A Thankful Farewell

Today was our last day working for Medical AIDS Outreach and we are sad to go! We hope that these past accounts of our experiences with MAO have been informative, sometimes entertaining, and moving.

In these past three weeks, we have seen much of the southern Alabama countryside. We have gone from Gainsville, a town of about 220 people, to Montgomery, the second largest city in Alabama. We have met so many different people and had so many different experiences.

While one can try to gain a taste for the southern HIV/AIDS crisis by just reading epidemiology studies and health reports, this literature will never bring out the human element of the fight against HIV/AIDS in the south. Every element of MAO, the educators, social workers, nurses, housing specialist, doctors, and administrators, all play such a crucial role in truly trying to provide a better standard of living to the thousands of HIV/AIDS victims in the South. Really, there is no better way sum up MAO’s dedication to their patients than to highlight Dr. Bhat’s one hour conversation with a patient.

We are excited to see the fruits of MAO’s work on their Access to Care initiative and were truly impressed by the care put into installing telemedicine facilities at the main sites. It was truly inspirational to hear about everything from rural bus routes to food banks in meetings when MAO was trying to think about how better to serve their community.  The staff at MAO and their life stories are truly mind blowing. It is hard to find as caring a team anywhere else.

It goes without saying that GlobeMed at Princeton finds itself lucky to have a working partnership with MAO. We look forward to the future and cannot express how amazing these past few weeks have been.

People don’t work [at MAO] for the money, they work here for the ideals

-Dr. Bhat

Beyond the Medication

Meet Doug McCloud, an enthusiastic worker in the Social Work department of Medical AIDS Outreach whose official title is Housing Specialist.

The Friendly Doug McCloud

Doug’s job is very important and it is one that most people do not realize when they think of HIV/AIDS treatment. Most people are under the impression that HIV/AIDS treatment is exclusively medically focused–which is true to some extent. An HIV patient needs consistently to take his or her medication in order to maintain a healthy CD4 count and low HIV viral loads. Medical AIDS Outreach, however, is not JUST the medical clinic. This non-profit organization seeks to treat every patient through a multifaceted approach. One of the most important approach is to make sure that the patient is not so destitute that he or she neglects treatment or doctor care.

If a patient loses his or her home, that counts as a sign of destitution. The mental and emotional burden that follows potential homelessness is phenomenal and the impact on the patient’s life is very severe. Of course, Doug’s job is not to “help the homeless” per-say (there are other support systems for that). His job is to PREVENT someone from becoming homeless.

Doug works primarily with the HOPWA (Housing Opportunities for Persons with AIDS) program. Based on current funding restrictions, there are basically two levels of aid offered to HIV/AIDS patients who qualify for housing assistance through this program: short-term and long-term.

Short-term (emergency) aid is where the program offers to subsidize a large portion of the patient’s rent or mortgage for no longer than 4 months. Long-term aid is where the program offers housing assistance for up to 12 months. In order for patients to qualify, they must meet a specific criteria. For example, the patient must have income (unless he or she had a negative experience that resulted in a loss of income for a determined amount of time). In order for patients to participate in the program, they must agree to meet all of their doctor appointments and annual housing checks. Of course, each housing plan is specific to the individual and the level of assistance offered is tailored to the individual’s need. And the best part about this program? It is CONFIDENTIAL. The landlord receiving a check does not know the individual is receiving assistance because of his or her HIV status. All checks and forms simply read “Housing Assistance” without any mention of HIV/AIDS. Anybody receiving aid through this program can be well assured that he or she will NOT be stigmatized.

Why is this program so important? A majority of MAO’s patient base live under the federal poverty level. Many face financial and emotional challenges at home, and what Doug and HOPWA hope to accomplish is simple: Let’s alleviate some of this stress so that the patient can actually have the RESOURCES that will allow him to go consistently to the doctor, the ENERGY to focus on their health.

We just want to allow clients to focus on their HIV health.

-Doug

Camden

No we are not talking about Camden, New Jersey. Far from the urban hustle and bustle of Camden, NJ, the place that we are ACTUALLY talking about is a fairly rural, peaceful city  about an hour and a half drive outside of Montgomery: Camden, AL. It is a tiny town composed of a little more than 2000 people and the intersection of several highways. Yesterday, we were privileged with the opportunity to give a presentation on “Safe Sex and Self Esteem” with one of MAO’s educators, Keith Taylor.

