Caught in Between

One of the exciting things about internships is that you can put theory into practice…meaning that I’ve been experiencing a lot of what I learned in my Health Policy and Management class..yay!

So part of this internship involves weekly site visits to other interns’ places, so we can be exposed to the different types of entities at work in health policy reform. Two that really stuck out to me were our visits to a free primary care center, and to a hospice headquarters, both in Detroit.  I named this entry “Working Day and Night” because these types of entities are always working to ensure that areas of care that are often neglected–primary care and end of life care–have a presence among disparate populations. There are always unknown, behind the scenes organizations working day and night to try to address our broken healthcare system, and they deserve some major kudos for that.

Mercy Primary Care Center services the uninsured on the east side of Detroit–and it offers services that help eliminate disparities among the underserved population when it comes to healthcare. It offers primary care (i.e. check ups), transportation, diagnostic services, medications, health education, and mental health counseling.

Mercy Primary Care Center...sorry the picture is so small

For FREE. All for free. When they told us this, I was in awe. There are not many places like this…and if there were more safety net providers like this, then people without insurance could receive care they otherwise would not get.  I just found this amazing. They showed us a video of patients at Mercy, and they all concluded that without this clinic, they would not be getting primary care and medications…at all. The clinic doesn’t do specialty services, but they will work with specialists to provide the care patients need as best as they can.

Imagine not being able to go to the doctor when you were in pain or sick, because you know you won’t be able to afford the $150 visit. Imagine having a job where you made more than the federal poverty line, so not low enough to qualify for Medicaid, but you make not enough to purchase your own insurance. What do you do?

This is why places like Mercy Primary Care Center are so important. They provide that extra support for the uninsured that they would otherwise not get. The center is also cool because it focuses on primary care. That’s an area we struggle with in our healthcare system, because people don’t work with their primary care docs enough. They don’t follow up or come in for regular checkups or get help with coordinating specialty care for a certain issue. The patients here can come once, or continue coming here, and not have to pay anything. Amazing!!

Visual description of a safety net

The other site visit I mentioned was to Hospice of Michigan. I definitely left here with a greater understanding of what hospice is and why it is so important.

I didn’t really know what a hospice was until last year, and even then I thought it was just a place where people accepted that they were terminally ill and they just prepared to die.

Hospices aren’t well known in our culture because Americans want this unattainable imortality. Consequently, we’re more likely to try everything in the book to combat disease and to try to create a miracle. But the CEO of Hospice of Michigan believes that Americans should be more accepting of death if it looks like a patient is terminally ill. And that their last days should not be spent in hospitals getting cut open and poked and radiated and tested…rather, they should be at home with family, taking medications that try to decrease their pain as much as possible but otherwise, enjoying their final times with their families.

Many don’t like the idea of hospice because it looks like the patient is just “giving up.”  But others see hospice as a means of accepting reality and trying to make the best out of a patient’s last days. When a patient is in hospice, doctors, nurses and social workers come to the patient’s home to talk with them , comfort them and give them medications…so it’s not really a place where people GO to die, literally.

If hospices were used more, then the amount of money used to implement last ditch efforts in an attempt to save a terminally ill patient’s life would decrease…arguably, the patient would also be happier and more comfortable in their last days. It’s a touchy subject that many Americans are not comfortable with, because of the American “never give up”  ideal.

So yea….two examples of non-hospital healthcare settings that are always working day and night to ensure that good care is given to those who need and seek it. I hope this entry was news to you, and that you learned from it!

My next blog will be a farewell to my internship/musings about my summer type thing, so stay tuned!

-Dominique

Me driving this past weekend, which included a visit to Lauren C. (photo credit to her as well!) Driving most certainly will bring a time for reflection. Yes, enjoy my key chains.

Excuse me as I join the other bloggers in writing another “advice” blog. I think in the back of our minds we know that August is creeping around the corner. For me, I know that senior year will be here in no time. And it’s made the last month quite a month of reflection.

This past weekend I ran away to the Homewood campus to drop off furniture for my apartment. OK, it wasn’t a run; it was more like a long crawl along the New Jersey turnpike.

