Minnesota Indian Health Service Spring Break Trip

tumblr_o4wpuqRvYP1vot8d2o1_1280This year, 15 first-year Geisel MD students and 2 TDI students embarked on a journey to Minnesota for spring break. We spent time in Minneapolis with the urban Indian Community and visited four different reservations across northern Minnesota. The trip gave us a glimpse into Indian history, culture, and health. You can read more about our spring break Indian Health Service trip on our blog.

Urban Health Scholars Winter 2016 Immersion Trip – NYC

2016 NYC Trip-group2Geisel’s Urban Health Scholars (UHS) organize immersion trips annually during each academic year to large urban centers around the country in order to gain a better understanding of the unique challenges faced by each of these communities. Each trip is centered on educational and service opportunities. These winter semester, second year scholars (Chinwe Echeazu, Freddy Vasquez, TJ Meehan, Andrea Jaresova, and Dwan Pineros) along with first year scholars (Aaron Briggs, Alec Fisher, Sarah Ghabbour, Spencer McFarlane, and TR Harris) traveled to the Big Apple. Scholars Brendin Beaulieu-Jones and Courtney Hanlon were unable to make it, but UHS was very fortunate to have been able to bring two other first years, Chris Louis and Angela Lee. Among the first years that applied but were not selected as scholars, these first years were consistently engaged in UHS events at Geisel and added a lot to the NYC experience. Additionally, UHS was able to have two Dartmouth premedical students join for the CCMP MLK event on Saturday. They brought lots of great questions for the medical students and enthusiasm to the CCMP volunteering event. UHS was very fortunate to be able to bring these new faces along, which provided for enriched experiences for all.

Each year NYC gives UHS the chance to expose ourselves to its unique challenges and successes and we were graciously given the opportunity to extend our network and develop new long lasting relationships.

Read the full trip report here…

Urban Health Scholars 2015 Fall Immersion Trip

UHS-fall2015The Urban Health Scholars of the Geisel School of Medicine at Dartmouth are a group of students dedicated to becoming competent practitioners, researchers, and public advocates for medically underserved urban populations in an effort to promote health equity and social justice. The purpose of UHS is to foster an increased understanding across the Geisel community of the needs of diverse urban populations, while providing the Scholars with the experiences and tools they need to positively impact the health of these same or similar communities in their future careers. As Scholars, we tailor our experiences and our efforts based on the following principles: cultural versatility, service and outreach, clinical medicine, and continued education.

In accordance with our mission and our principles, the Scholars organize immersion trips annually during each academic year to large urban centers around the country in order to gain a better understanding of the unique challenges faced by each of these communities.  Each trip is centered on educational and service opportunities. The second year scholars (Chinwe Echeazu, Brendin Beaulieu-Jones, Freddy Vasquez, TJ Meehan, Andrea Jaresova, and Dwan Pineros) along with the newly selected first year scholars (Aaron Briggs, Courtney Hanlon, Alec Fisher, Sarah Ghabbour, Spencer McFarlane, and TR Harris) traveled to the city in our closest vicinity, Boston, for our first trip of the year.  Boston has a vibrant and diverse population and is the home to several large academic hospitals, and the state of Massachusetts has diverse and dynamic communities and has been a pioneer in health care reform. Each year this city gives UHS the opportunity to expose ourselves to its unique challenges and successes and we were graciously given the opportunity to extend our network and develop new long lasting relationships.

Read the full trip report here…

Witnessing My First Death

By: Emmanuel Aryee ‘18

Yesterday, I saw a person die for the first time. I’m sure you must be wondering how I got here. You see, I’ve been interested in oncology for a while now yet whenever I tell people that, I’m mostly met with looks of concern and the occasional comment on how it will be a tough specialty for me and how I’m likely to see most of my patients die. While I have no doubt that my medical training will be sufficient to help me face any challenge I might encounter, I felt the need to begin my preparation to treat terminally ill patients early. This is why I didn’t hesitate to sign up for an elective entitled “Community End of life and Hospice Care” with Bayada Hospice in Norwich, Vermont.

Over the next couple of months, I learned a lot from my elective. I could articulate the difference between assisted living and a nursing facility. I became acquainted with the requirements for a patient to qualify for hospice care. I visited a number of nursing facilities in the Upper Valley, most of which I previously did not know existed. I got the chance to meet and interact with patients under hospice care, their family and their care providers. It was a very enlightening experience for me but it wasn’t one without difficulty. During the course of the elective, I had two patients die albeit in my absence. That all changed yesterday.

