoke a little bit of English. It was very scary to go outside and it was very difficult to go somewhere because of the culture shock. The culture was different. The living situation was different. The first years were difficult because we couldn’t go anywhere. We were like children learning how to walk step by step. We learned how to walk block by block. At that time we could only go to the temple and a Cambodian store that opened in the community. So people were not able to take the train or bus to travel outside of the neighborhood. We were both scared to get lost and confined. I’m of course talking about myself—that I felt confined—but I know that other people felt confined too. Imagine the older Cambodians who didn’t speak English. The first year was very difficult. Even now there are a lot of Cambodians who are ill and remain confined.

PIN: Yes. A lot of people don’t realize this. When I talk outside the Cambodian community the usual response is “that’s just the immigrant story,” that it’s the normal transition for immigrants when they resettle. As if all these issues can be generalized for all immigrants. However, obviously there are very unique circumstances that are endogenous to the Cambodian community as a result of the specific historical circumstances of their displacement and the resultant demographic outcomes as a result of the genocide.

WONG: Exactly. And refugees are disproportionately affected because of the multiple past trauma events of undergoing a war and genocide. The average number of trauma events a Cambodian refugee has undergone is 16. From torture, starvation, separation of family and friends, witnessing of killing, rape, and slave labor. So it’s not just acculturation, but the refugee’s past traumas and the resulting possible psychiatric distress and disability. Furthermore, these refugees were situated in economically distressed communities.

PIN: Please talk about the outreach in terms of strategies you talked about; eat, work and play?

WONG: Like our colleagues at Harvard, our approaches were a little unconventional and off-the-beaten path in trying to recruit and present ourselves in a way that community members would trust us. That really meant getting out there in the community and talking to people. Advocating for social changes, injustices. Challenging slum landlords in housing court, accessing social services, creating art programs that community members could participate in to beautify there community. The best forums usually are established places or places of faith, which play a very large role in community members’ lives. As Sarah said we often visited the temple on major holidays, made home visits, and attended weddings, funerals, religious ceremonies. We have always had a big component of also providing social services to meet the psychosocial needs of the community. We’ve had the privilege of being here for twenty years so we have followed people through the lifecycle; many of the patients grew up with us. We have been there through their marriages, through having children, through having teenage children, pregnancies, domestic violence, alcoholism, poverty, discrimination, deportation, etc. We really have run through the gamut in regards to problems and scenarios that community members have faced.

But one thing I think was pivotal for us during our time here is the realization that although mental health is very important, it’s important to stress economic and social sustainability. That comes from building community and empowering it through self-determination. So our approach has always been holistic. It was crucial when we partnered with the Committee Against Anti-Asian Violence in the Bronx, a grassroot organization in New York in the mid 1990’s. I just felt that at some point maybe six years after we started providing services, doors were closing on our community members. I didn’t feel they were progressing socially or economically; not because they didn’t want to but because of lack of investment of the US government and other institutions. So we partnered with The Committee Against Anti-Asian Violencethrough their youth leadership development project to organize and advocate for economic, social and health justice on behalf of the refugee community. We began to organize the community around other issues such as welfare rights, education rights, immigration rights, language rights, and accessing comprehensive healthcare. Witnessing the community mobilizing themselves and taking action was a highlight of my career. It was liberating to actually see the community developing consciousness and building its confidence.

If you ask me, as you’ve said before “how is it different?” I would say old models of recovery aren’t really effective anymore, and the humanistic/holistic approach to recovery is crucial. I really do feel hopeful with our community. I’ve seen that people really can recover from mass trauma and violence and can live very productive lives and can begin to trust other people again.

PIN: How have your patients progressed over this life cycle?

WONG: It’s a reality that some things may never really go away. Patients and community members still suffer from major depression; they still suffer from post-traumatic stress disorder. It doesn’t go away. But even if you have these psychiatric conditions, you can learn how to cope and live a fulfilling rich life. That’s huge. And that gives me hope. Our patients can still enjoy life, can still have positive healthy relationships with other people; you don’t have to be so isolated. I tell them they are not experiencing these things because of bad karma but because they underwent genocide and that it’s a normal reaction to terrible horrific events. I think it’s very reassuring and relieving for suffering people.

PIN: Sarah, can you elaborate on that?

SOPHUOK: I just want to add a point – about patients learning to cope and learning the result of the war was no fault of their own.  For some patients with severe psychiatric problems, the process was very slow.  We had to work very hard period. We encouraged them to do things that relieve them of suffering such as exercising, walking daily, socializing at the Buddhist Temple, engaging in meaningful activities, being of service to others.

