Introduction to the Global Health Scholars Program - Tennessee

Transcript

• 00:01Hi, everyone. I'm Kartik.
• 00:04Third year, in the primary
• 00:06care program here at Yale.
• 00:07And, yeah, I was very
• 00:09fortunate to be able to
• 00:10rotate in Grundy County, Tennessee
• 00:13as a second year,
• 00:15in spring.
• 00:16And I have a couple
• 00:18slides,
• 00:20that I'll go through. So
• 00:21Grundy County is basically in
• 00:23the southwest corner or southeast,
• 00:25excuse me, corner of of
• 00:26Tennessee. It's around, like, forty
• 00:28five minute drive from Chattanooga,
• 00:30kind of in the,
• 00:32like, southern end of of
• 00:34Appalachia,
• 00:35both, like, culturally and geographically.
• 00:38And, it's kind of located
• 00:40on a on a plateau.
• 00:41So,
• 00:42a lot of residents,
• 00:43kind of live on this
• 00:44mountain plateau and and culturally,
• 00:48kind of feels a little
• 00:49different from,
• 00:50like, the the lower areas.
• 00:52So you'll find, like, a
• 00:53lot of patients sometimes.
• 00:55They, like, consider the plateau
• 00:56as their home and can
• 00:57be a little hesitant to
• 00:59go off of that.
• 01:00But so while I was
• 01:01there, I rotated at a
• 01:03couple different clinics.
• 01:05One of them was,
• 01:06kind of, like, similar to
• 01:08a,
• 01:08like, more, like, primary care
• 01:10clinic you might find in
• 01:11the northeast.
• 01:13So I won't talk about
• 01:14that as much.
• 01:15But the the
• 01:17one of the clinics I
• 01:18was at, Tracy City Free
• 01:19Clinic,
• 01:20it was basically within a
• 01:21a community center started by
• 01:23this,
• 01:24local community advocate, Emily Parton.
• 01:28And and they basically,
• 01:31or I I should say,
• 01:32like,
• 01:33the overall, like, Tennessee is
• 01:34one of, like, ten states
• 01:36which hasn't expanded Medicaid.
• 01:39And there's there's around, like,
• 01:40fifteen percent of people in
• 01:42the county who are uninsured,
• 01:43but most patients in this
• 01:45clinic,
• 01:47were uninsured.
• 01:48That's why they were going
• 01:49to the free clinic.
• 01:50It's it's run by this,
• 01:51like, retired
• 01:52family medicine physician, doctor Phelps,
• 01:55and then his, like, friend
• 01:57who's a rheumatologist
• 01:58sometimes comes, I think, a
• 01:59couple days a month.
• 02:02And so I I was
• 02:03working with them.
• 02:05Usually, we would see around,
• 02:06like, four to six patients
• 02:08per day,
• 02:10and
• 02:11kind of similar. Like, I
• 02:12would see the patient and
• 02:13then,
• 02:14precept with them.
• 02:16I think the the
• 02:17the patient complexity was, like,
• 02:20higher than I was used
• 02:21to here,
• 02:22like, at at, like, Cornell
• 02:24Scott and PCC.
• 02:27I would I would say,
• 02:28like, the average or most
• 02:29most of the patients were
• 02:30kind of, like, in the
• 02:32top ten percent of complexity
• 02:34that you might find here
• 02:36at the PCC.
• 02:38But a lot of, like,
• 02:39chronic uncontrolled chronic diseases, like
• 02:41cardiac disease,
• 02:44psychiatric
• 02:45disease,
• 02:47Hep C,
• 02:49And, like, doctor Phelps here,
• 02:51has, like, really been a
• 02:52champion for hep c treatment,
• 02:54and so that this is,
• 02:55like, a excellent place to
• 02:57to learn about that.
• 03:00I I think it was
• 03:01it clinically,
• 03:03kind of, like, pushed me,
• 03:05in in terms of, like,
• 03:07seeing things that neither I
• 03:08nor my attending had seen
• 03:10before.
• 03:11So, like, patients,
• 03:12like, who who came in
• 03:13on insulin pump or,
• 03:16like, patients with bipolar disorder
• 03:18who needed,
• 03:19like, active management of their
• 03:21psychiatric meds.
• 03:23So so it's definitely,
• 03:24like a like a really
• 03:26challenging and also rewarding
• 03:28learning experience.
• 03:30And the other main clinic
• 03:32was, Bershba Springs, which is
• 03:35located in a in, like,
• 03:36a smaller,
• 03:38like, hamlet almost
• 03:39around, like, forty five minutes
• 03:41or so north of Tracy
• 03:43City.
• 03:44And and this, this is
• 03:46also a free clinic.
• 03:48Most of the patients here,
• 03:49again, uninsured.
