Special

Pull-Out Section

Produced by

Ravenswood Family

Health Center

Where Healthy Living Takes Flight

1Ravenswood Family Health Center

Dear Friends:

For over 45 years, community health centers (CHCs) across the nation have received federal 330 grants to provide primary health care to the

uninsured. With 23 million low-income and uninsured Americans receiving their primary health care at CHCs today, the threat in Congress to cut part or all discretionary funding is alarming.

Community health centers are absolutely essential to the implementation of the Health Care Reform in 2014. CHC’s need to expand primary care services and facilities to accommodate newly enrolled health plan covered patients, especially those on subsidized programs. Despite the need for improvements, undermining the Affordable Care Act by taking away key provisions is a bad idea. As Ian Morrison, author and futurist in health care planning observes about the debate:

“While it may be perfectly logical to talk about repeal and replace, it is a policy disaster in the making. Just like climate change, we don’t have time to play chicken. Healthcare costs are a national security emergency. Lack of coverage and care for low-income people is a national disgrace. Working families are financially devastated by illness. Mothers of children

with pre-existing conditions live in fear of being uninsured.”

Caution is needed. The proposal to block grant Medicaid to the states means every state will have to restructure their entitlement programs, including their contractual relationships with their medical providers. This will take apart systems that took decades to set up which is not only an unnecessary expense, it will reduce access to care to some of the most vulnerable populations, those with chronic diseases, disabilities, the aged and infirm as well as affect programs for preventing disabilities in children. Dismantling Medicare for our elderly retired citizens and leaving them exposed to the vagaries and speculation of the marketplace violates our social contract. As the richest industrial nation in the world this is unconscionable.

While Wall Street reports economic recovery is underway and corporations are able to pay out bonuses, and jobs continue to go overseas – the poor who did not cause this economic recession, remain trapped, caught in the “aftermath” with high unemployment, home foreclosures, and cuts in life-saving benefits. As one of the safety nets of health and social services providers, we are bracing for greater need and less

money. 23% of RFHC’s budget comes from federal discretionary funding. Best case, we expect a 5%-10% cut in government funding in the coming fiscal year. We have regrouped to see how we can make up the revenue with greater productivity and efficiencies but are concerned about the stress this brings to our already over extended and committed staff.

Please help us by contacting your Local, State and Congressional representatives. Let them hear voices of reason, voices of caring. Encourage them to use their legal powers to keep the safety net intact.

Wishing you well,Luisa BuadaChief Executive Officer

Committed to providing the

Luisa BuadaChief Executive Officer

qualityHighestcare servicesof primary health

Ana Tuipulotu’s day be-gins with phone calls to Pacific Islander

patients. She leaves a message for a patient who works 7 days a week as a caregiver. Ana recommends that she find a substitute so she can come in for a one-on-one education session. The patient’s Hemoglobin A1C (a measure of how well diabetes is being controlled) is 11.9, a blood sugar count that is dangerously high.

Ana grew up in the Kingdom of Tonga, an ar-chipelago in the South Pa-cific where the daily mean temperature is in the mid-70’s January through De-cember. She was a health educator there before com-ing to the States.

Diabetes is not common in Tonga, she says. The difference is the food and the lifestyle.

“Back in the Islands, people can’t afford soda, canned or frozen foods. Most people have their own plantation. Everything they

eat is fresh. They pull the taro and yams out of the earth and cook it the same day. If they need fish, they go to the sea, catch it and eat it. Or they kill a chicken from the yard.”

Food is an essential part of the culture. Every Sunday morning in Tonga, people wake early to pre-pare the meal, taking taro leaves, stuffing them with

meat and coconut milk, wrapping it with banana leaves and laying them on very hot stones in an earth oven that is covered over with banana leaves and soil.

“It’s quiet over the whole island; the only thing you hear is the church bells. In the afternoon, after families return from church, you set the food on a table and if you have 4 neighbors, you divide the food, putting a portion on a plate to give to each of them; they do the same for you.”

In the islands, she says, people are much more ac-tive. “You get up and go outside to work in the gar-den or hang the laundry. It’s not like here where you

stay in the house every day and lock the door and you only have a small patch for a yard.” These differences take their toll on the health of islanders.