In contrast to the only ~50% of the population that Africans Americans take up in the town, the education classroom was almost 90% African American. We had lively discussions about the nature of several STDs with Keith coming to the rescue whenever our knowledge was being stretched. Although we talked about everything from different types of prevention to the characteristics of viruses, the most important point we wanted to pass on was that your health is really your responsibility. To wear a condom should not be considered tacky or a turn-off. Far from it, wearing a condom demonstrates concern for your own health and the health of your partner as it helps prevent against STD transmission.

We were pleasantly surprised by how welcoming the people were to our message!

All in all, we spent roughly an hour in Camden. You may ask, why waste 3 hours of driving time just to reach out to a small classroom of no more than 30 people and “teach” for only 1 hour?  From our experiences with Keith and MAO, we can tell you that every bit of education makes an enormous difference. If there is anything that we learned from this internship, it is that the best way to fight the HIV virus is never to allow yourself the chance to contract it.

A Look at the Dothan Clinic

Dothan is one of the many Medical AIDS Outreach satellite sites. It serves Southeastern Alabama, covering an area all the way from the Florida state line to Troy, AL. In its 11 years of operation, it has moved twice and expanded. Today, it covers two sections of office space and serves close to 350 patients. This clinic is the “seed” of MAO’s Southeastern Alabama operations.

According to Angela Haveard, the nurse practitioner, they also travel regularly once a month to Troy, AL and Clayton, AL. These trips are extremely important because many patients can’t afford to travel to the Dothan clinic. They ensure that the greatest spread of population receive access to care. It is frustrating that often the issues limiting access to care are logistical, not medical. As long as the patients make it to the clinic, they will get the medicine they need to live healthy lives. Often, however, getting to the clinic is the hardest part. That said, this example is another reason why Benita’s future hopes for a medical transit system (focused in the Mobile area) is so important. Even with the transit system, though, many patients are still looking at losing a whole day of work to get a 15 minute check-up at a “local” clinic. Even in a modern country like America, the solution to the “access to care” problem remains elusive.

Angela Haveard, the Nurse Practitioner

Apart from having an administrative center in Montgomery, the Dothan clinic is completely self sufficient and has medical, outreach, education, and social services departments.

Today, we were privileged to be given a tour by Wanda, the office manager for the clinic.

The Wonderful Wanda!

Here are some pictures that will hopefully give you a better idea of the clinic:

The Outside Facade of the Clinic

A Hallway in the Clinic

One of the 3 Examination Rooms in the Clinic

As these pictures show, it is becoming nearly infeasible to continue to service the patients that come in with the current facility. Before we arrived, many patients were even standing in the waiting room because there was not enough space. It is not just the clinical side. On the administrative side, it becoming hard to find space to store patient files.

Patient Files

As the picture above shows, boxes of patient files stacked nearly to the ceiling of the facility. While many of these files contain deceased or previous patients, it is nonetheless imperative for the Dothan clinic to find a sustainable space for storing patient files. Also, storing files incorrectly could lead to legal problems. All the laws requiring clinics to keep files for a specific amount of time are very fuzzy. leaving open the possibility of lawsuits if a file gets lost and becomes accidentally publicly available.

Looking toward the future:

In order to address many of these logistical problems, MAO Dothan is looking at leasing a new site in the same office complex.

The New Waiting Room

Possible Storage for Patient Files

A Place for a New Telemedicine Clinic!

A New Hallway in the Clinic

Meeting Congresswoman Terri Sewell

From left: Dianne Teague, Sheng Zhou, US Rep Terri Sewell, Amy Li, Will Rutland

Yesterday, we did something out of the ordinary. After we visited the Selma clinic (about which we will write more about on Monday), we drove about two hours to a small town of which I bet nobody has ever heard: Gainesville, Alabama, which boasts a population of only 220 people. We found the small rural town extraordinary. Our first impressions were astonishment at the sheer rural feel of the place. What a small town feel! The entire town basically fits into one block (yes, just one). It has one grocery store, one restaurant, and no gas stations. What the town lacks in economic resources, however, it makes up in the hospitality and kindness of the people.

Many of them were gathered in front of the post office to hear Congresswoman Terri Sewell (representing the 7th district of Alabama) praise the people for their hard work and constant phone calls that eventually led to Sewell successfully saving their one and only US Postal Office. Please see the video below!  Sheng, Will Rutland, and I happen to be among the audience.

