Wednesday: Dr. Ansell, Community Health Centers and Cook County

 We started off our last day in Chicago with a trip to see Dr. David Ansell, current CMO of Rush Medical Center. Dr. Ansell has been serving the people of Chicago for his entire medical career, spending 17 years at Cook County hospital and another 10 years at Mt. Sinai before joining Rush.  He has been been pushing to close the gap in heath outcomes across races, openly battling patient dumping, and advocating for a single payer health care system. We had a wonderful discussion with Dr. Ansell, and got to hear about some of his experiences at Cook County Hospital, and how he has watched racial inequalities in health care grow in Chicago over the years. We even got signed copies of his book County!

Sharon Gates, Senior Director for Multicultural Affairs and Service at Rush, then took us on a tour of a beautiful clinic connected to Simpson High School, a school specifically for pregnant and parenting teens.  The clinic was built a few years ago to meet the prenatal and health needs of the women attending the school. This amazing clinic has 3 exam rooms, and provides excellent primary care to the women of the school right at the source.  We had a wonderful time talking to the passionate providers at the clinic about the community they serve, and the unique concerns and challenges of their patients. Sharon gave us the warmest welcome we received in Chicago, and we had a wonderful time hearing about her career and work serving Chicago.  We can't wait to see her again the next time we are in Chicago!

After our morning meeting with Dr. Ansell, we headed to the Chicago office of the Illinois Primary Health Care Association. We met with Ashley Colwell, the director of recruitment, and Dr. Rajesh Parikh, the vice president of clinical services. The Illinois Primary Health Care Association (IPHCA) is a nonprofit agency that oversees the federally qualified community health centers (FQCHCs) of Illinois. Their mission is to provide high quality health care to underserved communities, both in urban and rural areas, regardless of ability to pay or legal status, and we had the opportunity to learn about some of the ways in which they achieve this goal. In addition to providing medical care through family practitioners, internists, OB/GYNS and pediatricians, the Community Health Centers attempt to provide wrap-around services in the form of mental health workers, social workers, dental providers, and midwives. It is this patient-centered and comprehensive approach to health care that allows the IPHCA to be so successful in treating patients within underserved communities. One of the most amazing things we learned at this visit is that the Community Health Centers are ranked as one of the top ten most effective federal programs and are estimated to save the health care system between $9.9 and $17.6 billion per year, proving that excellent care can be incredibly cost-effective. Additionally, CHCs have a positive economic impact of $12.6 billion annually, providing a much-needed boost to some of America’s most economically depressed neighborhoods. Finally, we learned about the incredible loan repayment options available through the National Health Service Corps, along with the competitive salaries and excellent benefits provided to physicians working for the IPHCA. This was an informative visit that made us all want to move to Chicago and start working for a CHC! What a great program for those in need, both in rural and urban communities!

 

After our meeting at the Illinois Primary Health Care Association, we got a quick lunch and headed to our next meeting. We met with Dr. Dick David, a neonatologist at Stroger Hospital. Dr. David gave us a tour of the NICU, then spent some time talking to us about his experiences working at Stroger, and about his research into neonatal outcomes. Dr. David was very honest about the separate-but-not-equal care that is provided within the city of Chicago, where the uninsured must be seen at Stroger and those with insurance can go to other city hospitals. He talked about how the NICU has been affected by the availability of Medicaid to pregnant women and children, drastically reducing the number of patients being seen at Stroger NICU. Finally, Dr. David talked to us at length about his very interesting research into neonatal outcomes based on race and class. One of his research studies demonstrated that women who reported experiencing stress due to their race, for example being unable to find a job due or other racial inequalities, were significantly more likely to give birth to a low birth weight baby that required care in the NICU. Another study showed that women with high-stress-low-independence jobs, meaning that they experienced high levels of stress at their job but were not in a position to make independent changes or decisions, also showed worse neonatal outcomes. He pointedly discussed the effects of systemic racism in our culture on health outcomes, and encouraged us be both thoughtful and optimistic as we work in the future to tackle issues of health care disparities. This was an incredibly thought provoking meeting, and we look forward to continuing to think about these issues as we move forward.

