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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.

 

Junot Diaz Benefit for the Columbia Free Clinic (CoSMO)

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Junot Diaz returns to Columbia University in A Night with Junot Diaz: Una Lectura y Conversacion on Saturday, November 6, 8:00 – 10:00 pm. The event will take place at Alumni Auditorium and doors open at 7:30 pm.

CoSMO is the free-clinic run by Columbia Medical Students, one of a number of such clinics run by medical students in New York City (see our series on free and low-cost health care).  Two years ago, the clinic was fortunate enough to have  Junot Diaz, the Pulitzer Prize-winning author of “The Brief Wondrous Life of Oscar Wao” read from his works in a benefit performance.   The show was a sold-out and the auditorium packed.  Now Junot Diaz returns to read and discuss the immigrant experience in the US and minority treatment in the US health care system. The reading will be followed by a question and answer session.

Suggested minimum donation of $10. All proceeds will be donated to
the Columbia Student Medical Outreach (CoSMO).  Click here to buy tickets: https://www.ovationtix.com/trs/pe/8515295

posted by Matt Anderson

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.

Reminder – Application due July 30th for Northern Uganda Social Medicine Course

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Dear all,

We’re writing to remind you that applications are due in just over two weeks (July 30, 2010) for this exciting social medicine and global health course held in Northern Uganda. Please see the course invitation below and feel free to let us know if you have any questions:

Course Invitation 2011
We invite you 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. It is estimated that total student costs for the course will be $2650. 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 read the attached prospectus and 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,

Julian Jane Atim, MD, MPH
Amy Finnegan, MALD, MA
Michael Westerhaus, MD, MA
Brigham and Women’s Hospital
Division of Global Health Equity
Boston, MA 02115

Discussion in 2010 Course

Kingston New York Hospital Helps out US medical students in Cuba

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Joanna Mae Souers, an American studying medicine at the Latin American School of Medicine (ELAM) has written several times on the portal (see here).  She asked us to post the following thank you note:

David Lundquist, President and CEO of Kingston Hospital, of upstate New York, made efforts to organize supplies to donate to the students of the Latin American School of Medicine in Havana Cuba.  Supplies included masks, gloves, scrubs, and several other useful items that the students can use during their time in Cuba.  Because of the U.S. embargo against Cuba, supplies are limited and students are expected to bring their own.  It is very helpful when hospitals can help students out by donating supplies to alleviate them from these costs.

Kingston is where I grew up, and it is wonderful to get such positive support from local hospitals.  Many health care professionals don’t know about the program to study medicine in Cuba, but when they hear about the opportunity, in spite of political propaganda, they think it’s great and they look forward to anything they can do to support the students.  Cuba is well renowned for their public health care and international relief efforts, but what is little known is that there are over 100 U.S. students studying medicine in Cuba for free, with one catch, the promise to return to the U.S. upon graduation and practice in underserved communities.  Is that really a catch?  This is a gift from the Cuban government to the American people.

I want to thank Kingston Hospital for their generous donation and I want to encourage other hospitals to donate what they can.  If you would like to make a donation of medical supplies or books to the students of ELAM, please contact IFCO & Pastors for Peace via their website www.ifconews.org.

Thank you Kingston Hospital for your support!

[Editor’s note: For more information about this program, readers should visit prior postings on this topic.]

Update from US Student Joanne Mae Souers, studying medicine in Cuba

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Joanne Mae Souers, a New York State resident studying medicine at the Latin American School of Medicine (ELAM) in Havana, sent us this report on her activities:

Dr. Nelson Gonzalez on Rounds

Dr. Nelson Gonzalez on Rounds

The Hospital is Our Classroom; The Patient is Our Professor

As third year students at the Latin American School of Medicine the hospital is our classroom and the patients are our professors. We spend our days practicing patient histories and physical exams to tune and then retune our clinical skills.  Students from the U.S. and several Latin American countries rotate at Hospital Salvador Allende in central Havana.   Students from all over the world can be found at teaching hospitals all across Cuba.

Our first semester focuses on clinical medicine, physical exams, and the relationship built between the doctor and the patient.   This is where we step out of the classroom and into the “operating” room as they might say; where medicine starts with “hello.”  From the minute your patient walks in the door, you are required to take notes on what signs and symptoms they might reveal to help you develop a good differential diagnosis.

