In early September, members of Geisel's Urban Health Scholars program traveled to Massachusetts to attend several events that would give them a sample of some of the challenges and rewards of working with underserved populations in urban areas. A few of the scholars reflected on what they took away from the experience.
Thursday, September 4
Greater Lawrence Family Health Center
By Ali Corley (’17)
Our first stop on our 2014 Boston immersion trip was the Greater Lawrence Family Health Center (GLFHC) in Lawrence, Mass., just north of Boston. There we met with Dr. John Raser, a graduate of Dartmouth College and the Medical School, who showed us around and spoke about his work there. Dr. Raser is a family medicine doctor who lives and works in Lawrence and is an advocate for his patients both at the center and in the community. On our tour of the health center, Dr. Raser told us more about GLFHC and the type of medical care they provide. GLFHC has adopted a patient-centered medical home model, which emphasizes teamwork among health professionals and addresses health issues from many perspectives. They promote group health sessions, healthy lifestyles, and community-wide interventions to improve health in a lasting and effective way.
Dr. Raser discussed the importance of health professionals being involved in the communities that they work and live in. Doctors have great potential to be local leaders and can use their knowledge and respected positions to initiate healthy programs and initiatives. In fact, Dr. Raser recently started a project to open a bike shop in the community. We detoured along our tour of the health center to visit his shop, BiciCocina, which he started to fill the need of the city, which hasn’t had an operating bike shop open in several years. With BiciCocina, Dr. Raser hopes to promote active lifestyles and safe streets through youth programs and community events. We took the scenic route back to the health center and had the opportunity to walk through some of the Lawrence center streets and the common park. Lawrence is a unique combination of city and small town. We saw Italian, Greek, Irish, Dominican, and Haitian churches and buildings and were able to appreciate the diversity of the Lawrence population.
Back at the center, Dr. Andy Smith joined us for dinner and discussion. Dr. Smith spoke to us about the overlap between urban and global health and gave us a presentation about the qualities required to deliver care in both settings while also managing to maintain optimism, idealism and compassion. We learned about the special challenges that come with working in a primarily Dominican community and how the ability to relate to patients is enhanced when you speak their language or have been to their home country. Dr. Smith told us about cultural differences concerning patient-doctor relationships and how the strict professionalism we are taught in school may need to be adjusted depending on the patient. For example, he greets some of his patients with a hug and kiss on the cheek, which is custom in many Latino cultures. For others, he finds that showing them pictures of his family helps strengthen his relationship with patients and break down barriers to trust.
The Greater Lawrence Family Health Center offers programs for residency training and rotations in family medicine, with opportunities for Spanish language learning and immersion. After our vist to Lawrence today, I think many of us will consider pursuing these opportunities in our third or fourth years and beyond.
Friday, September 5
Revitalizing the Hennigan Elementary School with Harvard Pilgrim, the Celtics, and City Year
By Brendin Beaulieu-Jones (’18)
We kicked off the second day of our Boston immersion trip at Hennigan James Elementary School, where we joined Harvard Pilgrim, the Boston Celtics, and City Year for a morning of community service. Before jumping into the work, we heard from the principal of Hennigan James Elementary School, who stressed the importance of providing a warm, learning environment for children in order to contribute to a healthier, stronger community. The school is currently expanding to include sixth- through eighth-graders, and it serves as a pre-K learning center, Boys and Girls Club, and recreational center for the community.
After some additional opening remarks by the presidents of both the Celtics and Harvard Pilgrim, we enjoyed some brief entertainment by Lucky the Leprechaun (the mascot of the Boston Celtics) before heading out to start our work. A few of us painted the exterior of the school, including the courtyard, four-square courts, and main entrance, while others removed some weeds and debris from the neighboring fields. It was refreshing to have the opportunity to serve the Jamaica Plain community and help contribute to a more positive learning environment at Hennigan.
