Showing posts with label Medical Care. Show all posts
Showing posts with label Medical Care. Show all posts

December 23, 2019

Young Immigrant Doctor from Cuba Has Been Working as The Immigrants Own and Only Doc

Dr. Dairon Elisondo Rojas, a doctor from Cuba, treated patients in a migrant camp in Matamoros, Mexico.

Dr. Dairon Elisondo Rojas, a doctor from Cuba, treated patients in a migrant camp in Matamoros, Mexico.Credit...Ilana Panich-Linesman for The New York Times

By Miriam Jordan and Mitchell Ferman

MATAMOROS, Mexico — Under a canopy on the edge of a squalid encampment, a young physician named Dairon Elisondo Rojas holds office hours every day from 10 to 4.

On a recent afternoon, he saw children with diarrhea, colds, and asthma, among other ailments. Some he examined, treated and sent on their way with cough or cold medicine. For those who required special care, like a boy with a broken leg, Dr. Elisondo arranged a transfer to the local Mexican hospital.

Dr. Elisondo, 28, a native of Cuba, is the sole full-time doctor in the teeming tent city that has sprouted at the base of a bridge that connects the Mexican city of Matamoros to the United States. More than 2,500 migrants have squatted in the camp while their cases wind their way through immigration court in Brownsville, Texas.

He makes $30 a day.

“This is perfect, perfect,” Dr. Elisondo said in Spanish about the arrangement. “It’s what I know. It’s what I do best.”
So perfect he has not taken a day off since starting work in late October.

Like the migrants under his care, the doctor is stranded in Mexico by the Trump administration’s “Remain in Mexico” policy, under which asylum seekers who show up at the border are only allowed to enter the United States for court appearances.

He could be stuck in Matamoros for several more months, waiting for an answer on his immigration case. 

Dr. Elizondo, who has a specialty in critical care, has experience working in challenging environments thanks to Cuba’s medical-training program, which dispatches newly minted doctors on missions to impoverished allied countries.

After medical school, Dr. Elisondo was posted for nearly three years to a government clinic in Venezuela. With that country’s economy reeling, he witnessed close-up the suffering wrought by a shortage of medicine and food. He was recalled back home after he became a vocal critic of the government of Nicolás Maduro. 

“The government brought me back to Cuba, and that had consequences,” he said.

In his home country, he said, he was banned from practicing medicine and harassed by the police. Feeling persecuted and endangered, he and his girlfriend scrounged up enough to pay for travel to the United States to request asylum. They journeyed more than a month by plane, boat, and bus until they reached the southwestern border in mid-August.


ImageAngel, 10, broke his left leg playing soccer in the camp and was treated by Dr. Elisondo.

While Cubans for decades were allowed under a special policy to remain in the United States if they were able to make it there by land or sea, that welcome ended in the final days of the Obama administration. Cubans, who once may have traveled to Florida, now are subject to the same stringent immigration policies applied to other asylum seekers on the southwestern border.

“We arrived, presented ourselves and they sent us right back to Mexico,” Dr. Elisondo said of United States border officials.

Dr. Elisondo and his girlfriend got an apartment with other Cuban asylum applicants, and he found a job on the assembly line of a plant in Matamoros that churns out cases for cosmetics, he said.

Then one day, as he passed the ever-growing migrant camp near the international bridge, he spotted a big banner tied to a fence inscribed with the words “Medical” and “Médico.” Several migrants were talking to a person with a stethoscope dangling from her neck. It was a pop-up clinic opened in October by Global Response Management, an international nonprofit organization whose volunteer doctors, nurses, and medics have been deployed to places such as Iraq, Yemen, and Syria.

Dr. Elisondo said he was a doctor. Could he help?

“I thought, ‘If he’s licensed and credentialed, how could I not use him?’” said Helen Perry, the group’s executive director. She asked for his medical diploma and other documents, which he sent by WhatsApp.

After a two-day trial, said Ms. Perry, an acute-care nurse practitioner, the decision had been made. “Everyone agreed, Dairon is fabulous.”
Exposure to the elements, overcrowding, and lack of sanitation — there are few showers and the portable latrines are foul — have created conditions for illness to spread in the sprawling camp. Yet many migrants fear to venture far outside the camp, even to seek medical care because so many people have been victims of crime.

“Thank God for the Cuban doctor,” said Luis, a Honduran migrant whose family has been living in the encampment since September.

Luis, who like other migrants at the camp did not want his last name published, said he had recently taken his 9-year-old daughter to Dr. Elisondo for a chronic cough. The physician determined she had bronchitis and successfully treated her.

Inside a gray tent lay Angel, a 10-year-old from Honduras who had fractured his left leg playing soccer. Dr. Elisondo wrapped it in a splint and sent him to a hospital, where the boy got a cast that stretched above the knee. On Angel’s return, he found a set of miniature racecars awaiting him — a gift from the camp doctor to cheer him up.

