Tag Archives: Duke

Public Health in Action – Predictably Irrational

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Richard H. Thaler is a kind of a big deal, and if you don’t know, now you know.

Professor Thaler, who teaches at the University of Chicago Booth School of Business, was awarded the Nobel Memorial Prize in Economic Sciences last month for his contributions to the field, specifically in understanding human behaviors. His life’s work illustrated that humans act irrationally in consistent ways that can be predicted and modeled. The implications of his work transcend all sectors. In 2008, Thaler co-authored “Nudge” and encouraged governments to use their insights for public good. Enrollment in retirement savings accounts significantly increased with a slight change: enrollment was the default option, which forced people to “opt out” if they weren’t interested. Observing and prioritizing human behavior, such as what behavioral economists describe above as “inertia”, over standard economic theories of rational actors, has made all the difference and has created myriad pathways into practical application.

Take the Center for Advanced Hindsight (CAH) at Duke, founded by Ted rockstar Dan Ariely. It houses decades worth of social and behavioral science knowledge, researchers AND entrepreneurs all under the same roof. CAH’s current focus has been working with startups that address financial security or health behaviors.

Public health, like economics, was built on the assumption that people behave rationally at all times. Thaler and Ariely have challenged those assumptions time and time again. We, as public health professionals, need to lean into uncertainty, especially when in matters of health behaviors. The populations that are most at-risk and need public health folks the most don’t live in ideal conditions. They may or may not have stable income, housing, transportation or have access to their next meal. If we can’t assume that people will behave rationally in a “normal” situation, we can’t assume they would behave rationally in a “distressed” situation.

Those are exactly the questions that crossed Allison Sosna’s mind at various points in her life and she shares her experience with us, below.

 

Allison Sosna, aka Chef Alli, is the founder of the MicroGreens Project

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Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current role as founder of MicroGreens.

Allison Sosna: I was in college and on the rowing team. Food, at that time, was synonymous for fuel that my body needed to perform. Sure, I ate healthily – lots of veggies, carbs, and protein (mostly chicken and eggs) but I did not give it any further thought. In my junior year, I lived in Italy. It was there that I was enlightened by the power of food on a community and would therein change the course of my life. I lived in a small neighborhood outside of Rome where residents all knew one another. They knew the barista and asked him how school was going. They wanted to know if the butcher’s cold had gone away. Everyone cared about one another and food was clearly the denominator of affection. In Rome, I realized that I wanted to do something with food and people. I did not come back wanting to be a chef, but, I saw that as a way for me to create food and community. So, I volunteered as a prep cook down the street when I got back to DC. I loved it. I loved the physical exertion that went into working on the line during dinner service. I loved wearing a uniform and feeling part of a community; a diverse community of women, men, people of different races, and different backgrounds with different stories. The sociologist in me was in love.

Shortly after, I went to culinary school, had a jaunt in fine dining, and then got a full time job at Dean and Deluca. While I learned a lot there, I realized I wanted to do more with my community; I didn’t want to feed rich people anymore. I had veered off course from the initial eureka moment. Leaving that job, I landed a job at a non-profit called DC Central Kitchen overseeing Fresh Start Catering, the social enterprise of the non-profit. When I started, we were providing the food services for a private school for at-risk boys, but it was generic and too similar to the lackluster school food that America is known for. Seeing such, I brought in healthier options, started making food like meatballs in-house, a salad bar, and marketed our vegetables to be more “fun” by using them as anecdotes. For example, I would say that foods like roasted carrots was a veggie that basketball players ate to perform better on the court (It’s true!). We had a lot of success there and that led us to win a food service bid for 8 DC Public Schools. We served thousands of meals a day to low-income kids who didn’t have easy access to fruits and vegetables (in 2010). Kids, of course, were coming to school with chips and soda, but I wanted to do something about it. I thought about the parents or guardians that were at home with the kids. How did they eat? Was it influencing their kids’ eating behaviors? How could I shift behavior? What I drew from all these questions was the question of their budget. How does a low-income family eat healthily? If I was a parent on SNAP, how did I use my money? Did I know how to cook? Did I know what to buy? The majority did not. As a result, I started MicroGreens and the Allison Sosna Group (ASG). ASG is my consulting “firm” for menu development, food service consulting, and private chef services. I had left my job to start MicroGreens, but also needed an income! I continue to consult today.

MicroGreens teaches kids to cook on a budget of $3.50 per meal, per family of four. The program has graduated over 150 kids across the country, with the help of community leaders that want to make their neighborhoods healthier. MicroGreens can be implemented anywhere, for any income level, for any length of time, and with any age group.

I moved to New York City in 2013 and while I was still working on MicroGreens and taking chef jobs, I needed an income and a job I truly cared about. So, I applied to jobs in public health nutrition with a focus on project coordination. After a year and a half of coming close to many jobs (NYC is tough!), I went back to school for a Master in Public Health degree.

