New York City has long been the final destination for incoming immigrant families. Today, that population totals over 3 million people, and nearly 35 percent of them lack access to health insurance. Now one married couple is aiming to provide these families with the pediatric care they otherwise can’t afford.
Dynasty Pediatrics is a private practice with an office in Brooklyn’s Kensington neighborhood. Its founders, Dr. Marina Klotsman and her husband, Schmeil, provide affordable healthcare services for the borough’s newly settled immigrants, many of whom lack health insurance. As a result, the Klotsmans often end up waiving co-pays and other medical fees for those families struggling to make ends meet.
“We put a lot of effort, a lot of time, a lot of our own energy into this place,” says Marina. “It’s not even for business; it’s for the feelings we have. We want to help everybody.”
Schmeil agrees, adding, “The money’s not the main subject in this office.”
Dynasty Pediatrics is open Sunday through Friday, with hours late into the evening. The goal is to make it easier for working-class parents — many of whom support family members living outside the US — to bring in their children without disrupting their work schedules. The Klotsmans also help families explore insurance plans as well as local services like NYC’s universal pre-K program.
That sense of duty goes back to the husband-and-wife team’s own journey to the US from Kyrgyzstan. Schmeil left his home country in 1989 during the dissolution of the USSR, a period he remembers as marred by “chaos.” Marina left eight years later, in 1997, to further her medical career. They would eventually meet in Brooklyn through Marina’s uncle and marry soon after.
Learn more about the Klotsmans’ passion for helping others in the video above.
Tag: doctors
This Anti-Poverty Initiative Was Born in a Hospital Waiting Room
Dr. Michael Hole, a senior resident in pediatrics at Boston Medical Center (BMC), was used to hearing unusual questions from patients, but this mother’s was truly a first: “Can the clinic help me get my taxes done?”
Lacking an accountant’s expertise, Hole referred her to a free tax preparer. But when she returned for her newborn’s next appointment, the mom told Hole she’d taken two buses and a train across town, only to find the place closed. She tried once more the following week, but this time, she didn’t bring the right documents. Fed up, she forked over $400 to a local H&R Block — a huge chunk of her negligible four-digit annual earnings.
The woman’s experience wasn’t an aberration either, says Dr. Lucy Marcil, another BMC pediatric resident. “There were 27 free tax sites in Boston at the time, but they were rarely accessible to families. It might be in a church basement or be open from only 4 to 7 p.m. on a Tuesday. Others have a five-hour-long line of people,” she says.
Frustrated by the situation low-income families confront, Hole and Marcil cofounded StreetCred in 2015 to help working parents complete their annual tax filing. Their unique solution? Set up free prep stations at a place where parents show up regularly: In their case, the waiting room. While the doctor’s doing a check-up, a volunteer is using a W-2 and other records to fill out the parents’ Form 1040. (Often, the volunteers are employees elsewhere in the hospital, like a pharmacist or IT staff member, who receive tax-prep training from local partners.) Last year, StreetCred’s service returned more than $400,000 to approximately 200 Boston families.
Most of those savings come from applying the Earned Income Tax Credit (EITC), the federal government’s largest and arguably most effective anti-poverty initiative. Started by a Republican president in 1975 and given its current shape by Bill Clinton in 1993, the EITC is one of the few programs in Washington to enjoy bipartisan support. Essentially, working families making less than $53,500 can file a “negative tax return,” drawing a check from the IRS worth up to $6,242.
Unlike other entitlements that limit what a recipient can buy (think: WIC and SNAP’s restrictions to certain food items), the EITC’s payback is up to parents’ discretion. “A lot of what they spend money on is major expenses hanging over their head: credit card debt, a roof falling in or a car repair,” Marcil says. “Conceptually, the idea is that you take away financial insecurity and poverty and instability. Those things take up a ton of mental space, and removing some of that frees them up to be more actively engaged: reading to their kids or providing consistent schedules, rather than having to run off to a third job.” With what’s left over, Marcil adds, “they can buy fruits and vegetables for the baby, a winter coat or a high chair — all the things that we think of as necessities to raise a child that are really luxuries to them.”
