Archive for Uncategorized

Environmental Justice & Health Equity: What is our role as family docs?  

Posted in Uncategorized at 10:28 am by revolution.is.medicine

Hi Friends! Join our amazing residents as we lead a tour of our community along with talented leaders from environmental justice organizations in Los Angeles!

Register at the AMSA National Conference or by contacting our chiefs “Harbor FM Chiefs” <harborfmchiefs@gmail.com>,

Saturday, March 13, 10:30 am – 1:30 pm
Off-site
Environmental Justice on the Streets: A Tour of South Central Los Angeles

Join a limited number of fellow attendees for a Saturday morning tour of south central Los Angeles with residents and local community organizers from the Harbor UCLA Family Practice program.  Hear how environment, community, and health are intricately interwoven.  Learn best practices about street medicine and health justice!  The tour will take participants to visit Harbor hospital’s catchment area, the poorest and most underserved sections of Los Angeles.

Note: Space is limited.  Advance registration required

Town Hall Meeting with Congressman Adam Schiff  

Posted in Uncategorized at 12:08 pm by dmautner

Tuesday, August 11, 2009
Alhambra, CA
Town Hall Meeting – Congressman Adam Schiff

Given our commitment to vulnerable and underserved populations, it was no surprise to see Harbor Family Med residents and faculty making public our mandate for health reform. A seething, volatile crowd of thousands listened intently to the panel where Rep. Adam Schiff and others discussed options for reworking our broken health care system. Rowdy opponents of reform were met and even superseded by health care reform advocates, as we joined those supporting reform.

When we walked toward the crowd in our white coats, heads snapped around to watch us approach. We were greeted by people we didn’t know, over and over again: “We’re so glad you are here,” and “thank you for coming.” Interviewers with entourages turned their news cameras on us, asking what was important about health reform and how we would respond to the accusations of socialism perpetrated by those fearful of change. One woman touched my sleeve and said, “Doctor, what’s the right answer?”

People often don’t trust politicians. Who do they trust?

They trust their doctors.

This moment in history is our time, our opportunity and our responsibility to use the unique power of our perspective and education on behalf of our patients.

See you at the next Town Hall Meeting.

Dawn Mautner, MD
Chief Resident
Harbor-UCLA Family Medicine

Individuals Can Still Make A Difference  

Posted in Uncategorized at 8:32 pm by José Mayorga

Reflecting back on the summer months of 2007, it brings back warm feelings of a cramped high school classroom swarming with high school teenagers, undergraduates, medical students, residents and hundreds of nats. This past summer I had the wonderful opportunity to give back to a “Summer Project” that inspired me to become a family physician while attending medical school. The Harbor UCLA Summer Urban Fellowship is the most unique fellowship/program of its kind. You take Banning High School Students, Undergraduates and Medical Students from different parts of the country, mixed in with Harbor Residents and Attendings to create an unforgettable experience.

The Summer Project has different components:

  • Mentorship at all levels
  • Health Fairs within the Wilmington Community
  • Public Health & Poverty Medicine Lectures
  • Research Project on Children of Wilmington Access to Healthcare
  • Teen Peer Health Education
  • Clinical Experience
  • Community Health Talks

The students involved were extremely motivated to get things going. The undergrads and med students were an amazing group. Each had great strengths – to many to list – but the most impressive was how quickly they bonded with the high school students and placed these teens in critical roles in the Summer Project. It’s amazing what can happen without trying to force things, especially when people care to make a difference in others’ lives.

The Residents at first were on the outside looking in. We joined the group late because of our scheduled rotations. I remember talking to the residents and wonder what our role would be – the students had everything covered. Lucky for us, we had a new idea to introduce to the group. We created and modified various lectures to teach A Teen Peer Health Education class for the high school students. The goal for the Peer Health was to educate them in health, cultural, and social issues that affect their daily lives while providing them the confidence to teach the information to fellow teens. What made these lectures unique was we moved away from the standard lecture style format incorporated fun, interactive, and confidential exercises. The various topics covered were: Sex, Sexuality, Reproduction, STIs, HIV/AIDS, Cultural Awareness, and LGBT Issues. We also took field trips to watch Michael Moore’s Movie, Sicko and the Japanese-American Museum.

As the Summer Project continued we successfully had 2 Health Fairs in the underserved community of Wilmington, CA. The entire planning and execution of the fair was done by the students, while Residents and Attending assisted when needed. Over 500 people participated in health screenings such as Diabetes, HTN, Depression, Substance Abuse; some received mammograms, echocardiograms, and dental care. In addition, the program focused on door to door interviews for a research project looking at Children’s Access to Healthcare, Asthma and Obesity. These interviews were primarily conducted by the students in Spanish. The data analysis are ongoing but we are sure that the asthma rates in the Wilmington, CA 1.5-2.0 times the Los Angeles County rate – not surprising to some given the Port of Los Angeles resides in Wilmington.

The entire Summer Project culminated in a Health Summit held at the Banning High School Auditorium. The Summit gave the students the opportunity to analyze and present the various findings and activities of the Summer Project. Given its importance, the information presented at the Summit was broadcasted locally on various television networks (ABC, Univision, & KTLA) and written about in local newspapers. One of the proudest moments was watching several high school students be interviewed by local television reporters in regards to why Healthcare is a right for all individuals and express what they gained from participating in the Summer Project.

It may not be everyday that we see a small group of individuals make a difference but the Summer of 2007 sure did remind me that it is still possible if you try.

