RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Interpreter use in Klamath Falls, Oregon Project Date: 10/12/2009 United States Federal law requires that limited English proficient (LEP) patients be guaranteed effective communication in the course of a hospital or clinic visit. In order to assess the effectiveness of communication between providers and LEP patients in Klamath Falls, Oregon, Family Medicine and Pediatric clinics in this town were given a short survey on LEP patient population and interpreter use. All responding clinics have patients who are Limited English Proficient (LEP) and all utilize health care interpreters who are not certified (either bilingual staff or people to serve as interpreters brought in by the patient) as their primary method of interpretation. While these interpreters may have the skills required to be certified health care interpreters, this cannot be determined without undergoing the testing that leads to interpreter certification. This means that it is currently uncertain whether LEP patients are encountering accurate and effective communication in Family Medicine and Pediatric clinics in Klamath Falls, Oregon. Health of the Klamath Tribes Project Date: 3/16/2009 The purpose of this project was to educate myself and my peers about Indian Health Service and unique health and healthcare delivery issues faced by AI/NA patients, within the context of the Klamath Tribes as sole provider of IHS services in Klamath County. The Indian Health Service (IHS) is a unique healthcare delivery system that provides health services to nearly 2 million American Indians and Alaska natives (AI/NA) residing on or near reservations and 600,000 patients in urban areas. The Portland Area Office of IHS is one of 12 area offices around the country, serving 42 federally-recognized Tribes in Idaho, Oregon and Washington State. The project population was patients at the medical clinic of the Klamath Tribes Health & Family Services Wellness Center. Investigation methods included a meeting and extended tour with the Health General Manager, observation of patients at the Wellness Center, discussion of health and healthcare delivery issues with the clinic’s primary providers and use of Internet resources. Results: common health issues included opioid dependency, diabetes, hypertension and obesity, infant mortality, substance abuse and mental illness. Healthcare delivery issues included limited funding, need for providers, limited resources for a growing patient population, and lack of an electronic health record (EHR). Perceptions of Place, Health, and Illness Among Longtime Tillamook Residents Project Date: 3/16/2009 Cultural competence within health care systems and among providers is an increasingly important issue as public health officials and policy makers look for cost effective means to improve health. Cultural competence of medical professionals within rural American populations is particularly important in efforts to attract health professionals to rural areas, to augment the success of public health interventions, and to improve health outcomes and patient satisfaction. With this project, I added to cultural knowledge that bridges the urban medical community with rural, specifically Tillamook, Oregon, communities. I interviewed six longtime Tillamook residents who have lived in Tillamook for at least 50 years. I asked each of these participants a series of questions designed to elicit their perceptions on diverse topics, including personal history, geographic and cultural identity, occupational health, expectations of health care, experiences of illness and grief, and beliefs about depression. Three important, recurring themes included Tillamook residents’ positive perceptions of rural lifestyle and of Tillamook; their self perceptions as being independent, self-reliant, and stoic; and their shared belief that physicians should be skilled at developing high quality relationships with patients and that rural doctors are more successful at this than are urban doctors. These findings enhance our understanding of rural patients as ones who desire highly individualized health care with respect and support of their cultural values that include hard work, self-reliance and self-healing. Comparing Trends in Cardiac Disease between Multnomah and Klamath Counties Project Date: 2/9/2009 Background: Coronary heart disease (CHD) is the single leading cause of death in the United States. Mortality from CHD and overall incidence of CHD has been declining since the 1960’s. This trend has not been as significant in African Americans, Hispanic Americans, American Indians, individuals of lower socioeconomic status, and rural populations. Differing trends in heart disease have been observed within different sub-populations in Oregon. The purpose of this study was to compare trends in heart disease in the most urban area of Oregon, Multnomah County, to heart disease trends in a rural region, Klamath County. Methods and Results: Yearly, age adjusted heart disease death rate, coronary heart disease (CHD) death rate, myocardial infarction death rate, and risk factor data, including data on smoking, obesity, physical activity, diabetes, and cholesterol awareness data for Klamath and Multnomah counties was analyzed. Trends in heart disease mortality from 1995 to 2005 were compared. Heart disease death rates were found to be consistently been higher in Klamath County than in Multnomah County. Hispanics