On a typical day, Dr. Elisondo and a rotating roster of American volunteer health workers see about 50 patients. In addition to the camp’s residents, they serve another 1,000 migrants living elsewhere in Matamoros.

A handful of migrants with serious medical conditions, including a toddler with third-degree burns, have been allowed to enter the United States for care.

Dr. Elizondo treated Estephanie, 4, for asthma at the camp. Credit...Ilana Panich-Linsman for The New York Times 

Early this month, Global Response Management upgraded from a tent to a mobile medical unit, a gray trailer outfitted with fold-up examination tables, ultrasound machines, and equipment to perform basic diagnostic blood work.

Dr. Elisondo, who sports a neatly trimmed beard and a red T-shirt emblazoned with the group’s logo, has stabilized people who had epileptic seizures, appendicitis and heart attacks. But patients with upper-respiratory-tract infections, pneumonia and skin conditions such as scabies represent the largest share of his caseload.

With winter at hand, the clinic had been administering about 20 flu shots daily, until a shortage struck.

On a warm December day, Dr. Elisondo screened patients outside the trailer, with a bottle of hand sanitizer sitting next to his laptop.

Children on a rug in the open-air waiting area entertained themselves by leafing through “The Very Hungry Caterpillar,” filling in coloring books and playing with toys.

Stephanie, a 4-year-old girl from Honduras in pigtails, had asthma, her mother reported, but she had not been treated for it since arriving at the camp. Dr. Elisondo listened to her breathing and determined she needed treatment.

To ensure that she received the appropriate dosage of medication, Dr. Elisondo fashioned a spacer for her inhaler out of a paper cup. Medical-grade spacers are expensive; the paper cup served the same purpose. 

“Look at me right here, O.K.?” he told the little girl, and then sprayed.

A 3-year-old boy in a striped T-shirt got one of the few remaining flu vaccines. Sitting in his father’s lap, he grimaced when Dr. Elisondo poked his right arm, only to break into a smile when the doctor stuck a ladybug Band-Aid on it.

Dr. Elisondo said he could not predict how long it would take an immigration judge in the United States to rule on his case.

He crossed the bridge to Brownsville for his first court appearance on Dec. 4. His next one is not until late February.

Though he has no lawyer, he hopes to win his asylum case on his own, learn English and begin practicing medicine on the other side of the bridge, in the United States.

Ms. Perry said that if his plans did not pan out, he need not worry. “He doesn’t know this,” she said, “but I am going to send him to other places in the world. He is highly trained.”

Miriam Jordan is a national immigration correspondent. She reports from a grassroots perspective on the impact of immigration policy. She has been a reporter in Mexico, Israel, Hong Kong, India, and Brazil. @mirjordan

March 28, 2019

The Opioid Crisis is Fueled By The Lack of Giving Patients The Correct Pain Meds

 Nerve pain

The federal government released a report last week that came to a striking conclusion: More than 80 percent of the roughly two million people struggling with opioid addiction in the United States are not being treated with the medications most likely to nudge them into remission or prevent them from overdosing. This denial of care is so pervasive and egregious, the report’s authors found, that it amounts to a serious ethical breach on the part of both health care providers and the criminal justice system.

The Food and Drug Administration has approved three medications to treat opioid use disorder — methadone, buprenorphine, and naltrexone. All of them work by binding to the brain’s opiate receptors in a way that reduces the cravings that people addicted to drugs like OxyContin and heroin experience, but without causing the same euphoric high as those drugs. Methadone and buprenorphine have proved especially effective. Patients who take one of those medications are half as likely to die from their addiction; they are also more likely to stay in treatment, and they tend to have better long-term health outcomes.

Neither drug is new or experimental — methadone was approved to treat opioid addiction in 1972 and buprenorphine in 2002. Some countries have shown that increasing access to them can significantly drive down the rate of overdose deaths. In France, for example, policies that enabled more doctors to prescribe buprenorphine helped lead to a tenfold increase in the number of people whose opioid use disorder was being treated and to a nearly 80 percent decline in overdose deaths in just four years.

Yet, many drug courts and most residential treatment programs in the United States prevent participants from using these medications; and the rehabilitation programs that do offer them rarely offer all three options. The treatments are not available in most emergency rooms, as The Times has reported, even though studies show that patients given buprenorphine in an E.R. are twice as likely to be in treatment a month later than those who are given an information pamphlet. They are also not available in most prisons, even though a significant portion of the federal inmate population suffers from opioid use disorder. Opioid overdose is a leading cause of death among those who’ve been recently released. 