Dr. Ansell invited us to attend an presentation with him organized by University of Chicago students about the need for a trauma unit on the south side of Chicago. The University of Chicago Hospital is located in Chicago's south side, adjacent to a predominantly African American community with a historically higher violence rate. The hospital used to operate a trauma center in the area, but then closed the unit claiming that they were loosing money and unable to keep it open. The University of Chicago Hospital still operates a pediatric trauma unit, but does not accept patients over 16 years of age.  Since the closing of the trauma unit on the south side there have been some high profile trauma deaths, which some claim is due to the long transit time for care at other hospitals. The community of the south side has been demanding that the University of Chicago Hospital raise the age limit of the pediatric unit, or open an adult unit to meet the needs of the community. Students from the University of Chicago organized a presentation evaluating the need for a trauma unit on the south time, and the differences in ambulance transit time around the city.  This was an excellent presentation that opened our eyes to the complex issues that hospitals and providers face serving urban communities, and how local policy can dramatically impact care. Observing this presentation and the following discussion was a lesson in importance of providers partnering with the community in order to address the unique concerns and needs of their community. We learned so much, and it was a wonderful end to our incredible trip to Chicago!

Perhaps a few Urban Health Scholars will end up back in Chicago for residency!

Tuesday: Service, Sugar and Seniors

Today we were lucky enough to spend the day at the St. Philip Neri Parish in South Shore, which also happens to be the church where our very own UHS scholar Bianca grew up attending as a child! We were hosted by Bianca's lovely grandmother, coincidentally also named Evelyn, and her wonderful church members who greeted us so, so warmly.

We also had a special guest join us for today's activities -- prospective medical school student Chinwe, a native of Chicago. We began the day by helping out at St. Philip Neri's weekly food pantry, which runs from 9am-noon every Tuesday and is staffed by church volunteers who generously donate their time each week. Eligible local residents line up starting early in the morning and are let in 10 at a time to choose among the various items available -- canned goods, pasta, cereals, vegetables, fruits, meats, and more -- donated by local supermarkets and neighboring parishes. All clients of the food pantry are registered and sign-in at each visit. Due to the high volume of need in the area, all participants are limited to one visit per month.

 

 The UHS Scholars were glad to be put to work right away stocking and sorting items. Once the food pantry was open for business, Asha C. and Bianca helped clients choose items as they walked through the canned and dried goods section; Asha M. and Chinwe handed them their cabbages, potatoes, and celery, and Evelyn manned the fruit stand. We had over 50 clients coming through today, and it was amazing to see people walking out with bundles, bags, and suitcases (literally) full of food for their families. It was an awesome feeling and a great way to start off our morning!

 For lunch, we were treated to a wonderful lunch prepared by Bianca's grandmother and her church members. We then spent the afternoon giving a talk about diabetes management to a group of church women, who were a mix of diabetics, pre-diabetics, and those just interested in maintaining better health. The session opened up with a few women sharing how diabetes affected their daily lives, and what their biggest struggles were in maintaining their illness and health -- in particular, keeping up with exercise, eating right and managing portions, taking their insulin/medications, and forgetting to eat meals, especially a challenge for the women who lived alone. Several women also expressed frustration at the lack of coordination between multiple providers, particularly when it came to redundancy in medications and prescriptions. The need for better communication between providers and patients about what each of their medications was for exactly and why it was important to take, was something that emerged as a theme in our discussion, and something we all really took to heart as future providers.

 Afterwards, we delved into our talk about healthy eating by demonstrating as we did yesterday at the Ukranian Village clinic, the shockingly high amount of sugar in favorite every day items such as soda, orange juice, fruit cups, and flavored yogurt by scooping out the actual amounts of sugar onto a plate. And just like yesterday, everyone was shocked! We also discussed alternatives to these items and healthy snack ideas, the importance of reading food labels, as well as proper portion recommendations using My Plate. We then touched upon the way common diabetes drugs worked, and ended the session with the women sharing a few goals for their diabetes and/or health management. It was a long, but productive day, and such a wonderful experience with all of the church volunteers and women who were so generous and receptive, and reminded us of our own grandmothers.

