Hayhurst ’21: EMT for the Crawfordsville Fire Department

Neal Hayhurst ’21 — This summer, I had the opportunity to work as an EMT for the Crawfordsville Fire Department. First, I would like to thank Jill Rogers for organizing this for me and the Global Health Initiative for covering my housing costs. The time, effort, and money they have dedicated to me embodies the Wabash spirit and reminds me why I chose to attend this special college.

As an EMT, you meet people where they are. Patients don’t shower, dress up, and drive over to the clinic to receive the treatment we give. Patients sometimes need treatment in the middle of the road, in their car in a parking lot, or on the floor of a bathroom. These are all situations that I encountered this summer which required me to meet patients where they were. I guess you could say that our goal was to meet every patient at the starting point–whatever state of need they are in—and get them to our end point- the hospital in a stable or improved condition. The complicating part—the emergency part of emergency medicine–is that the EMT never knows what the starting point may be, which means it may be harder or take longer to get some patients to the end point and easier and more straightforward for others. Whether the patient is a man bleeding and in pain in the road, a man seizing in his car, or a lady who has fallen in her bathroom, we see each and every patient as deserving of our best work and our best effort to get them to the same endpoint. EMTs meet these people at their worst, their most vulnerable, and do what they can to heal.

The interpersonal connection between an EMT or paramedic and their patient is often just as important as a well-developed knowledge of emergency care. One of the paramedics that I worked with this summer told me that if you talk to a patient long enough and are truly interested in their story, they will tell you exactly what is wrong with them. I found that to be especially true in the context of older patients who can quickly become annoyed with poking and prodding and tests. It is so easy to become obsessed with data and the cold hard numbers and to consequently miss the easiest way, both for the patient and the care provider, to uncover the problem. It was fun to put the EMT skills I had learned into practice, but I think interacting with patients and learning how to connect with them and earn their trust was the most beneficial part of the whole experience for me as an aspiring physician.

 


Wilson ’19— St. Joseph County Department of Health in South Bend, IN

Chris Wilson ’19—This summer I am interning with the St. Joseph County Department of Health in South Bend Indiana, predominantly with the health education division. I am involved in a wide variety of activities including, but not limited to, co-teaching a lecture about nutrition to students at a local elementary school, participating in the Reducing Obesity Coalition, and helping to organize the Michiana Opioid Task Force Opioid & Addiction Summit. However, my main task is creating a lead poisoning and prevention education program. This program will be five weeks long and provides general information about lead poisoning, proper nutrition and hygiene to reduce the risk of poisoning, and home cleaning and remediation tips to prevent exposure to lead. Approximately 77% of homes in South Bend have lead based paint, which puts a lot of residents (especially children) at risk for lead poisoning. The purpose of the program is to educate families on what they can do to reduce the risk of lead poisoning, make their home lead safe, and prevent lead poisoning in the future.

I have learned a great deal in the short time that I have been here but one topic that really stands out is social determinants of health. While I had heard about them previously, I did not fully understand how social determinants of health effect an individual’s well-being. A person’s community and socioeconomic status are often as important as one’s genetics in determining overall health.

I plan to become a physician after Wabash so understanding how non-medical factors affect a person’s health is critical knowledge. This internship has provided a foundation of knowledge of how a patient’s community and education effects their health. Also, I have gained a deeper appreciation for public health and how medicine fits into public health. The opportunity to intern with the St. Joseph County Department of Health has provided me with experience in and knowledge of public health while also humbling me by allowing me to serve the community of South Bend.

Unity Garden Camp

The photo on the right is from our time at Unity Garden Camp. It’s a free camp that teaches kids about gardening, environmental sustainability, wellness, etc. We provided healthy snacks to this camp and had an activity/lesson. In this picture, the lesson was about eating a variety of fruits and vegetables. The activity was “Eat the Rainbow.” The kids would draw/write their favorite food of a certain color (e.g. drawing a banana in the yellow part of the rainbow, an avocado in the green part) within the corresponding color on a rainbow.


Whitaker ’19—St. Joseph Health System in South Bend, IN

Whitaker is on the far right, in the green.

