Archive for the 'Medical School Programs' 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.

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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
TBA

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

Wednesday, February 26, 2014
TBA

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

Cuba Leads the World in Lowest Patient per Doctor Ratio; How do they do it?

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by Joanna Mae Souers

*Paraguayan 5th year student participating in primary care in Havana, Cuba. (2011,by Joanna Mae Souers)

In early 2007, I began studying medicine at the Latin American School of Medicine in Havana, Cuba.  I entered the program not knowing much about the Cuban healthcare system, other than that it was universal and free.  “Now that’s a system I want to learn from,” I thought to myself, “It’s a system we could all learn from.”  Five years later, what have I learned?

There are many subtle and not so subtle differences between the Cuban and the U.S. health care systems which have allowed the Cubans to equal the U.S. with respect to their health statistics, but at a much lower cost and with better preventative and primary care.  In this paper I analyze just one of the reasons for the differences between the two systems; Cuba produces more primary care practitioners per capita.  How do they do it? Medical education in Cuba is free, all doctors interested in specializing must first serve two years working in primary care, and graduating doctors are not driven to specialize by salary incentives.  This socialist approach towards medicine and medical education assures the human resources necessary to provide universal and preventative healthcare to all.

People marvel at how Cuba has “accomplished so much with so little.”  And they marvel with good reason.  According to the World Health Organization, Cuba spent only $503 per capita on healthcare in 2009, the U.S. spent almost 15 times that sum.  In fact we in the US spent $421 per person just on the administration of the private healthcare insurance system, almost enough to fund the Cuban system. [1] [2] Despite dramatically lower costs, Cuba has some of the best health statistics and health indicators of any country around the world.

Although people like to compare and contrast the health statistics of the U.S. and Cuba, I think this a bit preposterous.  Cuba, a small island in the Caribbean, is being compared to one of the largest countries in the Americas with a very different history.  So in the table below, I have shown some health statistics on Cuba and the U.S. as well as the Dominican Republic and Haiti.  The Dominican Republic and Haiti are Cuba’s Caribbean neighbors; similar in size, history and geographic location.

*Statistical information provided by the World Health Statistics 2011 Report by the World Health Organization.

From this table, we can see that Cuba’s health indicators are more like those of the “first world” in the U.S. than its neighbors in the “third world.”  The life expectancy of the U.S. and Cuba is almost identical.  Cuba supersedes the U.S. in the categories highlighted.  So we continue to ask, “How do they do it?”  Could it have something to do with their philosophy that people need doctors?  Hence, their solution is to offer a free medical education to develop young, quality doctors dedicated to serving those in need.

Per capita Cuba graduates roughly three times the number of doctors as the U.S.   In 2005 Cuba had 70,594 doctors.  Before the revolution in 1959, there were only an estimated 6,000 doctors; somewhere around half left the country after 1959.  This means they must have graduated an average of 1,469 Cuban doctors per year, not including the some 5,000 international students who graduate each year from Cuban medical schools. [3]  When we later compare these numbers to the U.S. we see that Cuba graduates 3 times the number of doctors per capita, and the U.S. must import graduating doctors from other countries just to fill the primary care residency positions.

Critics of the “Obama Plan” say that there will not be enough doctors in the U.S. to take care of all the patients if everyone has healthcare coverage.  Obama encouraged the Association of American Medical Colleges to increase the number of graduating doctors by 30% in 2010.  Ever since 1980, U.S. Medical schools have graduated 16,000 doctors a year.  Meanwhile, the population of the U.S. has grown 50 million during the same period.[4]  A 30% increase would have meant we should have graduated 20,800 medical students in 2010, but we only graduated 16,838 according to the Kaiser Family Foundation.[5]  The number of residency programs at teaching hospitals in the U.S. has been frozen since 1997, funded by Medicare.  There were 29,890 residency slots filled in 2009,positions not filled by American graduates are filled by International Medical Graduates. [4]   This means we can estimate more than 1/3 of students in U.S. residency programs are International Medical Graduates (IMGs), students from another country or a U.S. citizen, like me, who studied in another country.

