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2 September/October 2010 MetroDoctors The Journal of the Twin Cities Medical Society

Physician Co-editor Lee H. Beecher, M.D.Physician Co-editor Peter J. Dehnel, M.D.Physician Co-editor Thomas B. Dunkel, M.D.Physician Co-editor Marvin S. Segal, M.D.Physician Co-editor Charles G. Terzian, M.D.Managing editor Nancy K. Bauerassistant editor Katie R. Snow

TCMS Ceo Sue A. SchettleProduction Manager Sheila A. Hatcheradvertising representative Betsy PierreCover Design by Outside Line Studio

MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodi-cal postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoc-tors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413.

To promote its objectives and services, the Twin Cities Medical Society prints information in MetroDoctors regarding activities and interests of the society. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contribu-tors, opinions may not necessarily refl ect the offi cial position of TCMS.

Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: [email protected].

For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood CircleMonticello, MN 55362 phone: (763) 295-5420fax: (763) 295-2550 e-mail: [email protected]

MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy.

Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available. For subscription informa-tion, contact Katie Snow at (612) 362-3704.

September/octoberindex to advertisers

TCMS Offi cers

President Edward P. Ehlinger, M.D.

President-elect Thomas D. Siefferman, M.D.

Secretary Anthony C. Orecchia, M.D.

TreasurerMelody A. Mendiola, M.D.

Past President Ronnell A. Hansen, M.D.

TCMS Executive Staff

Sue a. Schettle, Chief Executive Offi cer (612) 362-3799 [email protected] J. anderson, Project Director (612) 362-3752 [email protected] k. Bauer, Assistant Director, and Managing Editor, MetroDoctors (612) 623-2893 [email protected] r. Dittmer, Executive Assistant (612) 623-2885 [email protected] r. Snow, Administrative Coordinator (612) 362-3704 [email protected]

For a complete list of TCMS Board of Directors go to www.metrodoctors.com.

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MetroDoctors The Journal of the Twin Cities Medical Society September/October 2010 3

V O l u M e 1 2 , n O . 5 S e p T e M B e r / O C T O B e r 2 0 1 0

CONTENTS

Page 25

Page 32

Page 23

2 index to advertisers

4 PRESIDENT’S MESSAGE Soon gonna Be get Mixed up By Edward P. Ehlinger, M.D., MSPH

5 TCMS IN ACTION By Sue Schettle, CEO

6 LETTERS By Thomas P. Coleman, M.D., and Karen Lawson, M.D.

TCMS and MMa Co-sponsor aCo Conference

8 east european Medical Society of Minnesota By Elena Lev Polukhin, M.D.

11 Culturally Competent Care Means Safer and improved Care By Mary Beth Dahl

14 MMa Helps Clinics and Docs with improving use of interpreters

15 agency Fills Critical Health Community Void

17 Center for Cross-Cultural Health By Sandra Eliason, M.D.

19 People’s Center Health Services By Peggy Metzer, CEO

21 Culturally Competent Medical Care at west Side Community Health Services By K.A. Culhane-Pera, M.D., MA

23 new Health Care Ceo: Sara Criger, Ceo, St. Joseph’s Hospital

25 Sharing the experience: Honoring Choices Minnesota® Conference

27 First a Physician award

28 new Members/in Memoriam/Career opportunities

29 west Metro Senior Physicians/Call for Delegates/ Twin Cities Medical Forum

32 LUMINARY OF TWIN CITIES MEDICINE Arne S. Anderson, M.D.

On the cover: Providing culturally competent care and resources to our diverse communities. Articles begin on page 8.

Page 19


President’s Message

“Soon Gonna Be Get Mixed Up”

edward p. ehlinger, M.d., MSph

During the intermission of an on-campus Pete Seeger concert that I at-tended during medical school, one of the lead-ers of an activist gradu-ate student group took

the stage and asked for donations to help pay the legal fees of some of the group’s members who had been arrested during a protest outside the university’s administration building. Several people in the audience vociferously disagreed with the speaker and tried to shout him down. Soon there were shouts and angry words flying back and forth from every corner of the pavilion.

Today, I can’t recall the specifics of the protest or why there were such strong disagreements among audience members, but I can vividly remember exactly what happened when Pete Seeger returned to the stage. While deftly picking the melody of the first song of his second set, Pete made an announcement that went something like this, “I don’t agree with what the group is demanding, but I fully support their right to voice those demands. I also believe that there is a need for dissenting voices from all directions to be heard if our democracy and our society are going to thrive. Because of that, I will be donating my fee for tonight’s performance to their efforts. I am confident that they will use it wisely.”

Before the stunned audience had a chance to react, Pete began singing a song I had never heard before. The song was simple, lively and catchy. By the second verse, the audience had stopped arguing and shouting and was joining in the singing of the chorus. From that point on there was a sense of community among the crowd that hadn’t been evident before.

For the last 39 years I have periodically thought about the events of that night but had forgotten about the song. I had not heard the song again until last year when I purchased a Pete Seeger CD in honor of Pete’s 90th birthday. As soon as I heard the song, I remembered it as the song that calmed the crowd and created a sense of community during a very challenging, chaotic and divisive time. Listening to the words, I realized that the song is just as appropriate in today’s world of conflict and chaos as it was in 1971. Perhaps the message of this simple song can help us get through the struggles of dealing with differing perspectives and conflicting opinions in 2010 as effectively as it did 39 years ago. Here are a few of the verses from the song.

ALL MIXED UP by Pete Seeger

You know, this language that we speakIs part German, part Latin, and part Greek,With some Celtic and Arabic and Scandinavian all in the heap,Well amended by the people in the street.Choctaw gave us the word “okay,”“Vamoose” is a word from Mexico way,And all of this is a hint, I suspect,Of what comes next:

Chorus:I think that this whole worldSoon mama, my whole wide worldSoon mama, my whole world,Soon gonna be get mixed up.

Oh, this doesn’t mean we will all be the same.We’ll have different faces and different names.Long live many different kinds of racesAnd difference of opinion; that makes horse races.Just remember The Rule About Rules, brother:“What’s right with one is wrong with another.”And take a tip from La Belle France,“Vive la différence.” Chorus

As we strive to increase the diversity (broadly defined) of our TCMS membership and improve our cultural competency, I hope we can be appreciative of all differing cultures, voices, views and perspectives even if they contrast markedly with our own. Recognizing and accepting that we’re “All Mixed Up” may be the best and only way to develop the broader sense of community needed to successfully address the complex challenges that face medicine and our society today.


Sue a. SCheTTle, CeO

TCMS IN ACTION

Membership Survey ResultsThe members of the Twin Cities Medical Society responded to an electronic survey sent to them prior to the March 2010 TCMS Board of Directors Strategic Planning Retreat. The results of the survey were very interesting and helped to guide the Board as they worked their way through the development of the three year strategic plan.

The response rate to the survey was over 10 percent. Of those responding, 4 percent said they were very active in TCMS; 10 percent somewhat active; 86 percent not very active. 92.3 percent were non-board members or committee members; and 30 percent had recommended joining the Society to another physician; 70 percent had not.

When asked to rank the activities of TCMS and how important those activities are to our membership there was a clear and consistent theme. The chart below shows the results.

Top 5 Responses:

Next 4 Responses:

The survey showed that there was strong support for work at the local and state level as it relates to policy and that members understood and supported the work associated with public health. There was also strong interest expressed from members related to providing educational opportunities, practice standards and regulations, helping physicians become leaders, developing reimbursement strate-gies, social and collegial activities and some interest expressed related to particular local and state policy and funding issues (tort reform, GMAC, etc). The survey also provided some insight into our membership jour-nal — MetroDoctors was rated highly in terms of its value to our members. Many felt that the merger of EMMS and WMMS went smoothly.

The survey provided the board of directors with some clear direction as they went into the Strategic Planning retreat in March 2010. The discussions at the retreat as reported in an earlier version of MetroDoc-tors resulted in five key areas of strategic focus for TCMS. They include:

1. Public policy advocacy2. Community and public health initiatives3. Support the practice of medicine4. Promote the visibility, awareness and benefits of membership5. Effective management of resources

The TCMS executive committee and board of directors recently reviewed the Strategic Implementation Plan which sets the framework for achieving the goals of TCMS over the next three years. Currently TCMS has 5,817 multi-specialty members. Below is a summary of the categories of membership as well as various demographic information relating to gender and average age of our Regular Active members.

State public policy efforts

Community and public

health initiatives

Local public policy efforts

Liaison with elected officials

National public policy efforts

2.52 2.49 2.46 2.39

2.07

0

1

1.5

2

2.5

3

0.5

Importance of Activities—Top 5Scale: 3=important; 2=somewhat important; 1=not important

Continuing education

General Membership

Communications

Management of Society’s

financial resources

Opportunities for collegiality

1.84

1.88

1.9

1.92

1.941.96

1.86

Importance of ActivitiesScale: 3=important; 2=somewhat important; 1=not important

1.98

2

Input from the membership was extremely valuable throughout the strategic planning process as the Board set the future direction of TCMS. Please feel free to contact me if you have any questions. I can be reached at (612) 362-3799 or [email protected].

Regular Active

Retired

Residents

Medical Students

851

992

946

3,028

TCMS Total Membership —5,817

Of the Regular Active Members:

927—Female2,051—Male50—Not Listed

Average Age—50


L E T T E R S

I write these lines in response to a page entitled Alumni Profile: Healing Traditional Medicine, from University of MN Alumni Association, Sep-tember-October 2007, page 48; and Colleague Interview: A Conversation with Karen Lawson, M.D., MetroDoctors, July/August 2010, page 8.

Webster defines Shamanism as “a primitive religion holding that gods, demons, ancestral spirits, etc., work for the good or ill of man-kind through the sole medium of the Shamans.” Shaman is defined as a priest of shamanism, a magician.

I have had frequent contact with shamans, their practice of “spiritual healing,” and have observed its effect on their subjects. My wife and I spent a total of 13 years on the ground in Ethiopia between 1956 and 1975. After retirement from ORS practice in MN in 1988 we were asked to assist in church hospitals in Cameroon, West

Africa. The result was 16 yearly trips to Cameroon spending an average of four months there each year. Those months were spent in surgery practice and teaching interns from the medical school in Yaounde. Our last visit to Cameroon was in 2004, after which old age ended our foreign travels.

Over the years, bridges of friendship were developed with many shamans who received treat-ment for themselves and their families. Many re-mained incognito but some revealed their identity to me. The most powerful shaman of all lived on the south bank of the Blue Nile gorge in the Gendeberet wereda (county) of Ethiopia, an area of about 2,000 square miles, bounded by the Muger and Guder rivers which flow through mile deep canyons to join the Blue Nile. Our friend-ship started when this man was carried to us for five miles on a horse skin bed severely ill with typhoid fever, which was common in Ethiopia

at that time and continues to be so now in both countries.