and Native Americans residing in Klamath County had significantly higher mortality rates from cardiac disease. There was a decreasing trend in heart disease mortality and myocardial infarction mortality in Multnomah County from 1995-2005 that was not apparent in Klamath County. Prevalence of major risk factors such as smoking and obesity was also found to be significantly higher in Klamath County. Conclusion: Klamath County exhibits several disparities related to recent trends in heart disease. Primary prevention programs with improved outreach that are more specifically targeted towards those living in rural areas need to be established. Better access to health care is necessary in rural Oregon. Physician shortages must be addressed to improve both preventive and specialized care. Depression in Warm Springs Project Date: 10/13/2008 Depression is a serious condition that affects the mind and body, associated with a host of co-morbidities and potentially resulting in suicide. Factors associated with increased prevalence of depression that are certainly found in Native American communities include poverty, displacement, and relative lack of jobs. However, there are some barriers that prevent the people of the Warm Springs reservation from getting counseling help for depression, such as cultural factors, lack of knowledge about the local Counseling Center and its services, and misconceptions of poor patient confidentiality and costly services. To address the issue of depression in the Warm Springs community, I designed a pamphlet for the Counseling Center that would help in getting the word out to the community about the Counseling Center and the services they offer, appeal cross-culturally, aid in screening for depression, provide resources to help intervene, and dispel misconceptions. Uncontrolled Diabetes in the Hispanic Community of Hood River, Oregon: Identifying Barriers to Good Diabetic Control Project Date: 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. Screening for urinary Incontinence in Women > 50 years of age in Warm Springs, OR: An underdiagnosed issue Project Date: 9/8/2008 Urinary incontinence (UI) is a significant health issue with substantial social impact. However, this issue is often unaddressed by health care providers in one of its major populations, older women. The goal of this study is to illustrated the degree to which urinary incontinence in woman ages 50 and up is underdiagnosed in Warm Springs, OR. Warm Springs Health and Wellness Center is an Indian Health Services clinic and the only clinic on the reservation. A sample population of women ages 50 and up coming to the Warm Springs Health and Wellness Center medical offices between September 23 and October 6, 2008, were screened for UI using the previously validated MESA questionnaire for urinary incontinence. Surveys were scored and UI prevalence according to the MESA questionnaire was compared to prevalence according to IHS ICD-9 codes for UI. According to a VGEN search of EHR (electronic health record), Warm Springs Health and Wellness Center only had a 13.0% prevalence of UI women in aforementioned sample population. However, according to the MESA questionnaire at least 58.7% this sample population had some form of UI. Not only is UI unaddressed in this community, but patient knowledge and educational information is lacking. Therefore, the final product of this project is an educational pamphlet on UI. Social gatherings and community is a very important part of this population, hopefully addressing undiagnosed and untreated UI may be improve the quality of some of these women, allowing them to actively participated in community functions and gatherings without fear or embarrassments associated with UI. Old Believers of Silverton, Woodburn and Mt. Angel Area Project Date: 8/4/2008 10,000 Russian old believers community presents a significant percent of Marion county and especially Woodburn and Silverton area. Even though a great majority of them speak English well, their cultural specifics sometimes makes providing a health care for them difficult. Some of greatest concerns of health care providers were identified and included: culture and lifestyle of Russian old beliers; their general attitude toward medical care; family role distribution and medical decision making; women health issues, including early marriage and pregnancies as well as birth control; children health and immunizations; and end of life issues. These issues were then investigated and presented. Due to limit of time available for the project, information was collected from limited sources. Most Wanted: Clandestine Patients Project Date: 6/30/2008 There reside a substantial number of illegal immigrants in Milton-Freewater who are part of the larger Hispanic field worker community. The Hispanics in this rural area are not receiving access to medical care, and the barriers between the physician and this immigrant population in this community are complex, involving economical, social, political and legal factors. Low utilization of primary care services impedes in the prevention and early detection of disease; this negativity impacts the immigrant population as well as the community at large by potentially increasing the incidence of communicable diseases and by driving up healthcare costs due to an increased usage of emergency facilities. In order to investigate the extent to which these healthcare limitations are real and affecting the