By Nicole Rodriguez-Robbins
Of New York’s 60 community health centers that provide care to the underserved throughout the State, 27 are located in New York City. These centers, large and small, situated throughout the five boroughs, are very much reflections of the communities they serve, providing comprehensive care that is designed to meet not only basic and universal health care concerns, but the unique needs of their patients and neighborhoods.
I recently hopped on the subway and visited two New York City community health centers, one on Manhattan’s Upper West Side and the other in the Bronx to get a clearer picture of the unique needs of New York City’s diverse populations and how each of these centers has evolved to address these needs.
Healthier Food, Healthier Lifestyles in the Bronx
Urban Health Plan, whose home base is in the South Bronx, was initially the San Juan Clinic, run by local physician Dr. Richard Izquierdo. The clinic was founded in 1974 and designated as a federally qualified health center in 1999. Then as now, the South Bronx was one of the poorest New York City neighborhoods, home to a large Latino population, and an area with glaring health disparities and limited options for care. UHP filled that void, meeting the challenges of a community beset by high rates of asthma, teen pregnancy, diabetes and obesity related illnesses. Today, the center operates eight sites as well as eight school based health programs and 4 part time clinics in the Bronx and Corona, Queens that provide primary care services along with specialty care in cardiology, pulmonary medicine, podiatry, endocrinology, gastroenterology, nephrology, neurology ophthalmology, psychiatry, rheumatology and surgery. UHP’s programs emphasize healthy living through nutrition, exercise, behavior modification, and encouraging patients to take control of their health.
One of the innovative programs at UHP is the Canyon Ranch Life Enhancement Program (LEP). In partnership with Canyon Ranch, a luxury health spa in Arizona, UHP created a six week program for health center patients who are at high risk for various preventable illnesses. The program offers a wellness-based approach that incorporates physical activity, diet modification, and spirituality and stress reduction techniques. Primary care physicians, nutritionists, physical therapists, social workers, nurses and an on-staff pastor work cooperatively on a plan of care for each patient. LEP patients may also take advantage of a state-of-the- art fitness facility in the El Nuevo San Juan Health Center that includes fitness equipment, yoga classes, meditation and a certified personal trainer. During my visit, the Center’s intimate workout room was bright and salsa music played in the background as several women exercised under the guidance of a trainer, who encouraged them in Spanish. The space conveyed a feeling of comfort and community for these women who wouldn’t necessarily visit a gym or seek out physical fitness classes on their own. This fitness space and the LEP program is one example of how UHP has promoted healthy living through culturally appropriate programming. Another UHP Program, FIT FOR LIFE, is designed for children and their families to prevent and treat obesity and associated health risks including diabetes, hypertension, liver and heart disease. The program is geared to 0-4 year olds and their families and is supervised by a pediatrician at El Nuevo San Juan (Bronx) and Plaza del Sol (Corona, Queens) sites. A team of providers, medical assistants, nutritionists, behavioral specialists, and patient navigators work one-on-one with each family to manage the child’s care and to educate them about health. These programs are geared to helping parents make healthier nutritional choices for their children that are also affordable and culturally relevant. Robin West, UHP’s communications manager, explained that many of the center’s patients are of Latin American and Puerto Rican heritage, where rice and beans and other starchy or rich dishes are important staples. Providers understand that they aren’t going to convince patients to eliminate these foods completely from their diet. Instead, they advise patients about sound nutrition recommended healthy portion sizes and encourage them to add more vegetables and fruits to their meals. They also educate parents about how to read nutritional labels at supermarkets and encourage them to use farmers markets when possible to buy healthy produce. She explained that simple diet modifications like switching from juice to water, from whole milk to low fat or skim milk and choosing healthier, affordable snacks can make a huge impact on patient outcomes. Karla Giboyeaux, UHP’s bilingual staff nutritionist, does cooking demonstrations in both English and Spanish. These cooking demos feature healthy and affordable recipes for patients seeking to improve their diet. Recipes are compiled in a cookbook for patients to take home, and demos are available on a YouTube channel to watch at home. The new UHP site will have an in-house kitchen that will enable the center to expand their nutritional programming and to offer more cooking demos for patients.
Of course, no matter how motivated the patient, these programs are not likely to be successful unless nutritious food is available in the community. To that end, UHP also works with local supermarkets and bodegas to help consumers and their patients to make healthier food choices. The Shop Healthy Bronx, an initiative sponsored by the NYC Department of Health, works in partnership with Urban Health Plan to encourage local bodegas and food markets to offer healthier food options and teaches them how to display them in more appetizing ways. As a result of this program, the local supermarket now offers more produce options, healthy sandwiches and bottled water, and items labeled to identify nutritious options. All of these efforts help support the Center’s goal of creating a healthier environment and community.