In the current scheme of things, International Medical Graduates are continuously brought in to the U.S. to meet the needs of the growing patient population.  Unfortunately nothing bridges the gap, because there just are not enough residency positions and/or funding for teaching hospitals to produce enough doctors to satisfy the entire U.S. population.  Taking International Medical Graduates to meet the needs of the U.S. population only adds to the “brain drain” of developing countries around the world.  So as we produce fewer doctors, introduce more doctors from other countries; U.S. doctors work harder for less to meet the needs in the U.S. and a lot of the world remains catastrophically underserved.

Cuba leads the world with the lowest patient to doctor ratio, 155:1, while the U.S. trails way behind at 396:1.[6]  With a surplus of Cuban doctors, Cuba is able to help ailing nations around the world.  They have medical missions in over 75 different countries lead by nearly 40,000 health professionals, almost half of them are doctors.[7]  The United States by contrast imports doctors from poorer countries, further contributing to the brain drain of professionals from poorer countries to rich ones.

In Cuba education is free.  Room and board, books and amenities are included.  Doctors are not burdened by student loans and live comfortably though not extravagantly.  Harvard Medical School states in their admissions statement that an “un-married first year medical student” will spend approximately $73,000 for the 2011-2012 academic year.  This includes tuition, room and board, books, etc.[8]  Now times that by four and you have a whopping $292,000 to shell out to become a Harvard doctor.  With interest rates, loan deferments and default charges, you might end up like Michelle Bisutti.  She graduated medical school in 2003 with a $250,000 debt, in which by 2010 had increased to $555,000.[9] This may be an extreme case, but the Association of American Medical Colleges projected in their 2007 report that in 2033, students on a 10-year repayment program will only see half of their after-taxes salaries, the rest going to loan repayment.[10]

The cost of medical education in the U.S. causes more and more medical school graduates to turn to higher paying specialties and subspecialties rather than primary care or family medicine.  Dr. Thomas Bodenheimer writing for the New England Journal of Medicine, stated that “between 1997 and 2005, the number of U.S. graduates entering family practice residencies dropped by 50 percent,” based on data from the National Resident Matching Program. [11]  In the U.S. specialists predominate at a ratio of 2:1 (the reverse of other Western countries) while half of all outpatient visits are made by primary care physicians. [12]   This deficit of primary care physicians decreases people’s access to primary care and preventative medicine, causing increases in health disparities and healthcare costs.  This is because preventative medicine benefits the patient as well as reduces the number of Emergency Department visits and hospital stays.  If there are no primary care physicians to provide preventative care to the population, we see the population suffer as costs continue to rise.

* Family Medicine Residency Positions and Number Filled by U.S. Medical School Graduates. From the American Academy of Family Physicians, based on data from the National Resident Matching Program. [11]

According to a survey in 2008 by the American Academy of Family Physicians, family medicine graduates with less than 7 years of experience earn, on average, a yearly salary of $145,000.[13]  The difference in earnings between primary care physicians and specialists differed by only 30 percent in 1980, and dramatically rose up to 300 percent for some narrowly defined specialists by 2009.  In the graph below, we show the dramatic difference between median compensation for selected specialties compared to that of primary care.[14,15]

*Median Compensation for Selected Medical Specialties.
Data are from the Medical Group Management Association Physician Compensation and Production Survey, 1998 and 2005. [15]

When working in the U.S., almost every primary care physician I talk to has the same complaint, “Too many patients, and too little time.”  They are forced to see 20 to 30 patients a day just to meet pay-incentives and “keep their doors open.”  General/Family Practice physicians spend an average of 16.1 minutes with each patient per visit. [16]   Meanwhile, 18%, or roughly 48.2 million of the U.S. population under the age of 64 is without healthcare insurance.  They have no access to most GP’s or family practice physicians. [17]

We need to follow our Cuban role model, we need to be held socially accountable and produce more primary care physicians.  This can be accomplished by providing an education at full scholarship to those interested in primary care, or by increasing the number of medical students going into primary care by closing the compensation gap between primary care and the higher paid specialties.  These measures would ensure the population better access to quality primary care and preventative medicine.  It would bring down the cost of healthcare while allowing primary care physicians to practice under less stressful conditions leading to quality affordable healthcare for all.

