Lessons from Rural Medicine: It’s all about the relationship

SUNY Upstate RMED

Upstate medical student Cynthia Jackson and RMED preceptor Harry Capone, MD, right, talk with patient Bruce Crawford of Canastota. Cynthia's Rural Medical Education program training included seeing patients at TriValley Family Practice in Canastota. Photos by Jim McKeever.

Before she saw her first patient at TriValley Family Practice in Canastota in January, Rural Medical scholar Cynthia Jackson looked at the Post-it note given to her by her preceptor, Harry Capone, MD.

It read: RTR.

Relationship.

Task.

Relationship.

“He wanted me to see patients as people,” Cynthia said. “He wanted to know where they worked, if they liked to knit, things like that. Medicine has to do with how you relate to the patients, and he does that very well. He’s almost like a friend (to his patients), and he instills a sense of community here.”

When Cynthia saw patients, she kept in mind Dr. Capone’s philosophy that being a physician begins and ends with the same concept. It’s a relationship.

Dr. Capone said he heard the RTR mnemonic device at a leadership conference from a physician who had adapted it from a college crew coach. The original meaning was, “Row, Team, Row!”

Dr. Capone – an Upstate RMED student in the mid-1990s — said Cynthia’s warm personality, calm demeanor and willingness to learn were evident at TriValley Family Practice.

SUNY Upstate RMED

Cynthia Jackson talks with Lisa Leos, RN, at TriValley Family Practice.

“She takes constructive criticism well, and takes everything with the appropriate gravity but doesn’t let things get to her,” Dr. Capone said. “I’ve never seen her ruffled. She’s smart, takes constructive criticism well and has the right blend of humility and smarts.”

Before coming to Upstate, Cynthia graduated from Columbia University (economics and pre-med) and started a family.

“The feeling of wanting to be a physician never left,” Cynthia said. “I started my family early, and that allowed me to re-evaluate my priorities and commit to (medical school).”

She chose Upstate in part because her mom (Elsie Dieguez-Jackson, RN) and stepfather (Mark K. Jackson, MD) live in Central New York.  Cynthia enrolled in the College of Medicine in 2011, but she and her husband, Andre, found out she was pregnant — with twins — so she put it off another year.

“I didn’t plan it this way, but I’m much more appreciative,” Cynthia said. “I’m glad to have taken the time to make an informed decision.”

Cynthia said she had a positive experience in RMED and in each of her clerkships. “As a third-year student I can spend time with patients, which is harder to come by for residents and attendings,” she said. “RMED is so different, so unique and personal. You can give patients a lot of attention.”

SUNY Upstate RMED

Cynthia Jackson with sons Caleb, 6, and Josh, 8, at Canal Landing Park in Fayetteville.

In RMED, Cynthia appreciated getting to know patients. Many of them had an impact on her, she said, in particular a woman who was “somewhat non-compliant” and as a result was in the TriValley office frequently.

Cynthia took time to talk with her and learn her social history. By the end of one visit, both were in tears — but after that, the patient started taking better care of herself, Cynthia said.

During her pediatric rotation, Cynthia spent time feeding a premature baby who had respiratory problems. It was rewarding even though it had nothing to do with medicine, per se. Another patient, a teenager, opened up to Cynthia about her social issues, including gender identity.

These encounters, plus a five-week psychiatry rotation working with inpatients at Upstate University Hospital, are leading Cynthia toward specializing in psychiatry after initially considering pediatrics.

“What I loved about ‘peds’ translated to psychiatry,” she said. “I like working with people who can’t advocate for themselves.”

Cynthia said she never realized how disenfranchised mental health patients are. “They’re very vulnerable,” she said. “I was able to spend a lot of time with them.”

Finding and managing time is crucial for a medical student, especially one who has four young children.

After school and on weekends, Josh, 8, and Caleb, 6, take guitar and violin lessons, and are learning chess and a second language – Mandarin. The 4-year-old twins, Hope and Grace, start kindergarten in the fall, when Cynthia will be immersed in fourth-year courses and electives.

