Journal For Minority Medical Students

VOL. 22 21 NO. 41 • $5.00 JOURNAL FOR FOR MINORITY MEDICAL STUDENTS JOURNAL MINORITY MEDICAL STUDENTS

VOL.VOL. 22 NO. • $5.00 201NO. 4 / VOL. 21 NO. 1

•

$5.00

Journal for Minority Medical Students 2

T H E d i s pa r i t i e s I s s u e

NORTHERN & SOUTHERN CALIFORNIA

RESIDENCY PROGRAMS

IMMERSE YOUSELF

IN AN ENVIRONMENT OF SUPPORT Experience beyond the ordinary. At Kaiser Permanente you’ll have expansive, integrated systems at your fingertips, putting you that much closer to the information you need. Apply all you’ve learned in an environment that supports your growth– and your future.

For more information, visit our website at http://residency.kp.org.

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Charter Members 2010 American Academy of Family Physicians

Department of Veterans Affairs (VA)

Summa Health System

American Academy of Orthopaedic Surgeons

Harvard Medical School Minority Faculty Development Program

U.S. Army

American Academy of Pediatrics

Jefferson Medical College

U.S. Commissioned Corps

Association of American Medical Colleges

Kaiser Permanente California

U.S. Navy

Aurora Health Care

Long Island Jewish Medical Center

UAB School of Medicine

Boston Medical Center

Medical College of Wisconsin

University of Michigan Medical Center

Cedars-Sinai Medical Genetics Institute

MSU / Kalamazoo Center for Medical Studies

UPMC Mercy

Cincinnati Children’s Hospital Medical Center

Mount Sinai School of Medicine/ Elmhurst Hospital Center

Vanderbilt School of Medicine Office of Diversity

David Geffen School of Medicine at UCLA

Office of Minority Health U.S. Department of Health and Human Services

Wake Forest University School of Medicine

These special friends of the Journal for Minority Medical Students have demonstrated their commitment to reach out to minority medical students by placing their recruitment messages in each quarterly issue.

We salute them and encourage our readers to consider these programs as they continue their medical education.

North Shore Long Island Jewish Health System A Major Academic Health System Dedicated to Patient Care, Teaching and Research

Allergy & Immunology Colon & Rectal Surgery Diagnostic Radiology Emergency Medicine Family Practice General Practice Dentistry General Surgery Internal Medicine Neurology

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The nation’s third largest, non-profit, secular healthcare system, the North Shore-Long Island Jewish Health System provides care for people at all stages of illness throughout Long Island, Queens and Staten Island – a service area encompassing more than five million people. The health system includes 15 hospitals, four long-term care facilities, a medical research institute, three trauma centers, five home health agencies and dozens of out-patient centers. North Shore-LIJ facilities house more than 5,576 beds, and are staffed by over 7,000 physicians, 7,000 nurses and a total workforce of more than 35,000 – the largest employer on Long Island and the ninth largest in New York City.

For further information: Office of Academic Affairs Telephone: 516-465-3192 Fax: 516-465-3190 www.northshorelij.com

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47 Journal for Minority Medical Students

The disparities issue Vol. 22, No. 1

Features 34 The Disparities Issue Intro 35 Disparities & Health Care Reform 39 Economics & Health Care Disparities 42 Disparities News Roundup About the cover Emanuel Martinez

47 Health Care Access in New Orleans Following Hurricane Katrina: A Case Study in the Failure of a

Maize de Quetzalcoatl Oil, 24”x30” About the artist: Born in Denver, Colorado in 1947, Emanuel Martinez began his artistic pursuits as a means of escape from an oppressive childhood. As a forerunner of the contemporary mural movement that began in the late 60s, Martinez worked in the civil rights movement with Cesar Chavez and other prominent leaders. Three of the art works he did in that era are now in the permanent collection of The Museum of American Art at the Smithsonian in Washington D.C. The work of this prolific, highly versatile artist has won him numerous awards: including the Colorado Governors Award For Excellence in the Arts(1985), the Denver Mayors Award for Excellence in the Arts(1995) and the Denver Civil Rights award in 2001.

For more information: www.emanuelmartinez.com

Two-Tiered Health Care System by Aaron D. Fox, MD

Perspectives 6

Publisher’s Page

9

AAMC Perspective by Lutheria N. Peters

13 AMA Perspective by Sonja Boone, MD; Fred Donini-Lenhoff; Michael Kutnick 17 NMA Perspective by Willarda V. Edwards, MD 21 SNMA Perspective 23 APAMSA Perspective by Alex Cheng 29 AMSA Perspective by Sameen Farooq 50 A Second Opinion, Please by John M. Dunn, MD 56 Conference Report: Morehouse School of Medicine, 3rd Annual Conference on Health Disparities 57 Dr. Marc Nivet to Join the AAMC

Is family

medicine your calling

?

Care for people and communities.

explore family medicine

www.aafp.org/explore

JOURNAL FOR MINORITY MEDICAL STUDENTS PUBLISHER Bill Bowers EDITOR-in-chief Laura L. Scholes laura@laurascholes.com Contributing Writer John Dunn, MD SENIOR ACCOUNT EXECUTIVES Amy Harrison Campus Rep Liaison Vanessa Bowers ART Director Elizabeth Praisewater copy editor Robert Blue Marketing Director Erica Perkins PUBLISHER’S ADVISOR Michelle Perkins, MD SPECTRUM HEALTHCARE DIVERSITY & INFORMATICS PRINCIPAL INVESTIGATOR Bill Bowers VICE PRESIDENT OF OPERATIONS Tamika Goins SENIOR DEVELOPER/DBA Naresh Kumar TECHNICAL ADVISOR Johnny Johnson CONTRACT MANAGER Lorry Rome PROJECT COORDINATOR Amita Gavalas BUSINESS DATA ANALYST Claudia Anthony IT COORDINATOR Dr. Roz Haley

MYTH: It is nearly impossible to get into an orthopaedic residency.

FACT: You can accomplish the goal with vision and determination.

The truth is, entering any residency program is tough and competitive. However, recent figures show over 80% of senior medical students who apply for an orthopaedic residency position successfully match. So, if you’re driven to help restore patients to a higher quality of life, you can make it happen.

Our unique mentoring programs connect you with experienced orthopaedic surgeons who can personally guide you forward. We invite you to go online for all the information and resources to get started. You’ll discover it’s easier than you realized.

Choose a career in Orthopaedics— our unique mentoring programs offer personalized guidance and support to help push you ahead.

For more information, visit aaos.org/diversity or email mentor@aaos.org

J. Robert Gladden Orthopaedic Society A MultiCultural Organization

The AAOS extends sincere appreciation to Zimmer for its charitable contribution.

PUBLISHER’S PAGE

Remembering an Icon

By Bill Bowers, Publisher, Journal for Minority Medical Students

W

e at the Journal were sad to learn of the passing late last year of former NIH Deputy Director Ruth L. Kirschstein.

Kirschstein, 82, an MD who spent more than 50 years as a civil servant, died at the NIH Clinical Center in Bethesda, MD, after battling a long illness.

Kirschstein was an icon at the National Institutes of Health (NIH), with a scientific and administrative public service career that spanned more than half a century. After doing important laboratory work on the polio vaccine, she made history as the first woman to direct an NIH institute, the National Institute of General Medical Sciences (NIGMS). Later, she served as deputy director and acting director of NIH. Kirschstein was a strong advocate for research training, especially interdisciplinary predoctoral programs and programs to increase the number of minority biomedical scientists, physician-scientists, and scientists trained in emerging or evolving areas. She also personally mentored a significant number of people within and outside NIH. In 2002, as a fitting tribute to her many years of exceptional service to the nation, particularly in the area of research training, Congress renamed the National Research Service Award program in her honor.

“She was one of the icons of minor-

6 Journal for Minority Medical Students

ity health and health disparities,” said Lovell A. Jones, PhD, cofounder of the Intercultural Cancer Council and director of the Center for Research on Minority Health University of Texas M.D. Anderson Cancer Center. “She never

“Ruth embodied the spirit of the NIH. She was loved and admired by so many at the NIH, across the medical research community, among hundreds of members of Congress and around the world . . . There are few at the NIH who have not been touched by her warmth, wisdom, interest and mentorship.”

—Francis S. Collins, Director, National Institutes of Health

Ruth L. Kirschstein , MD spoke negatively of affirmative action, but saw it as something we must do to address the impact of past actions on a group of people who were also American citizens.

She was a role model for us all. If it were not for people like Ruth, individuals like myself would not be where we are today. ” We dedicate this issue of the Journal to her to honor and commemorate her legacy of commitment to promoting diversity and scientific excellence. She will be missed greatly.

In memoriam The Journal also mourns the loss of Larry Keith, a tireless pioneer in recruiting minority students into the health professions. He passed away February 17, 2010 from cancer; he was 58.

During his tenure at the University of North Carolina at Chapel Hill School of Medicine, Keith was instrumental in helping thousands of talented individuals, primarily underrepresented and disadvantaged minorities, to succeed in medicine and other health care professions.

Meet Dr. I-Didn’tThink-I-Could-Afford Med-School Morcos Claudine Morcos, M.D.

Don’t let finances get in the way of your medical school dreams. Check out AspiringDocs.org®.

It’s your go-to source for information about loans and scholarships, as well as the MCAT® and admissions. Get informed today.

© 2006 AAMC

Medical Students: A Career In Pediatrics Can Open Up New Doors The American Academy of Pediatrics (AAP) has a membership opportunity for medical students.

The AAP offers many benefits, both general and specific to medical students, including: x Affiliate membership in the Resident Section x Free admission to the AAP National Conference & Exhibition (NCE) x Discounts on all AAP products and services x Pediatrics 101—a resource guide from the AAP x Online Resources - An e-newsletter for medical students, - Medical Student Listserv®, - Access to the YoungPeds Network And much, much more!

For information please contact us at: pedscareer@aap.org or call Julie Raymond at (800) 433-9016 ext. 7137 or visit www.aap.org/ypn

MICHIGAN STATE UNIVERSITY KALAMAZOO CENTER FOR MEDICAL STUDIES

OUR MISSION

At MSU/KCMS, we realize that being an exceptional physician means having a balance between the personal and professional areas of your life. Our mission is to help you achieve your clinical and academic goals in a truly supportive environment. More than 180 residents take part in our residency programs and have exposure to the broadest range of health care. Our partnership with awardwinning Level One Trauma Centers means that from newborns to the elderly, you will have patient diversity that will allow for you to develop your skills to their fullest.

Michigan State University Kalamazoo Center for Medical Studies is a university and community partnership driven by a team of dedicated professionals committed to provide excellence in graduate, undergraduate and continuing medical education, knowledgeable and caring service, and research.

At MSU/KCMS, you will have opportunities to participate in a variety of research projects.

We are proud of our numerous awards and grants and our faculty that understands the correlation between great research and great patient care.

At MSU/KCMS, with quality of education comes quality of life. Almost half our residents own their own homes in a region that has been ranked as one of the best places in America to live. The “Kalamazoo Promise”—which provides free college tuition for students completing K–12 in the Kalamazoo Public Schools—low cost of living, clean air and an abundance of recreation means your hours outside of MSU/KCMS will be as fulfilling as those inside.

www.kcms.msu.edu · (800) ASK-KCMS

OUR VISION Michigan State University Kalamazoo Center for Medical Studies will excel in providing quality medical education. We will deliver expert, responsive patient care and pursue innovative research.

OUR VALUES MSU/KCMS offers fully accredited programs in Internal Medicine, Pediatrics, General Surgery, Family Medicine, Psychiatry, Orthopaedic Surgery, Medicine-Pediatrics, Emergency Medicine, Primary Care Sports Medicine Fellowship, and Transitional Year.

MSU/KCMS also offers an Osteopathic Traditional Internship and dually accredited AOA/ACGME Family Medicine and Internal Medicine residencies.

Compassionate Service Leadership Lifelong Learning Teamwork Commitment to Excellence

AAMC

perspective

Exploring the Possibilities: Medical School Centers Addressing Health Disparities Research

By Lutheria N. Peters, MPH, CHES

W

hile awareness, access, and the quality of health care have improved for minorities in the U.S., serious disparities remain.1 In July 2009, U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius released a report reiterating the persistence of health disparities across minority groups, especially across racial and ethnic minority groups.

The new report, Health Disparities: A Case for Closing the Gap, 2 cites recent secondary data sources to highlight disparities in areas of specific diseases and access to health care including routine care and prevention services. Select findings reveal that 48 percent of all African-American/black adults suffer from a chronic disease, compared to 39 percent of the general population.3 Fifteen percent of African Americans/ blacks, 14 percent of Latinos (as)/Hispanics, and 18 percent of American Indians/ Pacific Islanders suffer from adult onset diabetes. American Indians/Pacific Islanders suffer from diabetes at more than twice the rate of the white population, which develops the disease at a rate of only eight percent. 3 Hispanic/Latina and Vietnamese women comprise a disproportionate rate of cervical cancer cases compared with the rate for white women.3 More than one in three Hispanics/Latinos (as) and American Indians/Pacific Islanders and about one in five African Americans/blacks are uninsured. In contrast, one in eight whites lack health insurance.3 Hispanics/Latinos (as) are one-third less likely to be counseled

in specific regions such as south Florida, Texas, and California.”5 For these populations, pressing determinants of health include domestic violence, unemployment and lack of insurance, and language barriers, among a range of other health issues such as HIV/AIDS and tuberculosis.6, 7 These and other findings are based on national studies conducted by federal agencies (e.g., HSS’s Agency for Health Care Research and Quality, Health Resources and Services Administration) and foundations (e.g., the Commonwealth Fund), who are signaling the need to expand and redouble efforts to combat these and numerous other health disparities.

