By Robin Eisner

Stuart Weisberg’07 knew that during his M.D./Ph.D. training he would want to volunteer in the community in some way, possibly with children because he expects to specialize in pediatrics.
   So in 2004, while doing his doctorate research on the molecular biology of diabetes, Mr. Weisberg fostered a relationship with science teachers at Harlem’s Mott Hall School, an elementary and intermediate school that specializes in mathematics, science, and technology. What resulted is a program that each year brings Columbia medical and graduate Posterstudents to the public school to serve as mentors and judges on student science projects. In 2006, the Mott Hall Science Mentoring Program officially joined the P&S Club, giving the program continuity after Mr. Weisberg graduates.
   Mr. Weisberg is one of a growing number of P&S students dedicated to serving the community during their education. As the relationship between Columbia University Medical Center and the surrounding Upper Manhattan neighborhood flourishes, medical students have many opportunities to provide voluntary service in both curricular and extracurricular ways. More faculty members and resources are available to foster ties with community groups, and students, inspired to reduce disparities in health care for minority populations, are creating new volunteer programs all the time.

More Community Participation in Curriculum
“Students are devoted to the idea that they have to give back to the community where they are getting their medical education,” says Rafael Lantigua, M.D., professor of clinical medicine and co-principal investigator of the Columbia Center for the Health of Urban Minorities in the Center for Community Health Partnerships. “When I first came to Columbia more than 20 years ago, there were fewer community programs. Now, there are many, and the new dean has asked me to participate in a curriculum review with the goal of further increasing community participation as part of training.”
   Dodi Meyer, M.D., assistant clinical professor of pediatrics and director of community pediatrics, agrees that in the past five years Columbia has had tremendous success in securing funding for community-based projects to increase student volunteering, learning, and community involvement in physician training. “The school has made a commitment to include community-geared efforts in the curriculum,” she says. “All this resonates with the students, who then want to get even more involved.”
   In these win-win partnerships, members of the community educate the students about the socioeconomic, cultural, and health-care challenges facing the population living nearby, and the students, in turn, offer health-related, mentoring, and other support services to their “teachers,” explains Milagros Batista, community liaison for the community pediatrics program and co-founder of Alianza Dominicana, a 20-year-old nonprofit community development organization that offers services to approximately 17,000 New Yorkers at 11 sites.
   Some of the community-oriented programs fall outside the curriculum, such as the free, student-run, 3-year-old primary health care clinic for the uninsured called CoSMO (See P&S, Spring/Summer 2004) and Community Pulse, a student-created conference that addresses community health issues (P&S, Winter 2007). Others, such as TeamWoRx (P&S, Fall 2006), which facilitates the transition of students to the clinical third year by having students participate in community-based projects, are formal aspects of a P&S education.
   Still other medical student projects, such as SHOP, a beauty salon-based informal health information program for patrons; GIRLTALK, a high school-based program that addresses sexual and other health issues of teenage girls (P&S, Spring/Summer 2004); and AppleWars, an elementary school-based nutrition elective and obesity prevention initiative, initially involved only family medicine residents. The projects originated with residents in family medicine through their training in community-oriented primary care throughout their three-year residencies. Family medicine residents mentored medical students as the projects expanded to include students interested in community health, says Anita Softness, M.D., assistant clinical professor of family medicine and director of community medicine at the Center for Family Medicine.