This man’s title was Kallu, an Oromo word meaning “Chief Sacrificer.” As he explained it, he was controlled by a demon named Cherega, greatly feared by the Kallu’s subjects. When he traveled on his very tall mule, followed by a bodyguard of 10 well armed men with rifles and well filled cartridge belts, people would fall on their faces and stay prone while he passed. People were of-ten seen crawling on knees to the galma (spirit temple) to obtain favor with Cherega. On one occasion along the trail a screaming woman was seen pounding her head against a house wall. She had been ordered by the Kallu to give her small child to a childless woman who had requested a child from the Kallu. She dared not refuse his order.

One man related how when ill with what he called pneumonia, the Kallu said, “Bring six white bulls; we must kill them and pour the blood over you”; which was done. On the roof poles of the veranda running around the spirit temple (galma), a round structure about 50 feet in diameter, were hung the jawbones of cattle and sheep which had been sacrificed to Cherega; evidence that Satan and the demons require heavy dues from those who worship them.

The late Karl Eric Knuttson, social anthro-pologist from Stockholm, published the definitive paper about the Kallu system in 1967. [Author-ity and Change, a study of the Kallu Institution among the Macha Galla of Ethiopia, published by Göteborg 1967.]

Also, on the other side of the African Con-tinent, I encountered other traditional healers in the delightful country of Northwest Province, Cameroon. Cameroon is a favorite location for anthropological studies with its 250 tribes and languages, and animistic religions. It is important to note that my Cameroonian M.D. colleagues who were questioned about shamanism could see no way to integrate their evidence-based medicine with shamanistic practice. They had all suffered in childhood at the hands of shamans.

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Dr. Coleman,I very much hear the sincerity of your response and the intensity of the experiences you had over the years, and am certainly not in anyway suggesting the we bring dark religious practices, or sorcery, into the practice of modern medicine. Your experience, and indeed your very definitions of Shamanism, are not all encompassing, and indeed are not reflective of how this field is currently viewed in the contemporary world. Shamanism, as I teach and experience it, and as defined by current scholars in the field, is not a religion, but a world view and life path. In the Encyclopedia of Shamanism, by Christina Pratt, “Shamanism is not a system of faith, either. Rather, it is a group of common activities and experiences that link shamans and their unique experience of the world. The shaman and the people they serve value shamanism because it works; it meets their needs in practical ways. What shamans experience in their journeys in the spirit world is accepted as real.” John Mat-thews, in The Celtic Shaman, states: “Because it is not an organized religion as such, but rather a spiritual practice, shamanism cuts across all faiths and creeds, reaching deep levels of ancestral memory. As a primal belief system, which preceded established religion, it has its own universal symbolism and cosmology, inhabited by beings, gods and totems, who display similar characteristics although they appear in various forms, depending on their places of origin.”

While the terminology cross-culturally, makes this a very confusing situation, much of what you describe as experiencing in Africa would be considered sorcery, although healers and their practices do vary widely by culture. The common goal for shamanic healers would be the health and well-being of the tribe, the homeland, and the individual. According to Sandra Ingerman, contemporary shamanic scholar, we are seeing a “renaissance of shaman-ism, because it is a ‘path of direct revelation.’ Shamanism requires no outside authorities, intermediaries, or even beliefs — instead, it provides powerful tools to let you tap into the unseen world for insight and healing.” It is about seeing all things in the world as connected through unseen energies or spirit; a view that is increasingly shared by both physicists and ecologists. It is that philosophy of interconnection that I personally value, and I believe has something useful to offer modern medical practices. What is most important, however, is that we be respectful of the beliefs and practices of the patients and families with whom we work, because it is their beliefs that will impact their own healing.

Karen Lawson, M.D.

cfm?Section=PAACS&Template=/CM/HTML-Display.cfm&ContentID=19380), in the year 2000, had on its staff around 100 traditional healers and 10 M.D.’s — mostly nationals with a few expatriates. An M.D. from Canada contacted 50 traditional healers, visited their shrines, herb gardens, and studied their philosophies of healing. Fifty-four percent had some type of training by older healers and the rest had none. After train-ing by an older healer there would be initiation to the group with incantations and sacrifice of goats and chickens, the blood stained feathers of which were hung in his shrine and kept for their invisible power.

Most healers spoke of powers as coming from God. One said, “My powers come from The Almighty. He created herbs and gave knowledge to Lucifer who instructed me in a dream.” He thought of Lucifer as a messenger from God.

Most traditional healers receive remuneration in the form of goats, fowl and palm wine. Some demand cash. A man came to us with chronic osteomyelitis and non-union of fractures of fe-mur and tibia. He showed a photo of a shaman applying a splint made of goat leg bones to the fractures. The patient had paid the equivalent of $120 U.S. for one treatment and $80 U.S. for a second treatment which consisted of apply-ing the goat bone splint for a short time to the fracture areas.

Diagnosis of illness must be made usually in the shamans own shrine where his powers reside and where the oracles of diagnosis are scattered on the ground. Shamans do not look for signs and symptoms of diseases but for causes. Spider Divination is a common tool. (Gebaur, Paul 1964 Spider Divination in the Cameroons, Milwaukee Public Museum, Milwaukee.)

Another instrument seen was a monkey skull and spine assembled on a pivot. The skull was asked to tell the diagnosis. It spins and where it points when stopped gives the shaman infor-mation. Only one example of anything like a physical exam was given by a shaman who asked the patient to breathe into his closed fist. Then he would smell the hand for a diagnosis.

The shamans often used cuts on the skin to deliver herbal substances into the body, saying, “Since most illnesses move in blood we cut flesh and rub the medicine into the blood stream.” Kale in British Medical Journal, 1995, described this as a common way for HIV to be transmit-ted and also as a causative factor in high rates of staphylococcal endocarditis.

Experiences during my 88 years of life and 60 year acquaintance with medicine and surgery tell me that we should not integrate a shaman sys-tem based on superstition, ignorance and fear of the demonic world with evidence-based medicine and its life-saving and life-preserving advances.

Thomas P. Coleman, M.D.

University of Minnesota, 1953. Dr. Coleman joined Hennepin County Medical Society in 1967.

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East European Medical Society of MinnesotaFirst Steps and Future plans

By elena lev polukhin, M.d.

Several years ago I moved to Min-nesota and joined a small private clinic that provided care to East European immigrants — mostly Russian speaking. I was surprised to see how fast my census was

growing. In a short time my schedule was full and was booked several weeks in advance. I did not understand why so many Russians came to my clinic. I later learned that Minnesota has one of the largest Eastern European com-munities in the Midwest. It is one of several American states that welcomed Eastern Euro-pean religious refugees — Baptists, Pentecos-tals, Seventh Day Adventists, Catholics, and Russian Orthodox. I also realized this Eastern European community was vibrant, diverse and challenging.

The first wave of Slavic people came to Minnesota after World War II; those people were primarily from the Ukraine escaping the horrors of concentration camps and the war. Later on a mass influx of immigrants came from the former Soviet Union following the demise of the USSR at the end of the 1980s, beginning of the 1990s. For the last 20-30 years Minnesota has welcomed Jewish settlers and more recently Fundamental Christians. It is a unique group of religious people who dared to believe in God and not in the Com-munist Party and its phony socialistic ideas. These people were persecuted in the former Soviet Union; they were not allowed to leave the Russian Empire, and only several years ago this group of people was liberated. Today the number of Eastern European immigrants in Minnesota exceeds 240,000 and represents 15 official nationalities and 230 sub-nationalities

of the former Soviet Union as well as former East European countries1.

Any immigrant group, in general, presents with more health related challenges than the host population, and the Minnesota Eastern European community is no exception. Russia has the lowest life expectancy among industrial-ized countries1, and self-rated health in Russia and other eastern bloc countries is substantially lower compared to western populations2. The concept of mental health and disability did not exist in the former Soviet Union and other Com-munist countries. Conditions like depression, bipolar disorder, and schizophrenia were not recognized or differently diagnosed. Also, out of fear of reprisals, Russian citizens did not report signs of emotional discomfort to their doctors in their home countries. Even in the United States these new immigrants are underreporting mental health conditions today assuming the medical providers will inform the immigration officials and have them deported.

While working with the Eastern European immigrants my colleagues and I quickly realized that our patients were completely lost in the U.S. health care system: they did not understand the

difference between U.S. and their home country medical systems; did not comprehend the great advantages of the U.S. disability and social sup-port system; were unable to utilize community resources; and frequently continued to rely on dangerous folk medicine practices.

This is why the group of community lead-ers and activists in collaboration with the local government decided to organize the East Eu-ropean Medical Society of MN (EEMS). The development of this program was a shared vi-sion of authors: Drs. Leon Frid, Capt. Alex Tolstov, Gedaly Meerovich, David and Alla Vaynberg, Leo Grichener, Elaine and Tony Axelrod, and Alex Chernyaev; and in collabora-tion and support of local Minnesotans: Karen and Fred Haider, Drs. Ada Mayo, Dennis Dyk-stra, Constantin Starchook, Donald Jacobs; and international humanitarians like Drs. Anne Dykstra, Mark Young and many others. First steps were done in 2003, and initially the society functioned on personal funds of the president, board of directors and fellow members, sup-porters and pharmaceutical companies’ grants. In May of 2005 EEMS received the status of a non-profit organization and IRS tax exemp-tion status.

The first examples of EEMS activities were monthly educational articles in the Russian pa-per ZERKALO, community-based educational lectures and published educational booklets prepared in collaboration with American Slavic Institute. This activity of EEMS was well re-ceived by the community in Minnesota and abroad. In 2006 we received the invitation to join the national Russian American Medical As-sociation (RAMA) and continue collaboration with many international charity organizations.

While having good intentions, none of us had non-profit organization experience. Many mistakes were made, and sometimes we felt that all our attempts were futile, and that we would


never be able to help our people and ease their problems. But, gradually, we gained a reputa-tion in the community, people appreciated our drive and dedication, and Minnesota colleagues admired our persistence. I remember one day Leo Grichener called me. Leo was the EEMS Board member responsible for our educational publications in the Russian speaking newspaper ZERKALO. He said, “you know, I was sick and did not write an article for this month’s issue. The next day after the newspaper delivery, I received hundreds of calls inquiring about the missed article. Why was I thinking that nobody reads us? It was one of our happiest days!”

We did not know what programs to run and we decided to try several important, in our opinion, topics. I would like to tell you about some of our past, ongoing and future programs.

1. Medical Providers Directory. Our goal was to develop the network of Minnesota medical providers who are able and willing to deliver medical care to East European immigrants, with respect to the patients’ cultural and re-ligious beliefs. Minnesota has very few Rus-sian born physicians and they are defi nitely unable to help all of the people in need. We were amazed by the enthusiasm of local Min-nesota providers who wanted to list their clinics in our directory. Today EEMS has published three editions of the directory that lists phy-sicians, nurses, therapists, hospitals, nursing homes, pharmacies, nursing agencies, home care services, etc. Currently this directory is published in English and Russian, but we in-tend to broaden our services in Ukrainian, Serbian and Croatian.

