Friday, June 6, 2014

Treating the Soul and Body, One Smile at a Time

I realized the true power of Crossroad Health Center when one patient told me, "This is the happiest I have been in months!" This patient I shadowed with Dr. VanMilligan was elderly and suffered from depression. However, like any proud grandparent, the patient showed me pictures of her grandchildren and became more lively and silly as she talked to me more. The patient told me that this was the happiest she had been in months, after being able to talk and laugh with others who cared about her. She made me realize the impact that I could play in someone's life just by talking to them and really listening to them. I think this is one side of medicine that is not addressed as often. Mental health and social health needs to be included with physical health. For a doctor to treat a patient, they need to not just help treat the body but the mind as well. I think it would be interesting to see how this could play a part in public health and my medical career in the future.

I began volunteering at Crossroad Health Center in September 2013. Ever since then, I have worked on projects ranging from diabetic patient follow-ups, referral tracking calls, tobacco treatment calls, and pre-visit planning room work. My volunteer work at Crossroad has taught me the complexity of the medical field. Being a doctor is more than seeing a patient and prescribing medicines. During my Success in Health Professions course my freshman year at the University of Cincinnati, I learned about how treating a patient requires the cooperative and interdisciplinary work of nurses, doctors, medical assistants, administrative staff, allied health professionals, volunteers, and the so on. Crossroad Health Center has this unique community focus and is able to effectively work collaboratively to help their patients as a patient centered medical home.
The providers at Crossroad have showed me how to treat not just the body, but the soul as well. Dr. O'Dea knows many of her patients on an individual basis and the visit is not just focused on the person as a patient, but the person as a fellow human being and friend. One of my favorite quotes posted in the exam rooms is by Peggy O'Mara,"The way we talk to our children becomes their inner voice." As a future physician interested in pediatrics, I look up to Nurse Practitioner Brook Gumm and the way she is able to talk to children in a loving, friendly way and talk to parents in an informative and comforting manner.
I have realized that the projects that I have worked on have helped the patients and create a community for the patients to feel important. It is nice to have a community at Crossroad who cares about each patient as a person and works to bring a smile to each and every patient's face every single day.

- Mahima Venkatesh

Monday, May 5, 2014

Roots That Run Deep: Barriers to Healthcare for Crossroad Patients

If I have gained any insight from my time volunteering at Crossroad Health Center, it would be this: healthcare, like many things in life, becomes not simpler but more complex the more you learn about it. The social issues surrounding healthcare in underserved communities cannot truly be understood at a distance; rather, they must be experienced firsthand and engaged with an open mind and an open heart.

Over-the-Rhine is a complex, dynamic, and diverse community, and as such, the barriers to healthcare in OTR and surrounding neighborhoods are not simply reducible to poverty. We cannot simply throw more money into the system and expect health outcomes to improve. Rather, there are a whole host of social and environmental factors that come into play when considering the issue. From my time observing and talking with providers at Crossroad, here are a few of the more notable barriers to healthcare:

1)    Finances. Somewhat obviously, this is one of the major impediments to receiving proper care for the residents of an impoverished neighborhood such as OTR. Other issues such as lack of insurance or poor access to transportation stem from financial difficulties.
2)    Insufficient providers. Quite simply, there are not enough healthcare providers in OTR, and so naturally that results in a lower quality of care for the neighborhood as a whole. Moreover, very few providers are actually from the neighborhood itself, resulting in possible cultural disconnects or a lack of trust between patient and provider.
3)    Geographical location. An inner-city neighborhood is not exactly an ideal environment for good health. As an example, the high lead levels in the soil and older buildings is a constant concern for pediatric health in the community.
4)    Medical illiteracy. There is a great need for outreach programs in OTR and similar neighborhoods to increase overall medical literacy in the patient population. 
5)    Language. Very often a language barrier exists between provider and patient, resulting in less effective communication and poorer outcomes. For example, many of Crossroad’s patients only speak Spanish.
6)    Family situations. Broken and dysfunctional families are by no means unique to OTR, but they certainly can be a factor in such a population. Insufficient parental oversight is a common concern, leading to fewer office visits and follow-ups and less concern for the general health of children.
7)    Toxic charity. It is often tempting to think we can rush in and “save” a neighborhood like OTR. Throw enough money and medication at the problem, and health will improve. In reality, a lot of well-intentioned charitable work can actually undermine the establishment of sustainable healthcare structures by promoting dependency or even distrust of one-time initiatives.

