Archive for the 'New York' Category

2015 Left Forum in NYC: The Health Track & Something to celebrate

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Timeline Cover Photo 851 X 315

 

The 2015 Left Forum will take place on the weekend of May 29-May 31, 2015 at John Jay College in the Bronx.  Readers of the Social Medicine Portal readers may be interested in the Health Track.  (LF 2015 Health Track Flyer). We have a special reason to celebrate as the New York Assembly has just voted in favor of a Single Payer plan for New York State.  This is a small but significant victory.

Please come to our session on Faultlines in the Medical Industrial Complex on Saturday at noon.

Matt Anderson, MD

Health/PAC Bulletin Archives available online: A new resource for health activists

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www.healthpacbulletin.org_wp-content_uploads_2013_03_1988-Vol-18-2-Summer_Corrected-page-001

Health/PAC (the Health Policy Advisory Center) has recently posted PDF versions of all their Bulletins at: http://www.healthpacbulletin.org/.  The Bulletin was published from 1968 to 1994 and documented the work and analysis of progressive health activists from around the country.  The introduction to the collection provides a history of the organization and the Bulletin. Health/PAC’s organizational archives are housed at the Temple University Library: http://library.temple.edu/collections/scrc/healthpac-policy-advising.

Health/PAC was also responsible for the publication of three books:

  • The American Health Empire (1971): Chapter 1 is available at this link.
  • Prognosis Negative (1976): You can read a review from Science and Society
  • Beyond Crisis: Confronting Health Care in the United States (1994)

Health/PAC developed the concepts of “medical empire” and “medical-industrial complex.”  With time we have seen the increasing relevance of these terms for the analysis of a economic sector that makes up nearly 1/5 of our economy.  This is an invaluable collection for the critical analysis of health and health activism.

Stop the closing of Long Island College Hospital: Town Hall Meeting on 2/14/2013 @ 6PM

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Our colleagues in the New York State Nursing Association (NYSNA) and the Committee of Interns and Residents (CIR) have alerted us to action on 2/14/2013 to stop the closing of Long Island College Hospital. This is part of a much larger struggle to stop the privatization of hospitals in Brooklyn.

save lich

The rally will start at 6PM at the Kane Street Synagogue, 236 Kane St., Brooklyn. And here is the text of their call:

Nurses, patients, & neighbors.  Unite to Save LICH!

Hundreds of caregivers, neighbors,and elected officials are building a powerful mass movement to save LICH!

The SUNY Board of Trustees took an illegal and improper vote to close LICH. The good news: We were there in force — chanting, singing, and telling our stories. They snuck out the back door of their own meeting — without adjourning. Since they abandoned their official duties, we took matters into our own hands — and voted unanimously to rescind their decision! Our patients needs this hospital. We save lives every day. Even the SUNY Board was forced to admit that the story that we are “underutilized” is a lie! Our hospital is a lifeline for patients across Brooklyn. Just look at the lives we saved during Hurricane Sandy. We can and will save LICH! Governor Cuomo and the Health Dept. can step in any time to save LICH.

We’re building the movement to make them. Join us! For more information and to get involved, talk to your union delegate or Eliza Carboni at 347-213-0737 or eliza.carboni@nysna.org

 

People’s Power Breakfast and Speak-Out to Fix Health Care in Brooklyn: Wednesday January 11 at 7AM

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Stephen Berger, Investment Banker & Chair of Cuomo's Medicaid Resign Work Group

Doctors for the 99% will be out on Wednesday morning (1/15/2012) at 7AM to provide a people’s answer to a $75-a-plate power breakfast inside the Brooklyn Marriott.  Health industry and Wall Street insiders will be guests of Crain’s NY (the local business publication whose readers ARE the 1%) to talk about how to “Solve Brooklyn’s Hospital Crisis”.

Why a demonstration?

This protest is a response to Gov. Cuomo’s special work group on Brooklyn hospitals (chaired by Stephen Berger a Wall St. financier) which has recommended changing NY law to allow investors to own or operate hospitals that are in financial trouble. They also recommend that the state be given power to dismiss hospitals’ management and boards. Together, these changes will allow Wall St. to take over health care even more than they already have.

It is amazing that in an attempt to save money, the State would turn Brooklyn hospitals over to for-profit companies.  There is extensive evidence that privatizing health services results in increased costs, poorer quality, and increased health disparities.  The people who will profit are the for-profit companies.  The people who will pay? The taxpayers of New York and the patients who will lose access to safety-net institutions.