immigrant population, interviews were conducted and barriers to accessing medical care were discussed. A free blood pressure screening clinic was held three Wednesdays in the evenings at the only clinic in the town. The small turnout at these screenings despite aggressive local promotional efforts proved that the obstacles between provider and the immigrants are even greater than implicated. Traveling to the labor camp in person generated more interest in my project and greater numbers of volunteers were willing to participate in my interview and procedures. The main barriers to healthcare in this population were lack of insurance, fear of deportation, lack of time during the harvesting season, lack of transportation to the low-income clinic in Walla Walla, communication barriers, insufficient education regarding preventive medicine, and a feeling that any treatment will be unaffordable. Increasing awareness was accomplished by having a story printed in the newspaper highlighting that an entire community of field workers receive no primary care. This project has sparked new interest in starting a community-mobile outreach program targeted toward Mexican immigrants in rural areas. The War on Chronic Illness: A Questionnaire As A Weapon To Reinforce Healthy Habits and Aid Providers in Identifying Problem Areas. Project Date: 12/31/2007 Although chronic diseases are among the most common and costly health problems, they are also among the most preventable. People who are at risk for, or have chronic disease, often have poor self-management of their health. Tools are needed to help healthcare providers efficiently assess barriers to good health management. Health questionnaires can aid providers in quickly identifying areas that need to be addressed and help provide better outcomes for the patient and community3,4 The goal of this project was to develop a health questionnaire that could be used on a trial basis to gather information, and help patients think about their own healthcare management. A Spanish/English questionnaire was developed and administered to adult patients seeking care at the Virginia Garcia Clinic. The results of the questionnaire were reviewed in the patient context when possible, and anecdotal observations along with overall outcome trends were noted. Menos Pesticidas para los Ninos Felices Project Date: 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. Improving Screening Rates for Colorectal Cancer on the Warm Springs Indian Reservation: Using Radio and Internet Video to get the message across Project Date: 10/15/2007 On the Warm Springs Reservation in Central Oregon, the Indian Health Services (IHS) is responsible for providing health care to the members of the Confederated Tribes of Warm Springs. The IHS has a set amount of resources; therefore, preventative medicine is an important component of the healthcare system. One preventative measure, screening for diseases, can help lower costs and reduce incidence of diseases. The Warm Springs Health & Wellness Center (WSHWC) has a chronic care initiative that is exploring new ways of improving the screening rate and treatment of disease. One of the diseases being studied is colorectal cancer. As a part of the chronic care initiative, this community project created two new ways of encouraging tribal members to get screened for colorectal cancer. One is a radio ad campaign educating people on the need to be screened was implemented. The second is an animated video that demonstrates how to complete the screening test. Caregiver Perspectives on Childhood Obesity in the Warm Springs Community Project Date: 9/10/2007 Background: Much like other Native Americans across the United States, the Native Americans of Warm Springs, OR have high rates of obesity, regardless of sex or age. Caregivers have the opportunity to exert significant influence over the factors that contribute to obesity among their children. Methods: The BMI profiles of 600 Native American children in Warm Springs from age 5 through 14 were determined from electronic medical records. A survey tool was then developed and used to survey 19 caregiver-child pairs in the community. The survey recorded the height and weight of the child, and asked qualitative questions of the caregiver regarding the child’s weight, factors contributing to weight and general health. Results: Electronic medical records showed that 56.8% of children ages 5 through 14 were either at risk or overweight. On the caregiver survey, only 50% of caregivers of children who were at risk or overweight actually believed that their child was either “slightly overweight” or “very overweight.” For children who were at risk or overweight, 30% of caregivers agreed with the statement: “Some people are born to be fat and some thin; there is not much you can do to change this.” While the vast majority of caregivers believed that what a child eats (95%) and how much a child exercises (95%) are “very important” to their present and future health, only about two thirds of all caregivers believed that how much time a child spends in front of a TV (69%) and how much a child weighs (63%) are “very important” to their present and future health. About a third (37%) of all caregivers were “not at all concerned” that their child would get heart disease in the future. Gay, Lesbian, Bisexual, and Transgender Health Resources in Madras, Oregon Project Date: 10/16/2006 Several studies have estimated between 3 and 10% of