Joe Whitaker ’19 – “Things are going really well in South Bend. I’ve been working with Latorya Greene on two major projects. For the first project, I compiled a list of all of the bars in St. Joseph County and I collected info regarding their smoking policies, their structural layout, and any thoughts they might have on going smoke-free. For the second project, I’ve been preparing Indiana Tobacco Quit-Line information packets and delivering them to all of the physicians in network. On Friday’s I work as a volunteer at the family medicine clinic in the St. Joseph’s Regional Medical Center. I do simple things like getting patient’s vitals, cleaning rooms, and restocking supplies, but it’s great to meet people and see the variety of patients that come through the door.

In addition to my two projects, I also do community outreach events where I educate St. Joseph County citizens on the dangers of all forms of tobacco and I help get signatures for a petition. The petition advocates for two things: an increase in the purchase age of tobacco products from 18 to 21 and an increase of the cigarette tax by $1.50. I’ve had to do a lot of

Whitaker on the right in green

information seeking to be able to defend these two proposals but in educating myself I’ve really come to believe in the work we’re doing here. The community outreach programs have really influenced the way I view public health and those individuals who can slip through the cracks of the healthcare system. Ultimately, I’ll take the information I’ve learned here and I’ll carry it forward with me as I begin my career as a health professional.”

Joe is interning with the St. Joseph Health System in South Bend, Indiana.


Equihua ’20 —What is it you want to do, again? Primary care? Pick something else

Artie Equihua ’20

Artie Equihua ’20 — When I was around three or four years old, I told my grandfather I wanted to be a scientist. This statement did not evoke the greatest response considering he probably wanted (and still wants) me to pursue a career in professional sports. However, my fascination with science and deep desire to help those who feel hopeless has crafted my current dream of becoming a physician. However, even a kid who has dreamed of working in healthcare for his entire life can become overwhelmed by the negativity associated with it. Most recently, I had a discussion with a primary care physician working out of North Carolina. In our conversation he mentioned he had always wanted to be a doctor because of his love for science and his ability to utilize it in order to help people, but the current system was not allowing him to care for his patients to the extent he wanted to. Shortly after this comment he looked at me and said, “Healthcare is going to hell. What is it you want to do, again? Primary care? Pick something else.”

This encounter with the primary care physician had truly shook me. How could someone with such similar aspirations become so depressed and resentful toward healthcare? I tried to formulate a response that would somehow change the subject, and I ended up blurting out what his statement had made me feel. I started with the story involving my grandpa. I explained how I had identical interests and why I wanted to become a physician, but I did not say I agreed with his current perspective. Instead, I explained that I often, too, feel very cynical about the industry that I hope to someday find a career in; however, there is so much innovation and change already occurring that it keeps me hopeful.

Unfortunately, I could tell that he had not changed his position on the matter. Perhaps, he believes me to be naive, but I can live with that. Fortunately for me, with each new daunting flaw that I hear about in healthcare, I am exposed to the innovative work of twice as many people who are dedicating their lives to solving current healthcare issues on all levels. With so much innovation and optimism radiating from individuals at Volunteers in Medicine, HealthLINC, NCHICA, DHIT, Duke, UNC, and many other organizations, it is hard not to feel hopeful for the future.

This summer Equihua is participating along with Nathan Gray in a Global Health Initiative internship with Wabash alumnus Dr. Todd Rowland (www.bridge2medical.com). This is his second blog post in the series of posts on exploring the world of health care and those trying to revolutionize it. The G. Michael Dill Fund makes this internship possible.

 


Gray ’20 – Your Doctors Aren’t Talking About You—And That’s a Problem

Nathan Gray ’20, Dr.Todd Rowland ’85, Dr.Raj Haddawi, Arthur Equihua ’20. Dr. Haddawi helped found the Monroe County Volunteers in Medicine (VIM) Clinic in Bloomington in 2007, raising nearly $1 million in donations from the local community and engaging 200+ physicians in a volunteer effort. He now lives in Chapel Hill and was happy to meet with the students.

