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Profiles in primary care


mcw.edu EXTRA Primary care in Ukraine
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Fall/Winter 2013 issue (pdf)

Profiles in Primary Care icon Primary Care physicians practice on health care’s front lines, and sometimes those lines are drawn by patients’ unique needs and circumstances.

In our second installment of this multipart series, some alumni who care for special populations of patients discuss their perspectives and experiences in a profession whose call of duty is often above and beyond.

Serving special populations

Recently discharged from the hospital, Cindy, 59, needed frequent monitoring after experiencing blood clots in her lungs. Laid off from work and uninsured, she was unable to pay for physician visits or lab fees until Friendship Health Clinic intervened. The non-profit clinic, for which Edward F. Banaszak, MD ’60, PhD ’64, is medical director and primary care physician, provided the required blood work, secured diagnostic testing through local partners and continues to manage Cindy’s hypertension and asthma.

Cindy’s story is repeated across America, even in affluent cities like Naples, Fla., where she lives and Dr. Banaszak has practiced as an unpaid volunteer since 2003. For the underserved, access to primary care doctors is a lifeline that Dr. Banaszak believes should not be undervalued.

Dr. Edward Banaszak sees a patient at the Friendship Health Clinic in Naples, Fla.
Dr. Edward Banaszak sees a patient at the Friendship Health Clinic in Naples, Fla.
Dr. Mike Garrity reviews patient records with a team at St. Clare Health Mission in La Crosse, Wis.
Dr. Mike Garrity reviews patient records with a team at St. Clare Health Mission in La Crosse, Wis.
Dr. Kyle Jones provides care through the Neurobehavior HOME Program in Salt Lake City, Utah.
Dr. Kyle Jones provides care through the Neurobehavior HOME Program in Salt Lake City, Utah.

“I’ve never understood how one of the wealthiest communities in the nation provides financial support for their animal shelter and wounded birds better than their fellow man,” he said. “And we keep people out of the emergency room.”

The Friendship Health Clinic has served the Naples area since 1985 and now includes more than 25 physicians, nearly 10 dentists and 12 RNs. These providers manage between 5,000 and 6,000 visits per year from patients over the age of 50 who earn less than three times the poverty level. Most are unemployed. Many are indigent.

“A large number of these people have to make a choice – eat or pay for medicine,” Dr. Banaszak said. “Herein lies one of our problems. Most sample drugs are front-line drugs and expensive. If we give them samples, which eventually run out, then they cannot afford the refills.”

The clinic will instead prescribe generics, attempt to enroll the patient in pharmaceutical company free prescription programs or utilize grant money when available and appropriate. The clinic actually runs at an annual deficit of $125,000, but grants, philanthropy and a small endowment help cover the gap.

Dr. Banaszak practiced in Milwaukee for many years, including at the Zablocki VA Medical Center and as a clinical professor in family medicine and internal medicine at MCW before moving to Florida in 2000. He is passionate about caring for the underserved with dignity and quality.

“Motivation for endeavors like this varies,” he said. “It is usually curiosity at first. Then when one sees a patient with diabetes and a blood glucose of 500+ or a blood pressure of 200 mm hg treated successfully, more altruistic values appear to take hold. Medical practices that have money as their goal have to hurry through patients whereas these people can have our time.”

The patients of St. Clare Health Mission in La Crosse, Wis., similarly, receive the time of Mike S. Garrity, MD ’59, GME ’60. Every Wednesday for 11 years, the 80-year-old retired family physician has driven 120 miles round trip from his home in Prairie du Chien to volunteer at this free clinic that serves the poor and uninsured.

He staffs the continuity clinic and is among 300 volunteers who meet the challenges of this population, which include homelessness, addiction and compliance. It is not uncommon for Dr. Garrity to exchange phone numbers with patients so he can check on them directly on days he is not in the clinic. More than 40 years in rural family practice may have influenced his bedside manner.

Beyond western Wisconsin, Dr. Garrity also aimed in retirement to help a special population on the other side of the globe. From 2000-2004, he made nine visits to Ukraine and helped host several visits to the U.S. by a Ukranian contingent working to develop effective and efficient primary care services in the former Soviet republic.

“Our job in Ukraine was to establish model primary health care clinics and teach their doctors and nurses to approach practice in these clinics as a team,” he said.

