Learning from Cuba

Barone and Skinner in Viñales
Adam Barone, OMS-I , (left) and Daniel Skinner, assistant professor of health policy

Daniel Skinner and Adam Barone

For a week in March 2019, we were privileged to visit Cuba to learn about the nation’s health care system. Our contingent ran the health professions gambit, including people in nursing and medicine, health care administration, global health, health communication and health policy. But our mission was unified: to learn about health care in Cuba and use the experience to reflect on our situation in the United States.

While in Cuba we met with physicians (both urban and rural), diabetes and vaccine researchers, farmers, educators, medical students, HIV-AIDS patients and more. We visited medical schools, clinics, physicians’ offices, rural villages and more. We walked the streets of bustling Havana and rural Viñales. At night, we processed what we had seen and explored our thoughts – often with the sound of salsa music in the background.

Though Cubans acknowledge that their system is not perfect (and what system is?), they are proud of what they have accomplished in health care. Despite widespread poverty – compounded by a lack of resources that has been intensified by the American-led embargo – Cuba’s infant and maternal mortality and life expectancy rates are comparable to those in the United States, and lack the racial and class-based disparities that plague American health outcomes.

Cuba is deeply invested in medical education, for aspiring physicians both in Cuba and around the world. A drive through the western parts of Havana reveals a vibrant, sprawling complex of buildings immersed in vaccine and other biotechnological research. In a nation that cannot afford the high costs associated with widespread acute and chronic illness, Cuba’s focus is on prevention, from frank talk about STI prevention, to mandatory vaccines that are not part of our regular vaccine schedule in the United States – such as vaccines against tuberculosis, leptospirosis and typhoid fever – to the much-discussed treatment they are exploring for lung cancer, to genomic research that aims to prevent diseases before they arise.

Cubans emphasize the hyper-rational organization of the system’s three-level approach to health care delivery, with family physicians located in communities serving as the first point of contact (including house calls), “policlínicos” serving as a community-based second tier and hospitals serving as a last resort for cases of acute need. While Cubans are allowed to access any of these tiers at any time, most opt to utilize the system as it was intended. Few Cubans go to the hospital when they do not need to. The system incentivizes this through unfettered access and by building trust in the overall design.

A particular highlight of the trip was when we American students were afforded an hour to converse with Cuban medical students at the Victoria de Girón Institute of Basic and Preclinical Sciences.The students compared notes on their experiences. Despite significant resource differences in education systems, the students found they utilized common textbooks and study strategies. Perhaps the most important takeaway was the revelation that their lives – their aspirations, as well as challenges – were not so different. Two days later, as further evidence that friendships were in the making, the students met again, this time in an unplanned run-in at a fashionable Havana art and music center, where yet more conversation and connection took place.

Cuba has a lot to offer osteopathic medicine in particular. After all, osteopathic approaches to health care emphasize the importance of the physical exam and prevention, turning to pharmaceuticals and technologies only when necessary. In Cuba, where many drugs and expensive equipment are hard to come by, there is an opportunity to reflect on core principles and see what osteopathic principles can accomplish in a resource-poor environment. It is well known that Americans overuse medical technology and testing; in Cuba, the problem is the inverse, where the American embargo is making it hard for Cubans to get some of the medical equipment they need.

In the weeks and months to come, we plan to explore ways to strengthen connections with Ohio University and Cuba. The clinicians and researchers with whom we met emphasized their hope that we could see past diplomatic tensions and focus on mutual goals of addressing pressing health needs, such as collaborative diabetes and cancer research. Sometimes, working on common projects can serve as a kind of diplomacy in its own right. Other osteopathic colleges have found value in such connections as well. Clearly, as our experience reminded us, the future of medicine – from the training of clinicians to research – is in global connectivity.

Daniel Skinner, Ph.D., is assistant professor of health policy. He is director of Ohio University’s Comparative Health Systems – Cuba program, administered through the Global Health Initiative.  

Adam Barone, M.S., is a first-year medical student.

 

Behind the White Coat: A Night of Storytelling

 

Sami Nandyal, OMS-II

“‘But how are you really?’ This is the question that often aches in my chest, fighting to get through my lips and to the ears of my fellow medical students. And sometimes it is the question I am wishing to be asked. We spend countless hours of our life pouring information into our cortices, pushing and pushing forward, suppressing breakdowns, postponing the moment we let ourselves relax and unload ‘just until the exam,’ knowing very well that there is a mile-long line of exams following that one, waiting to be our next excuse to avoid wellness and vulnerability.