Nathan Gray ’20 — This summer I am fortunate to participate in a Global Health Initiative internship with Wabash alumnus Dr. Todd Rowland (www.bridge2medical.com) with my fellow intern Artie Equihua. This is the first of a series of blog posts where I share my experiences and observations about the healthcare field. I would like to thank the G. Michael Dill Fund for making this valuable opportunity possible.

During my week in Bloomington, I had the pleasure to shadow many of the staff at HealthLINC, a health information exchange, and at the Volunteers In Medicine (VIM) Clinic of Monroe County which provides care for the medically underserved. As I learned, in a healthcare system as fragmented as ours, a patient can quickly rack up a laundry list of medical care providers, and the failure of providers to coordinate their care can be deadly. Medical errors may result in as many as 251,000 deaths in the U.S. each year, making it the third leading cause of death in the country.1 Coordinating care and patient medical records across providers is critical to challenging this unacceptable statistic.

Health information exchanges, like HealthLINC, are playing an essential role in this battle by developing tools that aggregate a patient’s data into more complete and accessible records for all the providers using the tool. Sitting-in on a staff meeting and a conference call with their software developer provided Artie and I a unique peek into how these tools are developed, and my time at the VIM Clinic, which uses HealthLINC’s tools, demonstrated their important use.

The dedication of the VIM staff to their mission and the empathy with which they treated everyone who came into the clinic was an astounding sight. In my time at the clinic, I was inspired by an approach to medical care that was truly focused on improving patient outcomes of wellness—not only through clinical treatment but also by tackling the behavioral and social determinants of health whether that be overcoming language barriers, lifestyle counseling, or accessing social services. In carrying out their work, the VIM staff make effective use of digital health tools to the betterment of their patients.

Finally, a visit to the Critical Access hospital in Paoli, Indiana exposed me to the challenges for rural populations to access medical care. Critical Access is a designation given by the government to hospitals which serve rural populations and meet a number of other requirements. Critical Access hospitals, and especially their 24/7 emergency departments, are often an essential provider of care to these communities. Rural populations have greater difficulty accessing affordable medical care than their urban counterparts due to the limited supply of rural healthcare providers and other obstacles like transportation. It seems many now rely on the emergency departments of these hospitals as their primary care providers. This causes financial strain on the hospitals, is non-ideal for long term patient care, and if proper information systems are not in place, larger hospitals to which patients are transferred, may lack access to their patients’ complete medical records.

My experiences highlighted how various groups are working to reduce disparities in access and quality of care for the medically underserved and the important role that coordinated care plays in improving patient outcomes. In the coming weeks, I look forward to gaining a better understanding of the different actors involved in our healthcare system and how they are responding to changes in the industry of healthcare in innovative and patient-centered ways. A special thanks to Kathy Church from HealthLINC, the VIM Clinic staff especially Ed Hinds, and Sonya Zeller from IU Health Paoli for their time and effort in making this week so valuable.

1.         Anderson, JG; Abrahamson, K. “Your Health Care May Kill You: Medical Errors” Stud Health Technol Inform. 2017


Equihua ’20 – A Liberal Arts Perspective of Digital Health

Artie Equihua ’20 — This summer I am fortunate to participate in a Global Health Initiative internship with Wabash alumnus Dr. Todd Rowland (www.bridge2medical.com) with my fellow intern Nathan Gray.  This is the first of series of blog posts where I provide an update to the larger community. I would like to thank the G. Michael Dill Fund for making this internship possible.

This past week I had the privilege of observing a health information exchange called HealthLINC, in addition to, medical and business professionals at the Volunteers in Medicine (VIM) Clinic in Bloomington, Indiana. From observing these two organizations, I was able to see how the integration of technology affected the organization of the clinic and level of care provided to patients.