Fortunately, over the years, numerous summits, conferences, and workshops Lutheria N. Peters across the U.S., have created platforms for highlighting health disparities research on obesity than are whites. Less than one(e.g., the NIH Health Disparities Seminar third of people living within 200 percent Series Theme: Confronting Breast Cancer of the poverty line receive consistent man- Disparities, the National Conference on agement for the prevention of diabetes.4 Quality Health Care for Culturally Diverse In 2006, the Health Resources and Services Populations, the American Cancer SociAdministration (HRSA) released its Sixth ety’s 2009 Conference on Health Equity: Annual Report to the Secretary of the U.S. DeThrough The Cancer Lens and the 2008 partment of Health and Human Services (HHS) National Institutes of Health’s Sumand to Congress highlighting the challenges mit: The Science of Eliminating Health that lay ahead as academic health centers Disparities). But, perhaps not as visible, are prepare practitioners to care for the unthe various medical schools with formalderserved and other high-risk groups and ized or recently established centers focused vulnerable populations.5 A key finding in on health disparities research or related this report focuses on immigrant “popula- areas such as health equity.8 tions that continue to expand throughout For almost eight years, various medical the United States but are concentrated schools have been taking the lead to continued on page 11 Journal for Minority Medical Students 9

David Geffen School of Medicine at UCLA Committed to:

Excellence

•• Ranked Ranked among among the the top top ten ten U.S. U.S. medical medical schools*. schools*.

•• UCLA UCLA Medical Medical Center, Center, judged judged "Best "Best in in the the West" West" and and in the top five nationally* in the top five nationally* •• More More students students at at UCLA UCLA honored honored with with the the prestigious prestigious McLean McLean and and Cadbury Cadbury Awards Awards than than at at any any other other medical medical school school (Awarded (Awarded annually annually by

by National National Medical Fellowships, Inc. to the number Medical Fellowships, Inc. to the number one one and and the the number nation) number two two graduating graduating minority minority student student in in the the nation) •• Instruction Instruction and and mentoring mentoring by by distinguished, distinguished, awardawardwinning winning faculty faculty •• Research Research fellowships fellowships and and training training programs programs •• Small Small group group sessions, sessions, guided guided by by faculty, faculty, demonstrate demonstrate the the relationship relationship between between course course material material and and clinical clinical application application •• Combined Combined degree degree programs programs with with other other UCLA UCLA professional professional schools schools (Law, (Law, Management, Management, Public Public Health Health and and Public Public Policy) Policy)

Diversity

*U.S. *U.S. News News and and World World Report Report

• Superior recruitment, retention and graduation record • 2005 Entering Class: 12% African American; 15% Latino and 1% Native American • Strong alumni and mentor network • Affiliated hospitals and clinics providing one of the most broad and diverse medical training programs available • Celebrations of diversity including exhibits, distinguished guest lectures, multi-media and theatrical events, traditional food shares and film festivals • Comprehensive premedical outreach and academic programs • Outreach to designated health manpower shortage areas and communities

For additional information contact

The Office of Academic Enrichment and Outreach, David Geffen School of Medicine at UCLA, PO Box 956990, Los Angeles CA 90095 (310) 825-3575 www.medstudent.ucla.edu/prospective

The best medical education is personal………..………come home to UCLA!

aamc

perspective

continued from page 9

address health disparities by establishing centers of excellence that focus primarily on health disparities research and other related areas. Many of these centers are funded by the National Center on Minority Health and Health Disparities’ (NCMHD) Centers of Excellence (COE) Program established by Public Law 106-525, the “Minority Health and Health Disparities Research and Education Act of 2008” When the NCMHD COE program opened its doors in 2002, it was referred to as the Centers of Excellence in Partnerships for Community Outreach, Research, and Health Disparities and Training (Project EXPORT). In 2007, the program acquired its official title, the NCMHD COE program.

The NCMHD COEs employ a number of strategies to address health disparities.9 For example, Howard University’s Washington, DC / Baltimore Research Center on Child Health Disparities formed in 2001 is the only center funded by the Center on Minority Health that is focused exclusively on child health disparities. The partnership between Howard University Department of Pediatrics, Children’s National Medical Center, and the Johns Hopkins University Department of Pediatrics describes as its major goal “to conduct original and innovative research to improve health in communities of color and reduce child health disparities in violence-related injuries and exposure, substance use, and chronic diseases such as childhood obesity, diabetes, and asthma. This focus is based on evidence that adult health disparities have their origin in child health disparities and that social factors are important determinants of both child and adult health disparities in this country.”7 Strategies such as those implemented by the Howard University’s Washington DC / Baltimore Research Center on Child

Health Disparities help to increase the parities report, 2003. Rockville, MD. pool of investigators from health disparity 2. U.S. Department of Health and Human populations through the provision of opServices (2009, June 9). HHS Secretary portunities for research training and faculty Sebelius releases new report on health development. Other NCMHD COEs disparities: Minorities, low income develop partnerships that have created Americans more likely to be sick, less likely innovative studies into various conditions to get care [Online press release]. Resuch as breast, prostate, and pancreatic trieved from http://www.hhs.gov/news/ cancers; human papillomavirus; HIV; and press/2009press/06/20090609c.html cardiovascular disease. In addition, the 3. Mead, H., Cartwrigt-Smith, L., Jones, collaborations help disseminate health K., Ramos, C., Siegel, B. Woods, K. (2008). information to underserved populations Racial and disparities in U.S. Health care: A and increase the participation of health chartbook. The Commonwealth Fund. disparity populations in clinical trials.9 4. Agency for Health care Research and In closing, currently and in the future, Quality (2008). National health care dismedical students, residents, physicians, parities report. Rockville, MD. physician-scientists, biomedical research5. Health Resources and Services Adminers, and faculty will continue to be central istration. (2006). Sixth annual report to actors in the fight against health disparities. the secretary of the U.S. Department of As this brief summary demonstrates, they Health and Human Services and to conwill be working in sophisticated networks gress. Rockville, MD. of academic health centers, government 6. Carrasquillo, O., Carrasquillo, A. I., Shea agencies, and community partnerships to S., “Health insurance coverage of immicarry the torch that lights the way toward grants living in the United States: Differthe elimination of health disparities, and ences by citizenship status and country of better health and health care for all. origin,” American Journal of Public Health, 2000: 90, 6, 917-923.

Acknowledgements 7. Prudent N. Ruwe, M.B., Meyers, A., Special thanks to Lily May Johnson, MS, Capitman, J. (2005). “Health-care access manager, Diversity Policy and Programs, for children of immigrants.” In: Satcher, Association of American Medical Colleges D., Pamies, R.J., eds. Multicultural Medicine.

(AAMC); Ann Steinecke, PhD, director, (New York: McGraw-Hill.) 139-152.

Council of Deans, AAMC; Steven Shive, 8. National Institutes of Health (2007).

PhD, associate professor, East StroudsBiennial report of the director, National burg University; Delcora Williams, acting Institutes of Health, fiscal years 2006 & Acquired Immune Deficiency Syndrome 2007. Bethesda, MD. (AIDS) program manager, AIDS Secretar- 9. Pollock, H.F., Rice, A.J., & Echenberg, iat - Ministry of Health of Antigua, Social D., “Dental health of recent immigrant Transformation and Consumer Affairs; and children in the Newcomer Schools, San Lois-ellin Datta, PhD, past president, Datta Francisco,” American Journal of Public Health, Analysis.

1987: 77, 731-732.

References 1. Agency for Health care Research and Quality (2003). National health care dis-

Journal for Minority Medical Students 11

A

physiatrist is a doctor who treats medical conditions that can cause pain or limit function. Also called physical medicine and rehabilitation (PM&R) physicians, physiatrists provide a full spectrum of care from diagnosis to treatment and rehabilitation to restore maximum health and quality of life. This multidisciplinary specialty approach allows us to treat a wide range of patients from children to adults in an inpatient and/or outpatient setting. The physiatrist diagnoses and treats congenital anomalies, amputations, cerebral palsy, back and neck pain, spinal cord injury and other function limiting conditions.

Physiatrists perform electromyography/nerve conduction studies, write prescriptions for physical/occupational therapy, wheelchairs, braces and prostheses; and various types of spine injections.

Physiatrists treat conditions of the bones, muscles, joints, brain and nervous system, which can affect other systems of the body and limit a person’s ability to function. Example: A 56-year-old man has a stroke, leaving him temporarily unable to work and depressed. His physiatrist designs a comprehensive rehabilitation program, working with a neurologist to evaluate the brain’s adjustment to stroke, an occupational therapist to work on regaining motor skills, and a psychologist to help the man cope with his depression.

Physiatrists treat people, not just symptoms. By evaluating the impact of a condition on the whole person – medically, socially, emotionally and vocationally, the physiatrist help their patients understand and take control of their health.

world CHANGE you let the

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Child Family Health International Open to Students of the Health Sciences

Bolivia – Ecuador – India – Mexico – South Africa “Sure I got credit for my time in India and the clinical work might help me get into medical school. However, the mentality I have developed, my heightened perception of others, an appreciation of diversity and a newfound patience with life are the most important things I will take away from this experience.” Nicole Tierney, Infectious Diseases in Mumbai, India

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AMa

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Working to end disparities in health care Sonja Boone, MD, Director, Physician Health and Health care Disparities, AMA Fred Donini-Lenhoff, MA, Director, AMA Department of Medical Education Products Michael Kutnick, Manager, AMA Constituency Groups

R

acial and ethnic disparities in health care continues to be a vexing issue, with multiple dimensions and causes, including primary care physician shortages, inadequate levels of cultural competence among health professionals, lack of health insurance or under-insurance, and a challenging socioeconomic environment for those in medically underserved areas.

Nonetheless, committed medical students, physicians, and other health professionals are working hard to ameliorate the root causes of disparities and make a difference in the lives of their patients. The American Medical Association (AMA) is helping lead these efforts through the following activities.

The Commission to End Health Care Disparities Formed in 2004 as a collaborative effort of the AMA and the National Medical Association (NMA), the Commission focuses on four strategies:

• increasing awareness of disparities; • promoting better data gathering; • promoting workforce diversity; and • increasing education and training At its fall 2009 meeting, held in El Paso, TX, the Commission discussed and took action on critical issues relevant to health care disparities, particularly in light of current discussions of health system reform. Earlier this year, for example, the Commission wrote a letter to President Obama urging that any reform plan include: • access to high-quality health care coverage, including a focus on prevention, wellness, chronic disease management, and mental health; • collection of demographic and epidemiologic data throughout the system to detect and understand the causes of disparities and focus efforts to eliminate them; and

• strengthening the health care workforce, increasing both its diversity and cultural competence.

The letter, signed by Commission co-chairs Nancy H. Nielsen, MD, PhD, AMA immediate past president, and Sandra Gadson, MD, NMA past president, is available at: www.ama-assn.org/ama1/ pub/upload/mm/433/cehcd-obamaletter.pdf The work of the Commission in this regard was noted in an American Medical News article, available at: www.ama-assn. org/amednews/2009/07/13/prsb0713. htm For more information on the Commission, see: www.ama-assn.org/go/enddisparities Minority Scholars Awards To promote diversity and help with the rapidly rising cost of medical education, the AMA Foundation presented

Journal for Minority Medical Students 13

Ama

perspective

The AMA Doctors Back to School program was developed to increase the number of minority physicians and ultimately work toward eliminating racial and ethnic health disparities.

12 outstanding medical students from across the country with $10,000 Minority Scholars Awards earlier this year. The awards are given in collaboration with the AMA Minority Affairs Consortium.

The awards recognize scholastic achievement, financial need, and personal commitment to improving minority health among first - or secondyear medical students in groups defined as “historically underrepresented” in the medical profession. Less than seven percent of U.S. physicians fall within these groups, which include African American/Black, American Indian, Native Hawaiian, Alaska Native and Hispanic/Latino.

A list of the 2009 scholarship recipients is available at: www.ama-assn. org/ama1/pub/upload/mm/367/ minority-scholars-award-release.pdf Doctors Back to School program Launched in 2002, the AMA Doctors Back to School (DBTS) program was developed to increase the number of minority physicians and ultimately work toward eliminating racial and ethnic health disparities. The program sends minority physicians and medical students into the community as a way to introduce children to professional

14 Journal for Minority Medical Students

role models. DBTS aims to show kids of all ages, especially those from underrepresented racial and ethnic groups, that medicine is an attainable career option for everyone.

Recently, for example, more than 600 students of Bel Air High School in El Paso, TX, received a visit from AMA President J. James Rohack, MD; NMA President Willarda Edwards, MD; and National Hispanic Medical Association President Elena Rios, MD, as part of a DBTS event.

For more information, see: www. ama-assn.org/go/dbts Continuing Medical Education (CME) programs The AMA offers many CME programs in multiple formats. Two that are particularly relevant to those interested in addressing disparities are: • Strategies to Improve Communication with Hispanic/Latino Patients.

Covers skills needed to effectively communicate with a low-literate Spanish-speaking population, including a focus on clarity, cultural humility, and message confirmation.

• Educating Physicians on Controversies and Challenges in Health: Health

Care Disparities Among RacialEthnic Minority Patients. Provides physicians with a broad overview of health disparities among minority patients, as well as strategies to enhance services for these patients, including building trust and addressing language barriers.

See: www.ama-assn.org/ama/pub/ physician-resources/public-health/ eliminating-health-disparities/cmeactivities.shtml Ending Disparities e-Letter This free e-mail newsletter is distributed monthly to share periodic news, information, and updates related to eliminating disparities, and to keep readers abreast of the AMA’s activities/ projects in this regard. To subscribe, send an e-mail to Tanya Lopez at tanya. lopez@ama-assn.org or call (312) 4644616.