Baby Catching 101…Lesson #1 & 2  

Posted in Uncategorized at 1:49 am by José Mayorga

I recently flash-backed to the first day I found out my intern schedule. The emotions I felt made my whole stomach turn…I was to start on the California Hospital OB rotation! (or how I like to call the hospital – The baby delivering capital of the world!) You see, Cal OB recently underwent changes in which they lost their OB fellowship. This unfortunate loss has forced drastic changes on the most important aspect of an intern’s life – CALL. Call was officially q3days. Yes q3days (but as of 2006, shift work was added and no longer q3days). As I warmed up to the issue of doing my first rotation as an intern away from Harbor, I realized that one of us had to do it first – lucky me. Accepting the challenge & receiving affirmation from my fellow interns made things a little smoother to swallow. Towards the end of orientation we had a small pep-talk from our Program Director. He asked the group, “Who was starting Cal OB first?” As I raised my hand in pride & stated “That’s me,” he looked over, smirked, and uttered, “Good luck, you’ll need it…”

Lesson #1 – Hold it like a football

It was my very first night on call at Cal OB. As expected the OB triage was booming as well as the contractions on the L/D deck. The two of us, interns were doing our usual monitoring of laboring patients. I had spoken to my senior resident and mentioned that I officially never delivered a baby. He was very supported, taught me the techniques and mentioned he would be there to help. As the night went on, things became busier. I had just finished my hourly check on my patient and suddenly heard, “IS THERE A DOCTOR ON THE FLOOR!” Of course I hesitated but then realized I was the ONLY ONE. “Quick, this lady is crowning and the baby is about to fall out,” the nurse said. As I race into the room I had a few seconds to gown up and put gloves on. I frantically asked the staff to call in my Senior – he was to assist me with my first delivery. Unfortunately, someone forgot to tell the baby to wait. As the baby was going through its cardinal motions, I felt every emotion you can imagine – scared was the most dominant. Luckily, I saw to gloved hands enter the field. It was my Senior! As I looked over at him and back at the baby he leaned in to utter those famous two sentences…“Have you ever played football? Then hold it like one and don’t drop it.” The following words after that were…“you fumble it, we are dead.” Needless to say I maintained a good handle of the baby/football. I congratulated mom, grandma, and dad. Grandma mentioned it was her daughter’s first child and with all that emotion running through me, I uttered, “It was my first time too.” Grandma replied, “I noticed.”

Lesson #2 – Protection is key

Another sleepless night on call and many deliveries later…I was doing my usual rounding on my laboring patients. I had spoken to my senior regarding rupturing my patient’s water bag. We discussed her progress and he agreed that I should proceed. Without any problem I performed the procedure and noted amniotic fluid flowing out. As time went on my patient and her contractions were progressing nicely. The staff had asked me to assist in teaching mom how to push during delivery. I agreed, and positioned myself with a sterile glove at the edge of the bed. As I proceed to talk with the patient and examine her, the nurse mentioned that she had ruptured her membranes again. I thought nothing of it at the time since it was possible that the patient may have developed a fore-bag. At this point the cervix had completely dilated, contractions were every 2 minutes, and the baby felt engaged. We proceeded with the trial of pushing. As we began to count off her pushing, in slow motion I saw a WAAAVE of FLUUUID heading my direction. As I felt this warm, gooeey mess cover my body, I managed to only turn my head to the side and close my mouth…Everything came to a screeching halt – pushing stopped, nurses stopped, contractions stopped. I got up covered in my slimy mess and asked for a change of clothes and ordered the mom to stop pushing till I was done cleaning up. I went quickly into the bathroom and changed, came out with a smile and said, “Let’s put on some protection and have this baby.”

Todos Somos Marcos  

Posted in Liveblogging from Chiapas, Uncategorized at 10:45 am by Casey KirkHart

For the last 13 years, the Zapatista movement of the indigenous people of Chiapas has attained global recognition as a preeminent people’s movement for open and representative government, basic human rights and respect for the Earth and all its people. While many know the story, few have experienced first-hand their daily struggle to survive in extreme poverty all the while maintaining their fight for land, respect, food, and the freedom to live by their culture.

Shipra and I were invited by Dr. Juan Manuel, a local physician we have close contact with, and Mere, a “promator” (community health worker), to travel to a Zapatista community in the hills of Chiapas. This, in short, is what we did:
- Meet Juan Manuel and Mere in front of Hospital San Carlos at 8am.
- Travel by “collectivo” (shared van) from Altamirano through valleys and cloud forest to Ocosingo
- Traverse bustling market, carniceria, and shops in Ocosingo
- Eat tamales and atole (milk and corn drink) for breakfast
- Leave Ocosingo by “combi” (covered truck), and speak at length with Juan Manuel about Mexican history and history of the Zapatista movement
- Pass military checkpoint, no hassle
- Arrive at Municipio Autónoma Olga Isabel, a large Zapatista enclave
- Met many Tzetzal “coordinadoras”, indigenous women from many pueblos in the area who lead and organize around the movement. They lead the Zapatista “communidades en resistencia” (communities in resistance). They speak Tzetzal, an indigenous dialect, and little Spanish, making introductions difficult.
- With Mere, ride “combi” up bumpy dirt road to trail head and hike uphill through jungle and pine forests. Dodge a black snake. Stunning valley views.
- Arrive at Campanawiitz, a small indigenous village of several wood, tin-roofed, dirt-floored huts.
- Mere and Solomon, local promator, administer vaccinations in Solomon’s home as Shipra and I entertain the children with hand puppets and silly faces. Children and adults curious of us. Farm animals abound – chicks, dogs, a pig. Small black and white TV, decorations with tricolores (Mexico’s red, white, and green) and with health education posters made by Solomon. Solomon’s wife cooks lunch in adjacent hut, the air thick with the fire’s smoke.
- Lunch with Mere and Solomon of homemade corn tortillas, rice and black beans.
- Shipra and I examine Solomon’s sister pregnant at 38 weeks (baby’s heart sounds perfect, head down) and father suffering from osteoarthritis, we think.
- Hike back to dirt road along a ridge with valley views, through corn and bean fields and several cows grazing.
- Ride combi filled with lumber back to Olga Isabel where we speak with several Swiss human rights workers invited there to witness the Zapatista struggle as observers. We watch a DVD on the Zapatista movement. It begins to rain.
- Take short combi ride through the night to Chilón, a nearby town, where we sleep at the gorgeous home of Nely, a “partera” (midwife) and friend of Juan Manuel.
- Eat heuvos rancheros and Juan Manuel sees a patient as Shipra and I explore the fantastic hilltop views of Chilón.
- Return to Olga Isabel. Juan Manuel sees patients at Clínica Autónoma Municipal, Shipra helps the women bake bread, I chat with the men and shoot basketball. It is a warm, sunny day.
- Two more combi rides: one from Olga Isabel to Ocosingo (2 military stops this time, no issues) and then from Ocosingo to Altamirano and home.
- Happily home and grateful for the incredible experience, we eat, shower (after 2 days), and go to sleep.

