THE NEW YORK ACADEMY OF MEDICINE
2004 David E. Rogers Fellowship
Summary of Final Reports
Eric R. Arzubi
Yale University School of Medicine
The Mental Health Implications of a Successful Literacy Intervention in Struggling 3rd Grade Readers in New Haven, CT
EOL or Essentials of Literacy is the principal remedial program implemented in New Haven public schools to provide help for struggling 2nd and 3rd graders. This program aims to address six dimensions of literacy skill-building, essential to child development and has been proven to help children advance to an appropriate reading level. Through the Rogers Fellowship, Mr. Arzubi chose to focus on the secondary mental health benefits of EOL, which had not been previously examined. Mr. Arzubi was able to successfully measure the link between school performance and mental health by designing a protocol, which monitors 2nd and 3rd graders who receive EOL for one and two years, and compares them to students who have not participated in any EOL intervention. So far he has discovered a distinct correlation between literacy and mental health. Thus far, he has been able to successfully correlate poor reading scores with disruptive behavior. On a personal level, Mr. Arzubi was also instrumental in helping a struggling high school student enhance key academic skills and improve self-confidence by utilizing fellowships funds to tutor him one-on-one. Mr. Arzubi writes: “My experience as a David E. Rogers Fellow will undoubtedly prove to be a key step in my development as a child-centered physician. The resources and time afforded by the Program were well spent and had a direct, positive impact on at least one child’s life over the 2004 summer months.”
Suhani S. Bora
University of Michigan Medical School
Theatre as a Tool for Social Change: Identifying Strategies to Prevent Domestic Violence in South Asian Communities of Southeast Michigan
New Visions is a community based organization that aims to prevent domestic violence in Asian and Asian-American communities of Southeast Michigan. Ms. Bora designed a theatre workshop for South Asian youth at New Visions to create discussions on social issues using role playing techniques. The focus of her project was to create a safe environment for teenagers to speak out and to encourage exploration of culturally sensitive social issues without requiring participants to divulge personal experiences. Ms. Bora invited religious leaders and organizations in the South Asian community to attend a fall event that conveyed community assessment findings through performance skits. Through her experience, Ms. Bora discovered that establishing relationships with teachers, parents, and community members first is critical to the success of allowing teenagers to effectively communicate their true feelings regarding culturally sensitive and socially taboo topics. “Everything I have learned about how to approach and enter a new community will be applicable in my future as a physician meeting a new patient. This experience has strengthened my desire to become a primary care physician, to continue my involvement in community based health initiatves, and to be an advocate for those whose voices are silenced.”
Mark F. Brady
Brown Medical School
Highly Active Antiretroviral Therapy (HAART) for HIV-Infected Children in Siem Reap, Cambodia
Mr. Brady evaluated the system of recording non-directly observed compliance to Highly Active Antiretroviral Therapy (HAART) of patients in Siem Reap, Cambodia, and recommended changes to improve accuracy in tracking compliance. He was also instrumental in redesigning a database so the hospital could construct epidemiologic maps of the origins of patients. Because of the Fellowship, Mr. Brady had the opportunity to present a poster on the HAART effects on children in a Cambodian orphanage at the International AIDS Conference in Bangkok in 2004, and to produce a patient education video and work on a public relations project for a sister hospital in Japan. Mr. Brady’s designed a data collection template that will be used in subsequent evaluations of the HIV clinic upon IRB approval. “My fellowship experience opened me to the profound realization that I can have a bigger impact as a physician by doing research, teaching, and facilitating getting people in touch with the resources they need to help others. I have decided to study for an MPH in international health after next year in order to gain the skills necessary to bring my usefulness to undeserved populations to the next level.”
James F. Cowan
The Johns Hopkins School of Medicine
Developing a Novel Tool to Improve Patient-Provider Communication and Patient Safety in Acute Care Settings with a Focus on Urban Minority Populations
A report issued in 1998 by The Institute of Medicine estimated that between 48,000 and 98,000 deaths per year are due to medical errors, placing them between the fifth and eighth leading cause of death in the United States. Consequently, the annual healthcare cost is approximately $30 billion, with many of these medical errors disproportionately distributed among minority populations. Mr. Cowan’s Fellowship study was centered around designing a practical tool for evaluating and improving the communication and teamwork of caregivers during daily rounds to improve patient outcomes and quality-of-care, especially in underserved populations. He created a one-page evaluation sheet aimed at fostering feedback among hospital staff and implemented an observational model to provide feedback to physicians about their interactions with patients during rounds. “I am seriously considering a career in Critical Care Medicine as a result of my experience this summer, and I would certainly strive to expand this new science of patient safety in the delivery of healthcare. This is an important emerging trend that helps to reconnect all of us to the ultimate goal of medicine: to serve our patients and advocate for their health.”
