(Summer ’17) Anjali Misra, ’18
Anjali Misra (’18, Brain and Cognitive Sciences)
Anjali will spend the summer collaborating with the Family Van, a Roxbury, Massachusetts based mobile health clinic committed to bringing medical resources directly to individuals with the highest prevalence of preventable disease, highest rates of hospitalization, and highest number of avoidable Emergency Department visits. Her involvement will take two forms: volunteering aboard the van at health screening events around Greater Boston, and research related to the Mobile Health Map, an internationally collaborative resource for mobile health clinics. Widespread primary care is one of the single most powerful means to transform public health, and Anjali is enthusiastic to be a part of the effort by helping to make mobile medicine commonplace.
Check back for her updates!
August 12, 2017: Mobilizing medicineA summer of rewarding work with the Family Van and Mobile Health Map ended on Friday. Below are my parting thoughts on my experience this summer— it’s been an exciting and fulfilling journey, and I look forward to continuing to explore my interests in mobile medicine and public health for many years to come.
First, my mandatory update on the Mobile Health Map videos— they’re almost done! I recently received the rough cuts of the videos and I’m excited to share them on the Mobile Health Map website (and here) once they are officially complete, which should be later this week. I’m curious to see whether they have an impact on the number of clinics that choose to take advantage of the Quality Check-Up and the Impact Tool; I certainly hope they do.
Last Wednesday was my final time making the trek to East Boston to work with clients on the van. Part of me expected a low-key afternoon that mirrored the subdued feelings I’m starting to have as summer winds down, but as the past two months should have suggested, the afternoon was as lively as ever. At the start of the summer, I genuinely anticipated the upper limit of the responsibility I would be given on the van to be taking blood pressures, checking blood glucose and cholesterol, and conducting the occasional test for visual acuity and glaucoma. My supervisor told me I would be fortunate to have the opportunity once during the summer to refer a client to a community partner organization like the East Boston Neighborhood Health Center— what she considered to be one of the most meaningful steps we can take in connecting clients to long-term health solutions.
I didn’t anticipate having encounters like the afternoon I spent an hour on the phone with the Boston Housing Authority looking for information on permanent housing options for a hearing impaired client who stepped onto the van that day. I didn’t foresee being asked to explain mammograms and breast cancer to a Spanish-speaking Salvadorian immigrant who felt a lump in her breast over the weekend. And I couldn’t have imagined that even more rewarding than getting to give clients information about the organizations in their community that could provide them medical support in the future would be experiences like the one I had on my final Wednesday on the van, when a client came in seeking services and returned less than an hour later with her brother in tow, keen to have us provide him the services she had heard of for the first time that same afternoon.
I wish I could bring every one of my friends and peers to the Family Van, because the direct exposure and service to a population I neglected to realize even existed in Boston was a transformative experience for me. I can’t imagine how profound an impact it would have if everybody I knew were exposed to the disparities, had the opportunity to be part of the solution, and saw the positive outcomes of their work right in front of them. Instead, I’ll settle for hoping and knowing that the Family Van will continue to do meaningful work around Boston every day of the week, and commit to applying the values I learned here throughout my career in medicine and public health.
A key contributor to the outstanding experience I had working on the Mobile Health Map and with the Family Van this summer was the opportunity to see the impact of mobile health clinics both on a broad scale and on a local, personal level. Developing tools to increase mobile health clinics’ engagement with the Mobile Health Map nationwide demonstrated to me the value of measuring quality and multiple aspects of impact on the health care sector, and engaging with clients on the Family Van in East Boston every week reminded me why the larger scale work was important. I’m so grateful for all of the people who let me join them on their quest for a healthier life this summer!
August 2, 2017: Lights, camera, action!
Before the summer began, I hoped my direct service with the Family Van and research on the Mobile Health Map would complement each other, and together help me build a multifaceted perspective of the role mobile health clinics play in health care. I’m happy to report such ended up being the case, and credit both approaches for shaping what I have learned about the impact of, and the challenges associated with, mobile health care.