Do you ‘ear’ me?  

Posted in Liveblogging from Chiapas, Uncategorized at 4:56 pm by Casey KirkHart

As hard as it is to tear my thoughts away from the fantastic cultural journey I’m on, I think I owe it to myself to discuss the reason I am/we are here: to provide medical care to the people of Altamirano, Chiapas.

The pathology and variety of disease seen out here in rural Mexico is not as surprising as is the ability to practice modern, mainstream medicine, of course with limitations, in a place where one’d expect very very little of anything. I am grateful to the Sisters of Hospital San Carlos and those generous folk, physician or otherwise, who’ve come before me and helped bring this, and my experience in it, into reality. I marvel at diagnosing and treating relatively common ailments at least as I’ve been working in the pediatric ward here: bronquiolitis, neumonia, trauma, abscesos y celulitis, recien nacidos eutroficos y hipotroficos (full term and premie newborn babies). In a place where I expected close to nothing, I’ve found so much. Mexico is a land of plenty and of wealth, but of various sorts you might not anticipate.

My first patient was Jose Maria, a charming 3½ year-old boy. He had been admitted 5 days prior to my arrival with a hugely swollen, red and painful right pinna, the conch shell-shaped, floppy outer portion of the ear. He had been seen at an outside clinic and received antibiotics to no avail. What could have certainly been a simple outer ear or skin infection had developed into a serious infection of his ear cartilage – perichondritis (pericondritis en Espanol – See, Spanish no es tan dificil!). This condition can be very challenging to treat given the nature of the tissue itself: cartilage has very little blood flowing through it, and blood carries, among other precious things, antibiotics. If you’ve ever had your ear or nose pierced, you’d notice how while it may hurt like all heck, it bleeds very little (Big ol’ nerve endings, teeny lil’ blood vessels). That said, perichondritis requires up to 2 weeks of intravenous antibiotic, one that can eradicate, among other more common skin bacteria, a nasty little bugger called Pseudomonas, a common organism in this condition. Jose was started on an anti-Pseudomonal medication – Ceftazidime – plus another called Gentamicin for its synergistic effects with other antibiotics. Here, in a rural Mexican hospital, Jose was receiving exactly the treatment regimen he’d be receiving in any American hospital. Fascinating.

As with many things here, though, aside from maybe thunderstorms and black beans and rice, resources are limited. As one might expect, powerful, specialized antibiotics such as Ceftazidime are in short supply. Thus, after 7 days of treatment, Jose Maria consumed into his tiny vessels the entire hospital supply of the ear-saving serum. We continued the other antibiotic and since he made such great clinical improvement throughout his stay, we let him go home early to enjoy his family and his new and improved ear.



Jose Maria on the mend



Jose’s improvement and cheery mood leant for a more treasured and therapeutic plan: the bond of doctor and patient. Jose is a sweet, smiling young boy as you can see. I lucked out as I got to him as he was feeling better so I reaped the dividends of another’s poking and prodding. We joked, played, shared coloring time and he and his family were kind enough to sit for these pictures.



Ready for home

Originally uploaded by daprovocateur


Funny, aside from a few technological gaps in his care, of important but not of critical value, I could imagine the same scenario playing out in the States.

Part 2: Representin’ at the AAFP conference, Kansas City  

Posted in Uncategorized at 6:33 pm by Casey KirkHart

Want to make Casey happy? Then ask me to travel to a great city with my friends (and colleagues) to talk on and on about a job and place I love. Just look at how much fun we had.
Join us next year!

Harbor Family Medicine heads to Kansas City!

Only one thing can beat that, and that’s having the chance to meet dozens of enthusiastic, engaging medical students from all over the country ready to take on health care and transform family medicine.

Even while we physicians and residents grumble and lament over a crumbling health care system, inefficiencies, inequalities and stagnation in health and medicine, medical students can reignite our idealism and passions for change. Below is an account I wrote from last year’s AAFP Resident and Student Conference that details just what I mean. I’m happy to finally have the chance to share it!

Every year medical schools around the world graduate young physicians eager to continue the beautiful struggle. It is a pleasure to watch them work and to work with them. We owe it to them to help keep their (and our) dreams alive.

~Casey

Title: The future of Family Medicine is bright, I gotta wear dark-rimmed glasses
Subtitle: Report from the AAFP Resident and Student National Conference, Kansas City, MO 8/2 – 8/5/06

I’ve been known shine about the joys of working with med students. After all, I was one for 4 years and worked exclusively with them for 5, now going on 6. What is it about working with med students? Why is it SO darn fun? Maybe it’s their energy, their idealism, their readiness to take action and make change as we as docs struggle to keep from melting away.

