Organic Health Response: Supporting an Ecosystem of Diverse Community Health Initiatives on Mfangano Island, Lake Victoria, Kenya

When you hear the word “organic”, what is the first thing that comes to mind? Maybe a fruit? A vegetable? Or, maybe crops grown without pesticides? 

For second-year University of Minnesota North Memorial family medicine resident Charles (Chas) Salmen, MD, MPhil, the word “organic” means much more. In 2008, Salmen helped develop Organic Health Response, a non-profit organization that cultivates a resilient, healthy future for the people of Lake Victoria, Kenya.

Charles (Chas) Salmen, MD, MPhil

What is Organic Health Response? 

OHR is committed to addressing the devastating impact of HIV/AIDS among the remote island communities of Lake Victoria in Western Kenya. Through local and global partnerships, OHR is pioneering a series of initiatives to help these villages “respond organically--as unified communities--to the overwhelming socioeconomic, epidemiological, and ecological challenges they face.” 

The following post is a Q&A with OHR founder Chas Salmen, MD, MPhil.

How do you describe Organic Health Response (OHR) in your own words and what inspired you to help develop this organization?

OHR represents a team of local farmers, teachers, and health workers in Kenya supported by a network of graduate students, physicians, researchers and activists from around the world. I helped start OHR with a group of friends back in 2008. I had been living on Mfangano Island conducting ethnographic research to try to understand how these remote island communities on Lake Victoria had become some of the most HIV-infected populations on the planet. While working in a small village called Kitawi, I was approached by two farmers, Joel Oguta and Richard Magerenge, to see if I would help them build a community center on some land that they wanted to donate to their community. I had no idea what I was getting into, but we dove right in. 

Eight years later our community center, the Ekialo Kiona Center, is a 100% solar powered, free community center that provides unlimited access to high speed Internet to any resident who agrees to learn his/her own HIV status. We also use this center as our headquarters to support a "community health ecosystem" of diverse education, agriculture, and health programs. We have about 35 full-time Kenyan staff who run the center on Mfangano Island, and dozens of volunteers that support our work in the US.

Salmen onsite with the original members of the Ekialo Kiona design guild

Why did you decide to pursue family medicine? OHR seeks to minimize the impact of HIV/AIDS, so why family medicine vs. something like infectious disease?

I grew up in a small town in the mountains of Colorado, where my dad is a family doctor. I had a chance there to see the impact that family medicine can have not only within the confines of a clinic, but "out in the world". On Mfangano, it was clear that people lacked access to basic primary care. While the HIV virus is certainly a predominant pathogen in this part of the world, addressing AIDS, among other crucial health issues requires a broad approach, tackling sanitation, nutrition, education, livelihoods and gender equity. These are broad community health issues that family doctors are well equipped to tackle, alongside the innumerable infections, broken bones, unexpected deliveries, and health screenings that family docs are trained to treat. Once I realized I was hooked on Mfangano and wanted to be a doctor, family medicine was the only choice!

What has been your greatest takeaway from your involvement with OHR?

Humility. Working on a remote island in Western Kenya has been unbelievably challenging and rewarding. If I've become an expert in anything, it’s learning from mistakes because we've made so many over the years! Going slow, taking small steps, iterating and iterating, and revising and adapting to unexpected changes in your plan are a critical part of the slow, but steady march towards community health in rural sub-Saharan Africa. This process is not something that can be accomplished in a summer or within 1 grant cycle. Embracing patience and finding satisfaction in good teamwork and growing capacity are keys to happiness in this game. I'm grateful for my Kenyan colleagues and American partners who have helped me see this.

Microclinic seminar at Ekialo Kiona Center

What are your plans after completing residency at North Memorial?

I hope to continue working on Mfangano for the rest of my life. My wife and I have small thatch home there and plan to return often, visiting friends and family, and also assisting the EK center. I hope to stay connected with the University of Minnesota professionally to allow students, residents, other physicians, and learners to get involved as well. 

