Breaking Down Health Barriers With Urban Service

The Urban Service Track incorporates prevention and primary care in underserved communities into the training of future prepares health professionals. It’s a program of the Connecticut Area Health Education Center, housed at UConn Health. This summer, Urban Service Track students worked with the Hartford Department of Health and Human Services to go door-to-door in city neighborhoods to have conversations about preventive medicine and offer COVID-19 vaccinations on the spot. Three students who took part in this effort, Brian Liang (fourth-year UConn medical student and master of public health candidate), Eddyson Altidor (second-year UConn dental student), and Julia Levin (first-year UConn medical student), share their experience and how it’s shaping them as future clinicians.

(Julia Levin, Brian Liang, Eddyson Altidor, Chris DeFrancesco, December 2022)

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Transcript

Chris: Having advances in medicine like vaccines go a long way in elevating public health, but that’s only part of it. Today on the Pulse, we meet some folks who’ve been working to overcome some of the barriers to preventive medicine.

This is the UConn Health Pulse, a podcast to help you get to know UConn Health and its people a little better, and hopefully leave you with some health information you’ll find useful.

I’m Chris DeFrancesco. It’s one thing to have preventive care resources widely available, but it’s another to connect them with everyone who could use them. Take the COVID-19 vaccine, generally accepted as a milestone in the fight to overcome the pandemic, but what happens when folks are either unwilling to take it or unaware it’s an option for them?

Today, we welcome three students from the Connecticut Area Health Education Center, or AHEC, who’ve been doing something about it from the UConn School of Medicine, we have fourth-year student and MPH candidate Brian Liang and first-year student Julia Levin, and from the UConn School of Dental Medicine, we have Eddyson Altidor, a second-year student. Thank you so much for joining us today. Now, all three of you were involved in an important community outreach project this year. So let’s start with what that was and how you executed it going into the neighborhoods in the city of Hartford. To do what?

Julia Levin: Yeah, so as an interprofessional team, groups of medical, dental, physician assistant, social work, pharmacy, and nursing students that are all part of the Urban Service Track, which is an interprofessional education program run by the Connecticut Area Health Education Center, or Connecticut AHEC, went into the neighborhoods of Hartford and vaccinated any individuals that were willing to get vaccinated, or just engaged in conversations. So we, in our white coats, sometimes with winter coats underneath, and rain boots and toolboxes filled with syringes of Moderna and Pfizer and Johnson and Johnson vaccines went door-to-door along the neighborhoods in the north and south end of Hartford and knocked on doors, we rang doorbells. Sometimes there were angry dogs inside and sometimes there were smiling people, but we just engaged in conversations with individuals and really broke down the barriers to giving these vaccinations. And I think that’s one really important aspect of this door-to-door vaccination campaign, is that we’re practicing community-based based care. The boots are literally on the ground in underserved areas and we’re reaching the individuals that may not have had the resources or the knowledge about mass vaccination clinics, and we’re able to reach them and give them the preventative care in the form of the COVID vaccination to hopefully keep themselves and the people around them safe.

Brian Liang: I think, when we think about barriers, we tend to conceptualize it as, what are barriers keeping community members from coming into the office? But there’s also the additional barrier of how people see us when they only see us in the office. So what I saw was that when community members saw doctors, nurses, and pharmacists in the street just knocking on doors to try to educate about the vaccine, that kind of broke down a barrier of their understanding of who we were, right? We stopped being just this very siloed, isolated health care professional that they would only see once a year for their annual checkup, have a talk about vaccines, then leave and never hear it from us again. And we became more personable. And I think a great example of this was when we visited one house and everybody in the house was vaccinated except for the 12-year-old boy. And he was so scared of needles that his mom, without having the health care professionals there, she doesn’t want to really kind of deal with trying to coax him into getting the COVID-19 vaccine. But then when we were there, there was me, two pharmacists, we’re all kind of saying, “Hey, I got this shot. It’s fine. It hurts a little bit. We all agree that hurts, but we’re all still kicking. We’re all still very much alive.” And eventually, after a lot of conversation, the kid finally just kind of relented and let us give him the vaccine. He felt the pinch go in and he was like, “OK, fine. It hurt a little bit. You’re right, it did hurt a little bit, but I’m OK with getting a second one.” We’re like, “OK, great! Awesome!”

Chris: Nice. So situations like that, how does he get a second one then? You’re not going back to that same house, right? He’s got to go make his own arrangements for that?

Brian Liang: Right. I think one of the parts I really like about AHEC and UST is that we emphasize a lot about asking the community what they need and asking the community how they want to deal with a particular situation, and then we work together on how we fit into that picture, rather than us leading the charge, since that’s their community, that they know it best and we’re just kind of assisting. So in this case, we had worked with the Hartford Health Department to make sure we had business cards on hand that we could hand out to households and tell them, “Here’s when the vaccine clinics are, here’s the phone number to call. If you can’t make any of those dates, and if you have any other questions, we have two community health workers with us driving around in the vaccine van, who you can ask on the phone for additional assistance.