The group developed two clinics, one at Kharkiv Aerospace University and the other in the rural village of Korobochkino. The latter was particularly challenging as the clinic only had one physician, one dentist, 10 support staff and no running water. Teamwork overcame the obstacles, however, and today, Dr. Garrity reports, there are more than 20 university clinics and 200 rural clinics developed from these models. It was the medical equivalent of “teaching a man to fish,” he said.

A 1992 Wisconsin Medical Society Physician-Citizen of the Year, Dr. Garrity exemplifies the impact primary care can have on communities and individuals.

“There is no substitute for the patient-doctor relationship, and I have never lost my respect for the power of healing associated with that,” he said. “I worry that today’s incorporation of medicine could possibly threaten this relationship, and we would be the worse for it. With all the fragmentation of care that is available today, I think the primary care physician has taken on added importance in assuring that care is coordinated, efficient and effective.”

MCW pediatrician Dr. Lisa Zetley examines 7-year-old Brooklyn Triblett, who has cerebral palsy. Dr. Zetley cares for all three of Lashawnda Hills’ children – Brooklyn, 1-year-old Malik Smith and 12-year-old Cameran Brown at Children’s Hospital of Wisconsin’s Downtown Health Center, Milwaukee.
MCW pediatrician Dr. Lisa Zetley examines 7-year-old Brooklyn Triblett, who has cerebral palsy. Dr. Zetley cares for all three of Lashawnda Hills’ children – Brooklyn, 1-year-old Malik Smith and 12-year-old Cameran Brown at Children’s Hospital of Wisconsin’s Downtown Health Center, Milwaukee.

In the pediatric practice of Lisa Zetley, MD ’91, GME ’94, coordination of care carries added social significance and is often as complicated as it is essential. Dr. Zetley, Assistant Professor of Pediatrics at the Medical College of Wisconsin (MCW), sees patients at Children’s Hospital of Wisconsin’s Downtown Health Center, an academic medical home that provides primary care for a vulnerable population of Milwaukee children and adolescents. Her expertise is caring and advocacy for children in the foster care system.

“For children in foster care, the most difficult challenge has been to get health information about the children and to collaborate with child welfare workers, foster parents and biological parents to understand the complexity and depth of the needs,” she said.

In addition to mental and special health care needs, many foster children experience changes in social workers and foster homes, leading to increased likelihood of information being lost or appointments missed in the transition. Dr. Zetley has sought to obviate this repercussion by organizing the Foster Care Integration and Care Coordination Project, consisting of monthly meetings at the Downtown Health Center. There, child welfare and health care professionals gather to discuss specific cases with the pediatrician who cares for the child.

“These meetings have been very successful in sharing information and communicating health needs directly between professionals from different arenas who all serve one child or family,” Dr. Zetley said. “In addition to the direct benefit to the child, we all learn about each other’s systems and how to better communicate and collaborate to meet the needs of other children we serve.”

The effort has contributed to the development of the Foster Care Health Improvement Project, co-chaired by Dr. Zetley, which seeks to improve communication between child welfare workers and pediatricians on a larger scale and ensure children receive comprehensive exams upon entering foster care.

In addition to serving more than 7,200 patients per year, the Downtown Health Center is dedicated to teaching the skills of ambulatory pediatrics to the next generation of physicians. Dr. Zetley and other MCW faculty members there teach trainees along the entire spectrum of medical education: M1-M4, pediatric and med-peds residents as well as pediatric fellows. This provides an opportunity for Dr. Zetley to pass on that which inspires her about primary care, such as helping families feel confident in their abilities to raise healthy children and developing long-term relationships with parents and children based on trust and mutual respect.

“It is a privilege to be part of a child’s life and watch them grow up,” she said. “It is especially important to be able to remain a child’s pediatrician during and after their journey in foster care. Sometimes, I am the only consistent person who knows them during this unpredictable and very stressful time in their life.”

The urban population Kyle Jones, MD ’09, serves in Salt Lake City, Utah, also benefits from the patient-centered medical home model. He leads the primary care team for the Neurobehavior HOME Program, which treats patients with developmental disabilities and significant accompanying behavioral and medical problems. The program integrates primary care with psychiatric care, therapy, behavior support and case management. Dr. Jones said consistent coordination and communication among team members is critical in caring for patients’ complex issues.