Over the last year I’ve been intrigued with hospital food and its obligation (or lack thereof) to ensure that everyone has access to healthy food – from its staff to patients and also to visitors. While I am not trained in therapeutic meal development, I am trained to assist in cafeteria food services. I’ve been fortunate, by way of hustling and networking, to be part of the NYC Department of Health and Mental Hygiene’s Healthy Hospitals and Colleges Initiatives. We are working with food distributors to get chefs and food service directors healthier products for their hospital or college. It’s an incredibly rewarding experience to be on the other side helping the chef. I would have loved this help when I was working.

Me: What inspires you on a daily basis, especially when things get hard?

AS: On a daily basis, knowing that I am a part of something larger gets me through tough times. I know inherently that I am making a difference by bringing in healthier options for people. Every time a consumer replaces an unhealthy product for a healthier option, I know that I helped facilitate that. And as we all know too well, establishing healthy behaviors takes time.

As a student with a part-time job, I’m constantly moving around, not being able to cook for myself nearly as much as I want to, paying copious amounts for transportation, and don’t have a social life. But, I know I will, and am looking forward to graduating next year, when I can stay put and focus on doing work for my community full-time.

Moreover, the people I work with are incredibly supportive and that support allows me to focus on doing well in school and do an even better job at work.

Me: Tell us more about MicroGreens. How did you get into the social impact space? Why is it important to reach underprivileged populations?

AS: We must think about sustainability when we design programs. That being said, MicroGreens was originally going to be funded by a fast casual restaurant I was going to open. It would serve as part of the capital going into the non-profit. I’ve always believed that business needs to be part of the equation when designing interventions such as MicroGreens. I got 70% funded for the project but then had to let it go. I came close though and I’m proud of that.

If we do not focus on creating upstream programs first, we are doing a disservice to our communities, whether they are privileged or not. It truly does come down to the old adage “Give a person a fish and feed them for a day. Teach a person to fish and you feed them for a lifetime.”

One of the most impactful experiences I had with MicroGreens was not related to cooking. A student who had taken the class before was walking by our teaching classroom and walked in to say hi. He walked over to one of the kids who was having trouble cutting carrots (cutting carrots is hard!) and said “If you ever need help, let me know. I’m MicroGreens alumni.” Not only had this student learned skills and put them into action, but the program had instilled pride and confidence to teach others. There was a kindred relationship forming, a mentorship. That made me so proud.

Me: What are the current needs in New York City as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

AS: 1 in 9 residents have diabetes in NYC. Communities have little access to healthy foods blocks from affluent neighborhoods with endless healthy food choices. Soda ads saturate low-income areas and schools are without outside playgrounds. All determinants of health are so greatly intertwined that it can be overwhelming, especially for public health officials trying to make a difference. We talk a lot about that at school. How do we design interventions that encompass all contextual factors? First, by working with community stakeholders.

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Public Health in Action – Champions of Change

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The Looking Glass by Dave Meier

It’s been a full year since I created this blog and after reading each of my posts from the past year, I feel like it’s only the beginning.  Switch/Health has evolved so much more than I could have ever imagined.  Initially envisioned as a “one-stop shop” for all topics that directly or indirectly affect health outcomes, it has become a link to many great stories.  Stories of local leaders affecting real change in their communities.  Stories that describe how health and the healthcare system look from various lenses.  And most importantly, stories that describe their own evolution in finding purpose in their work.  I feel extremely humbled for the opportunity to share their stories with you.

The leaders listed below have been instrumental in empowering people in self-awareness and improvement.  I’m inspired to continue my search in finding the unsung heroes making an impact.  And I hope their stories offer you some insight and inspiration as well.

A Maria Hester – Dr. Hester Empowers Her Patients
Bri Isaacs – YogiBriii in the OC
Betty Jung – Web Master and Lecturer Betty Jung
Elizabeth Greenberg – Non-Scents Makes A Lot Of Sense
Rachel Safeek – Rachel Safeek Fights the Status Quo with “Fight Stigma”
Heather Freeman – Heather Freeman Believes We All Have Capes
Braden Rawls – Health Doesn’t Have to Cost an Arm and a Leg
Jonathan Bonnet – Walking the Walk
Elizabeth Poindexter – Mobilizing for Collective Impact
Ryan Shaw – Leveraging Health IT to Improve Outcomes
Patricia Carcaise-Edinboro – Hearing the Unheard
Michael Allen – Mind the Gap
Prathima Kannan – Communities Creating a Culture of Health

“The best way to find yourself is to lose yourself in the service of others.” — Mahatma Ghandi

Public Health in Action – Leveraging Health IT to Improve Outcomes

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In the broadest sense, Health Information Technology (HIT) is applying IT to health care in order to improve patient outcomes, quality of life and reduce health care costs.  The field is growing and fast.  By 2017, the field is predicted to yield over $30 billion.  And it’s not hard to find.  A recent visit to Apple’s app store can be overwhelming – even after filtering the apps down to “health.”