Sewell was able to keep the government from closing down the US Postal Offices in the rural towns of Alabama. To us, we think, “What’s the big deal about the post office?” To them, however, the post office is MORE than where they send and receive mail. It’s the center of town and the place for social gatherings! It is the line of communication between the town and the rest of the country. In fact, many elderly residents even depend on the post office for their medicine.

Meeting US Rep. Terri Sewell was such a memorable experience that we had to blog about it. She was an incredibly dynamic speaker, passionate about Alabama, and very focused on her constituents. Despite it only being her first year in Congress, she has accomplished many things for the Alabamians of her district. When Uniontown, Alabama’s sewage pipe leaked into their main water supply, she acted quickly in D.C. to secure the resources necessary to remedy the situation. When the tornadoes devastated Tuscaloosa, she persuaded President Barack Obama and his wife Michelle to see the damage personally and commit to the citizens’ disaster relief. Wow!!

Gainesville, AL.

After Sewell’s speech, we spoke with the congresswoman for about an hour. During our chat, we got the chance to talk to her about the Access to Care telemedicine program MAO is implementing throughout the rural regions.

US Rep. Terri Sewell seemed very interested and requested more information about theAccess to Care Initiative! Knowing Dianne Teague, MAO’s wonderful Director of Development, Sewell is no doubt going to get more information about the Access to Care Initiative than she can possibly imagine!

Overall, this trip was a wonderful experience and we are so glad we got this wonderful experience!

With US Rep Terri Sewell

Telemedicine at its FINEST

Amy and Sheng learning about telemedicine–while participating in a mock telemedicine procedure!

One of the most significant projects that our friends at Medical AIDS Outreach (MAO) is pioneering is the Access to Care Initiative (Please see the Donate Now tab at the top to learn more about what Access to Care is and why we support it!).

The Access to Care Initiative is MAO’s most ambitious mission to increase access to HIV healthcare for rural Alabama residents in the form of several telemedicine clinics placed strategically throughout rural Alabama. Telemedicine clinics will connect rural Alabamians with medical experts based in urban Alabama, a high-tech solution to the problem of limited HIV providers in Alabama. Some of these rural clinics are already running in disadvantaged rural counties surrounding Montgomery, including Selma and Greenville. On Wednesday, we will be able to take an inside look at what’s going on in Selma!

Telemedicine and the Program for Use of the Bluetooth Stethoscope

This is why telemedicine is so important and it’s often seen as the key to a promising future where everyone can get the care they deserve. We got to see telemedicine in action for the first time today. For those who don’t know what telemedicine incorporates, it can probably best be explained as a form of advanced “Skype” filled with fancy peripheral gadgets (like a bluetooth stethoscope) that the nurse in, say, Selma can use on the patient while the doctor watches–and listens–in real-time on the other end in, say, MAO in Montgomery. It’s a one-on-one experience between patient and doctor in real-time, with the nurse facilitating on the patient’s end. You can imagine the potential!

Not only does this eliminate the issue of doctors having to travel an hour to the rural clinics to deliver care (which takes away patient care in the urban areas and poses the problem of wasting the hours of transportation during which doctors cannot deliver care at all), it spares the patient (often uninsured, working full time, and lacking a car) the far travel to Montgomery from his or her rural home to seek HIV care. Many of MAO’s patients live in rural areas currently. Telemedicine and Access to Care is still at its infancy in MAO, but the results already look very promising! There is still so much potential, however. MAO still needs to develop and implement telemedicine further in order to expand its outreach.

For more information about the Access to Care Initiative, please contact Will Rutland, Access to Care Project Manager, at wrutland [at] maoi.org.

Telemedicine

The bluetooth stethoscope–one of the many peripheral gadgets at the doctor’s fingertips

Will Rutland explaining telemedicine while using it

Will Rutland

Remains of the Week

We  would like to first stop for a moment and thank those of you who have been reading the blog through the week for your patronage. We have received visitors from the United States, France, Germany, Jordan, Uganda, Madagascar, Cambodia, the UK among other countries. It is so refreshing to see a growing interest in the work and complexity of non-profit health work in the United States! That said, we will try our best to continue publishing high quality posts that will give you the most complete picture of our escapades in Alabama.

This post just summarizes the many events throughout the week that we have skipped in previous posts.