These past few weeks in the office, my primary focus has been on the informational videos I have been designing for the Mobile Health Map. There’s nothing quite like a deadline to expedite work, and having studio time booked at the Countway Library to record the videos motivated me to tie up all of the loose ends I have been keeping at the bottom of my to-do list recently. While revising citations and proofreading the script were among the less glamorous aspects of designing these videos, I’m hoping the effort will be pay off in polished, professional products that can communicate the true value of the powerful tools available to mobile health clinics nationwide via the Mobile Health Map. Before embarking on this video design project, I failed to realize how intentional one must be in specifying essentially every parameter of the plan to balance several goals simultaneously: keeping the videos short but descriptive, stand-alone but not redundant, explanatory but not too technical— the list could go on.
My design process oscillated between independent and collaborative throughout the summer, but I am grateful for the varied perspectives multiple members of the Mobile Health Map team offered, especially as we neared the end of the planning phase and prepared to record the videos. The members of a community that start and operate a mobile health clinic come from all walks of life, ranging from health care providers to religious leaders and educators. Resources like the Impact Tool and the Quality Check-Up may be designed with the best of intentions, but if not marketed and shared in a capacity that is easy to understand and actually usable for the target audience, are constrained by their complexity. We will receive rough cuts of the videos next week, so at this point I remain cautiously optimistic that the new informational tools will help bridge the gap.
I spent an afternoon last weekend on campus with a few friends, and we passed our time in the typical college student way— talking about our summer jobs, sending emails, and being photographed by large groups of tourists. (Maybe that last one is just an MIT pastime.) I laughed when my friend admitted his mental concept of the Family Van was equivalent to an ice cream truck that passed out Band Aids, but setting him straight reminded me that providing health care out of a repurposed bus is not the easiest concept to imagine. It appeared to make more sense once I showed him a photo of the Family Van, so I’ve resolved to make a larger effort to incorporate photos into my final blog posts in an attempt to better convey what working on the van is actually like.
One major perk of working in such a compact space is that everything I could possibly need is within arm’s reach.
No space goes to waste inside the Family Van! All of the walls are lined with educational pamphlets in dozens of languages for a variety of health concerns.
Not every shift on the Family Van is easy, especially when clients present with abnormally high screening results. Cholesterol testing in particular has its challenging aspects. The healthy value for total cholesterol levels is < 200 mg/dL, but every client I screened two Wednesdays ago had a value of 320 mg/dL or higher. Even without considering the language barrier that still persists in East Boston, repeatedly delivering discouraging news was a sobering practice. I wanted the clients to feel validated for their interest in being screened because it shows great personal accountability for one’s health. At the same time, the important takeaway was that significant diet and lifestyle adjustments, and perhaps even medication, were necessary in order to correct the issue. It’s a balancing act.
The summer is almost over, but I am sure the final weeks of my fellowship with the Family Van will be as enjoyable and richly informative as the rest of the summer has been. To be continued!
July 20, 2017: Driving change in health care delivery
Hello from the halfway point of my summer fellowship with the Family Van and Mobile Health Map! Activities in the office have become significantly busier than they were at the start of the summer, and I anticipate the next few weeks will follow suit.
Every week with the Family Van and Mobile Health Map team brings something new, and I am enjoying having work that is varied and engaging every day in the office and in the field. At the beginning of this week, I was surprised when I checked my calendar and realized the summer is now more than halfway over— time really flies.
I’ve always believed that the best way to get to know your community is to serve it, and can attest the principle has certainly held true for volunteering on the van in East Boston. Starting to recognize clients and being able to see now familiar faces of clients who made their first visits to the van at the start of the summer has been tremendously fulfilling. I am trying to remain conscious of how much education and information I provide to clients in an individual encounter, because one key aspect of the mobile health model is incentivizing clients to come back every week for more— which, as I see it, is the only true way to maintain a prolonged influence in their lives.
