RCHC Community Project Abstracts

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The Rural Elderly: A difficult to manage health care system?
Date of project: 2/9/2009

•61 million people live in the rural U.S. and 15 % of them are 65 years of age or older. When it comes to healthcare, the shortages have even greater implications for these rural elderly. So, it is the goal of my project to examine how rural elderly manage their healthcare. By using the current literature and interviews of patients and doctors, I have set out to understand if the rural elderly in Hood River find it difficult to manage their healthcare and to provide suggestions for improvements that all healthcare providers can use.

Uncontrolled Diabetes in the Hispanic Community of Hood River, Oregon: Identifying Barriers to Good Diabetic Control
Date of project: 10/13/2008

It is a well known fact that diabetes is one of the leading chronic diseases in our country today. However, it is not well known why some minorities have a higher risk to acquire this disorder. Compared with Caucasians, blacks have a 60 percent higher risk of developing diabetes, and Hispanics have a 90 percent increased risk. These numbers are astonishing. Now let us narrow our focus to the Hispanic group. Why is it that Hispanics are at higher risk? And why do they have higher rates of uncontrolled diabetes and less continuity of care for their diabetes in general? These are some of the questions that this brief study will attempt to answer. It will focus more on some of the barriers and problems faced by diabetic patients that receive their health care at La Clinica del Carino in Hood River, Oregon.

Complementary Health Services in the Mid-Columbia Gorge
Date of project: 8/4/2008

This project is a ‘survey of the scene’ of the various alternative and complementary health services offered in Hood River Oregon, and the Mid-Columbia Gorge (MCG) area. Utilizing internet searches, telephone directories, physician and physical therapy interviews; this project first lists all currently existing complementary services in the MCG area then the initial survey is followed by site visits, and interviews of 3 different area complementary health clinics. The clinics are questioned about the unique services they offer, the basic demographics of their clients, and how they contribute to the health of the population of the MCG area. The report concludes with recommendations for future patients seeking alternative or complementary health services.

Cardiovascular Risk Reduction in Hood River, OR: Availability without Access
Date of project: 2/11/2008

Although preventable, heart disease remains the number one cause of death in the United States. This study sought to examine cardiovascular risk reduction in an internal medicine clinic in Hood River, OR. Methods included observation of clinic practices, interviews with health care providers, and analysis of inpatient admissions for 2007. Patient education for cardiovascular disease in the clinic included brief, informal counseling performed during the visit and focused on risks that were identified through the patient’s history, physical examination, and laboratory evaluation. No handouts for patients were in use to augment this education or encourage lifestyle modification. A comprehensive cardiovascular risk reduction program was available but expensive, minimizing its utilization. The ultimate goal of this project was to create an efficient and educational patient handout aimed at increasing awareness of modifiable cardiovascular risk factors, encouraging lifestyle modifications, increasing patient-physician dialogue, and highlighting free or insurance-reimbursed programs available in the area.

Menos Pesticidas para los Ninos Felices
Date of project: 12/31/2007

La Clínica del Cariño is a community health center dedicated to serving migrant agricultural workers and other community patients who would otherwise be without health care. Children in agricultural households have been shown to have higher levels of pesticide degradation products than both their urban counterparts and their own parents. Long term sequelae of these exposures are not uniformly accepted, however, reports have been made in humans that chronic exposure to pesticides can cause malignancy, neuroendocrine deficiencies, and sterility. Pesticides enter the homes of agricultural workers on clothes, boots, skin, and dust. Levels of household pesticides correlate with children’s urine levels of pesticide degradation products. It is reasonable to expect that reducing these sources of exposure for children could reduce their risk of serious long term sequelae. Currently, few providers at La Clínica assess their patients’ level of pesticide exposure and educate their patients regarding how to avoid exposing their children. This study uses a questionnaire to assess the attitudes of providers regarding pesticide education, identify barriers to pesticide education, and establish solutions to these barriers. Providers are interested in educating their patients, but they do not feel that they have enough time to do so and often forget. These issues will be addressed by changing the well child visit forms to include prompts to address pesticide exposure and educational handouts regarding pesticide avoidance strategies. Additionally, parent questionnaires have been added to screen for pesticide exposure, lead exposure, TB exposure, autism, and failure to meet developmental milestones.

