Globetrotting for health care equality

Globetrotting for health care equality

Erica Terrini

News Editor

About 33.2 percent of all legal and non-legal immigrants did not have health insurance compared to 12.7 percent of native-born Americans, according to a study by the Center for Immigration Studies in 2007. One VCU professor and alumnus is striving to improve statistics like these.

Dr. Mark Ryan, 34, is the assistant clinical professor for the Department of Family Medicine in the VCU Health System. He works to provide health care to underprivileged populations and teaches medical students. For his efforts in the field, Ryan received a service award from the Medical Society of Virginia Foundation last semester.

Ryan’s crusade for improved affordable health care is not being fought alone. Representatives of free clinics were joined Wednesday at the State Capitol by the foundation and community health providers, who will bill patients what they can afford to pay. They already have support from Del. John M. O’Bannon III, R-Henrico, a doctor who touts the demand for services at a new clinic opened by CrossOver Ministry in his West End district.

The CT: How long have you been associated with VCU and the other institutions?

Ryan: “I graduated VCU School of Medicine in 2000, and completed my family medicine residency at the Blackstone Family Practice Program, which was part of VCU, but which no longer exists in the same form.”

The CT: Can you talk about the medical missions you conduct?

Ryan: “My first medical trip was as a team member, and took place in 2003–just as I completed residency.  This was a team that traveled to Honduras and worked in a rural hospital. My first trip as team leader was a small trip to the Dominican Republic in 2005, which has grown into our current medical service work.  In our current project in the Dominican Republic, we set up a free clinic in a local school, carry out house calls into the community, and work with undergraduates from the College of William & Mary’s Student Organization for Medical Outreach and Sustainability in community development work. Last year, I led a team of VCU medical and pharmacy students to the DR as part of VCU School of Medicine’s HOMBRE project.”

The CT: How many excursions have you gone on?

Ryan: “In total, I have participated in 10 trips.”

The CT: Where else have you gone?

Ryan: “I have been a team member on trips to Honduras in 2003 and 2007.  I led a team to Nicaragua in 2008.  My major focus has been in the Dominican Republic, where I have led teams from 2005 to 2010.”

The CT:Have you had any interesting experiences?

Ryan: “There are always interesting experiences, from patients with uncontrolled high blood pressures to patients with critical illnesses that have to be addressed with our limited resources on hand.”

The CT: Did you initiate these missions?

Ryan: “I would not say that I initiated these trips, but rather that each of the trips developed out of a coalition of interested individuals and groups.  I have been the medical director or leader on each of the Dominican Republic trips and the Nicaragua trip.”

The CT: Do you do any other international work?

Ryan: “I have not worked in any international capacity otherwise to this point.  I’m still trying to figure out how best I might be able to help with Haiti relief efforts.”

The CT: Can you tell me more about your work with CrossOver Ministry?

Ryan: “Right now my work at CrossOver is as a preceptor, supervising physician, for the Enhanced Teaching Practice. ETP is a partnership between the Department of Family Medicine, the VCU School of Pharmacy, the VCU Health Systems Office of Language Services and CrossOver. We work with first and second year medical students as well as pharmacy students and medical interpreter students to provide the student learners with an introduction to clinical medicine while also providing care to patients who would lack access to health care services otherwise.”

The CT: What inspired you to participate in free clinics?

Ryan: “I believe medical careers are service careers, and I feel called to help in any way that my skills will allow. Free clinics provide a critical safety net to patients who would lack access to health care due to lack of insurance, cost issues, or issues of legal residency status.”

The CT: What kind of an impact do you hope to have?

Ryan: “At the short-term level, I hope that we can provide excellent care to patients who need our health care services–both in the CrossOver setting but also in the international settings. In the long term, I hope that the students who participate in these programs develop a strong interest in working in primary care settings and in working with underserved or marginalized communities.”

The CT: What are your concerns with immigration and health? What is the central concern the public should know?