Well, I went on and on and on about this all weekend at the AAFP Resident and Student Conference. How could I not? We’d been chatting it up with only the most stellar med students and soon-to-be family docs out there, and to Jose and Linda, my dear fellow resident recruiters, it became quickly apparent that I had had my share of acquaintances there at the conference, thanks to AMSA. I was being recognized somehow. Few times by face – maybe a talk I’d given at their school. A lecture I’d hosted. More often it was the email address that gave me away.

We had reached a lull on Friday afternoon in the exhibit hall and the Harbor crew was chatting it up about all potentials we’d met when from around the corner and at high speeds comes zipping Justin from Vermont. He’s hard to miss: Stylish and slender even in his V-neck undershirt (the kind I could only get away with wearing, well, as an undershirt or when paired with black dress socks and Ray-Bans, a la Tom Cruise in Risky Business). His scruff and dark-rimmed glasses reminiscent of Elvis Costello though he really doesn’t look a thing like Elvis Costello but name someone with dark-rimmed glasses who doesn’t recall Elvis Costello. Physical attributes aside, what draws one to Justin is his energy: pure, creative, and infectious. With the speed at which he approximated our booth, I knew he was up to something – something big – and that I was in for trouble…

Read the rest of this entry »

kicking my oil addiction  

Posted in Uncategorized at 10:52 pm by Casey KirkHart

my car smells like french fries — badly burnt french fries

Exciting stuff, friends. My little baby “Yelley Elley”, my sunny yellow new-old diesel 240D Mercedes Benz, has made the leap off the grid. Just last week I started filling up with biodiesel. Straight out the pump, can you believe it?

What is biodiesel, exactly? Well, in this case, it’s B99.9 – 99.9% walnut and soy oil, 0.1% diesel fuel. So while I’m not 100% off the grid, I’ll take 99.9% any day. I’m paying a bit more ($3.30/gallon) but that’s $3.30 not going to Big Oil. Plus, my car smells like burnt french fries out the tailpipe (better than than smoky mess that spews from a semi-truck), helps the environment, and runs smo-o-o-oth.

There is at least one other of us at Harbor using biodiesel. Another uses compressed natural gas (and she wants just 5 mo’ minutes of sleep – hint hint). Several – I count 5 – use hybrid gas/electric engines including Su’s ever-recognizable Prius. So I KNOW at least a few of us are taking action on our wasteful use of the Earth’s precious resources, and I’m CERTAIN that we all are at least somewhat concerned. So, below I’ve posted a upcoming conference in LA on biofuels.

You can follow my adventure with biofuels at my blog for more updates on my life driving the fried flyer.
FIRST LOS ANGELES BIODIESEL COMMUNITY CONFERENCE TO BE HELD AUGUST 1ST

Press Contacts:Rob Reed: 310-399-3659 – rob@conservfuel.comGretchen
Gray: 310-880-3892 – gretchen.gray@sbcglobal.net

The first Biodiesel Community Conference will he held August 1, 2007 from 7pm to 10pm at Mt. Olive Church,1343 Ocean Park Blvd., Santa Monica, CA 90405. Los Angeles, CA – (July 16,2007) The Los Angeles Biodiesel Community Conference is open to the general public and will offer action-based discussions on Biodiesel Basics, Legislation, Local Distribution, School Bus and Other Fleet Usage, Biodiesel Education, and more.

The event is being sponsored by Southern California Disposal and Recycling, and will be hosted by The Los Angeles Biodiesel Working Group, the LA Biodiesel Co-op, Socalbug (the Southern California Biodiesel Users Group), and Josh Tickell, author of “From the Fryer to the Fuel Tank” and “Biodiesel America.”

The purpose of the conference is to empower and educate the public, local businesses and community leaders in their efforts to make biodiesel a viable fuel option for Southern California. Collectively we will establish a groundbreaking action plan that will provide the steps to expand biodiesel distribution in Southern California and establish new legislation that promotes sustainable fuel options.We, as a community, can make biodiesel an affordable and available fuel option. It is time for us to unite and take action today!

For more information, visit www.socalbug.org.Please contact Rob Reed or Gretchen Gray to schedule an interview with the following individuals to discuss the Biodiesel Community Conference agenda and action plan before or at the event: Josh Tickell – Author/Filmmaker; Kent Bullard – Chairman of Socalbug, a 501c3 non-profit organization, and Kris Moller – Owner/Operator of Conserv Fuel (www.conservfuel.com).

If you would like to attend the Biodiesel Community Conference please R.S.V.P. to: http://www.evite.com/pages/invite/viewInvite.jsp?event=RPOJJMHHFRVGPATDMHFR&unknownUser=true
– Kent BullardCFO (Chief Founder & Operator)Southern California Biodiesel
Users Group, Inc.kent@socalbug.org
805-218-6945

Human Guinea Pigs — “standardized patients”  

Posted in Uncategorized at 2:53 pm by los anjalis

Emily Yoffe describes in excruciating detail the adventures of serving as a standardized patient to medical students, to evaluate their physical exam skills. I remember the days of medical school when were evaluated in this way. It definitely was awkward, for both the medical students and the “patient”, but it was greatly appreciated. She shares some interesting stories in this piece:

Over the course of three days recently, I had 23 head-to-toe physicals from 23 second-year students at the Georgetown School of Medicine. I was the first person these would-be doctors had ever fully examined on their own. Some were shaking so violently when they approached me with their otoscopes—the pointed device for looking in the ear—that I feared an imminent lobotomy. Some were certain about the location of my organs, but were stymied by the mechanics of my hospital gown and drape. And a few were so polished and confident that they could be dropped midseason into Grey’s Anatomy.

