KOLAHUN: 1 oz. = 1 lb.

Southeast Health Center in San Francisco’s Bayview district, one might argue, is “Ground Zero” in the war on chronic disease in the underserved communities of the city. The disproportionate cardiovascular disease, diabetes, COPD, asthma, advanced breast cancer, sexually transmitted disease, substance abuse and homicide is usually the subject of any conversation regarding what is to be done about the area’s poor state of health; and the proposed solutions quite often include a line that goes, “Southeast Health Center…”.

“Southeast” solutions are usually costly and complicated secondary interventions. But when you thing about it, the place for cost effective and lasting prevention can be found in a nearby side of town, in the Excelsior district - at Balboa High School.

While temporarily filling a provider vacancy in the Balboa High School Teen Clinic, I met my future Southeast Health Center patients. Of course, as high school students, few of them had the cardiovascular disease, the diabetes, the COPD, the asthma, the advanced breast cancer, the sexually transmitted diseases, the substance abuse or the homicide problems. But they did have the socioeconomic determinants that made such maladies more likely to occur – poverty, low education attainment, fragmented families, language barriers and racial stigmatism, just to name a few.

Even though much of this was documented in the charts of kids visiting the clinic for acute illness and injury, family planning, free breakfast or just an excuse to get out of class – it bothered me that many of these social issues were not given the same importance as the biopsycho ones that we, as physicians, nurses, medical assistants, pharmacists, psychologists, social workers and health educators may feel more comfortable dealing with, because we see it as within the scope of our training and expertise.

Yeah, I noticed that many of them had documented low GPA’s in the HEADSS assessments, but would an intervention be documented in my Assessment/Plan? Would I wait for low GPA at Balboa High to turn into type-2 diabetes at Southeast Health Center before I could devise a sophisticated plan of attack; or into cocaine addiction where I’d likely have even less to offer?

When given such predicaments – there’s really only one question that I need to ask, “What would Justin do?”

“Assessment: Low GPA, poor college prep, no future goals beyond high school.

Plan: Follow-up 1 week for re-education.”

I did this for about a month. Kids coming to the clinic to discuss their class schedule, their plans for college (or lack thereof), income expectations and the cost of living, etc. Stuff like that.

Some told me that up till now, no one had ever asked them about their future or helped them plan for it, which brought me down for them. But the thing on their assessment that killed me was this…

GPA:_____1.7______

Career Goal:__NFL_____

Which led to the development of the instructional tool, below, that I would share with my patients. I made several copies. So they could take it home. And stare at it.

One kid told me he planned to play pro football. I then asked him if he was even on the school’s team. His answer was less than encouraging. Follow-up 1 week for re-education.

What Are The Chances? ☻= 50 People

Of Senior Year High School Football Players (330,000) …Becoming NFL Players?

☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻

☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻(only played high school ~ 310,000)

☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻

☻☻☻☻☻☻☻☻☻☻(college players ~ 20,000)

☻Play Football in High School and/or College, But Are Not Eligible for NFL Draft (328,750)

☻NFL Draft Eligible But Not Drafted

☻NFL Drafted But Didn’t Make The Team (100)

☻New NFL Players (150)

Half Of All Senior Year High School Football Players (160,000) Becoming Lawyers

☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻

☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻☻

☻Finished College Only (64,200)

☻ Applied To Law School, Not Accepted (47,700)

☻Didn’t Graduate Law School (5,400)

☻New Lawyers (42,700)

Oh, the looks on some of those faces! For many, this clashed violently with their expectations, their dreams, what they had always been told, to begin to see what they were actually capable of beyond, just playing football or no future at all. Better now, here in the teen clinic than 10 years from now in the health center. Know what I mean?

After the vacancy had been filled, I no longer saw patients at the teen clinic. Although I did learn that a young lady I’d seen there came by the clinic to tell me that she’d gotten in Berkeley and she wanted to thank me.

Just doing my job, I suppose. One ounce of prevention….

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KOLAHUN

An ongoing discussion about health care (and other stuff)

February 07, 2008

1 oz. = 1 lb.

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