Archive for the 'New York' Category
2 Comments December 4th, 2009 by bronxdoc
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
Add a comment November 24th, 2009 by bronxdoc
The 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
1 Comment August 28th, 2009 by bronxdoc
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
2 Comments June 15th, 2009 by bronxdoc
Riker's Island
The June 2009 edition of the American Journal of Public Health contains an article entitled: From Public to Private Care The Historical Trajectory of Medical Services in a New York City Jail” written by Noga Shalev, MD. Dr. Shalev is a graduate of the Residency Program in Social Medicine and this work developed from her 2006 Social Medicine Project. The article describes the evolution of health care services at Riker’s Island.
The Riker’s Island Penitentiary sits in New York City’s East River between Queens and the Bronx, just to west of La Guardia Airport. Riker’s is quite literally an island, connected to the Borough of Queens by a single bridge. It is one of the world’s largest correctional facilities with an average daily census of about 13,000 prisoners. Administratively, the facility houses ten jails that sit on the island and the Vernon C. Bain Center, an 800 person facility located on a barge just off of Hunts Point in the Bronx.
Vernon C. Bain Prison Barge
Dr. Shalev divides the history of health care at Rikers into three periods. From the opening of the prison in 1932 until 1973 medical services were provided by various New York City agencies. During this period numerous reports documented the poor quality of care provided to inmates. It seems clear that the Department of Correction’s concern for security trumped attempts to provide medical care to inmates. As noted in a 1958 report: “The Department of Correction is not now in background, equipment, or personnel capable of giving modern medical care—whether preventative or therapeutic—to the prisoner.”
Attempts to remedy this situation made little progress until the early 1970’s when a series of prison revolts including those at the upstate Attica prison and the Manhattan House of Detention (commonly known as “the Tombs”) led to reforms. This resulted in the second period of medical care at Rikers. From 1973 to 1996 Montefiore Medical Center provided health care under an affiliation agreement with the City. Health care on the island improved and the service was “the first correctional medical program in the country to be accredited by the Joint Commission on Accreditation of Healthcare Organizations” (JCAHO). However this period also coincided with the HIV epidemic and in its wake a resurgence of tuberculosis; prisoners were particularly affected by these twin epidemics. Costs for medical care increased substantially and in 1996 the Giuliani Administration decided to turn health care at the island over to a private contactor. The initial agreement with St. Barnabus Hospital was generally recognized as a failure. Costs did not decrease and there were ongoing concerns about the quality of care. Currently, care on the island is provided by the private, for-profit Prison Health Service, Incorporated. Concerns over costs and quality of care remain. Dr. Shalev characterizes this final period from 1996 to the present as one of “managed care” and the overarching theme of her paper is that health services at Riker’s have moved from public hands (the city) into private hands (for-profit corporations).
Dr. Shalev’s careful historical research, butressed by interviews with Montefiore staff, tell the story of a particular and certainly unique experience in incarceration. But the unique story of Riker’s illustrates the larger themes of how corrections have come to be seen as one more commodity on which profit can be made. And this gives powerful players a vested interests in keeping jails full. The result is a system described by some as a prison-industrial complex, by others as a penal state.
Here is the abstract of Dr. Shalev’s paper:
Over the past 25 years, incarceration rates in the United States have more than tripled. Providing health care services for this growing number of inmates poses immense medical and public health challenges. Focusing on the administrative and financial shifts in health care delivery, I examined the history of medical services in one of the nation’s largest correctional facilities, Rikers Island in New York City. Over time, medical services at Rikers have become increasingly privatized. This trend toward privatization is mirrored nationwide and coincides with the rising prevalence of incarceration.
posted by Matt Anderson, MD
1 Comment April 14th, 2009 by Aaron
April 13, 2009
Today at the Interchurch Center in Morningside Heights, Senator Kirsten Gillibrand (D-NY) met with a diverse group of community activists, labor leaders, and health care professionals to discuss priorities for health care reform. The demands of the group were simple – quality affordable health care we all can count on – and Senator Gillibrand’s response, which included overwhelming support for inclusion of a public health insurance option in any legislation on health care reform, suggested that she will be a strong advocate for health care reform in the near future.