Currently, I am at the Antonio Guiteras Unit of Internal Medicine run by Dr. Nelson Gonzales, a Specialist in Internal Medicine.  Every day we are tested on our knowledge of the pathological alterations in the physical exam. We see patients, go on rounds and learn first-hand how a patient is received, examined, diagnosed and treated throughout their stay.

I find our exposure to patients and first-hand clinical experience a essential counterpart to our classroom knowledge.  We are constantly applying our skills and seeing new clinical cases.  Recently we were addressing cases of dengue fever to control and quarantine a small outbreak in Havana and now we are focusing primarily on cases of suspected H1N1 influenza in adults with compromised health status.

If that isn’t enough patient exposure, fear not, we are on a weekly rotation at the hospital’s walk-in clinic where we see “walk-in” cases and learn from doctors making quick, accurate diagnostic calls.  Some of these cases are automatically hospitalized if they come in with severe health conditions requiring admission to the intensive care unit or those who present public health risks and need to be quarantined.  Examples of cases quarantined are those who present fever from areas endemic to dengue or present symptoms of an upper respiratory infection and pertain to one of the three risk groups of H1N1: pregnant women, children and/or patients with respiratory illnesses.

me behind the mask

Medical Student Souers

I look forward to my third year at the Latin American School of Medicine in Havana, Cuba, where we learn to practice medicine on the bases of altruism, honor and sacrifice as a commitment to society.  It is the patient that teaches us medicine; it is the hospital that sets the stage.   Dr. Nelson Gonzales profoundly states that he is not such an altruistic being just based on character, but because of his formation as a doctor in Cuba.

Social Medicine Volume 4 Number 2: Economic Crisis, Social Determinants, Participation & more

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We have just published a new issue of Social Medicine/Medicina Social, our bilingual, online journal.  It is available in both English and Spanish.  Our 13th issue touches on several important issues in world health including the current economic crisis and the WHO Commission’s on the Social Determinants of Health.  And, of course, the stories of activists like the young US students (shown below) studying medicine at the Latin American Medical School (ELAM) in Havana.  They will be traveling in the Southwest US this summer to discuss their experiences with the American Indian community:

SSWE group shot (7 x 3)

The Economic Crisis and Public Health

Barry S Levy, Victor Sidel

The current global economic crisis seriously threatens the health of the public. Challenges include increases in malnutrition; homelessness and inadequate housing; unemployment; substance abuse, depression, and other mental health problems; mortality; child health problems; violence; environmental and occupational health problems; and social injustice and violation of human rights; as well as decreased availability, accessibility, and affordability of quality medical and dental care. Health professionals can respond by promoting surveillance and documentation of human needs, reassessing public health priorities, educating the public and policymakers about health problems worsened by the economic crisis, advocating for sound policies and programs to address these problems, and directly providing necessary programs and services.  Full Text: PDF

An Interview with Sir Michael Marmot

The Editors

In August of 2008 the WHO Commission on the Social Determinants of Health concluded its work with the publication of a report entitled: “Closing the gap in a generation: Health equity through action on the social determinants of health.” The Commission’s chair, Sir Michael Marmot, was kind enough to answer our questions about the Commission’s recommendations. This interview was conducted by email in May of this yea

Social Medicine: We congratulate the Com-mission on its excellent work in bringing attention to the social determinants of health and the Commission’s call for health equity. We appreciated the Commission’s recognition that: “Social Justice is a matter of life and death.” We were also happy that the Commission included representatives of civil society in their work. This was an important affirmation of democratic values.
When thinking about health inequalities people often use the analogue of the ladder to show how the gradient of worsening health outcomes affects all people in society except (presumably) those at the very top. Thinking about the ladder leads us to pose the following question: Is making the ladder shorter (i.e. reducing inequalities) the only approach to inequalities or is it possible to imagine making the ladder disappear entirely?

Sir Michael Marmot: All societies have hier-archies. It is not conceivable, therefore, to have a society with no ladder. The conceptual framework of the Commission on Social Determinants of Health leads us to think of at least two (linked) ways to address the relation between position on the ladder and health: act at the societal level to reduce social inequalities, and break the link between position in the social hierarchy and health.

