Fighting Breast Cancer Among the Medically Underserved


Every October during Breast Cancer Awareness Month we like to take a minute and focus on the important work health centers are doing to fight this disease, which claims the lives of thousands of women every year.  About 1 in 8 women born today in the United States will get breast cancer at some point.  In 2013 (the most recent data available), 40,860 women and 464 men in the United States died from breast cancer.  For the medically underserved and uninsured, gaining access to early screenings for breast cancer can pose an enormous challenge.  By providing affordable and accessible screenings and launching education and outreach efforts to culturally diverse populations, health centers have been able to help boost the odds of early breast cancer detection and save lives. Health centers provided mammograms to more than 521,913  patients in 2015.  Over 121,000 women patients were diagnosed with an abnormal breast finding.

Studies show that health center patients are more likely to receive mammograms, clinical breast exams, and pap smears, regardless of whether they have health insurance. A case in point is the state of  Rhode Island, where health centers have helped to close the disparity gap in mortality rates from breast cancer among African American women, who typically suffer from higher mortality rates. Breast cancer death rates are 40 percent higher among black women than white women.

Throughout the month of October, health centers are offering discounted or free mammograms and conducting outreach and education to ensure more women have access to early screenings, which is critical to surviving breast cancer.




A Health Center Writes a Book To Help Children Understand Addiction

glfcOne can often find innovation where it is least expected, which is why health centers are such a unique model.  Resources are often tight in the health center world, but that doesn’t stop them from being creative community-based problem solvers.  We’re especially struck by the stories we hear about health centers fighting opioid addiction in their communities, and how they devise new ways to help the families and especially children who, all too often, suffer the collateral damage of addiction.

That brings us to Greater Lawrence Family Health Center (GLFHC) in Lawrence, Massachusetts, one of the poorest cities in the Bay State.  Wedged between a Rent-A-Center and the Save-a-Lot store is the Office–Based Opioid Treatment (OBOT) Program.   Here, patients can access medication-assisted treatment for substance use disorders in an integrative medicine setting.  GLFHC employs the team approach, whereby the patient and medical team establish patient centered goals, and the care is thoughtfully coordinated.  Services also include acupuncture group visits, massage, exercise meditation, yoga, herbal medicine and Tai Chi.  GLFHC’s work in integrative medicine and the treatment of chronic pain, which is typically at the root cause of addiction, is ground-breaking and, more important, generating results.  As one patient, a veteran, put it:  “It is about finding ways to manage the pain, not to eliminate it.”

An important centerpiece of the program is the group medical visits which offer counseling, treatment, and support in a group setting.

“Group visits allow members to share best practices, innovate in a community, receive support from one another, and receive services they otherwise could not afford in Addition to receiving medical management from a physician,” explains Jeffrey Geller, MD, the Director of Integrative Medicine and Group Programs for GLFHC  since 2000. “Group visits are proving not only to be cost effective and efficient, but seem to have better outcomes.  We particularly have  created a group visits model called ‘the empowerment model,’ which emphasizes trying new things and building relationships through projects.”

Geller describes one project that was conceived by a patient:

“One day a patient who had just been released from prison to probation came to his suboxone group visit that I run and said, ‘I wish there was some kid’s book I could read to my son that could let him know why I have been away and what I am going through.’ This set our group in motion and we found no effective books like this in our local library.  We worked over the course of 18 months to create and refine this children’s book.  We had no idea that it would ever be published broadly as it has been.  It was really a way for our group members to think about addiction, their addiction in the context of children and family.   There were about 12 people in all who helped write this book and are very proud of how it turned out.”

The book, entitled, “Daddy Used To Be Sick But He is Much Better Now,” was illustrated by artist and GLFHC staffer Jennifer Klein Roche.  It is is available for free and can be accessed by visiting this link.


What We Know So Far about Hurricane Matthew and Health Centers

matthew_ss4Updated 10/12/2016

We’re still trying to get the latest information about health centers located in areas that were pummeled by Hurricane Matthew over the weekend. We have reached out to our friends at the Primary Care Associations in South Carolina, Florida,  Georgia and Florida. We are also in contact with our partners at Direct Relief, the nonprofit organization which provides aid and support to health centers affected by disasters. Initial reports from our friends at the North Carolina Community Health Center Association are that flooding and power outages continue to pose a challenge for health centers.  Many health centers were forced to close sites or reduce hours yesterday when floodwaters made surrounding roads hazardous.  Doug Smith, President and CEO of Greene County Health Care, Inc. in Snow Hill, NC, told us that there remain high waters near some of his health center sites (one of them is in an evacuation zone), but that’s not deterring their mission.  At least one Snow Hill site will be open tomorrow from 9-3 pm. “We will help as many people as we can,” he said.

Thirty-one counties have been declared federal disaster areas. The greatest threat right now is inland flooding for central and eastern North Carolina that will continue through next week in many areas, according to state government website. News reports indicate that 19 people lost their lives in the storm.   State officials continue to warn residents to avoid driving on submerged roads.

Direct Relief reports on their blog  that they have sent hurricane packs down to health centers in areas hit by the storm, including  Goshen Medical Center (GMC). GMC serves 40,000 patients, at 30 sites, across nine counties. Their report yesterday said many of their sites remain closed due to water damage, power outages in about half of their sites, road closures, and staff being unable to reach the office.  Their corporate office also lost part of its roof.   Refrigerated medications have been lost due to outages. An estimated 1,000 people are displaced from their homes and are staying in shelters. The extent of the damage and the total impact of the hurricane is unclear as the storm swept through over the weekend and people are getting back to assess damage. Direct Relief anticipates needs for insulin, Tdap vaccines, albuterol, and hygiene items, and retains a standing stock of inventory from which a shipment is being created.  Roanoke Chowan Community Health Center in Ahoskie, NC, is also using the hurricane packs Direct Relief sent ahead of the storm.  Reports there indicate that major flooding has occurred over 5 counties as the  health center responds to the community.