Healthcare providers, from hospital systems to individual healthcare professionals, as well as healthcare payers (consumers, government, insurance companies) have bought-in to the promising field.  Startups keep popping up.  Health is a primary focus in various innovation challenges.

In the bigger picture of improving our healthcare system, I think HIT has the potential if leveraged the right way.  I recently interviewed Dr. Ryan Shaw, professor at Duke School of Nursing on his thoughts about the field and its potential in improving our healthcare system.

Here’s Ryan!

Me: Tell us about your past experiences in work, research and academia and how it ties to your current role.  Also highlight your interests in the field of Health IT and what Health IT could lead to in terms of health outcomes.

Ryan Shaw: My undergraduate studies began in computer science and mathematics. After 2 years I switched into nursing. It’s a strange transition but I wanted to go into a career path where I felt I was making a difference in people’s lives. After becoming a nurse, I went back to school to get a masters in informatics at NYU while working as a nurse in NYC. This allowed to merge healthcare and the IT side.

At the end of my master’s program, Duke University just so happened to offer an Information Technology fellowship as part of a PhD program for nurses. I applied for the competitive program and received the fellowship. I ended up working for Duke’s Health Company “Duke Health Technology Solutions” while studying for a PhD at Duke.

Following that, I eventually landed a job as a Professor at Duke’s Nursing School. I love this job and it allows me to do both science and education. On the teaching side, I teach in our masters informatics program. On the research side I discover how to use novel technologies and their data to help patients’ self-manage chronic illness. This is exciting work and allow me to work with an interdisciplinary team of physicians, pharmacists, psychologists, nurses, and IT gurus.

Discovering knew knowledge that will be applied in healthcare is extremely rewarding. While working as a clinician I was able to impact each of my patients lives, research allows me to have a much broader reach of impacting many more lives and creates knowledge that other people will build upon. Our world is changing, and information technology is becoming an integral part of peoples’ everyday lives and thus their health as well. My team and I capitalize on this social change and leverage technology as a conduit to improve health. It’s really cool.

Me: What inspires you on a daily basis, especially when things get hard?

RS: Academia is tough. There are real no work hours and no day is ever complete. I could work 24/7 every day for a year and still have more to do. A lot of what you propose is rejected and people don’t value it. Grants that you work months on don’t get funded, manuscripts are rejected, and sometimes you sit in the office asking yourself if you really do make a difference. In discovering knowledge, there is often nowhere to go to look for an answer. Scientists create answers, we seek to answer the unknown and discover more. You need a thick skin and perseverance is of the most important traits needed.

I drive inspiration from my family, I work through stress by exercising (I run a lot and use to be big into triathlon), and view this video from Apple to get me going.

The video reminds me that innovators are the ones who change world and those who succeed are the ones who keep trying even when they fail.

Me: What do you think it will take for our society to view health more seriously?  As in, why is health lower in priority to careers and education and relationships?

RS: Honestly, health doesn’t come first for many people – and likely won’t ever. Families, safety and financial security usually come first. And in my opinion, that’s probably OK. We need to eat, pay our bills, and survive. These all impact our health. That’s not to say health isn’t important, it’s critical.

For people to take health more seriously, is really going to have to come from the top. In my opinion, there is too much focus on the individual and treatment of health. It’s really societal and public value. We need a greater investment in communities and public health. We’ve created infrastructure that supports poor habits. I think many people forget that physical infrastructure and urban planning are so important. If we make it easy to drive your car to the drive thru down the street, then that’s what people will do. We need sidewalks, urban planning that encourages walking, and a cultural shift that values these things. This is happening, but for so long we’ve focus on suburbs, building a society that is car centric, and making delicious food easy to get. It’s just so hard to change individual healthy habits when the structure around you suggests the opposite.

Me: What are some things/concepts/ideas/insights you’ve learned from your research that can help improve health outcomes in individuals and on a population-level?

RS: Some of the concepts we’ve learned is that technology needs to be designed with the end user in mind. A lot of technology and how it functions is useful for young people and techies. But those aren’t the people who are most in need. The people in need, and the most expensive people in healthcare, are those with chronic illnesses (obesity, diabetes, hypertension, etc.). These are the people that could benefit the most from novel technologies and their data – and they are of all ages, young and old.

