Author: Manjit Bhandal

​Manjit Bhandal is a member of the Central Michigan University College of Medicine (CMU COM). She graduated with her bachelors degree from the University of California, Berkeley. Prior to entering medical school, she worked as a clinical research assistant at the Children's Hospital Oakland Research Institute, with the Berkeley Cardiovascular Medical Group, and at the Stanford Medical School. Her research interests include improving outcomes in cardiac transplantation as well as cardiac tumors. She is an avid reader, and loves food, animals, and traveling. ​

Categories
General Opinion Public Health Reflection

Feminine Hygiene: My Own Struggle at the Airport

Surrounding me in the Barcelona airport this past winter was the latest technology—new scanners and gadgets directed at catching radioactive and explosive material more quickly and safely than before. Large plasma screen TVs were on every corner, and numerous retail shops caught my eye at every glance. With an expansive collection of restaurants and shops, one would think this is more of a mall than an airport. Given the mini-mall appearance, I felt I would have no trouble finding a place to purchase a tampon or pad, as Mother Nature had unexpectedly paid me a visit and I was unprepared. After first checking the bathroom for a tampon dispenser and finding none, I went from store to store looking for a personal hygiene section. To my dismay, there were an assortment of shaving creams and toothbrushes and even diapers, but there were no tampons or pads to be found. After scanning all the stores in my immediate vicinity, I decided to inquire at the cashier desk, which was occupied by a female clerk. When I asked her about where I could potentially find some feminine hygiene products, she informed me that I was out of luck. Her and other female colleagues all kept tampons and pads in their bags because there was no place to purchase them in the area. Fortunately for me, they kindly provided me with a few from their stash for my long journey home.

While this may be expected in a less developed area with few resources, an airport that boasts being “among the top 30 busiest airports in the world”1 should have several places to purchase feminine hygiene products. I was incredulous that an airport outside a major hub in Europe in the 21st century had no place for female employees or travelers to purchase a pad or tampon. This is an issue that must be corrected—whether by adding tampon dispensaries or vending machines, or simply by increasing inventory in the numerous retail shops lining the terminals. The Barcelona airport, along with any other major public areas that are traversed daily, should be required to carry these products.

While I was fortunate enough to receive some aid from the female clerks at one of the retail shops, I know there have been many other women who have been inconvenienced by either lack of menstrual products or their cost. In the same month, another traveler at the Calgary YYC airport reported that she had to pay a whopping $15 for a box of tampons at the airport2. Of course, it is a known fact that prices in the airport are always much higher than in retail shops outside – same goes for museum gift shops and others located near tourist attractions. However, for a product that is a basic hygienic necessity for half of the globe’s population, it is prejudicial that it is also priced almost double what it is in a regular grocery store. That traveler’s post sparked a global dialogue as to why these products are not easily found or are not affordable in places that millions of women work or travel.

While a dialogue is an important start, we need to continue to bring this issue into the spotlight. No woman in 2018 should be forced to pay egregious prices for basic hygiene and even more importantly, there should be access to feminine hygiene products in all institutions, including schools, airports, and workplaces.

Source(s):

1https://www.barcelona-airport.com/eng/information.php

2http://www.metronews.ca/news/calgary/2017/12/04/viral-post-blasts-tampon-price-gouging-at-yyc-airport.html

Photo credit: Sor Cyress Source: Flickr

Categories
General Public Health

Human Trafficking: A Brief Guide for Physicians

Human trafficking. Like many things we hear about or read in the news, it seems like a problem of developing countries like Cambodia and Thailand. However, what we fail to realize is that human trafficking, also known as modern slavery, is alive and well within the United States and affects children and adults across all socioeconomic statuses. A harrowing fact is that up to 85% of people forced into human trafficking saw a physician at some point and more than 60% had at least one ER visit1. However, most physicians have not been trained on how to identify and help patients who are potential victims of human trafficking2. This article will hopefully provide more insight into what human trafficking is, how to identify a victim, and most importantly, how to help them.