Georgetown allowed me to be a “standardized patient”—that is, a trained person who is paid $15 an hour to be poked and prodded by inexperienced fingers, so that med students can learn communication and examination skills before they are sicced on actual sick people…

The concept of the standardized patient has been around for decades, but only in recent years have medical schools made training with them a regular part of their curriculum. I talked to a 50-ish physician friend about my experiences, and he said when he was in medical school and it was time for the first rectal/genital exam, the students were told to pair off and examine each other. “So, do you pick someone you like, or someone you don’t like?” he recalled. “Either way, it’s lose-lose.”

Now there are standardized patients trained for genital duty (they’re called GUTAs, for genitourinary teaching associates), but I signed up for something less invasive. Mine was the simplest possible assignment. I was to sit on the edge of a padded table in one of those awful, flapping hospital gowns, in a room equipped with recording devices in the ceiling. Each doctor had 30 minutes to conduct a standard head-to-toe physical: from my vital signs, to my nerve function, to my reflexes, etc. Then I was to go to a computer and check off whether they’d done all 45 parts of the exam (“Palpated for fremitus,” “Auscultated carotids”), and write my comments on their bedside manner…

Oh, it gets better. Check out the rest of her piece. Any thoughts on this concept of standardized patients? Any embarassing stories folks have to share?

What Big Pharma knows about you and your patient…  

Posted in Uncategorized at 12:27 pm by Casey KirkHart

In the multi-billion dollar world of pharmaceutical sales, the pharmaceutical industry (with the go-ahead from the AMA) joins you and your patient in the examination room…

A [pharmaceutical] representative can quickly access a breakdown of pharmaceuticals prescribed by any physician on a handheld computer, enabling that representative to deliver a tailored marketing pitch to physicians selected for their current prescribing habits.

How do pharmaceutical companies obtain such detailed prescribing data? Currently, retail pharmacies sell de-identified patient prescription records with limited physician identifiers to data intermediaries known as health information organizations (HIOs). By purchasing a comprehensive database of U.S. physicians from the American Medical Association (AMA), HIOs can link individual physicians to prescription records by using identifiers common to the pharmacy databases and the AMA database, such as a physician’s U.S. Drug Enforcement Agency and medical license numbers. They also can track a physician’s demographic and practice characteristics. The HIOs build prescribing profiles on the basis of these linked databases and sell them to pharmaceutical companies, which use the profiles to identify sales targets and plan detailing visits.

This practice continues unabated, much to the financial benefit of Big Pharma and the AMA, despite physicians’ disapproval:

Many physicians believe that using prescribing profiles in commercial marketing crosses a line of acceptability. A Kaiser Family Foundation survey found that only 60% of physicians were aware that drug companies have access to physician-specific prescribing data. When they were told of the practice, 74% disapproved. A physician survey commissioned by the AMA found similar levels of awareness (77%) and disapproval (66%). Anecdotes also confirm the survey findings, with one physician recently commenting, “It makes me feel like a rat in a maze when they put little nibblets in front of me to see if I’ll prescribe their drug”.

This is yet another staggering example of the ubiquitous presence of Big Pharma within and throughout medicine. With every prescription written, with every life-saving medication dispensed, with every sacred patient-physician relationship affirmed, Big Pharma is watching. For a more visual interpretation, click here.

There is a place for business and there is a place for privacy. Between patient and physician, there is no place for Pharma.

The above quotes excerpt from Prescriber Profiling: Time to Call It Quits, David Grande, MD, MPA, Annals of Internal Medicine, 15 May 2007, Volume 146 Issue 10, Pages 751-752

The Ashtray of the South Bay  

Posted in Uncategorized at 3:17 pm by Casey KirkHart

What’s so special about Redondo Beach?

Well, aside from its blue, breezy skies, its cute boutique shops and restaurants, and it being the beachside home to a number of our residents, Redondo Beach is the ONLY beach in LA County that is NOT SMOKE-FREE. For you visual learners, look here. Hermosa beach? Smoke-free. Santa Monica beach? Smoke-free. Venice beach? Smoke-free (though I’m not sure exactly what kind of smoke we’re talking about).

Cigarette butts on the beach recently got the attention of Rick Dickert, meteorologist for FOX 11 morning news and Good Day L.A., Redondo Beach resident and surfer:

From Rick Dickert’s blog
Ash Tray of the Bay
Apr 18, 2007

My home town…Something I am not too proud of. That’s right..Redondo Beach is the ONLY coastal city of the Santa Monica Bay that does NOT have a non-smoking ban…I collect more cigarette butts than any other item when I participate in beach clean-ups in Redondo.
Rick Dickert
Ash Tray of the Bay Resident

My response:

Apr 26, 2007
Rick, thanks for using your public voice to bring attention to this important issue.

I’m a physician, I work in Torrance, and I see the awful effects of smoking everyday: in my ex-smoker patients with heart and lung disease, in children with asthma caused by SECOND HAND SMOKE, and when I run the beach in Redondo, only to gasp through a cloud of sooty smoke.

Now, we the people need you, Rick, to take your voice, and the support of your viewers, to the Redondo Beach City Council to finally put an end to smoking in our public areas including the beach AND the pier.

Redondo Beach, the last and ONLY beach in LA County to permit smoking. Shame on US for not demanding our leaders take action.

Attend the next City Council meeting – http://www.redondo.org/cals/default.asp

Contact your councilperson directly. They work for YOU! – http://www.redondo.org/depts/council/default.asp

We have to take responsibility for ourselves in leading healthy lives. We know the right thing to do, but tobacco smoking is an addiction, a disease. We also have to care for each other and our community.

Make Redondo Beach smoke-free.

