2007

AIDS Prevention in Latinas
by Valarie Edwards

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The latest figures from the Centers for Disease Control and Prevention report that although Latinos make up only 14 percent of the U.S. population, they account for 20 percent of all new HIV infection cases. One program in northeast Georgia is trying to make a difference by teaching Latinas how to protect themselves and prevent AIDS infection.

Statistics show that Latinas who are infected with HIV had only one sexual partner. Tradition, however, often prevents Latinas from talking openly about sex. And that, according to Veronica Stowe, outreach coordinator for the North Georgia AIDS Alliance, can be deadly.

"In our community, if I have an infection, it's my fault. So we never blame our husbands or partners. We blame ourselves."

So tonight a group of Latinas are gathering over a meal of pork tacos and pina coladas to learn more about HIV. Some of the women are married, some are single. All are mothers. With scattered balloons and gift bags around the room, the meeting seems more like a cosmetics party than a serious gathering about health.

The women ask questions about HIV, how to prevent prevention, and they see a movie about AIDS in Spanish. They learn about the effectiveness of condoms and the dangers of having unprotected sex. And they learn that they shouldn't rely only on their partners to practice safe sex.

Programs like this one aim to break the stigma of AIDS in the Latino community and to reduce its prevalence. AIDS is now ranked as the third leading cause of death in Latinas in their twenties and thirties.

Wilkes Is Still Wild About Wellness
by Philip L. Graitcer

Ground zero for Wilkes Wild About Wellness is the Washington-Wilkes consolidated school system.

Gym teacher Terry Hamon leads about 45 8th graders through a game on indoor tag ball. Since Wilkes Wild About Wellness was started, seven years ago, all middle school students have a daily physical exercise class. She says, "In this game you're pretty much doing everything, your hand and eye coordination, agility, dodging, getting their heart rate up, running."

Down the hall, lunch hour is just finishing up. Cafeteria manager Nana Boatwright and her staff served about 750 lunches today. According to her, "We try to offer more fresh fruits and vegetables and we have a fully staffed salad bar and we use light dressings. It's a pretty busy place, We?re trying to get them to eat those 5 fruits and vegetables every day and we try to offer less salt, less sugar in our preparation."

According to Boatwright, the students don't even realize that some of the more fattening things have been taken out of the lunches and substituted with healthier items, like low fat milk.

Coach Russell Morgan, Washington-Wilkes' head football coach for the past 20 years, caught a lucky break a few years back when he had his cholesterol checked at the wellness program's annual School Health Fair.

"The nurse there that was checking me said you need to see you doctor immediately, your cholesterol was way too high, He told me that I could stroke out any day. My cholesterol was extremely high and he put me on some medication, and I had to change my diet, my eating, and I lost about 20 pounds just staying away from grease and fried foods."

Today there are other wellness activities going on in Washington, too. Early this morning at the Parks and Recreation department, about a dozen senior citizens walked laps around the gym. At the new gym, just off the town square, exercisers have been pumping iron since dawn.

Healthy living wasn't always a part of the Washington-Wilkes community. In 2001, 81 percent of the residents of Wilkes County were obese or overweight according to an MCG study. Because of that obesity, Washington-Wilkes residents had higher rates of cancer, heart disease and diabetes, too.

According to Dr. Lester Johnston, an internist and pediatrician in Washington, reducing obesity, is a straightforward two step process - eating less and exercising. Scott Lewis is the State Farm insurance agent in Washington. Three years ago, when he weighted 334 pounds, he attended a wellness program at his church and it got him things about choices and the negative effect of those choices.

Lewis now weighs 192 pounds. The wellness program gave him the knowledge he needed to lose weight; his own desire to live healthier gave him the motivation.

Funding for Wilkes Wild About Wellness ran out in 2005. There was no money to pay for the educators and when program publicly ended, leaders worried that without a formal program in place, would the residents would slide back into their old habits of not exercising and not eating healthy foods.

But for many, good eating and exercise habits had already become routine. Real change has occurred. At the high school, two of the three soft drink machines are gone. Enrollment for the walking clubs, the flex and stretch programs and kids' Tiger Tracks programs is full. The Parks and Recreation Department has an increased its budget and added more staff. And at the churches, alongside Bible study and healthier suppers, aerobics classes are being offered for women and couples.

It's still to early to tell if the wellness program has reduced obesity in Wilkes. Researchers from UGA and MCG are planning to survey the community.

