Wednesday, January 11, 2017

TMA Raises Physician Awareness of Human Trafficking

Editor's Note: In recognition of National Human Trafficking Awareness Day today, we are republishing this story from February 2016. This article was updated to reflect passage of a TMA resolution to raise physician awareness of human trafficking, and to include information about continuing medical education (CME) for physicians on human trafficking at TexMed 2017, TMA's annual physician conference.

Some victims of human trafficking are walking into physicians’ offices, and many doctors believe these visits put the doctor in a unique position to help them escape sexual labor and slavery, reports Texas Medicine magazine, the monthly publication of the Texas Medical Association (TMA).

Last year, TMA passed a resolution to help.

While it happens in many states, Texas is one prominent epicenter of the U.S. human trafficking trade, accounting for nearly one-tenth of the National Human Trafficking Resource Center’s tip calls in 2014. A 2008 Texas Attorney General report said nearly 20 percent of human trafficking victims found nationwide had been in Texas. And Texas Gov. Greg Abbott recently proclaimed January 2016 Human Trafficking Prevention Month.

Reports show many of these victims visit physicians, most commonly in emergency departments and urgent care centers. One such report compiled responses from a series of focus groups of female sexual trafficking survivors. Of those survivors who answered questions about their health care, nearly 88 percent told the winter 2014 Annals of Health Law they had contact with a health care practitioner while being trafficked.

Some physicians see those visits as opportune for helping the victims escape their situation.

“Medical providers are some of the only professionals that victims of human trafficking come in contact with during their period of slavery,” said obstetrician-gynecologist Melinda Lopez, MD, who founded and ran a clinic for sexual trafficking victims in Austin in 2013-14. “So we are really a window of opportunity for these people who are seeking access to services and to escape their situation. When we’re not able to pick up on some of those [signs] ourselves or even know what the risk factors are, or what to do with those after we do identify them, we’re missing that opportunity.”

Arlo Weltge, MD, vice speaker of TMA’s House of Delegates, said a resolution to raise physicians’ awareness of trafficking was a step in the right direction, because once physicians know what to look for, they’ll begin to recognize when a potential victim shows up in their exam room. TMA’s Medical Student Section introduced the resolution and the TMA House of Delegates, the organization's policy-making body, passed it during TexMed 2016, TMA's annual meeting.

To continue the progress physicians are making to help victims of human trafficking, TMA is offering continuing medical education (CME) at this year's TexMed in Houston.

David Gruber, assistant commissioner for regional and local health services at the Texas Department of State Health Services, told Texas Medicine more physician involvement in identifying trafficking victims and taking subsequent action represents “an opportunity to intervene, to break the chain of events.”

“I can compare it to being primed for Ebola or a highly contagious infectious disease or the doctor in Florida who identified the anthrax case way back in 2001,” he said. “If you’re attuned to something, you have a better chance of being able to recognize it. So if we can educate those in the medical community on signs and symptoms, much like we do for signs and symptoms of disease, then there’s a chance to do some good.”

Wednesday, January 4, 2017

Medical Students Help Provide Health Care for Refugees

By Wendy Rigby
Texas Public Radio

This article originally appeared on Texas Public Radio and has been republished here with permission.

Each Wednesday at St. Francis Episcopal Church on the north side of San Antonio, dozens of refugees from all over the world come for free care at the Refugee Health Clinic.

Students and faculty at the University of Texas Health Science Center in San Antonio have teamed up to operate one of the only student-run refugee clinics in the country.

In the past six years, more refugees have resettled in Texas than in any other state. That was before the state of Texas pulled out of the refugee resettlement program in September, citing concerns over terrorism.

The refugees who come seeking care are from the Middle East, southern Africa and Asia. They have fled violence and persecution. An estimated 5,000 refugees live within 3 miles of San Antonio's medical center.

Most who have resettled here receive temporary federal government health benefits that run out after six months or so.

"We really fill that gap before they can kind of get on their feet after they've lost their government benefits," says Michael Tcheyan, a medical student who volunteers at the clinic. "We feel like it's our duty, and it's their right to get medical care and to be connected with services that are going to make their life better."