Sometime yesterday afternoon, I got an email from Bayada asking for volunteers to be with Mary; an actively dying woman who did not have any family around. I replied saying I could stop by for an hour around 8 pm. As I drove to the care facility, I wondered exactly what I would do when I got there. From my previous experience seeing patients, I knew sometimes it was just enough to be there; this was however my first solo visit to an actively dying patient. There was the possibility that she could die before I got there or even after I left. I decided I’d just make good use of the one hour I had with her.

It was dark when I pulled up in the driveway of the facility and got out of my car. I made sure I had my Bayada ID around my neck to gain access to the building. I rang the bell at the door and was shown in by one of the CNAs who directed me to the nurse on call. She had been informed that a Dartmouth medical student would be coming in that evening so she walked me to Mary’s room. As we walked, she explained to me that Mary had stopped eating for the past four days. We walked into the room and I found a chair beside a wide awake Mary lying in bed. She shared the room with one other patient but tonight, the second bed was empty and she was alone in the room.

Valentine Godé-Darel on Her Sickbed by Ferdinand Hodler, 1914, oil on canvas (source Wikipedia)

Valentine Godé-Darel on Her Sickbed by Ferdinand Hodler, 1914, oil on canvas (source: Wikipedia)

Mary laid in bed wrapped in the bed sheets with a blank expression on her face staring at the wall in front of her. She had her nails painted pink and was wearing a fairly generic silver necklace. She was essentially nonverbal and except for the occasional incomprehensible outbursts, she mostly just moaned. It was very quiet in the room and all I could hear was the sound of Mary’s moans and the tick-tock of the hanging wall clock. I tried talking to Mary but she never replied. She just continued with her almost synchronous moans. Her mouth was slightly opened the entire time but her eyes were wide open; I don’t think she ever blinked.

Around 9:30 pm I knew the one hour I had promised to volunteer had passed but I didn’t feel like leaving. Mary was all alone and so far all I had done was watch her lie down; I didn’t feel very helpful. Not too long afterwards, her moans became louder. The sound was monotone and increasing in frequency. Honestly, I felt very useless looking at her. I tried to talk to her but that didn’t achieve much; I wasn’t even sure she could hear me. At this time, I noticed an old copy of the New Testament on a desk beside her bed. I didn’t know who it belonged to but it gave me the idea to sing hymns to her. I sang the first two lines of the first hymn that came to mind and I stopped. I don’t have a really good singing voice and as inconsequential as it might seem at this moment in time, I was worried I would be doing more harm than good. I decided to hum instead. I hummed the tunes of all the hymns I could think of. I eventually ran out of hymns. I did a Google search on my phone for more hymns and just went down the list humming all the hymns I was familiar with.

At this point, the sound of her moans became softer and less frequent. I cannot attribute this to me humming but I’d like to believe my presence provided her with some sort of comfort. She grew quieter till she stopped moaning altogether around 10:25 pm. I suspected she might be dead; both her eyes and mouth were open but she was very still. I looked at her chest for any signs of respiration but there were none. I continued to hum and watched her to see if I could find any signs of life. The next hymn on my list was “God be with you till we meet again.” I thought it was a fitting hymn. I hummed the tune, reciting the words in my head and walked out to get the nurse on call.

She came in, evaluated Mary and went out to get the RN. The RN also evaluated her and listened for heart sounds. She pronounced Mary dead at 10:45 pm. I closed my eyes and said a little prayer… till we meet again Mary.

