University of Cincinnati Department of Family and Community Medicine

Erin Capitena, Summer 2012

This summer, I worked on a number of projects, splitting my time among the River Downs Race Track Clinic, updating the Community & Homeless Resources map, healthy living classes at Su Casa Hispanic Center, and shadowing with the Healthcare for the Homeless program. Each of these experiences has reopened my eyes and reinvigorated my passion for working with society's marginalized populations.

Perhaps my most eye-opening experiences this summer occurred at the Track and while shadowing. The Race Track Clinic serves the workers on the "backside" of the Track. Many of the workers are migratory – traveling from racetrack to racetrack to work. The hours and physical labor are intense, with work often starting at 4 am and continuing through the evening. Those employees who live at the track stay in dormitories, which were described by the Track chaplain as being "like a third world country."

I cannot overemphasize the value of preventive care and education among the population with which I have worked. I saw patients who had not seen a physician or dentist in years (I mean YEARS – one patient told me he last saw a doctor in the 70s, another had not been to a dentist for 18 years). Similarly, I saw patients who clearly did not understand their health or medications – one man decided to stop his medications for high blood pressure and diabetes because he thought eating more fruit would improve his health. It had not. Through my experiences working with these patients, I saw time and time again the need for good health education and meeting patients where they are in their health literacy levels.

Not only did I witness low levels of health literacy in my summer experiences, but I also saw firsthand how many homeless patients need mental health services. According to the National Coalition for the Homeless, about 20-25% of the homeless population suffers from a severe mental illness ( "Mental Illness and Homelessness." https://www.nationalhomeless.org/factsheets/Mental_Illness.pdf). Based on my experiences, this is a conservative estimate for the patients I saw. Many of the Mobile Medical Van patients I saw while shadowing had depression, PTSD, anxiety disorders, or other mental health concerns. These patients, again, showed me the importance of good health care services. I know that working with Dr. Kiesler and the Department of Family Medicine has been an experience that I will remember throughout my training and my career. I aspire to continue working with and learning from underserved and vulnerable populations and to advocate for better health care, preventive services, health education, and mental health services.