Medical students from the Student Faculty Collaborative Practice of UT Health San Antonio help provide care along with students from the School of Nursing, the School of Dentistry and the School of Allied Health Professions, which includes physician assistants, physical therapy and respiratory care.

Layla Mohsin, 52, came to the clinic for dental care. She's a teacher from Iraq who came to the U.S. with her family of seven to escape the violence.

"We left Iraq and came to the United States because there is safety here. There, there is no safety," Mohsin says as her son, Karrar Al Gburi, interprets for her. "The main concern? The lethal explosive cars. You can get caught by an explosive car at any place, any time."

Laxmi Adhikari, a 65-year-old old man who fled Bhutan to a refugee camp in Nepal, is being treated for an itchy stubborn rash. He sports a T-shirt with a local high school team logo, a gift from one of the many people in San Antonio who he says have welcomed him.

"It's far better than the refugee camp," Adhikari says through Nepalese interpreter Dal Gajmer. "I trust and believe all of the nurses and doctors. They treat me very well."

Dental student Eduardo Vela is originally from another country, too. He understands his patients' challenges. "If you don't know the language, there are a lot of cultural differences. I myself grew up in Mexico, so I know a little bit of the feeling of being an outsider and then trying to fit in," Vela says.

The refugee population has many unmet medical needs, says clinic medical director Browning Wayman. "They are in search of people to manage their high blood pressure, their diabetes, their high cholesterol, thyroid disease, mental health issues," Wayman explains. "For a lot of us that went into medicine, we went into it to help people. This is a population that needs help, and so it's really a joy."

Funding for the Refugee Health Clinic is provided through the Kronkosky Charitable Foundation and St. Luke's Lutheran Health Ministries Inc., as well as the operations budget of the Center for Medical Humanities and Ethics, part of the School of Medicine of the University of Texas Health Science Center at San Antonio. Endowment funds, individual donors and the university pitch in to cover other costs.

Texas will continue to be home to new refugees. But instead of giving financial assistance to the state, the federal Office of Refugee Resettlement will be giving that money directly to nonprofits.

The refugees don't use the free clinic forever. The staff helps them find more permanent care. If patients need a referral to a specialist, they may have to find a way to pay for that visit.

The students and faculty also work to connect patients to whatever health coverage they might be eligible for, such as CareLink, a financial assistance program for health care services through University Health System. It's available for Bexar County residents who do not have public or private health insurance. The cost is based on family size and income.

Navigating the health care system can be difficult even for Americans, says one of the clinic's founders, Dr. Andrew Muck, an associate professor of emergency medicine at UT Health Science Center, so he says it is hard to imagine the difficulty for these refugees.

"You don't speak the language, may not have a job," Muck says. "And even though you're in the midst of this robust health system, you can't get in the door, can't get over those hurdles."

Tuesday, December 6, 2016

Get Your Influenza Questions Answered Today

Ever wonder how the influenza vaccine gets created every year if flu viruses keep evolving? Now’s your chance to ask the experts!

Between noon and 2 pm today, scientists from the Centers for Disease Control and Prevention (CDC) are hosting a flu vaccine “Ask Me Anything” (AMA) on Reddit. John Barnes, PhD, research microbiologist and team lead for the Influenza Genomics Team in the Influenza Division at CDC will answer questions about how the flu vaccine is created and advanced molecular detection (AMD) technology. AMD technology uses genomic sequencing (mapping the DNA of flu viruses) to create better-performing vaccines. Dr. Barnes and his team also will be taking questions about all things related to the flu and its vaccine, so head over there after noon to get all your nerdy science questions on influenza answered!

Also taking place at noon, the Texas Department of State Health Services (DSHS) is hosting a Twitter chat using the hashtag #DSHSFluChat. Twitter users can ask questions about flu prevention, the flu vaccine, and what to do if you get sick; tag it with #DSHSFluChat, and DSHS will be there with an answer.

Join the online discussions, then go out and spread your knowledge (NOT the flu)!

Thursday, December 1, 2016

World AIDS Day Reminds Us How Far We Have Come ― And How Far We Have Yet to Go ― To Stop HIV/AIDS

By John T. Carlo, MD
Dallas Physician
Chief Executive Officer, AIDS Arms

Today, December 1, is recognized as World AIDS Day. Since 1988, this day has been globally recognized as a day of commemoration for the more than 34 million people who have died since the virus got our attention back in 1981. 