“Una Sonrisa Para Todos” – A Smile For Everyone

by Adrianna Stanley ’18

Hands shaking and mind racing, I took a deep breath and walked through the door.  As my eyes adjusted to the bright overhead lights, I began to take in my surroundings. Metal cabinets filled with gauze, syringes, and vials of medications lined the right wall of the room.  I shivered as I felt a cold breeze coming from the single-unit air conditioner – a stark contrast from the 80 degrees I had felt right before entering.  A rhythmic beeping in the back left corner of the room drew my gaze to a bright blue machine riddled with knobs, tubes, and monitors, all of which were gracefully handled by the pediatric anesthesiologist in the room. I turned my attention to the amazingly courageous and beautiful 4-month-old little boy lying on the somewhat out-of-date operating table in the center of the room.  I thought about Carolina, his mother, who traveled five hours from her village to seek help for her son.  As tears streamed down her face, she hugged me tight, and whispered “God bless you” just as I was about to walk into the operating room.  “Suture please.” I quickly snapped back to reality as the surgeon stared at me in anticipation. “Sutura por favor,” I instantly translated to Dina – our Guatemalan surgical tech who spoke no English.  For the next three hours, I circulated throughout the room, translated and retrieved materials for Dina, discussed the case with our anesthesiologist, and ultimately became entranced by the intricate artistry of the surgical procedure.  It was not until little Jose Miguel was safely awake and in the post-operative care unit that I sat down and thought to myself, “Okay, so that is what it’s like to be in an operating room for the first time.”

Geisel medical student Adrianna Stanley with one of patients and their mother in Guatemala.

Geisel medical student Adrianna Stanley with Antonia and her granddaughter Perla, one of Free to Smile patients in Guatemala.

My trip to Guatemala was a medical immersion experience like no other.  I traveled with Free to Smile – a non-profit organization dedicated to improving the lives of the world’s most underserved children through cleft lip and palate surgeries. As a first-year medical student on the team, I was guided by Dartmouth alumnus, Dr. Frank Virnelli, and asked to help with Spanish translation and any other auxiliary services they may need – whether it was in administration, nursing, dentistry, anesthesia, or surgery.  From the moment we stepped off the plane in Guatemala City, we hit the ground running.  A whirlwind of faces, backgrounds, and professions to keep straight – I’ll admit, I was intimidated at first.  On our team of surgeons, anesthesiologists, dentists, nurses, technicians, assistants, and administrative staff, I was by far the youngest and most inexperienced.  It was not until I started conversing with the locals, meeting our patients and their families, and translating for our team members that I finally felt I could connect with the community, contribute to our team, and truly make a difference.

The week began with triage day.  Stepping into the clinic, we encountered a large group of very scared, nervous, excited, and grateful families.  The vibrant colors of traditional Guatemalan dresses combined with the intricate slings in which the children were carried swiftly caught my attention as we moved through the crowd.  Many of these families had never been to Guatemala City, let alone seen a group of foreign faces before.  Free to Smile works with a local Guatemalan organization called Compañeros Para la Cirugia (Partners for Surgery) that sends health promoters into very rural communities of Guatemala to seek out potential candidates for surgery.  They arrange all accommodations and transport for patients and their families to the city, and they provide post-operative follow-up care and monitoring of patients after our medical team returns to the United States.  On our triage day we screened over fifty pediatric patients for surgical eligibility as well as provided dental consultations for each of their family members.  By the end of the day most of the nervous looks of anticipation that had greeted us in the morning had melted into quite a few toothless grins that really warmed my heart.

Over the next five days, I ran to wherever I was needed or could learn something new.  In the pre-operative care unit, I worked with our nurse to take patient histories and vitals.  With anesthesia, I learned about the process of intubation, inquired about the various anesthetics involved, and even assisted in stabilizing patients during the sedation process.  On the surgical team, I scrubbed in, passed instruments, and am eternally grateful to the surgeons who spent countless hours explaining their techniques to me.  Supporting the nursing team, I had a wide array of roles from circulating in the OR to changing diapers, placing suppositories, and drawing up medications for the patients post-operatively.  Most emotional for me, however, was my role in conducting interviews of patients’ families.  Learning about Carolina’s economic hardships, the lack of nutritional and pre-natal care for Perla’s mother, the community’s heartless reaction to the birth of Maria Jose’s daughter, and the physical abuses rampant in these Guatemalan villages truly broke my heart.  Hearing their stories also made me think critically about the social and economic disparities that lie at the foundation of these medical problems and their role in shaping the way we deliver global health effectively.  I appreciate the work of Free to Smile for their continual presence in Guatemala, their cohesive partnership with local Guatemalan organizations, and their vested interest in improving all aspects of the lives of the underserved.

Ultimately, I am honored to say that over the week we successfully completed 41 surgeries – 12 cleft palate and 29 cleft lip repairs.  The lives of these children will be changed forever, as they now have the capacity to develop their speech normally, go to school without ridicule, grow up with confidence, and bring the option of a better life to their families.  Being a part of this team, connecting with the patients and their families, and reflecting on my own family’s struggles with poverty in Central America has truly reminded me of why I chose to become a physician in the first place – something often forgotten by medical students constantly buried in textbooks and exams.  I look forward to many more global health experiences in the future and a life-long career of giving back to my own underserved Latin American community so that they can achieve the human right to health that they deserve.