There’s just one problem: One in five eligible low-income Americans isn’t actually taking the credit. By situating the refund in a medical context, StreetCred has the chance to significantly boost participation rates. For one, 92.4 percent of kids see a pediatrician at least once a year, giving the doctor — a professional that commands parental trust — a chance to ask whether they know about the credit, just like they ask about guns, swimming pools and low windows. (Not that the EITC isn’t within their purview too: It’s been shown to improve maternal and infant health by, for instance, upping birth weight and decreasing maternal smoking.)
Next tax season, which runs from January 23 through April 18, StreetCred will test out their model at three new locations: Boston Children’s Hospital, South End Community Health Center and a homeless shelter. They’ll be looking to see how many families they can reach, the error rates on returns, the refund’s impact on the family and, finally, the way the service changes the family’s relationship with their healthcare provider. And they’ll be piloting another set of services: With their tax form filled out, the volunteer can check whether the family qualifies for other social services they might be missing out on, like Medicaid or a Section 8 housing voucher.
Beginning with Boston, doctors’ checkups are getting much more comprehensive, and families are clearly benefiting from it.
Homepage photo of Lucy Marcil by Matthew Morris/Boston Medical Center
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Correction: An earlier version of this story stated that StreetCred helps parents fill out their Form 1099; they actually assist with filling out Form 1040. NationSwell regrets the error.
What Wives of Veterans Can Learn from Female Soldiers, How Doctors Are Saving the Lives of Gunshot Victims Before the Trigger Is Ever Pulled and More
What Army Wives Need to Understand About Female Soldiers, The Washington Post
Much is said about bridging the military-civilian divide, but as writer (and wife of a veteran) Lily Burana realizes, there’s also a distance between the women who proudly sport the uniform and those who are married to someone wearing it. Knowing that the military is full of inspirational females — including those now serving in the Ranger division — Burana set out to build a bridge the only way she knew how: by sitting down to lunch and having a chat.
Are Doctors the Key to Ending Philly Gun Violence? Philadelphia Magazine
Renowned for providing lifesaving medical treatment to kids, doctors from the Children’s Hospital of Philadelphia are focusing their efforts on reducing the cycle of youth violence that plagues the City of Brotherly Love. The hospital’s Violence Intervention Program (VIP) grew out of internal discussions about the Sandy Hill Elementary School shooting in Newtown, Conn., and a shocking report from the city government, which found that 5,051 Philadelphia youth were shot or murdered between 2006 and 2012. It’s difficult to know for sure if the screenings, bully prevention lessons and intensive counseling sessions, which make up VIP, is reducing the number of gunshot victims, but the outlook is hopeful, considering most participants say they desire to be a normal teenager, not one packing heat.
The Power of Vision in Urban Governance, Governing
Every politician may have the goal of being dubbed a “visionary leader,” but Indianapolis’s former four-term mayor, Bill Hudnut, actually was. In order to bring forth the Midwestern city’s potential, Hudnut enlisted help from Indianapolis business and philanthrophic leaders and economic development experts at the Massachusetts Institute of Technology. Together, these heavy-hitters combined their strengths, collaborating on a plan that eventually brought $1 billion to the local economy — proving that collective vision and use of community assets is key to long-term impact.
The Mobile Health Clinic That’s Been Helping the Poor for 40 Years
In 1976, Dr. Augusto Ortiz and his wife Martha looked to a donated school bus as a means to achieve their dream of providing free medical care to the poor of Tucson, Ariz.
Today, The University of Arizona Mobile Health Program (MHP) visits communities in a big, shiny trailer stocked with all the amenities of a regular health clinic — including an EKG — but the spirit behind it remains the same 40 years later.
The MHP makes regular rounds of communities in southern Arizona, serving about 2,400 uninsured and under-insured people, plus those that don’t have regular access to health facilities. Additionally, since 2003, the MHP has run group prenatal care appointments for expectant mothers, serving many who would never have received the important care otherwise and resulting in the delivery of more than 200 healthy babies.