Zostavax and Hood River, OR: Raising Awareness of the Efficacy, Availability, and Cost of the Herpes Zoster Vaccine
Date of project: 10/15/2007

Herpes Zoster and its all too common complication of postherpetic neuralgia is widely recognized by the medical community as having a significant impact on the well being of the general population. Within the first week alone of the Hood River Rural and Community Health Rotation, four separate patients inquired about the nature of herpes zoster and the available vaccine. As the vaccine has only just recently received FDA approval, the public’s knowledge of its efficacy and availability is quite poor. A small community project was formulated to determine the prevalence of herpes zoster and the efficacy, availability, and cost of the herpes zoster vaccine as it relates to the patient population seen by the Providence Hood River Internal Medicine Clinic. Literature searches, brief health practitioner interviews, and development of a simple but informative fact sheet to be given to inquiring patients were the focus of this community project.

The Impact of the recreational tourist on the Hood River ED
Date of project: 8/6/2007

Hood River Oregon is situated in the heart of the Columbia River Gorge. It is surrounded by tall mountainous volcanoes, rivers, the mighty and windy Columbia, and miles of orchards and forested trails. Due to this setting, Hood River attracts sports enthusiasts from around the globe. Visitors come from Europe, Southeast Asia, Australia, South America, and nearby United States towns to enjoy this playground. While Hood River is only sixty miles from Portland Oregon, it is still considered a “critical Access area” in terms of medical care. The main hospital is owned and run by the Providence Medical system. The hospital only has twenty four inpatient beds including the ICU, and an eight bed emergency department. This area is facing a great deal of financial and medical difficulty as the closest medical neighbor in the Dalles, faces potential closure. Hood River has a population of five thousand. This number fluctuates seasonally with the summer winds and winter snow. Overall, the full time residents remain near a population of five thousand. This project was intended to investigate a small piece of this access problem. What is the impact of the visiting “recreational tourists” on a small town emergency department?

Increasing Access to Health Care in Hood River County: Mobile Health Unit
Date of project: 10/16/2006

Millions of Americans do not have access to health care especially in rural communities. Hood River County has a population of 19,691 with the following characteristics 18.1% are uninsured, 14% live below the poverty level, 15.5% on disability between ages 16-64, 36.2% of children on free or reduced lunch, and 27.2% are Hispanic. The barriers preventing people within Hood River County from accessing health care include transportation, distance to care, uninsured, underinsured, immigration status, language barriers, and lack of knowledge on how to access health care. Providence Hood River Memorial Hospital (PHRMH) serves Hood River County and is located in Hood River. PHRMH identified lack of access to health care as a major problem within the county and created Mission in Motion – Mobile Health Unit (MHU) to bring access to health care to the people of Hood River County. After interviewing employees and observing the MHU in action I learned about the MHU and how it was started. MHU is a 35-foot RV purchased from eBay and refurbished into a mobile health clinic that services the small communities of Hood River County. It is staffed by physician or physician assistant, medical assistant, and driver. The mission of the MHU is to provide first time medical visits to patients that do not have access to health care or do not have a primary medical home and then set them up with a permanent medical home. In the first weeks of service 32 patients were seen with the top three reasons being blood pressure checks, high blood glucose, and cold/sinus infections. The MHU is still in its early phases and there are some concerns regarding potential for abuse as a primary care center. Patients have been appreciative of the services. The community of Providence Hood River health system should be applauded for their efforts to increase access to health care among the population of Hood River County.

Increasing Awareness; Decreasing Risk: Hispanic farm workers and pesticide education in Hood River, Oregon
Date of project: 10/17/2005

Hood River, Oregon is the largest city in the 4 county Mid-Columbia region which spans the Columbia River Gorge between northern Oregon and southern Washington. The area is famous for fruit production, with raising and harvesting of cherries, apples and pears heavily dependent upon the region's large Hispanic population of seasonal farm workers and migrants. Though all Americans are exposed to pesticides, many studies have supported the fact that farm workers and their families are the most vulnerable to both the acute and chronic deleterious health effects of the more than 16,000 different pesticide products currently in use in the United States. Studies have indicated that potential chronic adverse effects of pesticide exposure include cancer as well as reproductive and developmental, immunological, neurological and behavioral effects. Though an official system exists across the country for notification of acute pesticide poisoning events, little emphasis is currently placed upon the long-term effects associated with chronic, low-level pesticide exposure. La Clinica del Carino, a federally qualified community and migrant health center established in 1986 in Hood River, Oregon, has been an active advocate for farm worker health for 20 years. This study attempted to clarify the reasons behind the current lack of focus on this important area of farm worker health in both the clinic and the community as a whole, as well as to suggest appropriate avenues for educational interventions in the future.

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