The State Department of the United States indicates that human trafficking consists of domestic servitude, forced labor, debt bondage, as well as sexual exploitation3. While these are different types of human trafficking, warning signs that a potential patient is a victim to these crimes tend to be very similar. The U.S. Department of Education has provided some common identifiers for physicians in all states to be aware of, including a patient who:

  • Makes references to frequent travel to other cities or towns
  • Exhibits bruises or other signs of physical trauma, withdrawn behavior, depression, anxiety, or fear
  • Lacks control over her or his schedule and/or identification or travel documents
  • Is hungry, malnourished, or inappropriately dressed (based on weather conditions or surroundings)
  • Shows signs of drug addiction4

Victims are often in attendance with their abuser, whether this is a pimp or “employer”, so it is important to speak to the patient alone to elicit a thorough history and help the victim. An excellent resource for all health care professionals in the emergency room is a phone app called “Sex Traff”5. It is designed by two physicians with the intent of helping health care professionals identify potential victims of sex trafficking using a simple screening questionnaire.

As the awareness of human trafficking increases, there is also an increase in health professional training sessions available in several cities across the nation, as well as online training available through the national human trafficking hotline: https://humantraffickinghotline.org/material-type/online-trainings. It is important that healthcare providers of all ranks be informed of this pervasive problem, as well as how to respond. Please share this information with your staff and colleagues, so that we can do our part to combat human trafficking.

Source(s):

1https://wire.ama-assn.org/delivering-care/how-physicians-can-identify-assist-human-trafficking-victims

2https://www.reuters.com/article/us-sex-trafficking-recognition/doctors-not-trained-to-spot-sex-trafficking-victims-idUSKBN0MC1XE20150316

3 https://www.state.gov/j/tip/what/index.htm

4https://www2.ed.gov/about/offices/list/oese/oshs/factsheet.html

5 https://play.google.com/store/apps/details?id=com.ncpl.sextraff

Photo Credit: Thomas Wanhoff Source: Flickr

Categories
General

Study Tools and Tricks to Doing Your Best in Medical School

Congratulations, you have made it into medical school! Now what? Where do you begin with all the resources designed to help you do your best in medical school? Not to worry, for no matter what type of curriculum your medical school may use, the fundamental resources that most medical students use remain the same. The following is a concise list of the best study tools to help you do well in your course work, as well as to best prepare you for your future board exams.

Best study tools:

  1. First Aid for USMLE Step 1. This book provides a generalized overview of the concepts taught in each of your courses. It is worth annotating as you go through the curriculum in your first and second years because the book is a compilation of key concepts tested by “the boards”. The boards, aka the Step 1 exam, is a key exam that you will take at the end of your second year of medical school, and the score you receive will help determine where you are matched for residencies. Needless to say, the boards are VERY important. Keep in mind that First Aid is only a simplified version of most of what you need to know for the boards, so annotating from lecture material is a must. Otherwise, you will likely not receive the board score you want. It is also worth noting that each year a new version is released, so aim to get the most recent one. The 2016 version is available here on Amazon for $45.
  2. First Aid Organ Systems. This book goes into greater detail than the First Aid for USMLE Step 1 book and is excellent for organ systems based curriculums. Though many USMLE blog forums have pointed out that there are more mistakes in this book than the USMLE First Aid book, the book is revised each year and any spelling and/or grammatical mistakes noted are made available online. Despite this, I’ve personally used and annotated the book, and it has greatly helped me in my organ systems courses. I will be using this, alongside First Aid for USMLE Step 1, as my step 1 study guides. The newest version is available in a two pack (one is organ systems and the other is basic sciences) on Amazon for $124.50.
  3. Pathoma. This book is gold for pathology. Every medical student should have a copy. It hits the high yield points for both in-class exams and for the boards, has videos available for more in-depth explanations, and is sectioned by different organ system pathologies. It also provides histological pictures and explanations as well, and is easy to read. Annotating lecture notes in Pathoma with also help you in preparing for the boards. A free trial version is available online. Full access, along with a hard copy, is available on the same website for $84.95.
  4. Goljan Rapid Review Pathology. This is another popular pathology book. It goes into much more detail than Pathoma, but it can be cumbersome to read. Most medical students prefer Pathoma along with lecture annotation, but if you prefer a more detail-intensive textbook, this is the one for you. The newest edition can be found on Amazon for $45. A newer edition (5th edition) is set to come out sometime soon this year, so keep a look out if you choose this text.
  5. Firecracker: While textbooks are great for learning, self-testing is equally, if not more, important. Firecracker is a USMLE Step 1 prep question bank that helps quiz you on material you learn throughout your course work. Starting from day 1, if you use one of the first aid books listed above in conjunction with your lectures, and begin quizzing yourself on the material with a question bank like Firecracker, you will be very prepared for your course exams and for your board exams. Firecracker is a tool that is best used throughout the school year to reinforce what you are learning in lecture. Firecracker is available for a free trial and for various prices for different lengths of time.
  6. USMLE Rx. This is another excellent online question bank that is designed to help prepare you for your board exams, and it is integrated with the first aid book. This question bank can also be used throughout the year to reinforce what you learn in lecture and has more questions overall than Firecracker, but it is also more expensive than Firecracker.  You can try a trial version online.
  7. First Aid USMLE Q&A Book: This book is like the aforementioned question banks but in book format. It provides questions, along with answer explanations in the back. One of the advantages of having a hard copy Q&A book is the ability to easily annotate and review notes; while you still have a note taking option in firecracker and USMLE Rx, it is more difficult to track. Nevertheless, the online question banks are easier to mark and review difficult concepts than the book. You can buy it on Amazon for $36.