A common trend I had observed while I was at the VIM clinic was the large number of prescribed medications each patient was taking from multiple physicians. As it turns out, one third of Medicare spending is on patients which have five or more chronic conditions and see an average of fourteen different physicians annually (1). On top of that, those with 5 or more chronic conditions are prescribed an average of 50 prescriptions a year (2). Thus, if a patient is prescribed medications from multiple different doctors, do all of the doctors communicate? How do they keep track of every medication prescribed to the patient? Unfortunately, the answer to the first question is most likely no. These are the questions that are currently being answered by innovative healthcare technology known as digital health. Luckily for the VIM clinic, HealthLINC provides a digital health software system called Med Management which enables physicians and other medical staff to input and track each drug prescribed to their patients, instead of relying on the patient to recite their entire medical list. Thus, the increased efficiency created by the integration of technology systems such as med management, enabled more personalized care than before.

Overall, my experiences with Volunteers in Medicine and HealthLINC has been both insightful and thought provoking. In just a week, I have established a much better sense of what a functional clinic needs in order to sustain its level of care and office efficiency. Yet, the knowledge gained from my experiences has only exposed more dimensions of the healthcare industry that I still need to explore.

Sources:

CBO Budget Options, Volume 1: Health Care. December 2008.
U.S. Department of Health and Human Services (2010). Multiple Chronic Conditions – A Strategic Framework: Optimum Health and Quality of Life for Individuals with Multiple Chronic Conditions. Washington, D.C. December, 2010.


Hodges ’19 – Little Flower Clinic

Matt Hodges ’19 — I spent this summer working at a Little Flower Clinic, a homeless clinic in Hazard Kentucky. Hazard is the county seat of Perry County, located in Southeastern Kentucky in the heart of Appalachia. Working in this setting with this population allowed me to experience the immense value of a liberal arts education in rural healthcare, and in healthcare in general. While at Little Flower I prepared health education presentations on type II diabetes and naloxone overdose intervention, engaged in community outreach, and accompanied the clinic’s case manager on her home visits to patients with chronic medical conditions. In all of these situations it felt as though Dr. Gelbman’s Sociology in Healthcare course had suddenly come alive, and seeing so vividly the real-world implications of what I learned in the classroom at Wabash stretched my critical thinking skills and left me exhausted at the end of each day.

The history and economy of Appalachia are both important in understanding its current health profile. For decades the economy of Perry County (and Southeastern Kentucky in general) was entirely dependent upon the coal industry. When the coal industry started to die, so did the economy. Now downtown Hazard resembles something along the lines of a ghost town that happens to have some people in it. Many people who worked in the coal industry lost their jobs and since many coal workers began work before they graduated high school, they don’t have the education necessary to find a new job that pays well. As a result of this, unemployment rates are through the roof and people have a hard time accessing healthcare.

In addition to this, Southeastern Kentucky has a sizeable dose of warranted medical skepticism. This region was the epicenter of the Opioid Crisis that currently raging through the United States (in fact, the heroin outbreak in Scott County Indiana was traced back to Hazard Kentucky). Many of the blue-collar workers in the area either experienced chronic pain as they aged, or required back surgery as a result of years of physically demanding work. Many doctors put their patients on liberally prescribed and poorly supervised painkiller regimens that got the patient hooked on opioids. Soon these high-powered drugs were being prescribed to almost anyone who complained of pain. A few (but not as few as you would like to think) corrupt physicians opened up methadone or suboxone treatment clinics so they could profit from not only getting their patients addicted, but also from weaning them off. This led to a physician distrust that can be felt in the community and many clinics (like Little Flower) are run instead by nurse practitioners, who are generally more trusted within the community.

A lot of the work I did involved health education regarding naloxone overdose reversal and the local Good Samaritan laws that protect individuals who try to help in the event of an opioid overdose. The wound left by opioid over-prescription is still very fresh, and a decent portion of the population still abuses pain pills (fortunately heroin has not hit the area quite as hard as it has hit some parts of Indiana yet). The local health department has also been providing great education in this area, but I discovered that active drug users weren’t likely to attend these events, but active drug users are the most likely to be the first responders to an overdose. So I set out to provide education to this demographic, and made several trips down to the local homeless shelter for that purpose. I unfortunately cannot go into detail on the life stories I heard there and still call this a blog post of reasonable length, but the impact it had on me was immense.

