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Future Doctors:Crossing Borders - Lessons In a Community's Culture, Diet and Health

A walking tour of a neighborhood provides context for medical students on the lives of patients who live there.

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Each year new medical students at The Mount Sinai School of Medicine take a walking tour of East Harlem.  The tour introduces students to the neighborhood they will train in for the next four years.  This educational experience is described in the following article.

Future Doctors, Crossing Borders: Lessons in East Harlem's Culture, Diet and Health,  NYTimes, 2004  [excerpts below]

The Mount Sinai School of Medicine, at 100th Street and Fifth Avenue, sits on the green line.  Step left when you head out the door and you are on your way down Museum Mile, past some of the ritziest addresses in New York City. It is the Manhattan of Manolo Blahniks and millionaire extravagance.  Step right and in moments you are in one of the poorest neighborhoods in the city, East Harlem. It is the Manhattan of chronic health problems, littered streets and persistent poverty.  

It is one of those geographic divides that are so singularly striking in New York; people separated by only a few blocks live worlds apart.

Faculty at Mount Sinai are determined to get students to think about turning right and, at the very least, becoming acquainted with the way the people who are likely to be their patients live.

''The goal is to show them a bit of everything,'' said Ms. Palermo, who is the research coordinator for the school's multicultural center as well as a community activist. ''Where the people live, the food they eat, the stores they shop in, the religions they believe in, the schools they attend and the parks where they play, while at the same time weaving in a discussion about the health. We want to try and get them to ask why this community continues to be underserved and has some of highest rates of chronic morbidity in the city.''

First stop is an intersection of two cultures, two histories, both vital to the story of Harlem: where Tito Puente Way crosses paths with Duke Ellington Circle. The two musical giants represent the two dominant ethnic groups in Harlem, blacks to the west and Latinos to the east.

When Mount Sinai Hospital was founded in 1852 to serve the growing Jewish population in East Harlem, the area looked very different.

''At that time, there were 128,000 Jews in East New York,'' said Dr. Daniel Hughes, one of the tour guides, who teaches preventative medicine and is also an urban anthropologist.

The Jews were followed by the Germans and the Irish, who in turn made way for an influx of Italians at the end of the 19th century. But it is the East Harlem of today, referred to as Spanish Harlem and El Barrio, that is the central focus of the tour.

''These students will be interacting with the people who live here as patients,'' Dr. Hughes said. ''They need to know the importance of indigenous folkways, to understand that patients will come to them with different belief systems.''

Nowhere was that better demonstrated than at the Justo Botanica, where everything from voodoo dolls to herbal remedies to healing candles are sold. The shops, whose origin derives from the Caribbean's mix of African, South American and Roman Catholic cultures, dot the neighborhood.

etc. 

Continue at the link for the full article.

Full NYTimes Article


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Community Health Profiles: East Harlem, NYC DOH, 2015 

There has been change but East Harlem continues to be a community where many live in poverty and are under-resourced.  Health disparities persist. 

ex) Despite a decrease in infant mortality across the city, the rate in East Harlem is still six times higher than the rate in the Upper East Side. (The Upper East Side is a neighborhood bordering East Harlem)  


What is a provocation or insight that might inspire others during this challenge?

It is important to be aware of, and have an understanding about, cultural context when caring for patients.
What tools, services, experiences might facilitate communication and learning between pregnant women/new moms/dads and their healthcare providers?
How might we bring communities and health providers together to support pregnant women/new families from diverse backgrounds?

How does this research relate to our use cases and personas?

This relates to healthcare providers, all mothers - those that are under-resourced, or have chronic medical problems, or both, and also to dads.

Tell us about yourself:

Pediatrician working in diverse, multicultural, underserved neighborhoods in NYC.
Interested in design thinking and social innovation. I am a mentor for Design For America, NYU student club.

Are you currently an employee of Sutter Health or UCB Pharmaceuticals?

  • No

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Photo of Peju

Thank you Bettina for sharing this program.
An understanding of your patient as a whole person in the context of their native environment is an under-considered aspect of health care, and yet the yawning gap that exists a lot between the health care providers, especially physicians and patients is a phenomenon that we see manifest everyday, sometimes hampering to fatality, the consulting room experience.
In my country, Nigeria, it is no wonder that women would rather still consult with a traditional birth attendant instead of a qualified medical doctor, and access to the hospital was not the panacea that the government was hoping that it would be, (and then built several primary health care centers).
Antenatal care attendance in the community that I work in, mimics the situation that you describe. I lived briefly in New York, upper east side and I did observe the anomalies in income and cultural distribution. This project, whatever comes out it, interests me very much indeed, because of the similarities to my own environment and I will be following this closely.
Thank you again, Bettina

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