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First-year medical student Adrianna Stanley writes about her experience working with the Free to Smile Foundation in Guatemala, where the group helped to put smiles on the faces of many children and their families.

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 I turned my attention to the amazingly courageous and beautiful 4-month-old little boy lying on the somewhat out-of-date operating table in the center of the room.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!

Andrea Jerasova '18 writes about the conclusion of the Urban Health Scholars' trip and their visit to New Orleans’ Healthcare for the Homeless site at the Veterans Affairs clinic.

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.

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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.

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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

Fernando Vazquez '18 writes about the Urban Health Scholars' visit to Teche Action, a federally qualified health center (FQHC), founded in 1974 to provide primary care to the underserved, rural regions surrounding New Orleans.

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.

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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.

 

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. Since Katrina, Luke’s House has delivered healthcare to the medically underserved every Tuesday. evening.

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.

The Urban Health Scholars visited Project Fleur de Lis, a non-profit organization that brings mental health services to schools.

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.

Having been provided an exciting glimpse into the field of organ transplant, half of the group headed to Slidell Memorial Hospital (SMH) in Slidell, Louisiana, about 35 minutes northeast of New Orleans. SMH is a 229-bed acute care community hospital that has been working to enhance the health of the local community for the past 55 years. We were fortunate to be able to spend the afternoon with Dr. William Jeffrey Long, M.D., FACP, FACC, a cardiologist who graduated from Dartmouth College in 1976.

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.

Shadowing Dr. Jefferey Long at Slidell Memorial Hospital

By: Brendin Beaulieu-Jones '18

UHS-Nola-6Having been provided an exciting glimpse into the field of organ transplant, half of the group headed to Slidell Memorial Hospital (SMH) in Slidell, Louisiana, about 35 minutes northeast of New Orleans. SMH is a 229-bed acute care community hospital that has been working to enhance the health of the local community for the past 55 years. We were fortunate to be able to spend the afternoon with Dr. William Jeffrey Long, M.D., FACP, FACC, a cardiologist who graduated from Dartmouth College in 1976.

A former U.S. Air Force fighter pilot and physician, Dr. Long has a storied history and was eager to share his experiences and insights with our group. Dr. Long was an interventionalist for many years prior to retiring from the cath lab. Our experience shadowing Dr. Long exposed the different aspects of cardiology, and we were fortunate to have the opportunity to interview and conduct a physical exam on a new patient. It was a fun experience to work collaboratively to apply our On Doc skills to interview the patient and complete a physical exam. Like any good teacher, Dr. Long asked us to present the patient and then challenged us to determine the differential diagnosis.  We also joined Dr. Long on his rounds through the hospital and ICU, which highlighted another component of his work.

In addition, Dr. Long arranged for us to meet with Bill Davis, who serves as SMH’s Chief Executive. Having joined SMH as its CFO in 2001, Davis described how he had helped lead the facility from a precarious financial and operational situation to being a healthcare leader and important resource to the community. It was valuable to hear how Davis responded to an evolving national health care sphere as well as an ever-changing local landscape. In addition, it was valuable to learn how Davis advanced existing health care services and collaborated with community support agencies to prioritize preventative medicine.

The afternoon provided valuable exposure to both cardiology and hospital administration, which opened all of our eyes to new possibilities within health care. We greatly appreciate the time we were able to spend at SMH, and wish we could have accepted Dr. Long’s invitation to search for some alligators on his riverboat in the swamps of Louisiana. Hopefully, the class of 2019 will be able to plan accordingly.

After a great morning at Project Fleur de Lis, we rushed to Ochsner Health System, which is southeast Louisiana’s largest non-profit, academic, multi-specialty, health care delivery system. We were fortunate to be able to meet with Dr. George Loss, and I think we’d all agree that it was one of the highlights of the trip.

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.

A Conversation with Dr. George Loss

By: Brendin Beaulieu-Jones '18

UHS-Nola-5After a great morning at Project Fleur de Lis, we rushed to Ochsner Health System, which is southeast Louisiana’s largest non-profit, academic, multi-specialty, health care delivery system. We were fortunate to be able to meet with Dr. George Loss, and I think we’d all agree that it was one of the highlights of the trip.

Dr. Loss, a graduate of Dartmouth College, is Chief of Ochsner’s Multi-Organ Transplant Institute and Chief of Surgical Services. Ochsner is the leading center for liver transplants, and it was intriguing to learn how Dr. Loss and his team acquire suitable donor organs to supply their patient’s growing needs. He described how facilities across the country pass up livers that they believe are too fatty for successful outcomes.  However, due to his team’s protocol and higher than expected outcomes, he is able to use livers that other facilities decline. In addition, Dr. Loss strives to retain the local supply of donor organs within Louisiana. He explained that by achieving the highest performance outcomes, competition is minimized as other liver transplant programs ask, “If Ochsner won’t use it, why should we?” It was remarkable to hear how Dr. Loss balanced Ochsner’s business objectives with advancing patient’s needs.

