Haiti Heroes

My heart is still with my friend in Haiti.

After more than a week of saving lives in Port-au-Prince, Haiti, our colleagues Dr. Flavia Mercado and Peter Anderson are on the way back to the U.S. I am very, very glad they are coming home now.

They failed to convince Dr. Michael Grady to return with them. I am very, very worried. But I think I understand.

We spoke yesterday by satellite phone. I asked him why he isn't coming home as scheduled, despite a physically and emotionally exhausting week treating hideous wounds in Port-au-Prince in an open-air, makeshift field hospital.

"You all have done so much," I said. "You're heroes."

"We're not heroic," Michael said. "Every day, I see Haitian people performing extraordinary acts of valor and endurance. They are the heroes."

That's so true. I guess that is why, when I see TV journalists saving lives, I feel two ways: Glad that they could help, and angry that they are making themselves the story.

Here's why Michael is finding it hard to leave. There is a line of people waiting patiently to see him. One will have an infected amputation. The next will be a little girl having trouble breathing. The next will have a dangling, broken limb.

There are fewer primary wounds now, but lots more infections and disease. Lots of people, especially kids, are having breathing problems, possibly due to all the dust they've inhaled. Today someone showed me a news story about doctors with nothing to do in Haiti, they clearly haven't found their way to the field at Matthew 25 guest house in Delmar 33, where Michael and a few other medical people are working.

A second team of volunteers from ServeHaiti, the charity he and I support, left today. Part of their mission is to bring Michael home. I hope they succeed. There will be a lot more to do as the remarkable people of Haiti heal.

Heart and Mind in Haiti

My heart and my mind have been in Haiti, but my body is not yet there.

That's been a problem for so many of the people who want to be there - to search for, comfort, or bury loved ones; to offer a hand to those in need; and to bring in much needed supplies and expertise.

With mind and heart one place and body in another, I'd been fading in and out, neither here nor there. That wasn't doing anybody much good, so with the help of my wife and friends, I'm now back together again, and helping my colleagues pull it all together to face the challenges ahead.

Three of my colleagues - Dr. Michael Grady; Flavia, a pediatrician; and Peter, an experienced Haiti hand - tomorrow are flying to the Dominican Republic. Their mission is to reach Gran Bois, establish a supply line, and extend our perimeter toward the disaster area. Behind them, a small army of volunteers stands ready to carry in supplies.

I'm not on that trip, but plan to follow as close behind as I can. I'll keep you posted on their progress.

Meanwhile, here are excerpts from a note we at ServeHaiti received from Amber Lynn Munger, a volunteer with connections to AMURT, KONPAY, and other service groups. Munger is at Matthew 25, a guest house in the Delmar region of Port au Prince that normally houses service groups traveling in Haiti and which now headquarters for volunteers treating some 1500 injured people on the soccer field behind the guest house.

Munger writes:

"Here at Matthew 25, we have been doing amputations, and other painful surgeries, with no painkillers, no anesthesia, nothing to work with. There are no tools for our doctors. We have numerous Haitian doctors and nurses here but no supplies! We have run out of antibiotics twice but then found them by searching at nearby clinics run by missions and NGOs.

Haitians are helping each other in glorious acts of compassion and kindness every where you look. These people have endured so much unspeakable and unnecessary suffering. I am today, as always, blessed to be walking with them in their struggle to overcome their awful and unfair circumstances, and am even more blessed to be sharing in the strength of spirit that makes each one of them my hero."

While scenes of violence and selfishness make good television, those on the ground in Haiti report vastly more scenes of peaceful cooperation, sacrifice, and heroism as communities come together. This fits with my experience of Haiti, a land that is blessed with one huge resource: tremendous resilience.

