Hayhurst ’21: Colorado, Resilience Code

Neal Hayhurst (’21), Dr. Serak (’05), and Michael Tanchevski (’20)

Neal Hayhurst ’21 — During my time in Denver, I saw a side of medicine that I had seen nowhere else, but not due to the rarity of the cases. The patients I saw came to Resilience Code with common problems but left with uncommon results because of the unique philosophy of the practice: use the cutting edge of medical technology and a holistic approach to give patients the best, most personalized care possible. The Resilience Code building contains the neurosurgery clinic, a physical therapy practice, an imaging clinic, a phlebotomy lab, and a micronutrient consultant which all work as one—everything a patient with a herniated disc, for example, may need to be treated effectively and recover fully.

This model naturally emanates from two basic principles that should be at the center of all healthcare: above all else, doing what is best for the patient and a vicarious understanding of the patient’s situation. Because patients often do not know what exactly they need, doctors are charged with the responsibility to integrate their medical knowledge with this vicarious understanding and empathy. Thus, a doctor should ask himself, how would I want my herniated disc treated? The product of such thought is the Resilience Code model where there is clear and efficient communication, seamless continuity of care, and the best medical technology. The interesting part of this model is the satisfaction of not only the patients, but also the doctors and other professionals. By making the patient experience easier and more intuitive, the healthcare professionals make their own jobs more enjoyable—partly because of the easier communication, but because they interact with mostly happier, less frustrated patients. Extra thought, effort, and selflessness is intrinsically rewarding, but may even come back around to make the job easier and more enjoyable.


Tanchevski ’20: Denver, CO with Dr. John Serak ’05

Neal Hayhurst (’21), Dr. Serak (’05), and Michael Tanchevski (’20)

Michael Tanchevski ’20 — I had the opportunity to spend two weeks of my summer shadowing a neurosurgeon in Denver, Colorado. Dr. John Serak, Wabash graduate of ’05, volunteered and opened up his home to allow myself and another Wabash student to observe him in the OR and his private clinic. It can be easy to speculate on how the life of a surgeon may look, but getting the opportunity to live it was the real deal. Having an extended externship of 2 weeks allowed us to see patients come into clinic to schedule a surgery, and on some occasions, we were able to observe their surgery and see them for post op checkups as well – giving us an all-encompassing physician-patient interaction.

What sticks out the most to me was the passion that Dr. Serak has for health care, but more specifically, the passion he has for the most efficient and effective health care. To provide some context, Dr. Serak is a neurosurgeon who predominately enjoys taking on spinal cases. With his operations, he uses a minimally invasive approach which leaves small incisions and keeps blood loss to a fraction of what traditional invasive surgeries would cause. Through learning this and observing how he interacts with his patients, you can see the model care taker that one should strive to become. His desire to be on the cutting edge of minimally invasive surgery speaks to the devotion he has to his field and the patients he takes care of.

It would be selfish of me not to share the most exciting surgery we had the privilege of observing. In my opinion, the most exciting surgery was the endoscopic discectomy – which is the removal of a herniated disc. This is a minimally invasive surgery, thanks to Dr. Serak’s approach, that only requires two small incisions and a microscope to complete, allowing us to watch the surgery on a monitor. What makes the surgery incredible is that the patient is awake for most of the operation and under local anesthesia, enabling them to leave the hospital a mere 2 hours later! To my surprise, as I reflect, it was in the shorter, hour long operation that I can draw the greatest take away from. Here, I gained the appreciation and understanding as to what it can look like to own your passion and use that passion as a means to serve others. It seems clear to me that Dr. Serak found the aspect within medicine that is most meaningful to him and has been able to craft it into something special that not only allows him to help others, but teach and inspire students like me. Thus, I gained the understanding to truly find and do what you’re passionate about as that will benefit the most people.


Eaton ’22: Houston, TX Memorial Hermann Hospital

Sean Blackwell, MD (’89) with (l/r) Cesar Mares (’22), James Eaton (’19), Dr. Blackwell, Chris Wilson (’19), and Ben Grubbs (’20).