2. Chronic Pain Management and rehabilita-tion Program. Pain is a big issue for Eastern European immigrants, and EEMS developed several clinical care plans: “Healthy Knee Joints” for the treatment and rehabilitation of arthritis and “Healthy Spine for the Healthy Future” for the neck and low back pain treat-ment (in English and in Russian). Our goal was to develop and implement clinical pathways and educational programs for the Eastern Eu-ropean Community in Minnesota in order to improve patients’ and providers’ understanding of comprehensive chronic pain, osteoarthritis treatment and the role of newer medications in its management.

3. Self-reported general and Mental Health Status and Disability of eastern european

religious refugees in Minnesota. This re-search project was accomplished in collabo-ration with Karolinska Institute in Sweden. EEMS funded this project since we needed the realistic data about general, mental health and disability issues in the Minnesota East European population. It was one of our very fi rst programs. It is completed, and the study results were published in prestigious scientifi c journals.

EEMS is deeply in debt for the endless help, collaboration and friendship of Dr. Kurt Allenberg (Denmark) and Dr. Julia Blomstedt (Sweden), who helped tremendously with this research project.

4. Dystonia program. This is one of our fa-vorite programs since it was developed and implemented by active community leader Vasyl Pelepchuk, Despite his tragic disease and dis-ability (he suffers from dystonia himself ) Vasyl continues his active community and church ac-tivities, trying to develop a peer support group for Minnesota dystonia patients.

5. Vocational rehabilitation pilot project is still in the planning phase. It is a mutual project in collaboration with the Russian American Busi-ness Cultural Association and the Department of Employment and Economic Development (Kimberly Peck, Director of DEED and Ste-phen Larson, vocational counsel). We want to develop and implement a vocational rehabili-tation program focused primarily on disabled immigrants of Eastern European decent. Suc-cessful implementation of this program will help our poor and disabled people to preserve the dignity and enhance the quality of life through a caring, stimulating and enjoyable environment.

6. adult Day Center for Therapeutic reha-bilitation for disabled and elderly eastern eu-ropean immigrants (in collaboration with the Director of Slavic Community Center Gedaliy Meerovich). We continue working with several adult day care centers providing educational activities and medical support to our elders. It is interesting that recently EEMS was contacted by the Hmong community asking to help them with a similar program.

7. Fitness program for eastern european disabled and elderly. This program became a reality because of the enthusiasm of Dr. Tony Axelrod and the support of Minnesota

Bodybuilding Association. EEMS wants to develop the fi tness program for elderly and disabled immigrants of Eastern European de-cent and implement it in adult day care centers, residence centers, and assisted living centers. This is a new program and we hope to develop it in the next several years.

8. Humanitarian Missions and international Collaboration. National and International Ex-change Program/Visiting Professorship. This is one of our most successful programs. When we started, we published information about our newly born society at the Russian American Medical Association, WHO and UNESCO websites. We were asking for good advice, direc-tion and help in development and implemen-tation of our programs. We got a tremendous response from our fellow colleagues from the U.S. and Europe who are dealing with Eastern European immigrants in other states and coun-tries. People kindly shared their experience with us, supported our efforts and tried to prevent us from most frequent mistakes (that we did anyway). As a result we have a great network

(Continued on page 10)

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of colleagues in Minnesota, other states and internationally. Since then we have continued our relationships including: exchange visits, workshops, and training for foreign medical providers interested in learning U.S. medi-cal management. In 2008 EEMS hosted Dr. Kybanych Takyrbashshev from the Kyrgyz Republic, from Kazakhstan and Belorussia.

9. Medico-legal program. This is one of the most popular programs, and its goal is to edu-cate the Eastern European community about medico-legal issues, social security disability system, no fault and workmen’s compensa-tion, and immigration issues. This program is designed in collaboration and support of the Minnesota Bar Association, under the guid-ance of a young community lawyer Nadia Polukhin-Pratt, William Mitchell College of Law graduate.

10. Mental Health Program. This is one of our biggest and most promising programs. It is divided into several small projects that include, but are not limited to the following:

• Support groups for patients and care giv-ers diagnosed with Alzheimer’s disease and other dementia-causing illnesses. These groups offer a unique cultural and linguistic way to understand and equip participants with tools to cope with Al-zheimer’s disease and its impact on one’s overall functioning.

• Support groups for parents of children ad-opted from Eastern Europe. These groups provide a forum for adoptive parents to discuss the unique challenges they are fac-ing, to provide mutual support and shar-ing of information, and to have medical/mental health professionals for support, guidance, consultations and referrals.

• Support groups for Eastern European women married to American men. These groups provide a safe and linguistically/culturally appropriate setting for women married through Internet dating services to discuss their concerns, support each other through the challenges of accultura-tion, to receive brief crisis counseling and referrals to medical, legal, and/or social services.

11. Mutual project with Slavic Community Center and Jewish Family and Children’s Services of Minneapolis (JFCS). This project began in May 2006 and is devoted to develop-ment and implementation of a Coordinated Health Services Collaborative program for Russian-speaking immigrants (CHSC). The program is funded by Blue Cross/Blue Shield Foundation as a continuation of existing JFCS programs. This program was successful and is well regarded in the community; we intend to continue our collaboration that is fruitful and beneficial for the community.

This is a very short list of the EEMS activi-ties, achievements and plans. We worked very hard to learn how to run a nonprofit organi-zation in Minnesota. Today, five years later, when our East European Medical Society is active and successful, we are thinking that we were blessed to meet people who took time to understand our ideas, support us, and share the passion to help simple people who came from the country where we were born. Today we feel much more confident and truly believe that EEMS can contribute to the East European Community of Minnesota. We are profession-als who can bridge all the gaps gracefully and appeal properly to each community, but we need local experience, knowledge and connec-tions. We continue working and learning from the best medical and professional leaders, and we are confident that we must continue run-ning the culturally sensitive community-based programs for new Americans of the Eastern European Bloc. REFERENCES: 1. University of MN survey. Department of Human Ser-

vices and Public Health. 2001. 2. M Bobak, H Pikhart, C Hertzman, R Rose and M Mar-

mot. Socioeconomic factors, perceived control and self-reported health in Russia, A cross-sectional survey. Soc Sci Med 1998; 47(2):269-279.

3. Y Blomstedt, S-E Johansson and J Sundquist. Mental health of immigrants from the former Soviet Bloc: a future problem for primary health care in the enlarged European Union? A cross-sectional study. BMC Public Health 2007; 7(27):1-12.

4. P Carlson. The European health divide: a matter of financial or social capital? Soc Sci Med 2004; 59:1985-1992.

5. Y Sungurova, S-E Johansson and J Sundquist. East-west health divide and east-west migration: Self-reported health of immigrants from Eastern Europe and the former Soviet Union in Sweden. Scand J Publ Health 2006; 34:217-221.

Elena Polukhin, M.D., president, East European Medical Society (www.eems-us.org). For more infor-mation contact Dr. Polukhin at (651) 890-2041, www.elenarehabilitation.com, or [email protected].

East European Medical Society

(Continued from page 9)

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Culturally Competent Care Means Safer and Improved Care

By Mary Beth dahl

Medical and non-medical staff members who are aware of cultural differences and dem-onstrate cultural sensitivity to

the diverse values, beliefs and behaviors of their patients provide a welcoming and inclusive health care experience. They also are more likely to understand the cultural clues that can help them provide the safest and best quality care.

Cross-cultural medical encounters can be puzzling for physicians who don’t properly in-tuit the behaviors of their patients. Vietnamese people may not ask providers questions or voice concerns. Not because they lack questions or concerns but because they value politeness and respect for authority. They may smile easily and often, regardless of underlying emotions. If they disagree or do not understand, they may simply listen and answer yes, then not comply with recommendations or return for further care.

Understanding a population’s shared his-tory and generalized characteristics can prepare providers to ask questions that lead to greater discovery. Somali refugees often suffer from unexpressed depression, anxiety and post trau-matic stress as a result of torture, loss of family members, and separation from family. Providers may have to dig deeper and spend more time with these patients to better understand their cultural characteristics and backgrounds in order to make the correct diagnosis, provide the best treatment, and make sure the patient truly understands the diagnosis and treatment.

Non-English speaking patients are more likely to delay seeking care, refuse services, and fail to follow recommended treatment if they don’t understand it. Staff members at a St. Paul clinic were having challenges ensuring that their

Hmong patients understood their instructions for taking medications. They realized that using family members as interpreters was not work-ing. The clinic decided to think about getting a trained in-person interpreter or telephone interpreter system for clinical encounters.

Today, changing demographics in Min-nesota and the nation are making it crucial for providers to recognize and address cultural issues. With recent growth in the number of immigrant residents to Minnesota, including many who speak languages other than English, patient populations are changing dramatically. Minnesota now includes the largest Somali and Liberian populations and the second largest Hmong population in the U.S. The largest urban Hmong population in the world resides in St. Paul.

Between 2005 and 2035, the Hispanic population in the Twin Cities is projected to nearly triple, while the African American population is projected to double. According to the Minnesota Department of Health Status Report, nonwhite populations in Minnesota represent more than 10 percent of the state’s population. The percent of Minnesota’s popula-tion that is nonwhite is projected to rise to 13 percent by 2015 and to 16 percent by 2030. The U.S. Census Bureau predicts that within the next 50 years, nearly one-half of the nation’s population will be from nonwhite cultures.

Cultural competence in health care de-scribes systems and policies that create an ef-fective environment to provide the best care to patients with diverse values and beliefs, as well as people with limited English proficiency and low literacy skills. Culture is influenced by many factors: language, age, gender, sexual ori-entation, place of birth, and length of residency in a country, as well as educational level, income level, disability, and individual experiences.

In many cultures, family dynamics dictate who makes health care decisions. After a Twin Cities physician understood how important family influence was in whether or not a pa-tient would follow his treatment instructions, he realized he could have been doing a better job of communicating with the Hmong and Hispanic patients and families in his practice.

People who come to the U.S. from other countries are often unfamiliar with Western medical customs and may distrust American methods of care. Several immigrant populations use home remedies not used in the U.S., such as dermabrasion techniques that leave marks on the skin, which may be misinterpreted by health care providers as signs of physical abuse. Failure to take into consideration a patient’s cultural and linguistic needs can result in miscommunication, inaccurate histories, and failure of the patient to follow medical advice. Lack of cultural understanding can lead to an inaccurate diagnosis with negative or even fatal consequences.