• 03:52And as far as who
• 03:54you'll work with here,
• 03:56there's a nurse practitioner, Ashley,
• 03:59who's there a couple days
• 04:00a week, I think.
• 04:02The the attending,
• 04:03doctor Nick Pumiglia, he's actually
• 04:05a YPC,
• 04:07alum, and,
• 04:09he comes in person,
• 04:11on some of the days.
• 04:12But some days,
• 04:13you'll just see patients independently
• 04:15and then staff with him
• 04:16in the evening.
• 04:19There are also student
• 04:20volunteers and interns,
• 04:23and I was able to
• 04:24meet a couple of them.
• 04:25And,
• 04:26they kind of, like, shadowed
• 04:27me, and then I did
• 04:28some teaching with them, throughout
• 04:30my time here.
• 04:32And,
• 04:34in terms of the,
• 04:35the patient population, I would
• 04:37say here, the patients tend
• 04:39to be not quite as
• 04:40complex as at the Tracy
• 04:41City Medical Clinic,
• 04:43but,
• 04:44still, you'll see, like, a
• 04:45wide variety of cases.
• 04:48There there's some kids as
• 04:49well, which you can or
• 04:51you can choose to, like,
• 04:53not see depending on your
• 04:55comfort level.
• 04:57And,
• 04:58in terms of, like, the
• 04:59the logistics of the the
• 05:01clinic, I think this was,
• 05:02like, the really interesting
• 05:04part, because the the labs
• 05:05are all done on-site.
• 05:07Or they're collected on-site, but
• 05:09then sent off to Quest.
• 05:10And so we would, like,
• 05:11fill out these order forms,
• 05:13to indicate which labs we
• 05:15want done. And then if
• 05:17if you wanna order a
• 05:18specialized lab test, then you
• 05:19have to look through the
• 05:20Quest,
• 05:21like this, like, thick booklet
• 05:22and and indicate which,
• 05:25which test you want ordered.
• 05:27Then the the a lot
• 05:29of time also I spent,
• 05:31like, learning about medications and,
• 05:33different alternatives to common medications
• 05:36because the the medications,
• 05:38at both of these are
• 05:39given out at both of
• 05:40these clinics. They function as
• 05:42dispensaries.
• 05:44And the they come from
• 05:46Americares says donated medications. They
• 05:49come from private citizens who
• 05:51will donate unused medications.
• 05:53And then the clinics also
• 05:55have some funding which allows
• 05:57them to purchase a supply.
• 05:58And so there there's the
• 06:00in Bershava Springs, in some
• 06:01extent, Tracy's, the the medication
• 06:04in the dispensary are kind
• 06:05of broken out into three
• 06:06sections, and
• 06:08and they'll kind of, like,
• 06:10point you towards using the
• 06:11donated medications first and then
• 06:14only resorting to, like, the
• 06:15purchased medications
• 06:17if, if needed. And so
• 06:20a lot of times, the
• 06:21clinic would have a lot
• 06:22of, say, like, telmisartan,
• 06:24omesartan,
• 06:25but not have, like, the
• 06:26losartan or valsartan that we
• 06:28might be more used to
• 06:29prescribing here, things like that.
• 06:30And so
• 06:31and so there there was
• 06:32a lot of time that
• 06:34I spent just, like, in
• 06:35the dispensary looking at the
• 06:36various alternatives and trying to
• 06:38figure out based on what
• 06:39was available,
• 06:41and, like, based on,
• 06:43what wasn't available as you
• 06:45can see in this photo,
• 06:47what a good option might
• 06:48be for the patients.
• 06:50And then once we pick
• 06:51the medications, then the staff
• 06:53or,
• 06:54like, sometimes,
• 06:55like I or the other
• 06:56providers, depending on time, would,
• 06:59like, count out the pills,
• 07:01using this pill counter and
• 07:02then, write the the prescription
• 07:05for the patients kind of
• 07:06kind of like this.
• 07:08Like, I'm sorry to interrupt
• 07:09you. I don't see that
• 07:10you're sharing your slides. I
• 07:12thought you were gonna be
• 07:13sharing them at the end
• 07:13after you're done talking, but
• 07:14I don't see that you're
• 07:15sharing your screen.
• 07:18Oh, oh, shoot. Okay. I'm
• 07:19I'm sorry. I thought that
• 07:20was shared. My bad.
• 07:23Let me try that again.
• 07:49Okay. Can you all see
• 07:50that now? Perfect. Yep. Okay.
• 07:52Sorry about that.
• 07:54But here, let me just
• 07:55quickly show. So the the
• 07:57this is Tracy City free
• 07:58clinic. This is,
• 08:01Bershava Springs Medical Clinic. These
• 08:03are, like, the lab forms
• 08:04that we filled out.