Changes to our health care should be made transparently and democratically. These life and death decisions should be made by the communities who will be affected, not by the bankers who caused our problems in the first place.

This is a classic example of using a “crisis” to push through unpopular policies that will benefit only the rich.

What is the background?

  • 20% of Brooklyn residents live in poverty. 40% of Brooklyn residents have Medicaid as their health insurance, and another 20% have no health insurance at all.
  • One-third of all Brooklyn residents lack a regular doctor, so they use emergency rooms (ERs) when they get sick. 46% percent of all ER visits in Brooklyn could be better treated in the community.
  • 6 of Brooklyn’s 14 hospitals are almost out of money and in danger of closing: Brookdale (Brownsville), Brooklyn Hospital (Ft. Greene), Interfaith (Bedford-Stuyvesant), Kingsbrook Jewish (East Flatbush), Long Island College (Cobble Hill), and Wyckoff (Bushwick). These hospitals serve low-income communities, where most people have Medicaid or no insurance, and many are immigrants and people of color.
  • Gov. Cuomo appointed a special workgroup chaired by an investment banker to suggest fixes for Brooklyn’s troubled hospitals. They suggested letting private investors come in to “save” these hospitals.
  • Brooklyn is fighting to keep hospitals open in low-income neighborhoods. Meanwhile, the wealthy east side of Manhattan is stuffed with well connected hospitals that grab public money, but give little care to low income communities of color.

What are the details of the demonstration?

We will be meeting Wednesday 11 January @ 7 am outside the Brooklyn Marriott, 333 Adams St (near Borough Hall / Jay St / MetroTech in downtown Brooklyn).

For more information visit: http://owshealthcare.wordpress.com or contact: owshealthcare@gmail.com

November 10th Fundraiser for El Punto en la Montaña, a Syringe Exchange Program in rural Puerto Rico

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Our colleague Dr. Rob Roose forwarded this announcement of a fundraiser for the El Punto en la Montaña Syringe Exchange Program in rural Puerto Rico. He noted that: “injection drug use and its related sequelae continue to be massive public health problems in Puerto Rico. There is very little political will or interest to support prevention efforts or offer treatment for substance users.  Over the past several years, some colleagues of ours and friends of mine in the harm reduction field have been doing some very excellent work providing syringe exchange for rural users in Puerto Rico. However, and unfortunately, their work is in jeopardy of ending due to lack of funding. ” A podcast describing the work of the clinic is available from the Harm Reduction Coalition.

HELP US STOP A DRAMATIC AND AVOIDABLE HUMANITARIAN CRISIS IN PUERTO RICO

Julia Burgos Latino Cultural Center – (1680 Lexington Ave, between 105 and 106 streets) -Thursday, November 10, 2011 – 6pm to 12am

Education + Access = Power

The AIDS crisis in Puerto Rico is out of control. Over 35,000 people live with HIV/AIDS and at least 50% of these are due to the (avoidable) sharing of contaminated drug injection. It has been proven that when free sterile syringes are made available to injection drug users (IDU), they stop sharing syringes and HIV infection rates go down dramatically. Moreover, HIV and Hepatitis C (HCV) infections are the direct result of the lack of syringe availability. Despite the epidemiological crisis in the island, the needs of these populations continue to be overlooked. While a syringe that literally costs cents can save hundreds of thousands of dollars in HIV and HCV medication treatments and unnecessary human pain, there are almost no monetary allocations to decelerate the progress of these epidemics. In fact, while HCV treatment is virtually nonexistent in Puerto Rico, studies have found that over half of PR IDU may be infected with HCV. This governmental negligence has caused a major and unprecedented human rights’ crisis. We are determined to take matters into our own hands by bringing life-saving services to PR IDU via activism and philanthropy. But we need you. Puerto Rico needs you.

Concerned NYC-based activists are asking you to support El Punto en la Montaña, a rural Syringe Exchange Program (SEP) that operates in the municipalities of Cayey, Cidra, Comerio and Aguas Buenas. While the HIV/AIDS epidemic is island-wide, drug users in rural municipalities have even less access to drug treatment services and sterile injection supplies than those IDU living in metropolitan areas, where syringe exchange, methadone treatment and other services are (somewhat) available. This is what makes El Punto unique. Since 2007, with a yearly budget of approximately $40,000, it has provided access to sterile injection supplies, education and nutritional services to over 600 rural IDU. 98% of these IDU had never received these services in their lifetimes prior to El Punto.