Returning to Hopkins felt like quite a dream to me. I haven’t taken classes at Hopkins since December. My memories of living in Building A, Charles Commons, and Homewood seem like ages ago. My weekly lunches at Tambers seem like they are all part of a fairytale told to me during my childhood days. And my classes have begun to consolidate together in one large dream, one large Hopkins dream. In many ways I feel much like a Hopkins alum – except with the thought in the way back of my mind that I know I’m not quite done.

I’ve always told prospective students to seize opportunities, to make the most out of Hopkins. But perhaps because of my time away interning at two organizations, my recent visit to Hopkins, and having just finished reading The Last Lecture, I’ve begun to question if I’ve followed my own advice.

At a wedding with my boyfriend in June. Weddings, just another event that most certainly will bring a time for reflection.

Sure, I studied abroad, seized research opportunities, and took advantage of extra-curricular activities. But then I ask myself – if I was a Hopkins graduate right now, is there anything I wish I had done? Am I completely satisfied with my Hopkins days?

It’s a stressful question to ask myself and it’s created a lot of uncertainty about things that were once so certain, but it’s made me rethink things. Maybe I don’t want to graduate a semester early; maybe I should explore more classes; maybe I want to do the Hopkins 4K in 2011; maybe I need to explore Baltimore some more. So I’m entering August with little idea of what courses I’m taking in the fall, with no idea of whether I’m graduating in December or May, and with an empty apartment.

And in many ways I’m in a completely different state of my mind than I was when I entered my senior year of high school. To the parents out there, this probably doesn’t sound like an ideal situation for your child to be in. In fact, I recently sat next to an incoming Hopkins freshman’s mom on the bus to work and, for the first time, I wasn’t able to answer a question asked to me by an admitted student’s parent: “What are you doing when you graduate?”

But, honestly, I feel more mature than ever before. Why? Because I’m keeping my options open, questioning my life plan – something that once felt so certain, and taking in my senior year with an open-mind. So, bring it August.

Cape Town has continued to surprise and amaze me over the past week. I feel more like a “Capetonian,” and as of today, I’ve officially become a University of Cape Town student. I’m taking great classes (or so I hope) but as I haven’t really spent too much time in the classroom, I’ll save that for a later post.

Since I last wrote, we ventured out of Cape Town to the beautiful beaches of Muizenberg, explored markets downtown, and experienced the highlight of the trip so far, a day at Mzoli’s Place. Mzoli’s, a part of Gugulethu township, is legendary for its Sunday braai, when hundreds of locals and tourists turn up for a day of music, drinking, dancing, and incredible bbq fare made with the restaurant’s secret sauce recipe.

I’ve never seen anything quite like it. The township itself is an extended network of shanty houses, some made from corrugated steel, others a little more solid. Gugulethu and other townships like it are more or less permanent structures, and many have been in place for decades. The government has tried to encourage the residents to build traditional houses, and a few have cropped up where the government has financed them, but most of the townships look like an endless field of steel roofs. Between the houses run dirt tracks, and as you move towards the edges, paved streets that lead back to the main road. Most of them are fairly safe if you know someone who lives there, but we aren’t encouraged to wander about, and they can actually be quite dangerous if you don’t know where you’re going. Needless to say, it was a great opportunity to be able to be there, and such a fun day as well.

We all piled into a few minibus taxis and headed over to Gugulethu, not quite sure what to expect. When we arrived there were hundreds of people already there, and at the early hour of 11 am the club music was already going. We got in line and each chipped in R30 (about six US dollars) for what later turned out to be a bucket of meat and a bucket of maize (ground corn). It was well worth the wait, and we passed the time with some serious people watching before literally digging in to our lunch when it arrived. We traipsed back to Rondebosch around four, covered in barbeque sauce. Not the classiest of days, but a really interesting introduction to Cape Town.

This weekend we also got the chance to explore the markets downtown, test out our haggling skills (mine aren’t so good) and stop by a food market as well. Another great adventure was our day trip to Muizenberg, a beach town about an hour outside of Cape Town famous for its multicolored bathing huts. It’s not quite warm enough to swim yet, but a few brave souls ventured in wearing wetsuits to surf.

We’ve all been planning trips, and hopefully in the next couple of weeks I’ll be able to report back on Stellenbosch (the beautiful wine country outside of Cape Town), shark diving, or the Garden Route, along with maybe a little bit about school as well.