Before this summer, I had never ventured to East Boston for any other reason than accessing the Logan Airport, and had little concept of its vast diversity. The clients I serve on the van are overwhelmingly Spanish speakers, but they hail from all over the world— some are well established residents of the community, and others are recent transplants whose first interaction with health care resources in the area is on board the Family Van. My Spanish skills have deteriorated dramatically since high school (sorry to all the Señoras who spent years teaching me) from lack of use, but after a couple of weeks it became very clear to me that even making a feeble attempt to speak Spanish goes a long way with clients in East Boston, who are generally more than willing to meet me halfway with their own mix of English and Spanish. I rely heavily on the basics, conjugating verbs strictly in the present tense, miming excessively, and using cognates whenever possible. Getting to occasionally work alongside community health workers who speak Spanish definitely smoothens my client encounters, but this aspect of work on the Family Van in East Boston has really impressed upon me the value of being able to communicate independently with clients as a prerequisite to having any degree of autonomy as a health care provider. I am reluctant to become too dependent upon translators, so armed with key vocabulary like la presión arterial and el azúcar en la sangre, I think I’m learning how to overcome the persistent language barrier. I couldn’t for the life of me remember how to say “health insurance” in Spanish last Wednesday, though, and was instead forced to come up with long-winded, unclear phrases I hoped were synonymous enough to communicate the point. The mystery was eventually solved, though, and these days I enthusiastically incorporate the phrase seguro de salud into conversations whenever the opportunity arises.
I love working on the Family Van because every shift is different. One interaction I had a few Wednesdays ago stood out to me in particular— I was filling out a form with a young client, a student in his early 20s, and asked him how he heard about the Family Van when he commented that he passes the van all the time and always hopes someone will ask him to come on board. This week, he said, the lady standing outside “read his mind” and asked him if he’d like to come inside. The client was exceedingly grateful for the services he would be able to take advantage of and resolved to return in future weeks for continued preventative screening.
As a part of every client encounter, I fill out a Service Provider Form. A series of questions on the form inquire about where the client typically accesses health care resources. As a result, another takeaway I’ve had from working on the Family Van is that a large number of the clients I work with do take advantage of traditional health care resources at the East Boston Neighborhood Health Center, which is located a few blocks down the street from where the van is stationed. Yet even for individuals who are coming from or are directly on their way to the health center, there are still services they seek from a non-traditional model. Whether for the convenience, the short wait time, or the abundance of educational materials available on the van, it came somewhat as a surprise to me that the service we provide is not necessarily just for those who do not access health care at all, but rather for a wide variety of people with ranging needs.
This summer has been a crash course on the MBTA: I take the Orange Line to Roxbury Crossing to reach the office, the Blue Line to Maverick in East Boston, and a combination of buses and Green Line trains for everything in between.
Progress in the office has continued to move along as usual, and I’m nearing the end of the informational video design project that has occupied my office time for the past several weeks. The project has been a wonderful opportunity to collaborate with a wide variety of Family Van staff and leadership team members, and it is interesting to see the differences in perspective that individuals with varying backgrounds have to offer. Hopefully by the next time I check in here our team will have produced two educational tools that mobile clinics are able to implement nationwide! More to come.
July 5, 2017: The Family Van, Wellness Within Reach
Hi! Greetings from Boston, where I’m spending the summer working for the Family Van, a mobile health clinic, and its sister organization, the Mobile Health Map. The first few weeks of my fellowship have been action packed and fulfilling, and I look forward to seeing where the rest of the summer takes me.
During college, my public health research interests and clinical experience have been primarily in emergency medicine. However, as much as I value lifesaving interventions during a critical moment, one of the best kept secrets in public health is the value of preventative medicine and primary care— the medical professions that have by far the most significant impact on reducing mortality and lowering unnecessary spending. Underutilization of these types of care has warped the role of Emergency Medical Services and Emergency Department (ED) visits into a crutch for patients with preventable conditions. Not only does this systemic failure in health care incur vast cost, episodic acute care is inadequate for complex health problems.
