Einstein Student Seizes Opportunity to Give Back

Conducting “Global Health” at Home in the Bronx

Juan Robles, a member of the class of 2011 who will have his M.D. conferred on June 1, 2011, shares how his education at Einstein and an opportunity to give back to the local community helped shape the young physician he has become. On May 31, 2011, he will receive the Dr. Isadore Rossman Memorial Award for Commitment to Community Health Care, presented to an outstanding student who has demonstrated a commitment to community health care.

Juan Robles, Class of 2011
As I look forward to graduation day, I reflect on my journey through medical school, marked by academic challenges as well as memorable experiences, including a unique opportunity to give back to Bronx, the place I consider home. Little did I know that one of the most rewarding moments would occur, not in a clinical setting, but from direct interaction with individuals in the community.

A few months ago on the Einstein campus, I was reminded of this experience when I ran into Keith, who I first met three years ago at West Farms Technology and Career Center (WFTCC), an adult education site only 20 minutes from the Einstein campus. Now a custodian at Einstein, at the time Keith was a custodian at WFTCC, as well as a participant in a project I conducted to fight the obesity epidemic afflicting the West Farms community

During that summer of 2008, while most of my classmates traveled abroad to do “global health” fellowships, I chose to participate in the Mayor’s Health Literacy Fellowship of the City of New York, which aims to promote better communication between patients and doctors. My assignment was to teach health literacy at WFTCC, located in the Central Bronx.

Juan Robles teaching a class at West Farms
For decades, West Farms has been one of the poorest communities in America, afflicted by high rates of diabetes, hypertension and obesity, largely due to poor access to green space, healthy foods and low levels of nutrition and health literacy. This represented a unique challenge for me, as well as an opportunity to contribute to the betterment of a community in need.

As I began teaching, I was shocked to learn that my students, including those who were U.S.-born, read and wrote at or below the fifth-grade level. This made my task harder since most materials available in the United States are written at or above eighth-grade level. Not surprisingly, many of the adults in my classroom were unable to obtain, understand or use written health information. They often, asked me about medications, procedures or instructions they weren’t able to understand from their physicians.

While teaching health literacy had foreseeable benefits, I also was in a position to act on more urgent needs, such as helping to fight the obesity epidemic that is very prevalent in the urban-poor Bronx. Yet I found that overcoming obesity in West Farms is a difficult, if not an impossible task — where cheap unhealthy fast food is easily accessible, outdoor green space for physical activity is sparse and health education is not aggressively promoted. Nonetheless, a week into my fellowship I started a weight-loss program for WFTCC employees.

Juan taking a participant’s blood pressure
Twenty-six employees, including administrators, custodians, teachers, social workers, front desk staff, secretaries and assistants, enrolled in the program. Keith was among these participants. He was concerned about his weight and wanted to learn healthy eating habits that would benefit him and his family.

Armed with a digital weight scale and a blood pressure cuff, I monitored everyone for a period of five weeks. As expected, the initial blood pressure measurements were high and, in many cases, way above the 140/90 cutoff line that signifies the need for therapeutic intervention. Only a few individuals were aware of this health risk or had sought medical assistance. In addition, the mean weight for the group was 209 pounds and some participants had body mass index measurements in the “morbidly obese” range.

After five weeks of individualized nutrition counseling, and self-directed effort, the results were positive: mean weight loss was six pounds (from 209 to 203), five participants lost 10 pounds or more and the combined group of 16 who completed the program lost 96 pounds! Even more encouraging were their blood pressure results: the mean systolic and diastolic blood pressure measurements dropped 3.4 and 4.1 mm/Hg, respectively (from 138.8/90.1 to 135.4/86).

In addition to these encouraging results, the West Farms community and its diverse population of residents, who come from all corners of the world, impressed me in numerous ways. Theirs is a vibrant and resilient community that has overcome the arson, drugs and crime of the 1970s, and made the neighborhood into a humane place to live.

Nonetheless, West Farms continues to be afflicted by poverty, unemployment, out-of-school youth and poor health. It is therefore important to underscore the need to step up our outreach efforts since, as my own experience has demonstrated, communities like this benefit greatly from simple health-promoting initiatives facilitated by motivated healthcare professionals.

Although my “global health” experience did not take place in some distant land, it turned out to be a great one right here in the Bronx. I can still envision the joy in the faces of the individuals who were empowered by their efforts to lose weight and take control of their health.

I also remember Keith thanking me for helping him and his family. He told me he was grateful for what he had gained from the experience, and that, for the first time, he truly felt that a healthcare provider actually cared about him.

At that moment it became clear to me that small community involvement could have a big impact; in effect, through teaching health literacy and conducting a small-scale weight-loss initiative, I was helping to improve lives.

And, I also learned that strong patient-doctor communication skills, cultural competence, compassion, empathy and respect go a long way toward truly helping others.

Posted on: Friday, May 27, 2011