OFFICE OF STUDENT AFFAIRS/DIVERSITY

The Medical College of Wisconsin (MCW) recognizes the importance of allowing its medical students the opportunity to exchange ideas with others who have talents, backgrounds, viewpoints, experiences and interests different from their own. To this end, the Medical College is committed to the recruitment, admission and graduation of talented students from diverse backgrounds.

SUMMER ENRICHMENT PROGRAMS

Academic programs are offered to local high school, resident and nonͲresident college level students through a series of educational pipeline programs. The Diversity Summer HealthͲrelated Research Education Program (DSHREP) allows undergraduate, graduate and medical students from diverse backgrounds, the opportunity to engage in a tenͲweek summer fellowship for students interested in the areas of cardiovascular, pulmonary and hematological research. The program is sponsored by the National Institutes of Health, Lung and Blood Division and offers a monthly stipend to participants.

ACADEMIC SUPPORT

The Office of Student Affairs/Diversity has implemented several new initiatives to support your successful study here at MCW and to provide enrichment experiences. We have a student counselor who is available to you whenever you need academic, personal or other counseling.

We also have our Academic and Career Development Specialist, who provides tutoring in areas such as study skills, testͲtaking strategies and helps develop a board preparation course, ensuring students’ ability to master the basic and clinical sciences.

STUDENT SUPPORT GROUPS AND COMMUNITY OUTREACH PROGRAMS

x

Student National Medical Association (SNMA) x La Raza Medical Association (LaRaMA) x American Medical Student Association (AMSA) x Physicians for Social Responsibility (PSR) x Applicant Host Program (AHP)

MEDICAL COLLEGE OF WISCONSIN AFFILIATED HOSPITALS, INC (MCWAH) The Medical College of Wisconsin Affiliated Hospitals (MCWAH) is a consortium that was established in 1980 to facilitate the administration of Graduate Medical Education (GME) programs conducted jointly by the Medical College of Wisconsin in conjunction with 10 health care institutions in the greater Milwaukee area; specifically Froedtert Memorial Lutheran Hospital and Children’s Hospital of Wisconsin are directly located on the campus grounds. In addition, MCWAH ensures the accreditation of its training programs by the Accreditation Council of Graduate Medical Education (ACGME). Currently, MCWAH employs 800 housestaff in 75 accredited residency and fellowship programs.

For more information contact Dawn St. A. Bragg, PhD Assistant Dean Student Affairs/Diversity (414) 456-8734 Trenace L. Cole Recruiter/Student Counselor Student Affairs/Diversity (414) 456-8735 email: tcole@mcw.edu Karen Shanahan, M.S. Ed. Academic & Career Development Specialist Student Affairs/Diversity (414) 456-8583 kshanaha@mcw.edu

NMA

perspective

HIV: Take a Step Toward Protecting Yourself and Others

by Willarda V. Edwards, MD, MBA President, National Medical Association

W

orldwide, there are an estimated 33 million people living

with HIV. In the United States, more than one million Americans are estimated to be living with the disease. An estimated 56,300 Americans become newly infected with HIV each year. On average, that’s one new infection every nine-anda-half minutes.

We also know that one in five of those living with HIV don’t even know they have the disease, and may be unknowingly transmitting the disease to others. Even more startling is that only 38% of adults say they have talked with their doctor about HIV. Too many Americans mistakenly believe that HIV is no longer an urgent problem in this country. This epidemic is a national crisis and each of us must expand access to prevention and testing.

The National Medical Association (NMA) is partnering with the U.S. Centers for Disease Control and Prevention’s

action for themselves, their partners, and their communities.

African Americans face the most severe rates of HIV infection in the nation. The HIV/AIDS epidemic in the African American community made its “debut” in the early 1980s and is entering its third decade as one of this country’s most critical and challenging health issues.

Among African Americans, HIV/AIDS has produced especially grave outcomes.

While African Americans represent approximately 12% of the U.S. population, they account for almost half of all new infections and nearly half of all people living with HIV in the U.S. Unfortunately, 24% of African Americans reported that they have not been tested for HIV because their physician never recommended Willarda V. Edwards, MD it. As one of 14 member organizations of (CDC) national HIV prevention campaign, the Act Against AIDS Leadership InitiaAct Against AIDS, to remind Americans tive, the NMA is leveraging our influence, that HIV continues to pose a serious resources, and member physicians to prohealth threat in the U.S. and encourage mote HIV awareness, prevention, and care everyone to get the facts they need to take within African American communities.

Journal for Minority Medical Students 17

Major strength lies in the quality of our faculty, residents and students

office for diversity house staff and faculty affairs

Vanderbilt School of Medicine is seeking to bring the best residents, fellows and faculty from all ethnic, racial and gender groups into this great Medical Center. As we broaden our reach, you will enrich our environment and make Vanderbilt a leader in promoting people of diverse backgrounds.

We invite you to visit Vanderbilt and learn more regarding our training programs or visit our website at www.mc.vanderbilt.edu/gmediversity.  U.S. News & World Report listed Vanderbilt Medical Center 16th on its 2009 “Honor Roll” of hospitals, a tribute reserved for a select group of institutions labeled the “best of the best.”  Vanderbilt is the third fastest growing health sciences center in the country in research funding.

 The Monroe Carell Jr. Children’s Hospital at Vanderbilt has been ranked No. 15 on a listing of best children’s hospitals in the U.S. by Parents magazine, the third national accolade earned by the hospital this year.  Our office supports the Minority House Staff for Academic and Medical Advancement (MHAMA), an organization of Vanderbilt house staff and advi sors. See website: www.mc.vanderbilt.edu/mhama.

Contact us by e-mail at omecca.b.dale@vanderbilt.edu or call 615-343-7958 André L. Churchwell, MD Associate Professor of Medicine (Cardiology) Associate Dean for Diversity in Graduate Medical Education and Faculty Affairs Vanderbilt University School of Medicine

www.mc.vanderbilt.edu/gmediversity

nma

perspective

HIV/AIDS is an epidemic that must be fought with everyone’s involvement.

Here are a few ways you can join the fight against AIDS in your community: • Encourage your family, friends, colleagues and neighbors to join the World AIDS Day Campaign; visit http://www.worldaidscampaign.org for more information.

• Get involved with or host a World AIDS Day event within your community. Visit http://www.hhs.gov/ aidsawarenessdays/days/world/index. html for event details.

• Know the facts about HIV/AIDS. Visit http://www.actagainstaids.org

for more information.

• Know your HIV status. You can get tested at your doctor’s office. There may also be free or low-cost testing sites in your area. To find additional HIV testing sites near you, text your ZIP to “KNOWIT” (566948), or visit http://www.HIVtest.org.

• If you’re a health care provider, you play a critical role in HIV prevention.

Your patients listen to you. Speak openly with them about HIV about reducing risk behaviors, getting tested and staying healthy.

By committing to the fight, you can

take responsibility for your health and protect loved ones against HIV. It is important to get the facts, know how you are at risk, how it is spread, and take action to protect yourself.

HIV/AIDS is an epidemic that must be fought with everyone’s involvement and a persistent effort on all fronts. It will take our collective will to continually reinforce key messages on HIV/AIDS prevention, testing, and treatment to adequately put muscle behind the words. We cannot afford to do less.

Journal for Minority Medical Students 19

Medical Student Programs at Harvard Medical School Boston, Massachusetts

VISITING RESEARCH INTERNSHIP PROGRAM (VRIP)

VISITING CLERKSHIP PROGRAM (VCP)

Sponsored by the Harvard Catalyst Program for Faculty Development and Diversity, VRIP is an 8-week mentored summer research program open to 1st and 2nd year U.S. medical students, particularly underrepresented minority and/or disadvantaged individuals from accredited U.S. medical schools.

VRIP is designed to enrich medical students’ interest in research and health-related careers, particularly clinical/translational research careers. VRIP offers students housing as well as a stipend and transportation reimbursement for travel to and from Boston.

Applicants must be U.S. citizens.

Sponsored by the Harvard Medical School Minority Faculty Development Program, VCP is open to 4th-year and last quarter 3rd-year minority medical students in good standing at U.S. accredited medical schools who wish to participate in a clerkship in any discipline at Harvard Medical School (HMS) affiliated hospitals. Housing and financial assistance towards transportation expenses to and from Boston are available. Students are assigned a faculty advisor, provided the potential to network with HMS residency training programs and have access to the medical school library, seminars and workshops.

Clerkships are offered year-round. Applications must be submitted 3-6 months in advance of the desired rotation.

For more information on Harvard Catalyst programs please contact: Vera Yanovsky, Program Coordinator Phone: 617-432-1892 E-mail: pfdd_dcp@hms.harvard.edu Web Site: www.mfdp.med.harvard.edu/catalyst

For more information please contact: Jo Cole, Program Coordinator Phone: 617-432-4422 E-mail: jo_cole@hms.harvard.edu Web Site: www.mfdp.med.harvard.edu

Program Director: Joan Y. Reede, MD, MPH, MBA Dean for Diversity and Community Partnership Associate Professor of Medicine Harvard Medical School

snma

perspective

SNMA members at University of Buffalo raise funds for Haitian relief

T

he aftershocks were still rattling buildings in Haiti when medical students at University of Buffalo medical students sprung into action to organize events to raise funds for Haiti.

In just three days, the medical school club, Hands Across Borders, and the UB chapter of the Student National Medical Association (SNMA) raised nearly $600 from first- and second-year classes. They are planning fundraising events.

“We have few resources, little time and minimal experience to draw on to help,” says Bridget Buyea, a secondyear medical student and president of Hands Across Borders, in an e-mail to fellow students announcing the effort.

“But I believe that together we can make a worthwhile contribution to the relief effort in the form of money.”

Buyea and Nkem Nweze, copresident of the UB SNMA, also e-mailed medical students suggesting

Dr. Paul Farmer of Partners in Health, Haiti they contribute online to Partners in Health, the organization established in Haiti in 1987 by Paul Farmer and colleagues, which now is a highly regarded,

worldwide health organization.

Farmer is renowned for his medical work in impoverished countries around the globe. In August 2009, he

Journal for Minority Medical Students 21

snma

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“I’m happy to see so many people stepping up and helping,” Nweze said. “These are people’s lives we’re talking about.”

was appointed United Nations Deputy Special Envoy for Haiti by former President Bill Clinton.

“Partners In Health is closely, more intimately tied with the Haitian people,” Nweze said. “We are helping them more indirectly, letting people know that they exist.”

Buyea shares the same sentiment.

“We have all heard of Partners In Health from before we even entered medical school, because of the amazing things they were doing in Haiti and elsewhere,” Buyea said. “We were confident they would use the money

22 Journal for Minority Medical Students

we donated to them well.”

The medical students organized a fundraiser, “Trivia for Haiti,” at a local bar, as well as a fund drive for medical and non-medical supplies. They are also considering organizing a medical student contingent to go to Haiti in the coming months.

“While that may not be feasible at this time,” says Nweze, “the summer months are looking more promising, and we are looking into partnering with the Christian Medical and Dental Association that does annual missions trips to the Hispaniola region.”

Nweze is thrilled that so many students are eager to aid the desperate Haitian population, and is looking forward to the upcoming fundraising events.

“I’m happy to see so many people stepping up and helping,” Nweze said.

“These are people’s lives we’re talking about.”

If you’d like to know more about Partners in Health, go to www.pih.org.

You can donate to Dr. Farmer’s efforts directly through their website.

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Taking Steps to Eliminate Health Disparities How Health care Reform Could Affect the AAPI Community

By Alex Cheng, National Secretary, APAMSA

T

he first year of President Obama’s administration has been dominated by one major issue: health care reform.

It was no surprise, then, that health care reform was at the forefront of this year’s APAMSA National Conference, held this past October in Los Angeles, CA. The opening session included keynote lectures from Assem. Mike Eng (CA) and Assem.

Fiona Ma (CA) and also featured a panel discussion that covered the various plans for reform being discussed in Congress. What these speakers and panelists brought to light was the fact that the Asian American/Pacific Islander (AAPI) community as a whole has great incentives to see health care reform passed— especially in the areas of expanded coverage, equality for legal immigrants, and quality of health care—and we, as the AAPI community, can do something about it.