Constantine A. Demetracopoulos
The Johns Hopkins School of Medicine
Incorporating Prevention and HIV Testing and Counseling in a Free Primary Care Clinic
The focus of Mr. Demetracopoulos’s project was to develop an effective procedure for implementing counseling services, educational interventions for conditions such as hypertension and diabetes, and HIV testing for patients seeking help at a free primary care clinic in Baltimore, Maryland. In collaboration with the Urban Health Institute, he used a rapid HIV testing procedure, which provides results in twenty minutes. Receiving life-changing results so quickly, as well as applying appropriate counseling necessary for patients with positive results were major challenges Mr. Demetracopoulos grappled with the during his experience at the clinic. Mr. Demetracopoulos was ultimately able to create a work flow for the clinic in which second year medical students obtained vitals from a patient and conducted relevant parts of the exam, and then advised first year students on specific testing or information a patient may require such as STD prevention or a lipid profile. “From this experience, I have learned three vital lessons that will remain with me for the rest of my medical career. First, the importance of prevention in the healthcare setting . . . Second, the importance of every member of the healthcare team . . . And third, the need for a physician to examine the community in which he is a part to determine the healthcare needs of the community, and seek to address them. These are lessons that will stay with me for as long as I practice medicine.”
Kerry Nai Pan Kay
Tufts University School of Medicine
Improving Diabetes Efforts across Language and Literacy
Many researchers have found that great disparities exist between literacy skills and the level needed to function in the healthcare system among immigrants, the elderly, and racial/ethnic minorities. This poor health literacy leads to health consequences. Mr. Kay chose to study Improving Efforts across Language and Literacy (IDEALL Project), a project that compares the effectiveness of automated phone-based diabetes management with group medical visits. She created a survey to establish a patient’s medication intake, organized a physician survey on patient outcomes, and conducted exit interviews and research on patient safety. Mr. Kay determined that if successful, the findings have the potential to change the health experience of patients from poor, elderly, and ethnic minority communities. “The IDEALL Project demonstrates that language eliminates barriers in healthcare and also helps build trust. . . . It is a reminder that even in this age of technology, the power of the physician-patient relationship still lies in one individual communicating with another.”
Laura Korin
Albert Einstein College of Medicine
HIV Status, Race/Ethnicity and Relationship with the Healthcare System
There have been numerous studies demonstrating that discrepancies in health outcomes are specific to minority populations. Particularly, health outcomes related to HIV/AIDS, which are worse among Blacks and Latinos than whites, and is also the case with chronic illnesses such as diabetes and asthma. Patients’ mistrust in the medical system and of physicians negatively impacts minorities access to and participation in healthcare services. For her Fellowship project, Ms. Korin examined how HIV status compared to race/ethnicity is associated with trust in the healthcare system and providers and perceived access to and discrimination within the healthcare system. Her project included participants from the Bronx site at Montefiore Medical Center enrolled in the Women’s Interagency HIV Study (WIHS), which measures the natural history of HIV infection in women. Participants were interviewed one-on-one and were asked to rate questions pertaining to perceptions of discrimination and access to heathcare, as well as trust in the medical system and healthcare provider. Through her Rogers project, Ms. Korin gained invaluable experience regarding the application of research principals and practices, and was able to explore areas of medicine she is passionate about: health disparities and sexual/reproductive health. Writes Ms. Korin: “Most importantly, this experience gave me a mentor who was a role model for me in envisioning my future medical career. . . . She inspired me to think about research as a powerful tool in advocating for disadvantaged and undeserved populations.
Nancy A. Levy
New York University School of Medicine
Chronic Hepatitis B Infection in New York City: A Local Snapshot
Although an effective vaccine does exist, chronic hepatitis B infection (HBV) remains the leading cause of cirrhosis and affects millions of people worldwide. Its severity and epidemiological impact, especially among Asian communities, has been gravely understudied and unnoticed in the health community. Because of the lack of substantial data regarding HBV infection, Ms. Levy was interested in compiling a source of information regarding the virus’s local effects on the New York City population for her Rogers Fellowship. Her project examined three data sub-sets of the local infected communitities: who was infected, how they were infected, and if affected were they being treated, and if so, where. Her aim in executing this project was to have the data utilized to pinpoint the communities most in need and establish HBV as a grave public health concern. “This project has strengthened my resolve to carve out a path in medicine that addresses the health needs of the underserved. . . . My exposure to the field of infectious diseases this summer was invaluable, and I have begun to consider the specialty for myself. I think the field offers many ways to contribute to marginalized populations here in New York City.”