Today we can celebrate The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), now showcased in President George W. Bush’s Presidential Library, as one of our greatest achievements, resulting in the largest mobilization ever of resources and efforts to fight a public health emergency. Prior to PEPFAR, and other groups such as the Bill and Melinda Gates Foundation, the number of people living with HIV in sub-Saharan Africa receiving life-saving treatment was 50,000; today it is more than 9 million. 

Here in the U.S., and in Texas, similar successes have been achieved, including better testing and immensely better treatments. However, World AIDS Day 2016 should also serve as a reminder that we are not finished with our challenges of HIV in our communities. New infection rates continue to climb in groups such as African American women, young gay men, and those sharing needles when using illicit drugs. While new treatments work so well ― we are on the verge of concluding that someone successfully treated is not infectious, and we now even have a pill which can be taken to prevent an HIV infection from occurring ― there is still a tremendous amount of work to be done. 

Today should serve as an important reminder that we all need to keep HIV on our minds, especially when thinking about the health of our patients. As a reminder, according to the Centers for Disease Control and Prevention, everyone between ages of 13-64 should be tested for HIV at least once. It’s not about determining whether someone is at risk or might be infected, it is about the clear health advantage of diagnosing HIV early, and the reality that most newly infected individuals had no identified risk factor or perceived risk. 

Finally for all of our physicians, nurses, social workers, and community members who have remained on the front lines during this crisis, World AIDS Day serves as an important day of recognition for your commitment to caring for our sick, overcoming the incredible fear and stigma still even today associated with AIDS, and doing the tremendous work to impact the lives of so many both here in Texas and around the world.

Dr. Carlo is chief executive officer of AIDS Arms, Inc., which combats HIV/AIDS in the community by improving the lives and health of individuals living with the disease and preventing its spread. Dr. Carlo also is vice chair of the Texas Public Health Coalition and former medical director of Dallas County Health and Human Services.

Friday, November 18, 2016

Let’s “Get Smart” About Antibiotics

This week is Get Smart About Antibiotics Week, and Texas physicians are raising awareness of appropriate antibiotic use. Antibiotics can’t fight viruses, so taking them for colds, flu, most sore throats, bronchitis, and many sinus and ear infections won’t help you get better.

In fact, taking antibiotics when you have a viral infection can actually cause more harm than good, because it increases your risk of getting an antibiotic-resistant infection later. Additionally, there are healthy bacteria in your gut that help break down nutrients for you to absorb. Taking antibiotics when it isn’t called for kills off some of these good bacteria, allowing harmful bacteria to grow in their place.

[Related: How Overuse of Antibiotics Is Creating Drug-Resistant Bacteria]

The Centers for Disease Control and Prevention created this helpful chart identifying which diseases can be fought successfully with antibiotics ― and which ones can’t.

Tuesday, November 15, 2016

Treatment to Prevent HIV Promising ― If Key Patients Can Get It

Austin family physician Cynthia Brinson, MD, says identifying candidates for HIV pre-exposure prophylaxis requires setting aside any assumptions physicians may have about the patient's risk for contracting HIV.

Physicians can block HIV spread with a little-known treatment — if they can identify high-risk patients and administer the treatment to them. The questions can be difficult for physicians to ask, however. The questions can be personal, and they can be awkward for a patient to answer; but they are necessary to determine whether a patient’s sexual behavior or drug use puts him or her at risk of contracting HIV (human immunodeficiency virus). When patients are at risk, doctors can prescribe the treatment, HIV preexposure prophylaxis (PrEP), that might curb that risk drastically, reports the Texas Medical Association’s (TMA’s) Texas Medicine magazine.

That's why family physician Cynthia Brinson, MD, strives to get all the information she needs, including uncomfortable-but-pertinent details on sexual behavior, when assessing patients for the Austin PrEP Access Project (APAP). The volunteer clinic provides HIV PrEP to patients susceptible to the virus that causes AIDS.

“I’ve heard many patients say, ‘I don’t want to talk to my physician because [he or she] wouldn't approve of what I’m doing,’ whether that’s true or not,” Dr. Brinson said. “And the physicians are making assumptions by saying, ‘I’ve known my patient a long time, and [the patient is] in a monogamous relationship.’ I think when we make assumptions about the people we know, we’re not really seeing people in the full context of a life.”