Still, for all the poor that have been helped by the MHP, the impact on doctors-in-training may even be greater. The clinic is staffed with medical residents and students in public health, pre-med and pre-dental programs at the University of Arizona. Tammie Bassford, head of the Department of Family and Community Medicine at the University, tells Linda Valdez of AZ Central, “It has a profound impact on students.”
Bassford recalls one time when MHP staffers asked a patient if she needed any help with anything besides her health. She told them that she lacked a pot big enough to cook beans for everyone in her family. The MHP was happy to provide her with one.
Dr. Ortiz died at age 90 in 2007, but his wife Martha, now 90, is still involved in fundraising for the mobile health clinic that they founded. She believes in helping the poor for purposes of altruism, but also for the practical reason of preventing the spread of disease. “If somebody is standing next to you in the grocery line and coughing, it’s possible they have tuberculosis, and don’t know because they can’t get to a doctor,” she tells Valdez.
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How 3D Printing Can Reduce Medical Expenses
Sometimes, it seems like medical expenses cost an arm and a leg (figuratively, of course). And that’s not just the case for patients, but doctors and researchers, too.
That’s all about to change though, thanks to a recent innovation involving 3D printing, syringes and the Michigan Technological University. The research team, led by Joshua Pearce, has created an online open-source syringe pump library — so now, instead of ordering equipment, doctors can download, customize and 3D print their own pump (which is used to give doses of medication or fluids to patients).
All of the designs are customizable and all a physician needs is a RepRap 3D printer, small electric stepper motor that drives liquids, simple hardware and a syringe.
“Not only have we designed a single syringe pump, we’ve designed all future syringe pumps,” Pearce tells Michigan Tech. “Scientists can customize the design of a pump for exactly what they are doing, just by changing a couple of numbers in the software.”
Not only is this more efficient for physicians, but the 3D printing will drastically cut the cost of the equipment as well. While most open-source syringes run about $250 to $2,500, a 3D printed one only costs about $50 (the cost of the materials).
According to the researchers at Michigan Tech, “the development of open-source hardware has the potential to radically reduce the cost of performing experimental science and put high-quality scientific tools in the hands of everyone from the most prestigious labs to rural clinics in the developing world.”
Michigan Tech biomedical engineer Megan Frost agrees. She’s been using the 3D pumps to inject agents into culture cells.
“What’s beautiful about what Joshua is doing is that it lets us run three or four experiments in parallel, because we can get the equipment for so much less,” she tells Michigan Tech. “We’d always wanted to run experiments concurrently, but we couldn’t because the syringe pumps cost so much. This has really opened doors for us.”
Presumably, with the advent of 3D-printed equipment, the financial savings will be passed along to patients. Meaning that going to the doctor’s will soon be a little less painful — on your wallet anyways.
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Would You See a Doctor Who Never Completed His Residency?
For most of us, going to the doctor can be as simple as making an appointment. But for some, especially those in living in rural areas, getting medical care can be much more difficult.
This is the case for those living in desolate locals of Missouri where 40 percent of the population reside, but only 25 percent of the doctors statewide practice.
However, that’s scheduled to change, due to a new law signed by Gov. Jay Nixon earlier this month. Under it, medical school graduates will be allowed to practice in underserved areas without completing their residency.
In every state, medical school graduates can’t apply for their license until they have completed a residency that lasts at least a year. That is, in every state except for Missouri. For those graduating in the Show Me state, they can begin to practice immediately upon completion of their licensing exams — even if the residency still isn’t finished.
Instead, the grad will work as an “assistant physician” alongside a “collaborating physician” who agrees to be responsible for the assistant. After a month, the assistant physician will be allowed to work independently, but still under the watchful eye of the collaborating physician.
The new law is dividing medical professionals. Proponents express its need considering how few doctors there are to serve underserved areas, which are defined as a place where there is a low ratio of primary-care doctors per 1,000 residents, a high rate of infant mortality or where many senior citizens and others live below the poverty line.