First is the concept of greater health insurance coverage. At first glance, cen-

Alex Cheng sus data on health insurance reveal that Asian Americans as a group are relatively well insured; specifically, the current three-year data (2006-2008) show that 16.6% of Asians and 18.5% of Native Hawaiians/Pacific Islanders were without

health insurance. These numbers, though higher than those for whites (14.6% for all whites, but 10.7% for “white, not Hispanic”), seem to compare favorably with other minorities (19.7% of Blacks, 31.7% of American Indian/ Alaska Natives, and 32.3% of Hispanics were uninsured). However, an April, 2008, analysis done by the Kaiser Family Foundation and Asian & Pacific Islander American Health Forum broke down the AAPI population further into separate ethnicities, in order to determine rates of insurance among these subgroups. Their report (which was based on data from 2004-2006) revealed that certain subpopulations in fact had greater rates of uninsurance: For instance, Korean Americans had the highest overall rate of uninsurance, at 31% of nonelderly; 21% of Vietnamese nonelderly were uninsured, and there were also high levels of uninsurance for Native Hawaiians/Pacific Islanders (24%)

Journal for Minority Medical Students 23

45"5&/ *4-"/% 6/*7&34*5: )041*5"North Shore-Long Island Jewish Health System Internal Medicine Residency

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Our traditional Internal Medicine Program has a history of producing high quality, board certified general internists and medical specialists. Some highlights include: UÊ ÊiÝ«> `i`Ê> LÕ >Ì ÀÞÊiÝ«iÀ i Vi]Ê V Õ` }Ê Õ Ì « iÊëiV > Ì ià UÊ-«iV > âi`ÊVÕÀÀ VÕ >Ê ÌÊi « >à âi`Ê Ê Ì iÀÊ«À }À> ÃÊ V Õ` }ÊiÛ `i Vi L>Ãi`Ê i` V iÆÊ L ÃÌ>Ì ÃÌ VÃÊ> `Êi« `i }ÞÆÊ«ÀiÛi Ì ÛiÊ i` V iÊ> `Ê«ÕL VÊ i> Ì ÆÊÃÕÀ} V> ÊÃÕLëiV > Ì iÃÊ­ /]Ê ÀÌ «i` VÃ]ÊLÀi>ÃÌÊV V]ÊiÌV°®ÆÊ>` iÃVi ÌÊ i` V iÆÊ}iÀ >ÌÀ VÃÆÊÜ i ¿ÃÊ i> Ì ÆÊ `iÀ >Ì }ÞÆÊ «> >Ì ÛiÊ i` V iÆÊ «> Ê > >}i i ÌÆÊ Ã« Ì> ÃÌÊ i` V iÆÊ «iÀ «iÀ>Ì ÛiÊ i` V iÆÊiÌV° UÊ Ê Ê L >À`Ê ViÀÌ v V>Ì Ê iÝ> >Ì Ê «>Ãà }Ê À>ÌiÊ vÊ Ç¯Ê v ÀÊ ÕÀÊ V>Ìi} À V> ]Ê Ê Àià `i ÌÃÊ­ ÛiÀÊÌ iÊ«>ÃÌÊxÊÞi>Àî UÊ"ÕÀÊ Ã« Ì> ÊÜ>ÃÊ>Ü>À`i`Ê>ʸ iÃÌÊ*À>VÌ ViøÊV i `>Ì ÊLÞÊÌ iÊ Êv ÀÊour work in competency care of Systems-Based Practice

• Exposure to state-of-the-art medical care including: bone marrow transplantation; sleep medicine; all forms of dialysis; open-heart surgery; advanced critical care; stroke unit; epilepsy unit • Full-time (24/7), on-site supervision by board certified hospitalists and intensivists

• Residents serve as mentors to high school students in a minority medicine pipeline program via a New York state grant

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Apamsa

perspective

Better [insurance] coverage does not necessarily translate into better access or quality—especially for AAPIs. and other South Asians (20%).

These data are significant because they reveal significant gaps in coverage for certain AAPI subpopulations that could benefit from the current health care reform efforts. In the same KFF/APIAHF report, for example, nonelderly Koreans were found to be least likely to have employer-sponsored health coverage (49%). This is not surprising because Korean workers are more likely to be employed with smaller firms and businesses, which are in turn less likely to offer health care coverage. However, a look at the recently passed House of Representatives bill (H.R. 3962, the Affordable Health Care for America Act) reveals that it requires employers to provide coverage to their employees or pay into a Health Insurance Exchange Trust Fund (with some exceptions, of course). Coupled with the presence of a strong public option, however, as well as the addition of credits to aid certain small businesses in paying for such plans, these reforms could begin to remedy holes in coverage for the Korean community.

In addition, the expansion of Medicaid to 150% of federal poverty level (FPL), as well as the creation of

a Health Insurance Exchange, could aid in helping subgroups that have lower incomes obtain health insurance.

Also, in light of the fact that 90% of uninsured Americans (Asian or not) fall below 400% of FPL, H.R. 3962 details that credits would be available to individuals and families with incomes up to 400% of FPL, in order to purchase coverage through the Exchange. Though popular belief is that Asians outperform all other groups in terms of socioeconomic status, data on income for subgroups such as Vietnamese and other Southeast Asians (Cambodian, Hmong, Laotian) reveal that median family incomes are still lower than those for the average American household, and these subgroups might benefit proportionally from the new changes.

Furthermore, H.R. 3962 gives legal immigrants equality with other citizens in terms of access to subsidies for health insurance (i.e. no waiting periods) and opens new doors for that subset of the AAPI community.

Unfortunately, the equal access legal immigrants would have to these subsidies would not be extended to programs such as Medicaid and State Children’s Health Insurance Program.

There is currently a five-year waiting

period imposed on legal immigrants applying for Medicaid, and legal immigrants do not currently have unrestricted access to apply to SCHIP; the House bill does not reverse either of these restrictions. Even so, equal access to subsidies is a step in the right direction, and will at least aid legal immigrants in purchasing health care coverage.

As much as these reforms will increase the number of people with coverage, however, they may not effectively address the questions of access and quality. Better coverage does not necessarily translate into better access or quality, especially for AAPI groups who might be less-informed or less-educated, or have language or cultural barriers preventing them from utilizing health care efficiently and effectively if and when they are finally covered by a plan. An ideal health reform plan would take into account such factors. Presumably, some individuals and families may not be aware of the usefulness of their subsidies towards health care and may just prefer (or end up unknowingly) having to pay the proposed 2.5% income tax.

As such, these reform efforts will not reach their full potential without educating key populations on the

Journal for Minority Medical Students 25

Apamsa benefits of purchasing health care coverage. The area of community and patient education is one through which I believe APAMSA, and the medical community in general, can make a serious impact. This might be manifested through spreading information at community health services, churches, and other cultural centers, similar to how others have spread awareness of diseases, such as hepatitis B. In addition to education at the local level, we can emphasize AAPI-specific research and education at the institutional

26 Journal for Minority Medical Students

perspective

and national levels. For instance, we can spread awareness of diseases such as liver and stomach cancers, and hepatitis B—diseases that have higher incidences in Asians or certain Asian subpopulations— that are currently underrepresented in research and traditionally less well funded. We can also continue to emphasize that disaggregation of the data is key for characterizing trends in health in the AAPI community. This can be done through proposing revised data collection methods, which would further separate

Asian Americans and Pacific Islanders into subcategories to distinguish the Asian American subgroups.

It remains to be seen whether health care reform will be passed these next few months, if at all. And though the current proposals are far from perfect, and may not soon rectify the many disparities regarding AAPI health, H.R. 3962 and the discussions in Congress are the beginnings of an effective plan for health care reform.

The very least we can do is to continue to learn more about the options, to advocate

Apamsa for our voices to be heard, and to educate our patients on the issues at hand.

References 1.

Race, Ethnicity & Health Care: Fact Sheet. Apr 2008. The Henry J. Kaiser Family Foundation and APIA Health Forum 2.

Immigrants’ Health Coverage and Health Reform: Key Questions and Answers. September 2009. The Henry J. Kaiser Family Foundation 3.

The Uninsured: A Primer. October 2009. The Henry J. Kaiser Family Foundation. http://www.kff.org/uninsured/upload/7451-05.pdf 4.

The Health Care Reform Imperative for the Asian American Community. Asian American Justice Coalition. http://www.

perspective advancingequality.org/attachments/wysiwyg/1297/Health careReformImperativeAsianAmericanCommunity.pdf 5.

The Affordable Health Care for America Act (H.R. 3962) 6.

Advancing Asian American Health Through Reform. Asian American Justice Coalition. http://www.advancingequality.org/ attachments/wysiwyg/7/AAHealth care.pdf 7.

Census Report 2009. http://www.census.gov/ prod/2009pubs/p60-236.pdf 8.

Health Inequities in the Asian American Community. Asian American Justice Coalition. http://www.advancingequality.org/attachments/wysiwyg/1/AAJC_Health_Disparities.pdf 9.

Combating AAPI Health Disparities Through Collective Efforts of Research and Advocacy, By Christopher Vanichsarn JMMS

Cincinnati Children’s Hospital Medical Center A National Leader in Pediatrics The Cincinnati Children’s Pediatric Residency program is dedicated to quality education; outstanding patient care; innovative discovery through clinical, laboratory, and outcomes research; and advocacy for their patients and families. You’ll have the opportunity to work sideby-side with excellent residents and faculty from all over the world, and with a variety of patients from all different ethnic and socioeconomic backgrounds.

The large number of subspecialty programs at Cincinnati Children’s allows the medical center to attract a wide variety of patients, and their patient volume ensures that your experience as a resident is comprehensive. In fact, almost every aspect of a residency at Cincinnati Children’s can be tailored to meet an individual’s needs. Each year they train approximately 175 residents in a variety of programs: •Categorical Pediatrics Pediatric Primary Care Track Pediatric Research Track Global Health Track •Internal Medicine / Pediatrics •Physical Medicine and Rehabilitation / Pediatrics •Psychiatry / Child Psychiatry / Pediatrics (Triple Board) •Human Genetics / Pediatrics •Neurology / Pediatrics

“The Cincinnati Children’s Pediatric Residency Program provides you with the opportunity to work side-by-side with excellent residents from all over the world.

You will work within all areas – from primary to quaternary care – with a variety of patients from different ethnic and socioeconomic backgrounds. We are unique in our individualized attention to each one of our resident’s needs and our dedication to family-centered care in our daily work. Upon graduation our trainees enter outstanding fellowships and primary care positions throughout the country. We look forward to answering any of your questions and making this the best experience in your professional career.”

Javier A. Gonzalez del Rey, MD, M.Ed. Director, Pediatric Residency Training Programs

For more information: www.cincinnatichildrens.org

Journal for Minority Medical Students 27

MOUNT SINAI SCHOOL OF MEDICINE Elmhurst Hospital Center & Queens Hospital Center

C

hallenging career opportunities at major teaching affiliates of the Mount Sinai School of Medicine. These two facilities are both 911 receiving centers. Elmhurst Hospital is also a Level I Trauma Center and Queens Hospital is a Certified Heart Station. Serving culturally diverse Queens County, these two centers offer unique training settings for learning clinical medicine.

Mount Sinai offers the following ACGME approved residency training programs at these institutions: All programs begin each year on July 1st.

Elmhurst Hospital Internal Medicine

• Primary Care (categ.) • Preliminary year

Pediatric Primary Care (categ.)

Psychiatry - Adult (categ.)

Psychiatry - Child

Queens Hospital

Internal Medicine Obstetrics/Gynecology

American Dental Association approved: General Practice Dental Residency (one year)

For more information and an application please call or write:

Mount Sinai Services Elmhurst Hospital Center House Staff Manager 79-01 Broadway, #A1-27C Elmhurst, NY 11373 718/334-2127

Mount Sinai Services Queens Hospital Center

House Staff Manager Room #N-633 82-68 164th Street Jamaica, NY 11432 718/883-4032

amsa

perspective

Health Equity: A Journey of Discovery A report from the AMSA/SNMA 2009 Health Equity Leadership Institute

By Sameen Farooq, Brooklyn College

A

s I boarded the Bolt Bus in New York headed for Washington, DC, I thought about my experiences as a premedical student and tried to gain a frame of reference for the activities I was soon to take part in as a Health Equity Leadership Institute (HELI) participant.

The process to unravel health equity began with the application, which proved to be thought-provoking and intellectually stimulating. I still recall the questions posed around race, gender, and social class, as they offered a great challenge of understanding the nature of not only the medical condition but also the social constraints that often are determinants of health and disease. Having never been placed among a group of like-minded individuals, I felt a sense of relief and awe as each of the other 14 medical and premed attendees brought with them experiences and insights that rendered our discussions more meaningful and powerful.

HELI was divided into three days which focused on education, service/ grassroots efforts, and policy advocacy.

The education aspect was thoroughly in-

Sameen Farooq triguing, as it exposed us to the grim realities of the current U.S. health care system.

It was amazing to read statistics and see graphs, but it was even more powerful to hear real stories from the medical students about their encounters with patients who were underinsured, uninsured, or faced other socio-medical constraints.

Day One Going into HELI, I knew that the U.S. health care system faced huge challenges in the realms of providing quality and affordable health care for all. It became apparent that I had much more to explore as the participants tried to answer a health equity quiz relating to the PBS documentary, “UNNATURAL CAUSES: Is Inequality Making Us Sick?�. The questions discussed the U.S. health care system and shed light on cost, coverage, population statistics involving mortality/morbidity, sociological and economical issues shaping health in the U.S. I got 12 of the questions wrong and realized my lack of sociomedical literacy.

We watched the documentary, which helped clarify the questions, and gave background information on the issues that cause inequity in the U.S. when compared with other developed nations. The education day also involved an activity that dealt with resource allocation and provided a way to examine the various social categories that can impact how individuals interact with one another, their communities, and society at large. We spent time talking

Journal for Minority Medical Students 29

Sunday, February 28, 2010 Harvard Medical School Joseph B. Martin Conference Center The New England Science Symposium, established in 2002, promotes careers in biomedical science. The aim of the symposium is to encourage postdoctoral fellows; medical, dental and graduate students; post-baccalaureates; college and community college students (particularly African-American, Hispanic and American Indian/Alaska Native individuals) to present their research projects through oral or poster presentations, to exchange ideas that can further their career development

Deadline for Abstract Submission: December 1, 2009 Abstracts should be submitted by postdoctoral fellows and students involved in biomedical or health-related scientific research.

To submit an abstract or to register: www.NewEnglandScienceSymposium.org All abstracts will be reviewed and applicants notified of their acceptance before the end of January 2010.

and to expand their professional network.

Sponsors/Funders: Harvard Medical School Office for Diversity and Community Partnership; Biomedical Science Careers Program; Harvard Catalyst Program for Faculty Development and Diversity; Genzyme Research; National Institutes of Health, DHHS; Office of Minority Health, DHHS; Harvard FAS Center for Systems Biology and NIGMS Center for Modular Biology; Harvard Medical School Department of Systems Biology and Cell Decision Process Center; Novartis.

CONTACTS Harvard Medical School Geeta Chougule Phone: 617.432.7770 geeta_chougule@hms.harvard.edu Biomedical Science Careers Program Lise D. Kaye Phone: 617.432.0552 lise_kaye@hms.harvard.edu

BSCP

Amsa

about the roles economics and social class play in determining access to care, as we accounted for the differences in care associated with class, race, and gender.