The round table discussion was organized by Health Care for America Now! (HCAN), a coalition of 850 member organizations committed to common principles for health care reform. In attendance were representatives from 1199 SEIU, AFL-CIO, ACORN, Citizen Action of New York, the New York Immigration Coalition, NYC for Change and about 20 other local and national organizations. In addition to Senator Gillibrand, NYC Councilman Daniel O’Donnell and a staff member from Congressman Ed Towns’s office were also in attendance. As a practicing physician, and a representative of the National Physicians Alliance, it was heartening for me to see so many people committed to fixing our broken health care system.
The meeting began with a welcome from Paula Mayo, Director of the Interchurch Center, and introductory remarks by Dr. L. Toni Lewis, president of the Committee of Interns and Residents. Dr. Lewis shared an example of the tenuous nature of health care delivery in our communities – the hospitals in which she trained, Mary Immaculate and St. John’s, have both recently closed leaving patients in an already underserved area of Queens in flux. She also introduced HCAN’s policy priorities: enacting legislation in 2009 that would guarantee the option of a public health insurance plan and working toward equal access to quality care in communities of color and low income areas.
The most compelling speaker at the round table, a young woman named Kelly Cuvar, shared an extremely personal story of her battles with both cancer and her private health insurance company. Diagnosed with cancer at 19, she described how every major life decision she has made since has been framed by the need to maintain health insurance coverage. Never in full remission despite treatment, her “prior condition” and her ongoing need for doctor visits and treatment has made every interaction with the insurance company a source of stress. “Everything was fight,” but at least as a 19 year old student, her father could do the battling with the insurance company. Now 10 years later, after losing her job last year and needing to pay for her coverage through COBRA, she is petrified that her coverage will run out, “I am frightened and it is all that I think about.” In arguing for an affordable public health insurance plan without restrictions on prior conditions, she made the heart breaking plea that she is hard working, she has bravely battled her cancer, but our convoluted system of health care is failing her and has left her uncertain about her future care.
Other speakers included Sherriann Cumberbatch, a small business owner from Staten Island who cannot afford health insurance for her employees or even her own family; Elisabeth Benjamin of the Community Service Society who questioned why private health insurance premiums in New York have been increasing at 81% – a rate seven times greater than increases in wages; Ralph Palladino of AFSCME DC 37 who argued that a public health insurance plan would introduce competition, stability, efficiency, and innovation into markets where the private insurance industry has failed to do so; and Theo Oshiro of Make the Road New York who emphasized that immigrant families pay taxes and contribute to the economy and should not be barred from public health insurance plans.
In response, Senator Gillibrand only spoke for a few minutes, but immediately affirmed her support for including a public health insurance plan in any health care legislation. She also acknowledged support for a House budget resolution that would allow the Senate to pass health care reform with a simple majority vote avoiding filibuster. She was clearly moved by Ms. Culver’s comments and spoke directly to the young woman telling her that the stress and strain that her family went through is unacceptable. In a flurry of powerful statements, Senator Gillibrand emphasized that a not for profit public plan must be affordable (no more than 5% of a family’s income and less for those who can afford less), easy to enroll in (suggesting a check box on tax forms for enrollment), allowed to negotiate for discount prices with pharmaceutical companies (similar to the VA), and should offer coverage to everyone. To her, health care is right, not a privilege. The junior Senator from New York is clearly going to be a champion for progressive health care reform…now what can we expect from Mr. Schumer…
Aaron Fox, MD
1 Comment March 30th, 2009 by bronxdoc
Tuesday, March 24, 2009 brought Dr. Martin Donohoe to Social Medicine Rounds at Montefiore. Dr. Donohoe, a Portland internist, is an Adjunct Associate Professor Department of Community Health, Portland State University. He is also a prolific writer and the editor of the Public Health & Justice Website (phsj.org). PHSJ contains a rich variety of materials on health topics such as Activism and Education, Women’s Health, Beauty, Body Modification, Cosmetic Surgery, & Obesity and Unnecessary Testing, Scams. A previous posting on the Social Medicine Portal discussed his critique of the diamond, gold, and flowers industry (See Alternative Valentine’s Day: No gold, No diamonds, No flowers?)