In addition, he described Ochsner’s commitment to improving the retrieval of organs and decreasing the gap between the actual donor rate and the utilized donor rate. We finished we a brief discussion of his team’s process for determining who ultimately received the scare supply of livers. It was fascinating to hear Dr. Loss share a few case studies and to consider the complicated ethical dilemmas that accompany each circumstance.

On Monday evening, we had the pleasure of having dinner with Dr. Elizabeth Sack, DMS ’10 at Domenica’s restaurant in downtown New Orleans. Dr. Sack recently finished her residency at Tulane University School of Medicine, where she served as chief resident in outpatient pediatrics.

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.

Dinner with Dr. Elizabeth Sack

By: Brendin Beaulieu-Jones '18

On Monday evening, we had the pleasure of having dinner with Dr. Elizabeth Sack, DMS ’10 at Domenica’s restaurant in downtown New Orleans. Dr. Sack recently finished her residency at Tulane University School of Medicine, where she served as chief resident in outpatient pediatrics. We were very excited to hear that Dr. Sack and her husband have since welcomed their first child to their family.

UHS-Nola-4At dinner, we learned that Dr. Sack was selected as a Schweitzer Fellow during her time at Dartmouth. Her project focused on increasing awareness of end-of-life care among medical students and the community. Elizabeth took additional time off during medical school to travel to Lambaréné, Gabon as part of the Schweitzer program, where she served as a junior physician in pediatrics at a primary care clinic. It was wonderful to hear Dr. Sack describe how these experiences enriched her medical training and professional goals.

After spending the past few months with her newborn daughter, Dr. Sack will be joining a private practice outside of New Orleans. Interestingly, the practice serves a majority of patients who are either uninsured or insured through Medicare and/or Medicaid. It was very valuable to learn about Dr. Sack’s residency experience and her process of selecting her first job, as we are all eager to learn about the different possibilities of incorporating our interests in serving vulnerable populations in our future work.

We thank Dr. Sack for making the time to meet with the Urban Health Scholars, and wish her the best as she transitions into her new position.

Monday morning began with a visit to the Interim Louisiana State University Hospital (ILH) where we met with Susan Todd, Angela Davis-Collins, and Paolo Zambito. Susan Todd is executive director of 504HealthNet, an association of 22 non-profit and governmental organizations in the Greater New Orleans area that provides primary care and behavioral health services. Angela-Davis Collins is director of ambulatory care services at ILH and Paolo Zambito is senior vice president for strategy and business development at Louisiana Children's Medical Center (LCMC) Health.

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.

Tour of ILH and University Medical Center

By: Dwan Pineros '18

Monday morning began with a visit to the Interim Louisiana State University Hospital (ILH) where we met with Susan Todd, Angela Davis-Collins, and Paolo Zambito. Susan Todd is executive director of 504HealthNet, an association of 22 non-profit and governmental organizations in the Greater New Orleans area that provides primary care and behavioral health services. Angela-Davis Collins is director of ambulatory care services at ILH and Paolo Zambito is senior vice president for strategy and business development at Louisiana Children's Medical Center (LCMC) Health.

UHS-Nola-3After introductions, Paolo Zambito gave us a brief history about the healthcare system in New Orleans and about the legacy of Charity Hospital and University Hospital in particular. Charity Hospital was founded in the 18th century and, along with Bellevue Hospital in New York, was among the oldest hospitals in the United States. Because of its location at the heart of the city, the hospital had been instrumental in providing care to the inner city populations of New Orleans. When Charity Hospital was closed in the aftermath of Hurricane Katrina, the city’s residents suffered a great loss and University Hospital became the area’s only Level 1 Trauma Center.

University Hospital was opened by the Daughters of Charity more than a century after Charity Hospital was founded. The hospital was purchased by the Louisiana State University System and together with Charity Hospital became part of the Louisiana State University Health Sciences Center, a public entity. Like its sister hospital, University Hospital sustained severe damage during Hurricane Katrina, but was not closed. The hospital was renovated and reopened after the storm. The hospital, now called ILH, continues to serve the people of New Orleans and is the main teaching hospital for the LSU Health Sciences Center.

Amid state budget cuts that affected the seven public hospitals in south Louisiana including ILH, the government of Louisiana announced in 2013 that LCMC Health, a non-profit corporation that managed the Children’s Hospital and Touro Infirmary, would lease and take over management and operations of ILH and the $1.2 billion University Medical Center slated to open this spring. Both facilities will be staffed by LSU faculty and residents and will continue to serve the uninsured. This public-private partnership exemplifies the trend of consolidation and privatization seen in healthcare nationwide.

After our meeting, we were given a tour of ILH by Angela Davis-Collins. Our tour included a visit to different departments including the Emergency Department and the Level 1 Trauma Center at the main hospital. The most memorable part of the tour, however, was a visit to the Medical Center of Louisiana at New Orleans Clinics and Ambulatory Services a few blocks down. The range of services offered at the site was wide, ranging from general surgery to physical therapy, among others. The most notable aspect of the medical center, however, was that it was housed in a former Lord and Taylor department store.