~Casey KirkHart, D.O.
Family Physician

Want to get more involved? I’m on a two-week public health elective that places me in the LA County Tobacco Control and Prevention Program policy unit and led me to a regular meeting of the South Bay Clean Beaches Coalition. There are always looking for support, especially from physicians, Redondo Beach residents, concerned citizens or all of the above (that’s you!).

Get in touch with me or drop a line to Joan Waddell @ joan@ncaddsb.com. She’s the program director of the Coalition and leading the effort to make all Southland beaches smoke-free.

NO-BUTTS can work for our smoking patients. NO-BUTTS can work for Redondo Beach too.

~Casey

Delivering  

Posted in Uncategorized at 11:48 am by Casey KirkHart

For interns, a long and arduous year has recently finished. And now the real fun begins. I’ve been sitting on this story all year, but I’ve been a leetle busy. Much has happened since those first 2 weeks, but the value of patience, attentiveness, and silence hold even more true after 30 deliveries so far…

….Can i tell you about my first delivery as a doctor? It’s my third of the day, but the previous 2 curiously resembled placentas (they were, you see). By early afternoon, it’s time to step it up with a real kid. Mom’s G3P2, is carrying a big baby, and is ready to pop, so they zip her back to the delivery room (aka OR without sharp stuff). Mom’s a real sweetheart, smiling and communicating in her stirups, and Dad’s there too, gowned and peering with awed eyes over her shoulder above his mask. The OB intern had been scrubbed in but for some reason she bailed (someone must have been bleeding out on the wards, I dont know) and I scrub in. She’s pushing smoothly when Cindy, the OB R2, gives me the go-ahead and I step up…ahem, between.

We’ve all had the assistant experience as med students and neophyte ‘terns: We chant along “7-8-9..10.” We watch the hand off from OB or midwife to pediatrician like a benched quarterback. We then have the pleasure of bringing a bouncing baby placenta into the world. It’s a GLORIOUS existence, I tell you. But when you are doing the delivery and it’s your show (well, Mom’s too), it’s like nothing else. I’m wide-eyed and try to take it all in. Under pressure, it’s tough. On more than a few occasions I connect eye-to-eye with Mom and with Dad. I watch them watching me and my reaction to it all. I watch the strip with and after each contraction and concerted push. I watch the head inch closer to me until finally mom is pushing and I’m pushing back, pinching that perineum, praying that the lac gods are shining brightly on me that day.

Finally that beautiful purple head pops out into my hands. Nuchal cord? No cord…but wait…where’s the shoulder? The anterior shoulder!? Suddenly, from behind me, Cindy erupts, shoves me out of the way (hello!? sterile field!) and calls – screams – for back up: “DYSTOCIA!!”. I plant a fist, then a forearm with all my weight behind it on her belly and Cindy pulls the HECK out of that head. You should have seen it. I’d have suspected that thing to pop right off, but when you’ve got 60 seconds to deliver that baby’s shoulder, you’ve got use all of your strength. Just as the attending and peds team are rushing in, the shoulder comes free and Cindy, shaking, sweating, catches that baby. A clamp and cut, a whimper, a heart beat, and (what a rush) the shriek you love to hear. But wait, I’ve got a task at hand. Now to Mom and a placenta to deliver, lacs to repair, where’s my lidocaine, bleeding to halt…but from amongst the madness, a voice of calm…the attending??:

“Don’t worry about the lacs. Don’t worry about the placenta. Just sit back on your hands, let mom rest, and thank God for that beautiful baby.”

And that’s exactly what we do. Moments later, baby is warm and clean and comes delivered in a happy bundle to Mom’s chest, Dad watching from over her shoulder. Silently I stand there with a gentle hand on the cord, watching Mom and Dad marvel in their new child. Again, we share a gaze, brief but long enough to enjoy the moment completely. Nothing needs to be said. In that after-delivery, after-madness silence we feel Life erupt in the room.

Thoughts from Central Juvenile Hall  

Posted in Uncategorized at 1:31 pm by Jyoti Puvvula

The alarm goes off at 7:30AM on Sunday. I toss and turn on my only day off in a while, that I do not need to wake up early- I debate with myself and look for excuses as to why I might consider continuing my blissful sleep instead of going into juvie hall and talking to troubled youth after the Sunday mass. I tell myself- oh! it is Father Greg (Boyle) conducting mass today- he can take any reading and instill hope into anyone- he can even keep the packed chapel with young boys and girls in juvenile detention awake, forget they are sitting next to their enemy gangs and bring them to tears. So I go.

After the mass, I head to the Girls Care Unit (which is the unit for girls with psychological issues requiring medications) for a group session. This week there are only four girls who manage to get themselves to group. Few of them who could not make it are unwell, another is in lock down and solitary confinement for over 24 hours now, for getting into a fight.

I start by asking them how their week was and when their court date is.

One tells us—she was doing fine until her gang was "dissed". She got into a fight since she had to defend it and ended up in lock up. She is upset she was not able to control her anger. Her court date is near and this will reflect on her. She may not get to go home for some more time. She has been here for over 10 months. That is the last time she saw her almost 15 month old daughter. She tells us that she has spent more time in here in the last 3 years than on the outs when she started getting into trouble at the age of 12 after her father died and she did not get along with her mother’s new boyfriend.