Other resources:

  1. Planner: Organization is KEY in medical school. If you find yourself lacking time to study, get a planner and start writing down your hourly/daily goals. It will help a lot, especially as exam time rolls around.
  2. Academic Success Advisor: Every medical school has one, and they may be called something different, but the function is the same – to help you find the best study strategies and tools that work for you. Make an appointment (soon after you begin classes) with your school’s academic success advisor and ask for tips and pointers on possible study strategies. Also, if you have questions about resources, advisors are the “go-to” people.
  3. Medical school textbooks: If your school does not include textbooks in their tuition fees, but you are still “required” to buy them, attempt to find free versions online first. Often, review books alongside lectures will give you the information you need. However, if the information still feels insufficient, old editions of the required textbook are a cheaper alternative to the required, new ones, and will give you all of the content you need. (For cardiology, I highly recommend Lilly’s Pathophysiology of Heart Disease. Well-written and easy to read.)
  4. Notecards: I started my first year with notecards/flashcards but realized soon that I was taking more time to make them than I was using them to study. However, many of my classmates swear by note cards and it works well for them. I still use flashcards for memorizing drugs or for difficult-to-remember concepts, but otherwise I have stopped using them. As I said, do not be afraid to try out new strategies when studying – you are still developing the study habits that will work best for you in the future.
  5. Whiteboard: Repetition is key for memorization. Drawing out mechanisms of action, or making charts and diagrams repeatedly on a white board can really help the facts stick. I’d highly recommend investing in one.
  6. OneNote: Most new computers come with the OneNote software and it is a great tool for organizing your notes online and retrieving them easily months later. I personally like to print out and write handwritten notes (I’m old-fashioned) but I used OneNote in the beginning and really liked it. Plus, if your laptop were to suddenly stop working, OneNote backs up all your information so you can retrieve it from the application on another computer.

Before going out and buying all of these books and purchasing subscriptions to the online question banks, do a little research this summer and decide which ones are the best fit for you. One of the things to keep in mind is that not only do you want to find good study resources to do well in your coursework, but also those that will best prepare you for your upcoming board exams. Doing well in your courses will set the ground work for being prepared for your Step 1 board exam. The best combination of resources is one general review book, one pathology book, and one question bank.

When you get closer to preparing for your board exam, you will be using the notes from your general review and pathology books, in conjunction with more intensive question banks such as UWorld. It is best not to overwhelm yourself with resources in the beginning, and it is OK to experiment with techniques and resources that work best for you. Of course I have not listed all the possible resources, as there are far too many. However, the ones listed here will provide a solid start to your academic success.