Chris: Sure. Eddyson, you’re a dental student. That’s correct. To the uninitiated, why would a dental student be out in the neighborhoods of Hartford giving people COVID vaccinations? Explain how that fits into the whole interprofessional aspect of this.

Eddyson Altidor: I think one important aspect of that is just being in the community. Even being a dental student, you’re dealing with community members that necessarily have issues from all over the body, so you have to understand how their overall health could also impact their dental health, and how their dental health could also impact their overall health. So being in a community, talking to community members, is a great way to sort of build that relationship with the community members.

Chris: I’d like to hear how the three of you got involved in Connecticut AHEC. You were the first one in, Brian, so let’s start with you. You’re a fourth-year and you’re also studying to get your master of public health. So what drew you into Connecticut AHEC?

Brian Liang: What drew me in was when I had gotten into UConn, I saw this email flyer from UST saying like, “This is what we do. We focus on primary care. We focus on community health.”

Chris: UST being Urban Service Track.

Brian Liang: Correct, Urban Service Track being the program that is under AHEC. So essentially that’s how AHEC gets med students involved, they kind of advertise as Urban Service Track, that incoming med students can then apply into. So I saw the flyer, I saw their focus on primary care and community health, and you know, that’s what grabbed me. And as it looked more into the website, I saw the different community programs, and again the emphasis on, in a manner of speaking, we’re transplants in a community, so we rely on the community to educate us on how to help them. And I really liked that kind of really down-to-earth approach.

Chris: Now, what aspect of medicine do you want to get into?

Brian Liang: I want to get into general medicine, so like family medicine or internal medicne. Internal medicine has an outpatient aspect to it, and I find that Urban Service Track and CT AHEC are really supportive of my goals in that regard, since I’m getting a lot more experience with the things surrounding of how to be a good community physician, and more than just a good physician.

Chris: Well, we certainly need that, so bless you for doing that and, and I wish you success with that path. Eddyson, you were about to make a point. I’m sorry.

Eddyson Altidor: Oh, yes. No, for me it was just the interprofessional aspect. Just working in dental offices and shadowing, I’ve noticed that there’s always a miscommunication between the dental staff and, let’s say, a pharmacist, or getting the patient checked off or certain procedures, there’s always this miscommunication. So the interprofessional aspect of UST sort of drew me in because I always love to learn how to interact with those different professions, see their perspective, see how they learn how to deal with problems. And if you could understand the people that you’re working with, I think it makes you a better provider for the community as well.

Chris: And what is it that you’re aspiring to do within dental medicine? Or do you know yet? Being a second year?

Eddyson Altidor: For me, I love preventative medicine. So that draws me into either pediatric, because I think that being able to communicate with kids from such a young age, you’re able to change and frame your mindset to how certain things about their health are being taken care of. Because a lot of times kids have a fear of going to a dentist or just going to physicians in general, so being there as a provider and understanding that fear, you could sort of ameliorate, and help shape their future.

Chris: Julia, what about you? You’re a first -year, so you’re kind of earlier along on the path here. What got you involved?

Julia Levin: I think there are kind of two specific things that drew me to the Urban Service Track, one definitely being interprofessionality, just to echo Eddyson. I think, or I know health care is a collaborative team approach to treating a patient, so it’s not just the dentist or not just the pharmacist that can give them the care that they deserve. So having the opportunity to work in an interprofessional team at such an early time in our training, I think can make us much better physicians, community physicians. And then I also think the second thing that drew me into the Urban Service Track was the ability to work in the community so often.

I’ve always really enjoyed volunteering and bettering the community, and I hope to practice within this area once I’m done with my schooling. So any chance I can get to, to meet my future patient population or potential future patient population, I’d love to take it.

Chris: And we won’t hold you to this because you’re a first-year, but do you have a sense of what it is that you’d like to practice, what type of medicine?

Julia Levin: I think I definitely am interested in the primary care specialties, maybe family medicine. I think it’s a great way to treat people of all different walks of life, ages, like they say, “from cradle to grave,” and definitely emphasize the preventive medicine.

Chris: I’d like to hear, any of you or all of you can answer, any preconceived notions about the health professions that you might have had going in that AHEC might have changed your mind about or opened your eyes to.

Brian Liang: That’s a funny question because we kind of already talked about this, which was, one of my preconceived notions was that doctors already knew how to do inter interprofessional communication. And then I realized that maybe they don’t, not all the time. And after going through so many learning conferences and doing so many of these community activities with pharmacists and nurses, and dental students, I feel like it’s like second nature to me. But then realizing that my colleagues, maybe other walks of life from other med schools, may not have that. And learning how to work with individuals who may not be familiar with navigating the complexities of different health care professionals with different like fonts of knowledge, and making sure that everybody’s on the same page and working in a synergistic manner instead of a confrontational manner.

