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Community Ties

One hundred years ago, the area that would become known as Sun Valley was considered to be among the healthiest places to live in the United States.
No one would confuse Sun Valley for one of the healthiest places in the U.S. today. In the words of Supervisor Zev Yaroslavsky, “Sun Valley is Ground Zero for the healthcare crisis in Los Angeles County.”

Located in an area that has been tagged as an “environmental justice” zone due to its concentration of landfills, wrecking yards, metal-plating facilities and other polluters, this community of 53,000 mostly working-class Latino residents in the northeast San Fernando Valley registers rates of asthma, obesity and diabetes that are significantly higher than most of the rest of the county. More than 20 percent of Sun Valley’s residents live below the federal poverty level. One-third lack health insurance. Everyday illnesses such as colds, flu, infections, and cuts and bruises go untreated for lack of conveniently located healthcare.

Soon, however, healthcare services will become available to the residents of Sun Valley. In May 2006, construction of a modern 10,000-square-foot clinic began on the campus of Sun Valley Middle School, which, when it opens in Fall 2007, will serve the entire community.

The Sun Valley Community Health Center represents a unique partnership between the David Geffen School of Medicine at UCLA, Los Angeles County, the Los Angeles Unified School District (LAUSD) and the Northeast Valley Health Corporation, a Federally Qualified Health Center (FQHC). LAUSD has provided the land, the county supplied $7 million for construction, the Northeast Valley Health Corporation will provide the comprehensive healthcare services, and the UCLA Department of Family Medicine will offer expanded asthma screening for the children and families of the community. As Dr. Gerald Levey, UCLA’s vice chancellor for medical sciences and dean of the David Geffen School of Medicine at UCLA, noted during the groundbreaking, “It really does take a village to transform an idea into reality.”

With 13 examining rooms, a pharmacy, lab, counseling offices, and education and training rooms, the clinic will be the largest and most comprehensive school-based clinic in the United States. The free and low-cost services that will be provided include preventive care, chronic-diseases management, dental care, mental health, and adult and pediatric medicine. Such a clinic is sorely needed for the community, says LAUSD Board Member Julie Korenstein, whose district includes Sun Valley. “Children will be able to get immediate healthcare, and parents, who oftenmust travel long distances to access healthcare, now will have it conveniently located in their own neighborhood.” Ties One hundred years ago, the area that would become known as Sun Valley was considered to be among the healthiest places to live in theUnited States. Community UCLA students and physicians in the Department of Family Medicine help bring primary care to one of the city’s poorest communities.

Those involved with the project have aspirations beyond Sun Valley. “We view what we are doing here as a model for similar partnerships to meet the healthcare needs of underserved communities elsewhere in the country,” says Dr. Patrick T. Dowling, chair of the Department of FamilyMedicine and a driving force behind the clinic.

In addition, the clinic will serve as a training site for UCLA medical students and family-medicine residents, helping them, through direct intervention in an underserved community, to gain a greater understanding and appreciation of community-based healthcare delivery and access, explains Dr. Dowling. Perhaps the experience will encourage some of those students to pursue primary-care medicine. In addition, Dr. Dowling notes, “We hope that the presence of our students and trainees on campus will inspire some Sun Valley students to consider a career in healthcare. Ideally, we’d like to train physicians from this immigrant Latino and working-class community who will then become mentors and role models.”

This dream has been six years in the making. In the summer of 2000, eight UCLA students who had completed their first year of medical school participated in the medical school’s summer research fellowship under the supervision of the UCLA Department of FamilyMedicine. They were taught how to conduct a random cluster survey of more than 300 households, asking the residents more than 100 questions regarding the health of their families. The survey revealed that, compared with surrounding communities, the residents of Sun Valley had pitifully inadequate access to healthcare services. Asthma was singled out as the most serious health problem in the community—a finding of great concern, Dr. Dowling says, since the National Institutes of Health has declared asthma, particularly childhood asthma in minority populations, a national health priority.

The UCLA summer research students also submitted lengthy applications that resulted in the community being designated a Health Professional Shortage Area (HPSA) for primary care. (Eighteen such HPSA-designated areas in Los Angeles County exist, which means they lack access to basic medical care and that they can receive federal funding to support healthcare services.) Once the need was documented, Dr. Dowling then proposed creating a clinic to serve the needs of the entire community.

“Our initial effort to promote a clinic was not, however, embraced by the community,” Dr. Dowling recalls. “At a meeting in the office of [then- City Councilman] Joel Wachs, we basically were shouted down by about 30 residents who didn’t understand what a family-medicine clinic would be, and who feared that it would attract drug users to the neighborhood. We were somewhat shocked by that, and disappointed.” But shortly after that rejection, Supervisor Yaroslavsky’s health deputy, Ron Hansen, recommended that UCLA Family Medicine attempt to partner with Sun Valley Middle School, which had some available land.

At Sun Valley Middle School, the concept was received more warmly, and an on-campus asthma-screening and early-intervention program soon was established, under the direction of Assistant Professor of Family Medicine Dr. Glenn Lopez, with the goal of one day creating a more comprehensive service on the site.

UCLA medical students and trainees, under the supervision of an attending physician, have screened more than 2,200 students and found an asthma prevalence of 14 percent, a rate that is significantly higher than the 4 percent reported by the Los Angeles County Department of Health Services for Hispanic children countywide. Further, 48 percent of the children found to have asthma had never been previously diagnosed. All these children have been referred to the UCLA-run asthma-education program on the school grounds and to their own primary-care providers. If the family did not have a physician, they were referred to the county’s Mid Valley Comprehensive Health Center in Van Nuys, which includes UCLA family medicine residents and faculty.

Another program targeting diabetes prevention and early intervention is now in development. The new clinic will serve as an ideal location to treat patients who come through both programs. “The clinic affords us the opportunity to intervene at a much earlier stage in terms of treatment for these conditions,” Dr. Lopez says.

Dr. Dowling sees these projects as the basis for a long-term relationship between the Department of Family Medicine and the community. “Through these projects we can establish strong ties with the Sun Valley community, a foundation upon which we will build to eventually address other difficult issues such as alcoholism, substance abuse, depression, family violence, obesity and diabetes,” he observes.

State and county budget cuts delayed the clinic for several years, but the logjam broke in 2004, and momentum picked up. Once completed, the clinic “will provide desperately needed high-quality healthcare to this community,” Yaroslavsky says. “It will have a profound impact in bringing a better quality of life to these kids and their families.”

Dr. Dowling, too, envisions the clinic delivering services that extend beyond the examining room. “We really want to empower people,” he says. “We have access to the school gymnasium, so maybe we can start an exercise class for parents. Or, because prevention always is more cost effective than treating a chronic disease, we can teach about some different ways of healthful cooking to help curb obesity and diabetes in the community. “Together,” Dr. Dowling says, “we can really make a difference in the healthcare of this community.”
 





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