RCHC Community Project Abstracts

Back to subject search page or search by preceptor site 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. Increasing Access to Health Care in Hood River County: Mobile Health Unit Project Date: 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. 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. Rural vs. University Medicine: A comparative review of data Project Date: 8/7/2006 Rural communities in Oregon face many obstacles to adequate health care relative to their urban counterparts, especially those with direct access to a teaching hospital. Among the more serious of these are: a lack of specialty care, a smaller selection of primary care, greater numbers of "working poor," and fewer clinical options for low income patients. Most medical students at OHSU are not exposed to non-university medicine until their third year of school, and even then, a miniscule percent of their overall education is dedicated to these pursuits. This project attempts to create a framework by which OHSU students can begin to understand the differences between rural and university health care settings before their clinical years. A Chart Review of Domestic Violence and Specific Co-morbidities on the Warm Springs Reservation Project Date: 3/20/2006 There is a higher rate of domestic violence (DV) in Native American communities, and in turn certain medical problems (DMII, cholelithiasis and cholecystitis, ect) also occur disproportionately in native populations. While it is known that there are a number of co-morbid conditions and problems that victims of DV experience, this has not been examined at length in Native Americans. The clinic staff on the Warm Springs Reservation have been concerned with the problem of DV for some time, and have led in the initiative to make screening for DV a GRPA requirement. As an extension of their efforts to identify victims of DV and increase outreach to this segment of the patient population, they had earlier examined the medical records of a random selection of 100 female patients and found that 58% of these women were identified as victims of some sort of DV. This information has proved useful in discussing the severity of DV on the Warm Springs Reservation, and has been employed as part of educational and grant writing activities. The attempt herein is to look at a select number of medical problems in the same patient sample, in order to gauge what variations in medical problems exist between those with a history of DV and those who have not been victims of DV. The hope is that this information can also be used in expanding educational efforts regarding DV and its comorbidities. Alcohol and Methamphetamine Related Hospitalizations: A Chart Review of 100 Warm Springs Patients Admitted to Mountain View Hospital Project Date: 10/17/2005 After noticing that a large number of Warm Springs patients were being admitted to the hospital as a result of alcohol or methamphetamine abuse, I decided to choose this as my project topic. I completed a chart review of 100 consecutive admissions to Mountain View Hospital in Madras, OR. All patients were older than 10 years of age. Emergency Department visits were not included. I found that 22 patients were admitted with either a positive urine drug screen (UDS) or a blood alcohol level above 0.08. Six patients had a positive UDS: 4 for methamphetamine and 2 for cannabinoids. A total of 30 patients were admitted for alcohol-related reasons, including intoxication, withdrawal or other conditions. This amounts to a 30% alcohol-related hospitalization rate, which jumps to 36% when admissions for obstetrical conditions are excluded. This is a high number of costly hospital stays, some of which could have been avoided if the patient had another place to stay while he or she became sober. The tribe may want to consider establishing such a place and investing the recuperated money into substance-abuse prevention programs. Stickers Don't Make You Smarter: Bringing Reach Out and Read to Coos Bay Project Date: 8/8/2005 A growing body of evidence supports early childhood exposure to reading as an effective catalyst for linguistic and cognitive development. The Reach Out and Read program, established in 1989 by a group of Boston University pediatricians, promotes early literacy and language development by bringing reading into the pediatric exam room. Participating pediatricians give each patient between the ages of 6 months and 5 years a brand new book at each well-child exam. Additionally, they are trained to appropriately counsel caregivers about the importance of reading aloud with their children. Several pediatricians in the Coos Bay/North Bend area expressed a specific interest in establishing a Reach Out and Read program in their medical offices. For this community project, several critical components of this process were addressed: application submission, generation of community support for the program, and solicitation of financial assistance. A number of service organizations, businesses, and existing grants were identified as promising resources for the program. A grant proposal was drafted and submitted on behalf of the program to the Coquille Indian Tribe Community Fund. Finally, the Reach Out and Read model was presented to representatives from several organizations, each of whom expressed enthusiastic support for the program. Health Care Services Available to