Opponents, however, are not so sure that this is the best solution for Missouri residents. Since many those living in underserved areas may need more medical attention, a recent grad with little experience might not be the best option.
Rosemary Gibson of the Accreditation Council for Graduate Medical Education is one such person wary of the law. “Primary care is not simple,” Gibson told Governing. “If you have a lot of older people living in rural areas, they have a lot of co-morbidities [such as diabetes combined with heart disease].”
Jeff Howell, a lobbyist for the Missouri State Medical Association, sees the law as a viable and helpful solution and believes that the critics’ concerns about the qualifications of the grads aren’t warranted. “They’ll still be in collaboration with a licensed physician,” Howell told Governing. “That collaborative practice never disappears.”
While those in the medical field continues to squabble over whether or not this is a good idea, for those in rural Missouri, this law could make a doctor a stone’s throw away.
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An App That Turns Everyday Bystanders Into Everyday Heroes
When an airplane passenger is in physical distress, the flight attendant calls through the speakers asking if medical professionals are on board. It’s a simple action that can make a huge difference. What if we could mimic this same outreach, 10,000 feet below, everyday on the ground?
That’s exactly what the smart phone app PulsePoint (for download here) makes possible, according to Emergency Management. Using the gadgets we all carry every day, municipalities that use the free mobile service are able to send out alerts to CPR-certified citizens who are nearby someone in need. In many cases, there are just a few minutes between life and death, so every second counts. By quickening response times, this app can help save lives — before an ambulance is even in sight.
PulsePoint doesn’t replace dispatched responders, but as fast as ambulances and emergency medical technicians try to arrive, they’re often not quick enough. Once 9-1-1 is dialed and the available crew is actually with the patient, it can be too late – making those that can arrive quicker a vital resource.
San Jose became the first area city to use PulsePoint in 2012 — the app’s founder and CEO, Richard Price, is from the area, having worked as an ex-fire chief of the San Ramon Valley Fire Protection District. Since then, it’s caught on thanks to support from a local hospital and the results it provides. A local hospital is also planning a public registry of automated defibrillators through a new, related app, PulsePoint AED.
With decreasing local budgets for emergency response, increasing populations and traffic congestion, the demand for innovations like PulsePoint is greater than ever. By alerting off-duty first responders, medical professionals, and other CPR certified individuals of a nearby need, PulsePoint turns them into valuable lifesavers, all with the tap of a phone, making the app early — and effective — when time means everything.
The Doctor’s Order? Spend More Time in Nature
We’ve all fallen victim to spending too much time cooped up inside, hunched over computers and binge-watching television shows. So in an effort to curb those nasty habits and get young people moving, one innovative Washington, D.C., doctor is teaming up with the National Parks Service to treat sickness with sunshine.
Dr. Robert Zarr is the chief evangelist for Park Rx — a database of parks and greenery that doctors can access when treating patients. The service allows physicians to locate a patient’s electronic record, ask them about what they like to do to keep in shape, and make recommendations to nearby parks based on their preferences.
With the help of the National Parks Service, the D.C. Department of Parks and Recreation and others, Zarr mapped out and rated 380 parks for activities, cleanliness, safety, and transportation accessibility, according to Fast Company. Doctors can print out recommendations with maps and pictures as a sort of natural alternative to prescriptions.
“We wanted to know whether actually prescribing a park during a doctor’s visit would change behavior,” Zarr said. “And the answer was ‘absolutely yes.'”
The program, which launched last July, has already acquired 30 participating doctors at Unity Health Care. The results have garnered around 550 prescriptions and feedback revealed an average increase of 22 minutes of activity per week among 400 children.
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Zarr claims his inspiration stems from Last Child in the Woods, a book about “nature deficit disorder” and its impact on our youth’s health. But the idea is also part of a National Parks Service movement to promote the outdoors as a health prevention strategy. Thanks to the doctor’s advocacy, the program is successfully combining medicine with nature.
While encouraging patients to spend more time outside as a means to improve health is nothing new, Zarr acknowledges it can require some convincing. “Once you get over the conceptual hurdle of prescribing park, and you believe the scientific literature that clearly says being outside is good for health, then all it takes is to push a button on a computer. They have to do that anyway.”