We need technologies that truly fit into their daily lives and we need to create infrastructure in the care delivery system that is able to use newer technologies such as wearable devices. As of now, we don’t have this structure. But its possible. If all of our patients monitored their daily data, software could manage most people and guide them in self-management of health behaviors. If people don’t correct those behaviors, it could be bumped up to a nurse or pharmacist to help them. And then after that, it could be bumped up to a physician. This would allow for true population management and would be cost-effective. It would also allow physicians to have a better understanding of their patients’ day-to-day lives when they actually see them in the clinic. This may enhance medical decision making. Check out the article, Mobile Health Technology for Personalized Primary Care Medicine, that we wrote on this.

Me: What are the current needs in your city as they relate to social determinants of health (i.e. SES, poverty, access to care, transportation, safety, etc.)?  Social determinants of health are any factors that directly or indirectly affect health.  For example, being homeless could cause stress and malnutrition which could drastically affect one’s health.

RS: The Raleigh-Durham is certainly trying to address some of these social determinants of health. For example, transportation wise we are trying to get in light rail that will have stops next to low-income housing. The bus system is being revamped to meet more people’s needs.

In terms of access to care, the affordable care act has and is helping with a lot of this. But North Carolina chose not to expand Medicaid as much as many other states, to access to care is still an issue for many people.

The city of Durham is quite focused on measures to alleviate poverty and help with homelessness. There is more focus on adding in sidewalks so people don’t walk in the street for safety reasons, they’ve been building affordable housing, and are pushing measures that new development including a % of low-income housing.

Public Health in Action – Walking the Walk

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Jonathan Bonnet, MD
Duke Family Medicine, PGY-3

I was fortunate enough to attend the National Physical Activity Plan Congress last week in Washington, DC and was inspired by many of the leaders working in the field of physical fitness and activity.

One program, in particular, really caught my attention.  Walk with a Doc (WWaD) has a simple idea: encourage physical activity in the community by walking alongside physicians.  I think it’s safe to say that the last time each of us had a visit with our doctor, he/she discussed our health behaviors and/or lifestyle, which more than likely included a question or two about how active we have been.  Physicians also typically encourage their patients to get active, eat healthier, cut back on alcohol intake and to stop smoking.  What impressed me the most is the extra step WWaD takes to engage with their patients and local communities.  They encourage their patients to walk alongside them.  By being outside and actually leading by example, I strongly believe that physicians not only connect with their patients on a higher level by building rapport, but it also makes the visit less formal and transactional.  If I were a patient and walked alongside my doctor and we chatted about things other than health and medicine, I would feel that much more comfortable and more willing to share any issues that I was having.  By re-shifting the context in which providers interact with their patients, using this less formal, social setting can have profound results.

I had the pleasure of meeting and interviewing Dr. Jonathan Bonnet for this blog post and I feel privileged to share his story with you all.

Me: Tell us about the path you’ve gone through – college/medicine/residency – and what captured your interest with Walk with a Doc.

Jonathan Bonnet: Sports had always been a large part of my life growing up. It wasn’t until undergrad at Ohio State University (OSU), when I fell in love with exercise and physical activity. I ended up majoring in exercise physiology, working in the exercise labs at OSU, and ultimately becoming a personal trainer and interning at Anytime Fitness. The ability to change lives with physical activity inspired me to do more for health and pursue a career in medicine.  As fate would have it, in my first year of medical school at OSU I discovered the national nonprofit  organization, Walk With a Doc (WWaD). Ironically their national headquarters was located in Columbus, OH.  Although the name had initially caught my attention, the people and program inspired me to get more involved and stay involved indefinitely.  I was struck most by the simplicity of the program, as well as the open invitation to the entire community.  The premise was simple: bring doctors and healthcare professionals together and practice what medicine preaches.  I loved the idea of literally ‘walking the walk’ with patients and the community.  The walks are a fun, social event, with the added benefit of everyone getting their daily exercise, too.  After getting involved with the local walks as a medical student, I initiated an Ohio State Walk With a Future Doc program with my peers. My passion for the program as well as my interest in promoting physical activity has continued through residency. With the support of the Duke Community and Family Medicine department, we launched the Duke Family Medicine (WWaD).  Although the walk targets the patients with obesity, it is open to everyone, including the Durham community at large.

Me: What inspires you on a daily basis, especially when things get hard?

JB: I am continuously inspired by the patients I see, my community, the WWaD leadership, and above all else my family and friends. When I see the people around me, with life situations much more challenging than mine, rise up and make the best of their circumstances, I feel truly inspired to help others do the same. I have been incredibly blessed in my life and have a passion to help spread and promote health and happiness to everyone around me.  Seeing family, friends, and loved ones suffer the consequences of largely preventable chronic diseases is devastating.  Research has already shown that lifestyle behaviors – being physically active, eating a healthy diet, not smoking, and maintaining a healthy weight – can prevent 80% of the chronic diseases we face.  This failure to translate what we know into what we do drives me to help make a difference. I firmly believe we can make a difference.  It won’t be easy, but it will absolutely be worth it. Dennis Waitly said “there are two primary choices in life: to accept conditions as they exist or accept the responsibility for changing them.”  I have chosen the latter.