A second girl of 16 tells us how she is too smart to be in a gang. She’s "gotta" do her time and get out. She is not sure she can stay away from the crystal meth that has consumed her life. She shares one of her writings with us:

Crystal…
Smelling it so deep
it took me for keeps
it sook me, I seen
trust me I became rusty
cutting crystal down
so I could sniff her.
Sniffing crystal is what I used to live for.
Now God take me with you.
Lead me, show me a path,
For confusion fills my head.
I need to heal!
Desperate to leave,
but am so scared of becoming free and run back to crystal.
God I am needy of you,
So make me stop tweeking. —PD

Another tells a fellow volunteer at the Boys Care Unit his court date is coming up and he is scared. He is 16. He has been here for a while and depending on his sentence may spend much of his life here. He shares his dreams, his aspiration if he is given a chance. He shares something he had written. It was written much more eloquently than I can remember, but it was something about –

…How your thoughts become actions…
And before you know it your actions define your destiny…

And then he goes on to ask Steven and Gilberto, if we can change his destiny?

I don’t know can we change his destiny. Can we change the destiny of a whole generation who have lost their youth behind these barbed wire fences?

Citizens Public Hearing  

Posted in Uncategorized at 10:07 pm by Anje Van Berckelaer

Last week I spoke at a Citizens Congressional Hearing on access to health care. It was attended, among others, by Representatives Diane Watson and Xavier Becerra, from the 34th and 36th congressional districts. I was hoping my own representative (Ms. Harman) would be there as well, but I guess she was working on that pesky ports issue.

The hearing was orchestrated by the California Nurses Association, a formidable organization.They’re responsible for, among other things, limiting nurse-patient
ratios. Last week’s hearing, though, was on an issue close to my heart: universal health care. Sadly, in the full hall, there were only a few docs, and a trio of medical students who gave up study time to come.

Anje speaks at the Citizens Congressional Hearing on health care.
Click on image for a larger view.

The experience was typical for a first-time anything for me: I got there late, drove around in circles trying to find the right parking spot, asked a cop, got lost anyway, but ultimately made my way to the right place after shedding all my various electronic and metal devices (those dangerous EKG calipers) to pass through the metal detector, raced upstairs, only to find that nothing had really begun yet.

In the conference hall, I found more people than I expected and was glad to see a couple of familiar faces among the medical students. The remainder was mostly nurses, but also teachers, actors, and others. Not surprisingly, the common theme in the testimony was that misfortune can happen to any of us. We’re all only a pink-slip away from being uninsured. The atmosphere was friendly, with so many like-minded activists in the room. I debated not speaking at all, since after a few testimonies it was clear that we all had more or less the same thing to say. For better or worse, though, when the doctor speaks, people do seem to listen. So I stood up, and, heart racing & red as a beet, I said my piece. I really am terrified of public speaking. It went over well enough, but next time I’m taking a beta blocker…

I’d like to think that sooner, rather than later, enough Americans will be angry enough about the haphazard patchwork of inadequate coverage we scramble together, that they’ll rise up and demand Medicare for all. Someone (seriously) made the suggestion that we recruit actors to promote the notion of universal health care to the American public. Well, why not? This is LA. But my money’s on the people.

Liveblogging from Pakistan – Entry #1  

Posted in Uncategorized at 3:26 pm by Catherine McPhee

Liveblogging from Pakistan blog posts are written by Harbor Family Medicine residents who elected to go to Pakistan for two weeks to provide medical treatment to those affected by the devastating earthquake that struck the northern region of Pakistan on November 21st. The posts from this resident organized trip serve to document their experiences.

Hi everyone,

We arrived in Balakot today, a very large tent camp community in the area of a former city, a city that no longer exists really, except for the people who survived the earthquake and are living here in the tents. How they survive like this for more than a few days or weeks amazes me, to be honest, much less for months. The tents are small, and wet. They’re on rocky rough soil, with water and mud everywhere. It has rained since we arrived, and probably for many days before. It is very cold and very wet. The roads are passable, but just. This morning we drove here, we had to drive around many areas where landslides were partially blocking the road (these are new, per Asif our guide, the rock slides weren’t there even just the night before when he’d driven home). Speaking of driving: I will never complain about LA traffic again. I’ll take the 405 anyday compared to this!!! :) To get into the Balakot camp, we drove over a narrow bridge which apparently used to be 5 feet to the left of where it is now, you can see the posts marking where the edges of the bridge used to be. I kept a tight grip on the edge of my seat, but it’s apparently pretty stable, despite it’s new location.

Tomorrow we hike up to another area, where I believe we’re going to stay and set up a makeshift clinic. This area, unlike where we are now, has not had any medical care available to them since the quake. There used to be a very narrow road to it, but even that is too unsafe to drive on, so we’re going to hike it instead. Lets hope that it doesn’t pour on us tomorrow, the way it is today! I’m not sure when you’ll hear from me again via email, as I don’t think we’ll have such things available there (currently I’m emailing from the Army base inside Balakot). We worked with a small Northwest Medical Team today that arrived here about a week before us, and have a clinic set up here at Balakot. They’re giving us some of their surplus supplies to take with us up to Sathpani, to help us get our clinic started. We won’t have much, and we’re not really sure what we’ll see, but at least being here today has us somewhat prepared. I see the women and children, Sanjeev and Fred see the men, and some of the children. In general, women take care of women, and men take care of men. There is no physical interaction between women and men who are not their husbands, including medical care. Even if a woman’s husband says that it’s okay for her to be treated by a male doctor, few women will be willing to do so.