the U.S. population are gay, lesbian or bisexual. Small towns often have very few organizations or agencies to support this minority. This project looks for resources for gay, lesbian, bisexual and transgender (GLBT) individuals in the town of Madras, Oregon. Local health providers and administrators were interviewed to identify steps that have already been taken to support health needs of GLBT patients. In addition, using several national health resources, suggestions were gathered for improving the clinical atmosphere and health care for GLBT patients at one local clinic and hospital in Madras. The findings and suggestions collected during this process were presented to and discussed by a group of family practice physicians in the community. Access to Health Care Services on Warm Springs Reservation: A Needs Assessment for a Mobile Health Unit Project Date: 9/11/2006 A mobile clinic offers the ability to provide primary medical services to individuals and families living in remote rural areas. While a mobile clinic may not offer the most efficient means for health care delivery, many communities may find that its value—measured by health services provided to people with few other resources—is worth the effort. Mobile medical health programs offer the possibility of reaching populations who otherwise may not access traditional health care services. Poverty and lack of mobility are examples of life circumstances that can create insurmountable barriers to obtaining these services. This project was the first step in determining the need for a Mobile Health Clinic on Warm Springs Reservation. I compiled quantitative patient database information on community access to the Warm Springs Clinic. I developed and held a Focus Group, as well as employed a written survey tool, to gather qualitative input from community members. The next step of this project will be to obtain funding through a grant, which is a project I would like to continue to work on with a future student placed at this site. Investigate the Use of Unconventional Therapy in Scappoose and Portland Project Date: 7/5/2004 Unconventional therapy has become popular in the United States. However, the role of cultural beliefs and population size in unconventional medicine use is not known. This study examines the prevalence of and the reasons that underlie unconventional medicine use in two culturally distinct populations in Oregon: the predominately Caucasian population of Scappoose and the Chinese American community of Portland. A survey was designed and was conducted at the Scappoose and Portland health service centers. Among the 14 Caucasian subjects interviewed in Scappoose, 57% reported using unconventional medicine at least once in their life. All of the 16 Chinese American subjects interviewed in Portland have used unconventional medicine. Whether in Scappoose or Portland, the respondents who had tried unconventional medicine used it for chronic medical conditions such as pain and allergies and consulted medical doctors for serious medical conditions including hypertension and renal failure. Furthermore, only 25% of the Portland respondents who used unconventional therapy informed their medical doctors compared to 75% in Scappoose. These results show that over half of the subjects in Scappoose and Portland have used unconventional medicine. However, the subjects in Scappoose are more likely to communicate their use to their medical doctors than do the subjects in Portland. This pattern of use elucidates the phenomenal prevalence of unconventional therapy and suggests that medical doctors should specifically inquire about the use of unconventional therapy when treating patients with different cultural beliefs. Herbal and Complementary Medicine Use in a Native American Community Project Date: 9/23/2002 BACKGROUND: Although the use of complementary medicine is known to be extensive in the general American population, the role of alternative treatment in this Native American community has not been described. OBJECTIVE: To determine the prevalence of use of complementary medicine, reason for use, how the patient first learned of the complementary treatments, sources of reliable information on alternative therapies used by the patient, and whether or not they had previously been asked about unconventional treatment by clinic personnel. METHOD: Cross-sectional interview of 21 patients seen in an Indian Health Service ambulatory care clinic. Herbal and alternative treatments were compared to prescription medications obtained by chart review to identify any interactions. RESULTS: Fifty-seven percent of individuals interviewed had used herbal medications or alternative treatment modalities at least once in their lifetime. Patients were likely to continue using herbal and alternative treatments if their initial treatment was felt to be effective, even if later treatments proved to be ineffectual. Herbal and complementary medicine ws used most often for health promotion, family and tribal tradition, and religious practice, as well as chronic conditions such as low back pain, migraine headaches, diabetes mellitus, and depression. Family and tribal traditions was found to be the most common source for first-time patient exposure to herbal and alternative therapies, followed by internet, friends, media advertising, and employers. Nearly half (48%) of all patients would look first to their family physician for reliable information on herbal and