Tuesday’s talk examined “Corporate Control of Public Health: Case Studies and Call to Action.” Dr. Donohoe has made the slides available on PHSJ. In this posting we wanted to discuss one of his cases studies: Bringing Bad Things to Life: The Alliance between GE Medical Systems and New York Presbyterian Hospital. This case study is available as a slideshow on the PHSJ website or as an article published in the journal Synthesis/Regeneration. (A slightly longer version of the article is also posted on PHSJ.org)
The Agreement
On September 8 , 2003, General Electric and New York-Presbyterian Hospital announced “a historic multi-year, several hundred million dollar partnership” between GE Medical Systems and the hospital. As per the GE press release:
An integral aspect of the engagement will have NewYork-Presbyterian Hospital adopting GE’s acclaimed management development and performance improvement methods. This will help build upon NewYork-Presbyterian Hospital’s strong leadership team and employee base to deliver superior patient care well into the future. NewYork-Presbyterian Hospital will implement leading edge tools for improving management, service quality and operational effectiveness. Employees will be trained in GE’s quality and process improvement programs. This balanced approach is comprised of Six Sigma statistical methodologies, change-management strategies (Change Acceleration Process) and team-based problem solving techniques (Work-Out™).
The GE/NYP deal raised concerns about the corporatization of medicine that were voiced in 2004 in the New England Journal of Medicine by Dr. A. M. Garber (Business and Medicine: Corporate Treatment for the Ills of Academic Medicine). Garber noted the agreement – said to last ten years and involve $500 million dollars – offered a series of discounts and financing for GE products that would create an effective lock-in for GE medical equipment. While noting potentially positive aspects of this relationship, Gerber questioned the wisdom of such a lock-in. He also noted the potential conflicts of interest arising from GE’s dual role as management consultant and provider of equipment. Finally Dr. Garber raised concerns about the multiple ways in which corporate consultants might deal with economic pressures facing hospitals. He painted an elegant picture of the ways in which corporate thinking can undermine the social mission of the hospital:
But any consultant could also help a hospital’s financial performance by pursuing strategies that do not benefit the public. Many academic hospitals could improve their bottom lines by cutting the amount of uncompensated care they provide and eliminating unprofitable services. They might also promote excessive use of high-margin services. For example, to the extent that physicians induce demand, any hospital that owns a scanner — and any physician who earns fees by interpreting scans — can raise revenues by performing scans for less critical or even dubious indications. Similarly, well-reported phenomena such as “DRG creep,” “upcoding,” and “unbundling” can increase health care expenditures without benefiting patients. Such practices may seem innocuous from the individual patient’s point of view, if they merely raise health expenditures generally. But a physician or hospital that takes advantage of reimbursement anomalies can also jeopardize patients’ health. Physicians and hospitals can be reimbursed more if a candidate for the placement of multiple coronary stents has the procedure divided among two or more hospital admissions than if they are placed as part of a single complex procedure. Is it plausible that clinical needs alone explain why so many patients have stents placed as part of multiple admissions?
Concerns about the deal were also raised in an article in the New York Times entitled: The Conglomerate Will See You Now; Is What’s Good for G.E. Good for Health Care? which asked:
IMAGINE a small town where one person not only owns the hardware store, but is also the banker and the doctor’s most trusted adviser. In a sense, General Electric is trying to play such a role in the nation’s $2 trillion health care industry.
The New York Times article discussed the possibility that the agreement would foster the use of expensive technology, a major factor in rising health care costs. As noted by Gerber above, expensive diagnostic machines often generate their own demand.
New York Presyterian’s Dr. Herbert Pardes responded to the Garber article in a two paragraph Letter to the Editor (published in February 2005). Pardes stated: “Our collaboration with GE Medical Systems is based on having access to business skills and cutting-edge equipment that, in our judgment, will benefit our patients and increase our ability to provide cost-effective, high-quality care. We purchase from GE only technology that the hospital deems to be in the best interest of its patients. We will never delegate to a third party any decisions regarding our patients and the manner or method of our delivery of health care.”
