Category Archives: Primary Health Care

Providing Behavioral Health Care in a Primary Care Setting

Extensive barriers to accessing behavioral health care exist in the United States – affordability, access to a behavioral health provider, fear of stigma. Each of these barriers can be eliminated or reduced by folding behavioral health services into the primary care setting, or “integrating care.” A national survey published by the Mental Health Association found that 32% of undiagnosed, asymptomatic adults would likely turn to their primary care physician if mental health concerns arose while only 4% would seek care from a mental health specialist.

Flipping the coin over, a strong case can also be make for integrating primary care into the mental health treatment setting. 68% of those living with mental illness in the United States also suffer from a chronic physical condition such as diabetes, hypertension and/or heart disease. The life expectancy of adults living with mental illness is reduced by over ten years due to their chronic conditions – not their mental illnesses. Thus those who regularly consult a psychiatrist or other provider regularly for counseling or medication management for their mental illnesses stand to benefit from the opportunity to obtain affordable primary care during the same visit.

Tarzana Treatment Centers in Southern California, serves as an example of successful integration. Dr. Jose Salazar of Tarzana explains, “Patients typically report higher satisfaction rates with health services that are fully integrated as opposed to those that are not,” while benefits to the provider include improved patient adherence and increased follow up to care.  Additionally, “many fully integrated care programs see their patient emergency department utilization reduce by 20%-30% [or higher],” lending our general healthcare system additional benefits from full integration.

The transition to an integrated care system is not without its challenges, particularly relating to an organization’s limited financial and human resources. Dr. Salazar explains that full integration of behavioral and medical care adds a valuable care component that may not be fully or even partially covered by third party reimbursement, such as case management and care coordination. Having undergone this transition already, staff members at Tarzana recognize now that “it is also important to change the culture and mindset of providers via training and development to operate in this new model, which has its own set of principles, values, and communication approaches.”

The transition to integrated care is a seismic shift in the way health care is considered and delivered. Through holistic care approaches – primary care integrating behavioral health and vice versa – these innovative organizations are ensuring that no patient is defined by a single diagnosis, but rather is understood and respected as a sum of his or her parts.

Interview: An AmeriCares Doctor in El Salvador on Family Care

Emma Cannon
by Emma Cannon, Latin America and Caribbean Intern at AmeriCares

When Dr. Nancy Melgar from La Clínica Integral de Atención Familiar, AmeriCares Family Clinic in El Salvador, visited the Stamford headquarters, I was lucky enough to interview her and hear her fascinating story: from showing a passion to become a doctor at a young age when she would cure her dolls to studying medicine in El Salvador and Cuba to finding her calling in the field of humanitarian work with AmeriCares.

The Gaps in El Salvador’s Health Care

Apart from her inspiring story, Dr. Melgar spoke about the structure of the health care system in El Salvador, giving me a better picture of where the clinic fits into the national framework. She explained the clinic fills a large gap in publicly-funded primary care for communities that do not fall under the reach of the Ministry of Health’s basic care initiative.

“Curanderos,” or traditional healers, also fill the gap in access to basic care. These healers don’t have technical medical training, but they are well respected, and a significant part of the population uses them for their medical needs.

Dr. Nancy Melgar is pictured here on the far right with fellow staff and AmeriCares staff visitors
Dr. Nancy Melgar is pictured here on the far right with fellow staff and AmeriCares staff visitors

Dr. Melgar said it is common for children to die of preventable diseases because they were brought to a curandero for healing when a medical clinic or institution could have provided treatment.

When I later researched the national health care framework, I found that El Salvador is one of few Latin American countries considered to be in crisis because the country lacks a sufficient quantity of health care professionals for the population’s needs. Moreover, roughly 35 percent of Salvadoran households live in poverty and don’t have access to health care and education.[1]

How Dr. Melgar is Helping Fill the Gaps

With knowledge of this health care system challenge, among many others due to a lack of desired coordination, Dr. Melgar and the clinic staff intend to help create a strong, sustainable network of communication within El Salvador’s health care system. This communication is vital to closing of gaps in primary care and preventing mortality from treatable causes, particularly for these children.