Expanded Services, and A Gleaming New Center for Women and Children on Manhattan’s Upper West Side
The William F. Ryan Community Health Network, a Manhattan-based health center founded in 1967, has grown over the years from a small demonstration project as part of St. Luke’s hospital to an extensive free-standing network now encompassing four primary health sites, a new Women and Children’s Center, and clinics in four transitional housing sites, a rehabilitation center, six school-based centers and a medical van. The majority of Ryan’s patients come from low-income and historically underserved populations. Approximately 88% of Ryan’s patients fall below 200 percent of the federal poverty line. Of their patients served, 67% are Medicaid or Medicare eligible, 10% have private insurance and approximately 24% are uninsured, often because they are undocumented. Ryan’s patients live predominantly in nearby Manhattan neighborhoods in Central Harlem, Morningside Heights, Upper West Side and Washington Heights and are from Latino, African American and West Indian backgrounds and newly arrived immigrants from African and Central/South America. To best serve their patients, Ryan’s staff is largely bilingual, with 60% of the staff fluent in both Spanish and English.
Originally located in a small storefront, the Ryan Center has operated a large, state-of-the art health center on West 97th Street since the late-1980s, but continued to provide some services on West 100th Street. In 2008, Ryan was forced to leave 100th St, and began to search for a new space in close proximity to their main 97th St. clinic. The center was considering expansion options when their back-up hospital, St. Luke’s Roosevelt Hospital Center in Morningside Heights, told Ryan that they wanted to close their pediatric and adult medicine outpatient clinics. Ryan entered into an agreement with the hospital to hire some of the hospital’s pediatric clinical staff, which would provide continuity for those patients affected by the closure by giving them the opportunity to retain their primary care doctors while becoming Ryan patients. To accommodate these new staff and patients, Ryan moved its Women and Children’s program to a new, separate nearby site. This move provided more space for adult primary health and specialty services at 97th St. – which was shortly renovated and upgraded – and provided for the expansion of the women and children’s health program to a brand new facility on Amsterdam Avenue, which opened in 2010. The 97th St. site was then able to become a rotation site for the hospital’s internal medicine’s residency program and help train residents on the how to provide primary health care.
I recently visited this new, state of the art Women and Children’s Center which houses the Women’s Health Department, Pediatric Department, Mental Health Department, Prevention and Outreach (PEO) Services, and Nutrition/WIC Program. The platinum LEED-certified building, designed to optimize patient flow and innovation, is a physically beautiful and comfortable space with large windows overlooking the street that allow natural light to filter into the waiting room. The waiting area is mindfully organized to provide a place for young children to sit and play or read with a separate section designated for moms with infants to have quiet space to wait. An adjacent room is available for breastfeeding moms who want privacy from the main waiting area. Breast feeding is encouraged by center staff as an affordable and healthy option for feeding babies; a lactation expert helps new mothers to learn breastfeeding techniques. The WIC office, on the same floor, provides an additional convenience for eligible families, who will receive free nutrition classes, counseling, and food coupons to purchase nutritious food. They also offer optometry services at the Women and Children’s site for children. Ryan continues to be at the forefront of providing comprehensive, convenient care to address the needs of their patients. At the Women’s Center, screening for postpartum depression is a routine part of care during the baby’s’ first check-ups. The center’s clinicians, obstetricians, nurses, social workers, and pediatricians establish trustful relationships with their patients and are trained to assess what can often be a sensitive issue for patients. If a medical provider feels a mother exhibits potential symptoms of depression, the mom is referred to the mental health service located directly downstairs in the women and children’s facility. This systematic screening for postpartum depression exemplifies Ryan’s overall philosophy of patient-centered care. Each time a patient comes in for a visit they use the opportunity to strategically screen for other health conditions or concerns. Walk-in care is available, a special adolescent clinic serves the needs of teens, and adult and pediatric referrals are made to a wide range of in-house specialists with allergy, cardiology, dermatology, endocrinology, gastroenterology, neurology, ophthalmology/optometry, podiatry, pulmonology, and urology all available at the center. This way, patients in this underserved community who may otherwise miss out on routine care because of economic or time constraints are assured that once they enter Ryan’s doors, their health care needs will be met.
William F. Ryan Community Health Network and Urban Health Plan are two examples of New York City health centers that have developed and customized their services to best address the needs of their communities. These centers both promote health care as a universal right regardless of one’s ability to pay. Both emphasize preventive health and wellness. And each has a model for growth rooted in the belief that they, first and foremost, do everything possible to understand and address the unique needs of their patients. As the Affordable Care Act reshapes the delivery of healthcare, our community health centers will be at the forefront, addressing the unique needs in their neighborhoods with sensitivity and a commitment to excellence deeply rooted in the communities they serve.