Me: What do you think it will take for our society to view health more seriously?  As in, why is health lower in priority to careers and education and relationships?

JB: In general, health is something that everyone, who has it, takes for granted. It is not until we lose our health, that we realize how precious and valuable it is. I think it is also important to realize that health encompasses more than merely being “not sick” or working out everyday. Health encompasses the physical, mental, social, emotional, and spiritual aspects of life. Health is much more difficult to measure than education, career accomplishments, or relationships.  One of my favorite quotes is that not everything that can be measured, counts, and not everything that counts, can be measured.  Health is a somewhat ambiguous part of life that is difficult to assign value, and it is not something that generally changes overnight.  The gradual loss of health, or what I would prefer to say, lack of vitality, makes it difficult to have a sense of urgency and need to prioritize health when it comes to day-to-day decisions. Eating unhealthy food or not being physically active any single day has minimal effect on long term health. It is the cumulative effect of the day-to-day decisions that promote or impair “health.” Humans are much better at understanding and appreciating short term consequences and that is why health tends to fall lower on the list of priorities for many people.

Changing this societal view on health is tough.  Culture and social norms dictate much of this. People who sacrifice sleep for their jobs are idolized. We tend to measure success by material goods, achievements, awards, and honors, rather than the parts of life that matter most: family, friends, health, etc. It is not something that will change overnight, but it has to start somewhere with someone.  That someone is you, me, and people like David Sabgir, who started WWaD. It doesn’t have to be profound. Simply deciding to embrace the challenge of being the healthiest version of you possible, is an incredible start. If there is demand, government, businesses, and societies will change. It will take an honest conversation with ourselves about what truly is important in life, followed closely by an enthusiasm, passion, and dedication to practicing those values everyday.

Me: What are some things/concepts/ideas/insights you’ve noticed that have helped/hindered health-related outreach and education in communities?  Specifically from a provider perspective.

JB: As a provider, one of the most challenging aspects of care is to really understand the situation and environment a patient is coming from.  It is difficult to do more than graze the surface of what a patient’s living situation and day-to-day life actually looks like in a 15-minute visit. Although it is easy to be idealistic and think everyone can adopt healthy lifestyles, the truth is that the choices we make are subsequent to the choices we have. Frankly, I have patients who do not have healthy options. It is choosing between two bad choices, and that makes it tough.  Oftentimes, it takes multiple office visits and getting to know patients very well before they feel comfortable discussing many of the underpinnings that contribute to their health, or lack of it. Patients are prideful and often times want to “please” their doctor by saying they take their medicine as prescribed and eat healthy, when in reality, the situation may be entirely different.  We know that social determinants of health play a far bigger role than the one-on-one medical care a physician provides, but these are “messy” issues, that do not have quick fixes. Aside from solving world poverty, I think the single best thing we can actually do in health care is to take the time to not talk, but actually listen to our patients and their stories. It is not until we understand our patients values and what drives them, that we are able to facilitate them in making the best decisions for their health.

Me: What are the current needs in your city as they relate to social determinants of health (ie SES, poverty, access to care, transportation, safety, etc.)?  Social determinants of health are any factors that directly or indirectly affect health.  For example, being homeless could cause stress and malnutrition which could drastically affect one’s health.

JB: As with any community, the social determinants of health play a much larger role in the well being of its members than anything that can be done by a doctor in a single office visit. Access to healthy nutritious food and water, medical care, areas to be physically active, education, shelter, and resources are all critical pieces of health. The Durham community is no different. There are individuals suffering from any and all of the aforementioned components. Obesity is arguably the most pressing health issue this country has ever faced, and social determinants contribute significantly to this. Although it is multifaceted, it has been exciting to be part of a residency program that understands these issues.  At Duke, we started a Walk With a Doc to facilitate physical activity among our patients, staff, and community. Additionally, we brought the Veggie Van program to the Duke Family Medicine Clinic every Thursday afternoon. The Veggie Van offers subsidized fruits and vegetables to the community in an effort to make healthy food affordable and accessible to everyone. We are also collaborating with the Durham Public Health Department to identify and offer other services that are beneficial to the community. None of these interventions alone will solve the problem, but it is our hope that the collective effort will yield meaningful changes in the health of our community.