Before I make our lives sound like something to be pitied, let me open the window and let in some other, coinciding rays of reality into the room. Many of us take steps each day to pursue our own wellness, for our own sakes and for the wellness of our future patients. We are working to keep human connection at the forefront of our minds, damming back science’s tendency to see patients and people as a clump of cells and molecules with or without dysfunction. We refuse to forget the experiences, hopes, fears, joys and pains permeating the tissues around hearts. When Aiesha came to me with the idea of Behind the White Coat: A Night of Storytelling, she was moved to bring out these hidden permeations in her peers and facilitate the connections and reminders of those elements within all of us.

The people we meet in class are all incredible people, and Aiesha and I want to know the students sitting next to us every day on a more personal level. After two months of medical school, Aiesha realized she only knew facts about her peers, not stories nor characteristics about them. We want to know their fears, their flaws, what events have made them the person they are.

On February 7, the normally treatment table-filled OMM room was dimly lit; an arch of seats speckled the ground facing a central riser where a microphone stand towered. People began filing in, hushed and subdued, maybe due to full bellies from the food that lined the hallway, the calming lights, anticipation or a combination of them all. Students watched eight of their classmates share tales of loss, growth, family, love and laughter. Two students shared original poetry about how their hometowns shaped them, one student talked about the regret of not speaking up and another taught us the lessons learned from losing a grandparent to disease and the importance of cherishing life.”

Aiesha Polakampalli, OMS-I

“The night ended with a first-year student volunteering to share a story about his relationship with his grandfather and how this relationship shaped his cultural identity. Before this event, I had never spoken to this student before, even though I know I walked past him almost every day in the library, his head buried in a textbook. Now, I can walk down the hallways of Grosvenor and see this student who before was a stranger, but now a friend who I can connect with over the pain of missing a grandparent. The students who performed and attended felt that this event was a necessary breath of fresh air, a humbling reminder of who we are and why we commit ourselves to a lifetime of service.”

On this February evening, more than 70 students, faculty and staff gathered in the OMM lab on our Athens campus to participate in “Behind the White Coat,” a storytelling event organized by Aiesha and Sami. Inspired by  “The Moth” Podcast, Aiesha and Sami created this space for students to share deeply personal stories with the intent of fostering community and enhancing connections with each other. We are thankful to the Barbara Geralds Institute for Storytelling and Social Impact at the Scripps College of Communication for their generous financial support for the event.


Watch the videos at YouTube.

Behind the White Coat Spotify Playlist


 

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3 questions all health care providers should be asking veterans

 

The 20 million veterans living in the U.S. today have specific health care needs unique to their military experiences, but research has shown that many civilian physicians feel uncomfortable or inexperienced dealing with health-related exposures and risks these veterans might encounter.

To help close this gap, Todd Fredricks, D.O. (’93), an associate professor of family medicine at our medical school, and Brian Plow, an associate professor in the School of Media Arts & Studies in OHIO’s Scripps College of Communication, created a feature-length documentary, “The Veterans’ Project,” with the goal of helping health care providers better treat veterans. The film uses real stories from veterans and health care professionals to highlight the challenges many combat and service-wounded veterans face when seeking care from military, VA and civilian health care systems.

To help physicians better understand and build trust with their veteran patients, Dr. Fredricks, a U.S. Army Colonel and medical officer with the West Virginia National Guard, has identified three simple questions that health care providers should ask all patients.

Question 1

Have you ever served in the armed forces?

Question 2

Did you ever experience any wounds, illnesses or injury as a result of your service?

Question 3

Have you registered with the VA?

These closed-ended questions help health care providers understand who the veterans are within their patient population, while giving veterans who are not comfortable with in-depth conversations about their experiences an out. To hear Dr. Fredricks explain more about the importance of asking these three questions, watch this video.

 

“The Veterans’ Project” is a production of Media in Medicine, a collaborative project led by Fredricks and Plow that brings together visual media, the arts and medicine to create and teach through storytelling. The award-winning film was shown Nov. 10 during the inaugural Columbus Veterans Film and Arts Festival, and has also been presented at the Columbus International Film & Animation Festival, the Broadcast Education Association Festival of Media Arts and the National Communication Association Annual Conference.