In the three decades since AIDS first became the United States' biggest public health scare, panic over the disease and HIV has largely disappeared. But the virus persists, especially in Texas, where Texas Department of State Health Services figures show more than 82,000 people were living with HIV in 2015.

The PrEP pill and treatment can stop that number from growing by preventing people from contracting HIV. Large clinical trials showed consistent PrEP use reduces people’s risk of getting HIV from sex by more than 90 percent and reduces the risk of getting it from drug injections by more than 70 percent, according to the Centers for Disease Control and Prevention (CDC). But many people at high risk don’t know PrEP exists, let alone how accessible it can be. APAP and other PrEP clinics around the state are working to change that ― starting with the type and tone of questions physicians ask patients.

Dr. Brinson said it’s important for physicians to set aside what they think they know about the patient and ask the questions they need to ask. She says when she tries to assess a patient’s risk factors for HIV, she avoids asking leading questions.

“I’ll ask patients if they’re involved with anyone sexually. And if they say no, I might ask them, ‘Well, if you were to be involved with someone sexually, would that be a male, a female, or both?’ and let the patient take it from there,” she said.

Yet physicians might not always ask the right questions because of the demands of a clinic visit or discomfort with taking a sexual history and discussing details of sexual relationships.

Houston adolescent medicine fellow M. Brett Cooper, MD, a member of TMA’s Committee on Child and Adolescent Health, said merely asking patients if they’re sexually active isn't gleaning enough information.

“For the adults right now, you’re missing out on that 18-29 [age group] if you’re not asking, ‘What gender are your sexual partners? Are you having sex under the influence of substances, whether that’s drugs [or] alcohol? How many partners are you having?’ That’s where CDC recommendations for putting people on it [PrEP] come into play, is your behaviors,” he said.

Dr. Cooper said physicians hope to reach the people at greatest risk more effectively. He said minorities tend to underuse many of the available services, and the highest diagnosis rates show up in African-American men having sex with men.

“The theory behind it is that there’s a lot more stigma in the minority communities around [men] having sex with men, whether you identify as gay or not,” Dr. Cooper said. “Then if you show up at a clinic for PrEP, people will look around and be like, ‘I know this person, I know [that] person.’ ”

Dr. Brinson agrees lack of awareness and patient trust prevent high-risk patients from accessing PrEP. She said eradication of HIV is possible, though; the goal of APAP is to see no new infections in Austin by 2020. While PrEP has been successful in gay white communities, she said her clinic has trouble reaching into the communities it would like to reach, such as Hispanic, African-American, and underserved communities.

We must do something to stop this continual infection rate,” she said.

Friday, November 11, 2016

Saturday Is World Pneumonia Day

This Saturday, Nov. 12, is World Pneumonia Day. It was created to raise awareness of the dangers of pneumonia, especially to children and the elderly, and to promote the pneumococcal vaccine as a way to protect against the disease.

Pneumonia is the world’s leading infectious killer of children under age 5, despite being preventable with vaccination. The pneumococcal vaccine is recommended for all children younger than 5 and for all adults 65 and older, according to the Centers for Disease Control and Prevention. The vaccine not only protects against the most common type of pneumonia, but also against meningitis and blood infection caused by the Streptococcus pneumonia bacteria.

Dallas infectious disease physician Ed Dominguez, MD, a member of TMA’s Be Wise ― ImmunizeSM Physician Advisory Panel, stresses the importance of getting vaccinated against diseases like pneumonia to his patients. He says even though these vaccines might not cover all strains of the disease, they help guard against life-threatening complications.

“The vaccines for influenza and pneumonia are effective in preventing severe complications, like death, from these diseases, although mild infections may still occur,” he says. “When a person notes that he still contracted the flu after receiving a flu vaccine, I always respond, ‘See? It worked, because you survived to tell me about it!’ ”

(The flu vaccine also helps protect against pneumonia, because severe cases of influenza infection can lead to pneumonia.)

Pneumonia is a devastating disease, but it is preventable through vaccination. For more about World Pneumonia Day, visit

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