An Apple a Day Keeps the Doctor Away: Unless he invites you to share an apple over lunch.

BFC volunteer Dr. Jason Woo hosted a women’s health lunch hour last week at our Northwest Center. As our clients sampled ratatouille, summer salad, and quinoa corn salad made with fresh ingredients from our gleaning program, Dr. Woo answered clients’ questions on everything from calming hot flashes to the benefits of hormone replacement therapy for menopause relief.

Lunch made with fresh ingredients from our gleaning program!

Dr. Woo even addressed the nutritional supplement debate: “Everyone is different,” he explained, “and this means that everyone requires a different regimen. Talk to your doctor about how to figure out what works best for you. Remember, don’t overdo it and take only one multivitamin a day.”

He added a word of caution: “Not everyone needs [a supplement] though, especially if you eat many fruits and vegetables and have a healthy diet.” This provided a perfect segue into a discussion of how to prepare heart-healthy vegetarian dishes and how the women can incorporate more vegetables into their cooking. Thanks to Dr. Woo, we may just have some new recruits for our garden workshop program!

As the hour came to a close and Dr. Woo finished his remarks, the women had only one question left: “When is the next one?” Due to the great turnout this time and the budding interest, we can only hope that the next women’s health lunch will be very soon.

Dr. Woo answers clients’ healthy living questions

A big thank you to Dr. Woo and the Health Resource Room volunteers for making this event possible! For the recipes from this event, please contact Ran Xiao, and if you want to get a head start on your own stress relief, join us for free exercise classes hosted by the Health Resource Room on Mondays, Wednesdays, and Thursdays from 12-1 pm in the medical clinic waiting room.

One step forward, two steps back: this time healthcare coordination

Disclaimer: This is an acronym-laden zone. Please proceed with care.

Sometimes we aren’t very good about celebrating our successes. That feels especially true right now in the sad story of the DC Regional Health Information Organization, which only just recently launched and is now, suddenly, suspended. (See this reporting in the Washington Business Journal to learn more.)

The DC Primary Care Association’s ambitious plan was to use the DC RHIO to coordinate the provision of health care services across the regional network of hospitals and specialists and community health clinics like Bread for the City. The goal was to achieve — through established channels of shared information — better patient-centered medical care with fewer errors, greater cost-savings, and protection for the most vulnerable people in our community.

It is a beautiful and exciting vision. In our unfortunate current reality, there are many separate data systems across the city, even within a single organization (like a hospital for example), that all track different pieces of care, without the ability to talk to one another. That makes for seeing a whole health picture very difficult. Think of it this way: in the 21st century, we can access all the world’s information from gadgets in our palm, but when we go to a neurologist or the ER, our doctors don’t have access to our primary doctor’s most recent labs and notes. James Turner of the HealthIT Now Coalition draws a parallel, “It’s as if we live in a time when someone with a Verizon phone can’t talk to someone with AT&T service. But this is healthcare!”

Consider the following scenario that our Dr. Randi lays out: “Say a patient of ours had a heart attack or a stroke. They have just been released from the ER, and they are confused and distressed. They might have no idea what doctors they saw, what tests were performed, or even the outcome of the visit. With a Health Information Exchange, we [providers] can look that patient up in the system, see lab results, medications prescribed, pathology reports, discharge summaries, and we can begin to piece the picture together for the patient. When we can help in that way, the patient is relieved and more informed and we can give them better care with less redundancy and run-around.”

And perhaps the best reassurance that we were doing the right thing with the RHIO: patients were behind it. When we would tell Bread for the City patients that we would be sharing their information with other providers in the RHIO, the response was often “Aren’t you doing that already?!” After all, that’s what quality healthcare and meaningful use of technology is all about, right?

While small at first – six early-adopter clinics and a few hospitals – the big vision for the RHIO entailed the interconnection of every point of contact in the whole system of care in the Washington DC for all the city’s patients.

So why then, if the project was underway, did the District halt the development of its Health Information Exchange? I don’t really know for sure, but I think it’s safe to say that it involves politics and money.

If the RHIO is not saved, a considerable amount of investment will go to waste — and the potential value will be lost. The District has announced the pursuit of a bare bones Direct Project model, instead of a more robust HIE – but this feels a little like salt in the wounds. This Direct Project is essentially just a protected email service — while it serves a function that could be integrated into a bigger HIE system, it falls far short of the comprehensive data sharing necessary to improve care.