24% of RFHC’s Pacific Is-lander patient population has diabetes.

Teaching patients to manage their diabetes is a top priority. Diabetes has alarming consequences, if unchecked. It takes aggres-sive training in self-manage-ment to help patients bring diabetes under control. RFHC’s Chronic Disease Management team has 5 Patient Navigators (2 Pacific Islanders, 2 Latinos, and 1 African American) who are trained to gently, but firmly coach patients in the man-agement of diabetes.

On Friday morning, 24 Pacific Islanders arrive for a special diabetes educa-

tion session. All of them are there because they have uncontrolled diabetes. 99.9% don’t understand the relevance of their A1C num-ber recorded on a paper handed to them at the start of the class.

Ana lectures for an hour. She talks with power and energy, gaining mo-mentum like a locomotive as she drives home the re-alities of diabetes. She dia-grams on the white board. “This is what happens when arteries narrow.” She mimics the muted boom-boom of the heart pumping harder. She sketches the kidneys that can fail, lead-ing to dialysis and warns of hemorrhage in the eye that can cause blindness.

She reaches into a box and brings out a life-sized foot. Blood glucose can in-jure the walls of tiny blood vessels that nourish your nerves, especially in the legs.

You can’t miss the mes-sage. Ignore diabetes and you can lose your eyesight, kidney function, even your limbs. The effect on the audience is obvious. From casual attention at the start to alert recognition. Their awareness collectively seems to have jumped from a 3 at the start to a 10 at the end.

2 Ravenswood Family Health CenterRavenswood Family Health Center

Ravenswood Family Health

Center’s mission is to improve

the health status of the

community we serve by providing

high quality, culturally competent

primary and preventive health

care to people of all ages

regardless of ability to pay .

— Mission Statement

Provide integrated, coordinated primary health care to low-income and uninsured residents of southeast San Mateo County

What we do

3

Primary Medical Care• Pediatric & Adolescent Medicine

• Adult Medicine

• Prenatal Care

• Screenings & Immunizations

• Women’s Health

• Referrals to Specialty Care

Integrated Behavioral Health Services• Crisis intervention

• Short-term Counseling

• Pediatric & Adult

Social Service Referral

• Parenting Support

• Psychiatric Consult

• Domestic Violence Counseling

Center for Health Promotion• Chronic Disease Management

• Health Education

• Health Coverage Enrollment

Ravenswood Family Dentistry• Pediatric & Adult Dental

• Preventive care

• Restorative & Periodontal care

• Oral surgery

• Emergency dental services

• Oral Health Education

Patient Navigator: Life Changing Coach

Ravenswood Family Health Center - Main Clinic Tel: (650) 330-74001798A Bay Road, East Palo Alto, CA 94303

Center for Health Promotion1805 Bay Road, East Palo Alto

Ravenswood Family Dentistry1807 Bay Rd., East Palo Alto(650) 289-7700

Belle Haven Clinic Tel: (650) 321-0980 100 Terminal Avenue, Menlo Park, CA 94025

Mobile ClinicVarious sites in the school district and where homeless congregate

Board of DirectorsMelieni Talakai, ChairJulio Garcia, Vice ChairManuel Arteaga, TreasurerMarcelline Combs, SecretaryJoseph Lopez, ParliamentarianVernal BaileySenseria ConleyCarlota FloresJonathan LindekeGordon RussellRaymond Mills, Board LiaisonSherri Sager, Board Liaison

Advisory CouncilPatricia Bresee, ChairMaya AltmanGreg AvisCaretha ColemanChris DawesGreg GalloRose Jacobs GibsonDr. Ross JaffeDr. Phil LeeDr. Richard LevyJohn A. SobratoDr. Frederick St. GoarJane Williams

Revenue

Expenses

Donations 2%Federal Grants 25%

County Grants 5%

Foundations 17%Public Health Insurance 51%

Ever since their inception, CHCs have received substantial legislative attention in a remarkable display of bipartisan harmony. In the face of a

national crisis in primary care, sequential legislative initiatives have sought to expand and strengthen the CHC paradigm. New England Journal of Medicine, 6/3/10

Clinic Operations 73%

Other 1%Development 4%

Management & General 22%

The Director of Stanford Health Library, Nora Cain, appointed Edgar Lopez to

be the medical librarian at its new branch in Ravenswood’s Center for Health Promotion. Since Edgar started, the number of people utilizing the library has tripled.