Swimming with Sharks
Dr. Pardes’ reassurances ring far less convincing when we know a bit more about General Electric; this is the main topic of Dr. Donohoe’s article. General Electric is the world’s largest company by market share. In 2007 it had revenues of $168 billion and profits of $21 billion. For a bit of perspective GE’s revenues are larger than the GDP of over 2/3 of the UN member states. The corporation is built upon a diverse set of products and services including media (NBC, Universal Studios, Telemundo), consumer appliances, power, aircraft engines, insurance, transportation, business systems, and medical services/equipment (see the Columbia Journalism Review website). Through GE Power, the company is a major force in nuclear power.
General Electric does not have a stellar history as a corporate citizen. GE’s history of corporate malfesance is discussed Dr. Donohoe’s article and also in a 2001 article in The Multinational Monitor entitled “GE: Decades of Misdeeds and Wrongdoing.”
Rather than review this history in detail, we will focus on one of these misdeeds that is particularly close to our home: the pollution of the Hudson River with 1.3 million pounds of polychlorinated biphenyls (PCBs). These PCB’s were released between 1947 and 1977 from two of GE capacitor manufacturing plants and became a major focus of organizing along the river (discussed in a slideshow from Clearwater and a series of FAQ from Riverkeeper). Thanks to GE, two hundred miles of the Hudson River are now the EPA’ largest Superfund site (see http://www.epa.gov/hudson/). Of note this is just of of several GE superfund sites.
PCB’s are good neither for the environment, nor for health. The EPA states: “PCBs are considered probable human carcinogens and are linked to other adverse health effects such as low birth weight, thyroid disease, and learning, memory, and immune system disorders.“ General Electric has devoted tremendous resources into evading responsibility for the cleanup (see Richard Pollock’s Is GE Mightier Than the Hudson?) For GI’s side of this story, see their website.
Crade to Grave Care?
Dr. Donohoe closes his article on GE with the following reflection:
It is abhorrent to imagine GE profiting from New York-Presbyterian Hospital requiring that a patient’s developmental anomaly or environmentally-induced cancer (a result of exposure to GE toxins) be diagnosed by a GE scanner and treated with GE-manufactured therapeutic devices. This is a macabre twist on the concept of cradle-to-grave health care.
The question then is whether we should be looking to or partnering with corporations like GE for models on how to run health care.
Posted by Matt Anderson, MD
Add a comment February 18th, 2009 by bronxdoc
Anyone who has driven across the Whitestone Bridge more than once or twice has probably noticed the large brick building located just east of the highway on the Bronx side. This is the home of the St. Joseph’s School for the Deaf, a school founded in 1869 and which moved to its 10-acre campus in the Bronx in 1913. St. Joseph’s is is one of eleven New York State 4201 schools which are supported by the state to provide educational services to children who are deaf, blind or physically challenged. Social Medicine Rounds last Tuesday (2/10/2009) took us to the School to learn something about deaf culture.
We were greeted by Patricia Martin, Noreen Collins and Roxana Aguilo who were gracious enough to spend nearly 90 minutes talking to us about the school and about the meaning of deafness. Dr. Martin is the Executive Director of St. Joseph’s and has been with the school for seventeen years. Ms. Collins in responsible for pupil personnel services and is the person to call (718.828.9000) for assistance with referrals . Ms. Aguilo is a former student at the school who works there now as a teacher’s assistant. Since she is deaf, she participated in the Rounds through the able translating abilities of Dr. Martin and Ms. Collins.
Dr. Martin began by distinguishing two definitions of deafness. Deafness can be seen as a pathology; this is what we could the “medical model.” In this model the important questions are why it occurred, how severe it is and how it can be fixed. But deafness can also be seen as a culture. From this perspective to have deafness is not to be dis-abled, but rather to be differently abled. To emphasize the reality of deaf culture, Dr. Martin read a poem entitled “Being Deaf” by Dianne Kinnee:
“What is it like to be deaf?”
People have asked me.
Deaf? Oh, hmm… how do I explain that?
Simple: I can’t hear.
No, wait… it is much more than that.
It is similar to a goldfish in a bowl,
Always observing things going on.
People talking at all times.
It is like a man on his own island
Among foreigners.
Isolation is no stranger to me.
Relatives say hi and bye
But I sit for 5 hours among them
Taking great pleasure at amusing babies
Or being amused by TV.
Reading books, resting, helping out with food.
Natural curiosity perks up
Upon seeing great laughter, crying, anger.