Part of the problem is stigma and a profound lack of awareness. Methadone and buprenorphine are opioids. They are weaker than drugs like OxyContin, fentanyl and heroin that have fueled the current crisis, but many law enforcement and medical professionals still see them as trading one addiction for another. Or they mistakenly believe that the medications should be used only temporarily, to help wean patients off stronger opioids. Or they see them as an optional complement to behavioral interventions instead of an essential component of opioid addiction management.

None of these perceptions is supported by the balance of scientific evidence.

There’s also a logistical barrier to getting these drugs into the hands of people who need them. Doctors are allowed to give methadone only at specialized clinics where patients must report every day for their dose. Lines at such clinics are often long, and according to the federal report, which came from the National Academies of Sciences, Engineering, and Medicine, Medicaid does not cover the treatment in at least 14 states.

Buprenorphine is available by prescription, but health care professionals must obtain a special license to write those prescriptions, a process that requires them to complete hours of additional training, grant the Drug Enforcement Administration access to all of their patient records and agree to strict limits on the number of patients they can treat with the medication. In many states, would-be buprenorphine prescribers also must submit to stringent criteria for insurance reimbursement. These restrictions also are not justified by scientific evidence. They are not employed by other countries, and they are not used to manage the treatment of other chronic medical conditions in the United States.

Fewer than seven percent of the nation’s doctors have gone through the trouble of clearing these hurdles. As a result, more than half of all counties have no licensed buprenorphine prescriber at all. That’s too bad. According to the national academies report, just about anyone with opioid use disorder — teenagers, pregnant women, people with other serious medical conditions — can be treated safely and effectively with the medication.

President Trump declared a public health emergency to respond to the opioid crisis in 2017, but so far that declaration has led to very little meaningful action. Congress passed a suite of opioid bills in the fall, but that legislation contained almost no funding. And in most states, strategies that might truly mitigate the disaster — from evidence-based addiction treatments like methadone and buprenorphine to proven harm-reduction approaches like needle exchanges and safe injection sites — remain vastly underutilized or outright illegal.

The editorial board represents the opinions of the board, its editor and the publisher. 

June 6, 2018

Young Men Do Not Look For Medical Help But Virtual Visits Are Changing That

 The Teladoc app on a mobile phone.
Source: Teladoc
The Teladoc app on a mobile phone.

Young men tend not to seek mental health help. Virtual visits are changing that

  • Nearly half of Teladoc's behavioral health visits so far this year have been with men between the ages of 20 and 35.
  • Stereotypes about men not talking about their emotions and phrases like "man up" add even more stigma than what already surrounds mental health.
  • Telehealth is emerging as an attractive way for young men to seek mental health help. 
It's not always easy for men to seek help, especially when it comes to mental health.
Stereotypes about men not talking about their emotions and phrases like "man up" add even more stigma than what already surrounds mental health. Young men busy with their careers may not think they have time to see someone. Telehealth is emerging as an attractive solution to overcome these problems.
Virtual visits allow people to connect with therapists and psychiatrists through video chats, phone calls and texts. One telehealth provider, Teladoc, said nearly half its behavioral health visits so far this year have been with men between the ages of 20 and 35.
The company started advertising more toward young men after identifying a need, said Chief Marketing Officer Stephany Verstraete. It's working. Young men engage with Facebook ads for behavioral health services at double the rate of moms with kids, the group that was traditionally considered the core target.
"What was surprising to us was we actually expected that young women were going to respond better, but I think for us it now feels intuitive," Verstraete said.
Nearly 9 percent of men said they experienced daily feelings of anxiety or depression, according to the Centers for Disease Control and Prevention's 2010 to 2013 National Health Interview Survey. Less than half of them took medication for these feelings or reported having recently talked to a mental health professional.
Men may feel ashamed to seek help because of stereotypes like "that's not what tough guys do," said Dr. Ken Duckworth, medical director of the National Alliance on Mental Illness. They may also think they're going through a rough patch instead of dealing with a mental illness like depression.
If they do decide to seek treatment, the health-care system can make it hard to find a psychiatrist who's within their insurance network. Once people find someone, it can take weeks to see them. Their condition can improve or worsen in that time, or they may change their mind. 
Teladoc says the average time from when a member contacts it to when the appointment takes place is less than a week. 
Dr. Chris Dennis, a psychiatrist who sees Teladoc patients, said he primarily treats young men for anxiety, depression, stress from relationships and work and sometimes substance use.

For many patients he sees, it's their first time using telehealth or even seeing a mental health professional. Dennis said they tend to ask many questions, such as, "why me," "why now," and "am I going to get better?"

Sometimes people will call him from work so their families don't hear. Some will call at home so people at work don't hear. He's seen patients at 7 a.m. and 9 p.m. He's even talked with people who were huddled in their closet where he could see their shoes in the background.