Every clinical encounter is cross-cultural. For example, many Russian immigrants are un-familiar with the cultural etiquette of American medicine and tend to expect more compassion and emotional closeness with their physician. In Russia a patient can confess to a doctor as if speaking with a priest. Also in Russia, hospital gowns are not provided during examinations; nudity is not considered shameful. Problems can arise in the health care setting directly from these cultural differences.

Evidence shows that despite improvement in overall health for the majority of Americans, disparity in the quality of care provided contin-ues to affect minority populations dispropor-tionately. In Minnesota, health care statistics for populations of color do not compare favorably



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to those of the white population — even though Minnesota is consistently ranked as one of the healthiest states in the nation. Illustrating this point, a local nurse noticed a recurring theme within her clinic’s African American patient population. Almost every other patient she saw seemed to have hypertension and heart disease. This observation was confi rmed by statistics which show that African Americans are affected disproportionately by the leading causes of death in the U.S., including heart disease and hypertension.

To address health care disparities and promote cultural competence in Minnesota, Stratis Health, with the support of UCare, is working with approximately 20 adult primary care clinics in a statewide cultural competence initiative. Participating clinics complete a pre-assessment survey and receive feedback on how well they are doing in relation to the Offi ce of Minority Health’s national Culturally and

Linguistically Appropriate Services (CLAS) Standards. Stratis Health then provides the clinics with recommendations for strategic planning and staff training. The clinics also each receive a demographic profi le of their service area, onsite consultation, education, and resources. At the end of the program, clin-ics will complete a post-assessment survey to measure their improvement. A similar project previously led by Stratis Health resulted in statistically signifi cant performance improve-ment on all 14 CLAS Standards by the 23 participating clinics.

Based on projected demographics for Minnesota and the nation, a large number of Minnesota’s future patient population will be people of color. Being deliberate about develop-ing an infrastructure for cultural competence in your health care organization is important. Everyone has a role to play. Knowledge, skills and attitudes are needed to communicate and interact with people of different cultures. To begin, physicians and staff fi rst need to care-fully examine their own beliefs about cultural differences. We all need to be aware of personal attitudes, biases and behaviors that can infl u-ence care of patients and relationships with colleagues and staff from different racial and ethnic backgrounds. As we challenge our own reactions to people who are different confront-ing racism, sexism, classism, and other forms of prejudice and discrimination in clinical en-counters we better understand and appreciate our commonalities and differences.

Hennepin Faculty Associates in Minne-apolis conducts mandatory staff education ses-sions on cultural competence. Faith Dohmen, RN, said, “This has been a great opportunity for us to do our part to reduce disparities in health care; it really is all about providing the best care for all our patients. These sessions have led to interesting discussions about staff ancestors and languages spoken in the homes of our staff members’ families.”

Health care leaders need to make cultural competence a priority, leading by example. Im-provement is possible. Conduct walkthroughs in the clinic and hospital to see what patients see every day. How friendly and accommodat-ing are staff members? Are non-English speak-ing patients aware of your language services? What are the wait times for interpreters? Are translated patient education materials available

and translated signage posted? How diffi cult is it for your patients to get to your facility and navigate your health system? Do your staff, administration and board members refl ect the diverse patient populations you serve? Find out if patients fully understand their diagnosis and treatment options.

The Annex Teen Clinic in Robbinsdale conducts monthly education sessions for staff and community health educators. Brooke Stel-zer, health education director, said, “Staff have watched DVDs on specifi c populations and have heard Minnesota International Health Volunteers speak, which has provided a great foundation to discuss a diversity of health be-liefs and refl ect on where we place ourselves on this continuum of beliefs.”

Hennepin Faculty Associates is currently educating its staff about the clinic’s existing cultural competence policies and practices, conducting walkthroughs, and updating its training to include information on the CLAS Standards. Plans also are in place to meet with leadership to discuss changes in job descriptions and performance evaluations, and creation of a bilingual complaint process and an advisory committee with members from the diverse communities they serve.

It is incumbent on the health care com-munity — physicians, leadership and staff to be intentional in supporting meaningful efforts to meet the cultural and communication needs of their patients in order to provide culturally competent care and ensure the long-term suc-cess of health care organizations. Explore the new Culture Care Connection website for pro-viders, www.culturecareconnection.org, to fi nd a variety of resources that can assist you in your efforts to provide culturally competent care.

Stratis Health is a nonprofi t organization that leads collaboration and innovation in health care quality and serves as a trusted expert in facilitating improvement for people and communities. Stratis Health lends its expertise to hospitals, clinics, nurs-ing homes, home health agencies, health plans, and other organizations across the health care continuum and has served Minnesota in a broad range of capacities since 1971. Mary Beth Dahl is the program manager for Stratis Health’s cultural competence initiative. www.stratishealth.org.

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Join MSIM Dues are just $150 per year. Members attend threedinner events annually at the Minikahda Club as a member benefit.

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MMA Helps Clinics and Docs with Improving Use of Interpreters

THrougH THe work of the MMA Mi-nority and Cross-Cultural Affairs Committee, the MMA has created an educational presen-tation on how to work more effectively with interpreters. “This has been an ongoing issue for physicians and clinics, and we thought that the MMA could provide a constructive product to help with this challenge,” said committee chair Dionne Hart, M.D.

Since the fall of 2009, four clinics and hospital systems in Mankato, Minneapolis and St. Paul have participated in the one hour presentation and feedback session. “The pri-mary focus is to remind physicians of the basic

components of how to work effectively with a trained interpreter,” said Hart. “We really don’t find that this information is brand new to anyone in the field, but a brush-up is always a good idea.”

In addition to completed sessions at ISJ-Mankato, Children’s St. Paul, Smiley’s Clinic and HealthEast Roselawn Clinic, there are three other sessions planned for 2010 in St. Cloud, St. Paul and Minneapolis. To schedule a presentation in your clinic or hospital system, please contact Dennis Gerhardstein at (612) 362-3745 or [email protected].


More than 18,000 immigrants and refugees settle in Minnesota annually to join existing family or start new lives. That means 10 percent of the state’s families speak a language other than English, thus raising challenges for main-stream and New Americans alike. Emergency, Community, and Health Outreach (ECHO) works to close communication gaps with lim-ited English proficiency (LEP) populations and by working with agencies to inform fami-lies about health, safety, emergency and civic engagement.

ECHO’s BeginningsECHO was formed in 2004 by local and state public health and safety agencies. Initial grant funding helped develop ECHO’s communica-tion model which supported emergency response activities initiated by local and state public health agencies seeking ways to communicate to LEP audiences during a public health crisis such as a pandemic or terrorist attack.

“Our communication model serves to educate during non-emergencies and activate during emergencies serving limited English Proficiency audiences,” says Lillian McDon-ald, ECHO’s executive director. “We connect organizations trying to reach limited English speaking audiences with key leaders from those communities and together we provide cultur-ally competent programming and outreach,” adds McDonald.

ECHO produced health, safety, emer-gency and civic engagement topics on public television broadcast statewide on Twin Cities Public Television’s Minnesota Channel. Cable stations extend the broadcasts on participating stations. ECHO’s toll free phone line, web-site and participating community-based radio stations also spread information to Hispanic, African and SE Asian audiences statewide. In-formation is extended to classrooms, clinics, and libraries through partnering organizations delivering DVD copies of programs or through streaming video housing an online library of topics on www.echominnesota.org.

ECHO’s GrowthInterest and use of ECHO’s communication model, materials, and community connections is growing. About a third of ECHO’s funding comes from government agencies working with ECHO to improve emergency response com-munications. Public and private agencies sponsor culturally appropriate programming on health or civic engagement topics that the agencies alone cannot produce. Individual and organizational fundraising helps cover the remaining third of ECHO’s budget.

ECHO's communication model of suc-cess has been documented locally and nation-ally including most recently in research titled Enhancing Public Health Preparedness for Special Needs Populations: A Toolkit for State and Local Planning and Response by the RAND Public Health Initiative. “One of ECHO’s critical suc-cesses has been in forging a positive response among a diverse population. It has done this by customizing each topic for each language and featuring native-speaking on-air personali-ties and expert guests” (RAND Public Health Initiative, 2010, p. 58).

ECHO continues to cultivate and

strengthen relationships within the commu-nity by extending partnerships to dozens of local and state governments and non-profit organizations. Last year, use of ECHO’s website doubled and program views have increased by 30 percent.

ECHO's EducationEach month, ECHO focuses on a different health, safety, emergency or civic engagement topic and produces a television program and supporting resources are created. So far, 70 different topics have been produced. Partners can play a role in this process as subject matter experts. “I previously worked with ECHO on the STI prevention video for the Hmong com-munity. It was such a huge success and I would love to continue working with you guys,” said

Agency Fills Critical Health Community Void

Lillian McDonald, ECHO’s executive director



Our partners include: • AmeriPride Services (linens and apparel) • Berry Coffee (beverages and food) • Stanton Group (group/individual insurance)

• SafeAssure Consultants (OSHA compliance) • AED Professionals (AED distributor) • IC System (debt collection)

Proceeds from MPS help to support the medical society’s operations. Please consider our business partners listed below as you look to reduce your operational costs.

TO LEARN MORE CALL 612-362-3704 OR VISIT: WWW.METRODOCTORS.COM/SERVICES.CFM

Laura Vang, Planned Parenthood Minnesota, South Dakota, North Dakota.

October’s focus is breast cancer. A grant from the Susan G. Komen Foundation under-wrote breast cancer programming in Spanish, Hmong, Somali and Low-Literacy English on TV, radio, phone, web and targeted outreach in English Language Learning (ELL) classrooms. The educational materials titled, “Breast Can-cer: Detection, Prevention, and Treatment,” are designed to educate and provide hope and resources to LEP audiences and health provid-ers who may not realize the cultural barriers impeding patients from seeking prevention or treatment when faced with a potentially curable disease with early detection.

Appearing in the program are local doctors, cancer experts, and health care or-ganizations, providing culturally competent information and inspiration to members of the Hispanic, African and Hmong community. “English speaking patients will also benefi t because the information is current and conver-sational rather than clinical or technical” says Paul Moore, the show’s producer.

ECHO in an EmergencyECHO’s system for quickly communicating critical health information was utilized in April by the Minnesota Department of Agriculture to inform Somali and East African audiences about dried uneviscerated fi sh at ethnic gro-cery stores in the Twin Cities contaminated with Clostridium bacteria known to produce potentially deadly botulinum toxin. Within hours, ECHO translated the Department of Agriculture’s news release into Somali and Oromo and circulated it through its partner network to key contacts within the East African community, ethnic media, and was posted on East African websites.

“Without ECHO Minnesota’s quick abil-ity to translate and disseminate our messages on this topic, we would not have been able to share this information with those key audi-ences as quickly or effectively as we did,” said Gene Hugoson, Minnesota Department of Agriculture Commissioner.

How to Use ECHOThere is no charge to become an ECHO Part-ner. People and organizations can choose to be Supporters, Promoters, Alerters, or all three.

