On Thursday, February 11, 2016, Maxine Golub, the Institute for Family Health’s SVP for Planning and Development was honored by the ECHO Free Clinic, for her years of service and support with the Walton Family Health Center. Bronx Health REACH Director, Charmaine Ruddock attended the event and stated, "It was an amazing speech to those new doctors in various stages of their residency. Maxine spoke to them of their work in the Free Clinic in the Bronx in the context of the challenges working in a borough ranked 62 out of the 62 counties in New York State per the Robert Wood Johnson Foundation county health rankings report, and in a country struggling with racism and socio-economic factors as health determinants. But she told them that even in this context, there are many reasons to be hopeful, and told them why. And then, she challenged them. It was one of the best speeches I have heard in a very long time."
Below is Maxine's speech.
Good evening. Welcome, and thank you to all of you for being here. Many of you have been far more instrumental to the success of the ECHO Free Clinic than I have been, so I’d like to offer a special welcome to Neil Calman, Amarilys Cortijo, and Sarah Nosal from the Institute, and Hal Strelnick and Ira Sussman from Einstein, as well as other members of the department of family medicine. I also want to take a moment to thank the folks at the Robin Hood Foundation, who have supported this work since 2009, and to my colleagues and friends at the Institute who came tonight to show their support.
I am truly humbled to have been invited to be your honoree and keynote speaker this evening. And I am deeply appreciative of your recognition of my work to support the ECHO Free Clinic, and to promote health and health care in the Bronx.
As Marika said, I was among the early supporters of ECHO, working alongside Drs. Calman, Cortijo, Nosal, Strelnick, Little, and many others to make this project a reality. Most of my work has been behind the scenes – administrative stuff like communications and fundraising. In my opinion, the real credit for this work goes to the student leaders who had the vision to start the clinic, and who have, over the years, insisted on its importance to both the patients and the students.
The Institute has supported the Free Clinic for two important reasons. The first is the recognition that even though our health centers provide free care to all, many uninsured patients don’t come because they’re afraid of getting a bill. This is particularly unsettling for those who are undocumented.
But an equally important reason we do this is because of the students. It’s so important to us, and to our mission to serve the underserved, that each of you has this opportunity to learn what it means to be indigent and have limited access to care. To meet, face to face, with patients who have not been to the doctor in years, or who have not taken much-needed medication because they couldn’t afford it. We hope that this experience will make each of you a better doctor, wherever you go, whatever you do.
The Institute for Family Health has worked in the Bronx since the early 1980’s. We have built and operated several health centers, created a residency-training program, now operated by Bronx –Lebanon, and led Bronx Health REACH, a community based participatory project designed to eliminate racial and ethnic health disparities, since 1999, led by Charmaine Ruddock, who is here this evening. And we’re not alone… Montefiore, Morris Heights, Bronx-Lebanon, St. Barnabas – all of have worked to expand access to primary care and related services.
And yet, where are we now? According to the Robert Wood Johnson Foundation, the Bronx is #62 out of 62 New York State counties. For those of you not familiar, the RWJ system is based on a tally of 35 criteria rolled up into 5 categories. Sadly, the Bronx ranks 62nd on health outcome, 62nd on social determinants, 61st on clinical care, 52nd on health behavior, and 33rd on physical environment.
So in spite of all the work that all of us have done for the past 35 years, all the new practices we have opened, the thousands of patients we care for, the hundreds of medical students and residents we have trained, we are still at the bottom of the state-wide barrel.
It’s depressing, isn’t it?
And if you want, you can also be depressed about what’s going on nationally. Politicians on the right promoting bigotry and hatred. Kids in Michigan getting lead poisoned from municipal water supplies. Countless unnecessary deaths at the hands of the police.
It is depressing. But I am not depressed, and I hope you won’t be either. Because more than any time in my work for the past 35 years, I see major changes happening all around us…
First, there is the Affordable Care Act. More people than ever before have health insurance in this country. I grant you there’s a long way to go, but it is a huge step in the right direction. Nationally, nearly 18 million people have gotten insurance, with 2.1 million in NYS, and over one million here in NYC.
And with the ACA came the Teaching Health Center Program -- creating a new funding stream to train 500 primary care providers to work in high need communities. Sure, it has its problems, but it is indeed another huge step in toward recognizing the importance of community-based primary care.
Second, there is wide spread recognition that social determinants of health – education, housing, income, nutrition, opportunities for exercise, safety, stress - make a greater difference in health outcomes than anything we do as individual providers. If you need a primer on this, I refer you to the work of Sir Michael Marmot, the president of the World Medical Association.