 

  1. World Health Organization (WHO 2011); Countries. [www.who.int/countries/en]
  2.  “Healthcare Marketplace Project, Trends and Indicators in the Changing Marketplace (Exhibit 6.11: Private Health Insurance Admin Cost per Person Covered, 1986-2003),” Kaiser Family Foundation, Publication Number: 7031.  [http://www.kff.org/insurance/7031/print-sec6.cfm]
  3.  “Cuba and the Global Health Workforce: Training Human Resources.” Salud! (Source Vice Ministery for Medical Education and Research, Ministry of Public Health) [http://www.saludthefilm.net/ns/elam.html]
  4. Sullivan, Paul.  “Discomfort at U.S. Medical Schools.” The New York Times; April 29, 2009.
  5.  “Total Number of Medical School Graduates, 2010.”  The Kaiser Family Foundation.  [http://www.statehealthfacts.org/comparemaptable.jsp?ind=434&cat=8]
  6.  “World Health Statistics 2011,” World Health Organization; WHO Press, Switzerland.
  7. Brouwer, Steve.  “The Cuban Revolutionary Doctor: The Ultimate Weapon of Solidarity,” Monthly Review, 2009, vol 60, issue 8 (January).
  8. Harvard Medical School Admissions, “Costs (Updated: 7/21/2011).”  [http://hms.harvard.edu/admissions/default.asp?page=costs]
  9. Pilon, Mary.  “The $555,000 Student Loan Burden,” The Wall Street Journal, February 13, 2010.
  10. Fuchs, Elissa.  “With Debt on the Rise, Students Face an Uphill Battle.” The Association of American Medical Colleges, January 2008.
  11. Bodenheimer, Dr. Thomas,“Primary Care – Will it Survive?” New England Journal of Medicine, vol 355;9. Pg 861-862.
  12. Alper, Philip R. “Primary Care’s Dim Prognosis,” Hoover Institution, Stanford University, Policy Review No. 158 (December 1, 2009).
  13. American Academy of Family Physicians, Income (2011).      [http://www.aafp.org/online/en/home/publications/otherpubs/debtmgmt/graduation/income.html]
  14. Alper, Philip R. “The Decline of the Family Doctor,” Hoover Institution, Stanford University, Policy Review No. 124 (April 1, 2004).
  15. Woo, Dr. Beverly.  “Primary Care – The Best Job in Medicine?” New England Journal of Medicine, vol 355;9. Pgs 864-866.
  16.  “Healthcare Marketplace Project , Trends and Indicators in Changing Healthcare Marketplace (Exhibit 6.5: Mean Time Spent with Physicians (in Minutes), 1989 – 2002),”  Kaiser Family Foundation, Publication Number: 7031, Information Updated: 4/11/05.      [http://www.kff.org/insurance/7031/print-sec6.cfm]
  17.  “2010 National Health Interview Survey (Tables 1.1A-B, 1.2 B)”, Center for Disease Control.  [http://www.cdc.gov/nchs/fastats/hinsure.htm]

 

Door-to-Door; Dengue Fever

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Medical Students and community members participate in dengue fever prevention efforts in Havana, Cuba (photographer, Joanna Mae Souers)

January, classes were suspended for medical students throughout Havana.  The dengue epidemic had reached its height and health officials decided it was time students joined the prevention efforts; door-to-door.  It is not the first time.  Medical students in Cuba have frequently been called upon for their volunteer services and solidarity to the community during epidemics and medical emergencies including Hurricane Katrina and the Chernobyl Disaster, political campaigns including “Bringing Home Emilio” and “Free the Cuban Five” and interests of state like harvesting potatoes and planting citrus trees.

When we first hit the streets we were armed with knowledge of disease prevention and assigned individually or in pairs to a city block.  We were oriented to visit each household daily, talk to each family about dengue prevention, teach signs and symptoms, and remit anyone in the home with fever to their local health center.  We were also given instructions to enter the homes, revise water tanks, and dispose of any items that could serve as fresh water containers where mosquitoes deposit their eggs.