WONG: This patient Sarah is referring to goes to the gym two to three time a week.  This was somebody who was completely homebound and confined when we started treating her 15 years ago.  She was paralyzed with her story and with her pain.  So she’s still limited in many ways but now she feels she has some control over the quality of her life and pain.  She can do things for herself; she can lead a more productive life. For us, progress doesn’t always translate into a job and although we feel work is a great value, being productive could also mean going to the park three times a week to meet your friends, or going to the temple on a daily basis. All of these activities are of great value and have a lot of healing qualities.

PIN: Again, that’s one of the issues: the old models of treatment are limited to the idea of providing English instruction and jobs.

WONG: Yes, it’s short-term thinking and a residual form of social welfare.

PIN: Yes, and what’s great about this is the fact that you have been providing services for over twenty years and it remains an ongoing process. You have acknowledged the reality that severe trauma does not magically go away.

WONG: Yes, it doesn’t go away but the way they see their lives, and the way they live their lives can still change. They are survivors, not victims anymore.

PIN: There’s a generation of Cambodians who immigrated here as teenagers or children, who came here when they were 14 or 15 and started high school here in the Bronx, or like myself were born in refugee camps but were raised in the inner-city; their experiences are very different because of their age. For the young Cambodians I met in the Bronx—and I think this goes across the board for all Cambodian diaspora communities in America—they have experienced their own unique forms of trauma inherited from their parents and compounded by the social ills of the inner-city.

When we started this interview, I played an audio clip of a teen I photographed in the Bronx who was speaking about her experience in regards to her parent’s trauma. You can hear a hint of trauma in her voice. For me it’s very profound how trauma can be passed on generationally. This is something I see in my own life. Have you treated people like this?

WONG: Yes, definitely. Within the last year there was a young Cambodian woman in her thirties and she was severely tortured during the Khmer Rouge.

This particular woman is a single mother with a seven-year-old daughter. She is one of the more traumatized and depressed patients that I have seen in a long time. It was just so clear how her depression and post-traumatic stress was affecting her relationship with her daughter. The little girl was taking care of her mother. Her mother was usually very depressed, very angry, and not able to parent her daughter in a consistent way. When I would ask, “Are you able to cook for your daughter or spend time with your daughter” she would respond, “No, I buy Chinese food or my daughter cooks her own meals.” Her daughter was going to sleep after eleven o’clock because her mother was not able to set boundaries and limits. The daughter was put in the role of an adult and that clearly affected the mother’s ability to be a parent.

Most of our patients are on psychotropic medication because it decreases their flashbacks, depressive and anxiety symptoms. This has helped her. Once her symptoms were relieved a bit, we were able to start talking about the importance of creating a secure and loving attachment with her daughter. When you’re that depressed it’s difficult to have an understanding of how your mental health problems can or are affecting your child and make the necessary changes.

PIN: What is your assessment of the community now? You’ve told me that you feel very hopeful, can you elaborate on that?

SOPHUOK: I feel very hopeful because our patients have received services and medication to help relieve them of their symptoms from trauma. They can now participate in community organizations like the Committee Against Anti Asian Violence and Mekong. With community organizational support, plus the temple our clinic that makes me very hopeful for the future. But still we need more. We do not have enough services for our community, which limits our progress but we have been actively working on Mekong.

Joyce Wong: I just feel hopeful to hear Cambodian youth say, “We want to be in charge of our community, we want to promote culture and dignity and we want to heal our community.” This makes me feel very hopeful. With these ideas we began to envision Mekong an emerging organization in New York City that will serve Southeast Asians by trying to improve the quality of life through community organizing, promoting arts, culture, language, and social services. It is a holistic approach to community organizing. Since last year we have been working with CAAAV to transition the Youth Leadership Project into an independent organization after a community needs assessment of Southeast Asians was conducted by emerging local leadership. On March 29, 2012 we will officially launch Mekong and that is something to celebrate and embrace. I would like to think that I’ve contributed a little grain of sand that creates hope and power.




EF Fellows are recent photojournalism school graduates who work as editorial assistants for the Emergency Fund and simultaneously create New York City-based photo stories on a topics consistent with the EF mission to “address critical issues that have not received the attention they deserve, or budding crises that are still over the horizon.”

posted by: Matt Anderson, MD

Cutting edge Social Medicine 2011: Resident Projects from the RPSM

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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.

Molly Broder, MD, Laura Polizzi, MD, MPH & Ravi Saksena, MD
Assessing Sources and Knowledge of Reproductive Health in 14-21 year-olds in the Bronx

 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.

Elizabeth N. Alt, MD, MPH
Implementing Group well child visits as part of a Patient Centered Medical Home at the Family Health Center
Traditionally well-child care occurs with individual providers, either family physicians or pediatricians. Studies suggest that group visits with patients in certain chronic disease management and prenatal care groups can improve overall health and well being, compared to individual visits.

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.

Cedric Edwards, MD
The Effectiveness of a Mobile Cervical Cancer Screening Program in Andhra Pradesh, India

 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.