In another activity, we were given the challenge of addressing stereotypes. With markers in our hands, we went around the large lobby area and wrote down all the things that came to mind as we thought about words such as “Asian,’ ‘black,’ ‘gay,’ ‘Muslim,’ ‘Hispanic,’ and numerous other descriptive words. It soon became apparent that there was not enough paper for us to write down everything we had been told, heard, or in some cases falsely believed about each other. In discussing the stereotypes, we had to confront issues of race, culture, and social worth as predictors for how we view others and access social systems. During the activity some of my fellow participants shared candid viewpoints. Closing out the day, we had a presentation on issues of cultural competency and social language as they play roles in the practice of medicine.

Day Two The next day of service built upon our educational work. While enjoying breakfast, we heard an interactive presentation on community health and the intricacies involved with organizing health fairs. After the presentation, we all shuttled into cars and headed to the Contee A.M.E. Zion Church in the Deanwood neighborhood of Northeast DC. One of the most shocking aspects of the service was the clear demarcations of disparity present within the community. Even though we could see the White House in the distance, this neigh-

perspective

borhood was by no means representative of the city that is home to both houses of Congress and numerous other important historical and cultural landmarks. Having had the opportunity to conduct community service learning work in South Africa, I had to remind myself that I was not thousands of miles away from the U.S. We conducted community health surveys and learned that this population had access to no major hospital center, and the closest tertiary care facility was nearly 40 minutes away. In addition, we helped run a mini health fair at the church, and the medical students performed basic health screenings and provided information on chronic diseases.

On our way back to the AMSA house in DC, we were presented with the challenge of shopping for healthy food on a meager budget of $15, which was equal to the daily take-home pay that a member of the Deanwood neighborhood would have to feed a family of four. It was a challenge to meet the nutritional requirements that doctors often place upon their patients unaware of the issues facing their patients in their households and communities, as well as the lack of access to healthy, affordable foods in less affluent neighborhoods.

Day Three The night before our final day, policy day, we had an insightful presentation on the Health Equity and Accountability Act of 2009 by AMSA/SNMA health policy experts. It was amazing to build upon the work of the last two days as we headed to the halls of Congress armed with stories, experiences, and knowledge of health

equity. We were divided into teams and developed a narrative for the lobby visit.

Early next morning, we packed into vans and headed to Congress. I still recall the pride I felt as I entered one of the Congressional offices to advocate on behalf of the legislation that called for more funding for community health endeavors. The legislation presented ways to increase equity through a focus on nurturing primary care medicine and focus on reducing social and environmental determinants of health in communities across the U.S. At the end of our lobbying visit, we headed back to the AMSA house in DC and we all went our separate ways.

As I look back now, I can firmly state that I made undeniable progress by being a part of this amazing leadership institute.

I consider this experience as truly offering a substantive way to meet passionate individuals, gain first-hand insight, and begin my personal crusade to make health equity a norm, not an exception in our society. _______________________________ Sameen Farooq is a senior in the Macaulay Honors College at CUNY Brooklyn College. He is pursuing a dual degree in Political Science and Biology. He is actively involved with AMSA and is currently working on community health, health equity, and global health projects. He hopes to start medical school in Fall 2010.

Journal for Minority Medical Students 31

4O LEARN MORE ABOUT HOW ) GOT TUITION COVERAGE A SIGN ON BONUS OF

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A MONTH WITH THE .AVY (EALTH 0ROFESSIONS 3CHOLARSHIP 0ROGRAM (030 WHILE GOING TO MEDICAL SCHOOL VISIT NAVYHEALTHCARE COM

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Š 2008. Paid for by the U.S. Navy. All rights reserved.

36 Journal for Minority Medical Students

The Disparities Issue The statistics are daunting.

Half of Hispanics and more than a quarter of African Americans do not have a regular doctor, compared with only one-fifth of white Americans.

And 28 percent of Latinos and 22 percent of African Americans report having little or no choice in where to seek care, while only 15 percent of white Americans report this difficulty.

In this issue we look at what’s being done to move from “citing statistics” to “inciting action.”

We encourage you to learn more about health disparities and join in the effort to bring equality to health care.

disparities & health care reform Health care dominated the Washington agenda for almost all of 2009 and as the year closes, the legislature seems closer than ever to passing a reform bill.

For the millions of Americans who are uninsured, underinsured,

or suffer from the effects of lack of access, there is hope that health reform will help address the fundamental inequities in the health care system and ultimately eliminate the racial and ethnic health disparities that continue to plague the nation.

35

a little background

disparities & health care reform

People of color in the United States are more likely than whites to lack health insurance, to receive lower-quality care, and to suffer from worse health outcomes. The causes of these disparities are broad and complex, ranging from societal issues such as poverty and racism, to health system factors

Income matters—but so do race

disparities, but a recent report esti-

such as access to health care facilities.

and ethnicity.

mated that between 2003 and 2006,

One of the most glaring inequities facing

Not surprisingly, individuals with lower

more than $200 billion could have been

people of color, however, is lack of health

incomes are more likely to be uninsured.

saved in direct medical care expendi-

coverage. New data show that 86.7

This is true for all racial and ethnic

tures if health disparities did not exist.

million people—one out of every three

groups. However, disparities in cover-

The direct and indirect costs attrib-

Americans under the age of 65—were

age persist even as income increases.

uted to health disparities contribute to

uninsured for some period of time dur-

For example, families earning more

the growth of health care costs, which

ing 2007-2008. However, a closer look

than $84,800 annually were more like-

is one of the reasons Congress has

at the numbers reveals alarming racial

ly to be uninsured if they were racial

undertaken health care reform. Health

and ethnic disparities in health coverage.

and ethnic minorities. In this income

care reform has emerged as a prior-

group, almost one-third of Hispanics/

ity for the President and Congress.

People of color were more likely to

Latinos (32 percent), nearly one-fourth

lack coverage.

of African Americans (23.6 percent),

reform legislation is to expand health

Almost half (45.8 percent) of people of

and one-fifth of other racial and ethnic

coverage to the more than 45 million

color under the age of 65 went without

minorities (20.8 percent) lacked cover-

nonelderly individuals who currently lack

health coverage for some or all of

age, compared to 16 percent of whites.

coverage. Other goals of the proposed

the two-year period 2007-2008.

legislation include improving the qual-

ing access to quality, affordable health

ity of care patients receive and reducing

alarming when broken down by race

coverage will go a long way toward

health care costs. Reducing and eliminat-

and ethnicity: More than half of

reducing racial and ethnic health dis-

ing racial and ethnic health disparities is

Hispanics/Latinos (55.1 percent), two

parities. But while health coverage

not a major goal of the proposed legisla-

out of five African Americans (40.3 per-

is necessary, it is not sufficient to fully

tion, but each bill contains a few provi-

cent), and one-third of other racial and

closing the gap. Health care reform

sions specific to racial and ethnic health

ethnic minorities (34 percent) were

proposals must also take into account

disparities, and there are other provisions

uninsured, compared to one-quar-

the unique social, economic, and cul-

not specific to disparities that have the

ter of whites (25.8 percent).

tural needs of communities of color and

potential to impact them, such as the

include strategies to effectively care

coverage expansions proposed in each of

for this rapidly growing population.

the bills. Although people of color repre-

The numbers were even more

People of color were uninsured for significant periods of time.

These findings indicate that expand-

One of the main goals of health

sent one-third of the U.S. population, they

Latinos were uninsured for six months

Health Reform and Communities of Color:

or more. Taken together, more than three-

How might it affect racial and

associated with disparities are shared

quarters of people of color (76.5 percent)

ethnic health disparities?

by everyone through money spent on

were uninsured for six months or more.

It is hard to know the true cost of health

medical care for conditions or events that

More than 80 percent of Hispanics/

36

comprise more than half of the uninsured.

The economic and opportunity costs

disparities & health care reform

rural residents, and people of color live in medically underserved areas, where the shortages already exist.

Several of the health care reform proposals contain provisions aimed at increasing the number of providers, particularly primary care providers, and increasing the number of providers in medically underserved areas.

could have been prevented, among other

credits and cost-sharing subsidies, as

things. Health care reform is a national

four out of five blacks, Hispanics, and

priority, and Congress is considering

American Indians and Alaska Natives

Disparities-Specific Provisions

several proposals that would expand

have incomes below 400% FPL.

Each of the proposals contain provisions specific to health disparities. In

coverage to many of the millions of individuals who currently lack coverage.

Medicaid Expansions – Nearly six

the House bill much of the focus is on

out of 10 of the 25 million nonelder-

providing language services to indi-

ly uninsured individuals with incomes

viduals with limited English proficiency,

below 150% FPL are persons of

while the Senate bill includes provi-

Employer Mandate – People of color

color. The House bill and the Senate

sions to improve the collection of data

are more likely to work at low-paying

HELP Committee bill would expand

on race, ethnicity, primary language,

jobs, and have decreased access to

Medicaid eligibility to include indi-

geographic area, and disability. Other

employer-sponsored coverage com-

viduals with incomes less than

provisions in the proposals address

pared to non-Hispanic whites. Although

150% FPL, including men and child-

cultural competency training for provid-

there are exceptions, the proposed

less adults, while the Senate Finance

ers, and ensuring services and infor-

legislation would require employers to

Committee bill would expand eligibil-

mation provided to individuals are cul-

provide coverage to their employees.

ity to 133% FPL. The federal poverty

turally and linguistically appropriate.

The employer mandate, along with the

level in 2009 is $14,404 for individu-

The House bill would reauthorize the

premium credits and cost-sharing sub-

als and $29,327 for a family of four.

Indian Health Care Improvement Act.

of color to obtain health coverage that

Improving Access to Care:

Other Provisions Related to

would otherwise remain unaffordable.

Community Health Centers –

Disparities: Indian Health Care

Community health centers fill a critical

Improvement Act – Under the House

Health Exchange – The House bill

need for communities of color, as half of

bill, the Indian Health Care Improvement

and Senate HELP Committee bill allow

the patients who receive care at a com-

Act would be reauthorized for the first

individuals with incomes above 150%

munity health center are people of color.

time since 2001. This is a compre-

FPL (133% for the Finance bill), to pur-

Each health reform proposal includes

hensive bill that addresses many of

chase coverage through a newly cre-

funding increases for community health

the needs of the American Indian and

ated health insurance exchange if

centers, which would help them meet

Alaska Native community, including pro-

employer-sponsored coverage is not

the needs of their patient population.

visions to improve health promotion

Expanding Health Coverage

sidies, would likely allow many people

and disease prevention services, pro-

available. To ensure that coverage would be affordable, premium cred-

Workforce Development – Numerous

visions to improve access to care for

its and cost-sharing subsidies, would

reports indicate the health care sys-

urban Indians, and provisions to mod-

be available to people with incomes

tem is experiencing or will soon experi-

ernize facilities where American Indians

up to 400% FPL. Many people of color

ence a shortage of health care profes-

and Alaska Natives receive care.

would be eligible for these premium

sionals. Many low-income individuals,

37

Immigrants – Legal immigrants

disparities & health care reform

would remain eligible for Medicaid.

However, most legal immigrants would continue to be barred from enrolling in Medicaid during their first five years residing in the U.S. Legal immigrants without an offer of credible coverage from their employer, and those with credible coverage through their

care system today are the result of

and ethnic health disparities. While

employer whose premiums exceed a

a myriad of factors, many of which

the coverage expansions proposed

specified percentage of their income

are outside the traditional health care

in the health reform bills will not be

would be eligible to receive premium

system, such as poverty, education,

sufficient to eliminate health dispari-

credits and subsidies on the same

and housing, and which are also not

ties, they are a necessary first step.

basis as citizens. None of the pro-

addressed as part of health reform.

posed bills would allow undocumented

Many of the provisions specific

People of color will likely benefit

from many of the provisions in health

immigrants to enroll in Medicaid or to

to racial and ethnic health disparities

reform, but these provisions are not

receive premiums credits or cost-shar-

included in the health reform propos-

likely to reduce the persistent racial

ing subsidies for coverage through

als rely on grants and demonstration

and ethnic disparities evident in the

the health insurance exchange.

projects. Due to fiscal constraints,

U.S. The disparities-specific provisions

it is likely that many people will be

in the proposed bills will likely have a

Prevention – People of color expe-

left out of the grantmaking process.

very limited impact on the disparities

rience higher prevalence and death

Demonstration projects are help-

in health and health care experienced

rates for many chronic conditions

ful to gather knowledge where little

by many people of color unless they

than whites, and the costs associ-

exists, but unless the findings are

are coupled with more comprehen-

ated with these diseases are high.

implemented in existing programs

sive measures. Like the expansions

All of the bills contain provisions to

or unless new programs are gen-

in health coverage, the disparities-

improve the overall health of the

erated to put the new knowledge

specific provisions in the proposed

population through improved access

into practice, it is unlikely there will

bills serve as an important first step

to proven preventive services.

be a significant reduction in racial

in addressing racial and ethnic health

and ethnic health disparities.

disparities. Given the billions of dol-

Where do we go now?

lars associated with health disparities

Although the elimination of racial and

ing the implementation of the premium

and the goal of reducing health care

ethnic health disparities is not a major

credit and cost-sharing subsidies,

expenditures through health reform,

goal of health reform, each of the

and the benefit design of health plans

the exclusion of more comprehen-

health reform bills contains provisions

within the exchange. Many of the rules

sive measures to address racial and

aimed at reducing health disparities,

and regulations regarding implemen-

ethnic health disparities represents

and others that will likely have an indi-

tation have yet to be written and will

a significant missed opportunity.

rect impact on disparities. However,

be critically important in determining

there are many factors within the

many pieces of the remaining puzzle.

Source

health care system that contribute to

Families First (www.familiesfirst.

health disparities that remain largely

legislation has the potential to signifi-

org) and The Henry J. Kaiser

untouched by the current health reform

cantly impact communities of color

Family Foundation (www.kff.org)

proposals. In addition, the racial and

and their access to health care. It

ethnic disparities evident in the health

also has the potential to impact racial

38

Much remains to be seen regard-

The passage of health reform

economics & health care disparities

How much will it cost to reduce health disparities?