As we toured the Lord and Taylor building, it was uncanny how vestiges of an up-scale department store remained in spaces that were now put to use for very different purposes. The carpeted entrance where sales racks once stood was now a patient registration and waiting area. Examination rooms lined the tiled walkways and were separated from the walkways by temporary walls. Fitting rooms were now office space and white cabinetry for merchandise display stood empty. The improvised use of the Lord and Taylor department store gave the impression that the premises were meant to be temporary and indeed they were when patients were first seen. A little less than a decade after Hurricane Katrina, it was startling to see an interim arrangement become a permanent fixture in the provision of healthcare. This was about to change with the opening of the new $1.2 billion University Medical Center.

After our tour of the Medical Center of Louisiana, we met with Jay Buras, vice president of operations at ILH. He gave us a tour of the impressive new facility. The University Medical Center is almost complete and will open later this spring. All of the departments and clinics at the Lord and Taylor building will have a new home in this complex. The difference between the two sites is night and day.

For example, we toured the department for Physical Medicine and Rehabilitation at the Lord and Taylor Clinic. The space was drab and felt cramped with a single corridor in between different exercise stations.  The new home of the department was spacious and had a large window, which provided plenty of natural lighting. The atmosphere was much more welcoming and we could understand why the staff we had talked to earlier was eager and looking forward to the move.

As much as we delighted in the tour of University Medical Center, some of us wondered if some of the resources that went into this new facility could have been put to better use. For example, the facility can accommodate a much larger number of hospital beds and examination rooms, but this expanded capacity exceeds what is needed. Management will mitigate wasteful use of space by limiting the number of beds and work spaces each department can use. Another example is the installation of artwork in the main lobby that costs hundreds of thousands of dollars. In a state where budget cuts for healthcare and education are always imminent, it was hard to justify why a publicly funded hospital should install expensive artwork when so many other healthcare needs were unmet.

We felt privileged and very thankful to have been given a tour of ILH and the new University Medical Center by Angela Davis-Collins, Paolo Zambito, and Jay Buras. We hoped that the new facility will improve and advance medical care to the people of New Orleans in the spirit and mission of the old Charity Hospital.

After leaving an amazing meeting at Tulane Community Health Center, we made our way across town to one of the many Ochsner hospital sites here in New Orleans. Thanks to suggestions from a Dartmouth alum, we were put into contact with Dr. Robert Link, an Emergency Department physiciUHS-Nola-2an who happily agreed to let all 6 of us shadow in the emergency room.

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.

Shadowing in Ochsner Clinic in the Emergency Department

By: Chinwe Echeazu '18

Saturday 3/15/15 - After leaving an amazing meeting at Tulane Community Health Center, we made our way across town to one of the many Ochsner hospital sites here in New Orleans. Thanks to suggestions from a Dartmouth alum, we were put into contact with Dr. Robert Link, an Emergency Department physiciUHS-Nola-2an who happily agreed to let all 6 of us shadow in the emergency room.

We were greeted with smiles and Southern hospitality as we entered the hospital, and we were given a brief history about Ochsner. It was the only Emergency Department that was still open after hurricane Katrina. Eleven health care facilities, including some in Louisiana, Alabama, Mississippi, and sometimes Texas, refer patients to Ochsner. The ER is usually so full that Ochsner was one of the first hospitals to implement a system called Que Tract. Within this system, patients are triaged at a much faster pace. The trauma levels I – III are seen first and once stabilized (and if possible) they are placed into sitting areas dispersed throughout the ER so that more patients may be removed from the waiting area. Dr. Link did state that this system has not been perfected and that although the pros are the ability to see more patients and remove them from the waiting room at a faster rate, the cons are unhappy patients that at times feel like they are not being attended to, and occasionally an overflow of beds. He stated that they are working on these issues.

We were split into pairs, Brendin and Freddy remained with Dr. Link, Andrea and Dwan shadowed with a second year resident in Emergency Medicine, Dr. Greenberg, and TJ and I shadowed a first year radiology resident. Just to name a few of the cases we saw, we were able to observe patients with: a fractured dens, an epidural hematoma, cholecystitis (this patient was discovered to have dozens of gall stones), mental disorders (ADHD, psychosis, bipolar disorder, depression, and anxiety) wounds that would not heal properly, abscess drainage, blunt force trauma to the face, and many more. Just that morning while meeting with Dr. Gugel at Tulane Community Health Center, we learned that Louisiana was almost the most violent state within the US and we were also informed that greater than 50% of patients seen have a mental disorder coupled with the ailment that brought them into the ER. So, unfortunately it was not surprising that we saw several patients diagnosed with a mental disorder or in the ER due to an injury from blunt force trauma. Not only were we able to see these various cases, we were constantly engaged throughout the observation and diagnosis process. We are humble and thankful to have been so welcomed and involved throughout the entire process. It was a wonderful experience, huge thanks to Dr. Link for arranging that for us.