An important part of improving the system’s effectiveness for Dr. Melgar is also the clinic’s educational programs. These programs help to inform the communities who visit the clinic about the importance of receiving basic care. She and her director, Dr. Quijano’s motto is:

“No dar por dar, que valoran su salud.”

This means, [inlinetweet prefix=”” tweeter=”@americares” suffix=”~Dr. Melgar #quote”]”Do not just treat patients, but make them value their health.”[/inlinetweet]

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Her testimony exemplifies the important crux between providing care and providing educational programs on prevention and treatment. By promoting communication with players in the national health care framework and working on grassroots education programs that will support individuals in advocating for their and their loved ones’ health, Dr. Melgar’s, the clinic’s, and AmeriCares work is geared toward strengthening the health care system in El Salvador from the top down and the bottom up.

This way, individuals such as the children whose deaths may be prevented by basic medical treatment can receive the care they need.


Notes:

[1] Annex 11. El Salvador. World Health Organization. Accessed June 23, 2014. http://www.who.int/workforcealliance/knowledge/resources/MLHWCountryCaseStudies_annex11_ElSalvador.pdf

Video: #StandUp with AmeriCares

This summer, our interns explored how crisis, disaster and poverty affect health care for millions of people. They wondered: “What if it were us?”

Share their video and #StandUp with them to help make the world a healthier place for more people every day.

An AmeriCares Sample Pack

After a week of my internship at AmeriCares, I found myself swimming in a pile of papers, project proposals, and pamphlets. I had abandoned taking notes almost entirely—there was too much cool stuff to write down anyway. With 3,000 local partners worldwide in 90 countries, the global reach of Americares is both interesting and complex.

So, for you, I have compiled the “AmeriCares 7-Dose Sample Pack” — small doses from the AmeriCares portfolio that provide a wider insight into the complexity of the work we do.

Dose 1: Constantly Truckin’ Along

AmeriCares sends an average of 10 aid shipments each day by air, sea and road – and each year our warehouse in Stamford, CT turns over 9 times. This means the warehouse, which is 51,800 square feet, is filled with completely new medications and supplies 9 times a year. To give some perspective, this warehouse is larger than an NFL football field, which is only 43,560 square feet!

Dose 2: Affordable Health Care on the Homefront

AmeriCares operates 3 free clinics across the state of Connecticut, and will soon open a fourth – bringing quality, compassionate health care services to the uninsured and underinsured in AmeriCares home state. The clinics have permanent locations in Bridgeport, Norwalk, and Danbury; the new clinic will be located in Stamford, CT. Simple impact math: each DOLLAR given to the clinics provides FOUR DOLLARS worth of medical care.

Dose 3: A Primary Care Hub in India

At 12 locations over 15-day cycles, families living in the congested slums of Mumbai receive a unique opportunity—an opportunity to receive quality health care and free medication from mobile medical clinics run by the AmeriCares India team. In the most recent year of operation, the clinics provided care to 36,000 patients. But, this is only a small fraction of our work in country. Across India AmeriCares serves an estimated 10 million people in 21 Indian states with the help of 55 partner organizations. From the mobile clinics in Mumbai to disaster relief in Uttarakhand, Americares is there ready to support health care in India.

Dose 4: Combating Cancer in Cambodia

Through a partnership with AstraZeneca, AmeriCares is working in Cambodia to combat breast cancer — the leading cancer killer of women worldwide. At the Sihanouk Hospital Center of HOPE in Phnom Penh, breast cancer treatment is coupled with caregiver training and patient education programs. The comprehensive initiative aims to raise awareness, improve early detection, and increase survival rates. In Cambodia, where an alarming number of women die each year as a result of breast cancer, often due to lack of awareness and high cost of treatment – this program makes a lifesaving difference.

Dose 5: Famines, Floods, and Cholera

Disaster—the word is both ambiguous and broad. But, when famine was declared in the Horn of Africa, AmeriCares was there with enough crucial medicines, supplies, and water purification to reach 180,000 people. When catastrophic flooding struck Pakistan, displacing more than 2 million people, we delivered more than $6 million in emergency aid. As cholera outbreaks occur across the globe, we combat the disease, which spreads rapidly in crowded camps after disaster strikes, by delivering treatments and supporting prevention training in Haiti, the Horn of Africa, Sierra Leone and worldwide.