A huge thank you to Stacy Henry and the Free to Smile Foundation, Compañeros Para la Cirugia, Dr. Frank Virnelli, Dr. Lisa Adams, Dartmouth’s Center for Health Equity, the Geisel School of Medicine, and everyone on my team for supporting me and providing me with the experience of a lifetime in Guatemala!

Urban Health Scholars Spring Break 2015 – Pt. 10

In March 2015, six medical students in Geisel’s Urban Health Scholars program went to New Orleans for spring break to experience and learn about the city’s challenging and distinct health care delivery system. They are sharing their experiences in several posts here on the Geisel Med Blog. You can find all their posts here.

Healthcare for the Homeless

By: Andrea Jaresova ’18

On Thursday morning, we concluded our trip with a visit to New Orleans’ Healthcare for the Homeless site at the Veterans Affairs clinic, where we had scheduled a meeting with Dr. Joe Kanter. When we arrived, Cindy, a nurse, gave us a tour of the facility. She explained that the goal of the clinic was to provide comprehensive primary care services to homeless persons in the city of New Orleans and surrounding parishes. While Healthcare for the Homeless is not an overnight shelter, it provides many other services in addition to primary care appointments, screenings and treatments for chronic disease. Some other services that the clinic offers are immunizations and dental care.. Furthermore, the center offered clean showering facilities, free laundry service, lunch as well as job application help.


What really stood out to us was the fact that the staff at Healthcare for the Homeless seemed genuinely happy to be there. It was very clear that Cindy and Dr. Kanter had a very positive relationship with the individuals who came by the clinie. Throughout our tour, we were greeted with many smiles and waves from both staff and patients.

We then met with Dr. Kanter to discuss his responsibilities in the clinie and the various challenges that most physicians faced when working with homeless populations in New Orleans. Dr. Kanter explained that one of the main challenges was being able to provide his patients with the medications they needed since most did not have insurance or any money to cover the costs, especially if they were suffering from chronic conditions. Furthermore, the staffing at the clinic was limited and Dr. Kanter was the only physician at that particular location. On the other hand, one of the positives was that there was a lot of trust between the patient population and the healthcare staff. This meant that many of the patients were very good about going to their follow-up appointments and receiving continuing monitoring for their chronic problems.

We were really glad that we could meet with Dr. Kanter on our last day. We drew some parallels between his clinic and Boston Healthcare for the Homeless, which we had visited in the fall. It was really interesting to see how different state policies influenced care for the underserved and how that impacted physician practices.


Final Comments

Our trip to New Orleans was amazing! It provided us incredible exposure to urban health and a fascinating introduction to a challenging and remarkably distinct health care delivery system. The experience strongly reinforced our interests in serving vulnerable populations and working to enhance health care delivery and policy within our nation. We are very thankful to all of our New Orleans hosts who made the trip possible, especially Dr. Darrell Solet and his wife, as well as the Geisel alumni who so generously support the Urban Health Scholar’s program. Thank you.

– Urban Health Scholars c/o 2018

Urban Health Scholars Spring Break 2015 – Pt. 9

In March 2015, six medical students in Geisel’s Urban Health Scholars program went to New Orleans for spring break to experience and learn about the city’s challenging and distinct health care delivery system. They are sharing their experiences in several posts here on the Geisel Med Blog. You can find all their posts here.

Teche Clinic

By: Fernando Vazquez ’18

Teche Action, a federally qualified health center (FQHC), was founded in 1974 to provide primary care to the underserved, rural regions surrounding New Orleans. Since its inception, it has grown to ten locations, including one school based site. It has also expanded to provide mental health services to its patients. FQHCs receive funding from the federal government, and so are required to provide care to anyone who walks through their door, regardless of insurance coverage, income, race, or gender. If the patient requires services that Teche cannot provide, they are referred to another clinic or hospital and are covered financially by Teche.


The Urban Health Scholars spent the day learning about Teche from one of its directors, Mrs. Diane Freeman. Mrs. Freeman introduced us to the medical staff, with whom we discussed Teche and FQHCs from the physician’s perspective. Brendin and I were then lucky enough to witness a young woman see the first ultrasound images of her unborn child. It was a remarkable experience. In the past, UHS has spent entire days at Teche learning the inner workings and challenges of such clinics. Although we were only able to spend one day there this year, the relationship between Teche and Geisel continues to grow, and we look forward to sending more of our peers to learn about their work in the years to come.


