International, Poverty, Justice, and Health Student Elective: Medical Schools Still Care

Two weeks for Christmas Break and we will be back to school. I thought I would take an opportunity to explain what the International, Poverty, Justice, and Health Elective (IPJH) is all about. The elective is a way for students at the University of Cincinnati College of Medicine to continue pursuing justice among the impoverished and medically underserved populations domestically and abroad. Our main focus throughout the year is to be involved with the people in and around Cincinnati. There a four sub groups within the elective for homelessness, women's health, Latino population, and childhood obesity. I currently serve on the homelessness committee.

In the homeless committee we sort of contain the category of "other" and we take care of anything that does not quite fit into the mold of the other three. Currently, we have random activities throughout the year, and because we are relatively new to the UC campus we are trying gain a presence by becoming involved in a variety of different areas. There are many opportunities to serve the homeless and there is a lot of space  for new ideas.

Learning by Doing: Medvouc and the ER

Learning in the classroom gets boring, but listening to a lecturer drone on about the creatinine levels in the urine and plasma is a lot more enjoyable after I have seen the application. Knowledge has been sinking in and while I still know next to nothing connections are being made for the reasons to learn about the minute details of any number of physiological concepts.

I was given the pleasure of being able to shadow in the ER and although I worked in the Emergency Department at Fairview hospital it was nice to see things from the perspective of a doctor. I experienced a small piece of the end goal of medical school that is the practice of medicine and caring for patients.

Last night I participated in Medvouc once again and this time I not only was able to present my patients in a clear and concise manner but I was also to make a few diagnosis, with the help of the doctor, and devise my own treatment plan for each patient. One patient in particular was especially interesting to me. After having just finished the cardio block I was able to diagnose a Mitral valve prolapse/Mitral valve regurgitation through auscultation, patient history, and vital signs.

I did not realize when I started that I would be able to diagnose and treat minor patients this quickly. I still have a lot to learn, but the little clinical experiences along the way help me to plow through the mundane reactions of biochemistry.

Music of the Heart: The Finale of Block II

Music, besides its round about connections with similar principles of study and discipline, would help me decipher heart sounds. Arrhythmias come in all different tones and qualities form a grand Chopin Waltz to a smooth jazz and every rhythm in between. I think I even heard Dave Brubeck's "Take 5" in split s1 and s2 with a systolic murmur thrown. After dissecting and analyzing of all different types of music listening for qualities like tone, pitch and rhythm are second nature.  It is too bad that they were not tested on the recognition of the sounds in a practical exam format. That will come next year.

This block was all about Cardiovascular System. So far it has been the most clinically oriented section this year. The skills and knowledge are directly applicable to the practice of cardiology many of the techniques and knowledge gained are in use on a daily basis and not just the necessary background information.

Well, Another Block is finally over and time is continually increasing its speed. It seems like only a few weeks ago I was scrambling to move all my things down to Cincinnati and looking for a place to live. Opportunities have been piling up and filtering through the different group involvements has been challenging. Coming from undergraduate when it was feasible to participate in every extracurricular known to man to medical school where one must make tough decisions of involvement.

I have narrowed things down to a select few that do not conflict with each other. They are as follows:

• IPJH Vulnerable Populations Student Elective -  this ties into my work with the homeless and will enable me to have a heightened involved with the medically undeserved.
• Neuroscience Elective Scholars Program - will allow me to continue in a limited capacity with research and help me gain clinical experience in neurology and neurosurgery.
• Medvouc - which I have discussed in previous posts. This will tie into the IPJH elective.
• American Medical Association - a form of student leadership in a national medical organization.
• Medical Wilderness Club - this one is just for fun.

Writing these down seems like there is a lot of extra work on top of classes, but most of these are a long term commitments which only has about 3-4 hours per month or less, and working with these organizations comes in spurts.

MedWar 2009: The Great Medical Race of Wilderness Warriors

All scenarios although seemingly real were all controlled situations, and no endangered species were actually killed during the race.

Aaron, the Nate, and I woke on a cold October morning with the sharp air piercing our lungs. We shivered either with excitement of the upcoming race or because of the 20 degree night we spent in our tents. We scarfed down the oatmeal random day old bagels and headed off to register for the race.

Team name: The Mounties

Destination: the world

Goal: Save as many as we could and make it home safely


The Rules were simple. Finish, save as many patients (mannequins) as you can, and DO NOT BECOME A REAL PATIENT. The scenario was a ten plus mile race around the world. It begin promptly, give or take fifteen minutes, at 9:15 AM.

It began in the USA with a mass canoe start. Thirty teams  of three people set off east across the lake to our first destination. As we landed at the shore somewhere in East Asia we ran to our first disaster. A bombing raid had just been carried out and civilian casualties were everywhere. We raced to the closest three bodies, assessed the scene and went to work. Aaron performed a Cricothyrotomy complete with fake blood, the Nate stopped the blood gushing from the wounded body, and I went to work on a motionless baby.