Trust Vital for Community Projects
Otibho Obianwu’08, community liaison for BALSO (the Black and Latino Student Organization), heard about SHOP — Salon Health Outreach Program — when she met Pablo Joo, M.D., assistant clinical professor of family medicine, director of predoctoral education, and co-director of the primary care clerkship, during her second year. “He told us a resident had started SHOP,” Ms. Obianwu says. “I signed on to SHOP because I felt that it was an excellent opportunity for BALSO students, including myself, to participate in a unique health promotion initiative that reached out to the community around us. I am interested in health promotion and preventive medicine and I think SHOP is a great way to bring health-related information to members of the community.”
   She helped organize three education sessions — on contraception, nutrition, and emergency contraception — at a salon frequented by Dominican women near a neighborhood family medicine clinic. The topics were chosen by the residents, who focused on subjects frequently addressed in the family medicine clinic.
   “We chose the salon because the owner had been receptive to SHOP talks in the past,” Ms. Obianwu says. “It was convenient for the residents who worked nearby and close to the subway for the medical students traveling there.”
The sessions took place on Tuesday or Wednesday evenings between the winter of 2005 and spring of 2006. A family medicine resident made a brief presentation and residents and medical students moved around the salon to answer questions. The volunteers always included Spanish speakers.
   Ms. Obianwu attended the emergency contraception discussion. “There were about 15 women ranging in age from mid- to late teens to early 60s in the salon, not all of whom were getting their hair done,” Ms. Obianwu says. “The salon is a social gathering place.”
   Ms. Obianwu had been concerned that older women might react negatively to the emergency contraception topic. But they didn’t, she says, and were open to the information for relatives. “We always left printed material in case someone did not feel comfortable talking about the issue with us,” Ms. Obianwu says.
   Encouraged by SHOP’s success, she and other volunteers hoped to expand it to African braiding salons in Harlem but decided they first need to develop trust with the owners, taking into account Columbia’s sometimes tense relationship with the Harlem community. “Even though another student and I who approached shop owners are African, the owners did not want a group with no ties to their community to come into a place that is a haven for them,” Ms. Obianwu says.
   Ms. Obianwu found SHOP gratifying and valuable for her training as a physician. “SHOP is an excellent opportunity to perform health promotion outside of the clinic setting. It is one thing for medical students and health professionals to understand the pathophysiology and medical management of diseases but it is quite a different thing to communicate this information to our patients.”
   SHOP is too early in development for it to be measured for effectiveness, but Ms. Obianwu says, “I believe that disseminating the information to the women is better than them not receiving the information at all.”
   Dr. Joo submitted the program as a poster presentation for the Association of American Medical Colleges annual meeting, so Ms. Obianwu and others attended the 2006 conference to share information about the program.
   “One of the reasons I came to P&S is because I met students during the interviewing process who were involved in the community and trying to improve the health of the residents around the medical center and throughout the world,” says Ms. Obianwu, who will take a year away from P&S next year to earn her master’s degree in public health and plans to work in developing nations. “Simply being in medical school is not the reason I came to medical school. Being involved in community service like SHOP was a major motivating factor in my choosing to attend medical school and for my selecting medicine as a career in general.”
   The responsibility to keep SHOP alive has been passed to Erica Farrand’09, the current BALSO community liaison. Ms. Farrand is looking for other salons and has contacted Alianza Dominicana to help. “We realized we need a cultural broker between the medical center and the community,” says Ms. Farrand, who also volunteers for GIRLTALK, CoSMO, and the Lang Youth Program.
The Lang program, which began in 2003, is run by New York-Presbyterian Hospital for Washington Heights students. The program offers science classes, clinical experiences, mentoring, internships, and college tuition assistance to seventh graders through high school seniors. The program’s goal is to increase representation of minorities in health sciences professions.
   Ms. Farrand has committed herself to be a buddy in the Lang program and to have lunch once a month with a group of four students, who are now ninth graders. She started working with them in eighth grade and will be with them until she graduates. “The social aspect of Lang is important to the youngsters,” Ms. Farrand explains. “When they meet with us informally they ask us candid questions about the process of medical school and see it can be done. These kids feel pressure to abandon their educational pursuits because peers are not as committed as they are. It can be a challenge for them to stay motivated, when their school might not have a math teacher. We also help them keep balance in their lives, telling them to take time for fun so they don’t get burned out too soon since they are starting young.”

