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.

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.

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!

2014 Community Service Award – The Siloam Institute

The Siloam Institute was recently recognized by the Tennessee Medical Association for its work training the next generation of health care practitioners in whole-person care.  Dr. Morgan Wills and Mark McCaw attended an awards ceremony where the video below was shown.

 

Dr. Morgan Wills, President and CEO of Siloam Family Health Center and Mark McCaw, Siloam Institute Director receive the 2014 Community Service Award given by the Tennessee Medical Association.

Dr. Morgan Wills, President and CEO of Siloam Family Health Center and Mark McCaw, Siloam Institute Director receive the 2014 Community Service Award given by the Tennessee Medical Association.

 

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:

Home visits bring heart

Guest blogger Will Tucker, one of seven students in this summer’s Community Health Immersion, writes…

Last week I had the marvelous privilege of shadowing Lauren Smith, a Family Nurse Practitioner with Siloam Family Health Center. The experience was an enormous blessing to me and I have rarely seen a more refreshing sight during a home visit. Most of my experience with patient interaction has always been in an office setting and this was actually my first interaction in a patient’s home.

“…I have rarely seen a more refreshing sight…”

Home visits open doors to greater understanding about barriers patients face. Photo credit: medicalhometeam.com

Amazement was my initial reaction as we were welcomed into their homes and I could tell that these appointments were full of purpose and provided insight to a fundamental aspect of Siloam, whole-person care. Chelsea and I were the students able to travel to the home visit that day and we both recorded notes as the patient/practitioner dialogue transpired, some of which was in Spanish.

Walls I anticipated to be up were non-existent in the visits as conversation flowed freely in two languages. I clearly witnessed the value of language that is so applicable in everyday life and is often the form of communication we take for granted the most. Language is a cultural component that conveys along with it meanings for objects or action that cannot be accurately translated, but we were blessed to learn from Lauren its importance in action.

“…not everything can be simplified down to chemical reactions…”

We also learned to focus on other cues a patient may unintentionally give through their environment or behaviors. Through careful observation of many factors in the home a much more thorough understanding of what affects patients on a daily basis is acquired. I have heard it said many times that personal daily decisions will always factor into a person’s overall well being more so than any other factor that a medical professional can assist with and if it were not clear already, I saw with much clarity the truth in that statement.

During each visit I listened intently to the interaction occurring and made various observations about the home and various family relationships that patients had established. I was even fortunate enough to get to read a few jokes in an almanac with the husband of a patient and somewhat dip my toe into the waters of fine trust that exist between patient and practitioner as an observer.

“…I was surprised to find that hope overflowed…”

While I expected home visits to be solemn occasions, filled with despair and hardship, I was surprised to find that hope overflowed and peace persisted despite all opposing circumstances. Emotional & spiritual support was provided by family and friends, physical guidance, emotional, and spiritual support was also supplied by Lauren as she reviewed medicines and plans of action with each patient. But the most important and intriguing facet is that all of those good things were firmly rooted in Christ.

Will Tucker is a rising senior at Union University.

Will Tucker is a rising senior at Union University.

At the conclusion of each visit Lauren sought to pray with her patients and in doing so acknowledged that not everything can be simplified down to chemical reactions, treatments, careful planning, medications to solve this and that problem, but that there are somethings we do not understand yet and may not at all. While I hope that we continue to make great strides in knowledge acquisition, always acknowledging God as its source, I also pray that we never forget the anchor that we have in the love of Christ and its compelling power to peace, understanding, wisdom, and its call to be whole in Him.

CHI expands with Kenny Namkoong

We are excited to announce one of the seven pre-medical students who will join us in Nashville this summer for the Community Health Immersion program.  Kenny & the others will live in and serve a local refugee community along with shadow providers at Siloam and reflect on God’s call to them through a career in medicine.  Click here to see the profiles of the other students joining us this summer.

Namkoong, Kenny - Profile

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How Whole-Person Care Fosters Patient Engagement

Lauren Holmgren, former 4th year ETSU medical student who completed her rotation at our clinic in March 2014

Lauren Holmgren, former 4th year ETSU medical student who completed her rotation at our clinic in March 2014

Leaving Siloam yesterday was bittersweet.  Not only was I leaving a clinic I have come to love and people who had truly made me feel like part of the team, I was leaving behind my role as a medical student.  Yesterday was the completion of my very last clinical rotation of medical school.  I will never again walk into a patient room and introduce myself as “the medical student working with….”  Instead, the next time I walk into a patient room I will introduce myself as “Dr. Holmgren”.  As I reflect back on my time at Siloam, there is no doubt in my mind that as I transition to “Dr. Holmgren,” the way I practice will be shaped by the time I spent at Siloam.  I have, somewhat selfishly, spent a lot of time this month trying to figure out what it is that allows the patients and providers at Siloam to create such a nurturing and health promoting environment because it is exactly the type of relationship I hope to one day have in my practice.

The conclusion I have come to…. it’s a combination of a number of things.  First and foremost, the providers at Siloam are interested in the whole person rather than just the medical complaints of their patients—their dedication to providing care for all aspects of a patient’s life from their medical needs to their spiritual needs to their social needs.  This focus and dedication allows the providers to make the best recommendations for their patients but that alone is not enough to care well for their patients. The patients have to take an active role in their healthcare.  The care and dedication of the providers to take care of the whole person is something patients recognize and I think that greatly contributes to patients taking an active role in their own health, but Siloam also requires their patients to be responsible for their healthcare.  I see this as a critical part of the success Siloam sees.  Patients understand that the clinic is not going to ask them to contribute more than they can afford but at the same time, the patients understand that they have to be invested in their own care.
Additionally, the patients of Siloam are a wonderful group of people.  They have a wide variety of experiences that have shaped their lives but they are all grateful for what they have and the care they receive at Siloam.  All of these things together have made an exceptional place to learn and a great place for people to get exceptional care.  I am truly grateful to have had the opportunity to be a part of such a wonderful clinic.

 

Guest blog post courtesy of Lauren Holmgren