Inquiring only to meet with a “Never mind” or
“Oh, it’s not important”.
Getting a summarized statement
Of the whole day.
I’m supposed to smile to show my happiness.
Little do they know how truly miserable I am.
People are in control of language usage,
I am at loss and really uncomfortable!
Always feeling like an outsider
Among the hearing people,
Even though it was not their intention.
Always assuming that I am part of them
By my physical presence, not understanding
The importance of communication.
Facing the choice between Deaf Event weekend
or a family reunion.
Facing the choice between the family commitment
And Deaf friends.
I must make the choices constantly,
Any wonder why I choose Deaf friends???
I get such great pleasure at the Deaf clubs,
Before I realize it, it is already 2:00 am,
Whereas I anxiously look at the clock
Every few minutes at the Family Reunion.
With Deaf people, I feel so normal,
Our communication flows back and forth.
Catch up with little trivials, our daily life,
Our frustration in the bigger world,
Seeking the mutual understanding,
Contented smiles and laughter are musical.
So magical to me,
So attuned to each other’s feelings.
True happiness is so important.
I feel more at home with Deaf people
Of various color, religion, short or tall.
Than I do among my own hearing relatives.
And you wonder why?
Our language is common.
We understand each other.
Being at loss of control
Of the environment that is communication,
People panic and retreat to avoid
Deaf people like the plague.
But Deaf people are still human beings
With dreams, desires, and needs
To belong, just like everyone else.
–Dianne Kinnee (Switras)
Dr. Martin went on to describe their work in the school. She pointed out that about 95%of deaf children are born into hearing families. If hearing parents don’t learn sign language, as often happens, this can be very isolating for the deaf child. This is a particular problem in Bronx where many parents don’t speak English. For immigrant parents learning American Sign Language involves communicating in a doubly foreign language. [A universal sign language does not exist; each spoken language has its own way of signing]. The result of this is that even when deafness is identified early on deaf children may not receive a great deal of language stimulation at home.
The school has responded to this challenge by providing programs in which parents can bring their children to the school as early as 8 months of age. Children come to the school on their own starting at age 3 and stay through the 8th grade. The school also offers a 10 session class on Thursday evenings for people interested in learning how to sign. The cost is $50.
Ms. Aguilo then spoke at length about her personal experience. She had been born in the Dominican Republic where there were no services for the deaf. Her mother brought her to the Bronx and she had been diagnosed as deaf at Jacobi Hospital. This was a great blow for her mother. Fortunately, they had a Spanish-speaking counselor at Jacobi who was able to explain the situation in a language her mother could understand. Her mother found learning sign language difficult and so Ms. Aguilo had great difficulty in communicating with her Mom. Ms. Collins mentioned that often parents came to the school requesting that the school tell children about the death of relative or a pet. In these cases the school asked the parent to come in and the school provided translation services.
Ms. Aguilo had been a student at St. Joseph’s and later enrolled at Rochester Institute of Technology where she majored in fashion design. But she was homesick for the Bronx and returned after only a year and a half. Now she was working as a teacher’s assistant. She has three children of her own (“and all of them hear”) and has taught them ASL. Her kids are tri-lingual, speaking English, Spanish (with the abuela) and ASL (with Mom).
The topic of kids lead to a discussion of their use as interpreters. Ms. Aguilo spoke in forceful terms that the American Disability Act gives deaf people a right to a translator and this right should be respected. “Don’t write”, she said. “Don’t ignore our rights. It only makes us angry.” The use of children as interpreter has also been an issue with our southeast Asian patients. For a list of translation resources, see the end of this post. Ms. Aguil0 also spoke about the coverage limitations imposed by SSI particularly in terms of cost-sharing for hearing aids.
Ms. Aguilo noted to us that deaf people can drive cars. Deaf persons had initially experienced difficulty getting auto insurance so they formed their own company. Accident rates are lower for deaf drivers than for hearing drivers.
Finally we touched on the controversy surrounding cochlear implants. A 2005 Scientific American Frontiers program provides an introduction to this topic. The program included a fascinating website that allows one the hear the evolution of CI technology.