And although you can still see overweight people on the square, they are parking their cars further away from the shops and walking the extra distance. Community wellness seems to have taken hold. According to Dr. Johnston, "Washington is on the cusp of great change. There is a huge potential here. So Washington is definitely heading in the right direction. I think the cup is half full and not half empty."

And hopefully that cup will be filled with skim milk.

Telemedicine: Specialty Care Comes to Rural Georgia
by Tim Lister

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At the Medical College of Georgia, Chief of Neurology Dr. David Hess is something of a pioneer. Back in 2003, he began a study of the treatment of stroke victims in rural Georgia, where there is a high incidence of strokes among the middle-aged and elderly. In treating stroke victims, the first three hours are crucial in administering the clot-busting drug tPA, which can prevent paralysis. But many patients live a long way from a major hospital. So Dr. Hess and a research scientist called Sam Wang developed a secure web-based system to treat stroke patients "remotely" at their local hospital. It's called REACH, and is now installed in nine rural hospitals across Georgia.

Mary Stansell, who lives in Elberton, in north Georgia, is one of dozens of beneficiaries. One afternoon in 2005, she was on the phone when she began to feel unwell. "When I went to put the phone down," she told me, "my arm wouldn't do what I wanted it to do and then my face felt funny and I thought I'm just tired; other than that I didn't feel bad." But Mrs. Stansell was having a stroke. Paramedics rushed to her to the local hospital. It's not equipped to deal with stroke victims, but it is hooked up via a video and data link to the Medical College of Georgia.

Within minutes of her arrival at the hospital, David Hess was logged into REACH at a friend's house in Augusta. REACH provides him and his colleagues with the patient's vital signs, and he can also talk to the local doctor and the patient. REACH also allows the neurologist to download the patient's medical history and evaluate a digital CT scan. Mrs. Stansell recalls Dr. Hess asking her weight and instructing the hospital on the right dosage of tPA. Within half an hour, her condition stabilized and feeling began to return to her arms and legs. She is one of dozens of stroke victims whose mobility, and even life, has been saved thanks to REACH. A study of 194 stroke patients in rural Georgia treated through REACH found that the great majority were administered tPA within two hours.

Dr Hess can log on to the system from virtually anywhere. "I've literally been in Taco Bell and done consults, I've been in hotels, I've been in San Diego and consulted on a patient in McDuffy County," he told me in his office at the Medical College. He believes REACH can be a life-saver for Georgians who live far from a big hospital. "If you live in a rural part of the US and have a stroke, the chance of you getting high quality stroke care is quite remote – and the chance of you getting tPA before we did this was nearly zero." REACH is generating interest in states across America.

REACH is just one of a growing number of applications for what's become known as telemedicine, where specialists use video hook-ups to monitor and treat patients hundreds of miles away. Telemedicine uses high-speed communications systems, computer technology and specialized medical cameras to examine, treat and even educate patients.

As well as a being known as the "buckle of the stroke belt," Georgia has a high number of diabetics. Nearly ten per cent of Georgians have some from of diabetes. An increasing number of them are benefiting from telemedicine as new equipment is installed in rural hospitals across Georgia. It's being rolled out to some 40 hospitals statewide as part of a deal the state struck with health providers Wellpoint and Blue Cross Blue Shield of Georgia to allow their merger to go ahead. The man who brokered the deal, Ga. State Insurance Commissioner John Oxendine, calls it "an attempt to equalize the quality of health care." The ultimate goal is that patients should not have to drive more than 30 minutes for specialized health care.

The town of Sylvania in Screven County lies midway between Augusta and Savannah. George St George runs the small county hospital, and telemedicine is transforming what he can offer the community. "Right now we've seen it being used in diabetic teaching with clinical dieticians, which we don't have here in the community. It's going to bring the clinical specialist via the telemedicine program to the rural setting rather than have our residents traverse 65 miles to Augusta or Savannah." Screven Co. Hospital is finding a new role for itself, with fewer in-patients and more out-patients. Marcus Nettles with Blue Cross sees plenty of applications for telemedicine. "Diabetes is huge, dermatology is a big problem. It's hard to find a dermatologist this far out."

Patients are often surprised to find out that the doctor treating them 60 or 100 miles away can see their every move. Nettles remembers the surprise of one senior: "Her first reaction when she came into the telemedicine room and saw our system, which looks like a PC with 2 monitors, was that she was going to be on TV and wanted to know if she could take a couple of minutes to fix her hair."