Urban Health Scholars Spring Break 2015 – Pt. 8

In March 2015, six medical students in Geisel’s Urban Health Scholars program went to New Orleans for spring break to experience and learn about the city’s challenging and distinct health care delivery system. They are sharing their experiences in several posts here on the Geisel Med Blog. You can find all their posts here.

Luke’s House: A Clinic for Healing and Hope

By: T.J. Meehan ’18

After a whirlwind morning and afternoon bouncing around the Greater New Orleans Parish, I finished the day off at Luke’s House Clinic in Central City. Luke’s House opened in the aftermath of Hurricane Katrina when the medical services of the city were severely compromised and the numbers of those who found themselves homeless and uninsured skyrocketed. Along with dozens of other new make-shift community health-based clinics, Luke’s House was an attempt to rebuild the city’s medical safety net.

UHS-Nola-8Since Katrina, Luke’s House has delivered healthcare to the medically underserved every Tuesday evening. The clinic is staffed by a steady stream of local volunteers from Rayne United Methodist Church, Mount Zion United Methodist Church, and the LSU Department of Medicine/Pediatrics Residency Program. Since Katrina, Luke’s House has continued to open its doors one night a week and on the first Thursday of every month. An average of 15-20 patients are seen in the two hours it is open on clinic nights. The medical staff sees patients suffering from chronic health conditions such as high blood pressure, conducts pre-employment physicals for the unemployed, and provides care for patients with more complicated health issues. In addition, Luke’s House is home to the local legend, Dr. Robert Lancaster (known as Dr. Bob), the city’s only no-fee psychiatrist. His work truly is extraordinary given Louisiana’s cuts in mental health funding, and its elevated prevalence of suicide.

In my time in the clinic, I assisted with patient check-ins and check-outs, and basic history taking. Although these may seem like trivial tasks, while doing these I had a great time at the clinic. It was obvious that every patient that came in during my time there was thankful for the services that Luke’s House is providing. Not only is the care free, but patients’ experience of care is also pretty good. There was minimal wait time, a volunteer Spanish translator helped Spanish-speaking patients throughout their visits, medical and mental health were integrated, and overall everyone in the staff appeared bright and excited to help. I felt like the care that I observed was the type of care that I would want to receive, which really made me happy because I understand how easy it can be for providers in under-resourced clinics to burn-out and appear defeated. I learned a lot in my one day at Luke’ House, but I think the one thing that will stick with me the most from this visit is the impact of having an upbeat attitude. The staff of Luke’s House is simply special. They radiate positive energy and optimism, and made me want to express a similar passion when I eventually have patients of my own.

Urban Health Scholars Spring Break 2015 – Pt. 7

In March 2015, six medical students in Geisel’s Urban Health Scholars program went to New Orleans for spring break to experience and learn about the city’s challenging and distinct health care delivery system. They are sharing their experiences in several posts here on the Geisel Med Blog. You can find all their posts here.

Project Fleur de Lis

By: Fernando Vazquez ’18

The Urban Health Scholars visited Project Fleur de Lis, a non-profit organization that brings mental health services to schools. The small team of five social workers manages to accomplish impressive feats by using a screener developed at UCLA. The screener is designed to identify relative risk of developing symptoms of post-traumatic stress disorder. If a child scores within a particular range, a note is sent home to notify parents of the free services available to their child. One-on-one sessions with a social worker from Project Fleur de Lis are reserved for children with more significant needs, while group sessions are used to work out issues between peers as well as to provide a safe space to socialize with individuals going through similar situations.

UHS-Nola-7Due to the organization’s small size, Project Fleur de Lis can only work with eight schools at a time. Despite this limitation, the team of social workers is quite impactful. If a child needs more profound, long-term care, they are referred to a psychiatrist to be seen free of charge. Any necessary prescriptions are also paid for in full. Project Fleur de Lis has been so successful in diminishing the taboo the dominates mental health elsewhere, that they are expanding their efforts to include training teachers and health care professionals to screen their students and patients for traumatic events in place of attributing misbehavior to faults in character.

It was quite inspiring to see such a small group take on this tremendous task so effectively and competently.