The other part of my experience that was the most eye-opening was accompanying our case manager Helen on her home visits. No matter how good the trust between a healthcare provider and a patient is, there is still a wall that goes up between them in a clinical setting. Visiting a patient at their home tears that wall down. It also gives valuable insight into things that might complicate their treatment plan that would have been entirely unknown otherwise. For example: it is a lot more difficult to eat diabetic-friendly meals if your oven has been broken for eight months. But the broken oven will likely never come up in a yearly checkup. Following Helen around showed me that even if a diagnosis is the same between a group of patients (hypertension, diabetes, alcoholism, etc.), no two patients are alike in their needs and have very unique social and economic situations that impact their medical care.

My liberal arts education at Wabash was instrumental in my perception of the health issues in Appalachia and their underlying causes. However, lessons I learned from the wonderful people at Little Flower could not have been taught in a classroom, and I will be forever grateful to them and to the Wabash GHI for allowing me to spend this summer in Appalachia. The experiences I had will continue to weigh on my mind as I continue along my career path as a health professional.


Grubbs ’20 – Child Family Health International S. Africa

Ben Grubbs ’20 — Durban, South Africa was an experience like none other. The city rich with history and culture is more than just a typical African city. It is a city not to be fully understood unless immersed into the different lifestyle. While abroad during the month of June, I learned what real struggles were. These real struggles involved not knowing if you were going to have electricity, clean water, or even food for dinner. In a city rampant with HIV, tuberculosis, and poverty, everything in life is quickly put into perspective. Our “first world problems” are suddenly not problems at all, they are actually privileges. Durban is faced with all of these challenges and still manages to thrive off of community and family relationships. Their culture revolves around one another and building those relationships. It is so unique and not one to be found anywhere in the United States.

While culture was a daily learning experience for me, it wasn’t the only thing. My mission while abroad was to learn about the problems associated with HIV/AIDS. With over 60% of adults testing positive for HIV, it is a problem that needs to be handled. Each of the weeks while I was there, I worked in a different hospital/clinic/pharmacy in order to see the problems from all aspects. I was lucky enough to ride along with a hospice company to homes and see the problems faced by millions of Africans first hand. Many patients lived in one room, tin-walled shacks that did not have running water or electricity. They lived with family and were unable to do anything due to cancer, TB, and other common diseases. While working in a pharmacy, I was able to pack and help distribute antiretrovirals (ARV) to those in need. Since ARV’s are free to the public, it is a very busy business. In the hospitals, I saw tuberculosis secondary to HIV which is rarely seen in an American hospital. The challenges they faced daily were not having the correct medicine to treat patients, not having the technology, and also not having the funds to continue to run the hospitals. The first week while I was in South Africa, the last oncologist for public hospitals in the whole province quit, leaving millions of patients out to dry. The wait list to see an oncologist was over six months and that was just a guess on the hospitals part. My whole time abroad, they were unable to hire any more so the oncology field was nearly nonexistent.

My trip to South Africa was truly an eye opening experience that changed my outlook on healthcare and life forever. I learned more than I could imagine that I will take with me for the rest of my life. I hope to translate what I learned abroad to a more local level in Crawfordsville in order to help us achieve the goals in the healthcare field.


Doty ’18 —St. Joseph Public Health Dept

Jade Doty ’18 — This past summer was an incredible learning experience that I know will hold many benefits in the years to come. I cannot thank the Wabash Global Health Programs, enFocus, and the St Joseph County Health Department enough for guiding me during my internship in South Bend, Indiana. During my stint as an enFocus intern, I worked closely with the St. Joseph County Health Department in the fight against low food access in South Bend. Additionally I worked with a team of other enFocus interns on a project that consisted of raising funds for a county wide mass CPR training event that will take place in the fall of 2017 and finding the best ways to locate and catalog all Automatic External Defibrillators (AEDs) in the St. Joseph County area.