On my own city block I had seen several issues solved and few to be addressed.  For example, I successfully mapped out the community and spoke face-to-face with at least one member of every household.   People were very cooperative and happy to receive us in their homes.  It was most important to see if anyone had come down with a fever or noticed any problems in the community concerning vector control and focal points where water was collecting and mosquitoes could be potentially breeding.

Most Cubans are well educated on the signs and symptoms of dengue and the methods of prevention.  Even before we speak to them, they have already heard the information from their local nurses, doctors, door-to-door inspectors, schools, community meetings, television, radio, and newspapers.  We may not have any new information to transmit to them, but we are able to bring to their awareness the severity of the epidemic and the importance of their continued cooperation in further prevention efforts by creating a presence in the streets.

The student efforts were so important because specialists were concerned that if the numbers did not return to a record low by the time the rains came in March, the epidemic would be out of control and cost many more lives.  Thanks to the students and the cooperation of the community our prevention efforts made a difference and progress was made just by going door-to-door.  The number of cases around the city steadily declined as cases were reported and prevention efforts were enforced.  The campaign lasted just a month, and in February with the epidemiologists satisfied and the community safe from dengue, we were on our way back to classes.

Updates from Medical Education Cooperation with Cuba (MEDICC) and a touch of Cuban rap music

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US Medical Students at ELAM in Havana

Our colleagues at MEDICC, Medical Education Cooperation with Cuba, have been very busy over the past several months and it seemed time for an update about their activities:

Nineteen US students graduate from ELAM (The Latin American School of Medicine)

This July 19 US students graduated from the Medical University of Havana’s Dr Salvador Allende Health Sciences Faculty.  They were a part of nearly 1400 international medical students who got their MD degrees in Cuba last month.  (See our previous post on How US students can get a free medical education in Cuba). MEDICC has posted pictures of some of the happy graduates on its website.

Chicago graduate Dr. Mena Ramos

This year is the 7th in which US students have graduated from ELAM; Dr. Cedric Edwards was the first US graduate in 2005.  Readers who would like to know more about ELAM should consult Don Fitz’s article published in the March Monthly Review entitled The Latin American School of Medicine Today.  This article goes over both the strengths and challenges of study in Cuba.

MEDICC support for US students studying at ELAM

The process of picking US students for scholarships is managed by IFCo/Pastors for Peace.  MEDICC, through its MD Pipeline to Community Service program has been playing a key role in helping these students make their transition back to clinical practice in the US.  This has involved financial assistance in the form of form of MNISI fellowships that allow students to prepare for and take their US licensing board examinations.  The fellowships are vital to make sure that ELAM graduates get positions in US residency programs and do well in those positions.  But MEDICC has also developed a mentorship program to give ELAM students practice working in US clinical settings.

If you would be interested in donating, $100 will  defray the costs of US exam fees and prep courses; $250 will allow students to prepare for their US board exams with 1,000 online practice questions; and $750 will  pay the full cost of one US Medical Licensing Exam.

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Would you like to become a mentor?

MEDICC is looking for US health care professionals who would be willing to mentor ELAM students. I personally have mentored several and found them to be a bright and highly motivated group anxious to demonstrate their history and physical examination skills (in fluent Spanish).  MEDICC’s Rachel True is responsible for the mentorship program and writes:  “As the cohort of US ELAM students continues to grow, so does our need for mentors all over the country.  We are currently looking for more mentors in the following areas of the country:  Atlanta, Washington, D.C., Texas, Southern states (AL, MS, LA), Chicago, Los Angeles, and the Midwest (MN, ND, MI).  If you have any colleagues or friends who might be interested, please let them know about our program and put them in touch with me.  If you would like me to provide you with a brief description of the program, I would be happy to do so.”