Pat’s Long Journey Ahead

Yesterday, we bid a heart-felt good bye to our friend Patrick as he prepared to leave for his bike trip across America.

Patrick Casey (left), Sheng Zhou (center), and Amy Li (right)

Yes, I said it right. Patrick is biking from sea to sea. He is participating in a FACE AIDS campaign called “Ride Against AIDS” to raise awareness for AIDS. It will last 67 days and more than 4000 miles. Over the course of the journey, they will travel past arid deserts, seemingly endless pastures, and icy peaks. Imagine our shock when Patrick informed us that he would not be able to stay with us for the last two weeks because he was biking across the country!

Please support him and the entire group team this year by either donating or offering housing by visiting this website: http://www.faceaids.org/rideagainstaids.html. They will be stopping by everywhere from San Francisco to Chicago, Boston to Omaha. We are even expecting a visit from Patrick and his crew at Princeton in August!

For information about Patrick, please see his bio at http://www.faceaids.org/raa2012/pat.html or contact him at patcasey349 [at] gmail.com!

Patrick Cutting His Good-Bye Cake

A Look at a “Normal” Day at MAO

It is a misnomer to describe any day at MAO as normal. Things can quickly change from taking notes furiously in order to catch every bit of advice from an employee at MAO to having an impressively realistic model of a male phallus disturbingly staring at you as you transcribe your interviews.

A “normal” day undoubtedly starts with us entering the the well-kept office of MAO as zombie-like creatures (too early), which stands in stark contrast to Keith’s bubbling enthusiasm and energy, shouting a salutation in our direction.

Usually days pass with us conducting interviews and sitting in on meetings, feeling in awe of the great efficiency and knowledge of the giants sitting around us. A day is also never complete without one Will Rutland life lesson or a Dr. Bhat medical lecture. To say we learned a lot would be an understatement.

At the end, we cannot help but be humbled by the enormous amount of work and time each employee pours into this entire operation. We can also never be thankful enough for their patience and willingness to educate us about the inner-workings of MAO.

Things to Which We Look Forward:

Please stay in tune for an inside look at the grant writing process at MAO, a review of the gay community in Montgomery, and a brief description of our survey findings. We will be taking a short break tomorrow, but look for more posts from us on Monday.

Also if there is any topic that you are dying to have addressed, please drop us a line in the comments or at princeton [at] globemed.org! Also please feel free to comment on any of our blog posts or raise points we did not mention!

HEALTH FAIR!

Condoms that look like lollipops

Today’s work with Medical AIDS Outreach was super exciting for us because we got to spend most of it helping Keith operate a booth at the local health fair in Job Corps!

Job Corps building

We were catering primarily to young adults roughly between the ages of 12 to 18, but hey, prevention starts early. The more educated these young people are, the better their ability to prevent against HIV contraction in the future (not to mention also against other harmful STDs). Most of all, our mission focuses on letting them know that there are resources in this community interested in helping them maintain healthy lives.

We passed out Medical AIDS Outreach material (including free access to HIV testing, condoms, and education at the clinic). We also passed out informational pamphlets: “Ten Good Ways to Protect Yourself from HIV and AIDS,” “Abstinence and Oral Sex,” “HIV/AIDS…Why You Should Care,” “Condom Power,” and “7 Stressful Things About Sex.” In addition, we had a wide variety of free male and female condoms, feminine hygiene “care bags,” keychains with condoms inside as emergency “stand-by’s,” and water bottles. The free things definitely enticed students to come to our booth and learn about HIV prevention techniques. One of these techniques is simply to use a condom when having sex. Condoms protect against both pregnancy and many of the STDs, including HIV. Throughout the day, we noticed that many of the students expressed a genuine interest in learning about HIV prevention and safe sex. There were those who were previously oblivious or apathetic to the importance of HIV prevention and benefited a great deal from our booth. Many left our booth with a new-found sense of awareness and conscientiousness about the significance of STD prevention and safe sex.

Keith and Sheng at the health fair table

Note: Medical AIDS Outreach is still informally known as Montgomery AIDS Outreach to many members of the community, despite the recent name change.

Here are some more pictures about our time at the health fair. 

MAO Information

Pamphlets

Amy at the MAO booth

Condoms!

If you live in the Montgomery-Prattville-Wetumpka area and would like more information regarding STD prevention or get tested for HIV/AIDS, we encourage you to visit 2900 McGehee Road, Montgomery, AL.