Public Health in Action – Rachel Safeek Fights the Status Quo with “Fight Stigma”

fightstigmaIn an earlier post, I marveled about Twitter and all the great things that have happened to me post-Twitter.  It blows my mind how much information there is out there on the internet…which is how I found Rachel Safeek.  Being the public health, upstreamist, social determinants of health geek that I am, I ran a Google search on “health disparities Duke” preparing for a trip down to Durham for one of my consulting projects.  Lo and behold, there were pages and pages of interesting websites, one of which was Rachel’s blog, blue devil banter.  Her perspective and activism was something that I wanted to bring into this blog.  What I value so much in activism and community mobilizing is that anyone and everyone has a voice – whether it’s a solo one or an army of voices – each and every one of us has a voice.

“Never be afraid to raise your voice for honesty and truth and compassion against injustice and lying and greed. If people all over the world…would do this, it would change the earth.” — William Faulkner

So without further ado…

Rachel Safeek
Founder, Fight Stigma Campaign
Duke University 2013
Program II: Health Policy, Human Rights, and Health Disparities

Me: How did you end up doing the work that you’re currently doing?  Student to activist to working at Duke.

RS: I first began working with HIV prevention and advocacy while studying global health as an undergraduate at Duke. I became interested in the various socio-economic factors that predispose women to HIV. My interests led me to spearhead a seven-month research project in Salvador, Brazil, investigating how violence (domestic, sexual, etc.) and economic vulnerability predispose women to HIV and other sexually transmitted infections.

Following my work with HIV, I joined and later became Director of an HIV testing program that offered free, rapid HIV testing at various locations in Durham, North Carolina, including Duke University Campus, Durham Technical and Community College, and El Centro Hispano, a resource center catering to predominantly Spanish speaking populations.

While engaging in HIV prevention work, I observed the manner and degree to which stigma was associated with HIV.  Moreover, overall sexual health served as a deterrent for many seeking HIV testing and/or medical treatment after sexual assaults, and openly discussing safer sex behaviors. This led me to found my organization, the “Fight Stigma Campaign” (FSC). The initiative was launched as a social media-based photo-campaign dedicated to educating the campus community about HIV/AIDS and encouraging HIV testing and open discourse surrounding safer sex, particularly among young adults.

After working with HIV prevention and advocacy for a year, I then turned my focus to HIV treatment. Currently, I am working as a Clinical Research Coordinator for the HIV drug trials at Duke Medicine, in which I oversee the enrollment and progress of patients in HIV drug studies at Duke. While I am now focused on the treatment end of HIV, I still dedicate significant time and effort to advocacy efforts for the FSC, all while I applying to medical school.  I hope to one day continue to work with issues related to women’s health and infectious disease as a medical doctor.

Me: What inspires you on a daily basis, especially when things get hard?

RS: As a Latina woman who represents diversity in healthcare, I am deeply motivated by a desire to give back to my community. Everyday, I have the privilege of engaging patients from a wide array of socio-economic and racial/ethnic backgrounds. These clinical experiences have afforded me the opportunity to observe first-hand the manner and degree to which racial/ethnic minorities are disproportionately affected by negative health status. Each individual interaction motivates me to continue along my trajectory of working with underserved communities—many of whom represent members of my own community—currently as a clinical research coordinator and HIV prevention worker, and later on, as a medical doctor.

Me: What do you think it will take for our healthcare system improve?  What do you think it will take our society’s health outcomes to improve?

RS: From a human rights standpoint, I believe that before health disparities can be adequately addressed, we must first acknowledge health as a human right. By ensuring individuals that they have a right to health, communities can mobilize to demand this right, raising awareness to the various socio-economic factors that prevent communities from attaining optimal health status. These socio-economic factors, including education level, access to healthcare facilities, transportation barriers, and poverty must be addressed in order to improve health care in our nation. I believe that these conditions stand a higher chance of being addressed if we can empower communities to vocalize their concerns by affording them the right to optimal health.

Me: In the health policy world, what do you think is the next big opportunity and how does this compare to the actual need of the population?  What I mean is that sometimes Congress and the needs of the public aren’t always on the same page…

RS: I think we can all agree that the Affordable Care Act represents a tremendous forward stride, in terms of affording individuals access to care. However, beyond health care coverage, there are still a multitude of factors that predispose populations to poor health, including lack of transportation to health care facilities, lack of access to sustainable nutrition, poverty, low socio-economic status, etc.

One prominent issue in healthcare that I believe is often overlooked is the lack of representation of minorities in healthcare settings. Having physicians and other healthcare workers of diverse backgrounds is necessary for appealing to the culturally-specific needs of patients.

According to the AAMC (Association of American Medical Colleges), African Americans, Hispanics, and Native Americans make up 25% of the U.S. population, but only account for 6% of doctors. Increasing the number of physicians from racial/ethnic minority backgrounds ensures the delivery of culturally competent and sensitive care, thereby fostering a sense of trust between patients and their providers and increasing patient safety and satisfaction. Minority physicians have also historically been linked to working with patients from underrepresented and marginalized groups, who often represent a large fraction of the sick population, further highlighting the importance of adopting progressive policies that encourage and aid minorities in their pursuit of careers in healthcare.