 

Summer research experience allows student to create hope for cancer patients

Nathan reynoldsHeritage College, Cleveland, student Nathan Reynolds, OMS II, gained firsthand experience in research-driven medical care this summer through the Pediatric Oncology Education Program at St. Jude Children’s Research Hospital in Memphis, Tenn.

Reynolds is one of 54 students in the country selected to take part in the program, where he worked under the guidance of Melissa Hines, M.D., a researcher and practitioner in the pediatric intensive care unit. Reynolds was part of a research team evaluating diagnostic criteria for hemophagocytic lymphohistiocyosis, a disorder of the immune system that causes the body to attack itself, causing organ failure and ultimately death, if untreated. By determining which diagnostic criteria are the best predictors of the disorder, the team hopes to increase the likelihood that future patients are diagnosed correctly in early stages.

Reynolds dreamed of a career treating cancer patients even before he started medical school. And now, thanks to his summer experiences at St. Jude, he appreciates even more fully how he can translate new research findings into hope for these patients. He also encourages other Heritage College students to take advantage of research opportunities to advance the scope and quality of health care.

Reynolds delved into his summer experiences through an interview with the college.

Why is it important for you to work with cancer patients?

I’m excited about the medical advances and research in the field of hematology and oncology, and that translates directly into my motivation for wanting to treat cancer patients. In the face of a catastrophic disease, I want to treat and help guide my future patients on their cancer journey to achieve the highest quality of life with the longest duration possible.

Who is your mentor?

My mentor was Dr. Melissa Hines, and she taught me the importance of integrating research into your clinical practice, as it helps you be a more focused and better clinician. She also taught me the importance of keeping a mentor throughout and beyond medical school. The idea of having a second set of eyes to look over a paper, or to discuss a manuscript or research proposal, is important on the continuum of a career.

Aside from your experiential learning in research and clinical treatment, what have you learned through this program?

We learned about the history and mission of the hospital; the ethics of clinical trials; the pathophysiology of hematologic and solid tumor malignancies in the pediatric population; the therapies the kids are given (chemotherapy, immunotherapy, radiation therapy, targeted therapy, surgery); the global mission of taking the research conducted at St. Jude and bringing it to developing countries; palliative care and hospice in the pediatric oncology population – as well as support services for the families; and St. Jude’s vaccine development and manufacturing operation.

What are the plans for publishing your team’s research findings?

We’re still about a month away from submitting the finalized manuscript, and it will be my first peer-reviewed article submission. I have one other publication, but it is a chapter in a textbook. Our project had two objectives: to evaluate the sensitivity and specificity of the HLH-2004 diagnostic criteria, and to create a novel scoring system based on readily available, non-invasive clinical and laboratory variables that can be used to predict an early diagnosis of HLH.

How has the Heritage College supported your efforts?

The Heritage College is doing a phenomenal job encouraging students to pursue research opportunities both within the institution and externally. The research process is integral to medicine, so having an environment that fosters that early on in our medical career will lead to more D.O.s being involved in research projects once we enter into our residencies and beyond.

Reynolds received a bachelor’s degree in biomedical sciences at Western Michigan University in 2012, before earning a master’s degree in public health from Hebrew University in Jerusalem in 2014. There, he developed skills in statistical analysis and research, which he applied through his work in the clinical trials office of the Taussig Cancer Center at Cleveland Clinic from 2015 to 2017. After working in data collection and regulation for lung, bladder and kidney cancer patients for two years, Reynolds began his medical education in 2017 at the Heritage College, Cleveland, where he recently began his second year.

Our People: Tom Fries, Sponsor of Founding Legislation

Tom Fries Image
Tom Fries was on hand at the Ohio Statehouse in April 2016 when the Heritage College celebrated 40 years of service to the state.

How lucky I was to be asked to have a part”

Tom Fries, a Democrat from Dayton, was serving his third term in the Ohio House of Representatives when he became lead sponsor of the 1975 legislation that created what is now the Ohio University Heritage College of Osteopathic Medicine. The former Major League Baseball player served six terms in the Ohio House and was appointed to fill a vacant Ohio Senate seat in 1982. Rather than seek election to a full term in the senate, Fries retired from the legislature and founded his own consulting firm.