El Punto has been able to operate thanks to funding from private foundations such as TIDES, National AIDS Fund-now AIDS United, NASEN and MAC AIDS Fund. CitiWide Harm Reduction (a Bronx-based SEP) and the Harm Reduction Coalition have also supported this program administratively, and with trainings and supplies. While these funders and institutions have helped El Punto throughout the past 4 years, the financial panorama for 2012 is grim. We need to raise $30,000 to guarantee full program operation during 2012.

Join our efforts to face an unprecedented humanitarian crisis. Join as at the fundraiser PUERTO RICO´S HUMANITARIAN CALL to be held on Thursday, November 10 at the Julia Burgos Latino Cultural Center (1680 Lexington Ave, between 105 and 106 streets). You can also send check donations by mail to 226 East 144th Street, Bronx, NY 10451. Please make checks payable to “CitiWide Harm Reduction/El Punto en la Montaña”.

Questions? Contact El Punto Chair Camila Gelpí-Acosta at 718-581-3983 or camilagelpi@gmail.com

Volunteers sought for NYC Doula Project

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The New York City Doula Project is seeking volunteers to work as doulas “across the spectrum of pregnancy.” Here is the text of their announcement:

What is a Doula?

The word doula is an ancient Greek term that translates to “caregiver.” A doula provides emotional support, pain management and relaxation techniques, and information to her clients as needed.

Birth – A Birth Doula will provide all of the above throughout a client””s labor and delivery, as well as the immediate postpartum period (about two hours after the baby has been born). The doula meets with clients prenatally to talk about birthing preferences, the creation of a birth plan, and to practice different positions and relaxation techniques for labor. Additionally, a birth doula provides a postpartum visit to review the client’s birth experience and refer them to any resources they may need. Birth doulas are on call for their clients for three weeks.

Abortion- An Abortion Doula will provide all of the above to clients who are choosing to terminate the pregnancy. The doula will stay with the client throughout her procedure, as well as part of the recovery period, and will remain in touch with the client as she desires thereafter.

About The Doula Project:

The Doula Project is a pro-choice New York City-based organization that was started in 2007 to provide free services to lower-income individuals across the spectrum of pregnancy. It was founded by pro-choice doulas and reproductive justice activists, two of whom currently serve as the Project Co-Coordinators. The Project is a volunteer led and run organization that trains and manages its own doula base. We currently have 3 programs that serve the greater NYC area:

1) To provide doula care to people facing abortion, miscarriage, and stillbirth (in partnership with a Manhattan Public Hospital and Planned Parenthood Brooklyn). You do not have to be a birth doula to serve as an abortion doula. We train our own volunteers on this component of care.

2) To provide doula care to people choosing adoption (in partnership with Spence Chapin Adoption Agency). Please be a trained birth doula to apply. We do not require a lot of experience, only a formal training with an established doula certifying program.

3) To provide doula care on a case by case basis to lower-income individuals who are not affiliated with either of our partner organizations. Please be a trained birth doula to apply. We do not require a lot of experience, only a formal training with an established doula certifying program.

We are recruiting doulas for all components of our mission, though priority is given to those who are interested in being both Birth and Abortion Doulas. While you are not required to serve as a doula for all components, you are expected to support the mission and values of the entire project and the work each individual doula engages in. You are also expected to attend all components of our training. We encourage you to apply for all components of our work!

Abortion Doulas:

We are looking for people interested in training as abortion doulas to work with clients in NYC clinics and hospitals. Doulas will be present and provide emotional support to clients before, during and after abortions. We are looking for people who can work at least 2 weekdays a month as well as complete 40 hours of training, provided by The Doula Project, in the summer of 2011. Trained birth doulas are particularly encouraged to apply, though we are excited to bring on reproductive health and justice activists who have no prior doula training.