To some cochlear implants are the latest medical miracle. But many in the deaf community see it as an attempt by the medical community to eradicate deaf culture. Ms. Aguilo was blunt: “I like being deaf. And cochlear implants say to me that I am not ok.” She did not think they were appropriate for children born deaf. But they were an option for hearing people who were becoming deaf. Dr. Martin stated that the school was neutral with respect to implants.
Interpreting Services
New York Society for the Deaf: 212 366-0075 (9AM-5PM)
Mill Neck Manor School for Deaf Children: 516 512-6222
Deaf & Hard of Hearing Interpreting Services, Inc.: 212 647-1092 (8AM – 5PM, requests for interpreting by appointment; call same number after 5PM for emergency interpreting)
Video Relay Service (VRS): Sorenson VRS 866 327-8877. You need to have either the video number or the IP address for the Deaf person to call in addition to calling VRS.
posted by: Matt Anderson, MD
Add a comment February 11th, 2009 by bronxdoc
Health Information Tool for Empowerment is an excellent website maintained by the Greater New York Hospital Association and sponsored by a number of foundations and corporations. This site is useful both for people who need services and for providers who help patients with inadequate or no insurance.
This website has a very extensive list of resources. For example, it lists 170 dental providers and 687 clinics. Each listing provides detailed information about the provider, including address, phone, services provided and even links to provider web pages. It is also possible to search for providers by zip code and distance you are willing to travel. The site also has a help phone number: (866) 370-HITE.
Here is a description of the site taken from their FAQ page:
The Health Information Tool for Empowerment (HITE) is the first online directory of health and social services specifically for uninsured and under-insured New Yorkers. With the click of a mouse, HITE allows professionals to link their underserved clients with a broad array of health and support services.
HITE has two components:
- Resource Directory. A comprehensive directory containing thousands of national, state, and local organizations and programs available to low-income, under-insured, and uninsured people, as well as links to dozens of Web sites that provide information on everything from how to apply for public health insurance to where you can get free or low-cost medications.
- Eligibility Calculator. Eligibility screening tool for public health insurance, private health insurance, and other public benefits programs. HITE links to two screening tools. The NYC Human Resources Administration pre-screening tool helps determine whether their clients meet the basic eligibility requirements for one of New York’s publicly funded health insurance programs: Medicaid, Child Health Plus (CHP), and Family Health Plus (FHP); or for a low-cost private insurance program. ACCESS NYC, sponsored by the City of New York Mayor’s Office screens for eligibility for public health insurance and other public benefits/government entitlements.
This posting is one in a series on free and low cost health care.
Posted by Matt Anderson, MD
2 Comments February 6th, 2009 by bronxdoc
The Youth Leadership Project organizers
There has been snow continuously on the ground in New York since before New Year, a somewhat rare occurrence in these days of global warming. And saturday, January 31st was a particularly cold night. As one approached the basement of the St. Nicholas Tolentine church, a few brave souls stood outside smoking cigarettes and talking on cell phones.
Inside was the first annual fund-raising dinner of the Youth Leadership Project, a South East Asian community group. A dozen or so large round tables were spread around a long white room. At the tables was a happy crowd made up mainly of Cambodian immigrants. The room was filled with the sounds of people greeting friends. They saluted each other by putting their hands together as if in prayer and making a slight bow. Little kids zoomed in and out from a neighboring “children’s” room, mingling briefly with the adults and then returning. A small bar in the corner did a brisk business while people waited for the evening to start.
Chhaya and Khamarin, two of the YLP organizers, started the evening with a brief introduction to the Youth Leadership Project and appeals for help with two current projects. One is the Justice is Healing project (covered in detail in our blog of October 15, 2008); the other is a planned community center (more details below). They spoke in English and then Chhaya’s mother Ousara Phok, got up and translated their speech, a “translation” that involved copious thanks to many of the people sitting in the room.
The speeches were accompanied by a three course meal from Huynh Catering Services. The Huynh family, originally from Cambodia, has a long tradition of catering and Victor, we were informed, “does all the Cambodian weddings.”