This recognition is so widespread that the national center for Medicaid and Medicare has recently issued a request for proposals designed to foster collaboration between health care providers and community service organization to address social determinants. The Institute has recently piloted a survey about social determinants in one of our Bronx sites, and found that 20 percent of those asked report at least one significant problem related to food security, safety, finances or housing.
Third, people are talking about race and racism in every walk of life – and the fact that race impacts health outcome is no longer a debatable question. The impact of race and racism is being discussed in campuses across the country. The NYC Health Department and the City University of New York have new departments focused on equity. It’s in the news, in our political campaigns, and in best selling books. This week, the entire NY Times education section is devoted to race. Our presidential candidates have met with Black Lives Matter, and acknowledged the racism in the poisoned water of Flint, Michigan. We have a long way to go to eliminate the impact of racism in our country, but these are critical milestones in bringing this issue to light.
Fourth, groups are acknowledging the need to work together to address health and health related concerns comprehensively. Locally, Bronx Health REACH, the Institute’s CDC project to address racial disparities in health, is working with bodegas, churches, schools, hospitals, health centers, health departments, elected officials and more to address health disparities. Together with folks from the Borough President’s office, Montefiore, and the NYC DOH, we have started a campaign called #NOT 62: The Campaign for a Healthy Bronx. And in spite of spending the past five years at the bottom of the list, RWJ recognized the power of the campaign and gave the Bronx one of eight “Culture of Health” awards nationally for this effort.
And finally, there are all of you. I have watched for the past 15 years as the students, with support from their very dedicated faculty, have built this clinic from nothing… from an idea someone had, to getting support from the college, to finding the Institute to be your clinical sponsor, to opening up, to seeing roughly 1,000 patients who make approximately 1,400 visits per year.
I have heard stories of patients who have not seen a doctor in years, often leaving chronic illnesses untreated. You have diagnosed patients with out-of-control diabetes, PTSD and other mental health problems, even cancer. You have provided physical exams to young people eager to find work. And in many of these instances, you were true heroes, battling the system to make sure that the patient got the care that he or she needed. Sometimes you even brought them there yourselves. And while I hope for a day when everyone has access to health care, and we can retire the free clinics entirely, you deserve tremendous appreciation for the work that you do. You have changed lives.
You, like your predecessors, are smart, hard-working, deeply committed students. I have great faith in your abilities, and deep confidence in you -- as the next generation of leaders in health care, in public health, and in civic life.
So if you’ll permit me, I’d like to end with a few reminders – for all us, really, since we all need them, but especially for those of you who will be graduating this spring.
These are the things that keep me from being depressed at the enormity of the challenges we face in our work. I hope they’ll work for you too.
1) Remember the ECHO Free Clinic. It’s a great example of what is right. For those of you leaving school, please don’t tuck it away as something you did in medical school that has no relevance to your “real” life. No matter where you choose to practice, there will always be folks who need a little more help, folks whose life experience has made it difficult for them to get basic care, folks who are afraid, folks who can’t pay. Be there for them – just as you are now.
2) Appreciate your colleagues, reach out across disciplines, and across institutions. Talk to nurses, social workers, community organizers, faith-based leaders, community members, even administrators! Healthcare is complicated, and growing more so. And addressing the social determinants of health will be even harder. We must work together to address the big challenges – to solve clinical problems, social problems, and financial problems. We may each see things a little differently, but we need each other.
It seems ironic today in light of what’s going on in Flint, but my very first job in health care was at Montefiore’s lead poisoning prevention program. It was there that I realized that the incredibly dedicated doctors I worked with could treat children, but could not prevent the problem. To do that, we needed housing organizers, tenants associations, lawyers, public health professionals, scientists and politicians. In 1981, led by a committed city council member, NYC passed one of the toughest lead laws in the country, requiring landlords to eliminate lead hazards before a child got poisoned. In 1984, a group sued the City to strengthen its enforcement. But as we all well know, this problem hasn’t gone away…
3) Which leads me to my last and most important point -- Stay in it for the long haul. Change is a long-term proposition. Don’t give up – the world needs you. Hold on to the determination that has brought you here, and keep finding ways to make things better. None of us can do it all, but each of us can do something.
And for those of you who are physicians: you have earned authority and respect. That’s powerful. I hope you will use that power to be a force for change and a voice for the underserved.
It has been my great pleasure to watch the unfolding and blossoming of the ECHO Free Clinic, and the look-alike clinics it has nurtured in NYC and across the country.
To be honest, in our first meetings 15 years ago, it never occurred to me that it would become such a fantastic program, caring for thousands of patients, and training hundreds of doctors. Or that students al
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