Are there any other interesting facts about yourself or OHR that you would like to share?

Check us out at organichealthresponse.org or shoot me an email at csalmen@organichealthresponse.org. I'm always happy to talk about this special place and our latest crazy ideas for community health. 

Ekialo Kiona (EK) farm team loads indigenous tree seedlings onto the EK emergency boat for transport to Kitawi Beach

To learn more about Organic Health Response, visit organichealthresponse.org. 

U of M Family Medicine Graduation 2015

Mac Baird, MD, and wife Kris
at our Photo Stop

University of Minnesota Family Medicine and Community Health held its annual resident and fellow commencement on June 2, 2015, at the McNamara Alumni Center on the University of Minnesota - Twin Cities campus in Minneapolis.

The event was catered by D'Amico & Sons, and music was provided by Four Voices String Quartet.

Fifty-four residents graduated from across our eight family medicine residency programs, along with fellows in sports medicine (two graduates), hospice and palliative medicine (three graduates), human sexuality (one graduate), and behavioral medicine (one graduate).

Twenty-five junior faculty and fellows also completed faculty development training in curriculum design, evaluation, and teaching skills. 

A number of family medicine residents and faculty were honored for excellence in teaching, research, and service.

Excellence in Research Award

The Excellence in Research Award was presented to St. Joseph's graduating resident Amanda Weinmann, MD, for a breast cancer screening modality, called molecular breast imaging. 

Weinmann's main roles on the research team were to develop methodologies to reduce patient exposure to radiation, improve image quality, and develop biopsy capability, allowing the imaging technique to be used for screening purposes. Throughout residency, she disseminated her research through peer-reviewed publications and national presentations.

"I was impressed with her ability to use resources wisely in conducting a background literature search to frame the problem, to use her computer programming skills to build a simulation model, and to apply scientifically sound judgement to thoroughly test and validate her design," said Carrie Hruska, PhD, associate professor of medical physics at Mayo Clinic, Rochester, "Ultimately, her design was manufactured and put into clinical use on the molecular breast imaging system. It was designed so well that it simultaneously improved our ability to visualize small breast lesions while also improving the sensitivity of the camera such that patient imaging could be conducted using a lower radiation dose."

Amanda Weinmann, MD

Faculty Awards

Two faculty were recognized for excellence in education of residents, medical students, and other health professionals: Phillip Fallt, MD, Affiliate Faculty Teacher of the Year, and Mark Yeazel, MD, MPH, Faculty Teacher of the Year.

Fallt is an affiliate faculty, teaching OB/GYN in the family medicine clinic to North Memorial residents. One nominator wrote that Fallt's "dedication goes beyond that of a preceptor," that he is "dedicated to the field of family medicine as a whole." 

Phillip Fallt, MD

Yeazel is faculty in our research area and at our North Memorial and University of Minnesota Medical Center residency programs. He also co-leads our faculty development training. Nominators said that Yeazel is "supportive, ready to teach, compassionate, deliberate, and thoughtful." 

Mark Yeazel, MD, MPH

Community Service Award

The Leonard P. Burke, MD, Memorial Award is given to the graduating resident whose family medicine training has resulted in a unique service contribution. St. Cloud's Jennifer Taves, MD, was honored for her work with Reach Out and Read. 

Under Taves watch, St. Cloud's residency clinic site distributed 250 to 300 books annually. 

The director of Reach Out and Read Minnesota, Lynn Burke, had this to say about Taves, "Her dedication, perseverance, and enthusiasm are the reason her clinic's program is thriving." 

Jennifer Taves, MD

STFM Resident Teacher Award

Nine residents from across our eight residency programs were presented the Society of Teachers of Family Medicine (STFM) Resident Teacher Award for demonstrated interest, ability, and commitment to family medicine.

Awardees included Jennifer Belisle, MD, Karen Borchert, MD, Stephen Clappier, MD, Alisha Fahley, MD, Scott Hanson, DO, Andrew Houghton, MD, Elycia Matushin, MD, and Jennifer Taves, MD.