Hope everyone’s enjoying their summer/Southern hemisphere winter! There’ll be more pictures to come, my internet is struggling at the moment!

Lauren

Photo Credit: Greco

Greetings from way across the pond…nearly 10,000 miles of flights away. After a week in London and a 12 hour overnight flight i am safely in Cape Town, and I love it!

It’s certainly very different. I’ve met some really great people so far and we’re all loving it but still can’t help but stop to think about how crazy this whole experience is. It’s easy to get used to this and think of it as any other study abroad experience until something happens to snap you out of it. Like going out to a bar and realizing a beer is $1.50 or hearing Xhosa (the “click language” on the bus) or seeing your RA’s break out into a singing clapping rendition of Shakira’s “this one for Africa”….circa 9 am in the morning. Other shocks included realizing that when I wake up here, my friends in America are still awake from the day before, trying to understand the complex social history of Cape Town, figuring out Africa is much bigger than I thought (Madagascar a five hour flight away?!) or seeing a huge AIDS awareness ad on the side of the house I’ll be living in for the next four months. I’ve found out that “Africa Time” is a concept I’ll need to adjust to, I’ve been shocked to learn what no indoor heating feels like (sleeping in fleece jackets and ski socks) and struggled to find gluten free foods.

I’ve been exasperated, thrilled, exhausted and overwhelmed in equal measure since I’ve gotten here but I can say already that I know I made the right decision to spend the next semester in Cape Town. South Africa is amazing, and such a different experience than anywhere else! I’m excited to travel, my bucket list of places and things to see is growing by the minute, and I can’t wait to start classes and see what the University of Cape Town is like. It’s so beautiful and Table Mountain is an insane backdrop to the whole city, I’m excited to start exploring.

I don’t have any pictures from Cape Town yet but here are a few from my week in London, where I had a last dose of “normal” before South Africa. It was great to spend time with my mom and catch up with old friends, and now that I’m here enjoying mid-winter weather, I’m glad a got an extra week of summer!

-Lauren

Seriously, we are. That’s kind of a public health major thing to say, but can you blame me? I am what I am. ;)

So why this title? Because I’m going to talk about my summer internship at the Greater Detroit Health Council (GDAHC), where the members fight for better quality of care for residents of Southeast Michigan. The council has about 12 members only, all women (yeah! lol. Well, women make up the vast majority of healthcare workers and administrators and policy makers in healthcare…and public health in general.) From its website:

“As a health care leader that is recognized regionally and nationally, GDAHC works with everyone who gets care, gives care and pays for care to lift the quality of overall care in the community.”

So this means doctors, drug companies, health plans, health educators, etc…anyone that has a part in healthcare is welcome to be a part of GDAHC. They work with these stakeholders to develop new programs, and they measure the success of health care entities like hospitals and doctors and doctors organizations to see how effective they really are. Once you identify effectiveness, programs to address any inequities or disparities are thought of and implemented. Wow that was a lot….lemme see if I can give some examples.

Description of the site

1.) MyCareCompare. This site was developed by GDAHC to measure the effectiveness of doctors’ measures on certain ailments, as well as the performance of hospitals in the southeast Michigan area. They are all scored with the same scale of course, on things like heart failure treatment, pneumonia treatment, and infection prevention…and much more. This is important because if a hospital sees it’s statistics publicly reported, it will do what it can to become better, and therefore look better. Now, it should do this because it’s the right thing to do, but that’s not how the world always works…so yea. And patients can compare the hospitals and choose one based on what it does best for their specific needs.

2.) SaveLivesSaveDollars. This initiative ended before I got here, but basically it was a huge effort with GDAHC and doctors, health systems, hospitals, etc to try to reduce costs of healthcare initiatives while increasing effectiveness. If you didn’t know, the US is horrible in the area of efficiency. Because there is so much technology and so much to try out to try to help patients, sometimes doctors just do everything they can pull out of their hats, partly because they don’t want patients to accuse them of not trying everything they can, even if a treatment has a very small chance of helping. So SaveLivesSaveDollars was created to try to get these healthcare entities in southeast Michigan to abide by evidence-based clinical guidelines for treatment rather than a “let’s just try everything in the book and see if something helps” aka overuse, misuse, and waste of treatment.