Daniel DeNoon
Senior Medical Writer, WebMD

Haiti After the Earthquakes

By Daniel J. DeNoon
WebMD Senior Medical Writer

My travel kit is packed with a big bottle of cipro, and I'll be starting anti-malaria prophylaxis soon. I'm scheduled to fly to Port au Prince on Feb. 3 with Dr. Michael Grady. We may go sooner, if we can be part of the relief effort.

Like everyone who knows anyone in Haiti, I keep checking my email inbox. Too many friends and loved ones are missing.

Unlike many, the news for me has been mostly good. As good as news can be when yet another horrible disaster has struck an undeserving people.

Nearly a year ago, I made my first eye-opening trip to Haiti after being invited to serve on the board of the service organization ServeHaiti.

The clinic we built in the mountainous region called Gran Bois is not far from Port au Prince -- but only as the crow flies. Human travel, up a tortuous "road," takes at least four hours, often much more.

The earthquakes are still shaking the ground, but so far the clinic stands unharmed. Our staff that was in Gran Bois, including Dr. Leo, are unharmed. But many of our Haitian friends and colleagues were in the city.

A few minutes ago I got one of those emails I've been looking for. The title: Boule is safe. I cried.

Earlier today, one of our volunteers sent a very different message. The title: Pray for me. Two of her loved ones are dead. I wept.

Watch this space for more news and stories. Please tell us about your Haiti connections, and what you know and don't yet know.

Keep on hoping. Keep on praying.

Alzheimer's Disease: A Special Segment

There is obviously a very large concern out there about Alzheimer's, especially since we are all living longer, and also may have to care for our parents as they get older. There's good reason for this: Currently, Alzheimer's affects over 5 million Americans, and that number is expected to grow to as many as 16 million by 2050.

We think information is one of the most important health tools you can have, and with that in mind I wanted to bring to your attention what I think will be a very important piece tonight on CBS Evening News, WebMD's partner-in-health.

Their senior medical correspondent, Dr. Jon LaPook, has for the last several months been preparing the most extensive segment he's ever been involved with since becoming a medical correspondent for the CBS Evening News with Katie Couric in 2006.

The network will devote six minutes (yes, that's six minutes, incredible for an evening news broadcast) of the 22-minute broadcast to present Dr. LaPook's look at the latest research in Alzheimer's in a segment called "CBS Reports: Where America Stands."

It will air on CBS this evening, January 12th, between 6:30 and 7 pm EST.

If you have concerns about Alzheimer's, or someone in your life is affected by it, I would urge you to tune in. I've worked with Dr. LaPook for the last few years, vouch for his dedication and skill, and I'm sure it will have terrific reporting and be full of important information.

As a warm-up, here are two links from Dr. LaPook premiering the event:

Senior Moment or Alzheimer's? The story

or

Senior Moment or Alzheimer's? The video.

I hope you get a chance to tune in for more this evening.

Sean Swint
Executive Editor, WebMD

To join the conversation, enter WebMD's Alzheimer's disease community board.

Massive Crib Recall

The Consumer Product Safety Commission has announced a recall of nearly 2.2 million Stork Craft drop-side cribs, including about 147,000 Stork Craft drop-side cribs with the Fisher-Price logo. These cribs were sold in the USA and Canada.

WebMD has the full details here including where the cribs were sold, model numbers, and what to do if you have this crib.
http://www.webmd.com/parenting/news/20091124/2point2-million-cribs-recalled

The recall involves cribs with dropdown sides because children may suffocate by getting their heads stuck between the side rail and the headboard. There have been deaths and several injuries associated with these cribs that we detail in our story.

Photo: CSPC

For additional information, contact Stork Craft toll-free at (877) 274-0277 anytime or visit storkcraft.com to order the free repair kit. CPSC urges parents and caregivers to immediately stop using the recalled cribs, wait for the free repair kit, and do not attempt to fix the cribs without the kit. They should find an alternative, safe sleeping environment for their baby. Consumers should contact Stork Craft to receive a free repair kit that converts the drop-side on these cribs to a fixed side.