Dose 6: Healthy Steps with TOMS Shoes

Health goes beyond taking the right medications and making the right appointments. For the children coming to the AmeriCares family clinic in El Salvador, good health continues with a new pair of TOMS Shoes. Since 2010, AmeriCares has worked with TOMS to deliver new shoes to impoverished children in several countries around the world — including Uzbekistan, the Philippines, Armenia, Guatemala, and El Salvador. Through its socially conscious One for One® model, the new TOMS Shoes these children receive will be replaced as they grow, to protect them from cuts, infections and soil-transmitted ailments like hookworms. Today, the children can tread softly and more safely toward better health.

Dose 7: When the Pain Doesn’t Wash Away, AmeriCares is There

Hurricane Sandy wreaked havoc on the East Coast —but just because the storm has passed does not mean that the devastation is over in the hearts and minds of survivors.

“Mental health services are often one of the most significant unmet needs after a disaster of this magnitude,” explained Garrett Ingoglia, AmeriCares vice president of Emergency Response. We’ve supported several programs that address this need – including counseling programs run by the YMCA in two-hard hit areas to help children cope with anxiety and trauma. Similar programs continue in Japan, to promote the mental well-being of survivors of the 2011 earthquake and tsunami. These programs are a crucial part of the recovery after the initial emergency response.

“Who Are We To Sit Idly By?”

John F. Kennedy once said that, “in the final analysis, our most basic common link is the fact that we all inhabit this planet. We all breathe the same air. We all cherish our children’s future. And we are all mortal.”

I believe that to bring about a solution to the strife and conflict that plagues our world, we must recognize most basic of commonalities. We are all human.

What differentiates the health outcomes of a child from an impoverished family in sub-Saharan Africa and the child of a doctor or a banker here in the U.S.? The simple answer: Where and when they are born. Birth — an unforgiving lottery — is often judge, jury and executioner. Every day 21,000 children die, from starvation, from disease, from war and from abuse. Yet so many people sit idly by despite the need for help, for health, for life. We cannot change every factor in an environment, but the scope of a conflict or problem should not disarm us. We would move mountains to save our own children. Are we not torn asunder at the spectacle of their pain? Then when regarding the unforgiving lottery that is birth, why is it that so many people can label a conflict or injustice as “isolated?” Poverty, disease, war — these are not environments children choose to be born into, these are not insulated by walls chosen by the downtrodden. They are isolated in that people refuse their commonality, deny their fortune of birth and unwittingly wall the poor, the sick and the conflicted within barricades that forever grow. We are here, they are there: more importantly, we are here, not there.

It’s our duty to stand up 

AmeriCares’ founder Bob Macauley championed “The Starfish Story” – a story of a boy who believed in making a difference, one life at a time. Similarly, the scope of a problem is not a justification for inaction. We often hear that a problem is too big or too obscure for any individual or organization to make a difference. This has proven to be a dangerous and sometimes fatal misconception. One act by one person may only alter the life of one person or it may alter the lives of one hundred; regardless of magnitude, opportunity is birthed from  what was perceived to be abandoned.

Where do we fit in? We are the bearers of hope and change to those who had no reason to believe. We are AmeriCares. We are no different than other people. We are human just as they are. So, what makes us so profoundly different? The answer is nothing; we are neither superheroes, rich, nor powerful. However, we embrace the commonalities that bind us and disregard the barriers between us. We do what we do, because we know that any change for the better  is progress.  Regardless of the capacity by which we can deliver humanitarian aid to help people in need – the fact that we stand up and do what we do, as efficiently and effectively as we possibly can – is what makes the difference.

“In the final analysis, our most basic common link is the fact that we all inhabit this planet. We all breathe the same air. We all cherish our children’s future. And we are all mortal.”

-John F. Kennedy

Speech at The American University
Washington D.C., June 10, 1963