The theme of this week, per block 1 faculty leaders, has been health inequities. In our IQ groups (small groups) our case has centered around STDs. As part of our learning experience we had the opportunity to head out into the community to learn more about HIV/AIDS. I was paired with one of my friends to head out to the county jail in downtown Cleveland (seriously, there is a jail directly across from the Browns Stadium!).
Care Alliance, a federally funded medical care center for the indigent population conducts public health research regarding medical care seeking behavior among HIV positive inmates upon their release from jail. Basically, I had the opportunity to shadow one of the researchers during her interview with an inmate. I had the opportunity to chime in and talk with the inmate during this time.
I got to know Steve pretty well. He is 29 and has been a crack addict for the last 20 years. Do the math. He's also done pretty much every other drug on this planet. Steve has a high school education and has been homeless the last decade. His family has pretty much shunned him from their lives and he was basically free to roam the streets and make money as a sex worker. Five years ago he was hospitalized to undergo surgery for pericarditis. The surgery was successful, but the experience was life changing. As he was resting upon completion of the operation, he was told of his HIV status. Awesome.
Five years later after some petty theft he's in jail on a cloudy day sharing his sensitive life story with some random "kiddie-doc" Indian student from the suburbs. What I haven't told you yet was how smart Steve is. Apparently he picked up Spanish and sign language while on the streets. He elaborately explained to me the concept of a secondary immune response. He also relayed to me his knowledge of 2nd generation atypical antipsychotic and their neurochemical effects. Wow. How did this guy ever end up on the streets and get to where he is?
It was pretty obvious in my time interviewing him that Steve had some serious emotional health concerns. His ADHD was blatantly obvious. He was frustrated at himself and at the system. He acknowledge that he needs help, but he's also angry at his family for not supporting him. Moreover, he's angry at himself for letting the people who were in his life, down. Apparently psychiatric care in jails consists of pill-pushing with minimal to no psycotherapy. I think all Steve wanted was to talk to someone. I could tell after sometime he felt a bit relieved to get his thoughts off his chest as he was really looking forward to scheduling a follow-up meeting with the researcher. His psychological concerns were compounded by the fact that his viral load has worsened over the course of his stay. He thinks he might have to start some treatment for his HIV soon. He probably should.
I became really interested in correctional and forensic psychiatry after my time at the jail. It just amazes me how addiction and emotional concerns are brushed aside. Aren't these supposed to be "correctional" facilities? How can you "correct" someone if you just have them take some antidepressants and their best medical care is some doctor on a television screen evaluating them from 200 miles away in Columbus? Perhaps if he saw a child psychiatrist at age 9, his life might have turned out different? Perhaps, not? My questions and insight are kind of premature based on this one experience, but I'm interested in learning more. It's kind of funny that I think of his HIV as an afterthought to his psychiatric problems, seeing as the purpose of the trip was to learn more about living with HIV. Really though, I don't think the emotional and physical components of the disease can be separated. They really are intertwined.
School this week has been pretty solid for the most part. Lectures have been boring, but the IQ group discussions have been good. Our final communications seminar, which was a synthesis of all the skills we've learned so far, went well. My IQ group took a field trip to our neighborhood in Cleveland which we are doing our population health project on. The neighborhood, South Broadway, is basically south of downtown and consists of the old Slavic village. It's kind of run down, but pretty much an average Cleveland neighborhood. They have a pretty cool ice cream place. I recommend the black walnut.
There were only two things this week which kind of sucked. First, my big left toe is bruised. I think this came as a result of my overly active kind of stupid and crazy weekend. First, I played several intense games of pick-up basketball last Friday. This is probably where most of the damage happened. I then played 9 holes of golf immediately after the basketball. After that I went swimming for an hour. The next afternoon I walked 18 holes of golf. On Sunday morning I rode the exercise bike for 20 minutes, played a quick 15 minute pick up game with the old-timers at the racquetball club and played another 18 holes of golf in the evening, but I rode a cart that time instead. The good news was I shot an 81, and I very well could have broke 80 had I not been stupid on two of the holes.
As a result of my being young and stupid, I limped around school the last several days. I wrapped my toe up with some tape yesterday and it feels much better now. I'm going to try to take it a bit easy this weekend (though I must get my Friday basketball in-it's a must). Not to mention, next week we have our block 1 exam, so I'll need some down time to study anyway.
The other thing this week, which was not fun, was purchasing a stethoscope. I never realized that picking a scope would be so time-consuming and nerve wrecking. I was torn between two particular types, but I ended up picking the one made of "trumpet brass and chrome." Yes, my stethoscope has chrome. I feel so special.
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