The nature evangelist is aiming to develop a mobile app and one day, hopes to add, “have you been outside recently?” as a primary question in patient pre-interviews when checking vitals. For many of us, that answer is probably be “not as much as I should.” But hopefully, the Park Rx program is helping to change that.
Back to Basics: How One Health Nonprofit is Rethinking Clinical Care
As Americans adjust to a new healthcare system, some providers are beginning to dig deeper into the social conditions that may lead a patient to seek medical treatment in the first place. They’re finding that sometimes, a prescribed antibiotic is simply not the answer.
That’s the thinking at Health Leads, a Boston-based organization that partners with healthcare institutions to provide non-medical assistance for vulnerable patients.
Why this new method of treatment? Too often, doctors end up prescribing medication, but instead of getting better, the patient actually worsens as he or she continues to live in poor conditions. The cyclical nature of this process leads to patients returning to seek more treatment, which then becomes a costly venture for hospitals. (For example, instead of giving medication to someone living in a car, what that patient may really need is access to proper housing or heat instead.) But what if doctors “prescribed” healthy food, housing or other basic needs?
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At Health Leads’s institutions, after seeing a doctor, patients are directed to meet with volunteer “advocates,” which typically are college students. These volunteers work with these patients to get them better access to public benefits and community resources. Their goal, according to the Stanford Social Innovation Review, is to transform the way institutions deliver health care by addressing how social factors can shape healthy living.
But the program, which connects 1,000 student volunteers with 14,000 patients and families, is keeping its focus small. Rather than expanding on a large scale, the project is partnering with just a few institutions — such as academic medical centers and for-profit hospitals — to create models for other institutions to emulate. Health Leads is also focusing on collecting data from its partnerships to further support transformation across the health care industry.
“Going small may not be glamorous,” Health Leads’s Rebecca Onie, Sarah Di Troia and Sonia Sarkar write. “But if we can couple a powerful on-the-ground demonstration with pathways to change the sector, we will have the opportunity at last to transform health care for patients, physicians, and us all.”
While addressing social conditions like public safety, economic inequality, and food security is nothing new, it’s important to see organizations like Health Leads make the connections between healthy living and health care.
This Medical School Is Training Doctors in Compassion
Many immigrants arrive in America desperate to escape persecution and torture in their home countries. The U.S. grants asylum to immigrants who apply for it within one year of their arrival and can prove that they suffered persecution based on race, religion, political beliefs, nationality, or belonging to a social group. Proving this is the trick, however, and most immigrants who arrive traumatized, suffering from PTSD or depression, don’t have the resources to pay for a medical evaluation to prove their ordeal.
That’s where medical students at the Weill Cornell Medical College step in, providing free medical evaluations to asylum seekers. It’s the first student-run clinic of its kind, a partnership with the non-profit Physicians for Human Rights. As Carmen Stellar, the clinic’s director of organizational operations and a second-year medical student, explains to the New York Daily News, “having a medical affidavit as part of their case triples the likelihood of their being granted asylum.”
Under the direction of professors, the medical students meet with about 60 immigrants a year seeking asylum. They perform examinations, looking for physical or psychological evidence to prove the immigrants’ claims in court. The medical students look for scars from torture, female genital mutilation, or psychological distress, assuring that the evidence matches the immigrant’s story. So far, the clinic has met with 117 asylum seekers from 40 countries. All of the immigrants they’ve worked with who have taken their claims to court—34 so far—have been granted asylum or legal protection.
Alejandro Lopez, in his third year of medical school, is the clinic’s executive director. He recalled the first asylum seeker he met with, a gay man from Nigeria government officials persecuted because of his sexual orientation, even killing his mother. “He received asylum. So that’s extremely satisfying,” Lopez says. “You feel like you actually did something to impact someone’s life.” With programs like this one training compassionate doctors, this is just the first of many lives Lopez and his colleagues will impact.
MORE: Paperwork Stood Between Immigrants and Their Dream, so This Group Stepped In