Job description:

  • Report to the assigned hospital/clinic each workday
  • Meet with clients in the clinic/hospital before abortion and answer any questions/concerns, help fill out paperwork, and provide pre-abortion counseling
  • Provide client with emotional support during abortion (includes 1st and 2nd trimester and laminaria placements). Please note: This means you will be expected to be in the operating room with the client as needed.
  • Provide clients with your number to call you anytime to talk after abortion.
  • Meet with clients anytime if desired after abortion

Commitment:

  • Commit to two 5- 8-hour weekdays per month (Monday – Friday 9-5PM)
  • Commit to meeting with the client outside of clinic setting after abortion, if desired
  • Provide personal number to client as desired
  • Attend monthly abortion doula meetings
  • Attend 40 hours of training in the summer of 2011 (includes 25 hours classroom over the course of one week/15hours clinic over the course of three to four weekdays)
  • At least one-year commitment to project
  • When working in hospital/clinic settings, become hospital/clinic volunteer and go through volunteer training

Adoption and Birth Doulas:

We are looking for previously trained birth doulas to work with birth moms who may be choosing adoption and with clients who cannot otherwise afford doula care. We partner with Spence-Chapin to provide doula support to their clients and support low-income clients who sign up through our website, free of charge. You do not have to have a lot of experience as a doula and will work as part of a two-person doula team. A back-up doula will always be provided for every birth.

Job description:

  • Coordinate with your partner doula to ensure that at least one of you will be available at all times during your five-week on-call period.
  • Meet with clients, for a minimum of two prenatal visits as desired by the client and as time allows
  • Assist client in the creation of a birth plan
  • Answer questions and provide resources per client””s request
  • Remain in constant contact with client before and during the on-call period, and after, as client desires
  • Provide continuous support at the time of the client””s labor and delivery
  • Meet with clients for a minimum of one postpartum visit after the birth, as the client desires

Commitments:

  • Participate in adoption training with Spence-Chapin (part of larger training we provide)
  • Commit to one (1) birth every 6 weeks
  • Commit to a minimum of two prenatal visits and two postpartum visits
  • Commit to the five-week on-call period with your partner doula. At least one of you must be available at all times during the on-call period.
  • Provide personal cell phone or pager number to clients
  • At least one-year commitment to the project
  • Adhere to Doula Project and Spence-Chapin policies and protocols.

Doula training will take place the weekend of June 18th and 19th (9am-5pm). In order to offset some of the cost of the training workshops, we will be asking each applicant accepted to the Doula Project to pay $25 on the first day of training. We recognize that this may be difficult for some of us; if this is the case for you, please just drop us a line. We will waive the workshop fee, no questions asked.

How to apply:

People with experience in doula work, reproductive health, rights and justice work, abortion counseling or health services are encouraged to apply. People under 30, people of color, queer and trans people and Spanish speakers are strongly desired. People with flexible/free weekdays are ideal. While we are willing to negotiate for the right person, priority will be given to those who can commit to at least two weekdays a month.

Abortion doulas and births doulas who take births through our website will serve in an unpaid volunteer capacity. Adoption doulas will receive small stipends through the adoption agency. We realize this is a big time commitment and will do everything possible to take care of our doulas and work within your schedules.*

You can get our application at www.doulaproject.org.

If you are interested in working with us, we are accepting applications now through April 25th. Please send completed applications at apply@doulaproject.org

 

More Low-cost & Free Health Resources: Acupuncture & Advanced Directives

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Swedish Institute

Low-cost acupuncture treatments

For several years, Manhattan’s Swedish Institute (226 W 26th St.) was the place to go for low-cost acupuncture treatment in New York City.  The Institute’s teaching clinics offer both acupuncture and Swedish massage.  A 13 week course of acupuncture cost $360 ($150 for seniors).

Earlier this week we ran into a colleague,  Dr. Ben Kligler, co-author of Integrative Medicine: Principles for Practice, who informed us that the Swedish Institute has been purchased by the Pacific College of Oriental Medicine.  He recommended the PCOM teaching clinic where acupuncture is provided by interns at somewhat higher prices than the Swedish Institute; see the details on their website. The address of the PCOM is 915 Broadway, 3rd floor.

Both the Swedish Institute and PCOM have interesting websites.  Here is the Swedish Institute’s explanation of what it’s like to experience an acupuncture session.

Advanced Directives

A recent article in The Teaching Physician (a publication of the Society of Teachers of Family Medicine) discussed a new (free) initiative to make it easier for people to both make – and retrieve – advanced directives.  “Information Technology and Teaching in the Office: Advance Directives Online” by Richard P. Usatine, MD, and Craig M. Klugman, PhD, University of Texas Health Science Center at San Antonio was published in the October 2009 edition and discusses Caring Connections (http://www.caringinfo.org/).