“I grew up in a culture similar this one,” he says. The son of migrant farm workers from Mexico, he spent his childhood in the Delta. He was 4 years old the first time he followed his parents into an orchard to pick up walnuts and 17 when he planted his last vineyard.

Edgar’s first love is music. An accom-plished jazz trombonist, he received a Bach-elor’s in Music from CSU Sacramento. He remembers well the man who first opened his eyes to future possibilities. “As an under-grad I had a professor, 6’6” tall, an African

American who was my role model. I realized, I can do this too.” Edgar went on to earn a Master’s in Library Science at the University of North Texas and is now in the dissertation phase of his Ph.D.

As a librarian, he catalogues the inqui-ries he receives: 59% are requests for in-formation about medical conditions. “One

gentleman with diabetes asked for my help. I showed him a Healthy Roads video that explained how you can examine the soles of your feet using a mirror. It was just what he needed to know. With a bad back he wasn't able to check for foot sores.

Like a true jazz musician, Edgar fields all sorts of queries. He’s sensitive to patrons with limited literacy and shows them the bi-lingual resources they can use.

“It’s my full-time job to not only assist the community but to support the staff that assists the community.”

He is proactive; he asks staff how he can help. He gathers research for medical providers and resources for health naviga-tors. And, he’s an ambassador who encour-ages community leaders to use the library. It’s Stanford’s gift to the community.

Stanford Health Library Comes to Life

Parents Make the DifferenceAccording to a study released in May by the Centers for Disease Control and Prevention, nearly 1 in 10 children now has asthma. – NY Times May 4, 2011

Total diabetes prevalence (diagnosed and undiagnosed cases) is projected to increase from 14% in 2010 to 21% of the US adult population by 2050. (Source: Population Health Metrics 2010)The dramatic rise in the number of diabetics has health care organizations across the nation making chronic disease management a top priority status. Last fall, Ravenswood was one of six community health centers in the nation to be awarded a three-year grant for a comprehensive chronic disease prevention and navigation services demonstration project.

The costly consequences: •Diabetesistheleadingcauseofnewcasesofblindnessamongadultsaged20–74years. •Morethan60%ofnon-traumaticlower-limbamputationsoccurinpeoplewithdiabetes. •Diabetesistheleadingcauseofkidneyfailure,accountingfor44%ofnewcases

Currently, more than 360,000 people in the United States are undergoing dialysis, according to the US Renal Data Service. Medicare spends approximately $73,000 annually per dialysis patient.

Let’s do the numbers

Ana Tuipulotu illustrates the effects of diabetes

East Palo Alto Area is a Hot SpotRates of asthma hospitalization are two

times higher in East Palo Alto relative to the nearby rates in Palo Alto (25.8 per 10,000 versus 12.6 per 10,000).*

Eddie Vasquez has been through a lot for a four year old. In his first year of life, he stopped breathing for a few

moments at a time for no apparent reason. One time when he was in a swing, he stopped breathing. His mother, Irma, called 911. Waiting for them to arrive she remembers, “I raised him up into the wind to get him breathing again.” For her it was a scary, helpless feeling.

When he was two and half, his lips turned blue and they took him to Emergency. He was hospitalized with pneumonia. “Everything changed once we saw him in the hospital on oxygen, taking injections. Seeing him going through all of that,” the father says, “we knew we had to quit smoking for his sake. It was cold turkey.”

Eddie was taken to see Dr. Eliza-beth Baca for follow up care. He was diagnosed with asthma and started on a treatment using a nebulizer. “I had to set the alarm and wake up every four hours throughout the night to put on the mask for his nebulizer treatment.” But, he continued to have occasional asthma episodes.

Dr. Baca put in a referral to San Ma-teo County’s Asthma Management Pro-gram which assists families of children with asthma when the child has had two emergency visits within six months and the symptoms are not being controlled with medical management.