Since the topic of money is on everyone’s mind these days— especially those debating health care reform—we found a recent study that tried to put a price tag on how much it will cost to reduce (or eliminate) health disparities.

economics & health care disparities

40

“Estimating the Cost of Racial and

cost the health care system $23.9 bil-

Ethnic Health Disparities� was a study

lion dollars. Medicare alone spent

done by Timothy Waidmann, PhD,

an extra $15.6 billion while pri-

a senior research associate in the

vate insurers incurred $5.1 bil-

Health Policy Center at The Urban

lion in additional costs due to

Institute in September, 2009. In his

elevated rates of chronic illness among

analysis, he looks into the magnitude

African Americans and Hispanics.

of current cost burdens both nation-

Over the 10-year period from 2009

ally and for several large states for a

through 2018, he estimates that the

select set of preventable diseases.

total cost of these disparities is approxi-

mately $337 billion, including $220 bil-

He estimated that in 2009, dis-

lion for Medicare, and that even with-

parities among African Americans,

out taking into any account projected

Hispanics, and non-Hispanic whites

growth in per capita spending, these

economics & health care disparities annual costs will more than double by

which is an important element in making

2050 as the representation of Latinos

the “business case� for reducing dispari-

and African Americans among the

ties. As Congress and the administra-

elderly increases.

tion make decisions about budgets and national health care reform legislation

Waidmann says that while the moral

that affect disparity reduction efforts,

case for these policies is straightfor-

knowledge of the potential economic

ward, it is also likely that excess dis-

benefits of those programs is crucial.

ease burden imposes economic costs,

Total cost of health disparities

2009-2018: $337 billion

disparities news roundup CARE's Dr. Helene Gayle Tapped to Advise Obama Administration on HIV/AIDS

CARE President and CEO Helene Gayle has been named as the chair of President Obama’s Presidential Advisory Council on HIV/AIDS. "As we organize numerous ways to engage the American people in confronting the HIV epidemic in our country, the Presidential Advisory Council on HIV/AIDS will play a critical role in developing and implementing a National HIV/AIDS Strategy," President Obama said.

"Dr. Gayle brings an intense commitment to fighting HIV/AIDS, and unique experience in advancing public health. I look forward to her leadership and counsel."

The part-time, voluntary post will complement Dr. Gayle's ongoing leadership of CARE, whose fight against global poverty, much like the world's response to HIV and AIDS, is firmly focused on women and girls.

"I would like to thank President Obama and Secretary Sebelius for the opportunity to serve in a fight I feel so passionately about," Dr. Gayle said. "Few things demonstrate how interconnected the world is today more than the AIDS epidemic and the U.S. government's response to it. I look forward to helping shape a strategy that not only promotes research, effective prevention, and quality care but also reflects the underlying reasons people are vulnerable to HIV and AIDS." Why are HIV trends in African-American communities increasingly mirroring those in Africa?

Gayle: If we look at health in general in this country, we know that communities of color are disproportion-

42

ately impacted by a whole range of things, whether it's HIV, diabetes, heart disease, drug use, or teenage pregnancy. Health disparities, in some ways, bring to light existing social and economic inequities overall. In many ways, diseases are a harbinger of social inequities.

Where should immediate attention be focused?

Gayle: The rural South and some urban communities continue to have pockets of very high rates of HIV, increasingly infecting women, and it continues to be a huge problem among young men of color, particularly men who have sex with men.

With numbers surging in African-American communities, does federal funding disproportionately target the white gay male population?

Gayle: People often say the (white) gay community or the black community, and the reality is, they overlap. The group that is most impacted by this epidemic is young men of color who have sex with men, and that is where our resources need to go.

What funding disparities need to be addressed?

Gayle: We have not invested in prevention as much as we probably should. We haven't really put the resources into making sure that people have access to their HIV status. Over half the people who are HIV-infected don't know it and continue to spread the disease.

A new lead in the effort to eliminate cancer health disparities Regardless of an individual’s dietary and lifestyle risk factors, living in a poorer or socioeconomically deprived neighborhood may increase a person’s risk for death.

his was the conclusion of one of many breakthrough studies T presented late last year at the American Association for Cancer Research Frontiers in Cancer Prevention Research Conference.

The researchers behind the NIH-AARP Diet and Health Study found that people living in poorer neighborhoods reported greater health risks, including heart disease and cancer, and were more likely to die sooner. Even after the researchers controlled for factors like diet and smoking, the risk for death increased as the levels of deprivation in the neighborhood increased.

The results of this study go to show that despite steady advancements in the war on cancer, progress continues to elude many populations. A multitude of factors, including socioeconomics, race, ethnicity, gender, education, and geography are all interwoven to put some people at a distinct disadvantage when it comes to cancer and other disease.

More generally, the study reveals how new or unexpected factors can play a significant role in one’s risk of developing cancer. Cancer prevention research like this may help individuals and communities take proactive steps toward better health.

disparities news roundup Racial Disparities In Diabetes Prevalence Linked To Living Conditions The higher incidence of diabetes among African Americans compared to whites may have more to do with living conditions than genetics, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health. The study, from the October, 2009, edition of the Journal of General Internal Medicine, found that when African Americans and whites live in similar environments and have similar incomes, their diabetes rates are similar, which contrasts with the fact that nationally diabetes is more prevalent among African Americans than whites.

In recent decades the U.S. has seen a sharp increase in diabetes prevalence, with African Americans having a considerably higher occurrence of type 2 diabetes and other related complications compared to whites. “While we often hear media reports of genes that account for race differences in health outcomes, genes are but one of many factors that lead to the major health conditions that account for most deaths in the United States,” said Thomas LaVeist, PhD, director of the Hopkins Center for Health Disparities Solutions and lead author of the study.

Some researchers have speculated that disparities in

diabetes prevalence are the result of genetic differences between race groups. However, LaVeist noted that those previous studies were based on national data where African Americans and whites tend to live in separate communities with different levels of exposure to health risks. The study accounts for racial differences in socioeconomic and environmental risk exposures to determine if the diabetes race disparity reported in national data is similar when black and white Americans live under comparable conditions.

Researchers in this study found that within their sample of racially integrated communities without race differences in socioeconomic and environmental factors, prevalence estimates of diabetes are similar between African Americans and whites. According to the study, previous research has demonstrated that when African Americans and whites access similar health care facilities their health care outcomes are more similar.

The study’s authors said their findings support the need for future health disparities research and creative approaches to examining health disparities within samples that account for socioeconomic and social environmental factors.

The study was supported by funding from the National Center on Minority Health and Health Disparities (NCMHD), a center of the National Institutes of Health (NIH).

43

disparities news roundup UCLA Kaiser Center for Health Equality gets $5.2 million grant Health plan and care provider Kaiser Permanente gave $5.2 million to the UCLA School of Public Health to endow the UCLA Kaiser Permanente Center for Health Equality.

The Center for Health Equality is dedicated to improving the health of underserved populations through research, community collaboration, and leadership development. The money will support partnerships with community-based organizations to conduct research and develop programs and strategies to eliminate health disparities.

"This generous funding from Kaiser Permanente will enable the center to expand its ability to bring critical resources and attention to communities with the greatest needs," said

UCLA School of Public Health dean Linda Rosenstock.

Funds will also go toward expanding the center’s training and technical assistance services, including the development and dissemination of multilingual, culturally appropriate materials, distance learning programs, and training tools. The center will place heavy emphasis on attracting and training new talent determined to eliminate disparities.

Center representatives say that stable financial support will allow community leaders and academics to devote sustained efforts toward raising awareness about health disparities, setting priorities and formulating shortand long-range solutions to urgent health issues.

Why is this med student smiling?

Photo courtesy of Vanderbilt University SOM

Because she just found out she can contribute to the Journal. So can youâ€”ďŹ nd out how! laura@spectrumunlimited.com

Insurance grants available to enroll Indian kids Department of Health and Human Services Secretary Kathleen Sebelius is urging tribes and Indian health providers to apply for new grants to enroll Native children in insurance programs meant to aid low-income families. The nation’s top health official announced the availability of up to $10 million in grants aimed at Indian youth who qualify for, but are not yet enrolled in, Medicaid and the Children’s Health Insurance Program.

The Children’s Health Insurance Program Reauthorization Act of 2009 set aside $100 million for fiscal years 2009-2013 to find and enroll eligible uninsured children, including $10 million specifically for Indian health providers.

As called for in the law, grants will be awarded by the Centers for Medicare and Medicaid Services to applicants whose outreach, enrollment, and retention efforts will target geographic areas with high rates of eligible but uninsured American Indian and Alaska Native children.

After the announcement, the National Indian Health Board (NIHB) noted that Native children tend to live in isolated areas and are uninsured at higher-than-average rates. “ This funding will save lives. Meeting the health care needs of our children today is a key in addressing some of the health disparities that our communities face now,” assessed Reno Keoni Franklin, chairman of the NIHB.

Meharry hopes to turn grant into cures with $21.4M to combat health disparities among minorities Imagine being able to thwart HIV with a cream or prevent a baby from premature birth in the early stages of pregnancy with a simple urine test. Meharry Medical College researchers already know they can do these things in the lab. But now they need to prove it in the real world.

The largest research grant in the school's history will help Meharry turn its clinical discoveries into new preventions, cures, and tests for HIV/ AIDS, premature labor and fibroid tumors.

The $21.4 million federal grant will make the difference between just finding the cures in the lab and actually putting the cures into action, according to Dr. Wayne Riley, president and chief executive officer for Meharry.

"We take it from the lab to the bedside," Riley said. "If it's not a cure, then a prevention to slow down a disease."

The National Institutes of Health will give out more than $75 million over the next five years to help four minority colleges expand their research and facilities. The universities' work will focus on health disparities among minorities. Fifteen

higher education institutions competed for the money.

The funds will be used to create the Meharry Clinical and Translational Research Center (MeTRC). Focus areas for cures and treatments will include HIV/AIDS and women's health.

"MeTRC paves the way for researchers to determine why these disparities exist, and to find new treatments that will close the gap," Riley said. "With this grant from the NIH, Meharry will be able to establish a national model for health disparities research, making us a global leader in the area."

The college has received several grants in recent months. NIH also awarded Meharry a $14 million grant for an endowment program that will lead to more jobs in research at the university. In addition, the school has received several million dollars in stimulus funds.

Meharry, along with Morehouse Medical College in Atlanta and Charles Drew University in Los Angeles, will receive about $4 million a year over the next five years to find ways to translate research findings into treatments for heart disease, kidney disease, diabetes, HIV/ AIDS, and other conditions common in minority groups.

NIH chose the three colleges as inaugural inductees into a new program that encourages researchers to speed up the process to introduce cures and treatments. All the funding comes from the NIH budget and is not stimulus related.

45

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"ETHESDA -ARYLAND HOHFWLYHV MSII, Alexis Mason, MSII, Ezinne Okwandu, Standing, from left: Sandrine Niyongere, MSII,

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49 Journal for Minority Medical Students

katrina & health care Health Care Access in New Orleans Following Hurricane Katrina: A Case Study in the Failure of a Two-Tiered Health Care System

By Aaron D. Fox, MD Albert Einstein University College of Medicine Theorists predict that due to differential access to power

to rebuild, there have been demands to fill the void left by

and resources among subgroups in a population, disparities

Charity Hospital’s closure, but an important lesson should

in health will be created or exacerbated by the introduction

not be missed. Simply replacing Charity with another under-

of new disease processes into the population or with any

funded public hospital, and replicating a two-tiered system

shock to the system. Those subgroups with better access

that treats patients with private insurance differently than

to resources will always secure a health advantage in times

those dependent on charity care, misses the opportunity

of stress. Though disparities in health existed in Louisiana

to replace the separate and unequal health care system of

before the tragedy of Hurricane Katrina, this crisis and the

Louisiana with a more equitable one that serves all people.

inadequate government response clearly demonstrated this

principle. Disparities in health outcomes worsened follow-

eliminated disparities that existed before and after Hurricane

ing the disaster with a disproportionate burden of morbid-

Katrina, it is clear that the two tiered system of health care

ity, including new diagnoses such as post traumatic stress

in New Orleans left thousands of individuals at risk. At the

disorder, falling on disadvantaged groups. With the closure

time of Katrina, adults with dependent children and incomes

of Charity Hospital, the only access point to health care for

less than 20% of the federal poverty level (about $3000 per

many of the poor and uninsured in New Orleans, thousands

year) qualified for Medicaid. Due to such restrictive require-

of individuals were left without a source for care, which

ments for public coverage, and the large number of small

likely worsened these disparities. As Louisiana attempts

business employers not offering health benefits, 21% of

While universal health care would not have completely

47

non-elderly adults in Louisiana had no health insurance prior to Katrina. In New Orleans the number

katrina & health care

was 26%. Because Louisiana state law mandates universal access to health care, the state funds a public system to serve the poor and uninsured.

Charity Hospital, the focal point of the public sys-

tem, accounted for over 80% of care for the uninsured in New Orleans, with the surrounding private

Bureau, the number of uninsured people increased at

hospitals caring for mostly patients with commercial

greater rates in Louisiana than any other state during

insurance (only 4% of their patients were uninsured).

the years immediately following Katrina. With more unin-

Eighty-two percent of Charity patients were economically

sured, and fewer sources of care for those without insur-

disadvantaged and two-thirds were African-American.

ance, there was undoubtedly much avoidable suffering.