Undocumented Immigrants in Madras, OR Project Date: 9/13/2004 Policy changes within the past ten years have limited undocumented immigrants access to insurance and health care. Undocumented Hispanic immigrants, many of whom are farm workers, suffer serious health problems because of the conditions in which they live and work. Due to fear of deportation most do not seeking medical care or preventive services for themselves or their U.S. born children. Studies have shown migrant farm workers to be among the most vulnerable populations with poor health outcomes and limited access to care. Madras has a large Hispanic farm worker population many of which are undocumented. These individuals face barriers in accessing health care due to lack of insurance, poverty, and language and cultural barriers. This study attempted to ascertain what health care resources are available to undocumented immigrants in Madras. The project design consisted of gathering information through interviews at area health facilities and observing patient care visits at a prenatal clinic targeting this particular population. Assessing the Resources Available to At-Risk Pediatric Patients Project Date: 8/9/2004 Individuals under the age of eighteen comprise approximately one fourth of the population of Baker County, Oregon. Nearly one fifth of these individuals live below the poverty line, which produces significant ramifications on this society as a whole. Physicians serving this population may offer not only medical services, but also refer other resources to these patients. Through interviews with representatives of community organizations and literature review, services available to pediatric patients who are of low-income families in Baker County were researched. In order to facilitate the awareness and utilization of these resources, patient education material highlighting medical, educational, social, spiritual, and recreational resources available to low-income Baker County pediatric patients was developed and distributed to various agencies in Baker City. Diabetic Disparity: The Educational Divide Between Hispanic and Caucasian Diabetic Patients Project Date: 7/7/2003 Diabetes is highly prevalent chronic disease that affects Hispanics more often than Caucasians. Its prognosis can be significantly improved with proper education. Unfortunately diabetic Hispanics have historically been under-educated on their disease. Hispanic diabetic educational status was evaluated in a Salem, Oregon non-profit clinic to determine whether this historical discrepancy existed in this population. No statistically significant educational deficit was found between Hispanic and Caucasian populations, however it is suggested that further analysis be performed and more Spanish-language material be made available for patients. Providing Comprehensive patient education materials in The West Salem Clinic. Project Date: 3/24/2003 After assessing patient education materials at West Salem Clinic it was found that very little to no patient education materials were available or disseminated to the primarily low income patient population. A written survey was conducted in Spanish and English, and the providers and staff were interviewed regarding the need for patient education materials. These queries indicated a need for the development of a comprehensive, centrally located, set of patient education materials, and a convenient method of distributing this information to patients. The goal of this project was to acquire these materials in Spanish and English and to develop a system to distribute this information in the normal course of office visits. Access to Spanish Language Health Information in Ontario, Oregon. Project Date: 11/5/2001 The Hispanic population of Oregon and the rest of the United States continues to grow rapidly, but unfortunately the number of health care workers who can communicate in Spanish has not. While in Ontario I found that not only is there a need for Spanish-speaking health care workers, but also for Spanish-language and culturally appropriate health information to hand out to the patients. Therefore I decided to translate and make some of my own, including translating patient handouts and making a teaching tool which relied more on pictures than words so anyone who was unable to read could understand them. Ranking of IHS Community Health Objectives and Community Health Issues Identified by Warm Springs Residents. Project Date: 11/5/2001 Each year, the Clinic Directors of the Portland Area Indian Health Service formulate a "Clinical Objectives for Fiscal Year - SES Workplan" (see pages 2-4). It is a list of important topics of focus for improving the health of the communities served by the IHS clinics. This project was an attempt not to determine the extent to which these objectives are being met, as that is done regularly through chart review by IHS employees, but rather to ask the question of residents of Warm Springs: What do you feel are the Community Health Issues most affecting you and those around you? To that end, a survey (or, more accurately, two surveys, as the original was revised following review of responses) was presented to patients and staff at the Warm Springs Health and Wellness Center. Respondents were asked both to rank the objectives identified by the Area clinical directors and to add others which were not listed. Back to subject search page or search by preceptor site