The public health nurse, Marty Rosier, went through the apartment identifying all

the things that were triggers. “All my can-dles and incense went into storage and I donated his stuffed animals to the neigh-bors. The only thing we can’t get rid of is his crocheted blanket. He has to have it with him to sleep. The nurse suggested we wash it in hot water and put it in the freezer in a plastic bag for two hours to kill dust mites. But he’s still using it.”

The nurse identified cleaning sup-

plies that are triggers and gave them the County’s safe list of non-toxic alternatives. “At first I was ‘iffy’ about it, but it works. Lemon juice, vinegar with hot water and a little bit of baking soda, it makes the walls real white.” The nurse addressed other problems–acover-upofblackmoldinthebathroom and in the carpet. The Coun-ty nurse and Dr. Baca both wrote to the apartment complex manager saying Eddie needed to be an apartment with hardwood floors. This month the family will move into a ground floor condo with no carpet.

“Asthma is a complex disease and there’s a lot for parents to understand,”

says Dr.Baca.A key component of asthma manage-

ment is to get families to be part of the process.

The Pediatric Clinic kept seeing the same families coming in again and again with the same issues. Parents were con-fused about the different medications. Like Eddie’s parents, many were not us-ing the control medicine which is key to re-

ducing inflammation. So, together with Sandra Nova, RN, Dr. Baca organized an Asthma Conference and called the parents of children who are seen most frequently. It was a pilot run that proved invaluable to parents, giving them a much better understanding of how to use medications and how to assess their homes for triggers.

Eddie’s mother told Dr. Baca, “This should be a required class for all par-ents that have kids with asthma. A lot of parents don’t understand much about it.”

Eddie is a lot better now. His doctor sees it. His father sees it. “He’s playing and jumping around. He’s being Eddie.

He used to come and tell you he’s not breathing right. Now he’s saying ‘I want to go. Let’s play basketball.’ He’s knock-ing on neighbor’s doors, ‘Can you come and play?'" RFHC received support from •SutterHealthgranttodevelopasthma action plan for pediatric patients with asthma•University ofWashington scholarship for spirometry training to assess lung function in asthmatic children. * Breathe California, Golden Gate Public Health Partnership. 2006 EPA Community Needs Assessment

Dr. Elizabeth Baca exams Eddie with father Edward LaDay

Edgar Lopez, Medical Librarian with Will Cerrato, Chronic Disease Manager

Grap

hic Desig

n by R

oyd H

atta

Ravenswood Family Health Center4

Long before Pat Bresee joined the Advisory Council of Ravenswood

she knew a lot about the concerns and challenges of families in the minority communities Ravenswood serves. For the better part of her professional life, she has been devoted to children and family issues, both in the courts and in volunteer work.

She is an attorney. Her first experiences reach back to her years in private practice in the 70’s and 80’s when she would visit children placed in foster care families in East Palo Alto. In the following 15 years she served as Superior Court Commissioner in San Mateo County, handling adoption and guardianship cases in Juvenile Court. The disproportionate number of minority children in the foster care system remains, to this day, a deep concern to her.

Through her Court work and 15 plus years as a volunteer, serving on the Board of the Peninsula Community Foundation and then Silicon Valley Community Foundation, Pat came to know and support the efforts of community nonprofits to strengthen capacity and resources to resolve community issues.

So, volunteering to serve on Ravenswood Advisory Council is a “hand-in-glove” experience.

What most inspires her? “Possibilities! At a time when

everybody is talking about pulling back and folks in Washington and Sacramento are telling people to pull themselves up by their own boot straps,” Pat sees a big difference in the spirit of the leadership at Ravenswood. “There’s an optimism and a confidence in moving ahead with Ravenswood’s expansion project.” She is investing in what she believes in. “We all have a stake in the health of others and the community as a whole. Everybody has a right to basic health care.”

www.ravenswoodfhc.org

See our Latest Videos at:

Dental Hygiene Externship Program As Ravenswood Family Dentistry continues to

expand its practice, Foothill College’s Dental Hygiene Program has provided much-needed support through dental hygiene student externs. Each Friday, two Foothill students spend a full day at the clinic, seeing patients and assisting Ravenswood staff in clinic operations.