Achieving Universal Health Care: A New Issue of MEDICC/Review

 MEDICC Review, the International Journal of Cuban Health and Medicine, published its most recent issue in July; the issue is entitled Achieving Universal Health Care and contains articles from Colombia, Brazil, Ecuador, Cuba, Vietnam, Ethiopia, and Nigeria.  The full table of contents is given below.  I was particularly interested in an update on medical schools who were seeking to be socially accountable (i.e. to train graduates who met the health needs of their countries, Roundtable: Revisiting Innovative Leaders in Medical Education) and a brief description of changes to the Ecuadorean health system (Sumak Kawsay: Ecuador Builds a New Health Paradigm). Following a new 2008 constitution health in Ecuador has been declared a right and discussion is underway about how build a care system built on sumak kawsay, a Quecha phrase translated as collective well-being.   This idea has been related to the concept of sustainable development as well as the Brazilian formulation of collective health (the Brazilian form of social medicine).

Finally, some collective well-being captured on the streets of Havana

For those of you who don’t speak Spanish, these are the “rappers of the third age”, i.e. geriatric rappers. The lead singer informs us that she has” five children, 11 grandchildren, five great-grandchildren and nothing stops me from singing and dancing.”

MEDICC Review, July 2011 Table of Contents

Editorial

Equity Matters

Interview

Roundtable: Revisiting Innovative Leaders in Medical Education

André-Jacques Neusy MD DTM&H and Bjorg Palsdottir MPA

Feature

Cuban Maternity Homes: A Model to Address At-Risk Pregnancy

Conner Gorry MA

Special Article

Global Pharmaceutical Development and Access: Critical Issues of Ethics and Equity

Agustin Lage MD PhD

Original Research

Intentional Injury in Young People in Vietnam: Prevalence and Social Correlates

Linh Cu Le MD MSc PhD and Robert W. Blum MD MPH PhD

Cuba’s Strategy for Childhood Tuberculosis Control, 1995–2005
Gladys Abreu MD MS PhD, et al.

Perspective

Raising the Profile of Participatory Action Research at the 2010 Global Symposium on Health Systems Research

Rene Loewenson PhD(Med) MScCHDC, et al.

Population-Level Approaches to Universal Health Coverage in Resource-Poor Settings: Lessons from Tobacco Control Policy in Vietnam

Hideki Higashi MPH MSc, et al.

Health Systems in an Interconnected World: A View from Nigeria

Seye Abimbola MD MPhil

Ethiopia’s Health Extension Program: Improving Health through Community Involvement
Hailom Banteyerga PhD

Making the Right to Health a Reality for Brazil’s Indigenous Peoples:

Innovation, Decentralization and Equity

Vera Coelho PhD and Alex Shankland DPhil

Impact of Court Rulings on Health Care Coverage: The Case of HIV/AIDS in Colombia

Ana Cristina González MD MA and Juanita Durán LLB

Abstracts

Cuban Research in Current International Journals

Viewpoint

Sumak Kawsay: Ecuador Builds a New Health Paradigm

César Hermida MD MS

 

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.

 

ELAM Students & Graduates Work with Cuban Doctors in Haiti

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I requested a year off from school to go to Haiti and work with the Cuban doctors after completing my 2nd semester of 3rd year at ELAM (the Latin American School of Medicine). I am one of 120 American citizens studying medicine in Cuba free of charge, with plans to practice medicine upon graduation in underserved communities of the United States and around the world.

When I arrived, I found several international ELAM graduates (http://elamedicosinternacionalistas.wordpress.com), including 7 United States graduates (http://www.michaelmoore.com/words/mike-friends-blog/cuban-trained-us-docs-complete-haiti-mission), and a number of Haitian medical students working alongside the Cuban doctors. We were stationed at a field hospital set up by the Henry Reeve Brigade of Cuban doctors on January 28th in a small central park of Croix des Bouquet, just outside Puerto Prince. Together we served displaced earthquake victims and patients suffering from inadequate health care services.