Whether for diabetes, skin problems, even psychiatric evaluation, telemedicine is saving Georgia patients long journeys to big city hospitals, and saving the health system money. To quote Charles Levy, chief of physical medicine and rehabilitation for the North Florida/South Georgia Veterans Health Service: "We are at a rare and exhilarating moment, poised to leap forward by using telecommunication technology to reach veteran patients regardless of time or distance."

In Mary Stansell's case, maybe saving a life. "I'm just thankful that the town I live in happens to be Elberton and they had this system installed here. If it hadn't been then I wouldn't be talking to anybody about what happened."

Trauma Care in Short Supply
by Josephine Bennett

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Chances are if you have an accident south of Macon, you might not get the care you need. There are only fifteen trauma centers around the state, and if you drive south on I-75 from Macon, you will not find another trauma hospital until you reach the Florida line.

Dr. Dennis Ashley is the Director of Trauma Care at Macon's Medical Center of Central Georgia, and he says that getting patients quickly to a trauma center is key.

"We refer to trauma care as the 'golden hour.' In general that first hour is very critical for us to get to the patient, to start assessing their injuries and then start treatment. And we feel that survival is better if we can get to the patient quicker and start those therapies."

There are only four Level I trauma centers in the state. Those are emergency departments that can provide everything needed after an accident. Last year, the Medical Center considered dropping its Level I designation. That's because Level I centers must have doctors in all surgical specialties on call. Medical Center spokesman Andy Galloway says that's expensive, especially when treating the uninsured.

The crisis has grown to the point where state lawmakers are now looking for money to fund a trauma system. Republican State Senator Cecil Staton is one of them.

"Some of the ideas that have been tossed around would be a fee on motor vehicle registrations, perhaps a modest fee on a monthly basis attached to cell phones, perhaps fines, greater fines for people who fall into the category of what we call super offenders, super speeders, or people who have DUI's. It's going to take a number of sources to come up with the money we need."

Senator Staton knows firsthand why Georgia needs a functioning trauma care system.

"One of the reasons I have a passion for this issue is four years ago, January 9th, I was in a head-on collision, an automobile accident, very serious. I found myself unexpectedly in the need of trauma care. Fortunately that accident occurred very near a Level II trauma center in Rome, Georgia."/

Senator Staton says trauma care in Georgia costs providers 250 million dollars, and the state is looking at contributing around 100 million dollars annually to the system. However, the cost in human lives is even greater according to Dr. Ashley.

"Georgia is 20 percent, about the national average, for death and mortality from traumatic injury. What that translates to in real numbers, if Georgia had an organized trauma system where all Georgians had access to quick trauma care and we, if we reached the national average with our mortality, then we would save 700 lives a year."

According to the U.S. Department of Transportation, Georgia is one of only seven states that does not have an organized trauma system.

Mental Health in Georgia's Prisons
by Helena Cavendish de Moura

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In Georgia, about one out of six prisoners have been diagnosed with a mental illness. Georgia's Department of Corrections has in the past come under scrutiny for its treatment of the mentally-ill. Today, despite so many positive changes, the mental health caseload continues to grow.

The Georgia Department of Corrections – following a nation-wide trend – is coping with an exponential growth in its prison population. It's a costly task for a state with an already burdened prison system – mentally-ill prisoners require highly-specialized counselors, constant therapy, and medication.

According to Dr. James de Groot, the state's Mental Health Director, Georgia is spending six and a half million dollars in psychotropic drugs alone plus the cost of hiring and training of additional psychiatrists and therapists to work in the prison system.

"We're at full capacity during the summer, we have our hands full trying to manage the crisis," says de Groot. "A lot of facilities for the mentally-ill are not air-conditioned. They can't cope with the heat and start decompensating by hurting themselves and hurting others and becoming really disorganized. So our CSU unit stays really busy during the summer."

The CSU – Crisis Stabilization Unit – is where inmates in critical mental stress are taken in.

Suicide attempts are not uncommon among some of the mentally-ill inmates as they enter the restrictive prison universe. The alarming sounds and forceful treatment can make some more defensive and can even exacerbate some of their symptoms.

Many of the inmates in Georgia's prisons are heavily medicated, and many are diagnosed with schizophrenia and bipolar disorders. Many come from poor communities where no mental health care is available and sometimes families do not understand their relative's mental illness. A crime had to be committed in order for them to get treatment.

