Making a Difference

On November 11, while attending my Executive MPH/MHA lecture at Columbia’s Mailman School of Public Health, my classmates and I were captivated by our professor, Dr. Michael Sparer, as he talked about the history of healthcare in the United States. Professor Sparer is a historian with an exceptional memory for dates and historical events that have shaped the healthcare system.?

During this weekend session, Professor Sparer delved into the origins of community health centers in the United States. The first two health centers were established by a doctor called Dr. H. Jack Geiger.?

Dr. Geiger, a lifelong civil right activist, was passionate about social medicine and social determinants of health. He believed that the moral duty of a doctor extended beyond treating illness. Doctors, he believed, were supposed to use their skills and expertise to understand and eradicate the root causes of illness. Things like inequity, poverty, education, lack of access to healthcare, hunger, discrimination, and many more. He explains his philosophy and approach incredibly well in this short documentary: Out in the Rural. ?

Two weeks after Professor Sparer’s lecture on community health centers, I started a job at Harbor Health’s Elder Service Plan as a part of its Program of All-Inclusive Care for the Elderly (PACE). Before joining the Elder Care Program at Harbor Health, I had sought advice from a few people, all of whom gave the same answer: “PACE has an excellent reputation.”?

As it turns out, Harbor Health owns the first center founded by Dr. Geiger. During my orientation, I shadowed various clinicians including rehabilitation specialists, doctors, and nurse practitioners. Without exception, they all embodied the passionate care Dr. Geiger envisioned when opening these centers.?I immediately knew the people who had advised me on my career transition had been correct.?

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The Program of All-Inclusive Care for the Elderly (PACE) program at Mattapan provides elderly patients with coordinated care, including end-of-life care. Each patient has a team of healthcare professionals working together to address their patients’ needs. The healthcare team focuses on what matters most to its participants, spending the time to ensure?they are taking the correct medication, addressing mental health needs, assessing mobility, safety, and much more. PACE serves participants from various backgrounds. However, for this diverse patient population, there is a common goal: keeping participants at home, happy, and healthy.??

PACE operates on a capitation model. This includes adult day centers during daytime hours, and a specialized unit?for participants with dementia. By enabling and managing participants in their homes,?PACE reduces the likelihood of?frequent hospitalizations, thereby reducing costs and facilitating timely referrals to various programs, including hospice care when appropriate. Furthermore, continuous 24/7 triage assistance from a healthcare clinician and coordinated care contributes to the success of the program. Moreover, by promoting patient-centered care through programs such as PACE, participants receive holistic care. This improves outcomes and participants' experiences across the board.??

I am delighted to be at this crossroads in my career. At Mailman, I learn how to investigate healthcare policies and procedures, generate ideas, impact ideologies, and collaborate with interest groups and institutions to provide the best, most cost-effective care to vulnerable populations. At Harbor Health, I am able to see what I am learning in action and apply my new skills in real time. ?

Just as exciting is the new ways in which I am able to teach and learn from my kids. As a physician, my daughter is keenly focused on the social determinants of health. As a future lawyer, my son cares deeply about the social determinants of injustice. Their pursuits and our conversations give me hope and leave me excited for the road ahead. I am committed to playing my part in making a difference.?