Friday, September 26, 2014

Considering The Whole Person

On my first day as an intern, I met a patient who has stuck in my memory ever since. He was a middle-aged man in torn up jeans and a windbreaker stuffed with grocery bags, unsuitable clothing for the frigid January weather. While sifting through an overflowing bag that held the man’s prescriptions, the doctor explained that the man was illiterate and needed help managing all his medications. From my very first day at the clinic, I have been surprised to find that severe social and health disparities not only exist, but also that they have always been so close. I have learned many lessons in compassion and understanding through direct interaction with the underserved members of my community, but I have also learned a great deal about the process of administering health care. This process has become very apparent to me through my participation with the Tobacco Treatment Group.

I have learned a great deal from being an active member of the group, but perhaps the most important thing I have learned is that a patient’s health is dependent on every aspect of their life. For the majority of patients, quitting smoking is not the only challenge that they are facing. Patients grapple with depression, drug and alcohol abuse, family issues, financial issues, and many others. All these struggles accumulate to affect the patients’ health. I have learned that all the challenges these patients face must be identified and addressed in order to move the patient toward better health.

Another essential aspect to this process is the patient-provider relationship. In my shadowing experiences, I have learned that in order to provide the most comprehensive health care, the providers must work very hard to build a relationship with their patients. This has led me to conclude the most efficient delivery of health care occurs when the patients can trust their provider and when the provider knows enough about the patient to be able to consider all the aspects of the patients’ lives that contribute to their mental and physical well-being. My work at the clinic has exposed me to the many social barriers to health that exist for the members of Over-The-Rhine. It has also taught me a great deal about the best ways to overcome these barriers. I am very grateful to have the opportunity to contribute to Crossroad’s important mission.


-James Kelly

Friday, September 5, 2014

Health and Happiness

When I say that Crossroad Health Center (Crossroad) is filled with the most hard-working, selfless, and caring doctors I have ever met, I am not exaggerating. Everyone who works at Crossroad is there purely to help people; being paid is not the purpose. I first applied to the Crossroad Volunteer Internship Program (CVIP) because I dream of opening my own clinic in another country one day. I thought that working at a clinic that helps the underserved in my own community would be a great way to see and experience what it would be like. I correctly assumed that I would gain an immense amount of knowledge, but I had no idea that I would have the opportunity to actually help people as only a college student.

At Crossroad, I make referral calls, shadow and assist doctors, and work in a pre-visit planning room. However, my main focus and passion at Crossroad is facilitating a tobacco treatment support group. Every Monday at 3:30, a group of people from all walks of life gather on the second floor of the clinic with one shared goal: to quit smoking. Many of the patients I meet in the group have been through so much in their lives – violence, incarceration, prostitution, alcoholism, drug addictions. They have worked tirelessly to free themselves of those chains and they come to the support group to fix one last thing in their lives. Quitting smoking is no easy feat. Nicotine is more addictive than crack, and several ex-crack users in the group can attest to that. It is so inspiring to even be in the presence of these people who have overcame so much, let alone have the opportunity to help them better their lives further.

Up until working with the Tobacco Treatment Group, I knew that smoking was not good, but I had no idea of the extent it can hinder life. Just looking around the circle, one can observe the terrible effects it can have on a man or a woman. The heavier smokers are out of breath from just talking, their voices are raspy, one is missing limbs because of amputations due to lack of circulation, younger patients look twenty years older, and almost all are poor and their addiction forces them to fork over six dollars whenever they need a new pack.

As the facilitator, I have become a cheerleader, a shoulder to cry on, a resource, and even a friend to many of the regular group members. It is heartbreaking to witness the frustration and despair that frequents our discussions, due to inability to quit. The doctor that comes to the group and I share methods to quit, stress management strategies, craving management, medications, tips, tools, and hope. Working at Crossroad has been the single most rewarding experience I have had in Cincinnati because I have actually been able to make a difference, all the while learning so much about health, life, and dedication. Group members that have quit since I began facilitating the group have already reported how much better they feel and how much their quality of life has improved. Health and happiness are the top two things that I want to spread in the world, and CVIP has given me the opportunity to do just that.

-Sami Nandyal

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

Dichotomy

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