Me: What are the current needs in Durham, as they relate to social determinants of health (ie SES, poverty, access to care, transportation, safety, etc.)?

RS: Durham, North Carolina, home to Duke University, is uniquely nestled in the Research Triangle Park (RTP), which is renowned for having the highest concentration of MD’s and Ph.D.’s in the world. While boasting this impressive statistic, the city’s high yield of educated individuals also creates a gradient of educational disparities within the area. As a result, there are tremendous racial and socio-economic disparities between the faculty and students of Duke University and the rest of the city.

Duke University Medical Center, nationally ranked as one of the top 10 hospitals in America, plays an instrumental role in affording individuals in Durham County and surrounding counties and states top-notch care. Also, Duke University, as a whole, is the largest employer in the county. However, while the University affords Durham locals various job opportunities, I believe a disparity still exists. Like most of America, the large racial minority population does not comprise the majority of the decision makers who determine how resources are allocated. While there is some representation on boards, this is not enough. In the end, the decision-makers are the ones who control resource allocation, who drive change and make improvements to benefit the community, especially in healthcare.

I believe there should be more progressive policies that aid those of disadvantaged socio-economic backgrounds and under-represented minorities in their pursuit of higher degrees to help diminish the gap in racial/ethnic disparities in education and health.

54 Hours to Innovate

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Thursday, August 7: I had a lot on my mind for the night going into the TSWHealth weekend.  This was my first official (cliff) dive into a formal entrepreneurship setting and I was excited for it.  But I’d be lying if I didn’t at least acknowledge that a part of me was scared at the thought of being out of my element – not only was this my first “entrepreneurship” event, but I’m not even from the area.  Both elements gave me a tinge of anxiety, but if you heard about the previous 12 months, you would realize this event was not going to faze me…you would realize that I’m at a point in my life where I not only tolerate change and uncertainty, but actually embrace and savor each and every delicious uneasy second of it.  Can I get a second helping, please?  So the fact that I had a lot on my mind didn’t have anything to do with worries going into the weekend.  The fact that I couldn’t sleep was due to my level of excitement.  Think kid in a candy store, but since I’m a little off and love savory foods, think of me in a buffet without sweet stuff.  Yeah, so giddy doesn’t capture how excited I was to attend this event.  I technically didn’t have a place to stay until Thursday morning.  I was determined and even had the backup plan of sleeping in the bathroom (Sorry American Underground and TSWHealth staff) – I was not going to let a minor thing like sleeping stop me from savoring the experience.

Friday, August 8: My bus was scheduled to leave at 11:00 am and arrive in Durham at 4:30 pm.  Awesome as long as there’s no traffic.  Scratch that, this is the 95 on a Friday, of course there’s going to be traffic.  As long as there’s minimal traffic, I’ll make it in time to pitch one of the three ideas I had going into it.  Winning!  And there’s internet and Wifi on board, so I can be super productive for this 5 hour journey.  Yes, great plan.  Fast forward a few hours and I’m boarding the bus and getting comfortable in my window seat.  First setback of the trip – after several attempts, no Wifi connection.  Buzzkill…there goes my plan to be productive.  At least I brought a few back issues of the New Yorker to read.  I’ll have to force myself to relax…

It’s 4:35 pm and I have no idea where I am in Durham.  I know that the event is within walking distance to the bus station, but no more than that.  Technology saves the day yet again and I’m within 4 blocks.

I officially check-in and head into the American Underground co-working space to mix and mingle it up with local entrepreneurs and “wannabes” like me.  With my Google swag in hand, I drop off my backpack and luggage and jump in head first.  Familiar theme?  That’s my M.O.  Sorry I’m not sorry.

The program starts at 6 pm.  Initial pitches start at 7 pm.  Is this real life??

Internal monologue: Breathe.  Relax.  You wanted this, so don’t let fear get the best of you.  Be you.  Have some confidence in yourself for goodness sake.  Now distract yourself by eating food and drinking water.  Go on, stay distracted.

Speeches and official business flies by and we’re grouped into teams for an icebreaker.  The idea – pick two random words and pitch a product idea for those two words.  5 minutes to get a plan together and break it down.  Hilarity ensues.

The time has come.  Our facilitator, serial entrepreneur Shashi Jain, asks the crowd “so, who’s pitching tonight?”  Hands are raised.  Somehow beyond fear, I’m one of the first five to pitch – third in line as a matter of fact.

I’m pretty sure I blacked out because all I really remember is uttering words and seeing hands come up after I asked the audience a few questions then hearing a few laughs before seeing the clock with 10 seconds left.  I passed the mic over to the next in line and tried to process what just happened.