James Eaton ’22 — This summer, I had the amazing opportunity to shadow a variety of doctors in the high-risk OB/GYN department at Memorial Hermann Hospital in Houston, Texas. During my time at Memorial Hermann I was able to join doctors on patient rounds, conduct research, and scrub into many surgeries. This experience not only educated me about medical specialties I was fairly unfamiliar with, but also provided me with firsthand experience working in emergency situations.

I think one of the most surprising things about my time at Memorial was how diverse our patients were.  The Texas medical center, which Memorial was apart of, is one of the largest medical centers in the world. Because of this, we took in many patients from a variety of countries, which allowed me to interact with people from cultural backgrounds I was not familiar with.  More importantly, I witnessed physicians and residents taking the time to understand the cultural backgrounds of their patients in an effort to provide the best care possible. This experience highlighted how the best physicians attempt to make a personnel connection with each of their patients.

One of the highlights of my time at Memorial Hermann was observing an in-utero endoscopic laser ablation, which is a fairly rare and complicated procedure that can correct twin-twin transfusion syndrome. It was fascinating watching a team of fetal surgeons simultaneously map and coagulate placental vessels in real time, especially because they were using extremely advanced technology to do so. This experience, along with the many other surgeries I observed, has drawn me closer to the procedure side of medicine. I am very thankful I had the opportunity to spend a summer at the Texas Medical Center, which would not have been possible without the help and generosity of Jill Rogers and Dr. Sean Blackwell.


Grubbs ’20: Houston, TX Memorial Hermann Hospital

Chris Wilson (’19) and Ben Grubbs (’20) in Houston

Ben Grubbs ’20 — Observing situations involving high risk pregnancies can be tough at times and beyond rewarding at others. My very first case involved a patient with anencephaly, a rare condition that results in the lack of development of a skull during pregnancy, something I was not prepared for. The physician consulted the couple for the next hour going over every option and possible outcome so that the family understood the severity of the situation and could make the best decision for themselves and the child. Immediately following, I walked into the operating room to observe an in-utero spina bifida neurosurgery, only the 87thsurgery at this hospital and certainly an extremely rare surgery that few hospitals in the world have the capability of performing. I discussed with the surgeon afterwards as he reminisced on the first one he did just a few short years ago, dramatically increasing the life span of a young girl whose family he keeps in touch with. It was a roller coaster of a first day seeing these cases and left me excited for the rest of my six weeks here in Houston at Memorial Hermann Hospital.

Cesar Mares (’22), James Eaton (’19), Dr. Sean Blackwell (’89), Chris Wilson (’19), and Ben Grubbs (’20).

My next experiences led me to the gift of life as I observed multiple caesarean sections resulting in the successful births of healthy babies. It is a moving sight to see the moment a baby takes its first breath and enters the world we have known for so long. You can’t help but imagine the life ahead of the child and think you may have been in that exact position many years ago. In a hospital on the leading edge of technology, there is always something new and groundbreaking going on whether it be research or surgery. It is promising for the future as we continue to correct conditions that were a sure death sentence at the turn of the 21stcentury with advancements from physicians that are compassionate about pushing forward the capacity of life and giving hope in situations where there is little. These experiences solidify my decision to enter the field of medicine and contribute a sliver to the progress of our world.


Wilson ’19: Houston, Texas Medical Center

Chris Wilson (’19) and Ben Grubbs (’20) in Houston

Chris Wilson ’19 — In the few short weeks I have been a the Texas Medical Center in Houston, I have learned a great deal about medicine, healthcare, physician-patient interactions, and what it means to be a good physician. Healthcare is constantly changing; new technologies and medications are developed every year, and physicians must learn how to incorporate these new developments into their practice. I have seen firsthand how frequently and vigorously doctors and other healthcare providers read primary literature articles about new developments in their field. Also, I have witnessed cutting edge procedures, such as laser oblation surgery, that have revolutionized fetal care and women’s health.