Examples of this are doctors and nurses who make guest appearances on ECHO’s programs, and clinics that help distribute ECHO’s DVDs and materials. “I give the Lead DVD (Lead Free Home Equals Lead Free Kids) to each family that I visit. I cannot tell you how important I think it is,” said Stephanie Hartman, PHN, MSN Saint Paul–Ramsey County Department of Public Health.

Most importantly, everyone can help promote ECHO’s work or connect ECHO to grants and programming to help sustain ECHO’s resources and activities. “Public Health’s job would be much more diffi cult without the ECHO presentations! I cannot thank you enough for the services you provide,” said Karen Ampe, PHN, Kandiyohi County Public Health.

The Mission of ECHO is to leverage part-nerships to develop and deliver vital health, safety, emergency and civic engagement infor-mation to help the ever-changing and diverse population integrate and become successful in our communities. Go to www.echomin-nesota.org to sign up to become a partner or a volunteer, and follow ECHO on Facebook and Twitter.

ECHO


To Learn More Call (612) 362-3704


By Sandra eliason, M.d.director of Medical programs

Center for Cross-Cultural Health

Despite improvements in the overall health status of Americans, mi-norities continue to lag behind whites in health status and ac-

cess to care. Since the 2002 Institute of Medi-cine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, each national health care disparities report has continued to document disparities related to race, ethnicity and socioeconomic status. These documented disparities in quality, access to care, and multiple types of care, pervade the American health care system.

The Center for Cross-Cultural Health (CCCH), has been working to help eliminate health care disparities since its founding in 1997 with its mission to “Advance health equity by addressing the root causes of poor health and supporting equal opportunities for good health.” Since that time, CCCH has developed cultural competency programs and tools, in-cluding organizational cultural competency assessments, resources for education and train-ing of health care personnel, and organizational cultural competency consultation.

One of the important areas in which CCCH is working currently is toward the disaggregation of race and ethnicity data to better defi ne health disparities. While much work has been done to attempt to defi ne dis-parities and fi nd ways to reduce them, the effectiveness has been limited by lack of ap-propriate data about the populations affected. In its Issue Brief Collecting Race, Ethnicity, and Primary Language Data: Tools to Improve Qual-ity of Care and Reduce Health Care Disparities, The Health Research and Educational Trust (HRET) states that collecting accurate data

is the basic foundation to eliminating health disparities and improving quality of care. They state that accurate data collected on patient race, ethnicity and language are necessary to address disparities in health care through a quality of care framework.

They state that “Efforts to eliminate ra-cial and ethnic disparities in health care must begin with valid and reliable data on race, eth-nicity, and language preference.” HRET has developed a uniform framework for collecting and reporting this information in hospitals. HRET’s framework includes standards and recommendations on the appropriate sources of race and ethnicity data, the timing of data collection, and an approach for categorizing race and ethnicity for analytical and reporting purposes.

The August 2009 IOM report brief, Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement, called on the Department of Health and Human Services (HHS) to develop nationally standardized lists for ethnicity categories, and spoken and written languages, with rules for aggregating ethnicity categories to the broader race and Hispanic ethnicity categories as defi ned by the federal Offi ce of Management and Budget (OMB). They asked for categories for locally relevant ethnicity choices.

Both The American Recovery and Rein-vestment Act of 2009 (ARRA) and The Medi-care Improvements for Patients and Providers Act of 2008 (MIPPA) reference the compre-hensive collection of patient demographic data, including race, ethnicity, primary language and gender information.” Additionally, MIPPA gives the Secretary of HHS the authority to develop approaches for data collection that measure disparities in health care services, im-plement strategies that address these disparities in a way that both protects patient privacy and

minimizes burdens on the Medicare program, and evaluate the success of these efforts in re-ducing clinical outcome disparities.

Locally, Minnesota Community Measure-ment is asking Minnesota clinics to implement what is hoped will be an effective and consistent effort to collect race, ethnicity and language data from all clinic patients in Minnesota. The Minnesota Community Measurement early adopters group, who were already collecting race, ethnicity and language data on its patients, discovered that at this time in Minnesota, “no two medical groups were using the same set of data elements,” to collect race, ethnicity and language data. Because of diffi culty in deciding on appropriate locally relevant ethnicity catego-ries in the early adopters group, the decision was made for medical groups in Minnesota to collect race/ethnicity categories based on the categories used by the OMB, along with country of origin and primary language.

This is an important fi rst step toward in-creasing cultural competency and decreasing disparities. Effective data collection will fi rst help defi ne where disparities exist, and can then be used to improve quality and effectiveness of care delivery targeted specifi cally to those patients experiencing disparities in health. For example, while we know that African Ameri-can women die more often from breast cancer than white women, we do not know specifi -cally within which area to target our efforts within the African American communities. If the incidence of breast cancer within the Somali community is negligible, for example, and high in the West African population, or higher in African American women who have been born in this country, should our resources be more targeted toward specifi c populations with higher risk? And, although the incidence of diabetes is increasing within the Hmong



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community, measuring rates of diabetes within the Asian population as a whole shows diabetes to be of less concern than in White or Latino populations. By not measuring the appropriate level of ethnicity to define Hmong population health, targeted efforts to screen for and treat diabetes in a culturally appropriate way are missed. As clinics collect data on the race, eth-nicity, and language of their populations, they will be better able to target quality programs and increase culturally competent care.

Within communities, also, there is a grow-ing desire for specific health data relevant to their community. Communities are aware that they will not be able to define their level of health or understand their own disparities and how to respond to them without data specific and relevant to themselves. There is a sense of being invisible within the health system when people cannot be identified by categories with which they identify themselves.

In a survey of over 50 community orga-nizations that CCCH carried out, one com-mon area for collaboration stood out — the need for health data to be ungrouped by race,

ethnicity or language rather than aggregated under the large OMB categories. Participat-ing community organizations agreed to work together to address this issue, and to collectively have a larger voice than any single organization could have alone. The group took the name ARCHé — the Alliance for Racial and Cultural Health Equity.

This legislative session, ARCHé helped move legislation through the Minnesota House and Senate which asks for an inventory of how race, ethnicity and language data is being col-lected in all of the programs of the Minnesota Department of Health and Department of Hu-man Services, as a first step to understand the data collection in Minnesota. This legislation was in alignment with work that MDH was already doing with a federal grant to inventory their data collection practices. Sharing of the inventory by MDH and DHS will help the community address the kinds of data that is of importance to them, and to define how the collection is best practiced.

The data disaggregation project is one of the important areas of work of the Cen-ter for Cross-Cultural Health. At the same time, CCCH is continuing consultation with

medical groups around culturally competent care, training on cultural competence and cross cultural communication, and convening with community groups to give a broader voice to their concerns.

Other areas of work are typical to the following: CCCH is consulting with a clinic that is experiencing frustration with a clinic patient population to try to lessen frustrations among the clinic staff, improve patient rela-tions, and lessen frustration for patients. After an internal assessment of clinic practices and an external assessment of patient experiences, recommendations will be made as to how to improve experiences for staff and patients alike, how to improve culturally competent care, and what training may be needed. That is just one of the types of consultation that CCCH does with clinic groups. CCCH has developed multiple assessment tools to improve culturally competent care in clinics, and continues train-ing in such areas as introduction to cultural competence, cross cultural communication, working with interpreters, and especially, how to begin collecting race, ethnicity and language data in a clinic. This training and consultation is done using both the HRET and the Min-nesota community measurement toolkits. It is a hands-on, step-by-step guide on how to begin to collect this data.

CCCH has assisted health and human service organizations with putting into place practices and policies that enhance the organi-zations’ ability to provide culturally appropriate services to their patients and/or clients since 1997. Additionally, CCCH has multiple deep relationships within communities, and works in the space between health care organizations/institutions and the communities who experi-ence health disparities.

Dr. Sandra Eliason, a physician with Fairview Health Services, has worked with the Center for Cross-Cultural Health since 2001, when she received a Bush Medical Fellowship to increase cultural com-petence in medical organizations. Dr. Eliason was a consultant to the AMA’s Ethical Force Patient Centered Care Initiative, one of three consultants to this program nationwide, and the only physician.

If your organization is experiencing difficulties with instituting the collection of race, ethnicity and lan-guage data, implementing culturally competent care, or if you have questions about any of these issues, Dr. Eliason can be reached at [email protected].


By peggy Metzer, CeO

People’s Center Health Services

Nestled in the heart of the Cedar-Riv-erside neighborhood, People’s Center Health Services proudly specializes

in providing affordable health care to patients of all racial, ethnic and socioeconomic back-grounds — and has for 40 years. As a Feder-ally Qualified Health Center, People’s Center Health Services is able to address financial barriers to quality health care with our slid-ing fee scale program. Serving disadvantaged communities and helping patients overcome barriers has always been at the heart of our organization.

At People’s Center Health Services, no one is denied care due to lack of insurance or employment status. We offer care on a sliding fee scale based on family income and family size to those with no insurance or a very high deductible. We accept most insurance plans, including those that are government-subsidized and if you don’t have insurance, our social ser-vice department can assist you in applying for the help you need.

People’s Center Health Services always strives to strengthen the cultural competency of our organization in order to best meet the expectations of all our patients, and with 79 percent of patient visits from communities of color and 64 percent of visits from East African patients, this has been a top priority. This means opening our minds and hearts to the community we serve and investing in resources to create a welcoming environment that celebrates diversity.

Our quest to best serve our patient base began with our patients...we listened and reached out to them so we could partner and connect around health and wellness concerns.

Our next step was to recruit and train personnel from the communities we served. Our goal was to develop a multi-lingual, multi-cultural staff so people from all over the world could relate to them and feel comfortable. As a result, our clinic currently has the in-house capacity to communicate in over 10 languages including Arabic and Farsi.

One notable example is Dr. Ahmed Mo-hamed, who joined People’s Center Health Services in 2008. His vast international medi-cal experience and fluency in Somali, Arabic, Italian and English, makes him a perfect fit for the diverse patient popu-lation in Cedar-Riverside and at People’s Center Health Services. Prior to working in the United States, Dr. Mohamed worked as a physician in hospitals and ref-ugee camps in Somalia and Ke-nya. His passion to help people from all walks of life makes him a natural fit at People’s Center Health Services.

Our diverse team is a blessing, but it also means we have to work toward bridg-ing in-house cultural divides among staff as well as between staff and patients. This is why People’s Center Health Services makes diversity training for all staff a priority. These frequent training sessions, with profes-sional facilitators, help build a better understanding of cultural awareness and what “respect” and “unconditional positive regard” means among many different people. Ultimately,

positive staff relations strengthen our aware-ness as compassionate and respectful care givers to our patients.

Because more than 50 percent of our pa-tient visits are Somali immigrants, People’s Center Health Services offers several special programs targeted toward this group. Everyone is eligible to participate, and program partici-pants include people with no Somali heritage.



