Christopher Dodd tends to a typical patient, Luis Orozco, 52, who had half of his left leg amputated after a cut toe turned into a gangrene infection.
Orozco, a welder, doesn't have health insurance and didn't monitor his diabetes, which, left unchecked, can lead to serious foot problems.
“This was something we could have taken care of,” Dodd said. “Maybe then this wouldn't have happened.”
Dodd, 32, is one of a handful of doctors-in-training who are marrying their love of medicine with their social conscience at the Jay Weiss Center for Social Medicine and Health Equity at the University of Miami. Launched in 2005, the center is one of four social residency programs in the country — and the only one that provides training from the first day of medical school to the last.
“I want to be engrossed day in and day out in the care of the poor,” Dodd says.
The current roster includes five residents and 26 medical students. Their work has taken them to the mountains of Peru, where they ran a mobile clinic, to Overtown, Fla., where they're researching women with HIV. They've traveled to India, where they treated patients who had never seen a physician, and to Tallahassee, Fla., where they lobbied for the Prevention First Act — a law that advocates better access to birth control.
The physicians-in-training are people like Reginald Saint-Hilaire, 24, a Haitian-American who grew up in Fort Lauderdale, Fla., and wants to improve health care in his homeland. And Brittany Ashlock, 31, who studied anthropology as a University of Miami undergrad and worked in an HIV clinic in San Francisco before returning to UM, where she is working on a medical degree and doctorate in microbiology.
“These kids are wonderful,” said Dr. Bart Chernow, director of the center. “They all want to volunteer and help other people. They want to go where the earthquake is.”
The program honors the memory of a rich man, Southern Wine & Spirits founder Jay Weiss, who believed that poor people have the right to quality health care. He was an admirer of Dr. Paul Farmer, the Harvard professor and founder of Partners in Health, the global health organization instrumental in cutting the AIDS rates in Haiti through its patient outreach programs.
Weiss funded the Ryder Trauma Center and the Sylvester Cancer Center at the University of Miami-Jackson. After his death, two of his daughters started the social medicine center as a tribute to their father's ideals. Farmer sits on its board.
“He was interested in getting doctors to do this as a career as opposed to a hobby,” said Weiss' daughter, Laurie Weiss Nuell, a social worker who sat for nine years on the Public Health Trust, the board that oversees Jackson Health System. “Typically doctors will go on their vacation and do some work. It's a great thing, but it's not sustainable.”
The concept of social medicine is catching on. In 2006, a quarterly Spanish-English online journal, Social Medicine, was launched by the Albert Einstein College of Medicine in the Bronx, which has run a social medicine residency program for more than 30 years.
“We think of things like the impact of mass incarceration — this has enormous ramifications for the community as a whole,” said Matt Anderson, journal editor.
In everyday life, social medicine can translate into more astute problem solving. The residents and students work with nonprofits and attend lectures from people like Steven Leifman, a state Supreme Court advisor on criminal justice and mental health; Cheryl Little, director of the Florida Immigrant Advocacy Center, and Ethel Nadelmann, executive director of the Drug Policy Alliance.
It takes a certain kind of doctor to take part in such a program. Students at the center pay their way as they would at any other medical school. Residents stay an extra year and get a master's degree in public health.
A physician often will graduate from medical school with $140,000 in debt, according to the American Medical Association. As a result, many doctors will gravitate toward lucrative specialties such as plastic surgery or anesthesiology — not community clinics.
“I am not interested in doing this for money,” said Anne Monroe, 30, who was a woman's studies major and met her husband, a social worker at Palmetto Hospital, while working in an HIV clinic in New York.
“Miami is a great place to do this type of work. I definitely wouldn't have had this experience if I'd done it anywhere else,” she said.
Dodd, originally from Seattle, set up clinics in Nicaragua and in rural Georgia before moving to Miami. He has since traveled to India with the Jay Weiss Center. But he says what he has seen in Miami is unlike anyplace else.
“You see everything. You see patients with TB, patients with advanced HIV, patients with chronic diseases like diabetes who just don't have access to basic care. Every time I see one of these patients, it gives me more and more inspiration to fight for a health care system where we can give people the basics.”
Additionally, Miami is a jumping off point for helping underserved populations in the hemisphere.
Case in point: the tele-medicine hook-up at the Center for Haitian Studies in Little Haiti. The Jay Weiss Center bought the equipment and Saint-Hilaire and Ashlock will examine patients in Haiti via video conferencing. Haitian doctors will be able to consult with physicians here.
For Saint-Hilaire, it's the perfect way to keep a foot in both worlds.
“Global health can include your neighborhood. And there are people all around that need help and I can do that. And I think that's great, you know?”
© 2008, The Miami Herald.
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PHOTOS (from MCT Photo Service, 202-383-6099): socialmedicine AMX-2008-08-29T08:01:00-04:00