This is Jenny Abrams, reporting live from the GA in Boston on 'Alternative Approaches to Health Care Delivery.'
After an inspring talk on a model for community health workers and 'accompanateurs' here in the United States, we moved on to a panel facilitated by Jen Kasper, pediatrician, DGH board member, and faculty at Harvard Medical School.
Erica Guimares, is a community health worker in Boston. Originally from Brazil, she came to the United States with her family during her last year of high school, and as she put it, became the 'family navigator'. This was the preface to her role as a community health worker and navigtor. Originally Erica worked for Head Start, serving as liason between the classroom and the home, and helping families form diverse backgrounds navigate the school system. She then was trained by PACT (see previous blog) and worked with CCA as a community health worker. Working in a team setting, she helped patients with complex needs such as facilitation medication administration, education on adherence, and common home visits. She currently works as the program coordinator and team leader of patient navigation program for Top Care Cancer Screening Navigation. Top Care is a novel heatlh information technology system that uses a visit-independent, patient-centric approach to screen a vulnerable population for preventable cancer.
To illustrate the role of the community health worker, Erica shared the story of one patient, Maria. Maria was a non-English speaking woman, who lived outside the Boston area, who was due for all 3 screening exams, mammogram, cervical cancer screening, and colonoscopy. Initially when Erika attempted to contact Maria, it took about 7 calls before she was able to talk with her. Maria was open to receiving the tests, but asked Erika if she could call her sister, as she depended on her sister both for transportation and translation. Upon speaking with her sister, she shared that her husband had recently had brain surgery, and she requested that the two of the three tests be scheduled on the same day, specifically in the late morning, to allow time for her to get her kids to school in the morning, and get home before they get out of school. Erika was able to schedule this appointment, but one week prior to the appointment, Maria's sister asked that it be changed due to continued social stressors in the family. Erika was able to reschedule the appointments a month later, and Maria was successful in getting her recommended screening. The entire process took about 4 months, and illuminates how necessary CHW's are in working effectively with vulnerable patients.
In describing her role, she shared, 'We are a bridge. We help providers connect to patients, and patients connect to providers. We help vulnerable patients achieve goals that seemed impossible, especially when everyone else has given up on them.' She hopes that community health workers will continue to be better acknolwedged in the medical community.
Juan Carlos Martinez started by sharing a little history of El Salvador, incuding the bloody civil war that the country suffered, only ending recently in 1992. Juan Carlos comes from a rural community called Estancia, that was particularly effected by the war. His communtiy consists almost entirely of subsistence farmers and is a community of scarce resources. Despite the poverty there, the people are very hard-working and passionate, and have fought over the years to pull their society out of poverty.
Juan Carlos works with CDH, Campesions para el Desarollo Humano, a local NGO who receives financial and volunteer support from DGH, as the director of the clinic CAIPES. Along with providing basic primary care services, CDH also works broadly to support health, including public health efforts, nutrition ('Siete Semillas' program), education ('Abriendo la imaginacion' program), among many others. Juan Carlos not only provides primary care services in CAIPES but also facilitates accompaniment of patients by volunteers to achieve specialty care in the nearest hospitals.
When asked about his experience returning to El Salvador after having trained in Cuba, he said 'To get a good education coming from my community is amost unthinkable.' Juan Carlos studied medicine at ELAM in Cuba, and feels there's much to learn from the medical system there. For example, the health costs in Cuba and El Salvador are the same, but the outcomes are dramatically different. Ademas, the costs in the US are dramatically higher with no real difference in outcomes with Cuba. Juan Carlos' medical education in Cuba was completely free. Not only do they take other Latin American medical students, but they also train students from all over the globe, including Americans. The only expectation they have is that these students will return to their countries to serve. There are ELAM graduates currently working in Haiti, and in all of Latin America. Unfortunately, the country of El Salvador has still not acknoweleged Juan Carlos as a licensed physician in his country after 3 years of volunteering his services post graduation.
Juan Carlos expressed his hope that people will care for the disadvantaged everywhere. He said, 'We share the same wishes as people from around the world, dignity, respect, peace.'
Matt Anderson is a physician and native of the Bronx. He began with a quote, 'Life is short, but the art endures' to start a lively conversation around medicine in protest movements and his recent experience in the Occupy Movement. He led off with a little history of physician involvement in health care reform and protest in the past, starting with the Socialist Medical Association in England, which went on to form the backbone of the universal English medical system. He then touched on the involvement of the Medical Committee on Human Rights during the Civil Rights Movement. This committee grew out of a nucleus of radical physicians at Albert Einstein, who decided to go down to the deep South and march alongside activists in solidarity. To prepare these physicians for their role, the group emphasized the accompaneteur model, with their pamphlet stating, 'When you arrive at the office of the civil rights group, do not expect to be received with open arms... Do not make the mistake of telling them how to run things...' This group developed a wealth of experience providing support to protesters, including partnering with the Washington DC Department of Health to care for protestors (quite the opposite of the role of the DoH in NYC during the recent Occupy Movement). Their documentation has been an incredible resource for current physicians working alongside protestors.
He went on to detail three main ways that we can use medical professionals in protest movements:
He then shared a little about his involvement in the current protests. At the second Occupy protest, physicians from all over NYC showed up from a variety of different organizations, including the NPA, PNHP, and physicians from Montefiore. Out of these three groups, Doctors for the 99% was formed to support the Occupy Movement. Despite all the controversial discussion around this movement, it has certainly sparked some conversation, including questions of: How can we provide health services outside of the current broken system (i.e. pop up clinics)? How would we want a new system to look? What is social justice? As Doctors for the 99% move forward, they hope to continue to stimulate this conversation, including how to interface with a new model of health provision in protests via street medics.
For more information, and to see some of the original documents from the Medical Committee on Human Rights, please check out his website at: http://socialmedicine.info
If you'd like to learn more about street medicine and how to be a street medic, you can Youtube the words 'Einstein political protest,' and find ~ 1.5 hours of informative video.
If you'd like to learn more about how to get voting registration at your clinic, go to: Rx.democracy
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