Cost-Conscious Care

Editor’s Note: One of the features of completing a clinical rotation at Siloam is learning about “poverty medicine” – delivering cost-conscious care. Andrew Wu, a 4th year Vanderbilt medical and master of public health student recently rotated at Siloam.  Andrew writes of his experience…

Wu, Andrew - VMS-IV - with Dr. Snader 10-2014

Dr. Brent Snader serves as a preceptor to 4th-yr Vanderbilt University School of Medicine student Andrew Wu.

One of my first learning experiences was an opportunity to learn how to practice in a cost-effective manner. A patient needed to be screened for colon cancer, which is normally done with a colonoscopy. However, due to financial constraints for this patient population, the alternative strategy of a fecal occult test was used in lieu of colonoscopy at this clinic. I found it interesting that these “alternative” methods were actually the standard for this particular patient population. In nearly all of my training, I was used to having almost unlimited resources at my fingertips. I could order labs and procedures without thinking much about the cost since they were either allowed for educational purposes or simply because the hospital could afford it. However, practicing at Siloam has allowed me to taste a bit of the reality of the cost behind the medical practice and how to appropriately adjust for it.

Looking for opportunities to give yourself to?

We often blog about medicine being a calling…one, to which practitioners are motivated by God’s tug on their life to pursue.  P.K.Lee - MSF in Sierra LeoneUnfortunately, “a not-so-funny thing happens on the way to the forum.”  Their motivation to practice medicine shifts.  As one of my colleagues often states, “many go into medicine to do good, yet come out of medicine to do well.”  Here is an opportunity to do good…and, possibly get back to that original “calling.”

Doctors Without Borders/Médecins Sans Frontières (MSF) helps people worldwide where the need is greatest, delivering emergency medical aid to people affected by conflict, epidemics, disasters or exclusion from health care. On November 6, 2014, medical and non-medical professionals are invited to a late afternoon presentation from 5-6:30 in Vanderbilt University Medical School’s, Light Hall, Room 208,  to learn more about how they can join Doctors Without Borders’ pool of dedicated aid workers. For readers outside the Nashville, Tennessee area or otherwise unable to make the meeting, more information about opportunities can be found at this link:  http://www.doctorswithoutborders.org/work-with-us

 

No magic solution…

The Siloam Institute offers clinical rotations to nearly 40 health professional trainees annually. Their rotation at Siloam helps them to deepen their understanding of how to engage persons living in poverty, work cross-culturally, and learn how to integrate behavioral health and spiritual care into their practice of medicine.

Click the video below to watch Samaiya Mushtaq reflect on a particular patient encounter stating, “I did not offer them a magic solution to their health problems, but I think they felt a little more healed after that visit.” Samaiya is a fourth-year Vanderbilt medical student who plans to pursue a residency in psychiatry.

Taking a lesson from impoverished nations

Photo Credit: Lwala Community Alliance

Photo Credit: Lwala Community Alliance

Siloam’s Community Health Immersion students worked to train refugee lay health workers for a more effective outreach to the refugee families in Nashville.  This work drew much of its inspiration from successful community health worker programs found in impoverished nations.

In a guest blog at Huffington Post, comments made by James Nardella (Lwala Community Alliance) resonate with our experience here in Nashville.

James writes:  “Scale and efficiency are important to moving health care goods and services….  But, when it comes to addressing the root causes for poor health in many places, scale can be a distraction. Delivering goods and services alone will not motivate people toward health seeking behavior.”  James goes on to point out that, “…health-seeking decisions are made at the family level.”

Read the full post of James’ excellent blog Heirloom Healthcare for the Poor by clicking here.

Lay health workers trained by Siloam students

“I‘m too much glad to see you because you are Nepali.” Greetings like this one from a Nepali man bring joy to 19-year old Anita Nepal who loves helping people in the Nepalese community of Nashville.  Anita, born in a refugee camp in Nepal to Bhutanese parents, was recently trained as a lay health worker by pre-medical students participating in Siloam’s Community Health Immersion program. Nashville’s Nepali community – mostly made up of refugees from Nepal and Bhutan – appreciate the cross-cultural understanding that Anita brings as she teaches within her community on the health topics she recently learned.

“Many of the Nepali people do not understand the health care system in America,” says Anita who works full-time in housekeeping at a local hospital. They struggle to know how to make appointments to see a doctor or how to get medicine from a pharmacy because as Anita says, “… in Nepal there were no appointments or prescriptions…you just show up and ask for what you need.”

“I learned many things – I can help many…”

For Siloam’s six-week Community Health Immersion program, pre-medical students were recruited from around the country to live in a refugee apartment complex in southeast Nashville where they trained nine lay health workers like Anita from the neighborhood. Training topics included preventative care like oral health, nutrition, and exercise, along with health navigation topics like how insurance works and the difference between an emergency room and a primary care clinic. Beyond learning how to teach lay health workers, the pre-medical students also explored how to see the vocation of medicine as a calling and to see how to care for patients as whole persons as Jesus did.

The pre-medical students’ work with the lay health workers is making a lasting impact.  The oral health topic alone made an immediate impact on Anita’s family of five who were resettled a year ago in Nashville after spending 21 years in a refugee camp in Nepal. “We did not know about dental floss or how many times each day to brush our teeth or for how long,” Anita says. “Now we do. I learned many things – I can help many Nepali and Bhutanese people.”

Lay Health Workers and CHI Students pose outside their apartment - 2014 - cropped

Pre-medical students and lay health workers pose outside following a training session. Lay health workers include (L-R) Samson Sarki from Bhutan (in turquoise), Paulos Ezekiel from Eritrea (in purple), and Anita Nepal from Nepal (in blue and red). Pre-medical students (L-R back row) include Will Davies, Stewart Goodwin, Kenny Namkoong, Frances Cobb, Caleb Huber, Will Tucker, along with Reinie Thomas (kneeling), and Lauren Roddy (in blue on right). Pre-medical student Chelsea Travis is behind the lens!

Off with a bang!

It has been quiet this week since our nine CHI participants (7 pre-meds and 2 directors) left town after spending an exciting six-weeks with us on a Community Health Immersion.  As we celebrate our nation’s independence this weekend, let’s also celebrate the ministry of presence that our freedoms allow us to carry out.  Check out this video that the students put together as a celebration of how God is moving in their lives as they prepare to be future physicians: