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How A Florida Medical School Cares For Communities In Need

May 14, 2013
Originally published on May 14, 2013 7:15 pm

If it's a Monday, you can usually find Dr. David Brown parked next to a lake in Miami, spending the day inside a 36-foot-long RV. He's not on vacation.

Brown is chief of family medicine at Florida International University's medical school. The RV is the school's mobile health clinic.

Every Monday it's parked at the Royal Country Mobile Home Park in northwest Miami-Dade County. "It's a beautiful place right here," he says. "But this is not a wealthy community."

Brown helps direct FIU's Neighborhood HELP program. It's part of the school's curriculum that connects medical students with families in neighborhoods where medical care is scarce.

Students visit families in their homes where they conduct examinations and provide basic care. But some things are better done in a clinic. So the medical school bought its own RV. "We're able to bring free basic primary care to our households relatively close to their community," Brown says.

In one of the RV's exam rooms, third-year medical student Veronica Alvarez met recently with patient Maritza Flores. Flores has diabetes and high blood pressure. With help from the school's faculty, Alvarez has been treating her since January.

Flores says with Alvarez's encouragement, she's begun exercising more and has improved her diet. And, thanks to FIU's doctors, she's begun taking medication for her diabetes and high blood pressure. In just a few months, Alvarez says, she's seen a big improvement. "The high blood pressure and the diabetes together is what you worry about," Alvarez says. "And now, her diabetes is well-controlled and her hypertension is well-controlled as well."

Over the last decade, a pressing need for new doctors has led many universities to open medical schools. Seventeen new schools have been accredited since 2005, and several are looking at new ways to train doctors.

When it was founded just four years ago, Florida International University took on a mission — to improve the health of nearby communities. Another focus for the school is to train more doctors in primary care.

Nationally, there's a shortage of primary care doctors — one that's expected to worsen as millions more Americans get access to health care under the Affordable Care Act.

But Dr. John Rock, the medical school's dean, says the two missions go together. Sending students out to treat patients in their communities teaches them the art of primary care.

FIU just graduated its first class from the medical school. Nearly half of the students, Rock says, are doing residencies in primary care.

Several other new medical schools are also developing programs that allow students to develop ongoing relationships with patients. And there are others that, like FIU also have a social mission — to improve the quality of life in medically-underserved communities.

In Miami, that includes places like Miami Gardens, where med student Danny Castellanos got to know a family that has 10 members, including a great-grandmother and five children.

Castellanos saw the family as part of a team that included a faculty advisor, a nursing student and a social worker. One of the first things they did was get all of the children qualified for Medicaid, which paid for their coverage.

Over the three years, Castellanos became involved in the healthcare of the entire family, including most recently the great-grandmother. She's now taking part in a telemedicine pilot program.

Castellanos says the school installed an electronic unit in the household. "It has a screen," he says. "It has a camera. It has a blood pressure cuff on it, a stethoscope which allows us to hear the heart sounds. We just ask her to place it in certain areas on her chest, ask her to put the blood pressure cuff on. And we get those kind of readings electronically."

The telemedicine pilot will be evaluated for its cost-effectiveness.

But, overall, FIU's Rock says the school's focus on improving the health of targeted communities already is a success.

And for families in the program, the benefits are even more tangible. They're much more likely now to receive regular checkups and less likely to use emergency rooms. "We also have increased health literacy, so they have a keen understanding of what some of the issues are," Rock says.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

MELISSA BLOCK, HOST:

There is a pressing need for new primary care doctors and that's led many universities to open new medical schools. Seventeen have been accredited since 2005.

NPR's Greg Allen has this story about the new medical program at Florida International University. It has a special focus on improving health in nearby communities.

GREG ALLEN, BYLINE: If it's a Monday, you can usually find Dr. David Brown spending the day inside a 36-footlong RV. It's Florida International University's Mobile Health Clinic. Every Monday, it's parked here in northwest Miami-Dade County.

DR. DAVID BROWN: This is the Royal Country Mobile Home Park. It's a beautiful place right here. But, you know, this is not a wealthy community.

ALLEN: Brown is the chief of Family Medicine at FIU's medical school and helps direct the school's neighborhood HELP program. It's part of the school's curriculum connecting medical students with families in neighborhoods where medical care is scarce. Students visit families in their homes where they conduct examinations and provide some basic care.

But Brown says some things are better done in a clinic. So the medical school bought its own RV.

BROWN: And so, what we're able to do is we're able to bring free basic primary care to our households relatively close to their community.

VERONICA ALVAREZ: (Foreign language spoken)

MARITZA FLORES: (Foreign language spoken)

ALVAREZ: (Foreign language spoken)

(LAUGHTER)

FLORES: OK. OK.

ALVAREZ: (Foreign language spoken)

ALLEN: In one of the Mobile Health Clinic's examining rooms, third-year medical student Veronica Alvarez is meeting with Maritza Flores. Flores has diabetes and high blood pressure. With help from the school's faculty, Alvarez has been treating her since January. Flores says she's begun exercising more and has improved her diet. And, thanks to FIU's doctors, she's begun taking medication for her diabetes and high blood pressure.

In just a few months, Alvarez says, she's seen a big improvement.

ALVAREZ: The high blood pressure and the diabetes together is kind of what you worry about. And now, her diabetes is, you know, well-controlled and her hypertension is just, you know, well-controlled as well.

ALLEN: Florida International University's medical school has made community-based health care a central part of its curriculum. When it was founded four years ago, one of the school's missions was to train more doctors in primary care. Nationally, there's a shortage of primary care doctors - one that's expected to worsen as millions more Americans get access to health care under the Affordable Care Act.

The medical school's dean, John Rock, says sending students out to treat patients in their communities teaches them the art of primary care.

JOHN ROCK: They really are able longitudinally to follow the patient, to give long-term care, not episodic care. And to have a keen appreciation about the social determinants of health.

ALLEN: FIU just graduated its first class from the medical school. Nearly half of the students, Rock says, are doing residencies in primary care.

Several other new medical schools are also developing programs that allow students to develop ongoing relationships with patients. And there are others that, like FIU, also have a social mission to improve the quality of life in medically-underserved communities.

In Miami, that includes places like Miami Gardens, where med student Danny Castellanos got to know a family that has 10 members.

DANNY CASTELLANOS: Yeah, it's a great-grandmother, a grandmother, a mother, five children and then, the uncle also lives there as well.

ALLEN: Castellanos saw the family as part of a team, one which included a faculty advisor, a nursing student and a social worker. One of the first things they did was get all of the children qualified for Medicaid, which paid for their coverage. Over three years, Castellanos says he became involved in the health care of the entire family, including most recently the great-grandmother. He says she's now taking part in a telemedicine pilot program.

CASTELLANOS: We put in a unit in the household. It has a screen. It has a camera. It has a blood pressure cuff on it, a stethoscope which allows us to hear the heart sounds. We just ask her to place it in certain areas on her chest, ask her to put the blood pressure cuff on. And we get those kind of readings electronically.

ALLEN: The telemedicine pilot will be evaluated for its cost effectiveness. But overall, medical school dean John Rock says the school's focus on improving the health of targeted communities already is a success. Families in the program, he says, are much more likely now to receive regular checkups and other preventative care.

ROCK: Very concretely, we have decreased the utilization of emergency rooms by these families. And we also have increased health literacy, so that they have a keen understanding of somewhat of the issues are.

ALLEN: Rock believes FIU's community-based health care focus can be a model for other medical schools. Using data from its first four years, the school expects to publish a paper soon on the program's success. Greg Allen, NPR News, Miami. Transcript provided by NPR, Copyright NPR.