Caring Connections was developed by the  National Hospice and Palliative Care Organization (NHPCO) with support from the Robert Wood Johnson Foundation.  The website offers a number of resources for people considering end-of-life care.  The one highlighted in the article was the ability to create and store advanced directives on line.

As noted on the site: “Advance directives allow you to document your end-of-life wishes in the event that you are terminally ill and unable to talk or communicate. ” They generally take two forms. In a living will someone specifies what kind of care he or she would like in future.  A health care proxy is someone who can make decisions for a patient if he or she is incapacitated.

As a practicing clinician I find that there are several problems with Advanced Directives.  First, people don’t fill them out. No one likes to think about their own death. Second, people often turn to lawyers who charge money to complete these forms. This is really not necessary.  The forms in New York State can easily be completed by a family.  [The specifics of advanced directives, however, vary by state.] Finally, there’s no logical, single place to put Advanced Directives so that they are easily retrievable in an emergency.

The Caring Connections site deals with both problems. State specific forms are available for downloading.  The forms come with very detailed instructions.  Once they have been completed users are encouraged to scan them and upload them to a Google Health Profile. This profile can then be shared with the key people who need access to the advanced directives.

One is always a bit reluctant to further promote the Google monopoly on the web, but this is a useful free service.  It is, however, only available in English, a true limitation in an ever more diverse United States.

More free stuff in NYC – medical and not

The Swedish Institute is mentioned in a wonderful book sent to us by a reader entitled The Cheap Bastard’s Guide to New York City. Interested readers of the portal should consider getting a copy at the New York Public Library (of course).

posted by Matt Anderson, MD

A Study of Mass Incarceration in the Bronx

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Bronx County Hall of JusticeThe most recent issue of the Journal of Health Care for the Poor and Underserved includes an article we wrote on the impact of mass incarceration on the communities we serve in the Bronx:

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

Here is the abstract of the article.

Objective. We examined the impact of arrest and incarceration on primary care patients in the Bronx, New York.

Methods. Patients at three clinics were asked eight questions concerning current and past involvement in criminal proceedings, arrest, and incarceration.

Results. One hundred eighteen patients were surveyed. Eleven (9%) patients were currently involved in criminal proceedings. Twenty-one (18%) currently had a family member in jail or prison. Twenty-nine (25%) reported ever being arrested; 65 (55%) reported that they or a family member had been arrested. Twenty-one (18%) had been incarcerated; 60 (51%) reported they or a family member had spent time in jail or prison. For most variables, rates were higher for men and the adults accompanying children at pediatric visits. Clinicians reported positive experiences discussing incarceration.

Conclusions. Involvement with the criminal justice system was common among our patients. Discussion of incarceration did not appear to have a negative impact on the clinical relationship.
Comments:

The United States incarcerates far more people than any other country in the world.  Last year, the Pew Charitable Trusts estimated that 1 out of every 100 American adults was behind bars.  The impact of this policy falls primarily on men, on minorities and on the working class.  The term mass incarceration was coined to describe how police targeting of specific neighborhoods (urban, minority, working class) creates communities where a large percentage of the men are in prison or jail.  Taken as a whole the Bronx has high rates of arrests and incarceration, although even within the Bronx some neighborhoods are affected more than others.  This is well illustrated in a series of maps produced by the Justice Mapping Center.

In our clinical work we have come to appreciate how incarceration affects not just the person imprisoned, but also their family.  Ailing grandmothers end up caring for children when Dad goes to jail and Mom has to find a job. Children grow up in a single family home while their spends years in jail.  Young boys who are having difficulty in school start playing hooky, get involved with petty crimes, end up incarcerated, and are then socialized by the prison gangs into more severe criminal activity.  And just as families are affected by incarceration, so too are their communities.

In this study we tried to assess how common arrest and incarceration were in our patient population.  Over the course of a few weeks in the fall of 2008, our clinicians asked patients a few simple questions about incarceration in the course of their clinic sessions. The data was collected in such a way as to protect the anonymity of the respondents.  In all we collected data from 118 patients at three clinics.  We found that 11 patients (9%) were involved in some type of criminal proceedings at the time of the visit.  Twenty-nine (25%) reported that they had been arrested at some time in their life and twenty-one (18%) told us they had spent time in prison.   Twelve percent of the families had someone return from jail within the past year.  What was particularly concerning to us was that involvement in incarceration and arrest was more common among the adults bringing their children in for care than it was among the adults presenting for themselves.