The first argues for reducing the slope of the social gradient. To see this, suppose, just for a moment, that the ladder were defined on the basis of years of education. People who had three years or fewer had life expectancy of 50 years, those who had 13 years or more had life expectancy of 80 and the rest were ranged in between in a graded way: the social gradient in health. Now if we had a societal change so that everyone had at least 10 years of education, and better health followed as a result, the magnitude of health inequity would be reduced. We have reduced inequities by making the ladder shorter. […]Full Text: PDF

Participation and empowerment in Primary Health Care: from Alma Ata to the era of globalization

Pol De Vos, Geraldine Malaise, Wim De Ceukelaire, Denis Perez, Pierre Lefèvre, Patrick Van der Stuyft

With the 1978 Alma Ata declaration, community participation was brought to the fore as a key component of primary health care. This paper describes how the concepts of people’s participation and empowerment evolved throughout the last three decades and how these evolutions are linked with the global changing socio-economic context.

On the basis of a literature review and building on empirical experience with grass roots health programs, three key issues are identified to revive these concepts: The recognition that power, power relations and conflicts are the cornerstone of the empowerment framework; the need to go beyond the community and factor in the broader context of the society including the role of the State; and, considering that communities and society are not homogeneous entities, the importance of class analysis in any empowerment framework. Full Text: PDF

Latin American Social Medicine and the Report of the WHO Commission on Social Determinants of Health

RAFAEL GONZALEZ GUZMAN

In October 2008 the Latin American Social Medicine Association (ALAMES) organized an international workshop entitled “The Social Determinants of Health.” Representatives of ALAMES’ seven regions participated in discussions of the various consultative papers prepared by the working groups of the WHO Commission on the Social Determinants of Health as well as the Commission’s final report. The workshop considered how ALAMES should respond to the work of the Commission. In this paper we summarize the main points outlined in the position paper prepared by the Organizing Committee1 as well as a synopsis of the main contributions made by each of the workshop’s study sections.  Full Text: PDF

For the full Table of Contents visit: http://journals.sfu.ca/socialmedicine/index.php/socialmedicine/issue/view/38/showToc

posted by Matt Anderson, MD

Update from US students studying medicine in Cuba (June 2009)

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SSWE group shot (7 x 3)

Here is the latest update from from Joanna Mae Souers, one of the US students studying medicine on scholarship in Cuba:

June 2009

Today there are 148 American students studying medicine at the Latin American School of Medicine in Havana.  They study within Cuba’s world-renowned system of universal health care.  Despite Cuba being a “poor” country, the World Health Organization (WHO) ranks the Cuban system among the top 10 in the world.  They study thanks to a scholarship provided within the same system of humanitarian medical  solidarity that has placed more than 21,000 Cuban doctors in poor third-world countries.

The 148 students originate from some of America’s poorest and most medically under-served communities. After graduating they plan, in line with the encouragement of the Cuban Government and our own Congressional Black Caucus, to serve the very same under-served communities from which they came.

As students attending ELAM we, have been given an opportunity to do something that has never been done before. On July 26, 2009, 12 American students from ELAM will board an RV for a road-trip of the Southwestern United States. Together we will spend two weeks as humble guests visiting Native American reservations, neighboring communities, hospitals and colleges to spread the word about our medical school opportunity and foster an exchange of information between all participating groups.

As we approach the one month mark in our countdown to departure we are motivated, poised, and excited about the road ahead us.  We are busy preparing for the exchange; writing up the material we hope to present, learning about the different communities we plan to visit and organizing our curriculum of exchange with guidance from our community liaisons.  So far we hope to visit with the following communities and organizations:

As students, we want to thank the following individuals and organizations for all of their support and guidance during the process of organizing this exchange.

We extend a special thank you to all of our donors and supporters for making this exchange possible, and we want to encourage further support.  We are just short of meeting our proposed budget and we hope to make that happen to make this tour possible!  We need your support, please check out our link (http://www.medicc.org/ns/index.php?s=30&p=4) and donate now!

Visit our website www.saludswexchange.org for more information on the exchange!

sent in by Joanna Mae Souers
Escuela LatinoAmericana de Medicina
Carretera Panamericana
KM 3,5
Santa Fe, Playa
Ciudad de la Habana, CUBA
CP 19108

Research Based Health Activism 2009 – Medical Student Elective

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Research-based health activism describes a growing sector of the medical and public health worlds where the classic skills of clinical research and epidemiology are combined with grass-roots advocacy to influence federal and state health policy, counteracting the influence of private industry and market forces on public and community health. The Residency Program in Social Medicine at Montefiore Medical Center and Albert Einstein College of Medicine has a rich tradition of innovations in community oriented primary care and a history of progressive research and practice. Our faculty, together with experts from throughout the New York Metropolitan area, will provide training in this growing field of research-based health activism.