When Charity Hospital was severely damaged by the

disaster and could not reopen, low-income and uninsured

job recovery and Medicaid waivers to cover some hur-

residents of Orleans parish were left with no place else to

ricane survivors, the uninsured rate in New Orleans

go. In fall 2006, according to a Kaiser Family Foundation

decreased to 22% among non-elderly adults, but dis-

study following Hurricane Katrina, 49% of residents of

parities in health care access persisted and disparities

the Greater New Orleans area reported problems with

in outcomes were already apparent. According to a fol-

health care coverage or access to care. Sixty-one per-

low-up Kaiser study, low income adults in New Orleans

cent of former Charity users had no source of care other

(those with incomes less than 200% of the federal pov-

than the emergency room; African-Americans were more

erty level or about $42,000 for a family of four) were

likely than whites to lack a regular source of care; and

still more likely to report no regular source of care and

15% of individuals with chronic health conditions such as

less likely to have received preventive care than those

diabetes or asthma, had no health insurance coverage.

of higher income. In the two Kaiser surveys, between

2006 and 2008, the rate of self reported fair or poor

After Charity’s closure these uninsured patients

most in need of continuity of care were left to find

health status increased from 19% to 46% in the economi-

a new source of care. With much damage to health

cally disadvantaged group. As a comparison, in 2008,

care facilities and many physicians relocating out-

only 19% of the higher income group rated their physi-

side of New Orleans, the already-stressed health care

cal health as fair or poor. Rates of self-defined fair or

system was not equipped to absorb such need.

poor mental health were also significantly higher among

In another early study of Katrina survivors, the impact

48

By spring 2008, three years after Katrina, with

low income adults (25% vs. 16%) and had increased

of this impaired access to care is readily seen. Seventy-

from 15% in 2006 in the economically disadvantaged

four percent of the surveyed population reported a chron-

group. Specifically, among former Charity patients, in

ic health condition that preceded the disaster. Of this

2008, 50% rated their physical health and 29% rated

group, 21% needed to disrupt treatment because of bar-

their mental health as poor or fair. While these numbers

riers to care. Predictors of treatment disruption were age

demonstrate significant disparities, they fail to capture

(with the non-elderly being at higher risk), social isolation,

the most extreme suffering, as those displaced to trailer

housing need, and lack of health insurance. Due to job

parks and temporary shelters outside of New Orleans,

loss, the already substantial problem of lack of insurance

reported even greater difficulty with access to care

was compounded, and according to the U.S. Census

and much higher rates of physical and mental illness.

katrina & health care

The reason for health disparities by socioeconomic

of care and avoid interruptions in medical treatment. As

status or race in New Orleans is not limited to lack of

New Orleans and Louisiana rebuild, local policy experts

health insurance, and insurance coverage alone with-

and community members will set priorities for their health

out a strong primary care infrastructure would not have

care needs. However, following the injustices that were

increased access to care. However, the two tiered

exposed and exacerbated by Katrina and the dispropor-

health system that exists in Louisiana, and all across

tionate burden of suffering that fell on the low-income,

the U.S., one that treats patients differently based on

African American population of Orleans Parish, a commit-

ability to pay, leaves a large percentage of the popula-

ment to health equity could be symbolic for the rest of

tion at increased risk. Our “safety net� for patients with-

the country in how to treat all citizens with dignity. If we

out insurance is porous, and sometimes, in the face of

are going to build a healthy society in New Orleans, and

disaster, the inadequacy becomes painfully evident.

across America, access to high-quality affordable health

care needs to be considered a right, not just charity.

An equitable health system would not have provid-

ed transportation for those trapped in the 9th ward as

The uninsured and underinsured will always have second-

the flood waters rose, but after the disaster it may have

class health status until we guarantee health care for all.

helped diabetic former Charity patients find other sources

49

A SECOND OPINION, PLEASE A Silent Assassin is Caught

by John M. Dunn, MD (Maria is seated at desk, studying, as Yvonne pokes her head into the room) Yvonne: Hey, girl!

Maria: (rises and runs over to give her a hug) Yvonne!

Yvonne: It’s great to see you, and you are look-

ing great! I guess you had a good summer?

Maria: It was the best, Yvonne! I lived with this

wonderful Ghanaian family, and the TB clinic was just incredible. How about you?

Yvonne: Well, I didn’t get to Africa, but the

hematology lab was incredible, too. I really hope I can keep doing research, at least part of the time anyway.

Maria: I guess you haven’t seen Anthony yet?

Yvonne: I’m still smiling, aren’t I? How could I have?

Anthony: (bursts into room wearing Hawaiian

shirt, sunglasses, Bermuda shorts with several leis around his neck) Mele Kalikimaha, friends!

Maria: He’s baaaack…

Holmes: Students, please! Show some restraint!

Yvonne: You brought restraints? Good. We can use them.

Holmes: Why don’t you mesmerize us with

an absorbing presentation, instead?

Yvonne: Well, yeah. I guess I’d better. This guy’s

really got me worried, Doctor Holmes. His symptoms just don’t come together for me.

Holmes: I heartily encourage you to listen to those feelings,

Yvonne. More and more nowadays you are being encouraged to think in terms of clinical algorithms and decision trees. These tools have their place, of course, especially for typical problems, but when a problem falls beyond your decision tree’s branches, it is imperative that you be able to think creatively, or “outside of the box.” The first step in thinking outside of the box is to recognize when something doesn’t fit. Please continue.

call out to her from his workshop and went in to find him sitting on the floor, mumbling. Eventually he was able to tell her “I don’t feel right,” but that was about all he could say. When I saw him he denied any headache, chest pain, shortness of breath or abdominal pain, and according to his wife, hadn’t had any recent fevers, vomiting, or other GI symptoms that she knew of. He seemed totally normal at breakfast this morning.

Anthony: So he’s having a TIA. Next case.

Holmes: Not so fast, Anthony. Certainly an acute neuro-

logical event is in our differential, but there could be many other possible causes for this gentleman’s symptoms.

Maria: Is he diabetic?

Holmes: Indeed, Maria, acute hypoglycemia is

one of the first things to come to my mind.

Yvonne: Good point, but no, he’s not, and the ambu-

lance crew checked his fingerstick, which was 110.

Holmes: Good. Did he have any other significant

medical history?

Yvonne: No, that really was it. No history of heart dis-

ease, diabetes or any other major organ or chronic diseases.

His only medication is hydrochlorothiazide, he doesn’t smoke or do drugs, and drinks an occasional beer in the evening.

Holmes: Very good, Yvonne. I’m glad to see that your history

taking and presentation skills haven’t suffered in your absence.

Anthony: Yeah, and I haven’t suffered in her absence Yvonne: OK. “HM” is a 70-year-old retired school shop teach- much, either.

er with a history of hypertension, who was in his usual state of good health until about 10 this morning. His wife heard him

Maria: Only those around you have suffered, right, Anthony?

continued on p. 53 50 Journal for Minority Medical Students

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Journal for Minority Medical Students 51

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A SECOND OPINION, PLEASE continued from p. 50

Anthony: Right. Hey, wait a minute!

Holmes: Sorry, Anthony, not a moment to lose. What

did you find on examining your patient, Yvonne?

Yvonne: He was well-dressed and appeared mildly anx-

ious and slightly confused. He kept asking, “What’s happening to me?” His blood pressure was only 60/40, heart rate 80, respirations and temperature unremarkable.

HEENT were also unremarkable: normal eye exam, no carotid bruises, neck supple. His lungs were clear, heart regular with a three out of six systolic murmur in the aortic area and no gallops or rubs. His abdomen was slightly obese with mild epigastric tenderness, no masses or bruits.

His stool was negative for blood. Neurologically he was oriented to person and place but didn’t know the day or time. His cranial nerves were normal, and he had some mild left-sided weakness of both his arm and his leg.

Holmes: Fascinating, Yvonne! An unusual combi-

nation of hypotension with focal neurological findings… What did you do for ancillary studies?

nal ultrasound, which was normal.

Yvonne: Well, of course we did an EKG right away, two of

ing hypotension, and then we will proceed to the bedside.

As you will recall, blood pressure is a product of cardiac output pumping blood against vascular resistance. Therefore a change in any of these three parameters, decreased cardiac function, decreased intravascular volume or decreased resistance, causes a drop in blood pressure. Causes of decreased cardiac function may include decreased heart rate or decreased force of contractility, which may be due to ischemia, medications, inflammatory conditions, mechanical obstructions, and so on. Thus far we have found no evidence of ischemia, but Yvonne’s patient does have a cardiac murmur. This may be significant. We have also found no evidence of depleted intravascular volume such as dehydration or blood loss. The final category, vascular resistance, includes such entities as sepsis or anaphylaxis for which, again, we have no evidence. I would submit that Yvonne’s patient indeed has a mechanical problem affecting blood flow to certain parts of his body, and that we can indeed pin it down with a more meticulous physical assessment. Shall we go see?

them in fact, thinking he might be having a silent MI. But they were both normal. We sent off some blood work, CBC, lytes and cardiac markers, but they were all normal as well. I thought he might be having a GI bleed but with heme negative stool and a normal hemoglobin, it seemed pretty unlikely.

Holmes: Yes, a GI bleed to cause this degree of

hypotension would likely declare itself in some other way, but it’s a good thing to keep in the back of your mind. I suspect your patient’s silent assassin hides elsewhere. Did you do any imaging studies?

Yvonne: Yes, we did a chest X-ray, which

was within normal limits ...

Maria: Mediastinum normal?

Yvonne: Yes, it seemed to be.

Holmes: What are you thinking, Maria?

Holmes: Good. Let’s review the basic mechanisms caus-

Maria: Well, I was thinking about a tho-

racic aneurysm, I guess ...

Holmes: Excellent thought.

Maria: But with a normal chest x-ray I sup-

pose that’s pretty unlikely.

Holmes: Hmm, well, I ...

Yvonne: Oh, and we also did an abdomi-

A Second Opinion: The Answer Yvonne: OMG! So Maria was on the right track! You go,

girl!

Maria: Well, yes, but that normal chest x-ray threw me.

It wasn’t until Doctor Holmes checked the pulses…

Holmes: Don’t be too hard on yourself, Maria. I must

continued on p. 58 Journal for Minority Medical Students 53

The Campus Rep Community Imagine having a place to voice your ideas, frustrations, goals, dreams—and getting to share that with other minority med students across the country.

Imagine getting to interview administrators and professors at your school to get them to discuss issues that affect you and your peers.

Imagine becoming a leader on your campus—someone people look to for guidance on what it takes to succeed in medicine.

This is what can happen when you become a Journal Campus Rep. We’d love to have you join the community. For more information, contact: vanessa@spectrumunlimited.com

TO P 3 M ED SCH O O L S U C C E S S S T R AT E G I E S 1. Get enough sleep.

2. Get enough exercise.

3. Become a Journal Campus Rep. Campus Reps act as the voice for the Journal of Minority Medical Students, keeping us in touch with the issues and concerns facing minority medical students. Campus Reps can write articles, answer surveys, and submit response cards. We value your input, and each month a Campus Rep is rewarded with a gift card or cash.

Want to join us? It’s super easy to do. Just go to the Journal website: www.minoritymedicalstudents.com Click on “Campus Rep Corner,” answer a few questions, and you’re all set!

58 Journal for Minority Medical Students

Conference Report Morehouse School of Medicine 3rd Annual Conference on Health Disparities Surgeon General proclaims more minority doctors needed

I

n one of her first speeches as Surgeon General, Dr. Regina Benjamin told the audience at the Morehouse School of Medicine’s 3rd Annual Conference on Health Disparities that Obama was committed to eliminating health disparities, improving access to health care, and providing care for all Americans.

She talked at length about the lack of minority physicians in America. Benjamin noted that the proportion of U.S. physicians who are minorities is only six percent — the same proportion as a century ago. “There’s something wrong with that,” said Benjamin.

The numbers come from a 2004 estimate of the percentage of U.S. physicians that are black or Hispanic. Blacks and Hispanics account for roughly 28 percent of the U.S. population, according to 2008 figures from the U.S. Census Bureau.

In the speech, Benjamin told health leaders in the audience to encourage young minorities to pursue careers in medicine or other ambitions.

Benjamin paid homage to the Morehouse School of Medicine and to her mentors there, two of whom shared the dais with her. She praised Dr. Louis Sullivan, a former U.S. Secretary of Health and Human Services, as someone “who has always been there for me.” Sullivan held the Bible when she was sworn in as surgeon general.

Sullivan praised Benjamin for her Bayou La Batre Rural Health Clinic, located in a tiny fishing village on the Alabama’s Gulf Coast. She had treated many patients who could not afford to pay her. After hurricanes and fires destroyed her clinic, Benjamin rebuilt it using her own credit cards, personal savings and donations. “She makes house calls, she drives a pickup truck, and she accepts oysters and corn as payment,” Sullivan said. “She is only at the beginning of her career.”

Dr. David Satcher, prior to his own appointment as U.S. Surgeon General, was Benjamin’s teacher between 1980 and 1982. Satcher, she said, taught her how to be a “servant leader,” someone who serves “not for the glory, not for the fame.

They see something needs to be done, and they do it.”

Benjamin has not said what her priorities will be during her four-year term. Some health policy experts have predicted she might become a leading voice on national health care reform, but she made only a brief reference to the topic in Thursday’s speech.

The surgeon general is a government health educator sometimes called “the nation’s doctor.” At times it has been a high-profile position, such as in the 1980s, when Surgeon General Dr. C. Everett Koop became the government’s leading spokesman on the emerging AIDS epidemic.

But in recent years, the post’s prominence has not been as evident. Last year, both the Institute of Medicine and Trust for America’s Health called for the Surgeon General to play a more prominent and powerful role.