The card study also brought to light issues that had previously been hidden.  One of our residents remarked:

The card study of incarceration brought on an interesting discussion with a patient of mine whose son was imprisoned for many years. She’s a patient I’ve seen several times in clinic but with whom I had never thought to broach this topic.

This data reinforces our sense that mass incarceration has a major negative impact on the families and communities we serve.  It suggested to us that knowing about an incarceration or arrest history may help doctors better care for their patients.  This also seems to be an area in which doctors can advocate for system-level changes – such as reform of punitive drugs laws, expansion of drug treatment programs, improvements in the school system – that can prevent people from landing in jail.

posted by Matt Anderson, MD

Health in Amsterdam & New York: A conference on the 400th Anniversary of Hudson's Visit

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hudson

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

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

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

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

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

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

Two abstracts

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

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

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

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

Further Details:

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

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

Posted by Matt Anderson, MD

A Historical Look at Health Care on Riker's Island by Dr. Noga Shalev

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rikers

Riker's Island

The June 2009 edition of the American Journal of Public Health contains an article entitled: From Public to Private Care The Historical Trajectory of Medical Services in a New York City Jail” written by Noga Shalev, MD. Dr. Shalev is a graduate of the Residency Program in Social Medicine and this work developed from her 2006 Social Medicine Project. The article describes the evolution of health care services at Riker’s Island.

The Riker’s Island Penitentiary sits in New York City’s East River between Queens and the Bronx, just to west of La Guardia Airport.  Riker’s is quite literally an island,  connected to the Borough of Queens by a single bridge. It is one of the world’s largest correctional facilities with an average daily census of about 13,000 prisoners.  Administratively, the facility houses ten jails that sit on the island and the Vernon C. Bain Center, an 800 person facility located on a barge just off of Hunts Point in the Bronx.

prisonbargevernoncbain-1

Vernon C. Bain Prison Barge

Dr. Shalev divides the history of health care at Rikers into three periods.  From the opening of the prison in 1932 until 1973 medical services were provided by various New York City agencies.    During this period numerous reports documented the poor quality of care provided to inmates.   It seems clear that the Department of Correction’s concern for security trumped attempts to provide medical care to inmates.  As noted in a 1958 report: “The Department of Correction is not now in background, equipment, or personnel capable of giving modern medical care—whether preventative or therapeutic—to the prisoner.”

Attempts to remedy this situation made little progress until the early 1970’s when a series of prison revolts including those at the upstate Attica prison and the Manhattan House of Detention (commonly known as “the Tombs”) led to reforms.   This resulted in the second period of medical care at Rikers.  From 1973 to 1996 Montefiore Medical Center provided health care under an affiliation agreement with the City.  Health care on the island improved and the service was “the first correctional medical program in the country to be accredited by the Joint Commission on Accreditation of Healthcare Organizations” (JCAHO).  However this period also coincided with the HIV epidemic and in its wake a resurgence of tuberculosis; prisoners were particularly affected by these twin epidemics.  Costs for medical care increased substantially and in 1996 the Giuliani Administration decided to turn health care at the island over to a private contactor. The initial agreement with St. Barnabus Hospital was generally recognized as a failure.  Costs did not decrease and there were ongoing concerns about the quality of care.  Currently, care on the island is provided by the private, for-profit Prison Health Service, Incorporated.  Concerns over costs and quality of care remain.  Dr.  Shalev characterizes this final period from 1996 to the present as one of “managed care” and the overarching theme of her paper is that health services at Riker’s have moved from public hands (the city) into private hands (for-profit corporations).

Dr. Shalev’s careful historical research, butressed by interviews with Montefiore staff, tell the story of a particular and certainly unique experience in incarceration.  But the unique story of Riker’s illustrates the larger themes of how corrections have come to be seen as one more commodity on which profit can be made. And this gives powerful players a vested interests in keeping jails full.  The result is a system described by some as a prison-industrial complex, by others as a penal state.

Here is the abstract of Dr. Shalev’s paper:

Over the past 25 years, incarceration rates in the United States have more than tripled. Providing health care services for this growing number of inmates poses immense medical and public health challenges. Focusing on the administrative and financial shifts in health care delivery, I examined the history of medical services in one of the nation’s largest correctional facilities, Rikers Island in New York City. Over time, medical services at Rikers have become increasingly privatized. This trend toward privatization is mirrored nationwide and coincides with the rising prevalence of incarceration.

posted by Matt Anderson, MD




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