Retail Health Clinics: Should you treat your sore throat at the supermarket?

By Denise Mann, MS
WebMD Guest Blogger

Nov. 2, 2009 – Buy groceries. Check. Pick up prescription. Check. Get blood sugar levels tested. Check. Get flu shot. Check.

Health care is increasingly becoming part of our one-stop shopping culture as retail health clinics pop up across the map. Retail health clinics are free-standing, walk-in medical kiosks in drugstores, shopping malls, and grocery chains that offer acute care for throat infections and earaches as well as diabetes and cholesterol screenings, routine checkups, and vaccinations. The fees are low, and care is often provided by a nurse practitioner rather than a physician.

The latest study shows that such care tends to be on par with that received in a doctor’s office or urgent care center and may even be better than the care received in emergency rooms for some conditions. The study appears in the Sept. 1 issue of the Annals of Internal Medicine.

In this study, retail clinics charged significantly less for services commonly offered for several hundreds of dollars by doctors in private settings. “The cost of care was much lower than compared to doctor’s offices and about 80% less than in the emergency room, and the uninsured save even more than insured,” explains lead author Ateev Mehrotra, MD, a professor of medicine at University of Pittsburgh School of Medicine and policy analyst at the Rand Corporation, a public policy think tank in Pittsburgh.

Not everyone is on board. The American Academy of Family Physicians does not endorse retail health clinics and believes that such health care delivery could interfere with the medical home, and other medical associations are concerned that the quality of care received care at these clinics may be sub-standard.

Acute care for simple issues is one thing, but some clinics may be branching out into treating more complicate health issues, and that is where things get dodgy. The jury is out on how well these clinics could treat more serious conditions, Mehrotra says.

If you build it, will they come?

The retail health clinic philosophy is ala Field of Dreams with a twist: If you build it they will come (as long as it is conveniently located and open late). “If we provide health care access where people live, work and play and they can go after work, on weekends, and when it is convenient, then people are more likely to avail themselves to it,” explains urgent care physician Matt Mesnick, MD, chief medical officer of Minute Clinic, a subsidiary of CVS pharmacy. “Tripping over a clinic is a nice solution to the health care access problem, and being open when it is convenient is a huge leveraging point,” he says.

As of now, there are more than 1,200 such clinics located throughout the U.S., according to the industry’s trade group, the Convenient Care Association.

“We are at the point where we are still trying to fine-tune the model and we will see a steady growth of these clinics,” Mesnick predicts. He discussed the growth and potential of retail health clinics at the General Electric Healthymagination conference in New York City, a two-week-long conference designed to introduce doctors, thought leaders, and patients to the next generation of medical care.

Mesnick sees these retail clinics as the ‘front porch’ of the medical home, a concept that refers to comprehensive primary care. In this scenario, the primary care doctor is on the first floor, and the retail health clinic ushers people into their lair.

Here’s how it works: Someone with diabetes goes to a drugstore or mall with a health clinic. He or she picks up their medication and gets a coupon for a blood sugar and diabetic foot ulcer check right next door. The results of these tests are input into an electronic medical record system and sent to their primary care doctor, so care is coordinated as well as convenient, Mesnick explains. Any issues are flagged and addressed by the primary care doctor.

Access still an issue

Such an approach could save lives, he says. As it stands, just 2% of people with diabetes are hitting their blood sugar targets. “Is it the fault of training, education, or is access an issue?” Mesnick asks. If access is part of the problem, getting more people with diabetes screened more frequently can help a greater number of people achieve their blood sugar goals and minimize the risk of diabetes complications and related hospitalizations.

For these clinics to really take off, coordination is needed, he says. Consider this: “If you bring Johnny in to pick up medication for an ear infection, then we can see when his last measles mump rubella (MMR) vaccine was or if he is due for any other vaccines,” Mesnick says. “If you have this access but don’t have the patient’s immunization records, it doesn’t work."