56 Journal for Minority Medical Students

Surgeon General Dr. Regina Benjamin (left) with Dr. John E. Maupin, president of Morehouse School of Medicine

Students Gather to Take on Disparities More than 250 students from Atlanta medical schools, colleges, and high schools gathered at the disparities conference to participate in a live teleconference with members of Congress, Donna M. Christensen (D-VI), Danny K. Davis (7th District - IL), and John Lewis (5th District - GA). Also on the panel were health care professionals involved in primary care. “Our ‘mini-conference’ was completely studentcoordinated and student-run,” says Deniece Johnson, MSII, SNMA Morehouse Chapter president and an organizer of the event. “We let the students ask any questions they wanted on everything from student health insurance policies to loan repayment programs to the future of primary care. The Congresspeople gave us great insight into the political side of the process.”

Organizers were thrilled with the results. “It’s so important for students to have an opportunity to let their voices be heard,” says Johnson.

Students also got an opportunity to attend the main conference, where they were exposed to a whole new side of the health disparities issue. Johnson recalled one speaker who talked about the importance of good urban planning—walkable neighborhoods, grocery stores and how it builds community and creates a healthier population at the same time. “This completely blew my mind,” says Johnson. “I’d never considered how many approaches we could take to health, outside of the more traditional ones that involve more physicians and public health workers.

“All of the students were definitely charged up by the conference,” she continues. “We learned that the only way we’re going to make any progress is if we start to think outside the box and put our heads together with people in different fields so we could do this.”

Dr. Marc Nivet to Join the AAMC T

he AAMC (Association of American Medical Colleges) announced recently that Marc A. Nivet, EdD, has been named the association’s new chief diversity officer. Dr. Nivet is currently the chief operating officer and treasurer of the Josiah Macy, Jr. Foundation. He will join the AAMC in spring 2010.

“Dr. Nivet will bring an inspiring strategic vision to the association’s diversity and inclusion efforts,” said AAMC President and Chief Executive Officer Darrell G. Kirch, MD. “He is someone who truly personifies the future of diversity leadership, while appreciating the past, and who will be able to articulate a compelling case for diversity and the importance of addressing health disparities.”

“I am honored and humbled to accept this role and am excited by the prospect of building on the important contributions of my predecessors,” said Dr. Nivet. “The AAMC is well known for providing unparalleled and unquestionable intellectual leadership to its membership and beyond on the value of diversity. As difficult as it is to depart a phenomenal organization as the Macy Foundation, I look forward to joining the leadership team at the AAMC to extend its research, programmatic, and advocacy efforts on diversity.”

A s chief diversity officer, Dr. Nivet will provide strategic vision for all of the AAMC’s diversity and inclusion activities, and will lead the association’s Diversity Policy and Programs department, which focuses on programs designed to increase diversity in medical education and advance health care equity. Dr. Nivet will succeed Charles Terrell, EdD, who stepped down on December 31,

2009, after eight years of service.

Dr. Nivet has dedicated his career to improving higher education by creating and supporting initiatives that increase diversity. As the associate executive director of the Associated Medical Schools of New York for seven years, he oversaw several programs designed

Dr. Marc Nivet to increase enrollment and retention of minority students in the health professions. He has also held positions as director of state outreach for The Sallie Mae Fund and director of the Office of Minority Affairs at the New York College of Osteopathic Medicine. In addition, he is a prolific writer and lecturer on diversity as a driver of educational excellence and has addressed topics on diversifying academic medicine, eliminating racial disparities in health and the health professions, and best

practices for increasing minority enrollment in health professional schools.

“Marc brings strong analytic and relationship-building skills, great energy and enthusiasm, broad familiarity with medical education, and a vision of diversity as essential for excellence. His combination of passion and talents is just what the AAMC needs as we work to increase diversity and inclusion across academic medicine,” said Carol A. Aschenbrener, MD, AAMC executive vice president and chief strategy officer.

A s chief operating officer of the Josiah Macy, Jr. Foundation, Dr. Nivet oversees the day-to-day operations of the foundation and manages an endowment of $150 million. The foundation supports programs designed to improve the education of health professionals in the interest of public health. He concurrently serves as special assistant to the senior vice president of health at New York University.

In addition, Dr. Nivet is a fellow of the New York Academy of Medicine and a past president of the National Association of Medical Minority Educators, Inc. In September, he was awarded the Riland Medal for Community Advocacy from the New York College of Osteopathic Medicine.

He is an adjunct professor in the School of Education, Health, and Human Services of Hofstra University.

Dr. Nivet received his EdD degree in higher education management from the University of Pennsylvania Graduate School of Education. He holds an M.S. degree in higher education and student development from Long Island University, C.W. Post Campus, and a BA degree in communications studies from Southern Connecticut State University.

Journal for Minority Medical Students 57

SECOND OPINION: the answer continued from p. 53

admit I was a little skeptical of that initial blood pressure of 60 and your patient walking in, and only mildly confused. Most of us would be flat on our backs with those readings. That made me wonder if the 60/40 was his true blood pressure, or it was falsely depressed. When we checked his pulses and found that the pulse in his right arm was much weaker than his left, as well as his right carotid pulse being weaker than his left, it confirmed my suspicions that Yvonne’s patient was suffering from a problem affecting the blood flow between his heart and his aortic arch or, in other words, his ascending aorta. Our chest CT merely confirmed our suspicions. I suggest you put in a page to our cardiothoracic surgery colleagues, Yvonne.

Yvonne: I did it as soon as we saw the CT. Holmes: Excellent. Although we often refer to this entity as

a “dissecting aneurysm of the aorta,” a dissection of the thoracic aorta is fundamentally different from other types of aneurysms. As you recall from your basic coursework, a dissection of the thoracic aorta occurs when there is a spontaneous tear of the intima, the inner lining of the arterial wall. Blood leaking through this tear in the inner arterial wall creates a false channel, and a hematoma forms between the inner and middle layers of the arterial wall. Depending on the pressures involved and the adherence of the arterial walls, this hematoma may spread a considerable distance, at times occluding arterial side branches.

As you will recall from your anatomy classes, the ascending aorta typically gives rise to the innominate artery which later branches into the right internal carotid and subclavian arteries, and thence to the left internal carotid and subclavian arteries. Yvonne’s patient exhibits a mild left hemiparesis, suggesting at least partial occlusion of the right internal carotid artery. His left arm blood pressure is much higher than his right, suggesting a greater occlusion of the innominate than the left subclavian artery, although even his left arm pressure is less than I would expect, based on his prior history and current condition. I therefore suspect that his dissection begins somewhere between the aortic valve and extends to the region of the left subclavian artery.

Yvonne: Wow…so is it the high blood pressure which

causes the tear in the first place?

Holmes: It may be a factor, but interestingly, hypertension

more typically causes a tear in the descending aorta. These are classically elderly patients with hypertension and atherosclerosis who present with a tearing or searing pain in the mid to upper back region. Dissections of the ascending aorta, however, more commonly occur in middle-aged non-hypertensive individuals with risk factors such as Marfan’s Syndrome or other connective tissue diseases, congenital aortic valve anomalies or pregnancy. They may also be relatively painless.

Anthony: So, my friends…to the OR again? Hey, that rhymed!

Yvonne: Lucky guess, you miserable pest! So did that.

58 Journal for Minority Medical Students

Holmes: Indeed you are correct, Anthony. Dissections of

the ascending aorta, so-called “Type A” dissections, are generally best managed surgically, with resection of the damaged section of artery and replacement with a synthetic graft. Descending aortic dissections, so-called “Type B” dissections, have a somewhat higher operative mortality and lower non-operative mortality, and thus surgery is less commonly employed, or more limited, in such a setting.

Maria: So what is the medical therapy? Blood pressure control?

Holmes: Yes, Maria. Generally a combination of vasodilat-

ing drugs such as nitroprusside and drugs which decrease cardiac contractility, such as beta blockers, is used.

Yvonne: When you look at the CT scan, it’s so obvi-

ous, but how come we didn’t see it on the chest x-ray?

Holmes: Unfortunately the ascending aorta mostly overlies

the mediastinum, making it difficult to distinguish clearly. The majority of aortic dissections which are clearly visible on plain chest radiography are the more distal, or descending ones.

Maria: What about his heart murmur? Is that relat-

ed to the cause of the dissection, or because of it?

Holmes: Excellent question, Maria! The short answer is, it

could be either. Our CT suggests the dissection is sufficiently distal to the aortic valve, however in some cases, particularly with connective tissue diseases, the dissection may arise in or around the valve, or it may extend to the valve in a retrograde fashion. In extreme situations the dissection may actually spread backwards to the pericardial space, causing pericardial tamponade. If the valve is involved and or tamponade is present, the surgery will of necessity include valve replacement.

Maria: Wow, Yvonne! That’s an amazing case!

Anthony: (singing) Amayy…zing case, how sweet

the sound, that saved a stud like meeeeee…

Yvonne: You know, Maria, I wasn’t really missing vacation that

much until just a few seconds ago. Let’s go get some work done.

Anthony: Sounds good to me. A hui hou kaua, females

of the species!

Yvonne: Hey, that gives me an idea!

Anthony: Really?

Yvonne: My research topic: Persistent cognitive defi-

cit due to heat stroke and too many pinhead coladas.

Anthony: But ...

Holmes: I fear you may be on to something there, Yvonne.

Until we meet again.

PAESMEM PROGRAM

CALL FOR NOMINATIONS

PRESIDENTIAL AWARDS FOR EXCELLENCE IN SCIENCE, MATHEMATICS AND ENGINEERING MENTORING PROGRAM The program, administered on behalf of the White House by the

The program, administered The Award: National Science Foundation, seeks to identify individuals and on behalf of the White organizations with outstanding mentoring or programs • The awards are standard grants in efforts the amount of House by the designed to enhance the The participation ofaccompanied groups (women, $25,000 each. grant will be by National Science minorities, and persons with Presidential disabilities)certificate. underrepresented in a commemorative Foundation, seeks to idenscience, technology, engineering, and mathematics (STEM). The tify individuals and orga• Each award will be used to continue the recognized activity. awardees serve as exemplars to their colleagues and are leaders nizations with outstanding • The Executive Office of the President ofNation’s the United States in the national effort to more fully develop the human mentoring efforts or proselects the awardees from those recommended by NSF. resources in STEM. grams designed to enhance the participation of groups • Up to 20 awards are made in a fiscal year. Since the a grant awardinception of $10,000, each invited to (women, minorities, Beyond and program’s in 1996, 178awardee individualsisand persons with disabilities) Washington, organizations D.C. for an have award ceremony at the White House, received this distinguished underrepresented inrecognition scievents, meetings with leaders in Federal sector eduPresidential recognition. ence, technology, engineercation and research, and focused workshops addressing effective ing, and mathematics (STEM). The awardees serve as exemplars to mentoring of students from underrepresented A report by the 2005 PAESMEM awardeesgroups. entitled Additionally, their colleagues and are leaders in the national effort to moreawardees fully receive a ceremonial Presidential certificate.

“Mentoring for Science, Technology, Engineering and develop the Nation’s human resources in STEM. Mathematics Workforce Development and Lifelong Productivity: Success Across the K through Grey Continuum” Beyond a grant award of $25,000, each awardee is invited to emphasizes the importance of mentors and mentoring in Washington, D.C. for an award ceremony at the White House, recogWho is eligible? developing a stronger, competitive, and more broadly nition events, meetings with leaders in Federal sector education and research, and focused workshops addressing effective mentoring engaged STEM workforce. To view this report, please visit: •of students Nominations may be made groups. by a colleague, administrator, or http://coen.boisestate.edu/research/specialproject.asp student, and are classified in two categories: individual from underrepresented Additionally, awardees andaorganizational. receive ceremonial Presidential certificate.

•

Organizations must be eligible to be an NSF awardee (see NSF Grant Proposal Guide for full details); individuals must be U.S. citizens and be affiliated with an organization eligible to be an NSF awardee. is eligible?

•Who Individuals may not be Federal government employees.

•• Nominations Both individuals and organizations must have demonstrated outstanding and sustained mentoring and effective may be made by a colleague, guidance to aorsignificant number of underrepresented students at the K-12, undergraduate, or graduate education administrator, student, and are classified in two levels for at least five years. categories: individual and organizational.

• Organizations must be eligible to be an NSF awardee What required? (seeis NSF Grant Proposal Guide for full details); individuals must be U.S. citizens and be affiliated Individual nominees require: an organization eligible tothe bementoring an NSF awardee.

• with A statement summarizing activitiesmay thatnot constitute the government basis for the • Individuals be Federal nomination, including a list of students employees. mentored; •• Both individuals and organizations must have A biographical sketch of the nominee; and • demonstrated Letters of support (a maximum of 5) from outstanding and sustained mentoring and students attesting number to the nominee’s andcolleagues effective guidance to a significant of demonstrable and sustained achievements in underrepresented students at the K-12, undergraduate, mentoring underrepresented students in STEM. or graduate education levels for at five years.

(The letters will be available to least nominees upon request).

Organizational nominees require: • A statement summarizing the mentoring activities that constitute the basis for the nomination, including activities contributory to student success and materials documenting sustained achievements in mentoring underrepresented students; • A brief institutional or organizational description; and • Letters of support (a maximum of 5) from colleagues and students attesting to the organization’s or institution’s demonstrable and sustained achievements in mentoring underrepresented students in STEM. (These letters will be available to nominees upon request).

Contact Information: Daphne RaineyNational Division of Undergraduate Education Science National Science Foundation Foundation 4201 Wilson Blvd., Suite 835 | Arlington, VA 22230 Phone: 703-292-4671 | e-mail: drainey@nsf.gov

For more information Highlighting the Presidential Awards for Excellence in Science, and to see abstracts of Mathematics and Engineering Mentoring program current awards, please visit: sponsored by the National Science Foundation. http://www.nsf.gov/funding/pgm_summ.jsp?pims_id=5473 Deadline: October 6, 2010

National Science Foundation

Highlighting the Presidential Awards for Excellence in Science, Mathematics and Engineering Mentoring program sponsored by the National Science Foundation.

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