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

Medical Students Experience Urban Medicine

Recently retired UMN faculty Barbara Leone, MD, left,
precepts with a med student at Broadway Family
Medicine Clinic, located in an underserved area
of Minneapolis.

The following story, written by Minneapolis-based writer and editor Barbara Knox, first appeared on the University of Minnesota Foundation website in August 2013. This story has been edited and was shared with permission in our latest newsletter.

Fact: When the Affordable Care Act (ACA) is fully implemented next year, there will be a dearth of primary care doctors awaiting the onslaught of newly insured patients.

Consider the numbers: In 2011, only seven percent of medical school graduates nationally chose a primary care career, despite the fact that more than half of patient visits are to primary care doctors. Fifty years ago, more than half of America’s doctors practiced primary care; today, fewer than one in three are primary practitioners, and many of those doctors are nearing retirement.

The problem only gets worse in urban settings, where common health disorders—high blood pressure, obesity, diabetes—are prevalent and primary care doctors scarce.

Not surprisingly, medical schools across the country are looking for ways to bring students face-to-face with what they call the “underserved” urban population. Often such exposure encourages students to consider a career in primary care.

“Primary care is known to be the most effective, most efficient way of delivering health care,” says Chris Reif, MD, MPH, one of three co-directors of the Urban Community Ambulatory Medicine (UCAM) clerkship. UCAM allows 12 students per year to spend a three-month rotation at an urban family medicine clinic in Minneapolis or St. Paul.

“Most of our training in medical school is devoted to health and disease in individuals,” says Reif. “But UCAM asks, ‘How do we promote the health of the community in places where the burden of disease is heaviest?’”

The Power of UCAM

When alum Elizabeth Beckman, MD, started medical school at the University of Minnesota, she already had a passion for working with an urban population struggling with mental illness. She naturally looked for opportunities to build her experience with that patient group. When she discovered UCAM, her interest only grew.

“UCAM was far and away the best experience I had in medical school,” says Beckman, who recently graduated and began a combined family medicine/psychiatry residency at the University of Cincinnati. “The time I spent in a family medicine clinic taught me how essential it is to help patients improve their health in the context of their community, instead of just within the context of the medical system.”

UCAM is a forerunner to the Metropolitan Physician Associate Program or MetroPAP. Both urban programs owe their existence to the University of Minnesota’s renowned Rural Physician Associate Program or RPAP.

Established in the 1970s, RPAP was the first program of its kind to offer a clerkship that sent medical students into rural settings to work in family medicine clinics. RPAP was so successful that it has served as a model for other medical schools around the world looking to launch similar programs.

In the early ’90s, it also inspired a group of second-year medical students to launch UCAM.

UCAM Beginnings

In 1993, Joanna Perkins, MD, MS, then a medical student, and a couple of her classmates were regular attendees at the American Medical Women’s Association meetings on campus.

“Several of us in the group started talking about what we’d be doing for clerkships,” recalls Perkins, who is now medical director of outreach and a staff physician in pediatric cancer and blood disorders at Children’s Hospitals and Clinics of Minnesota. “Several people were interested in RPAP, but a few of us were more interested in working in an urban setting. So we went to the RPAP administrator and asked what we’d have to do to set up a similar program in the city.”

Perkins, along with Anne Edwards, MD, and Colleen Townsend, MD, did the legwork, and UCAM was officially launched in 1994.

“I worked at the Bloomington Lake Clinic in South Minneapolis [since relocated after a fire],” says Perkins, “and while I ultimately chose to work in pediatric oncology, I knew I wanted to continue to serve in that same community.”

UCAM not only immersed the students in the clinic setting but also exposed them to the cultural realities of the neighborhoods in which they served.

“We met with Hmong shamans and Native American healers,” Perkins explains. “We went to community advocacy group meetings and sat in on neighborhood focus groups. We wanted to complement the medical experience with supplemental cultural learning.”

Why It Works

UCAM director David Power, MD, right, with a patient.

UCAM clearly met a need, and students responded enthusiastically—and still do today: The clerkship is already filled for the next two years with students eager to get hands-on experience at sites like Broadway Family Medicine Clinic in North Minneapolis (the clinical arm of the University of Minnesota North Memorial Hospital Family Medicine Residency) and La Clinica in West St. Paul.

“UCAM gives students exposure to the very real and practical side of medicine,” says David Power, MD, MPH, UCAM co-director. “They learn not just about the illnesses so prevalent in these communities—depression, chemical dependency, diabetes—but how to fill out disability paperwork or how patients qualify for Medical Assistance. Nowhere else in the Medical School curriculum is there information on these sorts of real-world problems.”

It’s very common, Power adds, to hear students say that UCAM was a life-changing experience. Besides gaining clinic experience, the students spend time with their mentors, co-directors Reif and Timothy Rumsey, MD, a family physician who works at United Family Medicine Residency and runs a clinic one day a week at the Dorothy Day Center in St. Paul.

According to Power, UCAM has been overwhelmingly successful in encouraging students to consider a family medicine career: About two-thirds of UCAM students go on to work in primary care. That’s significant today, as medical schools struggle to meet the growing demand for primary care doctors.

The Ladder: Lifting the Next Generation of Health Leaders

Photo provided by The Ladder.

The Ladder is a unique mentorship program/club in North Minneapolis for kids who are interested in health careers.

The club incorporates service learning, leadership development, and progressive mentorship.

Program Goals

• Build a community of learners and leaders
• Create supportive intergenerational and peer-to-peer bonds
• Bridge the divide between communities and their academic neighbors
• Link young members and their families to a viable pathway for capacity building through personal and community enrichment

North Memorial residency faculty Reneé Crichlow, MD, is one of the founding members of The Ladder. The following Q&A with Crichlow about this innovative program was shared in a previous edition of the Family Medicine Connection.

Photo provided by The Ladder.

Q. What is The Ladder?

A. Our motto is “lift as you climb, build as you grow.” One of the most important aspects of The Ladder is progressive mentorship, meaning every member is both a mentee and a mentor. For example, kids who are in middle school are encouraged to continue their efforts by older medical scholar mentors, like high school students. The middle school students also support each other with peer-to-peer praise, and the same middle school students encourage the elementary students to continue to make good choices. This type of support continues, moving up the ladder.

Q. What happens at The Ladder?

A. The Ladder holds monthly meetings in North Minneapolis. Meetings include lunch; check-in, discussion, and personal reflection; as well as hands-on learning experiences relating to some aspect of the medical field.

Q. What is the future of The Ladder? 

A. We are partnering with the Urban Area Health Education Center (AHEC) at the University of Minnesota’s Urban Research and Outreach-Engagement Center (UROC). I see our future as an expanding, exciting organization that is a pipeline of support for those interested in any health care career or even just building a good application for college. We are committed to the North Minneapolis community and to each other. Check us out at www.TheLadderMN.org.