However, the most valuable thing I have learned is how doctors communicate with patients. Patients visit doctors for a variety of reasons and often have questions about their health and bodies. The doctors that I have had the privilege to observe have not only clearly and concisely answered their questions, but have also reduce their patients’ stress by connecting with them in a very human way. Technology is great and improves our lives in many ways, but nothing can replace in person conversations between patients and physicians. While medications will continue to improve and more of our communication will be digital, face-to-face conversations between doctors and patients and alleviating patients’ fears will always be one of the most critical parts of healthcare.

 


Mares ’22: UT Health McGovern Medical School

Cesar Mares ’22 — This summer, I am one of four students to participate in the junior medical school student internship with alumnus Sean Blackwell ’89 and the UTHealth McGovern Medical School in Houston. Each week, we rotate through a different department within the OB/GYN practice in both hospital and clinical settings. Rotations have included week-long stints in the Resident Clinic, Fetal Center, Obstetrics (labor and delivery) and Gynecology.

The OB/GYN practice is truly hybrid. It provides a steady balance of surgeries, patient visits and office work. I’ve witnessed a number of noteworthy surgeries performed by high risk fetal intervention specialists in the Fetal Center such as laser ablation surgery to treat Twin to Twin Transfusion Syndrome and a fetoscopic endoluminal tracheal occlusion (FETO) to treat a fetus with congenital diaphragmatic hernia. During my time here, numerous doctors have suggested pursuing surgery. While doctors will always be in demand, technological advances hint at a future where regular and uncomplicated patient care is completely digital. Outside of the OR, physicians effectively communicate diagnoses and treatments to their patients and fellow colleagues. Doctors provide the best care to their patients by practicing evidence-based medicine. Research reports, data charts and the most up-to-date statistics decorate the walls of the resident lounge. Attendings continuously praise residents who speak with numbers and research-supported facts. But patient care extends beyond the numbers.

Physicians who serve in a diverse city such as Houston must be culturally competent. Societal habits and cultural norms are regularly mentioned in safety meetings and discussed with patients. Good doctors adopt a holistic approach with each patient. More importantly, good doctors love their craft. They are lifelong students of science and technique. Becoming a physician is not easy. The emotional and physical demands of this career are unappealing. Residency is by no means glamorous. Despite all of these things, every doctor I’ve encountered so far would not give up their job for anything. This internship has reinforced my decision to pursue medicine. On a much deeper level, my experiences here have reignited a desire to practice medicine in underserved populations.


Lakomek ’21: Frontier Nursing Univ and Little Flower Clinic

Eric Lakomek ’21 — This summer I have had the pleasure to participate in an immersive learning experience funded by the Wabash Global Health Initiative with Frontier Nursing University and the Little Flower Clinic. I was given the opportunity to experience rural health firsthand at a homeless clinic in the community of Perry County, Kentucky.

Eric Lakomek (l) at an outreach program with the Little Flower Clinic

Before, I begin to dive into what I was able to observe and complete this summer, I think that it is important to discuss a little bit of background on the area I worked and lived. The coal industry used to be the largest employer of the residents in the county. In 2012, when the mines started to close, thousands of individuals lost their jobs and their livelihood. This led to a sharp increase in the homeless population due to the fact that there just wasn’t anywhere else to work and make a decent living. From the grueling work in the mines, many individuals suffered from chronic pain and turned to pain prescriptions to cope. Eventually, this area became the posterchild for the opioid crisis. Perry County was recently ranked 4thin the United States for pain prescriptions with enough pills prescribed to supply each person in the county with 175 pills per year.

Working in the homeless clinic, I was able to see the most vulnerable population and how this directly affected them. I was able to learn about the many treatment methods used to combat the crisis. In addition, I was able to learn the day to day operations of a grant-funded primary care clinic. I worked with two amazing nurse practitioners, Vera and Allyson, who taught me so much about different conditions and how a practitioner must approach treating an individual holistically, due to limited resources available.