Mary A. Piscitello
Columbia University, College of Physicians and Surgeons
An Epidemiological and Community-Based Approach to Mother-Child HIV Infection in La Romana, the Next Step
Ms. Piscitello examined the impact prenatal voluntary HIV counseling and testing programs (VCT) have had on HIV positive mothers in La Romana, Dominican Republic. These programs were implemented in seven clinics throughout the La Romana region by students participating in last year’s David Rogers Fellowship Program, after the discovery that more than two-thirds of the HIV infected women getting prenatal care were not receiving the counseling, testing or care needed to implement the new routine practice of preventing vertical transmission. Ms. Piscitello specifically focused her efforts on the patients treated at Salud Publica, the public hospital that accepts all patients regardless of lack of insurance. She began interviewing all relevant hospital staff of patients during a visit, and then determined the strengths and weaknesses of each phase. Her evaluation included evaluating waiting rooms, prenatal exam rooms, laboratory, and counseling rooms. She then utilized the data and observations collected by creating a tracking system to measure the percentages of patients lost at various phases of the patient procedure. “Our experience has broadened our understanding of the importance of “cultural sensitivity” more than any lecture course could have . . . working on this project has cultivated our interest in participating in local and international community-based health efforts.”
Thai Lan Nguyen Tran
University of Vermont College of Medicine
The Consistency of Condom Use among Female Sex Workers in Vietnam
For her Rogers Fellowship, Ms. Tran chose to travel back to her childhood home of Vietnam and confront the HIV/AIDS crises prevalent among female sex workers. Her goal was to identify factors contributing to the inconsistency of condom use among female sex workers, other than work site and client characteristics. Twenty-one qualitative interviews were carried out with subjects recruited from massage parlors, brothels, and clubs in Ho Chi Minh City in the summer of 2004. Female sex workers were recruited by peer educators through fliers, community health centers, and street outreach workers. The interviews were anonymous and requested information regarding drug use, barriers towards not using condoms, knowledge about AIDS, medical issues, and perception of risk for STDS and HIV. This study aims to protect and educate the general public of Vietnam about the risks of HIV/AIDS, as well as promote the benefits of HIV testing. “This research opportunity in Vietnam not only brought back my childhood dreams, but also inspired me to pursue a career in public health.”
Yen Ngoc Truong
Tufts University School of Medicine
Stigma and Discrimination Faced by People Living with HIV/AIDS in Vietnam
Living with HIV/AIDS is difficult even with access to quality healthcare and support from family and friends. For people who have been diagnosed with HIV in countries such as Vietnam where accurate information regarding the disease is not widely disseminated, there exists a stigma that often results in job discrimation, early retirement, and job dismissal. For her Rogers Fellowship project, Ms. Truong focused on the struggles faced by HIV positive people in Vietnam. She carried out this project in Vietnam by compiling a comprehensive report chronicling past and current research publications and studies gathered from sources such as United Nations Vietnam and Save the Children United Kingdom. Vietnamese and American researchers will be able to utilize Ms. Truong’s report to create comprehensive questions for studies presently being carried out in Ho Chi Minh city. Ms. Truong writes: “My experiences in Vietnam have made me more aware of HIV/AIDS issues in patients and appreciative of the value of social workers and other professionals that complement the role of physicians in handling patient care. . . . I can only expect further reflection in coming years will result in further personal and professional growth. . . . Mere words on paper cannot adequately describe how wonderfully gratifying this experience was.”