There are numerous other factors in play. The point to be made here is that these issues are complicated, and require that we take the time to truly educate ourselves on the situation before taking action. Only in that way can we be assured that our action will be efficacious. Time spent at Crossroad is invaluable in this respect, as it is both an opportunity to serve and to learn.

- Michael Petrany

Monday, April 21, 2014

I was sitting at a desk in the clinic, my mind on autopilot as I clicked through patient files on the computer. It was the kind of boring but necessary work that any well functioning medical practice is built on. This particular morning, I was updating primary care providers in a new patients' medical records.

I was so focused that when my fellow volunteer, Cameron, tapped me on the shoulder, I jumped about a foot in the air. "Someone is looking for you. There's a Spanish patient." Chagrinned about being interrupted and perplexed by the lack of detail (Who needed me? What was the nature of the visit? Was it a quick question or an entire visit?), I rose and followed him to the door of the small counseling office, which I had never entered.

The counselor introduced herself and quickly explained the situation as she turned the knob and ushered me in. Already in the room was a middle-aged, Hispanic woman who had an appointment with the counseling intern. I introduced myself as a student translator and began the awkward process of sorting out the session.

I worked out the details of the story: the woman was a patient of the clinic and had been referred by her primary care doctor. She filled in the rest of the story, which took 45 minutes to relay, between my mistranslations and her rapid cadence. Several months prior, she discovered her partner was abusing her granddaughter. She confronted him, at which point he threatened her with violence and fled the scene before he was apprehended, released, and finally skipped his arraignment. He is now at-large and authorities don't know if he has fled the country, a fact his family refuses to confirm or deny to our patient. She lives in constant fear he will return and guilt over what happened to her granddaughter. Additionally, her lack of closure over the whole situation leaves her wracked with confusion, self-blame, and depression.

As her words washed over me, I allowed myself a minute of reflection. How had I gotten here, walking the fine line facilitating a tearful discussion of very personal mental health issues, when minutes before I was just quietly completing my clerical tasks.

But this dichotomy is the essence of our program. It helps students understand both the practical and the human side of primary care in such a population. We're asked to contribute in the less glamorous but absolutely essential daily functions of the clinic but also given the privilege of working with patients and learning through our interactions with them. By learning through a variety of sustained experiences, the C-VIP program is preparing future physicians to be more informed, hard working, and compassionate professionals.

- Julia Tasset

Monday, March 24, 2014

Medicine and Faith

On our website, Crossroad’s mission reads: “Our mission is to give honor to Jesus Christ by providing accessible, comprehensive health care in partnership with our patients and community leading to healthy, changed lives.” Despite being raised in a Christian home and always wanting to be involved in medicine, it was not until becoming an intern at Crossroad Health Center that I saw the tangible effects of faith and medicine together.

While shadowing Dr. Roberts in the fall, I was able to meet a patient who had a terminally ill daughter at home. The family had decided to forego any other extreme measures and had been relying on prayer to heal their daughter. According to him, the prayer was working. It was extremely touching to hear this man talk about his child and the healing that the family was experiencing. He than began to talk about his love for Crossroad. He said, “without Crossroad, it would be disastrous.” The patient explained how much the health center means to the community and how without it, the community members would be entirely lost. He went on to mention the sense of peace he felt every time he walked through the doors on East Liberty Street.

This experience, in addition to every other interaction of which I have been a part or witnessed, has made me truly appreciate what Crossroad does—so much so that I even did a final project on the health center last fall. I was able to share all the inspiring aspects of Crossroad with a class full of students who hope to follow Crossroad’s example and become active citizens in the community.

When I joined the Volunteer Intern Program, I was a pre-medicine student hoping to become a surgeon or emergency physician. Now, after eight months of interning, I hope to be a physician assistant, possibly focused in family practice. Witnessing the relationships that the providers have built with their patients is something I hope to experience. Especially in this time of turbulence in the medical field, primary care is so important. If it was not for the opportunity I have had here at Crossroad, I do not know that I would have realized the importance of that primary care provider and patient relationship strengthened by faith and community in the healing process.

- Shannon Reilly