Well ahead of most of the teams we set out for our next destination, a dream of mine for a long time, Everest. When we got there we found that Aaron had come down with a severe case of High Altitude Cerebral Edema (HACE) a common pathological state in high altitude zones. In addition to that he had sustained an isolated mid shaft femur fracture as well as a severe neck injury. The cure: splint the leg, dexamethosone, and getting him down off the mountain.

Just as we got down the mountain we were instructed to board a plane (AKA walk) to Antarctica, where I was found with a severe hypothermia. Aaron instinctively got me off the ground, the Nate selflessly through his own coat on to of me and they began to build a fire. After burning through the pencil we were provided with the Nate and I came down with snow blindness in the form of goggles that were blotted out.

As we continued our journey we met with a kidnapping in South America, a man with a fishhook in his lip in Wyoming, neurotoxin poisoning in France, a safari in Africa, and finally finishing with basic survival skills in Australia. Finishing 23rd place we were tired, cold, and hungry. Ready for sleep and a hot shower.

For full details about Medwar click on the link.

Medvouc Update 2

Since my first time at Medvouc I can tell a large difference not only in my patient interview but also in my diagnostic and treatment ability. While there is always a doctor looking over my shoulder, I give the physician my diagnosis and treatment plan of the patient.

The first bridge that I had to cross was the lack of confidence in my decision. There is a mental block that seems to be in my mind that I am not allowed to make major treatment calls or a diagnosis from my days as an EMT in the emergency room. The last physician who was with us wanted us to be able to present the patient very systematically. The patient's name, age, chief complaint, physical exam findings, diagnosis, and treatment all needed to be ready. And after all that work done he expected to tell us, "No, here is what we will do instead."

One of the things I have appreciated about UC is the opportunities they provide to get to know the medical profession from many different aspects. From shadowing doctors in the ER to working at Medvouc, they give you ample time to crossing the gap that separates the textbooks from the clinic.

My first Dose of Medvouc: Medicine for the Homeless

"This is real third world medicine." the doctor with us explained. "We've got no money, we live off donations, and these people have no transportation or viable way to pay for healthcare. It is just like practicing in the third world."

Tuesday night was my first healthy dose of the medical practice. I saw patients, gave and received a flu shot, and even made a diagnosis or two. Mostly I was able to practice conducting a thorough medical history, obtaining vitals, and completing a physical exam. It was fantastic. I left the clinic really feeling like I was on my way to becoming a doctor with a strong desire to learn more. More over it was fun, and in the midst of medicine being muddled with the hard sciences of biochemistry and physiology during the first year, I was taken back to the beginning, the source of my desire to become a physician.

The smell of the homeless shelter brought back more memories than I can count from my days with the Marie Sandvick Center in Minneapolis. I recall being a helpless sophomore in college on the cold windy streets trying to explain to a man that he needed to get to a shelter. I just wished and hoped I could do more, and for the first time since I have been involved with the homeless I feel as though I made a physical difference in their lives. I was able to do more than just a coat or a bowl of soup, but even as I write this I realize more and more than I am still just a band-aid with a glimmer of home for the future.

above is a picture of the fountain square fountain in downtown Cincinnati

Medvouc and the Beginnings

Last Friday I had the privilege of training to work at the Medvouc clinic. Medvouc is a student run clinic for the homeless at a shelter. I will be able to be an active participant in the diagnosis and treatment of the men and women living on the streets. At the training I learned to give an intramuscular injection (IM) used for vaccinations, an intradermal injection used for the Tuberculosis test, and a refresher on blood pressure and vital signs. More about this clinic will come when I have started actually working there, but I think it is necessary to mention how I was first interested in the homeless. This is not a short story, but I have made it as brief as possible and will split this story into two posts.

People have asked me how a boy from Cleveland ended up at Northwestern College in Roseville, MN. The simplest answer is Streetlight Ministries. When I first visited Northwestern College in November of 2002, it was because an old friend from California went there, and I thought maybe I would like it as well. I went to a practice piano lesson with one of the teachers and was not overwhelmingly pleased. Although later my teacher in Cleveland Mrs. Kwon begged me to reconsider after hearing me play when I came back.

The friday evening of my visit, I stayed with a guy named Steve, an apparent mathematical genius, who really didn't know what to do with me. He gave me two choices: a football game at the Metrodome and Streetlight. I didn't have any money so I took the free option.

November nights in Minnesota are not a walk in the park. It was about 9 degrees that night and windy. I was not dressed for the weather or prepared for the cold which I grew to love, but I toughed out the night, visited two homeless shelters, and a met some men on the street corner. The connection I made with the ministry was instant. It was not a happy or easy time, but it was joyous.

When I arrived at Northwestern College in August 2003 to attend classes as a biology major I looked forward with great anticipation to the first night of Streetlight. For the next three years I was committed. I made the conscience decision that on friday nights I would be working with the homeless. For the first year I primarily worked with the men on the streets, for the next two years I worked as leader with the students coming each weak, and the last year I helped the leaders.