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Examples are: the Somali Post Traumatic Stress Disorder Program, Somali Diabetes Program, Somali Obesity Program, and Somali Hepati-tis Program. In addition, we are developing a Somali Diabetes Education Video. Since the video will target the Somali population, we will use a Somali video production company and will produce three versions: one in Somali, one in Oromo, and one in English.

In addition to having a medical clinic that embraces culturally diverse needs, People’s Cen-ter Health Services prides itself on its Behav-ioral Health department. We understand the advantages of helping individuals, couples and families address mental health needs through ongoing therapy with a licensed professional. Many of our patients are recent immigrants from East Africa. They have unique needs. Thus, we have invested extra resources into developing a Post Traumatic Stress Disorder Program to support their health and well-being. Most of our PTSD patients have experienced

torture or exposure to torture as a result of civil war in countries from which they fled. In molding our program to fit these situations, our behavioral health staff has matched our PTSD program with the cultural beliefs and practices of our patient base. Our team is well versed in East African religions and culture and comfort-able discussing traditional practices with PTSD clients. As part of this enhanced program, we have developed four major cultural competen-cies, which have resulted in high demand for PTSD clinic services: • Knowledge of resettlement issues encoun-

tered by East African asylum seekers, who have fled civil war.

• Cultural competence with traumatized people from East Africa.

• Comprehension of personal torture and war trauma, as well as collective trauma experienced by this group.

• Complex coordination with interpreters, who provide translation services to PTSD clients.Working with patients who have PTSD

is a very individualized process. Each patient meets with a therapist/counselor and develops a care plan to address their unique circumstances to empower them to make small changes that will impact how they can better deal with their symptoms. There is a growing need for in-novative approaches that address current gaps in services, increase access, and show prom-ise in reducing the incidence and severity of symptoms in PTSD patients. This is a need People’s Center Health Services continuously works to fill.

When it comes time to sit down and re-view our demographic reports, statistics and financials, we know what the numbers say about our patient population. But it is in the patient stories and interactions that we see the true impact of working toward a better under-standing of our culturally diverse patient base.

One of our patients, a 67-year-old Somali man who was a successful merchant and busi-nessman back home, made plans to flee Somalia after he lost everything in the war. Every month he meets with our clinical social worker. He sometimes cannot talk about his losses without crying. Instead, he prefers to reminisce about the world he knew before the conflict. Because the People’s Center Health Services clinical social worker lived in Africa during the ’70s, they have many shared memories.

Directly after a follow-up PTSD visit, he said to the clinical social worker “I fear I will never again in my lifetime experience the dignity and beauty that once was my Africa, but visiting with you each month helps me remember, and for a short while, I am happy remembering the sweeter times.”

Our clinic experiences patient interactions like this on a daily basis and, ultimately, they fuel our passion and drive. Working to best serve our patients is a steady process of evalu-ation and self-awareness as an organization. It means conducting patient surveys, holding patient-based focus groups, listening to the ideas of our community and staff, and always asking ourselves “How can we do better?” It requires a diverse, agile staff and a set of unique services that reflects the wants and needs of our patients — two key components that make People’s Center Health Services a medical home to thousands of patients.

People’s Center Health Services



By K.a. Culhane-pera, M.d., Maassociate Medical director

Culturally Competent Medical Care at West Side Community Health Services

Culturally Competent Care. Cultur-ally Appropriate Care. Culturally Re-sponsive Care. Cultural Humility. As

physicians, we have heard these terms (and others!) through the years, and have seen many changes through the decades as organizations and individuals have tried to deliver better patient-centered care to patients outside the health care mainstream.

At West Side Community Health Ser-vices (“West Side”), we have always emphasized culturally competent care. West Side is a non-profi t 501(c)(3) community health center (or Federally Qualifi ed Health Center (FQHC), which is also sometimes known as the “nation’s safety net”). We have been serving medically underserved individuals and families for over 41 years. West Side was begun in 1972 by a few volunteers serving the Latino community in a one-room clinic in a local church, who had a vision of a culturally responsive clinic for Spanish speaking people. Now, West Side is the largest FQHC in Minnesota, serving over 32,000 patients a year from multiple ethnic groups including White, Black, Latino, Hmong and Somali patients.

In 18 locations across St. Paul, West Side provides primary medical and dental care at three medical clinics, two dental clinics, four homeless clinic locations, and nine school-based clinics in St. Paul high schools. We are family physicians, physician assistants, nurse practitioners, midwives and dentists provid-ing outpatient primary and dental care led by an executive director and community board. Our patients are often isolated from traditional medical care due to lack of insurance (49 per-cent are uninsured), low incomes (83 percent have incomes below 200 percent of the federal poverty level), race or ethnicity (84 percent

are from communities of color), the language they speak (44 percent do not speak English as a fi rst language), or their complex health care and social needs.

Throughout the years, we have considered it our goal, our responsibility, and our strength to deliver culturally competent services to a wide variety of people. For us, culturally com-petent care means having many facets of care, such as the following: 1. Sixty percent of West Side employees are

bilingual-bicultural professionals, includ-ing receptionists, medical assistants, lab technicians, phone operators, medical re-cords personnel, nurses, midwives, nurse practitioners, physician assistants, and doctors who provide primary care.

2. Bilingual-bicultural interpreters are avail-able during all clinic hours.

3. Signs, information and health educational materials are written in Hmong, Spanish and English at a fi fth grade reading level.

4. Pharmacology doctors provide education about medicines and diseases as well as provide low-cost medicines for people without insurance.

5. Social workers, psychological therapists and behavioral health professionals ad-dress patients’ social and emotional needs that can promote mental and physical health.

6. Patient advocates assist patients with reg-istration, insurance questions, co-pays and West Side’s Discount Program.

7. The Discount Program allows patients without insurance to receive medical care at an affordable price. The Discount Pro-gram is a sliding-fee scale program based on household income and federal poverty guidelines. We turn no one away for in-ability to pay.

8. A myriad of special programs provide sup-port and medical care, including diabetes

education, an HIV clinic, SAGE cervical and breast cancer screening, Healthy Start prenatal care, antenatal classes, and car seat education.

9. Most importantly, West Side staff respect patients’ autonomy to make medical de-cisions in the context of their cultural milieu. We are committed to working with patients and families to support their need to be understood and to understand. Providing such multi-faceted, individu-

alized care is challenging, of course. Provid-ers and staff must be motivated to serve the under-served, and must be well-trained, beyond medical expertise, in working with patients from diverse backgrounds and cultures. Find-ing and retaining culturally responsive staff can be diffi cult, especially in the context of today’s limited primary care workforce. And providing care for the uninsured in tight fi nancial times is an enormous challenge. Like all community health centers, our budget is supplemented by grants from the federal government (Section 330 of the Public Health Service Act) as long as we comply with its multiple regulations. We also rely on and our workload is reduced



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At West Side and other community health centers, such challenges are part of our every-day work. But they also lead us to our greatest impact. The following vignettes highlight how we deliver culturally competent care and the difference it makes for patients: • A 67-year-old Hmong woman arrived

at the clinic, embarrassed to explain that for several months she had vaginal bleed-ing. Although she had never had a pap smear, she allowed the Hmong-speaking female doctor to perform a pelvic exam and even smiled at the end of the visit, feeling relieved that her problem was go-ing to be addressed. Later she returned for the results, heard the diagnosis of cervical cancer, and accepted her referrals for com-plete evaluation and multiple treatments.

• A 26-year-old pregnant Latino woman was diagnosed with gestational diabetes. Having watched her grandmother die of gangrenous limbs from diabetes in Mex-ico, she was fearful about what diabetes would mean to her pregnancy, her baby and her future. She met with her provider and a Spanish-speaking diabetes educator every two weeks. She learned a lot about diabetes, and she channeled her fear into action: walking 30 minutes every day, eat-ing small amounts of refried beans and tortillas, measuring her sugar four times a day, and ultimately taking four shots of insulin every day. After delivering a normal-sized infant, she continued her diet and her exercise, determined to cre-ate a different future for herself and her children.

• A 57-year-old Latino man with diabetes, hypertension and obesity, became home-less last winter and experienced frostbite to three fingers on his left hand. Afraid no one would help him, he sought care at a homeless clinic. To his relief, he found people who cared for him who spoke Spanish, accompanied him to the ER and accompanied him to the hand surgeon, so that ultimately his fingers healed and he was able to avoid an amputation.

• A 56-year-old Hmong man was diagnosed with cirrhosis from Hepatitis B. He came

to us after his initial hospitalization and diagnosis. Fearful of spreading Hepatitis B through the family, he had started eating and sleeping by himself, and had stopped hugging his wife, children and grandchil-dren. With the help of his Hmong physi-cian, Hmong community health worker, and Hmong social worker, he learned more about the disease, and was better able to cope with the poor prognosis.

• A 42-year-old Latino woman was con-cerned about a breast lump because her aunt had died from breast cancer in Mex-ico. Without insurance, we were able to obtain a breast exam, a mammogram, and a biopsy for her under the SAGE program, ultimately giving her the reassuring diag-nosis of fibroadenoma.

• A 23-year-old Latino pregnant woman understood her baby had a cleft lip, but when he was born, she was horrified at the sight, and could not stop feeling guilty, responsible and repulsed. With assistance from her Spanish-speaking midwife and family doctor, and with support from the social worker, she was able to keep all surgical appointments and within nine months, was happy with the cosmetic results.

• A 62-year-old unemployed and uninsured white man was not able to afford pre-scription medicines for hypertension, and was overusing alcohol to cope with his depression. He came to the clinic feeling ashamed about his situation, but after receiving medical care, he applied for the Discount Program, obtained low-cost medicines, and had discussions with a social worker about alcohol and started attending Alcoholics Anonymous.

• A 58-year-old Hmong man with weight loss, fatigue, and polydipsia/polyuria was depressed when his provider diagnosed him with diabetes mellitus. Fearful of being disabled for the rest of his life, he was reassured to find education and lively role models when he joined the Hmong diabetes support group. He became an active member, as well as an active partner in managing his diabetes with his fam-ily physician, diabetes educator, social worker, and community health worker.

For more information about West Side Com-munity Health Services, please visit our website at www.westsidechs.org.

West Side Community Health Services



New Health Care CEO:Sara Criger, CEO, St. Joseph’s Hospital

Editor’s note: MetroDoctors continues to highlight newly named health care executives. Each CEO has been asked to outline his/her vision and challenges for their organization as well as offer some personal insights.


It is common to ask CEOs to identify their biggest challenges and op-portunities. To start with something different, what was your biggest surprise when you came to St. Joseph’s Hospital?

I distinctly remember my realization of the incredible things happening at this 250-bed hospital! St. Joseph’s wasn’t really on my radar before then; in fact I only previously knew it as the big parking ramp on 35E in downtown St. Paul. But I quickly realized it was a very humble Catholic Hospital with several “best in class” programs.