During my main project with the Health Department, I did a thorough analysis on all the census tracts in South Bend that were labeled as Food Deserts. In short, a food desert consists of an area where there is an abundance of low income residents, limited amount of food resources, and the spacing of residential living and food resources are far apart. I compiled a report of these census tracts which included the number of residents living below the poverty line, the number of SNAP (food stamp) recipients, Health statistics (such as number of residents with type 2 diabetes, high blood pressure, and high cholesterol), and the average cost of providing food for a household in a given census tract. This analysis held many interesting findings that showed that these census tracts were definitely food deserts and how poor health statistics were the results of this problem. The census tracts held a poverty percentage average of 35.6% (the national average is 14%), an average of two SNAP distributors, per census tract, and health statistics that soared above national averages. I hope that these specific findings give the city information that helps identify the problem of low food access in South Bend and helps them see a clearer way to solving this issue.

After this analysis, I conducted focus groups, researched several case studies, and found recommended next steps for the city of South Bend to take on their fight against low food access. One possible next step I found very interesting was providing a special shuttle system that would provide direct transport to several grocery stores for South Bend residents. I compiled all of these findings into a single 40-page report that I delivered to the Robin Vida, the head of the St Joseph County Health Department, and Samuel Milligan at the end of my internship.

My second project garnered some great learning experience because I had to create a business plan with a team of interns. Myself and two other interns were required to find the best practice to catalog AEDs in St. Joseph County. We believed that if we went out into the city and actually did some hard ground work in high dense areas, we would be able to produce results that would identify whether there is a lack, surplus, or moderate amount of AEDs in public spaces. These results were recorded and will be used to show a sample of the number of AEDs in public areas, which will further the county’s plan on whether to pursue cataloging more AEDs or creating a more strict AED policy for other businesses.

I enjoyed my time and learned a lot while working for enFocus and the St Joseph County Health Department. I was fortunate to work for an organization like enFocus, where the company is small enough to see the ins and outs of all their work from the top down, but still make a large impact with various projects in the St Joseph County area. While working with Robin Vida at the St Joseph County Health Department, I gained the perspective of how health departments work and how much they have the potential to benefit the cities and towns they are in. Robin was a tremendous mentor, as well as everyone at enFocus. I strongly suggest that the Wabash Global Health Program continues to keep ties with South Bend, enFocus and the various Health Systems in the St Joseph County area. I was blessed to have such a great learning experience.


Hansen ’19 – Fairbanks School of Public Health

Evan Hansen ’19 — Over the past eight weeks I have been working with the IUPUI Fairbanks School of Public Health. Each year the Your Life, Your Story summer camp supports up to 30 low income campers in a program, designed to reduce their risk of poor health outcomes. The 5 day camp took place from June 19-23 and it was one of the most fulfilling weeks of my life. This camp provided teens (ages 12-18) the opportunity to learn problem solving skills and develop their sense of identity and sense of self through creative outlets such as storytelling, music, art, and sports.

It has been a while since I was last at a summer camp, but I quickly felt the same enthusiasm. The three sessions I went to on a daily basis were storytelling, music, and theater. I am certainly not gifted in music or theater but I wanted to show the campers I could learn just like them.  Each camper highlighted their interests on an initial survey, and the professional storyteller was a very popular choice. In addition to the three activities there was a resilience building session led by community leaders. For about two hours each day, the resilience building involved various individual and group activities. As a mentor I was responsible for organizing events, observing the campers, and of course having a great time by participating in the games.

Our staff of ten mentors was comprised from all across the country. Since most of the campers spoke Spanish as well as English, it was very useful to have a couple mentors that were fluent in Spanish. From Colombia, Alabama, Georgia, Indiana, and North Carolina we all shared a similar passion for working in health careers. Some of us have medical school ambitions while others have recently graduated from IUPUI with degrees in public health. The interactions I had with the campers, mentors, and activity leaders affirmed my interest in physical therapy because I was able to witness the importance of serving others. The camp was a very fulfilling opportunity for myself because I was able to practice Spanish in a very active setting.

Throughout this internship I have developed my leadership, teamwork, and communication skills. Since this was the fourth year of the camp, a former mentor trained myself when I arrived back in May. With only a couple days before she was leaving for Swaziland, we had a lot to cover in a short amount of time. Over the next several weeks I attended various public health meetings with Dr. Bigatti and aided her with a couple other projects. Sitting at a desk planning events and training other mentors is all worth it for the incredible fun that awaited at Your Life, Your Story.