Passion and Commitment
The many other medical students who participate in community projects are passionate about why they do it. “We learn a lot of science in class, but we also learn about health disparities and that so many diseases adversely affect African-Americans and Latinos,” says BALSO president Taison Bell’09, who works for CoSMO and is a mentor in the Lang program. “The problem is not something that we can just gloss over. We want to do something to help change the situation.”
   Jeanne Franzone’09, Catherine Seager’09, and Abigail Chiverton’09 have been working with girls and boys between fifth and eighth grades on their basketball and other athletic skills in the Police Athletic League after-school program at the 168th Street Armory. “We do it because we hope we can have an impact on the community by interacting with children,” Ms. Franzone says. “Although we are not yet doctors, we can begin to help educate young people about leading a healthy lifestyle.”
   “Working in the community helps us see how we are different from patients, that we may have different education and cultural experiences,” says Stefan Samuelson’08, a Brown Primary Care Scholar. “By understanding those differences and figuring out how to bridge the gaps, we hope we can provide the best care.”
   Christopher Hale’09, volunteers at CoSMO and worked on a project with resident Maria Kim, M.D., and Alianza Dominicana to develop a cookbook with health-conscious recipes featuring Dominican cuisine. Mr. Hale speaks Spanish fluently and volunteered as a translator in a free clinic before starting medical school. For the book, he interviewed a few neighborhood residents about barriers to better nutrition. Edited transcripts are included in the book. “The problems in health care can be overwhelming,” Mr. Hale says. “As a medical student I cannot change the world, but I can try to make changes in my community.”
   All the community-oriented projects allow medical students to transform their world as much as they can, given the time constraints of training. “I helped develop the Mott Hall program mainly because I feel that a quality science education is incredibly important for young students. Their future careers, and their future health choices, depend on it, so I wanted to do something to promote science education in this community. A bonus for me was being able to practice communicating with children,” Mr. Weisberg says. “For the mentors, it means being connected to the community where they are going to school. They see the students from Mott Hall on the street and they say hello, and it makes them feel they are doing something special in the world of Northern Manhattan.”

A Sampling of Community Projects Involving Medical Students

AppleWars: This first-year nutrition elective, which began in March 2006, brings medical students to nearby fourth and fifth grade classes to educate children about making healthy food choices and preventing obesity.

Brown Primary Care Scholars: This medical school track allows a small group of students to focus special attention on family medicine or general pediatrics and to work on community-based projects.

CoSMO (Columbia Student Medical Outreach): The free, student-run primary health care clinic for the uninsured provides care to about 200 patients. Approximately 250 students, from all health sciences schools, are listed as volunteers. Students are now doing fund-raising to offset some operating costs.

Community Pulse: This annual student-run conference, inaugurated in 2006, addresses the issue of community health, both locally and globally.

GIRLTALK: Medical students go to high schools and talk to teenage girls about reproductive health issues and HIV-AIDS.

Hep B Screening (with the Asian Pacific Students Association): Students partner with clinics and organizations in Chinatown and Washington Heights to do hepatitis B screenings.

La Dieta de Milagros (The Miracle Diet): Alianza Dominicana and New York-Presbyterian Hospital resident Maria Kim developed a cookbook with health-conscious recipes featuring cuisine from the Dominican Republic. Medical students interviewed community members for the book.

Lang Youth Mentoring Program: Medical students coordinate, teach, counsel, and provide leadership training for students in the program, which offers science classes, clinical experiences, mentoring, and internships to students from the seventh grade through high school.

Mott Hall Mentoring Program: Medical and graduate students provide mentoring on science projects for Harlem’s Mott Hall Public and Intermediate School. Volunteers can either advise on seventh grade projects or be judges for one day at school-wide science fairs.

S-Prep (State Pre-College Enrichment Program): Medical students help teach and coordinate this rigorous academic program for minority and economically disadvantaged high school students, grades 9-12, who are interested in science, medicine, or related health professions. This year marks the 20th anniversary of the program, which has served hundreds of students who have enrolled in higher education institutions across the nation. CUMC’s Office of Diversity is participating in statewide celebrations of the program and its graduates.

SHOP (Salon Health Outreach Program): The health education initiative, started by family medicine residents, takes place in community beauty salons and now includes medical student participation.

Striding for Better Health: In this program, medical students volunteer to help Washington Heights teens become more physically active and health conscious. They do team and other sports with fifth through eighth graders in the Police Athletic League after-school program at the Armory.

TeamWoRx: Started as a way to foster camaraderie as medical students make the transition into their third year, students in 2006 launched team projects in the Washington Heights community, including clean-up projects, working in community gardens, reading to children, and meeting the elderly in senior centers.