Ross MacDonald, MD:
Montefiore Transitions Clinic: Reaching the Recently Incarcerated

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.

Shwetha Iyer, MD:
Improving Resident Counseling Competence: Implementing and Evaluating the Impact of a 5A’s skills-based obesity curriculum

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.

Preetha Iyengar, MD:
Effectiveness of a Brief Health Education Intervention to Address Chronic Malnutrition in Quito, Ecuador

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.

Anjani Reddy, MD: 
Exploring GME Social Accountability

[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.

Irene Hwang, MD: 
Development of a Longitudinal Curriculum in Correctional Health at RPSM

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.

Ari Kriegsman, MD & Allison Stark, MD, MBA: 
A resident-driven approach to systems-based practice education and innovation at a primary care medicine ambulatory teaching clinic

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.

Bonnie Stahl, MD: 
Routine Gonorrhea and Chlamydia Screening for Women entering Methadone Mainteance Treatment: Is it worth it?

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.

Asiya S. Tschannerl, MD, MPH, MSc: 
What is a Social Medicine Doctor?

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.

Feyisara Akanki, MD & Scott Ikeda, MD, MPH:
Staff perceptions of Patient Centered Medical Home implementation in two urban clinics

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.

Richard Gil, MD:
Screening, brief intervention and referral to treatment (SBIRT) for opioid abuse in an urban hospitalized population: a pilot study

 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.

Harini Kumar, MD
Making Exercise a Reality: Zumba Bronx

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.

Anna E. Jackson, MD
Retention and Screening of Immigrant Patients in the South Bronx

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.

Justin Sanders, MD, MSc
Meanings in Methadone:Perceptions About Methadone Doses Among Individuals in Methadone Maintenance Treatment.

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.

April Wilson , MD & Lin-Fan Wang, MD
Perspectives on reproductive healthcare access among homeless female adolescents living in family shelters in the Bronx

 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.

Jason Beste, MD
The Use of Traditional Botanicals among Pregnant Women in Rwanda

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


Register now for Doctors for Global Health 2010 Annual Meeting

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Doctors for Global Health will be holding its 16th Annual General Assembly from July 29th to the 31st at Loyola Marymount University in California.  You can register now at: The People’s Health Movement (PHM)/USA circle will be holding a pre-conference meeting in the days preceding the conference.

The theme of the Assembly is Community Action for Health and Social Justice: Health Begins Where We Work, Live, and Play.  Here is a synopsis of the Program:

Keynote Speakers: America Bracho and Theresa & Blase Bonpane

Dr. America Bracho is the Executive Director of Latino Health Access a community health center in Orange County, California.  She was the subject of a 2009 profile by Bill Moyers which discusses her work as a community organizer.

Theresa and Blase Bonpane are founders of Office of The Americas, an educational group dedicated to furthering the cause of justice and peace in the hemisphere.  The Office sponsor a weekly radio program on KPFK (Los Angeles) called World Focus.

Panel discussions:

Health and Human Rights of Migrant Communities

  • Steven Wallace, PhD- UCLA Center for Health Policy Research
  • Kyrsten Sinema- Arizona State House of Representatives
  • DREAM Act students
  • Irma Cruz Nava, MD- CEPAFOS, Oaxaca, Mexico
  • Samaritans Patrol of Arizona

The Right to Food and Food Justice:

  • Anuradha Mittal- Executive Director of the Oakland Institute
  • Anje Van Berckelaer, MD- Robert Wood Johnson Clinical Scholar
  • (others TBA)

Other activities:

  • Tour of Father Greg Boyle’s Homeboy Industries and Skid Row
  • Physicians for Social Responsibility discussion on nuclear technology
  • Update on People’s Health Movement-USA
  • Lively conversations, networking, socializing, and music
  • Updates from DGH partner communities in Mexico, El Salvador, Peru, Guatemala, Sierra Leone, Uganda, and Burundi.


Please register now at

posted by Matt Anderson

Barriers to Accessing Health Care for Asians: From the Bronx to Cuba

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For 20 years Joyce Wong, a friend and colleague, has worked as a licensed clinical social worker  with the Cambodian and Vietnamese refugee community in the Bronx.  We wanted to share with readers of the Portal some of her recent work examining immigrant health care both in the Bronx and in Cuba.

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

A visit & lunch at the Chieu Kien Buddhist Temple


Phuc Kien Temple in the BronxLast Sunday Social Medicine Rounds took place at the Chieu Kien Buddhist Temple located at 2011 Clinton Avenue, a few blocks southwest of the Bronx Zoo.  For those who do not know the neighborhood, the Temple was easy to miss, particularly given the fierce rainstorm outside. It occupies a nondescript building across from a big apartment complex. The front door is almost completely obscured by an iron gate. Indeed the only visible sign that this a temple is a yellow circle above the door with a pink lotus flower in the center.