Favorite memory: “Walking into the renovated Grosvenor Hall with George Dunigan [now the college’s director of governmental relations].” Fries had seen the building previously: “It was still a dormitory ready to become a medical college.” After the renovation, “the cafeteria had been transformed into an anatomy lab complete with 16 cadavers in the walk-in cooler! We commoners don’t see that every day.”

On changing attitudes: “In the beginning, barriers existed among the established disciplines of medicine. I believe [the Heritage College] was the driving force in Ohio to help completely destroy the roadblocks and biases that existed. Today, osteopathic medicine is totally integrated in all disciplines of health care and has been the leader in a more holistic … approach in treatment to the patient.”

Making the grade: “I go back to the original criteria for entering students, which was, ‘Would this young man or woman be the kind of practitioner [the college] wanted to produce?’ By that I think they always wanted to graduate a doctor with personality, compassion, common sense … and of course the ability to succeed academically. But grades were not always the determining factor. And that’s the way it should always be.”

Point of pride: “Having a small part in creating such a vibrant, progressive institution that’s made a difference in millions of lives for 40 years now. Every once in a while I stop and think how lucky I was to be asked to have a part in the creation of [the Heritage College]. Not to mention the wonderful people I’ve met along the way.”

Parting thought: “Whatever you all are doin’, keep on doin’ it!”

Our People: Mark Loudin, Technology Expert and Friend

Mark-Loudin

“I have never enjoyed anything more than becoming friends with our many students”

There are those who sit in the front of the class and those who prefer the back of the class. And then there are those who’d rather sit with Mark Loudin.

How many of our alumni, faculty and staff did a spell in the Irvine 194 lecture hall control booth with Mark? Mark joined the Heritage College in 1999 as multimedia producer and director, with a responsibility and an incomparable talent for ensuring that the classroom technology works effortlessly for faculty and students. A familiar face – and voice – to nearly half of our graduates, many of us have have appreciated his warm welcome and a moment of respite in that dark room, participating in the classroom intensity from behind the glass wall, and enjoying Mark’s company, counsel and hundreds of refrigerator magnets and collection of college memorabilia.

Favorite part of his job: “Seeing a first-year student attending orientation, timid and afraid, without confidence and a bit more than overwhelmed. In four short years, that same individual blossoms into a confident, competent leader and then graduates – and enters a practice as a trusted and life-altering physician.”

Thoughts on technology: “Computer-age students have demanded that we change the way we approach education. We record and post thousands of classes and events and make them available in minutes online. We have integrated several types of technology into a cohesive unit of learning, which is unique of any medical school on the planet. Our students are amazing, and giving them the proper tools to learn and truly integrate the medical knowledge they must possess helps them in the real world.”

Inspiration: “I have had a very fortunate career. I have interviewed two sitting presidents, worked NFL sidelines for thousands of games, won a bunch of TV awards. All of that pales in my mind to the pride and accomplishment I feel on a Heritage College graduation day. I have never enjoyed anything more than becoming friends with our many students, and I certainly enjoy keeping in touch with as many as I can.”

Parting thought: “Let’s go! On to the next ideas, advancements and accomplishments!”

Our People: Sherman Brooks, ‘Resident Dean of Humanity’

yearbook024Reminisce with any member of our first class and sooner or later you’re likely to hear about Sherman Brooks, who served as mentor, confidante, adviser and tutor to students from 1976, when the college opened, till his retirement in 1985. And he did it all while keeping the hallways clean.

“There was a janitor – he was the nicest guy,” remembers 1980 alum Stephanie Knapp, D.O., now a pediatrician and allergist in Pennsylvania. “He was from southern Ohio. He was very encouraging when we were studying at night. He was such a great guy, and I really remember him and how kind he was and how welcoming.”

Knapp is just one of the many alums who still remember Brooks, who died in 1987. A 1978 student yearbook featured an in-depth feature on him, reporting that the custodian “has gained a legacy of respect from the osteopathic students by not only being a physical plant employee, but also a ‘resident dean of humanity’ … What can you say about a janitor who can tell you how cadavers are preserved, explain the functions of the heart, know the birthdates of 59 students and root and cheer for them through every arduous step of their scholastic career?”