In the first six months the hospital was established, we addressed the needs of more than 70,312 patients; 53,588 at the hospital and 16,723 in the field. We performed a total of 2,506 operations on-site, with 786 major surgeries; including emergency caesarean sections, ectopic pregnancies, thyroidectomy, hernias, hydroceles, hysterectomies of uterine fibroids, orthopedic surgeries and more. We assisted 116 natural births. We diagnosed 3,533 patients with our on-site laboratory and diagnostics center. We saw 3,192 patients for x-rays and ultrasounds. We treated 8,778 patients with physical therapy, and we hospitalized 2,053 patients on-site (Information provided by the Henry Reeve Brigade of Croix des Bouquet Statistical Report, June 2010).

When you stepped out of the hospitals and into the streets the only question that came to mind had to be, “where is the aid?” It was obvious, even six months after the earthquake that little progress had been made, with little to no evidence of monetary support. Hundreds of thousands of people were still living displaced in make-shift tent cities. The city still resembled a disaster zone with buildings teetering above cracked foundations, while corpses remain beneath the rubble. The doctors seemed to be the only relief effort making a difference.

The Cuban doctors were accomplishing more than what the international community was willing to recognize. Croix des Bouquet was just one of several field hospitals established by the Henry Reeve Brigade to serve communities in and around Puerto Prince free of charge. CNN even had to apologize after interviewing one of the Cuban doctors and crediting him as Spaniard. Fortunately, Cuban doctors aren’t looking for recognition; they are out to save lives and continue to do so all over the world.

The Henry Reeve Brigade has since moved on to other emergencies, like the fires plaguing Russia. Other Cuban doctors have replaced them to continue serving the Haitian community free of charge. Brazil and Cuba have signed a trilateral accord with the Haitian Health Minister to establish three hospitals staffed by Cuban doctors located in communities surrounding Puerto Prince where health services are limited to non-existent. Cuba has been dedicated to sending doctors to Haiti for 11 years. Amidst the unfortunate circumstances of the earthquake, they continue to fulfill their commitment to the Haitian community by sending doctors. With the success of the students working alongside the doctors, they now have plans to send more students in the years to come.

Note: Article written by Joanna Mae Souers. Photograph titled, “Joanna Mae Souers on Wound Care” was taken by Cuban photographer, Juvenal Balán. The other photographs were taken by Joanna Mae Souers.

Social Medicine Course in Northern Uganda

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We invite medical students to apply for the second annual Beyond the Biological Basis of Disease: The Social and Economic Causation of Illness, an on-site immersion course in social medicine offered at Lacor Hospital in Gulu, Uganda from January 10, 2011 through February 4, 2011. This intensive course designed for 15 international medical students (clinical years) and 15 Ugandan medical students (3rd-5th year) from Gulu University intersects the study of clinical medicine in a resource-poor setting with social medicine topics such as globalization, war, human rights, and narrative medicine, among others. This highly-interactive course is taught through a combination of lectures, small and large group discussions, films, community field visits, ward rounds, and clinical case discussions. Credit for away-rotations can also be arranged. This total includes roundtrip travel to Uganda from the US ($1700), full room and board in the hospital guesthouse ($500), and a course fee ($450).

For more information, we invite you to view the short video about this year’s course, available at:

If you have any questions or are interested in applying, please email us at social.medicine@yahoo.com. Applications are due July 30, 2010.

Sincerely,
Michael Westerhaus, MD, MA
Julian Jane Atim, MD, MPH
Amy Finnegan, MALD, MA
(course instructors)

2010 AECOM Student-Run Social Medicine Course

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doveJanuary 6th, 2010 will mark the beginning of the Albert Einstein College of Medicine student-run Social Medicine Course. This course is a unique opportunity for the Einstein students to cover “essentials of medical practice not taught in medical school.”  This year’s list of speakers amply illustrates the connections between clinical practice and social activism.

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

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

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

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

Posted by Matt Anderson, MD

New issue of Social Medicine (V4N3) Just Published

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Social Medicine, our open-access, online academic journal has just published its latest issue. Here is a brief summary of the articles all of which are available for free at www.socialmedicine.info and www.medicinasocial.info (in Spanish).

Children in post-Civil War Nepal singing revoutionary songs

Children in post-Civil War Nepal singing revoutionary songs

Special Theme: Social Medicine & War

For this special theme issue on Social Medicine & War, Dr. Vic Sidel served as guest editor. His lead editorial (co-authored with Dr. Barry Levy) examines the diversion of resources to war and the preparation for war.

