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!