3.) Community Health. Now, this is the section of GDAHC that I’m helping out with, primarily. Specifically, I have to help come up with a plan that would help the hospitals and doctors offices in southeast Michigan collect racial, ethnic and language data from their patients. Why is this important? Is it discriminatory? Nah. So basically, collecting this REL data (as we like to call it) is important, because hospitals and doc’s offices can look at the data according to race and see patterns like…maybe Latino men aren’t getting as many referrals to oncologists for prostate cancer as white men are. Black women aren’t getting screened for breast cancer as regularly as Asian women are. and etc. REL data will allow these places to see if they have any disparities within their departments, and then they can create a plan to address any disparities. A plan is needed to help train healthcare professionals in collecting these data because for many, discussing race, ethnicity and language is sensitive, and raises questions like…will this info be used to treat me worse…will someone use it to see if I am an illegal immigrant…will it be used to racially or economically profile me…etc. So yea, cool stuff.

In addition to that, I’m helping to update a brochure for the uninsured in Southeast Michigan..some of the clinics and services listed in the current one are old and outdated, and it’s awful if a person desperate for care calls a number but can’t reach anyone. That helps no one in the end and the person still has no access to care in their area…so yea, updated info is important.

I’m helping to also create a “snapshot” of the health stats in Southeast Michigan, so people can have a quick read about some of the disparities in the area.

And I’m helping with some data entry for GDAHC’s diabetes in the workplace project. Basically, this committee offered many employers in the area a training for diabetic employees, so that they would learn more about how to take care of their disease (you’d be surprised at the number of people with diabetes who have little to no clue on how to take care of themselves!!!!!!!1) Then after the training, surveys are to be completed by these employees about how the training helped them and how often they are implementing what they learned. I’m helping to enter the info from the surveys so that they can be scored, which will give some statistical data on whether the trainings are helping the employees.

So yea. I am quite busy here at GDAHC, but enjoying it so much. I have a meeting in the morning with the President and CEO of GDAHC tomorrow morning about improving race relations in Detroit…should be interesting!

Um let’s see, other things I do in this internship? Well, each Friday, we have site visits to other student’s internship placements, so we go there and learn about what that site is doing to address healthcare disparities. Last week we visited the Detroit Health Department and saw how much they really do for and offer to the under/uninsured community, and how much they have to deal with politics. The week before, we visited a community health center in Detroit that also gave services to under/uninsured people, mainly Blacks and Latinos. This week, we are visiting a primary care center (primary care is ultra important!!), and then helping to clean up the aforementioned community health center as our community service project for the summer.

SEE YA!!

HOWDY!!

I hope you all are enjoying your summers. I think for this entry, I will write a little bit about mine.  About the city I am currently living in…Ann Arbor.

So if you didn’t know, I was blessed enough to land a nice internship at the University of Michigan School of Public Health, in the Health Management and Policy Department. I’m with 22 other interns, living in Ann Arbor but commuting to Detroit.

So how is Ann Arbor compared to Baltimore? I’d say completelyyyy different. I don’t even know where to begin. We’re staying in some of the dorms here, and it’s been pretty cool to share a space with 22 people I’ve never known before. The only downside is that the dorms have no AC and believe it or not, Michigan is just as hot as Bmore in the summer, maybe 5-10 degrees cooler but that’s about it. So I’m sweating in front of a fan as I write this, but what can you do. If anything, I will always appreciate AC from now on!

Me and my roommate's names on the door of our room

Ann Arbor is full of trees. LOTS AND LOTS of trees and I love it. I mean we have trees in Baltimore duh, but this place is so green, and just seems like a really nice community. The University of Michigan is HUGEEEEEEEEEEEEEEEEEEEE, so huge, so the immediate area around campus is completely affected by the school.  It’s a real college town and there is a lot of U of M “GO BLUE!” Pride.

I couldn't believe this when I saw it...talk about school pride! ;)

Yesterday, my roommate and I tried to find the Ann Arbor parade, but failed, so instead we spent 3 hours walking around the area and we still didn’t even reach half of the campus and the grad schools. Everything here is close, unlike JHU where the undergrad is in Charles Village, and other grad schools are downtown (with the exception of the School of Education and the Business School…they’re closer). But with U of M, we walked to the school of law, dentistry, public health, business, med…it’s kind of nice. I won’t lie, one thing I always wish JHU had more of is sports school spirit, but U of M has 100 times more students (ok, exaggeration) and way bigger sports, plus it’s a public university, so yea. It’s nice to see everyone wearing “Go Blue!” apparel and having so much pride in their school. JHU has pride, but since it’s so independent, I think we show it in our own way.