We will keep you posted on developments as they come in.


Going Green at NACHC

NACHC trainings are going greenIn an effort to reduce waste and save trees,  NACHC is implementing a going green initiative that will slowly phase in technology for accessing training materials. The first phase of the green initiative was implemented over the summer at NACHC training courses. Hard copies of presentation slides were not provided on-site at NACHC trainings and instead attendees were encouraged to download then from the MyNACHC Learning Center.

With the approaching Financial, Operations, Management/ IT (FOM/IT) Conference in November we thought we’d answer some questions about the initiative:

How to access course materials on MyNACHC (3)Below are some Q&As to help our training participants with this transition.

Q: How do I access my course materials?

A: You will be sent a “Welcome” email with instructions on how to access the course materials in MyNACHC approximately one week to 10 days prior to the course.

Course worksheets, toolkits, case studies, and all other materials used on-site during the trainings will still be provided in hard copy.

Q: What do I need to bring to the course with me?

A: Any worksheets, toolkits, or case studies that will be used during the course will be provided on-site in a course binder.  If you would like copies of the presentations (PowerPoint slides), or any of the supplemental reference materials you must download them from MyNACHC yourself.  You can then either bring them electronically on your personal devices, or have them printed for you to bring with you.

Q: Do I have to print the course materials?

A: This is a personal decision.  If you would like to have the PowerPoint slides in front of you for note taking, then we advise that you download and/or print them to bring with you, otherwise there is no requirement that you need to print them.  You will have access to the materials electronically for at least one year after the course.

Q: How long will I have access to the course materials electronically in MyNACHC?

A: Participants will be able to access all course materials for up to one year after taking the course. 

Have more questions? Need more information? Let us know in the comments section.


The Health Center Movement From Its Roots Featured in the American Journal of Public Health

H. Jack Geiger, MD, and John Hatch during the construction of the Tufts-Delta Health Center

H. Jack Geiger, MD, and John Hatch during the construction of the Tufts-Delta Health Center

If you haven’t done so yet, take a moment for yourself and read the special article penned by H. Jack Geiger, MD in the American Journal of Public Health, “The First Community Health Center in Mississippi: Community Health Centers Empowering Themselves.”  One of the founders of the Community Health Center Movement, Dr. Geiger walks us back to rural Mississippi in 1965, when a Community Health Center was envisioned and proposed as a way to “intervene in the cycle of extreme poverty, ill health, unemployment and illiteracy.” To help readers fully appreciate the noble and enormous task of such a proposition, Geiger vividly describes the living conditions of residents living in Bolivar County, Mississippi during that time:

“Black people in poverty, particularly the isolated, rural Black ex-sharecroppers and ex-plantation workers who constituted the vast and silent majority of the Black community, lived an unceasing and often losing, struggle against disaster.  They were hungry; there was no food. They were unemployed; their skills had been made obsolete by the mechanical cotton picker, the herbicide-spraying crop duster, and the ironies of the cotton and other national crop-subsidy acreage restriction policies.  The median family income was $900.  They lived in crumbling, patchwork shacks with leaky roofs, rotting floors, buckling walls, gaping windows, newspapers for insulation, and crude stoves for heating and cooking– when there was firewood. Many drank contaminated water from drainage ditches and used dilapidated surface privies for sanitation  Infants under such circumstances often ingested their own excrement; children lacked the shoes to walk to school, the clothes to wear to school, or given these, the food to sustain learning…”

Dr. Geiger recounts how until the 1960s Americans had not looked to community health services as a means to address population health problems and implement social change in access to food, housing, clothing, water, sanitation, education and economic opportunity. Everyone understood that intervention was needed to fight poverty, but starting a program, and a host of community-based organizations that would address these social ills over the long term was daunting. Yet, it was done.

Community organization at the then-called Tufts-Delta Health Center began in 1966, followed by training that took place in an abandoned movie theater. Clinical health services were launched a year later in a church parsonage. Not long after, 10 local community health associations linked with the health center began to flourish, run by the people, for the people.  Soon there was  modern health center facility employing more than 200 people from the surrounding area. The North Bolivar Farm Cooperative (related to the health center but independent of it, Geiger explains), produced vegetables to be distributed to worker members. Dr. Geiger explains:

“These institutions served the community, and they were staffed by the community: every Black household in the poverty population in all of northern Bolivar County had at least one (and often more than one) adult member actively participating in decision-making, program-planning and program operation through a local health association… Together with Medicare, Medicaid, food stamps and other programs, the health center’s work improved the health status of its roughly 12,000 Black residents of North Bolivar County. Incidences of fetal losses, infant mortality rates, infectious disease and chronic illnesses such as heart disease, hypertension and diabetes all went down.”

It’s hard to imagine what health care would look like today were it not for the daring experiment undertaken by Dr. Geiger and fellow community organizer John Hatch, and many other dedicated foot soldiers.  Today, the health center movement is made up of more than 1,300 health centers, serving 25 million Americans, a phenomenal trajectory.  Yet, don’t be fooled into thinking this is an outsized health care program that has moved away from community   The heartbeat of such growth has come about because it is in fact driven by community, or as Geiger himself notes, “There is no other part of the American health care system in which patients themselves have such a powerful voice.”