Most of my time was spent doing outreach with the case workers at the clinic. I accompanied them to farmers markets, community events, and also on home visits. It was extremely interesting to observe the approach of bringing healthcare into the homes and lives of others, rather than have them come into the clinic. I believe that this makes many of the goals for the patient much more attainable because they feel more comfortable in their home setting. There is a large distrust of medical providers in the area so bringing healthcare to the people seemed to open many more people up. This, in my opinion, helped reduce many adverse health outcomes because barriers could easily be identified.

While I was seeing patients and doing outreach, I also completed a community needs assessment and project based off of the results I received. As identified in the community needs assessment, heart disease is the number one killer in Perry County. Heart disease has many complications, but hypertension and diabetes are two leading root causes of this issue. Diabetes prevalence in Perry County stands at a staggering 16%. This may be in direct correlation with adult obesity rates of 40%. Both of these rates are significantly higher in this community compared to Kentucky and the United States.

Eric Lakomek at an outreach program with the Little Flower Clinic

Diabetes and Hypertension are two of the most common chronic conditions that are prevalent in the Little Flower Clinic. Many patients that come into Little Flower are living on low income and cannot afford to purchase the necessary items needed to manage their condition. Therefore, when they are diagnosed with having hypertension or diabetes, the only materials the patient receives are medications and glucometers through their insurance. If a patient presents without insurance or cannot afford to pay, then many aspects of managing their conditions are not met. This led me to provide diabetes/hypertension care kits. Patients were able to receive blood pressure monitors, weight scales, wristwatch pedometers, and pill cases. These items allowed the clinic to distribute necessary health management equipment to patients in need so that they can help reduce adverse health outcomes. In addition to the diabetes/hypertension care kits, I provided education to bring A1C levels, cholesterol levels, and systolic/diastolic blood pressure down. Recipe booklets and brochures were created to educate patients on affordable, healthy recipes to make for themselves.

After reflecting on my experience this summer, I can truly say that I have changed in so many different ways. I have become much more appreciative of the things that I have in my life. The cultural experience in Appalachia has opened up my eyes to and taught me so much about who I am as a person and future physician. I will never forget my experience this summer at the Little Flower Clinic and I will continue to recall upon the information I acquired to use to improve the lives of others in the future.

 


Rotaru ’22: Data in Public Health and Beyond

Alexandru Rotaru ’22 — When people hear the term “public health,” most think of vaccines, health inspections, and PSAs that tell you what to do to prevent catching X disease. However, my experience as an EHS Fellow at the Montgomery County Health Department revolved more around the behind-the-scenes side of public health: data. My responsibilities included vector control and inspections – data collection –, plotting public health interventions and subsidized living units into a Geographic Information System (GIS, for short), and making sense of it – data entry and analysis –, and educating the population using the spoken and written word, through two articles, and three posters – acting based on the data. 

Vector control involved trapping and identifying mosquitoes to keep the population safe from West Nile Virus. Because we trapped daily, we had a lot of room to experiment and came up with hypotheses and research questions regarding where we would catch the most mosquitoes. Naturally, some of them were unfruitful, yet I feel more confident about making such hypotheses and testing them out in general, now that I have the experience of reaching dead ends before a breakthrough, which will help me in my career as a Chemist.

With GIS, I was tasked with plotting and cross-referencing subsidized homes through the HUD program with public health interventions, in order to identify any sort of vulnerable communities and correlations between different kinds of data. Through this project, I got a glimpse of just how much inter-agency effort is needed in order to maintain the health and safety of county residents. Communication is paramount when it comes to addressing issues in a community, and clearly defining roles and jurisdictions are key to effective collaboration.

On the education side, I wrote two articles – one addressing the community concerns and stigma around a sharps disposal program, and the other on how surveillance is the key to solving public health issues – and created three posters – one on proper sharps disposal, one on using a sharps clipper, and one on reducing the impact and breeding of mosquitoes in the home and community. Writing about public health was a challenge at first, as was creating a poster. It took a lot of patience, trial, and error, yet I feel more confident in those abilities, and I have become more realistic in my expectations regarding how difficult doing something familiar on an unfamiliar topic can be.