"(Virtual visits are) a prime opportunity from a treatment and engagement perspective because they're doing it on their own time in a safe environment that's comfortable for them," Dennis said.
Young men, in particular, tend to be more comfortable using technology since they grew up using cell phones and playing video games, Duckworth said. Of those that use Teladoc's behavioral health services, 29 percent request visits through the mobile app, compared with 27 percent of mothers and 15 percent of baby boomers. 
"If young men are willing to use telehealth, it would be a fantastic development for public health," Duckworth said. "We haven't been able to get them into treatment because of expectations and societal roles that real men don't fill in the blank. That's the thing we're up against. If this is the vehicle they're comfortable with, then that's great."

October 19, 2017

A Navy Hospital Ship Sits in Puerto Rico Mostly Empty While Hospitals Go Without

A floating state-of-the-art hospital is anchored off the coast of hurricane-ravaged Puerto Rico, but those in need are struggling to board the ship.

The Navy hospital ship Comfort has 250 beds for patients on the island shut out by clinics without supplies and other facilities lacking electricity.
But only 33 of those beds — about 13% — have been filled in the two weeks since the ship arrived, CNN reported.

“I know we have the capacity,” the Comfort’s mission commander and Capt. Kevin Robinson told the news station. “I know that we have the capability to help. What the situation on the ground is . . . that’s not in my lane to make a decision.” Puerto Rico Gov. Ricardo Rossello told CNN the problem is rooted in “the communication flow” between doctors and the territory’s Department of Health, which is tasked with referring patients to the ship. Hospitals said they were unaware what standards patients need to meet in order to board the medical facility.

“I asked for a complete revision of that so that we can start sending more patients over there,” Rossello said.

The hospital ship was deployed as part of the federal response to Hurricane Maria, which left the 3.4 million American citizens on the U.S. territory without power. Residents also face water and food shortages as well as ongoing health risks. Almost a month after the hurricane made landfall as a Category 4 storm, 86% of Puerto Rico is still without electricity and nearly 30% of residents do not have access to drinking water. Most cell towers and antennas are also still down.

The hospital did welcome one new patient Saturday — a baby girl who was born on the ship.
“I never thought that our special moment would happen here on this ship,” Sara’s father, Francisco Llull Vera, said in a statement Sunday. “Everyone has been so helpful and gentle while caring for our baby. I hope this opens the door for those who still need help to seek out the Comfort.” 

New York Daily News

More from CNN                           

 A floating hospital could help desperate patients in Puerto Rico, but nobody knows how to get there.

Clinics on the island have been overwhelmed with patients since Hurricane Maria made landfall there, but patients and staff say they’re not sure how to start sending sick people over. The ship, the USNS Comfort, is sitting right offshore with just 13 percent of its 250 beds in use nearly two weeks after it arrived.

The Comfort was deployed to Puerto Rico as a part of the US federal response to the storm, which devastated the island and left hospitals vulnerable to power outages, limited water supplies, and food shortages.

The Puerto Rico Department of Health gets to decide which patients can get care aboard the Comfort, but referrals have been minimal so far.

Ricardo Rosselló, the governor of the island, told CNN that the issue was not because of a lack of infrastructure, or physical means of getting patients to the ship.

“The disconnect or the apparent disconnect was in the communications flow,” Mr. Rosselló said. “I asked for a complete revision of that so that we can now start sending more patients over there.”

For doctors and care providers working in clinics and hospitals running on generators, speeding up the process could mean life or death for patients. While the official death toll has crept up to 48 so far, reports from the island indicate that people have been dying in hospitals as doctors run out of medication or fuel from generators, leaving people who rely on oxygen, or dialysis, at risk.

As of Sunday, 85 percent of the island still lacked power.

Captain Kevin Robinson, the mission commander aboard the Comfort, told CNN that help is waiting for those in need. The ship has 250 beds, and just 33 of them are in use.

*Headlines about P.R.

*San Juan mayor sends public plea to Trump over Puerto Rico crisis
*Jennifer Aniston has donated $1 million to Puerto Rico
*Trump's popularity dives after lackluster Puerto Rico response
*Donald Trump launches fresh attack on Puerto Rico
“I know that we have the capacity. I know that we have the capacity to help. What the situation on the ground is… that’s not in my lane to make a decision,” Mr. Robinson said. “Every time we’ve been tasked by [Puerto Rico’s] medical operation center to respond or bring a patient on, we have responded.”

"The military and every department in the Federal government have only one head over others, one commander, one channel of orders coming from the very top. Particularly the military, trained to go by the rules of engagement or operation. They need precise orders and they need the authorization of money to take on tasks that they have not been financially preauthorized.  You can't order the navy to go and help someone without making it possible for those orders to be enforced. You can't also say do it today and tomorrow you say something contradicting.
You know who the commander is. He was elected by our Electoral college system, which still stays as the law of the land and it will remain so as long as we have one political party controlling everything that comes down from Washington DC and wants to keep the status quo on the system that gave them a victory the last time around."   Adam Gonzalez 

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