Today I saw mostly women and children with complaints of cough, fever, etc. I was scared, the first time I laid my stethoscope on a child’s back this afternoon, I expected to hear crackles everywhere, I was sure that living in these conditions, they would all have terrible pneumonia, and in fact a couple did. But not all, some were just your run of the mill URI….at high risk still I’m sure for becoming something worse, but somehow, not there yet. I don’t know how these people maintain even relatively well, all things considered. They live many people in each small wet tent, on the wet cold ground, with blankets and fires to keep them warm. They have nothing else. And yet they smile as you walk into the room to examine them, they play with their children while you examine them, they gratefully accept whatever medications you give them (along with a 2 week supply of vitamins), and they smile again a quick goodbye before they rush off into the cold rain to go back to their tents. I am humbled. I cannot complain of anything, for even though I’m cold and tired, I’m wearing a warm Columbia jacket, I have warm waterproofed boots, and I’ll sleep tonight in a relatively dry tent inside a mummy bag. When my toes get too numb I’ll pop a toewarmer into my socks and be thankful for the 6hours of heat that the package says I’ll have. And in two weeks this will be something I tell other people about, from my warm and stable home in California. But these people will still be here, in these same conditions, surviving.

Thanks for all your prayers, the Pakistani people need them more than I can describe.

With love,
Cathy

their children’s future  

Posted in Uncategorized at 8:45 pm by los anjalis

Mom and dad look weary and frightened as dad holds their 2 month old daughter in his arms.

mom: “Doctor, how will this meningitis affect our child?”

dad: “will she have brain damage?”

you did the right thing by bringing your baby in early, I say. I explain to them that meningitis is an infection of the fluid surrounding the brain and spinal cord, that the treatment consists of antibiotics in case of bacterial cause, and that there are varying prognoses for an infant with meningitis. I address their concerns, try to calm them. They need some reassurance—their eyes are bloodshot, they have not slept for the past 2 days with their worries and baby’s fevers.

mom: “You know, doctor, this is our first child together…”

dad, finishing her sentence: “and we want to provide her with the best opportunities in america, all the opportunities we couldn’t have. We worked so hard in the phillipines… to come here and start from scratch, just so that we could build a beautiful life for our children.”

mom and dad hold back tears. I am reminded of parents’ ultimate love for their children, the immense sacrifices that immigrants make for their childrens’ futures, and what my own parents felt about the opportunities they wanted to provide for me. At that moment, three thousand miles away from my parents, I missed them more than I have in my seven months in this new city.

Pain  

Posted in Uncategorized at 6:16 pm by Daniel Castro

I hear the nurse ask, Señora, on a scale of one to ten, do you have pain today?
Si, Ten.
I shudder and walk into the room.
Buenos dias Señora.
How is it that you have ten out of ten pain and still walk and breathe and live I wonder?
This damn JCAHO requirement that we assess pain in our patients will be the death of us I mutter. Don’t these people understand that the ambulatory arena is not the same as a post-op suite or a surgery ward?

Our administrators don’t care—just do it. It’s required.
We don’t really care what it means, is what I think they are really saying.

Well Señora, tell me about your pain. Where does it hurt?
It hurts all over.
Where does it hurt the most?
Everywhere.
When does it hurt the most?
All the time.
Does anything ever make it better?
No.

I am quiet and she becomes uncomfortable.
In more than a familiar routine, I ask about her sleep, her memory, her appetite, her weight.
I find that once she had energy, that she was full of life and full of dreams.
That she would struggle to make a better life, if not for her then for her children. I find that her life has been falling apart. That each dream has slowly been eroding, a gentle and almost unnoticeable erosion of the strength that has driven her and in turn her family.

I come to understand the hardships she has endured and see the scars on her soul that have come from the injuries and the indifference her children have endured and the hopelessness that has resulted from her inability to protect them.
I translate the suffering into guilt and grief. She has not been able to give them the things they wanted, but she has worked so hard. She has not given them as much of herself as she feels they might have needed.

Yes, this strong and proud woman is in pain. The pain is centuries old and has settled in her soul. There is no knife that can cut it out, there are no pills that can heal. I hand her a tissue as she begins to cry, but she doesn’t need one. There are no tears. They ran out about the same time that her dreams began to die. All that is left is the shudder from her soul… and I become lost in the pain in her eyes.

I regroup. Her heart, her lungs, her abdomen, her muscles—things seem to be in working order. I smile as I think of bottling justice and giving her three tablespoons a day. Taken with hope for a better world—a place where people care for and about one another.

I smile and touch her gently. I think we can help I whisper. Take these once a day. When can you come back?

How is it that you can have ten out of ten pain señora, and still walk and breathe and live I wonder? As I walk into the next room I glance at the chart—ten out of ten pain…

Welcome to the Harbor-UCLA Department of Family Medicine blog.  

Posted in Uncategorized at 6:01 pm by Daniel Castro

This is an exciting project for us as we attempt to find our voice and contribute to the dialogue on health and the practice of Medicine in underserved communities.

We have developed a simple vision for the future of health care: that there is equal access to evidence based health care, that we address the many social needs that contribute to both health and illness and that we provide a strong focus on prevention and education strategies.

While our vision is not complex, translating it will require persistence and dedication. It will involve reengineering how health care is delivered, empowering self care and addressing risky health behavior. It will also involve focusing medical education in a somewhat different manner than occurs presently. In addition, the notion that health care can only be addressed in the hospital or office needs to be dispelled; in fact self-care strategies can not only be taught in the office but can equally be taught in community settings with measurable effectiveness.

Our journey as a program has evolved from an effort to meet the needs of our most vulnerable communities while attempting to meet the educational and social needs of the physicians we train to go into these locations. Our evolution will never be completed as long as these communities continue to have unmet needs and overwhelming challenges—this will require at least several lifetimes of diligent work to accomplish.

We would like to elaborate on how we are attempting to address the changes that we see as necessary to reform our health system. In addition, we would like to share the perspectives we have developed from working in the trenches with our most vulnerable patients and their communities; our frustrations, our inspirations and the everyday human condition we encounter.

1403 W. Lomita Blvd Suite 102
Harbor City, CA 90710
Tel: (310) 534-6221
Fax: (310) 326-7205
Email: harborfp@aol.com