Meeting with Dr. Megan Sandel
By Hayley Jones (’17)
After an exciting morning working with the Boston Celtics and Harvard Pilgrim at the Building Healthy Communities day of service in Jamaica Plain, we headed to Boston University’s medical school to meet with Dr. Megan Sandel, a graduate of Dartmouth's medical school, for a Q&A about Boston’s Medical-Legal Partnership. Dr. Sandel’s enthusiasm and understanding of the social determinants of health were engaging and exciting to hear about. Even better, work that she has done has helped to create laws that holds landlords in Boston responsible for basic upkeep so that apartments in Boston are less likely to make people sick. The law addresses mold, mice, and other infestations that can adversely affect the health of inhabitants. Dr. Sandel’s exuberance for understanding how housing status affects health outcomes from children to HIV positive individuals was outstripped only by her determination to search for a solution. UHS took away much more than information from the Q&A.
Boston Health Care for the Homeless
By Cristina Alcorta (’17)
On Friday afternoon, we had the opportunity to meet with Dr. Jim O'Connell, President and one of the founding physicians for the Boston Health Care for the Homeless Program (BHCHP). We were very much looking forward to meeting the man who established the nation's first medical respite program for homeless persons and implemented the first electronic medical record for a homeless program.
With open arms, he welcomed us to his brainchild. Starting our tour off with a little history, Dr. O'Connell brought us to the historic main entrance of the old Mallory Building, describing its historical roots as Boston's center for medical pathology research and city morgue from the 1930s to the 1990s. We then shuffled to a conference room for a discussion about homeless health care and street medicine. Here, we learned about the Family Van, which brings necessary items such as blankets and warm soup to individuals on the streets. Dr. O'Connell feels that it is important not to offer medical services right away, because homeless individuals are often wary of the medical system. "They feel like they are going to get locked up, or taken away," he explained. Instead, Dr. O'Connell simply lets them know he is a physician as he leaves and that they can approach him if they ever want or need to.
Under the Affordable Care Act, affordable insurance is no longer an issue for the homeless. However, that does not mean problems have subsided. Ten percent of the BHCHP participants are chronically homeless. That is, they have been living in the streets for over one year. Fifty percent of the first-come-first-served beds taken up each night are used by that ten percent. Individuals not only need services, but support to find housing and manage a stable household. Unfortunately, many do not find the support they need to be on their own. Many do not find comfort in shelters: some fear large crowds; couples refuse to be split up; others feel enclosed. A patient once said to Dr. O'Connell, "I do not like the shelter because I cannot tell which voices are mine. . . . When I'm on the street I know which are mine and which aren't."
In addition, the majority of homeless individuals suffer from major, incapacitating mental illness. Those suffering from substance abuse have a difficult time staying sober and continuously fall back into the cycle of hard-core, chronic addiction. Overall, mortality rates continue to be high.
Our tour continued. A personable, compassionate man, Dr. O'Connell stopped at various points during our tour to introduce us to a patient or a dermatology resident to get a glimpse of their experience with the BHCHP. He shared deep and personal stories of the homeless individuals he has met throughout his time with BHCHP which encompassed both sad and triumphant anecdotes of his dearest patients. We saw several facilities, including the dental offices, pharmacy, inpatient floors, and the outdoor patio meant for moments of relaxation.
At each stop, we learned about the several services offered to patients: dentures, medications, prenatal care, walking aids, and initiatives to accommodate transgender individuals. We saw the rooms where patients slept and the rooms where they played bingo, cards, and pool. Though the homeless world faces strenuous trials each day, BHCHP seems to provide at least an iota of stability and calm in a sea of chaos.
Some of the hallways proudly display photos of the smiling faces of former patients of the BHCHP. "Turns out they wanted to have their pictures taken. It made them happy," said Dr. O'Connell. Most, however, had already passed away at too young an age.
Mattapan Healthcare Revival
By Fernando Vazquez (’18)
“When you connect with Mattapan Community Health Center, good things happen.” The organization’s motto is quite the understatement. For nearly 20 years, Mattapan Community Health Center has been organizing a revival; a festival centered on enabling community members to become more competent in taking charge of their health. From cholesterol screenings to dental checks, the event brings together an underserved community and not only educates them, but also urges attendees to spread the word to neighbors that help is available to all. Geisel’s Urban Health Scholars capped an immersion weekend with the valuable lesson in the importance of true integration into the communities we will go on to heal and serve.