It will be another busy year of balancing medical school with family life. But there will be time for visits to the local library and trips to the playground.

“You can still be a mom and pursue this,” Cynthia said. “I like to share that message.”

SUNY Upstate RMED

Upstate RMED student Cynthia Jackson with her 4-year-old twins, Grace and Hope, at Canal Landing Park in Fayetteville.

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A two-minute window to prove ‘all the little things do matter’

SUNY Upstate

Medical student James Osei-Sarpong Jr. and Michelle Bergquist, his supervisor in the Family Resource Center on the 12th floor of the Upstate Golisano Children's Hospital.

It was 6:58 p.m. on a Saturday and Upstate medical student James Osei-Sarpong Jr. was getting ready to call it a day.

He was finishing his shift as a circulation desk assistant in the Family Resource Center on the 12th floor of Upstate Golisano Children’s Hospital, and wanted to head home to relax before studying renal anatomy and physiology.

The FRC closes at 7 p.m. James had been there since 11 a.m. and was working by himself. As he started to close the doors, a woman appeared.

Her young son had been admitted to the children’s hospital from the Emergency Department. She had heard about the FRC and came to see if she could get any movies on DVD for her son to watch.

James didn’t think twice.

“We’re closed on Sunday,” he said. “I wanted to make sure she had something for her son.”

The woman picked out a couple of movies, staying about 15 minutes before going back to her son’s room.

“I made conversation,” James said, breaking into a smile. “I’m good at it.”

James doesn’t think he did anything extraordinary, but the story has been making the rounds. “I was just doing my job,” he said.

Clinical reference librarian Michelle Bergquist, James’ supervisor in the Family Resource Center, is happy the story’s out there.

“I get comments all the time about the students here,” she said.

About 15 students and volunteers help fill out shifts in the Family Resource Center. Hospital patients and family members rely on the FRC to look up information on diseases, check out movies and video games or just relax in a quiet, comforting space.

Bergquist said this is not the only time James has been courteous and helpful to a family member or a young patient. “It’s what I expect of him,” she said. “He knows that.”

The closing-time visit by the patient’s mom, Bergquist said, is an example of how a seemingly small gesture can make a huge difference in somebody’s life; of how the smallest things can have the biggest impact.

“Two minutes – that’s how fast you can improve someone’s perception,” she said.

The FRC is a perfect place to do that.

“It’s a place where we have the opportunity to make a difference in small ways,” Bergquist said. “Coloring a picture here can make (a child’s) day, give them a sense of control and put a smile on their face. Everything we do here is based on helping patients feel normal, and being involved and engaged with them.”

James is happy to be a part of all that.

“All the little things do matter,” he said. “The patient is the main concern. There are many ways to fill the role. I’m not a doctor yet, but having a conversation, the mercy you show to others, can be part of the healing process. It’s an important thing to take away.”

James’ time in the FRC is drawing to a close. He will work this summer as a research assistant in the Department of Surgery, and then begin his second year of medical school. His heavier study load and preparation for board exams won’t allow him time to work in the FRC, but he hopes to volunteer there when he can.

Before coming to Upstate, James graduated from Syracuse University in 2013 with a degree in biology. He took time off to work in research and to graduate from the AMSNY Post-Baccalaureate program at the University at Buffalo.

James had never worked in a library before, but is grateful for the chance to talk with kids and their families to help make the hospital experience as pleasant as possible.

“You have to give your best effort all the time, despite the circumstances,” James said. “You never know what they’re going through. I have faith in God, and everything you do best is for him, not for yourself.”

Any student interested in working at the Family Resource Center can e-mail Michelle Bergquist at bergquim@upstate.edu.

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Future physicians’ parting gift to Syracuse: ‘Feed the City’

SUNY Upstate Match Day

Upstate medical students Matt Helm and Leesha Helm married two weeks after Match Day (above). They are holding a food drive on campus this month in conjunction with a "Feed the City" community engagement event May 18.