Now what? Rather than lose years of progress and millions of dollars which put DC at the cutting edge of health information  technology, we think DC should reconsider this new direction. The DC RHIO is an investment worth protecting. Let’s ensure the effective implementation of the health information technology initiatives that we need to modernize our healthcare system. The State Health Information Exchange is really a valuable public utility — so the Mayor and City Council should be committed to identifying budgetary solutions for next year and beyond. We need $3,086,000 to be funded to DCPCA through the Office of the Chief Technology Officer to save DC RHIO. Please contact the Mayor and your Councilmember today and ask them to invest in our city’s health.


Sisters Helping Sisters to Thrive: Report-Back from the Women’s Collective Training

Recently, Liz Nafziger and Ri Turner, two of Bread’s Medical Clinic Coordinators, attended a day-long training run by Abby Charles, former Advocacy and Policy Coordinator of the Women’s Collective, DC’s premier organization for women affected by and at-risk for HIV/AIDS infection.

Once we had successfully navigated the twisty corridors of Northeast DC’s Greater Mount Calvary Church, the first thing we noticed upon walking into the training room was the amazing collection of attendees. Primarily black women, the attendees ranged from Women’s Collective outreach workers (HIV-positive women who do peer outreach to promote HIV testing and prevention, including the use of the female condom) to managers of a residential shelter for women, from OB/Gyn nurses to community organizers who run a monthly meeting for African immigrant women in Maryland. We felt incredibly fortunate to share the day with such a dynamic group of women.

During the first half of the training, we learned about the problem – the impact of HIV/AIDS on women (especially in DC, where the overall HIV infection rate is over 3.2%, one of the highest rates in the country). Although HIV is sometimes thought of as a disease that primarily affects men, we learned that women are also affected by HIV at an increasing rate. Additionally, some factors make women especially vulnerable to the impact of HIV. For example, women are more likely than men to be economically dependent on others, which makes it more difficult for them to insist on safer sex practices, and also makes them more vulnerable to intimate partner violence and rape.

Once we had begun to grasp the impact of HIV/AIDS on women, we learned about the unique needs of women affected by HIV/AIDS. For example, more often than men, women bear the burden of dependents, such as children or aging or disabled relatives. Financial or material benefits (such as monthly supplemental food) are generally issued on an individual basis, designed to alleviate the economic impact of HIV on a single woman. However, those benefits often end up spread thinly among that woman’s dependents, leaving little or nothing for her own support. Similarly, women who are already overwhelmed with taking care of the needs of family members have a greater tendency to neglect their own health – they may prefer not to know about their own health status rather than add another problem to an already overwhelming plate of responsibilities. As a result, women may end up being “late testers,” which means they are not diagnosed until less than a year before their disease progresses to full-blown AIDS.

Finally, we learned about the Women’s Collective’s model for serving the needs of women and girls affected by HIV and AIDS. What makes the Women’s Collective a truly unique organization is the fact that it is run by and for a peer network of women affected by HIV/AIDS (and mostly black women, which is especially important in the District, where 90% of women newly diagnosed with HIV between 2001 and 2006 were black women, even though only 58% of women in DC are black). Additionally, the Women’s Collective emphasizes the importance of addressing the impact of HIV/AIDS by integrating four different programmatic thrusts:

•Treatment – Healthcare services tailored toward women with HIV/AIDS

•Prevention – Outreach, education, and referral services

•Advocacy – Coordinated efforts to change the institutional structures that perpetuate the prevalence of HIV infection and create barriers to access to treatment and resources

•Administration – The resources necessary to maintain a stable and sustainable organization to oversee the other three program areas

We enjoyed learning about the Women’s Collective model and reflecting on its similarities and differences from our model here at Bread for the City. Stay tuned for an upcoming post which will give more detail, specifically about the amazing advocacy work that the Women’s Collective is doing in the District, and how that work relates to our advocacy efforts here at Bread for the City.

By Ri J. Turner

Our new clinic is an eye-opener

This post authored by Health Corps’ Tonya Hamilton and medical clinic coordinator Liz Nafziger. Apologies for the headline pun.

Now that Bread for the City’s medical clinic has expanded, our array of health care services is expanding too! Last week, the Prevention of Blindness Society of Metropolitan Washington (POB) set up shop in our new eye-care room. Patients received vision exams and appointments for follow-up care at the Washington Hospital Center (WHC).