With that said, what are your biggest challenges and opportunities?

In my mind the biggest challenges often provide for the greatest oppor-tunities and health care reform has to be right up there. We’re going to see changes in the coming years that are unparalleled and, realistically, we are heading into some uncharted territory. We know there will be financial implications. In the immediate term, St. Joseph’s is slated to see a cut in government funding for many of the neediest patients, just like most other hospitals. And as a CEO, I am concerned about that. Additionally, health care reform is likely to continue taking patients out of the hospitals for their care — delivery models will be more focused on home care and non-hospital settings for certain procedures. And while it is the right thing to do, this will have additional financial implications on hospitals — especially in the short term while the new reimbursement models are being designed and implemented.

But we also are on the cusp of tremendous opportunity. The federal reform legislation sets us on a clearer path toward reimbursements for out-comes and improved health. The accountability spelled out in the reform doesn’t call for anything more from health care providers than we ought to be demanding from ourselves. And we are well positioned to keep moving forward at St. Joseph’s. I’m proud of our outcomes on CMS measures and the infrastructure we’ve created to keep improving clinical outcomes, as well as our accomplishments in reducing — even eliminating — complications.

I have to say one more thing about reform. The rancor and incivility of the debate were disap-pointing — and, to be hon-est, nothing frustrated me more than the stated posi-tion that we are better off financially as a community if we “cut health care cov-erage” for those insured by GAMC. Let’s be real, our hospitals and health care systems aren’t going to stop providing care just because the State of Min-nesota stops paying us. But we are going to create a wider chasm between the haves and have-nots for the right kind of care. I feel very strongly about that and, as CEO of a hospital in the urban core, I see the results every single day.

The uninsured include — though certainly not exclusively — the addicted and mentally ill. Our Emergency Department is often their lifeline, though I don’t know anyone who thinks that is a good way to deliver care. These, and many other patients, are living crisis to crisis. There’s no such thing as a medical home for them. Health care reform, I hope, will help us improve these inequities very soon.

What attracted you to St. Joseph’s?

That’s a long list, but one particularly appealing feature is the durable and very rich mission. We’re the oldest hospital in Minnesota, founded by the Sisters of St. Joseph of Carondelet in 1853. The Sisters remain a strong presence and their ideals have created a platform for remaining true to our community — both the haves and the have-nots — with a commitment to the very best care.

Those principles create a framework through which programs of distinction grow and flourish at St. Joseph’s. A good example is our National Brain Aneurysm Center (NABC). It started less than a decade ago and is now one of the top five centers for aneurysm treatment in the United States. The physicians in NBAC and St. Joseph’s not only meet established national clinical benchmarks in care, but they often are

Sara Criger became Ceo of St. Joseph’s Hospital in 2007. She’d been president of Fairview ridges Hospital in Burnsville for five years before that, capping nearly 16 years of leadership roles in the Fairview system. She recently discussed her leadership at St. Joseph’s with MetroDoctors.


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creating new evidence and benchmarks in outcomes for stroke, neuro-vascular surgery and intervention, and neurointensive care for patients.

The same can be said about our Heart Care Institute. We’re early, and safe, adapters and advancers in heart care, interventions and surgery. Another reflection of our culture and the commitment to care.

Tell us more about physicians and their role in St. Joseph’s programs like the National Brain Aneurysm Center.

The key to that program, and others, is the physician champions who drive us toward a higher goal. One of the common threads among them is their tenacity, a near-obsession for excellence in care for patients; they also share St. Joseph’s vision. That’s a good alignment.

It’s not always about the high-end technology, either. One of the programs I’m proudest of is the HealthEast Mental Health and Addic-tion Medicine program at St. Joseph’s, where about 50 percent of our patients have a dual diagnosis of addiction and mental health disorders. There are only a couple other programs in Minnesota that treat dual diagnosis patients — the challenges are significant with this complex patient population.

But we have very dynamic physician leadership of our interdisci-plinary program and we’re showing that treatment can bring hope into the lives that a lot of others dismissed as hopeless.

We’ve carved out a unique identity at St. Joseph’s. We’re not all things to all people but what we do, we do very well. And that often ends up surprising people.

How does St. Joseph’s surprise people?

Let me tell you about our Maternity Care program. At St. Joseph’s, we have the lowest Cesarean section rate in the country — about 10 percent. We’ve held steady, while the rate keeps climbing elsewhere; it’s 32 percent nationally and 26 percent in Minnesota.

Our partnership with HealthEast’s midwifery program is essential to that accomplishment but it takes more and — to be honest — I think we’ve achieved something that eludes most hospitals. We’ve created an environment where the relationship between the hospital staff, the ob-stetricians and family practice physicians, and the midwives is based on mutual respect, a commitment to a unique approach to care together, and a steadfast commitment to safety. Our culture doesn’t just permit that, but it encourages that kind of vision and collaboration.

The result is that we are providing a unique care experience in the Twin Cities with very high patient satisfaction to moms, babies and families. Some are from different cultures, and they are looking for an experience that fits most closely with their heritage and beliefs. Other mothers from all walks of life — they have done their research and are coming to us from throughout the metro area and see us as a “birth destination.” They know our partnership between midwives and physi-cians is going to help them deliver on their own terms, and safely. Our mantra in Maternity Care is “our turf, your birth.”

What keeps you going?

Rounding, whenever I can. Being on the floors and in the places where the patients are and where their families are…where care is happening.

There’s nothing like it. A CEO is going to spend a lot of time in meetings, but the more time I can spend rounding, the more my deci-sions as a leader are informed. I love to spend time with physicians and nurses and everyone else who is part of St. Joseph’s. The listening and understanding are essential. We may not always hear what we want to from each other, but you have to listen to each other in order to understand.

Rounding keeps me connected to the team and to patients. I meet people whose lives have been turned upside down by a brain hemor-rhage. That keeps me focused on being the best for the patient and the family. And I meet the market-savvy moms-to-be with plenty of options or the middle-aged gentleman with schizophrenia and a drug problem with very few options outside of St. Joseph’s. Their presence at St. Joseph’s keeps it real for me — we have to be the best for everyone.

Everyone plays a critical role at St. Joseph’s. Ultimately, mine is to make sure the physicians and staff have what they need so we can be the best for our patients. It’s not always easy, but it is actually that simple.


Color

Sharing the Experience: Honoring Choices Minnesota® Conference

Honoring CHoiCeS MinneSoTa® (HCM) is a collaborative, community-wide initiative to promote discussions and systems for advance care planning. From January through June of this year, seven locations in the Twin Cities area served as the initial pilot sites to test and refine the Honoring Choices Minnesota program.

On Tuesday, July 20, 2010, a conference was held to present the outcomes and learnings of the HCM pilots. Reports were given by each site to summarize their work during the past six months. Allina and Park Nicollet, who are both actively involved with Honoring Choices Minnesota, also provided updates on their respective implementation of system-wide advance care planning standards. These PowerPoint presentations can be viewed on our website at www.metrodoctors.com.

Advance care planning expert, Bud Hammes, Ph.D., from Respecting Choices® at Gundersen Lutheran Health System, shared national and global advance care planning news

and offered feedback to the pilot teams on their work.

Kent Wilson, M.D., the medical director of Hon-oring Choices Minnesota, discussed next steps, which includes a revision of the HCM health care directive, development of patient edu-cation materials, a second round of pilot sites begin-ning in January 2011, and a civic engagement com-ponent with partners Twin Cities Public Television and the Citizens League.

The seven pilot sites were: Fairview Ridges HospitalHealthEastFairview Oxboro ClinicHealthPartnersFairview Red Wing Medical CenterHennepin County Medical CenterFairview Eagan and Rosemount Clinics

Bud Hammes, Ph.D., (left) and Kent Wilson, M.D. after the conference.

Kent Wilson, M.D. and Bill Hanley of Twin Cities Public Televi-sion are filmed for a brief spot on TPT regarding Honoring Choices Minnesota.

Sylvia Bobbitt, of Fairview Oxboro Clinic, discusses the efforts of their pilot.

Anne Gilmore, LICSW presented the work of Hennepin County Medical Center.


Entries must be postmarked byOct. 15, 2010

Established in 2007, this award recognizes an unsung hero of the Twin Cities Medical Society who, through his/her dedicated and untiring service to the profession of medicine, has made an outstanding contribution to community service; worked on public policy issues; played a signi� cant role in the governance and success of the Twin Cities Medical Society; or other noteworthy (local) volunteer medical service.

NOMINATION FORMNominee:Name:

Home Address:

Home Phone:

I believe he/she is deserving of this recognition and meets the quali� cations of this award because

Supporting documentation would be greatly appreciated.

Nomination submitted by:Name:

Address:

Phone Number:

E-Mail Address:

Entries can be submitted: By Mail: First a Physician Award Twin Cities Medical Society 1300 Godward Street NE Suite 2000 Minneapolis, MN 55413 By E-Mail: [email protected] By Fax: 612-623-2888

If you have any questions, contact Kathy Dittmer at 612-623-2885.


C A R E E R O P P O R T U N I T I E S See Additional Career Opportunities on page 29.New MembersLisa O. Erhard, M.D.Oakdale OB/GYN, P.A.Obstetrics/Gynecology

David R. Hilden, M.D.Hennepin Faculty AssociatesInternal Medicine

Andrea L. Lampland, M.D.Associates in Newborn Medicine, P.A.Pediatrics

Michael P. Leehy, M.D.Bethesda HospitalInternal Medicine

Kathleen R. Michalk, D.O.Western OB/GYN, Ltd.Obstetrics/Gynecology

Stacy L. Noyes, M.D.Oakdale OB/GYN, P.A.Obstetrics/Gynecology

Jason B. Olinger, M.D.Metropolitan Anesthesia Network, LLPAnesthesiology

Daniel M. Ries, M.D.Regions HospitalPediatrics, Hospitalist

In MemoriamTHeoDore “TeDDY” BerMan, M.D., passed away July 19, 2010 at the age of 61. He graduated from the University of Minnesota Medical School. He specialized in pulmo-nary disease. Dr. Berman practiced with the Minnesota Lung Center and the Minnesota Sleep Institute.

roBerT geraLD “gerrY” CarLSon, M.D., 80, passed away July 17, 2010. He graduated from the University of Minnesota in 1954. He practiced general surgery in Will-mar, MN. Starting in 1965, Dr. Carlson be-gan his life-long training, study and practice of cardio-vascular surgery. He trained with Dr. C. Walton Lillehei. Dr. Carlson helped pioneer revascularization surgery, which in-cluded the use of the membrane oxygenator and implementation of the current technique of direct coronary artery connection that is now used world wide. As assistant professor of surgery at Cornell University Medical School, he participated in the first heart transplant

in New York City in 1969. He finished his ca-reer teaching chest surgery at Texas A and M University Medical School. Dr. Carlson served his country as a captain in the Air Force from 1956-1958.