Anyways, yea. huge school. Here are some pics of the buildings…I am not sure which is which but they’re still pretty impressive…this school is beautiful.

The internship gives us cars and gas to romp around Ann Arbor with, so that has enabled us to go out a lot and see the area. It’s not a city like Chicago or NYC or Baltimore, but it has it’s own charm. I really am appreciating my time here and being able to compare it to my home in Baltimore. I feel very at home here and considering this is my first time being anywhere in the midwest, much less away from home…and that’s a good sign! Go Blue!

I shouldn’t be up because I have to be at work at 8:30 am tomorrow. But tomorrow will be cool because we’re surprising one of the interns with lunch tomorrow for his birthday. I’m also excited because there is an art fest and mini carnival coming to Ann Arbor this week, and apparently lots of store sales…so I will probably be posting  alot more frequently, so more to come!

-Dominique

Hello all,

Hope everyone had a lovely 4th of July! Here in sunny NJ we celebrated with a power outage on a 95 degree day. Not quite the festivities we all had planned for, but certainly interesting. I spent the morning decorating bicycles with toddlers as they prepared for the ultra-serious bike parade, complete with awards and blue ribbons, that marks every 4th of July here in Summit. It was a great weekend all-round, complete with a healthy dose of Americana before I ship off to South Africa (the official countdown has begun…49 hours until takeoff).

The last couple of days have been busy here as I try to wrap up loose ends and check off all the things on my to-do list before I leave. My time in South Africa will be neatly bookended by two of my favorite American holidays, the 4th of July and Thanksgiving, so before I get too teary-eyed about missing my sister’s birthday or her start at NYU, I remind myself that I will be back stateside just in time to see the Macy’s parade, eat tons of turkey, and enjoy the end of fall.

one of the many things I’ll miss, the beautiful fall weather.

I couldn’t be more excited about finally getting the chance to travel to South Africa, but it will certainly be strange to suddenly be 7000 miles, a six hour time difference, and a two day flight away from my family, my friends, and almost everyone I know. I can’t imagine not seeing my family, and especially my sister, Suzanne, for four and a half months. I don’t know what food I’m going to eat, what stamps I’ll have on my passport when I return, who my friends will be, or even where I’ll be living in Cape Town!

The uncertainty really is insane, and to be honest if I start to think about it too much my brain hurts a little. It feels a bit like starting Hopkins again, only on a different planet. And according to some frantic googling, that planet is precisely 12566 kilometers, or 7809 miles, or 6785 nautical miles away from my home (and this is the direct route).

google maps laughed at my attempt to get directions between Summit and Cape Town.

I will really miss my friends, my roommates, my family, my nice cozy bed at home, the ability to pick up the phone if I’m having a bad day and talk to my parents…or if it’s a really bad one, buy a Bolt Bus ticket back to New York for the weekend. I’ll miss Whole Foods, I’ll miss my car, and gluten free food, and the hammock in my backyard at home. I’ll miss family dinners, and seeing my sister move into college. I’ll miss American television, though I barely watch it while I’m here. I’ll miss birthdays and celebrations and the start of school at Hopkins. And watching the fireworks last night and all those patriotic commercials afterward, I realized there’s one last thing. I’ll miss that indefinable “American-ness” that was out in full force this weekend.

pictures like this, from the white house official flickr, have been making me weirdly emotional.

I’ll miss you, America!

The list of things I’ll miss is long, and what I’ll gain by going to South Africa is still hugely unclear, but though I may not have a list of things I’ll love in Cape Town yet, I know that by the time I return in November, I definitely will.

My blogging over the next few months will become a little more sparse, but I’ll try to post pictures from my travels as often as possible! I can’t wait to see what adventures I’ll have.

Happy summer everyone,

-Lauren B.

p.s. for those not fluent in Afrikaans (and who isn’t, really?) the title of this blog means “goodbye, America.” South Africa actually has 11 official languages including SiSwati, isiXhosa and Xitsonga but strangely enough none of those have online translation services.