Access to health care is still an issue for the masses, Mehrotra says. Most of the clinics are in dense, urban areas. One-third of people in cities live within a 10-minute drive from a retail health clinic.

“We did find that people who go these clinics are young adults who don’t have a primary care doctor, so retail clinics are serving a population that aren’t that well plugged in to the health care system, but these clinics are located in wealthier neighborhoods,” he says. “Some had hoped that clinics would serve the underserved, and that’s not happening."

SOURCES:
General Electric Healthymagination conference. New York.
Matt Mesnick, MD, chief medical officer, Minute Clinic.
Ateev Mehrotra, MD, professor of medicine, University of Pittsburgh School of Medicine; policy analyst, Rand Corporation.
Mehrotra, A. Annals of Internal Medicine, Sept. 1, 2009; vol 151: pp 321-328.
Rudavsky, R. Annals of Internal Medicine, Sept. 1, 2009; vol 151: pp 315-320.

Is Your Doctor’s Office Fat-Free?

By Denise Mann, MS
WebMD Guest Blogger

Oct. 27, 2009 -- You leave your house at 6:30 a.m. so you are sure to be the first person in line at the lab to have your blood work done. This way, you won’t be late for work, and with any luck, you will have the results of the tests by day’s end.

No such luck. You ended up sitting in the waiting room reading an outdated issue of People magazine and a few brochures on disease prevention for more than two hours before your name was even called, and didn’t get to the office until after lunch. Obviously, the results of your lab work were also delayed.

Sound familiar? Maybe not for long. Growing numbers of health care institutions are trimming the fat, and going lean. This doesn’t mean lay-offs, it means de-cluttering, reprioritizing, shifting resources, and striving to avoid bottlenecking in waiting rooms.

Lean can mean different things in different industries. For example, in the technology arena, lean means getting material through the factory, assembled, to the customer, installed, and ready to use faster than anybody else -- defect free, says Gary Reiner, senior vice president and chief information officer at General Electric.

Reiner spoke about the "leaning" of health care at the General Electric Healthymagination conference in New York City, a two-week-long exhibit designed to introduce doctors, thought leaders, and patients to the role that technology can play in improving health care.

Fat-free health care means less frustration

In health care, getting lean means improving patient satisfaction by cutting down length of stays or wait times without sacrificing care. It also means reducing costs. It’s about the bottom line -- but that doesn’t have to mean staff lay-offs or sub-standard care.

And many hospitals and health care systems are adopting this new mode of thinking by hiring consultants to put them on diets, so to speak. Brigham and Women’s Hospital in Boston, for example, got lean and cut average waiting time from 14-17 minutes to about 4-5 minutes. They also improved the lab turnaround time, and boosted patient satisfaction by 80%.

Lean is not mean

Tejas Gandhi, assistant vice president of management engineering and center for lean at Virtua Health, Marlton, N.J., is a believer. Going lean saved $14 million for the four health care systems that make up Virtua.

“Lean is about creating value from a customer prospective, and the customer is the patient who wants to know ‘how quick can I get home after a procedure or exam?’” he says.

In some cases, lean may involve some redesign. “Nurses and doctors walk miles and miles each day within their hospital hunting for equipment, looking for medication, charts, and supplies, but if they had the right tools in the right place at the right time, they would be able to spend more time by the bedside,” he says.

This strategy added 600 hours of doctor-patient face time -- and that is win-win.
“Patient satisfaction and employee satisfaction jumps the more time that the clinicians spend by the bed side because that is what they both want,” he says.
Lean is not mean, he says. “Many people may think lean is about job cuts, but we have not had a single layoff,” he says.

SOURCES:
Gary Reiner, senior vice president and chief information officer at General Electric.
Tejas Gandhi, assistant vice president of management engineering and center for lean at Virtua Health, Marlton, N.J.
General Electric Healthymagination conference in New York City.