A special thanks to Chinwe, for joining us today and being AWESOME in her help with the food pantry and diabetes education!

We ended the evening with a wonderful dinner with two awesome Geisel Alum's (who met as first years in on doc!!) Dr. Jill Rosno and Dr. Chetan Huded are both in residency at Northwestern, love the city and enjoying serving Chicago's diverse and urban population. We had an amazing time hearing about their path to residency, and their memories from Hanover. 

-Evelyn

UHS hearts Chicago

We've been having so much fun in Chicago, we thought we would share a few pics of us exploring the city and checking out the local favorites!

We couldn't come to Chicago and not visit the Bean!

We had an amazing time in Millenium Park checking out all the skyscrapers.

The train stops were beautifully painted in this neighborhood!

Of course we couldn't come to Bianca's hometown without checking out the amazing food they have to

offer!!!





















 Had to get a taste of the famous Garrett's popcorn!

                                                              

Monday: Exploring Community Health

We had an amazing time visiting two community health clinics in Chicago. First, we traveled to the Ukranian Village to volunteer at the Community Health Clinic.  

This neighborhood is particularly interesting because it has the largest population of Polish people outside of Warsaw, Poland.  The clinic goes above and beyond to service not only the Polish population but also the nearby Mexican neighborhood.  Community Health Clinic is completely funded by private donors such Blue Cross and Blue Shield, Rush University, Astra Zeneza, and Bank of America.  Because of these donors the clinic is able to offer a plethora of medical services, including adult internal medicine and dental services, as well as medications, completely free of charge to patients.  The diverse patient population is dependent on the clinic's use of Spanish and Polish speaking interpreters, nurses, physicians, and staff.  The effectiveness and efficiency the clinic offers is rooted in its multilinguial capabilities.  Health care is provided on the heels of the five thousand volunteer medical providers.  Only three of the staff members are paid. Amazing! 10,000 patients a year have benefited from the clinic's presence in the community.

 

 Healthy eating was the focus of the day's work.  Specifically, we wanted to draw patients' attention to the amount of sugar and fat in the foods they eat daily.  Using the nutritional information on the back of McDonald's french fries cartons, chicken nuggets, juice containers, and soda pop cans we demonstrated the amount of fat and sugar in each of these items by scooping out the equivalent amounts in Crisco and sugar onto a plate.  Patients were shocked to find that some foods thought to be healthy, like fruity flavored yogurt, actually contained as much sugar as a can of Pepsi, and that small fries contained a heaping amount of fat. Patients were then easily motivated to discuss ways to change some of their eating habits.  We informed them of healthy snack options that can easily be substituted.

 We gave out flyers for fitness, body, and health classes the clinic offered for free to their patients.  These included yoga, zumba, nutrition, and diabetes classes.  The Community Health Clinic is an advocate for patient centered care.

Next we traveled to the Hispanic Health Coalition where we spoke with Ester Sciammarella, the Executive Director.  She spoke with us about the challenges of collaborating with other organizations to provide the best services for their patients. We talked about the clinics concerns about how upcoming implementation of the ACA will impact undocumented patients. She also highlight the importance of networking and getting involved in local policy to create systems that best support patients. This was a wonderful and inspirational conversation, and the Hispanic Health Coalition is a strong advocate for Chicago's Latino patients.

Volunteering at a Local Women's Shelter

Our scholars planned to have a little bit of a later start this morning, to give us some time to catch up on sleep after last night's exciting shift at Stroger Hospital ER and Trauma Unit, plus the loss of a precious hour of sleep due to Daylight Savings! We got up and got ready, enjoying the complimentary breakfast at the hotel, and headed out to the South Side of Chicago.

We arrived at the Women's Shelter at 11am to start our volunteer activities. The shelter we visited is run by Family Rescue, a social services agency that works to provide comprehensive support services and shelter to victims of domestic violence in Chicago. The facility provides shelter to women and their children, up to 18 years of age, who have experienced domestic violence and are in need of a place to stay. In addition to lodging, the shelter provides education groups for women, including parenting classes, decision making groups and addiction support groups. They also provide groups for the children staying at the shelter, along with counseling and a great array of wrap-around services, including court advocacy and future planning assistance. Family Rescue is funded by a combination of state funding a private donations, but they stretch every dollar to provide incredibly compassionate care for the women and children they are working with.