Julia Levin: I think there are definitely a lot of misconceptions about what different health members of the health care team do. So being able to work with students that are within different health care disciplines allows us to learn about what they’re doing, about what their responsibilities are, about what their goals are, and gives us a better idea of who our future colleagues will be.

Eddyson Altidor: And for me, I think, coming in, I always used to just think health professionals are just providing care. And being in UST, you should have experienced that it’s not just about providing the care, but how do you do it? And how do those, the population that you’re providing care to, how do they perceive you? What could you do to sort of meet them on the same ground? It’s not just that, “OK, I have care for you,” but, “Let’s meet somewhere where we could all come to the same agreement.”

Chris: I’d like to close with what you might say to people who are a couple years behind where you are on the path to the health professions and what they might get out of this.

But before we do that, we’ll start with you, Brian, since you’re kind of on the tail end of it. Do you have any particular experiences that you’re going to take from this and you think that you’re going to apply to your future?

Brian Liang: I think one of the experiences that really struck me was when I was one of the co-leads for the Migrant Farm Worker Clinic. Now this was pre-COVID, but I think that was one of the activities I fortunately got to participate in where I really got to see kind of everything at work that we’re learning in AHEC. For example, in the professional aspect of it, we had a pharmacy table. All the pharmacists were there. We’d talk to the pharmacists, tell them what we found out from the medical interview with the farm workers, and then from there we do phone calls every Friday with community health workers and social workers, and the rest of CT AHEC to figure out how to do follow up, when to do follow-up, what conditions they should look out for when doing follow up, and kind of connecting these very transient migrant farm workers with consistent access to health care.

Chris: And Julia, since you’re kind of more toward the beginning, you’ve got a little bit of experience. Do you have anything that you’ve taken so far or if not, what are you hoping to get out of it over the next couple of years? .

Julia Levin: I think that the biggest thing I’ve learned from practicing partner-based community care, like is always practiced with Connecticut AHEC, is the importance of being flexible. And I think that advice can work into almost any aspect of anyone’s life, but realizing that as advocates for health equity within the community, you need to be flexible to what the communities want and make sure that you are removing barriers, but also not imposing yourself in a way that the community doesn’t want you to be there. So making sure that you’re listening to their desires, their wants, and being respectful, because ultimately it’s their space. And as a future physician, I hope to be able to maintain that respect by optimizing the flexibility within my practice.

Chris: Eddyson, you’re more than a year in now, so you can kind of go looking forward or looking backward, or both.

Eddyson Altidor: I think an important aspect is, all those experiences sort of set in as a reminder to the reason why you’re in a health professional field in the first place. So being out there in the community, interacting with community members, it’s just a daily reminder, it just continues for me to make sure that in the future I’m always involved in the community no matter where I’m at, and I think that’s an important aspect because giving back is always vital to the health profession.

Chris: All right. And so for the folks who are a couple years behind you who are thinking about a health profession, what would you say to them about the experience that they have to look forward to if they were to decide to join a Connecticut AHEC and/or Urban Service Track.

Eddyson Altidor: I would say there’s no other way to do it, because medicine, no matter how you look at it, whatever profession you look at, is interprofessional. You’re always going to be dealing with, either if it’s pharmacist, dental, the physician, whomever’s involving your team. There’s always going to be a team. You cannot accomplish anything by yourself, so you’re always going to be dealing with individuals. And being in UST sort of puts all that together for you to learn how to work with those team members, how to communicate properly and just provide better care in general. ,

Brian Liang: I would tell those prospective or future students that they should be prepared to learn a whole different paradigm of medical education that just really isn’t emphasized that much. We talk about how we try to train med students to do like people-to-people skills, but profession-to-professional skills are something we definitely don’t focus on as much. So that’s definitely a gap that CT AHEC and UST really fulfill. And also the whole office-community kind of interaction too, so they can look forward to being enriched in that regard.

Chris: And what about you? .

Julia Levin: I think one really great thing about the Urban Service Track is the emphasis on treating underserved communities. So within our traditional health profession curriculums we’re taught about the sciences and the anatomy and the physiology and all that fun stuff. But sometimes we miss the part about these vulnerable populations. So by learning specifically about, whether they’re urban populations, youth, geriatric, formerly incarcerated individuals, by specifically learning about those specific communities and then working with them in community-based settings, I think we have a great opportunity to enhance our skillsets above and beyond just the physiology and the traditional medical or dental curriculum.

Chris: Fantastic. Julia Levin from the UConn School of Medicine, also Brian Liang from the UConn School of Medicine — and the Graduate School, master of public health candidate as well — and Eddyson Altidor from the UConn School of Dental Medicine, thank you so much for joining us today.

Julia Levin: Thanks for having us.

Eddyson Altidor: Thank you.

Brian Liang: Thank you.

Chris: That is our time for today. For future Doctors Levin, Liang and Altidor. I’m Chris DeFrancesco. Thank you for listening to the UConn Health Pulse. Be sure to subscribe so you can catch us next time, and please share with a friend.