“The state-of-the-art clinic at Ravenswood allows them to try equipment that they may not have tried before,” Externship Coordinator Joyce Bettencourt says of the partnership.“They quickly become more independent and self-confident with these experiences. It is truly a ‘win-win’ partnership.” To date, the students have given over 250 hours of service to Ravenswood’s patients.

While the clinic has benefitted from the contributions of Foothill’s students, the externs are also coming away from their experience at Ravenswood with a greater respect and appreciation for working in the community. Many students have encouraged their fellow students to volunteer at the clinic, and some have come back independently to continue their service. Foothill Professor Phyllis A. Spragge says, “We see our former graduates volunteering in our partner clinics. That is the strongest legacy of the program.”

Stanford Patient Advocacy ProgramWhere can college students get hands-on under-

standing of primary healthcare in a community setting without travel-ling overseas? If you ask some of Stanford’s Patient Advocates, they might say Ra-venswood Family Health Center.

In a partner-ship between the Stanford School of Medicine’s Office

of Community Health and Ravenswood Family Health Center, undergraduate students take a year-long inten-sive course training them in medical practice and cultur-ally competent care techniques. In return, they have the opportunity to apply their skills at Ravenswood, under

the supervision of a medical provider. Students participating in the program assert that their

clinic experience is much more than just an internship. Carmen Stellar, one of the current Advocates, explains that her experience was nothing less than transformative. “I became interested in Stanford’s Patient Advocacy Program because it integrates classroom learning with community service,” she says. “I have become aware of the extreme need within the community, which can only be alleviated by the cooperation of many helping hands.”

The skills-based learning model has also inspired students to continue their work in community health care settings. Zach Wettstein, an Advocate focusing on creating educational materials for Ravenswood patients, credits his positive relationships with Ravenswood staff and providers with his increased desire to pursue a career in medicine. Of his plans for the future, he says, “I hope to work with a community-based organization to improve public health outcomes. After my time here, I’m even more excited to get out and start working towards the goal of equitable access to health care.”

Pharmacy Assistance ProgramJames Smith and Abigail Thornburg have been vol-

unteering in the Ravenswood dispensary since October of 2010. Because of the support James and Abigail have provided to the Ravenswood Pharmacy Team, more patients have been able to receive their medications through a reduced cost pharmacy program, savings them hun-dreds, if not thou-sands of dollars.

James and Abi-gail help the Raven-swood pharmacy technician order medications, com-plete applications, and call patients to inform them that their medications are available for pick-up. Recently, the Ravenswood dis-pensary has been undergoing some major changes and both volunteers have been instrumental in helping the Ravenswood staff stay on top of their work loads.

When asked what they enjoy most about volunteer-ing at Ravenswood they both mention the interaction between the patients and doctors. James compared it to a larger clinic like Kaiser, saying, “The patients come in more often here, and the doctors seem to have a better rapport with their patients. It makes family practice seem more interesting.” Abigail added, “I like how it feels like a community–Ireallyrespectthedoctorswhoworkhere!”

The Ravenswood staff and patients thank James and Abigail for all of their help this year. We also want to wish Abigail well as she begins her freshman year at Dartmouth this coming fall!

Externship Coordinator Joyce Bettencourt spends time in clinic with hygiene students who have participated in Ravenswood Family Dentistry’s program

Carmen Stellar and Zach Wettstein are patient advocates at Ravenswood Family Health Clinic

Abigail Thornburg spends time sorting medications in the dispensary

Patricia Bresee Chair, Ravenswood Advisory Council

Please mail to:Ravenswood Family Health Center1798A Bay RoadEast Palo Alto, CA 94303 Tel. (650) 617-7830 Fax (650) 321-1156Visit our website to donate online

We Need Your HelpWe welcome your donation of cash, stock, or gifts in kind.

Name:

E-mail:

Address:

City: State: Zip:

Please send information about Ravenswood Family Health Center

Enclosed is my contribution of $

I would like to remain anonymous

Ravenswood Family Health Center is a tax exempt 501(c)(3) nonprofit agency

Spotlight on Volunteers