• 08:06This is kind of, like,
• 08:08a photo from the the
• 08:09dispensary.
• 08:10And then these are, like,
• 08:11the some of the pill
• 08:12counters that we would use
• 08:13to to count out the
• 08:14medications.
• 08:18Let's see. But, yeah, I
• 08:19think I think those were
• 08:20the,
• 08:21kind of, like, the logistics.
• 08:22And then tray Tracy City
• 08:24free clinic also has, like,
• 08:25paper charting,
• 08:27because that that was kind
• 08:28of like a like a
• 08:30what what the the physician
• 08:31there was used to. And
• 08:32then, Bershia Pass Springs has
• 08:34its own,
• 08:36EMR, which is which,
• 08:37actually, I I enjoyed using
• 08:39quite a bit.
• 08:41And,
• 08:42yeah, in in terms
• 08:44of, I guess but before
• 08:46I get into this, I'll
• 08:47just talk about, like, my
• 08:49overall
• 08:50clinical reflections. I I think,
• 08:53it definitely, like, pushed my
• 08:54clinical skills quite a bit.
• 08:56I think in terms of
• 08:58people who are interested in
• 09:00procedures,
• 09:01there there is opportunity.
• 09:03There can be opportunity to
• 09:04do that, I think, particularly
• 09:06with the rheumatology,
• 09:08days. I I was only
• 09:10there for four weeks,
• 09:12since I did this as
• 09:13a private ambulatory rotation. But
• 09:14if someone's there for six
• 09:15weeks, I think there would
• 09:17be more opportunity.
• 09:19And then Tracy City also,
• 09:20like, the the physician,
• 09:22the the attending would would
• 09:23sometimes draw the labs himself,
• 09:25and and I I was
• 09:27not super comfortable with that.
• 09:28But if if you are,
• 09:29then that's that's something that
• 09:31that you could do as
• 09:32well.
• 09:34And,
• 09:35and and I think I
• 09:36think more more broadly,
• 09:38I think it it it
• 09:40was it was valuable in
• 09:41terms of, like, reflecting on
• 09:43on my own biases and
• 09:45then,
• 09:46and, like like, kind of,
• 09:48like,
• 09:49increased exposure to,
• 09:51people from Appalachia since this
• 09:53is not a region of
• 09:54the the country that I've
• 09:55spent a lot of time
• 09:56in before.
• 09:57And I I as, like,
• 09:58a person of color, was
• 09:59was worried about,
• 10:01racism,
• 10:02but
• 10:03found that that was not
• 10:04the case. And and,
• 10:06yeah, talking with other other,
• 10:08people of color rotated here,
• 10:10it sounds like that that
• 10:11was a similar experience for
• 10:13them. And so I think
• 10:14that that part was was
• 10:15really reassuring.
• 10:18And then I I think,
• 10:19overall,
• 10:20the rotation
• 10:22just, like, was was
• 10:24it, like, increased my
• 10:25interest in rural medicine and
• 10:28was just, like,
• 10:29yeah, overall, one of, like,
• 10:31the best rotations, I think,
• 10:33from my time here at,
• 10:34at YPC.
• 10:36In in terms of,
• 10:38fun things to do,
• 10:40there's, like, a lot of
• 10:42great hiking, lot of great
• 10:43country cooking nearby.
• 10:46And,
• 10:47I think one one of
• 10:48the weekends I ended up,
• 10:49like, being invited by my,
• 10:52like, landlady to attend her
• 10:54church,
• 10:55and got to meet some
• 10:56of the members of the
• 10:57congregation there, which was really
• 10:59cool since I had personally
• 11:00never been to a church
• 11:01before,
• 11:03and then ended up, like,
• 11:04helping one of the,
• 11:07like, local community members,
• 11:09with some repairs on on
• 11:11his RV.
• 11:12And so I think you
• 11:13you'll you'll kind of, like,
• 11:15find ways to, like, meet
• 11:17meet some of the community
• 11:18members outside of clinic to
• 11:20which can be really rewarding.
• 11:23And then I did also
• 11:24end up taking a weekend
• 11:25trip to to Birmingham while
• 11:26I was down there. That's,
• 11:28like, two and a half
• 11:29hours away. And then if
• 11:31you wanna take, like, weekend
• 11:32trips to, like, Atlanta or
• 11:33Nashville, those are all, like,
• 11:35one and a half, two
• 11:36hours away.
• 11:38Yeah. So, overall, would would
• 11:39highly recommend,
• 11:41this rotation,
• 11:42both for, like, learning about
• 11:44rural medicine and then also
• 11:45just,
• 11:47direct the cultural experience in
• 11:48general.
• 11:49But, yeah, happy to take
• 11:50any any questions in the