Featured image:
Contemplate by Walt Stoneburner

Categories
Emotion General Public Health

What a Horse Named Lightening Taught Me – Equine Therapy and its Unconventional Uses

Lightening is a beautiful white mustang who enjoys back massages. He loves being around his older brother Lincoln, but shies away from people. Lightening came to Hopewell Ranch in Michigan a few years ago, after barely escaping death. He was abused by his previous family, who disciplined him with a metal two-by-four and cracked his skull. Then they tried to starve him to death. Fortunately for Lightening, he was rescued and became a therapy horse at Hopewell Ranch.

What is equine therapy? Horses like Lightening, with troubled pasts, are used in unique psychotherapy for women and children recovering from domestic violence, cancer patients, veterans, and the list goes on. Equine therapy can also be used for professional development, by teaching the importance of using body language rather than verbalization to elicit responses.

Recently I had the opportunity to visit Hopewell Ranch and participate in one such professional development session. Having never been around horses in my life, I was quite nervous prior to the session. As soon as I stepped in the arena, the horses took notice and the silence between us was powerful, but made me even more nervous. The horses studied my body language, determined that I was not going to harm them, and slowly came over to me. While I was still very cautious, the gentle nature of the horses helped calm my nerves.

After the horses got to know me, I was tasked with identifying some of their personality characteristics based on their reactions to my touch or command. Lincoln, another beautiful Mustang, was clearly the leader of the herd and quite protective of Lightening, who was very nervous and cautious around strangers. Responding to my touch, Lincoln remained steadfast and was no longer nervous around me; however, Lightening continued to shy away from me and recede into the shadow of his brother.

Next, I was placed on a team in order to perform a physical exam on Lincoln, our assigned horse, and finally, we were tasked with getting him to maneuver through a self-made obstacle course. Each task focused on cultivating different skills, such as learning to read body language, working in a team, and leading. Physicians are often required to read a patient within the first 30 seconds of entering the exam room. They must be able to work well in a team and step back when necessary so others can get the job done. A physician must also exude confidence as a leader so a patient has confidence in him or her; equine therapy helps integrate all of these important physician skills.

The most powerful part of this session for me was, again, the silence. Many times, we take speech for granted and believe that because patients can verbalize their thoughts and feelings, they will tell us everything we want to know. However, working with these horses, particularly Lightening, revealed to me the necessity of gaining the trust of my patients. If there isn’t a trusting patient-doctor relationship, they will not feel comfortable sharing their life circumstances or the challenges that need to be overcome to successfully implement therapy. For example, a patient may be homeless, abused, or depressed, but there may not be outward signs at first glance. Learning to read a patient and being able to get him or her comfortable enough to share information are great assets to have in the physician tool belt, because they will help make accurate diagnoses and enable successful treatment.

Beyond professional development, equine therapy is an incredible resource for an array of psychotherapy candidates including, but not limited to, addicts and the handicapped. The founder of Hopewell Ranch, Jodi Stuber, has an incredible story of her own that led her to open this ranch. She lost her daughter at five months in utero, but named her Hope, and then decided to name the ranch after her. In Hope’s memory, Jodi has helped people fight drug addiction, has helped cancer victims learn to ride and experience joy while they endure intensive chemotherapy, and has helped children faced with abuse and disabilities feel empowered, all through the teachings of horsemanship.

Equine therapy is a lesser known, but phenomenal, therapeutic method, and my first experience with Lincoln and Lightening will definitely not be my last. I encourage everyone to seek out equine therapy – for fun, for mental health, and for professional growth and development.

Learn more about Hopewell Ranch in Weidman, MI.

Featured image:
Picture taken by author at Hopewell Ranch. Lightening (left) and Lincoln (right)

Categories
General Innovation Lifestyle Public Health

A New Type of Pharmacy – On Food Pharmacies and Their Importance for Type II Diabetics

In a world where drug companies and pharmacies remain pervasive, an innovative take on the word “pharmacy” is being developed in Redwood City, CA. A new food pharmacy has just opened up, stocked with fresh fruits and vegetables. Just what the doctor ordered – literally! Instead of paying supermarket prices for these foods, all you need is a prescription from the doctor.