By bringing mobile health care resources directly to individuals with the highest prevalence of preventable disease, highest rates of hospitalization, and highest number of avoidable ED visits, the Family Van works to address issues with health care utilization directly at the source. This model is tremendously powerful and its application to public health is an untapped opportunity that I am motivated to correct. Globally, underutilization of traditional primary care stems from a variety of sources ranging from inability to pay, geographic distance, or stigma associated with being screened for disease. Mobile health clinics are uniquely impactful in their ability to diminish all of these barriers. Basic screening for common risk factors requires minimal equipment and thus, minimal cost. Traveling clinics can meet patients where they live, study, work, or worship— reducing the required distance of travel to mere steps away. And normalizing regular screening for conditions such as hypertension and HIV in an entire community can eliminate individuals’ reluctance to seek attention for preventable conditions.
I am spending my summer engaged in direct service volunteering on board the Family Van, as well as working on the Family Van’s research effort, the Mobile Health Map—a web-based collaborative resource for mobile clinics. The Mobile Health Map was motivated by a lack of data on the efficacy, target population, and best practices for clinics, and is now an international resource for individual clinics and researchers interested in evaluating and improving their operations.
I began working with the Family Van in mid-June, armed with a lot of enthusiasm for organization’s mission, but with less of an idea for what my weekdays would look like. I spend three days a week in the Family Van office in Roxbury conducting research related to the Mobile Health Map, and one afternoon a week on board the Family Van providing direct service to clients in East Boston. Spending my time exploring these two very different aspects of the mobile health sector has been uniquely informative, and I’m grateful for my time serving clients on the Family Van as a reminder of why it is important to improve the status of mobile clinics on a larger scale through the resources available to individual clinics through the Mobile Health Map.
The Family Van, parked at 123 Meridian Street in East Boston, where I spend my Wednesday afternoons working with clients seeking free medical services.
In the office, my efforts have been focused on the accessibility of Mobile Health Map website tools to potential users. The Mobile Health Map’s most valuable resources for affiliated mobile health clinics are the Quality Check-Up Tool and the Impact Tool (which allows users to evaluate their program’s impact on clients, their impact on saving costs within the health care system, and their bottom line impact— the return on investment). The members of the Family Van and Mobile Health Map leadership teams that I work with stress the significance of the Quality Check-Up Tool in particular— a resource they feel is not currently marketed to its fullest for all of the value it has to offer individual programs. The Quality Check-Up Tool is based on the aims for public health quality as defined by the US Department of Health and Human Services, specifically related to how equitable, proactive, health promoting, transparent, and effective an individual clinic is. Our vision, and my first project for the summer, is to produce a series of videos to be shared on the Mobile Health Map website that explain the value of the tools and walk users through what can otherwise be a confusing process of collecting and uploading clinic data. Not only will the clinics be able to take greater advantage of the opportunity to improve their practices, but their involvement will also provide Mobile Health Map with more data we are keen to have on the mobile health sector.
On board the Family Van I am learning from the staff and clients I work with, and similarly gaining a deep appreciation for the non-traditional approach to health care that the Family Van embraces. My largest takeaway so far is that the culture of the Family Van is very much client-centric, and focused around building community even as a priority above checking off boxes on a patient record form. The reason the Family Van is so integrated into the communities it serves is because of a culture the volunteers and staff members go out of their way to foster— one that places an emphasis on treating clients as equals and values incremental change.
I’m walking away from the first few weeks of my fellowship with a greater sense of the value of primary care and preventative medicine. I am enthusiastic to continue working throughout the summer to make the most of mobile medicine’s potential to reduce the damage done by preventable disease in underserved areas, both in my community and in all of the others I am now connected to via the Mobile Health Map network. More updates to come in the next few weeks!