Quoting from their introduction to the three original research articles about war, Drs. Sidel and Levy write:  “Dr. Andrea Angulo Menasse, a researcher from Mexico City’s Autonomous University, documents the very personal story of how the violence of the Spanish Civil War affected one family. In her case study the trauma suffered by Spanish Republicans is traced through three generations and crosses the Atlantic Ocean as the family moves is exiled in Mexico. Dr. Sachin Ghimire from the Centre of Social Medicine and Community Health of the Jawaharlal Nehru University reports on his fieldwork in Rolpa, Nepal, the district from which the Nepal Civil War (also called the People’s War) originated in 1996. Based on 80 interviews, he documents the difficulties faced by health care workers as they negotiated the sometimes deadly task of remaining in communities where control alternated between Nepalese Special Forces and the Maoist rebels. Finally, Colombian researcher, Carlos Iván Pacheco Sánchez, from the University of Rosario in Bogota, brings an epidemiologist’s tools to examine the impact of the ongoing armed conflict in the border Department of Nariño. His discussion is informed by the current debate over health care in Colombia where a recent Constitutional Court decision has found that the current health care system violates the right to health.”

Closing the Gap: Where are we one year later

a87ad0d1a8In August of 2009, the WHO’s Commission on the Social Determinants of Health issued a bold call to eliminate health disparities within a generation. Three articles in this issue look at what has – and has not – happened in the intervening year. Our second editorial examines the international response to the Commission’s call. José Carlos Escudero explores the meaning of the report for the WHO and underscores the report’s limitations. A detailed critique of the report, along with an alternative approach to addressing health inequities, is offered by Dr. Anne-Emanuelle Birn. Dr. Birn’s critique is especially important for offering important historical background by exploring how Europeans in the 19th century – notably Louis-René Villermé, Edwin Chadwick, and Friedrich Engels – each approached the social disparities that arose during the Industrial Revolution.

The Peckham Experiment

peckhamhealthcentreWe are also very pleased to publish three classic texts describing the Peckham Experiment, an innovative community center built in England during the Depression. The Pioneer Health Center was designed around the idea of studying (and fostering) what makes people healthy, rather than what makes them sick. Imagine that!

Please visit the journal and explore the breadth, depth and scope of social medicine past and present. Along with some suggestions for the future.

posted by Matt Anderson, MD

Doctors, Medical Student Volunteers Needed in Rural El Salvador

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catierika

Catlin Polley in Estancia

This note comes from our friends at Doctors for Global Health:

Could I…

…Take a year out of med school between my third and fourth years?

…Delay residency for a year after graduation?

…Leave my practice as a physician or my retirement for a time?

In Estancia, El Salvador, a clinic in a remote, rural community needs you. To trek up mudslicked hillsides in the dusk to find a pregnant women who can´t move her limbs or a man in a hammock with a toothache run out-of-control. To think about and act upon the lack of latrines and the rampant childhood malnutrition. To face the health effects of rising food prices and strip mining projects, and to be called to speak out…

Come, work with Doctors for Global Health www.dghonline.org, a volunteer-run organization of health providers, teachers, psychologists, artists, and anyone with a mind for health, that seeks to foster a vision of Liberation Medicine through accompanying grass roots projects in Latin America and Uganda.

It is an amazing education in being a community physician, in public health, and the need for activism on the policy level. You will be challenged in your medical knowledge, but mostly in your personal sources of energy, motivation, courage, and strength. You will changed by people living in poverty who work for liberation.

For more info on this amazing international health opportunity, please visit the website for Doctors for Global Health, www.dghonline.org. If you want to talk about volunteering in Estancia or about what it’s like to break from the traditional course of medical education, feel free to contact us.

Solidaridad!

Don Lassus and Caitlin Polley

Current 4th year medical students from Baylor and Penn volunteering in Estancia, Morazan, El Salvador

Note: This posting was corrected on 2/14/2009.  The original posting had a photo that was not from Estancia.




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