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Maria Melendez knew something had to be done. As Latinos moved into the homes once occupied by Irish and Italian blue-collar families who had moved to the suburbs, New Haven year seeking care lagged. The neighborhood had no Spanish-speaking doctors, recalled Melendez, who came to the city from Puerto Rico in the mids to be with her husband. The few medical services available tended to focus on children. Determined to meet the larger health needs of her community, Melendez ed with members of the local chapter of the Alliance for Latin American Progress to start a free clinic.
Volunteers from the Yale School of Nursing staffed the makeshift clinic three nights a week. Funded through a combination of federal and state grants, Medicaid, and private insurance, the clinic accepts all patients. Provision of health care in New Haven has long linked the community with health care providers at Yale. Cross-pollination between Yale and the community has led to real progress in such areas as infant mortality, but health problems persist. New Haven remains a city where poverty and chronic diseases are intertwined.
Rates of chronic disease far exceed those of the state as a whole and those of surrounding communities, according to DataHaven, a local nonprofit. More than a fifth of city residents suffer from food insecurity, compared to 7 percent in outer-ring communities. About a quarter of the people in those neighborhoods suffer from asthma, double the state rate, according to a DataHaven study.
The incidence of diabetes—13 percent—is nearly twice that of the state as a whole. The economic gap is equally New Haven year seeking. Unemployment there is 24 percent, and almost 46 percent of residents live below the poverty line. As the saying goes, your ZIP Code reveals more about your health than your genetic code. In the face of such challenges, health care professionals and researchers in New Haven have in recent years adopted a new approach. Rosenthal, M. The program teaches Yale trainees principles of epidemiology and biostatistics, as well as how to work with community partners to identify critical challenges to the health of individuals and communities.
A physician can tell a diabetic to take a daily walk, she said, but what if gunfire on the street keeps people indoors? And what good is it to recommend a diet that includes fresh fruits and vegetables in food deserts where produce is unavailable? This is the cake. Medical professionals also need to know what works—community gardens that provide good inexpensive food, and walking trails for exercise—and leverage those positives, she said. Her A1C glucose level was a sky-high 16, nearly three times that of a nondiabetic.
At the Cornell Scott-Hill Health Center, Williams enrolled in a new nutrition and cooking class for people with the same problem. It was a revelation. Carbohydrates, she learned, were the culprit. Williams not only learned what to avoid, but how to read labels and cook healthier food. She no longer put sugar and other unhealthful ingredients in her beloved collard greens. The result: Williams cut her A1C glucose level by more than half and lost 10 pounds.
These people were my friends, and they were looking out for me. The course teaches patients which foods to eat, which ones to avoid, how to read labels, and how to cook healthier meals, said Natalie Lourenco, P. The cooking and nutrition course is an opportunity for us to take more time and reinforce the other things that need to happen.
Others are expanding the concept. Lee Cruz, a director of community outreach at the Community Foundation for Greater New Haven and a member of the Chatham Square Neighborhood Association in Fair Haven, wants doctors to understand the realities of life in a poorer community. Physicians need to know the difficulties people face in obtaining fresh food, exercising, and getting to an appointment, he said. That requires more than handing out pamphlets and engaging people at a table for 30 seconds.
To that end, Cruz has worked with Yale to sponsor walking tours of Fair Haven for medical students and residents so they can get to know the neighborhood and its people. The tours have proven a big hit, he said. Cary Gross, M. The approach of focusing on specific diseases and identifying the best pharmacologic therapy—the biomedical model—has reached its limits, Gross said. Medical professionals must understand the lives of their patients if they are going to make a lasting impact on improving their health and well-being, he said.
When Cruz takes residents and students in the health professions on walking tours of Fair Haven, he starts along the banks of the Quinnipiac River at a memorial to the 29th Connecticut Colored Regiment, whose members served in the Civil War. He wants to remind the future doctors of the injustices that black men and others have faced in this country. One way that the foundation is tackling the problem is the Healthy Start Program that seeks to reduce the black infant mortality rate in New Haven. The program, which recently celebrated its 20th anniversary, has cut the infant mortality rate for black babies about in half, Harris said.
But the program, which accepts mothers of all races and ethnicities, has New Haven year seeking percent black participation, below its goal of 50 percent. The reason: blacks are less likely to engage with health care professionals. Harris attributes that to a long New Haven year seeking of medical professionals judging blacks. The dearth of black health care professionals—Latinos are more likely to encounter Latino doctors and nurses—is another factor, he said.
He attributes the stubborn inequity in outcomes at least in part to the legacy of racism. She became depressed and anxious, and her physician prescribed Xanax. She graduated to heroin and soon found herself a full-blown addict. The drug, she said, is everywhere. Luckily, Saunders got help. The center put her in treatment and on methadone, and she has been off heroin for two and a half years. Driving the problem is fentanyl, a highly potent cheap synthetic heroin, much of it from Mexico, that has flooded the region, Taylor said. In Fair Haven, Lagarde said her biggest concern is treating undocumented immigrants.
The neighborhood has the largest concentration of undocumented immigrants in the city, and they make up a ificant percentage of her clients. President Donald J. Whatever obstacles may lie ahead, Melendez is confident that Fair Haven will meet and overcome them.
In the early s, Maria Melendez, recently arrived from Puerto Rico, saw that there were no Spanish-speaking doctors serving her new neighborhood of Fair Haven. With others in the community as well as local groups, she launched a campaign that led first to nursing visits and then to the establishment of the Fair Haven Community Health Center. Looking at the big picture In the face of such challenges, health care professionals and researchers in New Haven have in recent years adopted a new approach.
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