Many more pitches came and went – a total of 28 to be exact – and it was now time to vote.  Each attendee had 3 votes for their favorite pitches and these were used to narrow the number of ideas down to the final 10.  From here, attendees chose the idea and teammates they wanted to work with.

Unfortunately my idea didn’t make the final 10, but that will not stop me from pushing forward with it.  If you’re really curious to know what it is, let’s talk.  If you’re really curious and are a smartphone app developer, call me in 5 minutes.

Teams are formed and our initial idea: a way to improve care coordination in the healthcare system through a compatible card that connects all EHR/EMR systems.  Similar to the model already used successfully in Taiwan, among other countries.

My (super talented) Teammates

0810141450aMichael McNeil – MS4 student at Duke Medical School

Jared Pelo – ER Physician and Founder of EyeScribes

Thomas Hubschman – Guru of Software

Brandon Hill – Design Strategist

Akhil Karibandi – Engineer wunderkind from a little known soft drink company

Emily Mangone – PhD student at UNC Chapel Hill

Matthew Brown – MBA student at Clemson University

David Melgar – Owner of an IOS development company

GrassRoutes Networking – Honorary teammates, advisors, counselors, cheerleaders, purveyor of laughs

Saturday, August 9:  The purpose of today is to gain advice from the experts and do some market research about our idea/product.  9 am, our team reconvenes over breakfast and bonds over lack of sleep and dire need for caffeine.  The “getting to know you” phase of team dynamics.  I felt like I was at a speed dating event, but less pressure and more fun.  Maybe that’s another idea entirely…

We prep all the way until our mentors arrive to hear our idea/product.  The reason I still call it an idea, was because after a long night deliberating, we still have yet to reach a minimal viable product or MVP.  We are optimistic that conversations with our mentors will provide us with some valuable insight.

11 am – 5 minutes post conversation with our mentors.  The main takeaway: a legislation is in place to do the exact thing that we were planning to do.  Time to panic?  Yes, now would be a good time to start.

11 am – 1 pm – Panic.  Discuss.  Problem solve.  Discuss.  Brainstorm.  Panic.

1 pm – The team regroups and decides on the MVP.  Next step – mobilize into teams to tackle the following: 1) website and working demo, 2) consumer research and 3) presentation.

1 pm – 5 pm – Tons of progress at this point.  We have a working demo, tons of great feedback from the people and a barebones PowerPoint presentation.

The rest of the night is a blur.  All I want to do is eat or sleep.  My brain doesn’t work any more.  It is a mushy bowl of oatmeal.

Sunday, August 10:

5:30 am – Why my body automatically wakes me up at 5:30, I don’t know.  But it has been happening like this since July.  I suspect it has to do with efficiency and the fact that I really am most productive between the hours of 7 and lunch.  I choose not to fight being uber tired and actually am excited to finish strong a la Lance.  This is our Tour de France.

7 am – I’m the first one in the building again.  House cleaning staff knows my face and they think I’m part of the organizing team.  I politely smile and get started on my routine: open and respond to emails while listening to my playlist on Soundcloud.

9 am – Our team is in full strength and ready to slay dragons.  Mr. McNeil is our fearless leader is wearing Batman socks and is confident about the pitch.  Chances of pulling this one off for the gipper (and I’m somewhat of a betting man): 31%.

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12 pm – Mandatory check-in with the group.  We are not only hungry, but now stressed about finishing the presentation and practicing the pitch.  Low blood sugar and stress turns me into Betty White like the Snickers commercials.  Not a happy camper because I just want to eat and finish this thing.

2 pm – Mandatory “cease fire.”  No more major changes to the pitches and PowerPoints.  Kegs arrive…my mood instantly picks up.

3 pm – The show starts and the rest is history.

Curious about what happened?

All you need to know is that each attendee walked in a “want-trepreneur” and walked out an entrepreneur.

“The most important reason for going from one place to another is to see what’s in between, and they took great pleasure in doing just that.” — Norton Juster

Why did I write this?

3 reasons:

1) I want to brag about my amazing teammates.  They energized me to look beyond the status quo and reinforced my main motivation to join this event – create a movement to improve health at the individual, community, state, national and international level through innovation.  I’m confident they will always be around to bounce ideas off of and keep me addicted to entrepreneur-ing.

2) I want to express my utmost appreciation to the TSWHealth organizing staff, volunteers, mentors and all the rest who were in one form or another involved in bringing this event together.  It was a huge success and I thank you for letting me be a part of it.

3) I want to inspire anyone who reads this to dream.  And dream big.  Dream your wildest dreams and then dream even wilder dreams.  The catch about entrepreneur-ing is this: there is no glass ceiling.