To groups like the National Alliance for the Mentally Ill and the Treatment Advocacy Center, the mentally ill are actually being demonized by the criminal system. Critics believe they should be in treatment centers, not in prisons. But, as Dr. De Groot acknowledges, sometimes that's not an option.

Peachcare – Victim of Its Own Success?
by Emily Kopp

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Peachcare – Georgia's child health plan for working families – may be a victim of its own success. Booming enrollment is drying up funds. Congress says it will find more money. But lawmakers aren't promising when that will happen, and some fear the program will have to kick families off the rolls first.

Terri Benn has her hands full with her two-year-old daughter, Jasmine. Jasmine suffers from chronic ear infections. Her older brother, Jordan, is autistic. Benn says she used to struggle to pay for his health care. She took Jordan to the physician and had to pay $90.00. The prescription cost $140. She had to borrow money from her family to get it filled. She says she felt like a bad mom.

Then Benn learned about Peachcare two years ago. She's a private-school teacher in Jonesboro and earns about thirty thousand dollars. That's too much to qualify for Medicaid. But, she says, family health insurance through her school runs about $500 a month. Like many working parents, Benn says Peachcare is the only real option.

Benn's children are two of more than 270,000 on Peachcare rolls, and the system can't handle the load. State administrators are freezing enrollment March 11th to save money. That could leave 100,000 eligible children without health care. Even so, Medical Assistance Plan Chief Mark Trail says Peachcare could be in the red by April.

But time is running out. Lawmakers in Atlanta and Washington have been playing a game of chicken to see who will pay the Peachcare bill first. Georgia Senator Saxby Chambliss notes Congress moves slowly. "While we want to make sure this gets done, we can't guarantee it gets done before Peachcare runs out of money."

Chambliss says the U.S. Senate could act this week, but he cautions state lawmakers to come up with a back-up plan. Meanwhile, State House Speaker Glenn Richardson doesn't want to save a federal program with state dollars. "It means Georgia would have to take money from elsewhere, where the federal government should pay. It's their program."

Richardson says Congress should find the emergency cash while state lawmakers try to contain long-term costs. He advocates shaving the highest-earning five percent of families off Peachcare rolls. A State Senate Task Force would prefer raising premiums rather than turn people away. Both proposals are likely to generate debate at the State Capitol. Georgia lawmakers have put aside other financial decisions while they wait for Congress to act on Peachcare.

Mentally Ill Women in Prison
by Helena Cavendish de Moura

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Up until 1995, about six percent of the Georgia prison population was receiving mental health services, but in the next eight years – through 2003 – that number grew by about one percent a year. Now, about 15 to 15.5 percent of the total inmate population is receiving mental health services.

Some of this increase may be the result of reductions in community mental health services and substance abuse services that have been occurring since the 1990s. The mentally ill – especially those in rural communities where there are few mental health and substance abuse services – have few options.

Inmates with mental illness are trapped in a cycle of recidivism. Many come from poor communities where treatment and counseling are not available. Common offenses among the mentally-ill prisoners are loitering and drug use. Advocates say the mentally-ill are being punished for crimes that could have been avoided had they received appropriate treatment. Sometimes judges in rural counties prefer to incarcerate someone who is severely mentally ill because they will be able to receive mental services in the prison system. For the poor, prison is one of the only ways they can get help. But often help comes with a high price, and it arrives too late.

Colquitt County Migrant Farmworkers' Clinic
by Mary Kay Mitchell

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Vegetables are a vital 650-million-dollar crop in Georgia, second only to Vidalia onions in value. Since vegetable production is so labor-intensive, the farm economy depends on large numbers of healthy workers.

Financial and cultural barriers often prevent farm workers from getting the health care they need. In Colquitt County, there is a health clinic that is tackling the problem.

Kent Hamilton employs seasonal workers from Mexico, who are in the U.S. on Guest Worker visas. Hamilton says that providing these workers with accessible and affordable medical care is essential. But getting adequate medical attention is difficult because these low-income workers don't have health insurance and can't speak English.

That's why Hamilton and his workers turn to the Ellenton Health Clinic. Operating with federal grants, the Ellenton Clinic provides primary health care services for people who earn more than 50 percent of their income from farming. But that's not all the Ellenton Clinic has to offer. Founder and Director Cynthia Hernandez enthusiastically describes a broader vision that goes well beyond the exam rooms she can see from her book-filled office. She's convinced that the key to improving rural health care is to take a preventive health approach.