Facing the Subjects

Sheng and Amy preparing for the day’s data collection at a university campus

Yesterday, we took our day off from Medical AIDS Outreach (MAO) not to relax from our busy schedules, but to travel to university campuses and do some DATA GATHERING for our research project: AIDS Sigma in Caucasian College Age Students in Montgomery, Alabama. This investigation–among many other things–delves into students’ awareness for AIDS and HIV prevention, attitudes toward others who are HIV positive, as well as knowledge about the accessibility of HIV testing in their area.

Why the focus on Caucasians, you ask? Well, that happens to be the population for which MAO has less data. More data focus on African Americans, which is justified because they pose roughly 70% of the HIV/AIDS patients in Alabama. We, however, want to provide a different way of looking at health education that can give MAO more resources for which to effectively provide care and education.

We surveyed a total of 19 students, with each survey in accordance with IRB approval. It was a long day, but it was very rewarding and we uncovered very interesting trends. We are still working on transcribing the interviews and analyzing the data. With the gathered information, we hope to draft a report/proposal  for submission to MAO.

Keith and Will have both been instrumental in the planning process as well, and we appreciate their incredible support and encouragement every step of the way!

Sheng and Amy hard at work

Amy Li during one of the interviews

Amy Li

Sheng Zhou during an interview

Sheng Zhou

We will keep you posted about our results.

What Makes the Machine Spin

Benita Hollis and Dr. April Truett

It is no question that a non-profit is an enormous financial operation. It actually appears to be a little counter intuitive. After all, how can something that makes no profit (hence “NON-profit”) stay afloat?

To give you an idea of the scale of Medical AIDS Outreach, Inc.’s (MAO) budget. During the fiscal year, they ran on a 3.5 million dollar budget. Most of it was funded by Federal Grants (60%) with Ryan White Federal Funds composing the greatest portion. Other sources included local government, state government, and education grants. Other than Federal Grants, MAO also received payments from insurance companies (medicare, medicaid, Blue Cross Blue Shield, and private insurance groups).

Unfortunately, unlike for-profit clinics, MAO cannot depend on Blue Cross Blue Shield and private insurance groups for over 90% of it’s expenses. In fact, 38-40% of its clients are uninsured. Many of these uninsured are still in the process of applying for Medicaid or are in the waiting period. Some don’t even qualify for medicaid.

Complicating things even further, there is often a 2-3 month delay on grants coming in. Dr. Bhat sums up the problem best:

I can’t just tell my power company that I will pay the bill 3 months later。

Cash flow at MAO is an enormous problem. When pay day comes and the grants have not yet come in, MAO often has to draw from the reserve. At least, that’s the goal because MAO is working on building a reserve for the future.

As a general rule, all organizations should build up a reserve of at least 3-6 months. For MAO, this means building up a reserve of 1.5 million dollars or so. Yet, government grants don’t provide a source of capital that can later become savings. Only private donations are likely to be used for savings. Yet these donations don’t even add up to 100K. Put this together with MAO almost breaking even on their expenses and it is easy to see that MAO has not matured to this stage yet.

As MAO grows though, it will need obviously need more capital. With no new influx, MAO can only adjust and readjust to where the need is greatest. If Education needs money, the money may have to come out of a plan to buy a new bluetooth stethoscope. In an industry where everything is vital, it is often difficult to make these hard decisions. Running a non-profit requires god-like flexibility and extreme diversification.

Benita Hollis, the CFO, manages this entire operation. According to her, almost 45% of her time is just dedicated to writing reports back to grants in order to account for the money. These include financial and data reports.

Ultimately, what MAO’s financial arm (aka Benita Hollis) seeks to do is to bridge the element of need in the community with available funds. Providing vital community services, it is necessary that MAO continue to thrive and hopefully expand. With the hard work of Benita, MAO may even see the introduction of transit lines in the future that will help patients without cars get to clinics.

Despite all the challenges, the rewards of a smoothly functioning financial backbone are great, perhaps even an existential necessity. This is built through cautious planning, a focus on the future, and flexibility. Benita offered the following advice: when looking at a new program, if it doesn’t offer at least 2+ tangible benefits, it is probably not worth it. After all, with each new consideration brings in a host of obstacles. Before any non-profit can successfully stay sustainable, it must ask itself:

What is the business of staying in business?

Benita Hollis   6/6/2012