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

Community Health Care in Cuba

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On September 27th 2009, Dr. Joan Beder, Dr. Susan Mason, and Joyce Wong, CSW spoke at Social Medicine Rounds on Community Health Care in Cuba. Drs. Beder and Mason have recently published a book of the same title which we have reviewed on the Portal (see: New Book on the Cuban Health Care System).

Breast Cancer in Cuba

IMG_0537Dr. Joan Beder began with a discussion of her work with breast cancer patients. Dr. Beder is a professor of social work at the Wurzweiler School of Social Work at Yeshiva University. She has an interest in oncology services and specifically services for women with breast cancer. She began her talk by pointing out some of the contradictory aspects of work in Cuba. Cubans have guaranteed rights to health and education; this something that we did not have in the US. Yet it was clear walking around Havana that Cuba is  an impoverished country where food was rationed.

Dr. Beder noted that the Cuban system provided essentially the same treatment options – chemotherapy, radiation, and surgery – that were available to patients in the US. But the supply of drugs was quite limited. Breast cancer screening programs had been impacted by the US trade embargo; the Cubans could not obtain the best mammography film and equipment because it was produced in the US. As a consequence higher than necessary doses of radiation were used in mammography.

Dr. Beder was asked by the  Cubans to provide some guidance on helping women with the psychosocial consequences of breast cancer. She worked with the Federation of Cuban Women which runs a series of Women’s Centers where breast self-examination and mammography are promoted. Initially they considered setting up a self-help hotline for breast cancer survivors. This turned out to be problematic due to the deficiencies of the Cuban system; people may not always have access to a phone in a private setting.  Her work led her to undertake a training program  in the special needs of oncology patients for Cuban social workers.

She concluded by pointing out that cancer is now the second leading cause of death in Cuba; cardiovascular disease is number one. Cognizant of this, the Ministry of Health has begun a special national program to train doctors in the prevention and early detection of cancer.

Schizophrenia and Mental Illness

Susan Mason teachingDr. Susan E. Mason is also a professor of social work at Yeshiva University; in addition she is  a professor of sociology and the chair of the college departments of sociology and political science. Her area of expertise is schizophrenia and she is the co-author of Diagnosis Schizophrenia: A Comprehensive Resource for Patients, Families, and Professionals, a fascinating book which uses patient stories to describe what it is like to have schizophrenia.

The Cuban approach to mental illness also has been shaped by a context where resources are limited and medications are in short supply; again, this is due – in part – to the effects of the embargo. Psychosocial treatments have been emphasized and mental health is based on three principles: community, prevention, integration. Arts and music programs are valued and accepted as mental health interventions. She described with a mixture of amusement and admiration how official meetings might be interrupted for a short break allowing the participants (“even the Ministers”) a chance to sing and dance. (It was later suggested that this would be a great idea for hospital rounds).

Care for mentally ill patients was often provided by social workers who live in the same community as the patient and make house calls as needed. When patients needed more supervision, family members were paid to stay at home and care for them. When a family member was not available, patients were placed in a foster home.  Since family members (or foster families) were paid, patients with mental illness were not typically viewed as an economic burden for their family or community.  Dr. Mason shared some pictures of a day program run from a private home. The atmosphere was quite domestic and she remarked: “It feels like you just want to hang out there.”

Did this model work? Dr. Mason expressed frustration that despite the theoretical advantages of this community model for psychiatric care, there was really no hard outcomes data to demonstrate that it was effective.

A Healing Environment

joyce wongJoyce Wong is a social worker at a Bronx community health center where she works primarily with South East Asian immigrants. She grew up in Washington Heights in a community that was largely Cuban and later traveled to Cuba to visit Havana’s Chinatown. This had once been one of the largest “Chinatowns” in the Western Hemisphere. With emigration, the population has dwindled considerably and now consisted primarily of the elderly.

In Chinatown, she interviewed elderly men to learn how they had managed to survive in Cuba after leaving their homes in China. She found the men relied on ethnic pride and identity, maintaining their language, and consciously suppressing painful memories. She described this not as a form of repression, but rather as a conscious decision to look for happiness and self-healing.

Ms. Wong made a short film about her trips to Cuba, a place she felt was a “healing environment.” La Magia de Cuba (Cuba’s Magic) is a montage of music and photos and is available on Picasa at this  link.


To read more about this work, please consult Drs. Mason and Beder’s book: Community health care in Cuba.

The situation of Cuban patients, denied access to the best possible care because of the US trade embargo was denounced by Amnesty International in September. Readers interested in learning about the health impacts of the embargo should consult their report: The US Embargo against Cuba: Its Impact on Economic and Social Rights.

posted by Matt Anderson, MD