For the next six months, POB will work with us to provide patients with comprehensive eye exams (and Spanish translation services too).

Wendy Gasch, the Prevention of Blindness ophthalmologist visiting us from WHC, told us that these kind of vision care services for low-income people are “virtually nonexistent” in the District. POB does operate an eye-care clinic in partnership with the KIDS Mobile Medical Clinic. But So Others Might Eat (SOME) is presently the only other community clinic that provides routine eye care.

Our health insurance system does not adequately provide for eye care, leaving many people unable to pay for even the basics, such as glasses. Medicaid, for instance, only covers new glasses once every two years. A simple everyday accident could leave someone who can’t afford to purchase their own pair (like thousands of our clients) without proper oculation for years!

The cost of this gap in coverage is obvious. If you can’t see, then you can’t read. And if you can’t read, you can’t get or keep a job. Think of the challenges of parenting without proper eyesight; think of the potential risk of accident to oneself or others.

Given the dearth of eye-care resources in our community, Dr. Gasch explained to us and our patients about how you can support your visual health through many of the same practices that are essential to a healthy lifestyle. Exercise, healthy eating habits, not smoking — these things prevent many eye problems such as macular degeneration, which is caused by diabetes (a very prevalent illness among our client population).

So it goes without saying that we’re thrilled to be finally able to provide this critically-needed service. The eye clinic will occur monthly at the moment, but we hope to expand it in the future. (You can visit our Northwest Center Expansion page to support our efforts to make the eye clinic a permanent feature of Bread for the City! Your donations will bring us closer to full-time vision care)

For this, we’re grateful to the Prevention of Blindness Society for this transitional clinic opportunity. They are the largest agency working for the prevention of blindness in the United States, and have been dedicated since 1936 to serving the eye care needs of low-income and homeless persons. Thank you, POB!

–Thanks to Tonya Hamilton and Liz Nafziger for contributing this post.

>Information Superhighway to Health!

>Here at Bread for the City, health care isn’t just about treatment. It’s also about learning how to live healthier lifestyles. But it’s impossible to learn everything there is to know in the space of a doctor’s visit, so we work hard to help our clients learn how to educate themselves about health issues.

Fortunately, there is an incredible amount of information about health available today — if you know how to find it. Unfortunately, most of our clients don’t have access to the great source of this information: the internet. So we’ve begun to consider an additional step in the educational process: one of the most effective ways for our clients to become health literate is by becoming computer literate.

Dr. Randi Abramson, BFC’s Medical Clinic Director, has recently initiated a long-term goal of hers: a computer literacy program. “Having access to health information empowers clients to understand and take control of their own disease,” she says, “which is especially important when our clients feel so powerless in other areas of their life.”

Understanding diseases like diabetes or hypertension dispels myths about them and allows patients to take control of their condition through means like diet and exercise, rather than simply accepting their disease as unavoidable and untreatable. We’re pleased to announce that our new Computer & Health Education Class invites just such self-empowerment.

This new project has largely been made possible by George Washington University’s Health Information Partners program, directed by Karyn Pomerantz. GW has supplied Bread for the City with a grant to fund the project and training for the instructors.

The first of these courses covers how to turn the machine on, navigate the operating system — and even the basics like using a mouse. The next class teaches students how to log on to the internet and use web browsers. After that, students start investigating websites that can give them reliable information about various health topics. They explore user-friendly websites that don’t require high literacy, like Healthy Roads Media, which features short videos on topics like “Smoking”, which are viewable in many different languages. Students have also discussed the credibility of information on various sites, and gravitated towards dependable sites like Family

This process opens a lot of doors for clients, not only empowering them to make educated life/health choices, but also to take advantage of the rest of what the internet provides: e-mail, news, jobs, entertainment, etc. Since many of our clients do not have internet access at home or work, this has been a very popular new program. Check back soon hear more about what clients are getting out of the class.

>Cooking Class Kickoff

> On Monday, December 14, we kicked off a new cooking class at Bread For the City’s Southeast Office. The Northwest cooking class has been well underway, and now we’ve taken the maiden voyage to start one up on Good Hope Road. We had a grand time making delicious, healthy, and easy Mediterranean food. Sharon Feuer Gruber, our Nutrition Initiative Adviser, taught us how to make Greek salad, Syrian rice and lentil mujadara, and carrots in orange sauce.