Brooks reportedly had a lifelong interest in medicine, and had asked Ohio University to transfer him to work in Grosvenor Hall when the new medical school opened. “He would quiz the kids, and they loved him,” recalls Chip Rogers, who first worked for the college as assistant and driver to first Dean Gerald Faverman, and later went on to become director of alumni relations and director of advocacy.

In 1990, a number of people who had been with the college from its earliest days got together to honor the man who had always remembered students’ birthdays and had a kindly word to offer when they needed one. Some 25 year later, the Sherman Brooks Memorial Scholarship is still helping first-year students from small southeastern Ohio towns who have expressed an interest in rural family practice.

Do you have a Sherman story? If so, please share below.

Our People: Harry Meshel, Senator and Lobbyist for the Heritage College

Meshel_Banner

“The rest of the state still needs you”

It could be fairly said that the Ohio University Heritage College of Osteopathic Medicine would not exist without Harry Meshel, an Ohio state senator from 1971-93. The Youngstown Democrat forged a coalition of lawmakers, physicians and academics to lobby for and pass the legislation that chartered and funded the college in 1975.

Osteopathic connection: “I had always had an affection for the osteopathic process. My late wife had a D.O. who was a good friend of hers. Both of our kids were born to her.”

A college’s difficult birth: “Everybody was against us except [the Ohio Osteopathic Association]. My tradition in life is, when people start objecting, you fight harder. You teach them to respect you and understand you. That’s what you have to do with legislation. We began working, we drew allies in, got the speaker of the house interested, and got people in the senate interested.”

Motivation: In addition to his belief in osteopathic medicine, Meshel saw the college’s potential to transform health care in southeast Ohio. “I was on a social mission. There was virtually nothing else down in that corner of the state.”

A sweet victory: “Politics is usually a long line of headaches – people making you crazy, you never get to close any doors. It’s like a doctor: Sometimes you can’t solve the problem. But when you’re able to close a few doors, when you get to solve the problem, that’s satisfaction. [Helping establish the college] has been a wonderful experience for me.”

Point of pride: “That the doctors coming out of Ohio University stay here. They stay in the state. The school has just gone great guns. It’s one of the most pleasant surprises, how fast OU grew and how well they did. I was very happy and proud to be a part of it.”

Parting thought: “Don’t stop! You’ve just begun to build. You’re so successful. It’s like sports: Just because you’ve won a few games doesn’t mean you get to quit. The rest of the state still needs you. Kick the pants off the competition!”

 


Founding Voices
Perspectives from those whose personal story is woven into the college’s beginning. 

Our People: Anthony Chila, D.O.

Chila_Banner

“The hands-on part is central to the whole idea”

Chila has had contact with every Heritage College graduating class, and his passion for teaching osteopathic manipulative medicine (OMM) has left many Heritage College alumni with a favorite Chila story. He joined the Heritage College faculty in 1978, and today is a professor emeritus of family medicine and faculty practitioner at University Medical Associates. A leading authority on OMM, he has served a variety of leadership roles in the American Academy of Osteopathy and in 2013 received the American Osteopathic Foundation’s Educator of the Year award.

Favorite class?: “I always had a great deal of favoritism for the Class of 1982. I enjoyed that group of people tremendously. I think they had as much fun with me, poking fun at me, as I had with them, harassing them. It was just a kind of a chemistry with that particular group. And that, by the way, was part of my learning process.”

Osteopathic medicine’s “secret sauce”: “The hands-on part is central to the whole idea of what an osteopathic physician is or is to be. Unfortunately, there is so much material thrown at students that it just boggles my mind that they can struggle with the hard-core academic material and still have some interest and some hope that they want to get something from the hands-on.”

His inspiration: “That ‘aha’ moment when you are working with your hands and you are trying to explain to a student or intern or a resident what it is you are looking for, how it is that you are preparing to make a diagnosis and what it is that you’re doing when you are implementing a treatment. There is something about that close work one-on-one with the student or resident over a patient and there seems to come a time when a huge light bulb goes on and a student literally says ‘aha, I understand what you’re talking about.’”

Parting thought: “Happy 40th anniversary, Heritage College of Osteopathic Medicine. It’s been a pleasure and a privilege to be with you.”

 


Founding Voices
Perspectives from those whose personal story is woven into the college’s beginning.