complementary treatments. While over half of clinic patients interviewed reported using herbal or alternative treatments sometime in their lifetime, only 5% had ever previously been asked about herbal and complementary medicine use by personnel in the clinic. CONCLUSION: Use of unconventional treatments is common among patients in this Native American community. Patients demonstrate a willingness to discuss use of herbal and complementary therapy and have an expectation that their medical providers will be knowledgeable about these treatment options. Unconventional treatment use is not related to patient dissatisfaction with conventional medicine and patients perceive no conflict between these different health system beliefs. Mexican American attitudes and perspectives regarding Type II Diabetes and its modifiable risk factors. Project Date: 9/23/2002 CONTEXT: Mexican Americans have a genetic predisposition to Type II Diabetes Mellitus, whcih theoretically evolved from a "thrifty gene". In an increasingly obese and sedentary society, the frequency with which Mexican American youth and young adults are acquiring Type II DM is reaching epidemic proportions. OBJECTIVE: To explore cultural-specific attitudes and beliefs pertaining to Type II DM and its modifiable risk factors with the goal of providing valuable information about prevention strategies in a culturally-sensitive manner. DESIGN: A cross-sectional survey of 15 parents of school-aged patients at the Woodburn Pediatric Clinic appearing for routine clinic visits. Specific information about respondents included age, country of birth, and linguistic capabilities. Children's ages, weights (kg), and heights (meters) were recorded. BMI's were calculated using the equation kg/meters squared. Respondents answered 10 short-answer and 5 multiple-choice questions in their language of choice (Spanish and English), which addressed attitudes and beliefs surrounding four major themes: Diabetes, obesity, eating habits, and physical activity. Brief 5-10 minute follow-up interviews conducted by a skilled bilingual investigator provided clarifications of both questions and answers and explored additional commentaries on behalf of respondents. RESULTS: One-third of patients were considered obese (95th percentile or greater for weight) The majority of parents attributed diabetes and obesity to the excessive consumption of foods high in fat and carbohydrates. Only two believed diabetes was due to a "susto" (fright). Parents of obese children were concerned about their children's weight. Most parents felt that it was important to provide a variety of fruits and vegetables to their children and convince them that fruits and vegetables were necessary for good health. Half of the children engaged in sedentary activities (TV, video games, computer) for 3 or more hours per day. Seven of the children engaged in near daily physical activity, however the majority of these had a BMI at or above the 90th percentile. Parents who were active on a daily basis attributed activity to work-related activity (3) or walking 1/2 to 2 miles per day (3). The remaining nine were minimally active or sedentary. Parents encouraged their kids to engage in sports so they can be healthy, but only three were proactive about exercising for health and involving their kids in habitual exercise regimens. CONCLUSIONS: Mexican American parents are appropriately aware of the role of excessive fats and carbohydrates as a risk factor for diabetes. However, there is little awareness about the role of physical activity in diabetes prevention. In general parents do little to encourage their children to exercise, nor do they model physically active lifestyles to their children. Recommendations for cultural-specific approaches to diabetes prevention were provided based on these findin Creating Culturally Appropriate Materials To Encourage Drinking Water On The Warm Springs Reservation. Project Date: 9/24/2001 The potency of providing health care in a manner that is consistent with people's cultural traditions is becoming evident to many. Those in attendance at the Barbados III conference held in Rio de Janeiro in 1993 go beyond deeming such practice powerful; they declare that people have a right to receive such care and to have their own health care practices disseminated: "Indigenous people have an undeniable right to their history and cultural heritage. The medical establishment should... collaborate in a more decisive and committed way in the formulation and application of preventative health policies, including the legitimation of ethno-medicine as a fundamental contribution of ethnic culture for all humanity. I am not yet knowledgeable enough about allopathic medicine to legitimize ethno-medicine with any authority. However, I certainly agree that "(i)ndigenous people have an undeniable right to their history and cultural heritage" and am aware that scientists who have investigated indigenous medical practices have discovered that they often make sense from a scientific cultural perspective. Thus, when the nutritionist at Warm Springs asked me to design posters that would encourage water drinking, I was excited about attempting to do so in a way that honored the cultures of the three nations on the reservation. In this paper I will first give a demographic, historical and philosophical context to my project and then will discuss the project itself. Back to subject search page or search by preceptor site