The first of its kind, this food pharmacy is an annex to the existing Redwood City free clinic known as Samaritan House. Patients with type II diabetes can get a prescription for fruits, vegetables, and even fish from a physician, and then pick up the free food at the pantry to help better manage their diabetes. The food is procured and delivered by the Second Harvest Food Bank, which is one of the largest food banks in the nation, feeding almost a quarter of a million people each month. Second Harvest also provides nutritious cooking demos given by local nutritionists1.

This one-year pilot program serves as a reminder that food is often overlooked as a primary method of treatment and prevention; a reminder we might need during our incessant drive to memorize pharmaceuticals and their mechanisms of action. Even when it is known that a patient’s congestive heart failure and diabetes may not be adequately controlled long term by medication alone, oftentimes physicians are strapped when it comes to options. Providing education on proper nutrition to a patient who simply cannot afford fruits and vegetables remains the passive and limited option, whereas food pharmacies such as Samaritan House are active steps in the right direction.

 

Source(s):

1http://www.sfexaminer.com/food-pharmacy-for-diabetics-launched-in-redwood-city/

Featured image credited to the US Department of Agriculture

Categories
Public Health Reflection

The Flint Water Crisis – The Physician’s Role

Flint, Michigan is a community of 100K residents, the majority of whom are African-American or of lower socioeconomic status. In the recent Democratic debate held in Flint, one mother spoke to the huge challenges that plague the community, including mold in classrooms, unqualified teachers, and the water crisis. In 2014, city officials decided to switch from the Detroit water supply, which gets fresh water from Lake Huron, to the Flint River, which has a long history of contamination, particularly with lead.

Flint residents knew of this contamination and saw brown water flowing in from their taps. They complained for years, long before the media hype, but city officials ignored their voices. Some residents noticed clumps of their hair falling out and an odd taste and smell to the water they were drinking.1

To investigate these claims, Dr. Mona Hanna-Attisha, a pediatrician at Hurley Medical Center and assistant professor at Michigan State University, conducted a city-wide study on the water in Flint. When she recognized that there were alarming levels of lead in the water, she alerted the Environmental Protection Agency (EPA).2 Only then did elected officials start taking residents’ complaints to heart.

Dr. Hanna-Attisha earned the Freedom of Expression Courage Award as well as the respect and gratitude of her patients and peers by speaking up. However, the brave doctor tells CNN in an interview that she was attacked viciously by the state of Michigan when she first presented her research and tried to warn officials of the ongoing crisis. She says she felt “physically ill”3 because of the backlash and professionally vulnerable because her reputation as a physician and researcher was at stake.

Despite the potential professional consequences, Dr. Hanna-Attisha fought for her patients and for the children of Flint, Michigan. In doing so she sent out an important message to physicians: sometimes we must be the voice of the people. It is our responsibility to fight for our patients, whether that means exposing a public health crisis, or more mundane daily tasks like calling health insurance agents to get a patient’s medication covered.

Flint is not the only city in the United States that is dealing with public health crises. However, this particular crisis and Dr. Hanna-Attisha’s role in bringing it to light serves as a reminder for all physicians and medical students: we are public servants and have an obligation to report public health issues in order to ensure the safety of our patients and the general population.

As the notable English physician Sir Henry Howarth Bashford once said, “After all we are merely servants of the public, in spite of our M.D.s and hospital appointments”. Let us not forget this role as we continue through medical school and enter into our practices.

Sources:
1http://www.motherjones.com/politics/2016/01/mother-exposed-flint-lead-contamination-water-crisis
2http://www.freep.com/story/news/local/michigan/flint-water-crisis/2016/01/30/flint-water-lead-health-qa/79475642/
3http://www.cnn.com/2016/01/21/health/flint-water-mona-hanna-attish/

Featured image:
The Flint River, August 2014 by George Thomas