ACPM 2013: Day 2

Today was a lighter day than yesterday, mostly because I didn't want to go to the all-afternoon session on reducing childhood obesity among Latino children in Arizona (crazy, I know, since that's usually my area of interest in tropical medicine...).

The day started with a 4ish mile trail run, starting at 6am. As I joked to my former program director (also running), I don't know who did the risk assessment for that exercise, but whoever it was should clearly be fired. Running on trails before the sun comes up (and in the cold--I think it was about 38 this morning) was not a very good idea. We did get to watch the sunrise over the mountains as we ran, though, which is always one of my favorite sights.

Once we had breakfast and got cleaned up, it was time for the first plenary session, which I think was misadvertised. The lecture was called Population Health, but I kept waiting for him to stop talking about primary care and start talking about population health, which he never really did. The second session was equally disappointing. It was about vaccine updates, which last year was a very good talk, going into all of the recommended changes to the vaccines and vaccine schedules from the CDC and why they made those changes. Maybe there just weren't very many changes and they had to fill the time with something else; I don't know.

After that was my break in the afternoon (see above comments about not going to the thing about obese children), which I used to fill out questionnaires and quizzes to get credit for the hours I'm here. Then we had the last session, which was about the future of preventive medicine. They had some interesting ideas, but none of them were all that applicable to preventive medicine in the Army.

Tomorrow's my presentation, so I hope I'm prepared!

ACPM 2013, Day 1

Yesterday I flew into Phoenix, Arizona for the American College of Preventive Conference. Sadly, with all of the budget stuff that's going on in Congress right now, the Army doesn't have the money to pay for me to attend, but since it is my specialty's conference, and I'm presenting on Saturday, I forked over my own money to come. And it's ACPM, which I've been attending since I was a med student.

The day started with hitting an overcrowded gym (preventive medicine types like exercising) before I grabbed breakfast and hit the registration table, getting my first-ever "ACPM Member" badge (instead of Med Student Section or Resident Physician Member badge). The opening plenary speaker today, the editor-in-chief of the American Journal of Preventive Medicine, talked about the health care system (a popular topic at these meetings). Specifically, he talked about the fact that it isn't a system; it's a bunch of people doing whatever they want and ignoring the other pieces of the puzzle. He compared it a construction company that built houses by telling everyone to do what they usually do and giving nobody blueprints, which I thought was an interesting (but probably apt) comparison. These kinds of fractures, in his opinion, are what is driving up the cost of healthcare so much in this country, and changes that we're making (like Obamacare) are the same as rearranging the deck chairs on the Titanic while it's sinking. He said we need to be more like engineers, who actually think about systems as a whole, and if we did that, we would not only be more efficient (and therefore cost-efficient) at providing healthcare, but better at it, too.

The next session I went to I fully expected to be bored during. It was titled: "Linking Primary Care and Public Health: Where Are We?" I expected it to be about lifestyle medicine--talking to people about what they eat and how they need to exercise. I was pleasantly surprised to find that it was more about how primary care uses what we find in public health to do primary care better. One speaker, the health commissioner for Georgia, used the example of infant mortality, which was much higher in Georgia that most other states. They looked into what was causing infant mortality in Georgia and elsewhere, found out how to impact the most common causes, and implemented them. As a result, infant mortality dropped.

I think my favorite session today was the keynote speaker, former U.S. Surgeon General Richard Carmona, who was Surgeon General from 2002-2006. He talked about the plague of politics on science and medicine and how whenever politics gets involved in science, everyone loses. He used specific examples, both from his own term as Surgeon General, such as fighting with the Bush administration about how abstinence only sex education has no science behind it because it doesn't work, and older examples, going all the way back to the bubonic plague outbreak in San Francisco at the turn of the twentieth century, when the public health commissioner of San Francisco (or California, I'm not sure) wanted to quarantine ships coming into harbor, and the state of California disagreed because they thought it would ruin tourism and trade. That one went all the way up to the president, who sided with the medical people, which led to the end of the outbreak. The point that he really drove home is that, while the Surgeon General is a political appointee, he can't be the physician of the president or the party that put him into office; he has to be the physician of the United States, and to do that, he has to follow only the science, and not the politics that tries to get involved in it. He was an amazing speaker and brought the entire audience to our feet when he was done.

After a few more sessions in the afternoon, we had the med student/resident/young physician happy hour, which was "light appetizers" (which I ate enough of to count as a full dinner) and then preventive medicine trivia, which my team won. I even got a prize: MRSA and a CDC mug. I don't know why the picture is sideways.

Training the Medics

Yes, it's been a while since I've last the blog... Sorry. I wish I could say a lot has happened since my last post, but sadly, that's not really true. It's pretty much the same thing on a daily basis: work-out, go to work, go home, sit on the couch, go to bed, repeat. With the occasional variation for a weekend.

So I'll write about what's been occupying my time at work: how to train the medics.

We have about 25 junior medics (private first class-corporal), all of which are very bright, for junior medics. They were recruited for civil affairs by being at the top of their classes during Advanced Individual Training (AIT); once selected for civil affairs, they completed a seven week CAMS course (Civil Affairs Medical Specialist), which went over basic preventive medicine, environmental science, and veterinary medicine. More than half of them have gone to a paramedic course and are now certified paramedics. They're great at trauma care; unfortunately for that, most of what the medics are probably going to be encountering in Africa is going to be tropical medicine and not trauma.

Fortunately, I happen to be a little bit good at tropical medicine (and that's not just me saying that... The American Society of Tropical Medicine and Hygiene agrees, and gave me a certificate saying it).

So between the environmental science officer, the vet, and myself, we came up with the perfect (okay, not perfect, but decently good) training plan, with two hours lectures once a week, on Wednesdays from 2-4 pm. We presented this to the company commanders, but sadly, the presentation did not go as planned. The company commanders were concerned that we were trying to tell them what to do with their people, and told us that they'll get back to us with a plan for how they want us to train their medics.

That was over a month ago. Still no word on what that plan is.

In the meantime, we've been doing what we can to "unofficially" train the medics. I put "unofficially" in quotes, because everything is, actually, official (we keep careful records, because the medics need a certain number of hours of training a year to maintain their certifications), but just not without the approval and/or knowledge of the company commanders. Through the super-secret sergeant channels (that's what I call how all of the non-commissioned officers get things done), the senior medics who work in the aid station contact the senior medics in the company and tell them that we're going to do training, and if their junior medics are free, that they're welcome to attend. For unofficial training, we've so far done "stump the professor", where the medics asked me any question they had about diseases in Africa (on which they stumped me on one disease--guinea worm), and practicing inserting IVs, which Mary, the vet, ran (she even brought in her dog so the medics could practice on the dog as well as each other). Both went very well.

We've also had official trainings, which so far has consisted of one guest speaker, a Nigerian-born physician from the CDC. He came in to talk about his research on hepatitis that he's done in the Coastal Region of Georgia, and compared that to hepatitis trends around the world. Some of the statistics were a bit pedestrian, but overall, the medics were very attentive throughout and asked some good questions, so I'm proud of them. We have another presentation scheduled for a couple of weeks from now, when the dermatologist from Ft. Stewart is going to talk about tropical dermatology. Should be a good presentation.

Long story less long, training the medics to know what they need to know about tropical medicine, before they go to Africa, isn't easy, but we're finding a way to make it work.