With the speeches over, the very serious business of dancing began. Monorom, “one of the best Cambodian bands”, had been invited from Philadelphia and clearly knew what music the audience wanted to hear. Very quickly the dance floor was full. There were several different types of dances. Madison looked something like a line dance and can be seen at this link. Next came the circle dance (ramvong) a slow dance in which the dancers made elaborate movements with their hands as their hips swung slowly from right to left and back. Genders alternated in the circle. It was explained that in the old times unmarried people were not allowed to touch as they danced, thus the physical separation created by the circle. Finally, the Saravan dance which seemed to draw the most enthusiastic crowd.
We found a few minutes to catch up with Khamarin, one of the YLP leaders. He is a 20 year old student at New York College of Technology with plans to become a X-ray technician. He was born in the US and wasn’t entirely sure where in Cambodia his parents were born. His mother, he thought, came from Battambang and his father from a very small village.
Khamarin’s first experience in organizing came in 1999 when his aunt, a YLP
Chhaya and Khamarin
organizer had been campaigning against the welfare reforms of the Guliani administration. (This campaign was the subject of a film “Eating Welfare” made by CAAV: Organizing Asian Communities, the parent of YLP). Khamarin was quite young at the time but could not help being impressed by the fact that his aunt had brought people to the community to help. Thinking back now, he remembers how his elderly grandmother had started doing piecework about the time of the welfare cuts. She sewed small hair bands (scrunchies) in her apartment. He thought she was doing it as a hobby, but later he realized how many women in the community were doing this kind of piece work. “They would do the sewing and then the kids would cut the bands apart and sort them into piles.”
In 2001, 2002 the YLP organized ACE gatherings: Arts, Community, Empowerment. “We would be broken up into little groups and have to cook an entire Asian meal right there,” he said, “You would interact with people who you wouldn’t normally meet.” He learned about “the whole other side of the world.” This led him to training in community organizing and in 2006 he participated in the community health survey that was part of the “Justice is Health” campaign. He would knock on doors and ask questions about health problems and experiences with the medical system. health. He remembered one elderly woman. “My Khmer is not all that good, but it was enough to understand her.” She told him that it had been 5 or 6 years since she had seen a doctor. She had complaints. Back pains, leg pains and recurrent nightmares going back to the war. But it was too much trouble to go to the clinic and have no one there who would understand you. And if she had to take the children to translate, they would miss school.
We discussed YLP’s vision of a community center. The YLP house at 2473 Valentine Ave now serves as an unofficial community center and people gather there for holidays. But it is small for the group’s ambitions. They hope to create a Mekong Center that will serve local southeast Asians, not just Cambodians. It would be place to teach cooking, sewing, gardening, art, and dance. “These are our people’s skills, even though here they are not looked on as skills.” A group of urban planning students from Hunter College had helped them out. As a school project the students had created plans for rebuilding the current house into a real community center. Estimated cost: $2 million. Now it was YLP’s job to figure out what they would do with the plans.
Khamarin said that he had never been to Cambodia. He is afraid of flying. What he knew of Cambodian history he had learned from YLP. His schooling had not taught him much about his parent’s native country.
The Cambodian community in the Bronx has suffered multiple traumas. But this was not in evidence last Saturday night.
posted by Matt Anderson, MD
Add a comment January 9th, 2009 by bronxdoc
After our earlier posts on free and low-cost health care in New York, we were approached by someone seeking care for a broken tooth.
Our earlier post had suggested the NYU College of Dentistry Clinic and similar clinics at other dental schools. We also mentioned New York City Department of Health dental clinics for people up to age 21. (Our patient was 23).
The nagging memory of a 2006 social medicine rounds (12/19/2006) led us to the Mayor’s Office of Citywide Health Insurance Access, a part of the city government which tries to make health insurance available to as many New Yorkers as possible. Their website has an extensive listing of Health Resources for the Uninsured. This page provides links to low cost dental services, mainly in hospitals. The site also has links to community health centers, as well as information on medications, mental health resources, and vision services.
If you have no insurance, this is a useful site to visit. It provides a screening tool (it shows up as a sidebar on each page) to help you determine if you might be eligible for any public or private insurance plans.
Finally, – in terms of free non-dental services – this week we learned the NYC DOH offers free condoms and lubricants to organizations that will distribute them for free. Click on this link.
Brush your teeth and floss after each meal, stay away from sweetened drinks and have fun (safely).
Posted by Matt Anderson, MD