Hernandez and her co-workers have expanded the clinic into a one-stop shop for community services. The Clinic joined with the University of Georgia Cooperative Extension Service and the Georgia Department of Human Resources. The Clinic offers diabetes control programs and programs to help farm workers and their families prepare healthy food. There's also an after-school program for children of the farm workers.

Hernandez hopes that similar collaborations in rural communities all across Georgia will result in the healthiest farm workers and the strongest farm economy in the nation.

Specialty Care in a Rural Setting
by Joshua Levs

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Part 2 – Listen online

Throughout Georgia, like in the rest of the country, people who live in rural areas often have trouble getting the kind of healthcare they need. Some have to drive hours for specialty care that could save their lives. But for residents of three rural counties, all that has changed thanks to an innovative clinic that is also making its services available to those who can't pay.

The beginnings of this story start in the last century, when a young doctor named Robert Cowles moved to rural Tennessee to open a medical practice. According to his grandson, Dr. Bob Cowles, his grandfather didn't want to do it, but the Governor of Tennessee asked him.

Today, in a modern way, Bob Cowles is following in his grandfather's footsteps. Cowles has set up a state-of-the-art medical facility in Greensboro, Georgia, near Lake Oconee. The new clinic has separate buildings that look like villas, and each focuses on a different medical specialty.

It's rare for a rural area to offer this kind of care – and it wasn't easy to create. But it was Cowles' dream. And he and his family wanted to move out of the city to this beautiful area. That meant giving up a successful full-time practice in Atlanta as a urologist and starting this clinic all on his own.

It succeeded quickly. He opened up a urology practice here in 1999, and his first week he saw 14 patients. Now he sees that many an hour.

That's partly because of the lack of competition. So the demand was there, but there was a limited supply of specialists. To attract other doctors, he had to offer more than patients and the beauty of Lake Oconee. As a financial incentive to get good doctors, he offered them a chance to be part owners of the clinic and participate in various profit centers of the clinic such as laboratory, x-ray, surgery, cancer, and other things.

The clinic is growing, with 42 doctors on staff. Because of Reynolds Plantation, Lake Oconee has attracted a large, wealthy population, and many of the residents have insurance. But before Cowles hires a doctor, he asks them whether they are willing to look after people who don't have any money. And if the answer is "no," then Cowles suggests they practice elsewhere.

The Cowles Clinic serves Medicaid patients and in the past year, according to Bob Cowles, has given out $200,000 in free medical care to those who couldn't pay and did not have insurance. He says that's much like what his grandfather did decades ago in rural Tennessee.

Financial Crisis at Atlanta's Grady Hospital
by Helena Cavendish de Moura

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Atlanta's largest public hospital is drowning in debt. Grady Hospital – the largest trauma center in the southeastern United States – is in desperate need of more than $200 million to remain solvent. Grady's financial collapse has serious consequences not just for metro Atlanta – its crisis could reverberate across the state.

According to recent studies, poor fiscal management and outdated technology are just a few of the reasons causing the demise of one of the most vital public health systems in the Southeast. Grady's physical plant is old and deteriorating. Experts say its inefficient customer service and general administration have created this financial crisis of epic proportions.

Pete Correll, former Chairman of Georgia-Pacific, co-chairs a 17-member Grady Task Force that is exploring the causes and solutions for Grady's ills.

"The Grady situation is truly dire, and that institution is in a death-spiral. They are losing in excess of 3.5 million a month from operations, and they owe 65 million dollars to the medical schools.They are simply going to run out of money."

If Grady closes, Correll sees a patient tsunami that will sweep across the metropolitan area that can jeopardize patient care and trauma care throughout Georgia.

Grady's Level 1 Trauma Center is the only one in North Georgia. That means it can treat victims of interstate pile-ups and shootings as well as a public emergencies, like avian flu. The next Level 1 Trauma Centers are in Macon or Chattanooga, and they are much smaller. Grady is also nationally known for its burn, HIV and neonatal units.

More than 75% of Grady's patients are on Medicaid. The rest are mostly the uninsured, and that's another big reason for the financial problems.

Grady taskforce member Tom Bill, with Cousins Properties, says the large hospital has to be carried by more than just Fulton and DeKalb Counties.

Many of Georgia's doctors have trained at the hospital. Now, Grady Memorial itself is on life support, and if it fails, Atlanta's poor won't be the only ones to bear the consequences.

A final report by the Grady taskforce will be issued in mid-July.