When we first arrived, we spent a few minutes hearing about the program from the director and learning about the resources they provide. Then, we got to work with some service projects! The first task was to head into the basement and start organizing the clothing and linen donations. As it turns out, we have some expert folders in our group!





Next, we headed into the huge pantry to sort the food, and into the laundry room to work on folding more linens and arranging toiletry items to make them more accessible. We had a great lunch with two of the directors, and had the opportunity to talk to them more about the challenges they face in their line of work. They spoke about what brought them into working at the shelter, as well as the challenges that many of their clients face. It was wonderful to see how much love they had for the women they worked with, and their unconditional acceptance of what the women brought when they arrived at the shelter. We were glad to be able to give our day to such a great organization and help them in a small way!

We headed back to our hotel to update the blog, catch up on e-mails and get ready for dinner. We have a busy few days ahead - check back soon to see what we have been up to!

Saturday: Arrival and Stroger Hospital Visit

Welcome to the Urban Health Scholars Chicago Spring break blog!

Day One of our Spring Break trip got off to a great start! Four first year scholars, Asha C., Asha M., Bianca and Evelyn, met at Logan Airport bright and early to catch our flight. We were all still feeling the effects of finals the week before, so students used the plane ride to catch up on a little bit of rest and relaxation

Once we arrived in Chicago, we had less than 3 hours to get to our first appointment at the John H. Stroger Jr. Hospital at Cook County. We were incredibly fortunate to have some of Bianca's family members meet us at the airport and drive us to the hotel, saving us a lot of transit time. We checked into our awesome hotel in downtown Chicago and got ready to really begin our trip!

Dont worry! Our "patient" is a volunteer 4th year student

We spent Saturday night shadowing in the Stroger Hospital ER and Trauma unit for their 4pm-12 shift. We were excited and nervous to see the ER, and not entirely sure what to expect going in. The ER serves over 100,000 patients a year and accepts everyone, regardless of their ability to pay.





Additionally, the hospital has a Level 1 trauma center and burn unit, so they see some of the most severely injured patients in the city. The result of all of this is an incredibly diverse patient population that presents with a huge host of health needs, ranging from emergent to chronic health conditions and medication refills. We split into pairs and each spent 4 hours in the ER and 4 hours in the trauma unit. Fortunately for the people of Chicago, it was  a very quiet night in the trauma unit! Our students enjoyed hearing about the experiences of a number of medical students and residents, and even got to learn about how to read an ultrasound. The students and physicians we met with were incredibly hospitable and welcoming, giving us the opportunity to ask lots of questions and learn from their experiences.


The Trauma unit may have been having a quiet night, but the same could not be said for the ER! Our students were incredibly fortunate to have the opportunity to shadow Dr. Patrick Lank, an ER attending at the Stroger Hospital and Dr. Neeraj Chhabra. Dr. Lank took us along for his busy evening of seeing a wide variety of patients, demonstrating the art form of meeting patient needs, both physically and emotionally, in the ER. Our time with Dr. Lank demonstrated the importance of everything we have already learned over the past two semesters: from watching an inferior alveolar nerve block to discussing a cold agglutination test, we all reflected on the incredible relevance of "basic" sciences in medical care. Additionally, Dr. Lank talked to us about his experiences in urban health and patient care, providing great insight and many teaching opportunities for our scholars. We feel so lucky to have the opportunity to meet Dr. Lank and Dr. Chhabra and watch them work - they were compassionate, gentle and caring towards patients, while finding every opportunity to teach us something new. They were truly physicians to look up to.

We also appreciated getting the chance to meet a number of other physicians and medical students in the ER. Everyone was so friendly and constantly looking for learning opportunities for us during our night of shadowing.

Thank you so much to everyone who helped organize this great learning opportunity and who met with us while we were visiting. A special thanks to Dorothy and Patrick, awesome 4th year medical students. And to all the 4th years we met, good luck with match day!