STFM Resident Teacher Awardees

MORE

• View photos from our fun Photo Stop. 
• Read tweets using the hashtag #umnfamilymedgrad. 
• See our formal graduation photos. 

Duluth residency faculty, staff, residents

UMN Family Medicine Resident and Fellow Commencement

McNamara Alumni Center

University of Minnesota Family Medicine and Community Health held its annual resident and fellow commencement on June 5, 2014, at the McNamara Alumni Center on the University of Minnesota - Twin Cities campus in Minneapolis.

The event was catered by D'Amico & Sons, and music was provided by the Daddy Squeeze Trio.

Fifty-eight residents graduated from across our eight family medicine residency programs, along with fellows in sports medicine (two graduates), hospice and palliative medicine (three graduates), human sexuality (one graduate), and behavioral health (one graduate).

Seventeen junior faculty and fellows also completed faculty development training in curriculum design, evaluation, and teaching skills.

A number of family medicine residents and faculty were honored for excellence in teaching, research, and service.

Excellence in Research Award

The Excellence in Research Award was presented to Mankato graduating resident Joanne Genewick, DO, for her study of advance directives.

While working on hospital service, Genewick routinely saw patients who had not taken action to direct their care at end-of-life. A 2013 study from the American Journal of Public Health revealed that "more than 60% of adult participants wanted their end-of-life wishes to be respected; yet, only a third had completed advance directives." As Genewick found, this gap is not uncommon.

To understand the gap, Genewick studied patients who completed advance directives to gain a better understanding of what motivated them to take action.

Among her findings, she discovered:

• Language mattered—how physicians approached the conversation of end-of-life care impacted patient action.
• Targeting various age groups based on readiness to listen showed a direct correlation to patient action.
• Individual patient factors, like education level, had an impact on patient action. 

Joanne Genewick, DO

Faculty Awards

Two faculty were recognized for excellence in education of residents, medical students, and other health professionals: Deanna Bass, MD, Affiliate Faculty Teacher of the Year, and Andrew Slattengren, DO, Faculty Teacher of the Year.

Bass is affiliate faculty, teaching and providing integrated psychiatry services at three of our family medicine residency programs: St. John's Hospital, St. Joseph's Hospital, and University of Minnesota Medical Center. She was honored for her innovative teaching methods and development of unique tools like the Rapid Interview for Psychiatry model and 50 smart phrases for primary care providers (to improve diagnostic and treatment planning skills). Bass has been a valued member of our teaching team for nearly two decades. She is an advocate for primary care and integrated behavioral medicine.

Deanna Bass, MD

Slattengren is faculty at our North Memorial Family Medicine Residency and currently chairs the planning committee for the 2014 Family Medicine Midwest Conference. He was recognized for his passionate, innovative teaching; commitment to scholarship; and patient care delivery. In their nomination letter, North Memorial residents wrote, "Slattengren created an environment where inquisitive learning is supported and valued."

Andrew Slattengren, DO

Community Service Award

The Leonard P. Burke, MD, Memorial Award is given to the graduating resident whose family medicine training has resulted in a unique service contribution. North Memorial's Keri Bergeson, MD, was honored for building a partnership between North Memorial residency and Exodus House, a homeless shelter in Minneapolis. More specifically, she designed a longitudinal rotation for residents in North Memorial's underserved medicine pathway to provide clinical care at Exodus House once/week.

Throughout her medical training, Bergeson has demonstrated a passion for underserved medicine and a commitment to community service. The director of health services for Catholic Charities, which operates Exodus House, said, "Keri Bergeson, MD, has both head and heart, which is the best combination for a physician."

Her community outreach and service extends beyond this noteworthy project; she has also been actively involved with the Phillips Neighborhood Clinic, a free clinic in Minneapolis, and the Interprofessional Street Outreach Program.

Keri Bergeson, MD

STFM Resident Teacher Award

Nine residents from across our eight residency programs were presented the Society of Teachers of Family Medicine (STFM) Resident Teacher Award for demonstrated interest, ability, and commitment to family medicine.