Ryan: “My main concerns are immigration and health circle around the fact that it is short-sighted to ignore immigrant health issues just because of legal residency status and other barriers that limit access to care. There are many reasons that we should reach out to these communities. At the most fundamental level, healthy families raise healthy children and many of the children in these families are U.S. citizens. If we promote the wellness of the family, we promote the health of these children. Taking the longer view, the Spanish-speaking community in Richmond is a fairly young community, but it is going to be a long-term community. I do not think that this will be a temporary or transient event. I think these families are here for the long haul. Right now, people have some idea of where to go if they get sick (ER, Bon Secour Care-A-Van, CrossOver, etc.) but might not fully appreciate the value of preventive care. If we do not find a way to promote preventive care and wellness care in the community, in 10 or 15 years I believe we will face a large number of patients who seek health care due to the complications of chronic illnesses that could have been addressed or prevented much earlier. To ignore these individuals is, to me, unjust. If you choose a more pragmatic approach, ignoring these individuals is penny wise but pound-foolish.”

The CT: Can you explain The Una Vida Sana project and how it got started?

Ryan: “Una Vida Sana grew out of my concerns I noted above coupled with my great experiences working with undergrads and medical students in international settings.  I wanted to structure a program that would provide medical outreach to the Spanish-speaking community while also providing a service learning outlet for students in the VCU Schools of Medicine, Pharmacy and Nursing as well as Spanish medical interpreter students from the VCUHS Office of Language Services.  At this point, our outreach and screening have been focused on blood pressure and diabetes screening, but in the long run we could expand the program to other conditions such as depression, HIV, etc.”

The CT: How has your experience been working with VCU medical students?

Ryan: “I find working with students at all levels to be invigorating and inspiring. Students keep you honest and keep you on your toes, while providing valuable insights into projects and providing the energy that helps keep us all going. To work with such enthusiastic and inspired students is an amazing experience.”

The CT: Are you aware of any other programs that provide medical students with the opportunity to help struggling communities?

Ryan: “On the medical school side, I am familiar with the CARITAS program (which provides health care services in Richmond’s homeless shelters) and student-run clinics at CrossOver. Beyond that, I really can’t say. I’ve been busy enough that I’m not fully acquainted with other options.”

The CT: Do you have any other future projects?

Ryan: “My wife and puppy probably would agree: Last year was a busy year, and I think I have enough on my plate for now. Having said that, life pulls you in funny directions, and you never know what might come up.”

The CT: Has funding ever been an issue for your work?

Ryan: “Funding is always an issue. We get around that by leveraging volunteers and donations to get as much as we can out of limited resources. Una Vida Sana has been supported wholly by donations and volunteer time; no money has been spent thus far. That will need to change if we expand the project, but we would still aim to keep the budget minimal. On the international side, we have started a nonprofit organization, the Dominican Aid Society of Virginia–, to support the work, and we have been fortunate to receive a number of donations like money and supplies to help with the work.”

“We also keep costs down–volunteers on the international trips pay their own expenses, and we average about $3.50 or so in supplies for each patient we see. I think that provides good value for the cost. At the same time, wealthy benefactors and generous friends are always welcome to contact us.”

The CT: Is there any additional information readers should know?

Ryan: “A few final points. To me, medicine is a service career and I feel that physicians are in a position of trust in our communities. I think we should seek to help in our communities and overseas in whatever ways we can. You do not have to decide whether to serve in the U.S. or overseas.  You can, and I think should, do both to the extent that you are able.”

“There is a quote I once heard from looking online, I think it might be a quote from Albert Schweitzer that I think is a good summary of what I believe: ‘But however much concerned I was at the problem of the misery in the world, I never let myself get lost in broodings over it; I always held firmly to the thought that each one of us can do a little to bring some portion of it to an end.’ If each of us, in our own way, works to end some small portion of the misery of the world, then the entire world benefits.”

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