JoSePH P. ConnoLLY, M.D., age 86, died on June 23, 2010. He graduated from the St. Louis University School of Medicine in 1952 and practiced family medicine.

PauL LewiS Joern, M.D. died at age 43 after a two year courageous battle with malignant melanoma. He graduated from the University of Minnesota, and was a board certified anesthesiolo-gist in Buffalo, MN. During the last two months of his life, Dr. Joern and his family worked to establish a foundation to help people who struggle with melanoma — half for research and half for families who struggle financially with this cancer.

CHarLeS e. “CHuCk” LinDeMann, M.D., age 86, passed away peacefully at his cabin

on Clearwater Lake in Deerwood, MN, on May 29, 2010. He received his M.D. degree from the University of Minnesota in 1946. After serving as a doctor in the U.S. Army, he specialized in internal medicine at Southwest Internists, P.A., in Minneapolis. A natural leader, he was elected president of the Hennepin County Medical Society, vice-president of the Minnesota Medi-cal Association, president of the Minnesota Chapter of the American Society of Internal Medicine, and chief of staff at St. Mary’s Hos-pital. In recent years he served as chair of the health care committee at Friendship Village in Bloomington, where he was a resident.

JoHn B. MaunDer, M.D. passed away July 20, 2010 at the age of 89. He graduated from the University of Minnesota. He served as a captain in the United States Air Force. Dr. Connolly specialized in obstetrics and gy-necology.


C A R E E R O P P O R T U N I T I E S

See Additional Career Opportunities on page 29.

See Additional Career Opportunities on page 30.

•TCMS Members•

WE NEED YOUR PARTICIPATION to serve as a DELEGATE at the

Minnesota Medical Association’s Annual Meeting

September 15-17, 2010 (Wednesday evening–Friday afternoon) Breezy Point Resort near Brainerd, MN

TCMS is eligible for 119 Delegates. This is your opportunity to make a difference by testifying at the reference committees, acting on the resolutions submitted state-wide and voting for your colleagues willing to serve as your MMA Officers.

Contact Kathy Dittmer at [email protected]

or (612) 623-2885 to participate.

West Metro Senior Physicians

The TCMS West Metro Senior Physicians Association met at the Black Forest Inn

for its June 8 meeting. We had a grand turnout for the presentation by Bette Hammel and Karen Melvin on their new coffee table book, Legendary Homes on Lake Minnetonka. The slide show and detailed description of the homes was enjoyed by all.

The next meeting will be held on Tuesday, September 21, 11:30 at the Broadway Ridge Building, 3001 Broadway St., NE, Minneapo-lis, MN. Brenda Paul, MS MA, State Quality Measurement Program Development Project Manager, will be our guest speaker.

For more information about the Sep-tember 21 meeting or about joining this as-sociation, contact Kathy Dittmer at (612) 623-2885, [email protected] or visit our website at www.metrodoctors.com. Go to the Foundations tab, West Metro Medi-cal Foundation, and then Senior Physicians Association.

NEW! Twin Cities Medical ForumSpeaker: Stephen T. Parente, Ph.D., Carlson School of Management

Friday, November 19, 2010 7:30 a.m. – 8:30 a.m.

United Hospital John Nasseff Medical Center, 333 North Smith Ave. St. Paul, MN – Miller/St. Luke’s Conference Rooms

Watch TCMS website for additional information, www.metrodoctors.com

Twin Cities Medical Society Presents

For further information, please contact:

Patti Lewis, Director Human ResourcesStillwater Medical Group | 1500 Curve Crest Boulevard | Stillwater MN 55082

(651) 275-3304 | [email protected] | www.stillwatermedicalgroup.com

Bringing the best to you

Stillwater Medical Group is an 85 Physician multi-specialty grouppractice affiliated with Lakeview Hospital. For more than 50 yearswe have been providing comprehensive healthcare services in thebeautiful St. Croix River Valley in Stillwater, MN. The historictown of Stillwater is located just east of the Twin Cities metro areaand offers excellent recreation as well as a small town feel.

Current Opportunities in:

Family MedicineGastroenterology

OB/GYN


C A R E E R O P P O R T U N I T I E S Please also visit www.metrodoctors.com for Career Opportunities.

Introducing the“Career

Opportunities”section of

MetroDoctors!

A great avenue forprofessionals to learnabout job opportunitiesAND a perfect place forrecruiters to promoteopenings!

Care

er O

ppor

tuni

ties

Recruiters, call for ourspecial recruitment rate.

Betsy Pierre, ad sales763-295-5420

[email protected]

with just one click

you will fi nd information

on the latest TCMS news,

events and legislative issues;

Board and committee actions;

past issues of MetroDoctors;

and new career opportunities!

Visit TCMS at www.metrodoctors.com

Fairview Health Services

fairview.org/physicians TTY 612-672-7300EEO/AA Employer

Opportunities to fit your life Fairview Health Services seeks physicians to improve the health of the communities we serve. We have a variety of opportunities that allow you to focus on innovative and quality care. Shape your practice to fit your life as a part of our nationally recognized, patient-centered, evidence-based care team.

Whether your focus is work-life balance or participating in clinical quality initiatives, we have an opportunity that is right for you:

CardiologyDermatologyEmergency MedicineFamily MedicineGeneral SurgeryGeriatric MedicineHospitalistInternal Medicine

Med/PedsOb/GynPainPalliativePediatricsPsychiatryPulmonology/Critical CareUrgent Care

Visit fairview.org/physicians to explore our current opportunities, then apply online, call 800-842-6469 or e-mail [email protected].

Sorry, no J1 opportunities.

THE STRENGTH TO HEAL and get back to what I love about family medicine.

©2009. Paid for by the United States Army. All rights reserved.

Do you remember why you became a familyphysician? When you practice in the Army or ArmyReserve, you can focus on caring for our Soldiers andtheir Families. You’ll practice in an environmentwithout concerns about your patients’ ability to payor overhead expenses. Moreover, you’ll see yourefforts making a difference.

To learn more about the U.S. Army Health Care Team,call SFC Daniel Ebbers at 952-854-8489,email [email protected], orvisit healthcare.goarmy.com/info/e928.

32 July/august 2010 MetroDoctors The Journal of the Twin Cities Medical Society

B y M a r v i n S . S e g a l , M . d .

LUMINARY

ArNE S. ANDErSoN, M.D.

of Twin Cities Medicine

This last page series is intended to honor esteemed colleagues who have contributed signifi cantly to Twin Cities medicine. Please forward names of physicians you would like consid-ered for this recognition to Nancy Bauer, managing editor, [email protected].

Arne Anderson, M.D. has modestly served our Twin Cities commu-nity — perhaps as no other, before him or since — for well over a half century. He has been and remains a visionary, a pathfi nder, a founder, a pioneer … and a darned nice chap.

Dr. Anderson was Minnesota educated during the great depres-sion, having obtained his B.A. at St. Olaf College and his M.D. at the University of Minnesota — both institutions having since honored him with Distinguished Alumnus Awards. His Pediatric Fellowship at the Mayo Clinic was followed by the attainment of an M.S. degree in pediatrics and pathology after returning to the U of M.

His mid-1940s U.S. Army service was performed domestically and in Europe, and other volunteer foreign service activities later led him to sites in Africa, India, Thailand and Brazil.

In addition to the dedicated family life he has enjoyed with his wife, Rusk Dalton Anderson, and their 10 children, his most pro-found commitments have been with two major community institu-tions, Children’s Hospital (CH) and the Saint Louis Park Medical Center (SLPMC). He was a founder of the original Minneapolis CH, a driving force in its early development and a benevolent facilitator in its more recent successful merger with Saint Paul Children’s Hospital. He served CH in many capacities — medical director, trustee, president/CEO and senior consultant. Dr. Alan Goldbloom, current president/CEO of Children’s Hospital and Clinics of Minnesota, spoke of Dr. Anderson in glowing terms:

“ … a visionary who was bound and determined to create a children’s hospital, despite most of the other community hospitals being opposed to it. It wasn’t just a building he was after; rather the creation of a unique, family-centered environment that would ensure that all children, regardless of socioeconomic status, had access to the highest of quality care.”

At Children’s, he cared for kids (a Master Clinician), instituted a fi rm and continuing collaboration with the U of M Pediatric Depart-ment (an Educator), studied the effi ciencies and effectiveness of care

delivery (a Researcher) and — perhaps most importantly — inspired his colleagues, staff, patients and their families. In 1949, Arne Anderson was one of the 10 original founders of the SLPMC, a predecessor to Park Nicol-let Health Services (PN). Dr. David Abelson, present CEO/president of PN, nicely summarized Dr. Anderson’s long standing association with that suc-cessful multifaceted organization:

“ … his infl uence as a role model continues to shape PN … committed to serving the commu-nity both in and out of the exam room … his remarkable vi-sion enabled him to understand what needed to change while preserving and enhancing the essence of physicians’ work.”

Among the many positions he held at the SLPMC were president of Trustee Board, founder/director of the Research and Education Foundation and chief of staff. Dr. Anderson worked with Senator Hubert Humphrey to enact a supplemental food program for women and children — just one of an array of remarkable activities which ranged far beyond CH and PN. The American Academy of Pediatrics, the Minneapolis and Edina School Boards, the Viking Boy Scout Council, our Minnesota Medi-cal Association and Southern Minnesota Medical Society, Fairview Hospital, Mount Sinai Hospital and Mount Olivet Church are but a few of the entities that have benefi tted from his wise counsel. His countless accolades and honors included two very special ones related to our local medical societies — the prestigious Charles Bolles Bolles-Rogers and Shotwell Awards. At the dedication of a Children’s Hospital Education Center named in his honor, he was described as a superb, competent and compassionate professional who fought a personal war against misfortunes that befall children — ill health, poverty and racial discrimination. As he has for many years, Arne Anderson continues to “walk the halls” of Children’s and Park Nicollet. Perhaps his shock of fl owing reddish hair has become silver, but his enlightening involvement and vision are constant reminders of core values in medicine as he engages us in conversation steeped in experience and wisdom. We are proud to honor him as a Luminary in Twin Cities Medicine.

You’re always there for them.

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And thanks to HealthEast® Concussion Clinic at Bethesda Hospital, I could play it safe.The HealthEast Concussion Clinic offers a three-legged approach integrating neuropsychology, physical therapy and medical care to manage concussions. We utilize tools such as ImPACT™ cognitive testing and take advantage of our team’s extensive experience and expertise including neuropsychology specialists who fine-tune treatments for each unique, individual concussion. So patients like Simone can return to their daily lives and favorite activities, safely and successfully.

For more information about the HealthEast ConcussionClinic at Bethesda Hospital located in St. Paul, please visit bethesdahospital.org or call 651-326-4323.

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