Awardees included Eli Horn, MD, Joanne Genewick, DO, Elizabeth Meichsner, MD, Maiken Strohm, MD, Susan Pleasants, MD, Natalya Lyadova, MD, Kate Brown, MD, Brittany Kalmi, MD, and Gaurav Nigam, MBBS.

MORE

• Check out Storify to read tweets from the event. 
• Visit our Facebook page to see an event photo album. 

A fun shot with our UMMC residency grads and faculty

Researchers Actively Communicate with Decision-makers

University of Minnesota family medicine faculty Susie Nanney, PhD, MS, and her research team are taking an active role in communicating research findings of the School Obesity-related Policy Evaluation (ScOPE) study to decision- or policy-makers, i.e., state agencies, advocacy groups, and lawmakers.

ScOPE is funded by the National Institute of Child Health and Human Development. The study primarily looks at school obesity-related policies to examine the impact on students.

Susie Nanney, PhD, MS, seated front, and team presenting
preliminary findings to decision-makers.

Most often research is published in academic journals and read by few non-academics. Yet, Nanney’s group has taken the unique approach of inviting decision-makers to hear and respond to the study’s preliminary work versus waiting to learn findings several years down the road. The results are communicated in an easy to understand way, specifically targeted to a lay audience of non-researchers.

Initial findings suggest:

1. It is important to monitor school weight-related policies and practices—for changes over time and with a health disparities lens.

2. The quality of school district wellness policies vary by region in the state of Minnesota.

3. Minnesota school and food activity policies are having a positive effect on student fruit, vegetable, and pop intake as well as physical behaviors and weight, especially among students in schools in low-income communities.

Nanney is the principal investigator of the ScOPE study. She is active in research and community initiatives promoting school wellness. Nanney earned her PhD in public health research and holds an MS in community nutrition. She is also a registered dietician.

Learn more about ScOPE at www.healthdisparities.umn.edu/research/scope.

Hippocrates Cafe Performs on National Stage

Earlier this week, Hippocrates Cafe performed a new version of The Essence of Family Medicine at the American Academy of Family Physicians Residency Programs Solutions Symposium in Kansas City, Missouri, for a crowd of 600 residency program educators, administrators, and support staff.  The show explored the joys and challenges of family medicine.

Hippocrates Cafe in Kansas City

What is Hippocrates Cafe?

Hippocrates Cafe uses professional actors and musicians to explore healthcare topics through story and song. Shows are non-prescriptive in nature with a radio drama-feel, typically running 30 to 60 minutes in length.

Each show kicks off with the “Hippocrates Cafe Theme Song,” performed by Dan Newton and Robert Bell of Cafe Accordion Orchestra. Hippocrates Cafe creator and director Jon Hallberg, MD, then introduces show topics and provides narration throughout, giving context for performances.

L-R, Rob Bell and Dan Newton

Professional actors and musicians perform carefully selected readings and music, designed to illuminate the chosen topic. Readings incorporate equal measures of humor and serious reflection; sources range from novels to poems to scientific journals. Music selection includes a variety of genres (e.g., classical, jazz, gospel, contemporary).  

Guthrie actor and University of Minnesota medical student
Mark Nelson reviews his readings before a show.

 Since its launch in fall 2009, Hippocrates Cafe has performed nearly 60 shows, covering more than 30 health care topics. Performances have been held in a variety of venues on the local and national stage, such as national medical conferences, the University of Minnesota, Mayo Clinic, Target Field, the Weisman Art Museum, and beyond.

Topics have included baseball and medicine, the brain, cancer, the common cold and influenza, family medicine, eating disorders, and mental health.

About the Creator

Jon Hallberg, MD, wears many hats, including serving as associate professor in family medicine at the University of Minnesota and faculty advisor for the Fisch Art of Medicine Student Awards; medical director at the award-winning University of Minnesota Physicians Mill City Clinic; and regular medical commentator on Minnesota Public Radio. Hallberg also serves on the board of Ten Thousand Things Theater Company and as company physician for the Guthrie Theater and team physician for Minnesota Twins baseball.