Before we started cooking, we talked a bit about whole grain versus white products. In the process of turning whole grains to white grains, a vast majority of the nutrients, vitamins, and minerals are lost. For instance, 75 percent of the iron in wheat is in the germ and bran, both of which are removed in the process of making whole grains into “white” products. And this is why Sharon made sure that the rice we cooked was whole grain, so we can get what our body needs. A common complaint about cooking brown rice is that it takes too long, but Sharon suggested that you can submerge the rice in water the night or morning before you plan to cook it, and by the time you’re ready to start dinner, it’ll only take 20 minutes.

Throughout the class, we all learned a number of helpful tidbits about various foods, such as grating a little lemon zest onto your salad, which could be good for the liver. We were reminded not to peel off the cucumber skin as we chop it up for the salad, because the skin is full of nutrients and has fiber. Even each of the spices and garnishes we added to the carrots had an important health component:cinnamon, cumin, and parsley.

As we sat down to the meal, we devoured the delicious food and had enough to share with some staff at the Southeast Office, enjoying a delicious family dinner. Sharon reminded us to listen to when we feel satisfied, not full. It’s all too easy to go over the threshold that our body needs, especially when the food is so good. Needless to say, we all had seconds on the carrots and salad, which disappeared quite quickly!

Each of the participants was delighted with the meal. “The carrots would be a good holiday dish. I can take them to a potluck,” mentioned Linda H. Diane added, “I like to learn about good ways to fix foods I can eat that are good for me, because I eat a lot of foods that aren’t so good.”

We’re hopeful that the workshop can be a learning experience for all as we continue to improve our eating habits. Every time I participate, I surely learn an abundance of new tips! We look forward to continuing the program as we begin to become stronger advocates for healthy living within the communities we serve.

Here’s the ingredient list if you’re interested in trying these delicious recipes for yourself!

Greek Salad
-Romaine lettuce
-Feta Cheese
-Lemon (juice squeezed for dressing, grated zest/peel for garnish)
-Olive oil (dressing)

Syrian Mujadara
-Brown rice (twice as much rice as lentils)

Carrots in Orange Sauce
-Baby carrots
-Orange juice
-Fresh parsley (chopped in at the end for flavor/garnish)

>Volunteer Spotlight: The HEALing Clinic

>[Today’s post was contributed by Bread for the City’s Medical Director, Dr. Randi Abramson — ed]

Most evenings around 5 pm, the staff at Bread for the City begins to wrap up their work for the day. But for the past 2 years, the end of our business day has marked the beginning of another program: a special, after-hours session at our medical clinic run by a very energetic and unique group of medical students.

Three years ago, when they were just first-year medical students at George Washington University, Rani Nandiwada, Deb Bear, Jay Chelluri, Irina Fox, and Patrick Lowerre approached Bread for the City and asked if they could run an evening health clinic. They were new to DC and even new to health care. But (along with the help of Lisa Alexander, the Assistant Dean for Community-Based Partnership at the GWU Medical Center) they had a vision in which they would practice medicine as part of their community.

We were thrilled with the idea and the HEALing (Health Education And Learning) clinic was born.

Since the HEALing clinic launched two years ago, a steady flow of enthusiastic GWU medical students have volunteered each week. The students see patients, work in the lab, provide health education, and help out wherever we need them — all in an environment of learning. It was a joy to see the students teach each other, to see the fourth-year students take on leadership roles, and to see the newer students jump right in and share ownership of the clinic.

Given that our community is in a major healthcare crisis in large part because there aren’t enough doctors practicing community healthcare, we are proud to say that Bread for the City is a training ground for tomorrow’s primary care physicians.

The HEALing clinic is also criticaly important to our client community. Many Bread for the City patients can’t come to see a doctor during the day, due to tough work schedules. The HEALing clinic provides yeat another much-needed medical alternative.

Although the original founders of the clinic are graduating this year, they have made certain that the clinic they began can continue long after they have moved on. And so, it was with tremendous gratitude, that we awarded Rani Nandiwada, Deb Bear, Jay Chelluri, Irina Fox, Patrick Lowerre, and Lisa Alexandar a Good Hope Award for their Beyond Bread Community Reformation at our 4th Annual GHA breakfast.