“The population I work with has historically had very low satisfaction with the health care they receive, as our current system isn’t set up to adequately serve them,” he said. “We have excellent patient and caregiver satisfaction scores, which means a lot to all of us on the team. Being able to provide quality care to a medically difficult population that struggles to find that care elsewhere inspires me to keep working hard to help patients get what they need, when they need it.”

Successes are felt by the entire team, exemplified by one of Dr. Jones’ patients, a woman with intellectual disabilities, depression and type 1 diabetes. She had multiple emergency department visits and clinic no-shows. The team performed a home visit, secured a clinic appointment, addressed her food insecurity, provided appropriate diabetes education, adjusted her anti-depressant medications and insulin, and provided counseling on self-motivation and well care.

“She has shown a lot of initiative to improve her life,” he said. “She has not been to the ED in over a year. With the assistance of the entire team, we have helped to turn her life around, something which would not have happened so dramatically or quickly in a typical care setting.”

In a career largely dedicated to rural primary care, Mike Reinardy, MD ’66, encountered his share of atypical settings, perhaps none as unique as his solo practice on the Menominee Indian Reservation coinciding with the restoration period in the 1970s when the Tribe’s federal recognition was restored.

Throughout his life, Dr. Reinardy maintained an attraction to different cultures and to a bucolic life, but for a time his career and then military service prevented him from following that vision. The Vietnam War, however, reinforced his desire for a life change.

“While in Vietnam, I got a look at how the vast majority of people in the world lived, and it was not pretty,” he said, “I didn’t feel comfortable going back to the life I had in Milwaukee.”

A series of serendipitous events led him to Menominee County, where he set up shop in the basement of the Tribe’s community center. He had a waiting room on one side and a small lab with a microscope and centrifuge in the corner. He obtained an X-ray but couldn’t develop the films. The closest hospital was more than 20 miles away.
As a primary care physician, Dr. Reinardy became part of the tribal community. He served on the County Mental Health Services Committee and as an ex officio advisor to the County Health Committee. He was instrumental in designing a new clinic made possible by the restoration act, but by the time it opened in 1977, circumstances had pulled him in a new direction, to a rural group practice in Antigo. The people always remained close to his heart.

“One of the high points of my career was after I retired in 2003. I contacted the clinic they built in Keshena, and they needed someone for a month to cover for someone’s vacation,” he said. “I did a month locum tenens. People I had delivered as babies were bringing in their kids. It was wonderful to see how well it was functioning, and that’s to the credit of the community. It came full circle for me, and was one of my most enjoyable times in practice.”

Primary care in Ukraine

Through the American International Health Association, Mike S. Garrity, MD ’59, GME ’60, helped develop two clinics in Ukraine, one at Kharkiv Aerospace University and the other in s rural village named Korobochkino.

Dr. Garrity said the university clinic served a campus of 7,000 students and faculty, and his team was enthusiastically received and supported by the dean of that institution. At Korobochkino, a village of about 2,800, the clinic was seeing about 35 patients daily.

“There was a fair amount of apprehension between our team and theirs but this quickly dissipated, and we became very good partners,” Dr. Garrity said. “They did a fabulous job cleaning up and remodeling available space, and we provided excellent equipment. Their visits to the United States help to solidify our relationships and show them that the system worked.”

In addition, his team also developed two medical libraries staffed by bilingual nurses and a Skype communication between them. The librarians not only communicated regularly with Dr. Garrity’s team but worked with staff to facilitate research and study.

The photos below show some of the results of their labors:

Korobochkino Clinic as it looked originally.

Korobochkino Clinic as it looked originally.

Korobochkino Clinic room as it looked originally.

Korobochkino Clinic room as it looked originally.

Remodeled Korobochkino Clinic.

Remodeled Korobochkino Clinic.

New exam room at Korobochkino Clinic.

New exam room at Korobochkino Clinic.

One of two new learning centers at Kharkiv Clinic.

One of two new learning centers at Kharkiv Clinic.

The Korobochkino Clinic staff.

The Korobochkino Clinic staff.

The new student health center at Kharkiv Aerospace University.

The new student health center at
Kharkiv Aerospace University.

 

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Comments / Ratings

Title:
Dr Michael S Garrity
By:
Donna Reed
Date:
11-21-13  8:12 PM
Comment:

This does not surprise me in the least. Dr Garrity was the best Dr that ever treated anyone at the Gunderson Luthern Clinic aka Farrell clinic and we miss him dearly. Bless you Doc !

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