All in all, the biggest takeaway of this experience, besides working with data in public health, was that I have had the chance to explore all the different career paths related to public health, and further narrow down my future career path. I am thankful that the Global Health Initiative has offered me such an amazing opportunity, and I hope I will be able to use the skillset acquired through this internship during the school year and beyond.


Gray ’20: Works with IRHA to Bring Healthcare

Nathan Gray ’20 — This summer, I have been able to continue my exposure to rural healthcare through my internship with the Indiana Rural Health Association (IRHA). As one might guess, the IRHA is focused on aiding the access and quality of healthcare available to rural communities in Indiana. During this internship, the IRHA staff have exposed me to a variety of their different initiatives and have brought me in on tasks and projects that developed specific skills I had identified an interest in cultivating.

Primarily, my work has been on their Crossroads: Partnership for Telehealth grant which is done in conjunction with the Richard Lugar Center for Rural Health. This grant helps provide a telehealth platform that rural clinical sites can use to expand access to behavioral healthcare services to their rural communities. On this grant, I’ve helped with roll out and implementation of the equipment and program at partner sites as well as promotion of the program with potential partners. Additionally, Abraham Kiesel and I will be helping with Community Health Needs Assessments in a number of counties around the state later this summer. These assessments provide important information for provider systems and hospitals about the pressing healthcare needs of their communities. I’ve also been lucky enough to have some exposure to data analysis and grant writing.

My experiences with the IRHA this summer require me to employ an interdisciplinary set of skills and knowledge about health systems that I have gained through my time at Wabash and during other GHI-sponsored internships. In addition to honing and adding to my healthcare professional skillset, I expanded my professional network tremendously through my participation in the IRHA annual conference and partner meetings across the state. I would like to thank the Global Health internship for this opportunity.


Kelly ’21: St. Joseph County Department of Health Intern

Patrick Kelly ’21 — My internship at the St. Joseph Department of Health has truly been a fantastic experience. I have been able to tackle my own project while also experiencing and observing the many facets of the health department. I would like to give a special thank you to the Global Health Initiative, Jill Rogers, Dr. Eric Wetzel, and Dr. Sam Milligan, for the opportunity to participate in this awesome internship experience.

Communication and Provider List

At the health department, I have been creating a list of local primary care physicians in St. Joseph County. With this list containing physicians, clinics, and contact info, we are hoping to improve communication throughout the local public health infrastructure in St. Joseph County. I have also been researching best–practiced communication methods for different providers and different health departments. Later this year, we are hoping to develop a monthly newsletter from the St. Joseph County Department of Health with updates about health in the county.

School Camps

I have also been able to visit lower end elementary schools with the health department team and give healthy living lessons. Educating young people about healthy living is super important when thinking about the longevity of the community and public health because there is a huge correlation between education and health outcomes in a community.

Community Health Program

I’ve also had a great opportunity to participate in a community health program led by Dr. Mark Fox and Dr. Joe Kotva where we are focusing on the social determinants of health. I participated in a “neighborhood survey” in South Bend of about eight different neighborhoods, and we presented to the class to see the difference in each. We were looking at things like access to education, employment, transportation, food, healthcare, decay, parks, common spaces, and community protection. It was very interesting to see how these factors affected health outcomes. We also noticed big differences amongst the neighborhoods and the disparities in health equity. It was truly fascinating to see how it correlated with life expectancy. We looked at a map of life expectancy and saw a difference of 13 years, but only 3 miles apart, which is super interesting to think about.

I’ve learned that a community plays a huge role in improving public health. It is not just the health department or the doctors, but the community as a whole needs to team up to make an impact. We have also split into different groups to come up with a community need to improve public health, and have the opportunity to present this information to other community members.