Pavithra Venkat
Yale School of Medicine
Perceptions of Contraceptive Safety, Efficacy and Side Effects among Low Income Latina and Non-Latina Women
Recent research studies indicate that Latina women are much more likely to experience unintended pregancy, which in part is attributed to low contraceptive use. While various studies have focused on socioeconomic status and low access to care as a factor in the lack of birth control methods among this community, no methodical research exits to suggest that attitudes and beliefs towards utilizing contraception is a major contributing factor. The goal of Ms. Venkat’s project was to carry out a study to determine the ideas held by urban Latina women about the most commonly used contraceptive methods: birth control pill, depo-provera injection, ortho-evra patch, and the intrauterine device. This research was carried out by disseminating surveys to women in Bellevue Women’s Clinic in New York over a four-week period. The questionnaire requested information regarding beliefs about safety, efficacy, and side effects of contraceptive methods and was available in both English and Spanish. The results demonstrated that Latina women are generally overly concerned with the risks associated with contraception, and underrate the benefits they may receive. In Ms. Venkat’s words: “I gained real-time exposure to working in an inner-city public hospital that serves a largely indigent population. . . . My summer further motivated me in my quest to become an OB-GYN and to serve the populations that I was able to do research with this summer.”
John A. Villanueva
University of Minnesota Medical School
Insights on HIV and Condoms among Teens in the South Bronx: Study of Perceptions that Influence a Teen's Choice to Practice Safe Sex
Statistics provided by the Centers for Disease Control and Prevention report that there is a higher percentage of adults living with HIV/AIDS in the Bronx than in forty-five other U.S. states. This alarming information regarding the prevalence of HIV/AIDS in such a concentrated area, in addition to Mr. Villanueva’s interest in infectious diseases and adolescent health, influenced his choice to examine the issue of safe sex and HIV among teenagers in the South Bronx. For his Rogers Fellowship, his goal was to determine the number of teens who are considered to be high or low risk for the HIV infection, as well as who and what influences their decision to practice safe sex. Mr. Villanueva executed this project by designing an anonymous survey for teens from ages thirteen to nineteen regarding their sexual practices, race, gender, and information or advice provided by peers, family, and their school sex education programs. The results collected from 601 participants demonstrate the need for intervention tactics necessary for education and improving awareness of such an influential population. “My experience in the South Bronx has further enriched my understanding that the prevention of HIV not only involves the tangible physical barriers to contracting the virus, i.e. condoms, but also the complex socio-economical and cultural factors that play into the minds of individuals when they decide whether they will practice safe sex . . . it is only when teens have self-worth that they will take the proactive measures to respect their bodies and follow the necessary precautions (i.e. practicing safer sex) to sustain their overall health.”
Tanyaporn Wansom
University of Michigan Medical School
A Grassroots Response to the War on Drugs: Harm Reduction by and for Intravenous Drug Users in Thailand
For her Rogers project, Ms. Wansom spent the summer in Thailand, focusing on the struggles injection drug user’s face in obtaining treatment and their exposure to the HIV/AIDS epidemic. She also researched harm reduction mesaures available in this region such as access to sterilized needles and participating in safer sex. She quickly became aquainted with the War on Drugs campaign executed by Prime Minister Thaksin Shinawatra, where IDU’s and their families are forced into boot camp, imprisonment and forced rehabilitation. During her time spent in Thailand, Ms. Wansom wrote pamphlets introduing IDU’s to information on how to avoid hepatitis C, visited drug treatment centers in Bangkok suburbs and Chiang Mai, attended the International AIDS Conference, and served as an interpreter for the Thai Drug Users Network and the Thai Network of People Living with HIV/AIDS. Because of her fellowship, she was also able to write an article chronicling her experiences in Thailand for the publication The New Physician. “This past summer, I was forced to confront not only global disparities within the field of HIV/AIDS, but also was introduced to the marginalized among the marginalized . . . my work with IDU’s has prompted me to not only get involved with addressing disparities within marginalized populations, but also in educating others about these populations in the United States.”
Lisa Jun-Pei Wong
Stanford University School of Medicine
Oral Poliovirus Vaccine Mutation in Infants in Mexico: Implications for Immunization Policies in Developing Countries
Poliomyelitis (polio) is a crippling infectious disease that remains highly dangerous among disadvantaged populations. Currently, inactivated polio vaccine (IPV) and oral polio vaccine (OPV) are the only vaccines used for preventing the virus. However, OPV has the potential to mutate to a neurovirulent form that can cause vaccine-associated paralytic polio (VAPP) and because it is the considerably cheaper vaccine, it is used frequently in developing countries. For her Rogers Fellowship, Ms. Wong chose to explore the frequency and timing of mutation in OPV in infants in Mexico, the transmission rate, and whether individuals who change diapers are highly susceptible due to the fecal-oral transmission route. Her technique included: recruiting participants, vaccinating infants, collecting fecal samples of vaccines and their contacts, interviewing participants regarding diaper-changing habits, and transferring the samples to Maldonado Laboratory at Stanford University in California. Through her research, she is fighting to minimize health disparities in poor communities in an often overlooked developing country. She writes: “After my return from Mexico, I have met many patients from Latin American countries. I feel much more comfortable and better able to communicate with them after having lived and worked in Mexico.”