Jon Hallberg, MD, introduces a show.

Learn More

Hippocrates Cafe has an active presence on Facebook and recently launched a Twitter account.

Healthy Cooking for Healthy Communities

Johnna Nynas

Healthy Cooking for Healthy Communities is a series of free classes about healthy cooking, nutrition, and wellness designed to address the obesity epidemic at a local level. Classes were launched by University of Minnesota medical student Johnna Nynas as part of her Rural Physician Associate Program (RPAP) experience in Bemidji, Minnesota.

The program was well received by the community and garnered local media attention. Nynas hopes Healthy Cooking for Healthy Communities can serve as a model for those interested in implementing similar programming in their own communities.

What follows is a Q&A with Nynas about this innovative community project.

Q.  How did you get the idea for this community project?

A. My mentor, rural family physician Suzy Human, MD, and I share an interest in nutrition and healthy cooking. During my RPAP experience, we spent a great deal of time providing nutritional counseling to patients in clinic; however, words do not always translate into patient action. Using a group visit model, we created an extension of the clinic environment where patients could receive targeted nutritional information.

Q. Can you describe a typical healthy cooking class?

A. Classes are facilitated by an interdisciplinary team of family physicians and local chefs and held in a community kitchen environment, like at Harmony Foods Co-op in Bemidji. Each class features demonstrations on how to prepare healthy meals using fresh, whole ingredients; unlike traditional nutrition classes, this allows patients to see how easy and delicious healthy cooking can be. Family physicians are available to answer patient questions about wellness and provide community education on everything from the health benefits of omega-3 fatty acids to postpartum weight loss. The nutritional education takes into consideration social issues, like picky eaters, busy schedules, cultural norms, budget concerns, and food availability.

Q. How were classes received by participants?

A. I believe the success of this program is best measured in participant comments. Here are some of my favorites: “loved the idea of incorporating vegetables in a delicious way;” “my family loved the recipes;” and “need more classes like this.” Pre- and post-class surveys were used to gather information on how well the classes improved participant knowledge of healthy ingredients and confidence in implementing changes at home.

Q. What makes this program innovative?

A. Its design. I researched barriers to office counseling cited by primary care providers and developed a program that would circumvent common pitfalls, like out-of-pocket patient costs, patient motivation to change behavior, provider knowledge of nutrition, and knowledge of cooking methods. The classes challenge common misconceptions that healthy cooking is expensive, tasteless, and time-consuming by showing how simple and delicious it can be to eat healthy. The most impressive aspect of this program comes down to health care costs. Physicians typically rely on referrals to nutritionists to help patients improve their diets; such visits are often not covered by insurance and may cost up to $300. These free classes provide two hours of cooking instruction from professional instructors; a delicious, healthy meal; education about nutrition concepts like portion sizes and reading food labels; and time to ask questions of health care providers.

Q. How did you finance Healthy Cooking for Healthy Communities?

A. Classes were free to participants, but cost $24 per person to operate. Funding came from Sanford Health in Bemidji and a David Mersy Student Externship Program grant from the Minnesota Academy of Family Physicians.

Q. What are the plans for continuing or growing this program?

A. The current RPAP student in Bemidji, Kelly Fellows, and rural family physician Suzy Human, MD, are continuing to bring these healthy cooking classes to the Bemidji community. My hope is that the work we have already done on this project will serve as a model for others interested in implementing similar programming. More formal research is needed to prove that this can be an effective way to help patients make meaningful, long-term behavior changes, but our experience has shown that patients are ready and excited to see this kind of innovative approach to medicine. Ultimately, I plan to continue my work on this project during residency and as a practicing physician. I would love to see this grow into a nonprofit that could distribute a formal curriculum, making it easier for hospitals and clinics to implement this in more communities.

For more information, e-mail me at nynas@umn.edu.