Two students who will graduate from Upstate’s College of Medicine this month are doing their best to “feed the city” before they leave for their medical residencies in Hershey, Pa.

Matt and Leesha Helm – who married April 2, two weeks after Match Day – are collecting food on campus and raising awareness about hunger in Syracuse. A food drive takes place on the downtown and Community campuses throughout May, and a “Feed the City” community engagement event is 6 to 7 p.m. May 18 at Faith Chapel on West Seneca Turnpike.

“Feed the City: Exploring and Addressing Food Insecurity in Syracuse, NY” was Leesha Helm’s capstone project for Upstate’s Master of Public Health graduate program. (She will receive a dual MD/MPH degree at Commencement May 22.)

The Feed the City program is a ministry at Faith Chapel, where Matt and Leesha are members. It delivers food to homes of individuals in need who live in low-access areas in Syracuse, and also provides a great deal of social and spiritual support, Leesha said.

SUNY Upstate MD MPHFor her capstone, Leesha completed a qualitative study in which she interviewed volunteers of the program to better understand their views on food insecurity in the city, and how they felt their program helped. She’ll present her findings at the community engagement event May 18.

“This capstone was one of my most fulfilling opportunities during my MD/MPH training,” Leesha said. “It allowed me to merge the worlds of clinical medicine and public health in a pursuit to gain community support for a valuable Syracuse program.”

Leesha said Feed the City is in desperate need of stronger, more stable community partnerships, more food sources and more financial support. She and Matt hope the May 18 event will help build partnerships and awareness among food banks, food retailers, restaurants, and community leaders and officials.

Hunger is more prevalent in Syracuse than many people realize, Leesha said. More than 35 percent of city residents are classified as poor, and 12 percent of households don’t have adequate access to supermarkets.

In addition to supplying food to families who don’t have consistent access to food, Feed the City builds powerful relationships with the recipients, Leesha said. This is just as valuable, or more valuable, than the actual delivery of food itself, she added.

“We really hope this program can get the help it needs to impact more people,” Leesha said.

The Helms will start their residencies this summer at Penn State University’s Hershey Medical Center in Hershey, Pa. Leesha is going into family medicine, and Matt will specialize in dermatology.

 

FEED THE CITY COMMUNITY ENGAGEMENT NIGHT

Wednesday, May 18

6 to 7 p.m.

Faith Chapel

4113 W. Seneca Turnpike, Syracuse

RSVP to Leesha Helm (formerly Leesha Alex) at alexl@upstate.edu

 

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MPH student’s Rahma Health Clinic hosts fair May 14

Rahma Clinic

Mustafa Awayda, MD, medical director at the Rahma Health Clinic and a student in Upstate's Master of Public Health graduate program.

The driving force behind the Rahma Health Clinic’s May 14 Health and Wellness Fair is a student in Upstate’s Master of Public Health graduate program – Mustafa Awayda, MD, the clinic’s medical director and a physician at the Syracuse VA.

The free health and wellness fair takes place from 11 a.m. to 3 p.m. at the clinic, 3100 S. Salina St. on Syracuse’s South Side. Screenings will be offered for chronic illnesses such as diabetes, cardiovascular disease, breast cancer and high blood pressure.

Health fair visitors will have a chance to speak privately with a physician. A certified nutritionist also will be on site to answer dietary questions, and fresh fruits and vegetables will be for sale.

Rahma – which means “mercy” in Arabic — was founded by a group of citizens concerned about the large number of uninsured local residents and their resulting poor health, Dr. Awayda said. The staff is composed of local physicians, other medical professionals and community members who volunteer.

The Rahma Health Clinic is licensed as an Article 28 Free Clinic by the New York State Department of Health. Setting up a free clinic reflects the Islamic tenet of “ongoing charity,” providing something that continues to provide a benefit, Dr. Awayda said.

The clinic is open Saturdays for several hours and occasionally on Wednesday evenings. Patients and insurance companies are not billed.

Dr. Awayda hopes the May 14 fair increases awareness of the clinic and attracts more patients, thereby reducing visits to hospital emergency rooms.