David Ping-Hsin Wu
University of California, San Diego, School of Medicine
Community-Based HIV Prevention and Testing among Clients at the UCSD Student-Run Free Clinic, Pacific Beach and Downtown Sites
Without an HIV/AIDS vaccine or cure, one of the most important preventative methods remains being aware of one’s HIV status by receiving regular testing. It is especially vital for at-risk populations such as intravenous drug users and those who engage in unprotected sex. Mr. Wu’s project was to introduce a quicker method for HIV testing at the UCSD Student-Run Free Clinic at Pacific Beach and downtown sites in California, and to implement a counseling component to the HIV testing process. Mr. Wu was particularly interested in assessing the self-reported attitude and behavior changes during pre- and post-HIV counseling sessions. The primary accomplishments of his study were enhancing the HIV testing procedure by offering patients the option of obtaining immediate results with the OraQuick testing method. All patients were given mandatory HIV/AIDS assessments, counseling, future testing appointments and accurate information regarding risk factors that lead to infection. “This project has enabled me to be more in tune with what’s going on with a patient. This for me is at the heart of medicine: good communication skills and a caring attitutde earn trust from the patients who are then more likely to listen to what I have to say. I will continue to build upon and refine this skill. It is only through clear and direct communications that safe messages can be carried through. ”
Julie A. Yee
University of Rochester School of Medicine and Dentistry
Evaluating the Stigma of HIV-seropositivity as a Means to Assist with the Recruitment and Acceptance of HIV Vaccine Trial Participants in Soweto, South Africa
The World Health Organization released statistics citing that 11 percent of 43.8 million inhabitants in South Africa tested positive for HIV. With the AIDS virus ravaging in African communities at such an unmanegeable and alarming rate, the need for scientists to implement HIV vaccine trials has never been so critical. Because social stigmas exist towards the subjects that participate in HIV vaccine trials, this has deterred a number of people from participating. For her Rogers Fellowship, Ms. Yee examined the prejudices existing within the Soweto community surrounding HIV vaccine trials and then explored steps towards alleviating these obstacles. A thirty-eight question survey on the following categories was designed: sociodemographic characteristics, knowledge regarding HIV/AIDS and HIV vaccines, perceptions of those who participate in vaccine trials or who test HIV positive, and personal experiences with HIV/AIDS. Ms. Yee was also able to participate in a Vaccine Discussion Group, which she found to be one of the most rewarding aspects of her experience in Soweto. “I have to say that I found role models in many of the physicians and nurses who had to deal with such difficult issues every day. Their compassion, assertiveness, and skills were inspirational and have further motivated me to work in an undeserved community when I become a physician. Furthermore, the results of this research provided further evidence for me of just how much community members place their trust in physicians and rely on them to provide accurate information and healthcare.”
Warren K. Young
Brown Medical School
A Cross-Sectional Study of Serum 25 Hydroxyvitamin D Levels in HIV-Positive and HIV-Negative Children and Adolescents from an Urban Environment
For his Rogers Fellowship project, Mr. Young chose to focus on specific urban populations in New York City as his subjects in determining if there are significantly reduced levels of vitamin D in perinatally-acquired HIV children and adolescents. His study consisted of examining serum 25-hydroxyvitamin D levels of HIV positive participants against a HIV-negative control group, coupling each HIV-postive subject with a HIV-negative subject by matching the following criteria: ethnicity, age, gender, and the particular time period that the serum sample was extracted. Mr. Young also ulitized the Block Kid Questionaire designed by Dr. Gladys Block from UC-Berkley to analize the dietary intake of vitamin D by food consumption in a week’s time by each participant. Mr. Young was also granted the opportunity of spending time at the Center for Comprehensive Care at St. Luke’s Hospital Center interacting with HIV positive patients aged six to sixteen in order to comprehend the course of their illness. Through this experience, he was able to determine that many children diagnosed with HIV have been able to enhace the quality of life by the impact of effective new drug treatments. “With the advances in treatment regimens, and the successes that have resulted, many children with HIV are living longer and more productive lives than people would have imagined a decade ago. . . . I learned more about the humanism behind being a physician, and the challenges that a physician faces in caring for patients beyond basic medicine.”