In October 2009, we will offer a one month elective for 4th year medical students interested in research based health activism. The course, now in its 8th year, combines both didactic and project based approaches, culminating with a research proposal that students can complete at their home institutions.

The didactic lectures will introduce three major topic areas: research methods, health policy, and advocacy skills. Individual and small group mentorship will be provided to help students utilize these skills by developing their own independent research proposal. Other sessions will include physician-activist guest lecturers and visits to state or private health organizations that both create and influence health policy.

Finally, students will develop a research proposal for a project reflecting their interests and an advocacy plan to gain the maximum health policy impact with the results. This proposal will be presented on the final day of the course at a luncheon including all students, the course directors, returning session leaders, and Peter Lurie, MD, MPH, from the Public Citizen’s Health Research Group.

FACULTY AND RESIDENTS:
*Aaron Fox, MD, Clinical Instructor of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Course Director, Research-Based Health Activism Course;
*Viraj Patel, MD, Primary Care Resident, Montefiore Medical Center

FOR MORE INFORMATION: Please contact Aaron Fox, MD at this link: Aaron Fox

Past Programming Tracks:

Health Policy and Activism—The history and the present: Bertrand Bell, MD: Making Real World Change As A Physician—Jo Ivey Boufford, MD: Public Policy—Joseph Ross, MD: Health Care Organization—Ernest Drucker, PhD: A Plague of Prisons: The Epidemiology of Mass Incarceration—Oliver Fein, MD: National Health Insurance for the US: Has Its Time Come?—Paul Lipson, Chief of Staff and Siddharta Sanchez, Community Liaison for Immigration & Environmental Affairs for Bronx Congressman José Serrano: Health Topics as they relate to the policies in the Bronx, NY—Ruth Macklin, PhD: Research Ethics: Protecting Human Subjects of International Research—Eva Metalios, MD: Human Rights Clinic—Barbara Seaman: Women’s Health Activism—Peter Selwyn, MD, MPH: Research and Advocacy at the Dawn of AIDS—Peter Sherman, MD: The Affects of Domestic Violence on Children—Victor Sidel, MD: Social Injustice and Public Health, and War, Terrorism, and Public Health—Hal Strelnick, MD: Health Policy at Local, State, and National Levels—Bruce Vladeck, PhD: Medicare and the Role of Physicians in the Future—Sidney Wolfe, MD: Research Topics/Questions

Research Methods—how to produce activist research:

Matthew Anderson, MD, MSc: Planning the write-up process of your project—Chinazo Cunningham, MD: Grant Writing—Robin Flam, MD, DrPH: Uses of Epidemiology—Aaron Fox, MD: Social Epidemiology—Nerina Garcia, PhD and Lucia Ferra: Qualitative data use and analysis—Alison Karasz, PhD and Galit Sacajiu, MD, MPH: The Underline Construct—Paul Meissner, MSPH: Using Secondary Demographic and Clinical Databases—Robert Roose, MD: Quantitative data use and analysis—Galit Sacajiu, MD, MPH: Research Questions—Nancy Sohler, PhD, MPH and Galit Sacajiu, MD, MPH: Study Designs

Advocacy—how to create change:

David Appel, MD: Lobbying—Ramin Asgary, MD, MPH, MSc:Humanitarian Assistance: The Principles—Oni Blackstock, MD: HIV/AIDS in Ghana: Adherence and Stigma—Bob Goodman, MD—Pharmaceutical Industry and Physicians—Kirsten Goodwin of GMHC: Coalition Building—Hillary Kunins, MD, MPH, MS and Carolyn Chu, MD: Case Workshop: Advocating for Choice—Janice Lieberman, NBC Studio: Media Relations in Health Research and Advocacy—David Matthews: Harm Reduction and HIV: a grass root organization—Steve Max of Midwest Academy: Intro to Organizing and Strategy Building—Mini Murthy, MD, MPH, MS: Women’s Health and Human Rights—Zena Nelson: The South Bronx Food Cooperative—Adam Richards, MD, MPH: Public Health and Human Rights Praxis in Burma—Minesh Shah, MD: Public Speaking—Lanny Smith, MD, MPH, DTM&H: Liberation Medicine, Health and Human Rights—Leonora Tiefer, PhD: FSD-A Case of Disease Mongering and Activist Resistance

Click on the links below for:

Course Brochure 2009
An application for the course:  2009 application
Articles about the course from the journal of general internal medicine, Academic Physician and Scientist and the New York Times

Aaron Fox, MD




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