SUNY Upstate CNYMPH

The Rahma Health Clinic, 3100 S. Salina St., Syracuse, hosts a free Health and Wellness Fair May 14 from 11 a.m. to 3 p.m.

He said the clinic will be able to hire a nurse and administrative assistant now that the mortgage on the property has been paid; Rahma is sustained by board member contributions, donations and grants, with help from an annual fundraiser in October.

On a typical Saturday, the Rahma staff will see six to eight patients, usually with complaints like abdominal pain, colds, high blood pressure or issues related to diabetes.

The clinic doesn’t have expensive diagnostic equipment, and many supplies are donated, Dr. Awayda said. Many patients come from the neighborhood, but others hear about it and come from as far away as the Southern Tier.

All of the clinic’s services are free. Appointments are requested at (315) 565-5667.

If there is a language barrier, Dr. Awayda tries to have someone there who can communicate with the patient in his or her first language.

The entire community has embraced the Rahma clinic, Dr. Awayda said — citizens, organizations, physicians and other health care professionals from Upstate, the VA and Syracuse Community Health Center.

Dr. Awayda, who will graduate from Upstate’s Master of Public Health program this year, attributes much of the clinic’s growth to the MPH program.

“Every single course in the MPH program helped us set up Rahma,” he said. The clinic was founded in 2010 and began seeing patients in late 2012.

Some of Dr. Awayda’s MPH classmates are helping with the May 14 fair, including Michael Rosenthal.

“I’m a big fan of the Rahma Clinic,” said Michael, who surveys the patients to gather demographic data on clinic usage. “It’s such a great environment with an amazing group of volunteers.”

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Medical students shine in Dearing writing competition

SUNY Upstate Bioethics

Four students in the College of Medicine were honored for their creative works in the 2016 Dearing Writing Awards ceremony last week. From left, Annette Liem, Jordana Gilman, Brielle Stanton and Kaitlin Kyi. Photo by Debbie Rexine.

Four Upstate medical students were honored for their creative talents in the 30th Annual Dearing Writing Awards sponsored by the Center for Bioethics and Humanities.

Kaitlin Kyi took top poetry honors for “Kind of a Bummer.” Second place went to Jordana Gilman for her poem, “She Says/He Says/Emily.”

In the prose category, Brielle Stanton won first place for her essay, “A Collection of Firsts.” Second place went to Annette Liem for “Mr. Carter.”  Kaitlin, Brielle and Annette are third-year medical students, and Jordana is a second-year medical student.

The students and the employee category winners were recognized at a celebration and reading last week in the Medical Alumni Auditorium.

“It’s wonderful to have this core of creativity” at Upstate, said Deirdre Neilen, PhD, associate professor of Bioethics and Humanities, as she introduced the winners. “Each of your pieces spoke very deeply to us.”

President Danielle Laraque-Arena, MD, attended the celebration and thanked the writers for recognizing the importance of pausing and reflecting on our role as healers. She also thanked them for sharing their gift of creativity, “the essence of who we are.”

Kaitlin’s “Kind of a Bummer” is a love poem about how we say (or don’t say) good-bye; Jordana’s poem, “She Says/He Says/Emily,” combined separate conversations from three different areas of her life.

Brielle’s essay, “A Collection of Firsts,” came from notes on “firsts” she experienced during her third-year clerkships, including observing open-heart surgery; Annette’s “Mr. Carter” essay was based on a cancer patient she met at the Syracuse VA hospital during her medicine rotation.

Employee Category Winners

Ann S. Botash, MD, won in the employee category for poetry with “Taking the Stand.” Second Place went to James Dwyer, PhD, for his poem, “A Hard Year With Haiku.”

Emily Weston, RN, won in the employee prose category with “The Hero.” Peter Cronkright, MD, won second place for his essay, “Meaningful Use.”

Standardized patient Pam Freeman received the first B.A. St. Andrews Award for her poem, “Triptych: 65/75/85.”

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