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Students SHOW they care at homeless clinic

Clinic meets need for both health care and caring in homeless populatoin.
ASU students from range of fields — from finance to nursing — staff the clinic.
April 8, 2016

Student Health Outreach for Wellness offers range of medical services for the underserved and — for the month of April — their pets, too

Monique Greco and Garnett Johnson might go hungry sometimes, but they make sure their dog Codi never does.

The homeless couple was visiting the Student Health Outreach for Wellness clinic (SHOW) in the heart of downtown Phoenix, which for the month of April also features pet-health services thanks to an ASU student’s initiative.

“Codi is everything to us,” said Greco about her 8-month-old pit bull, who was getting an exam, micro-chipped and a full set of vaccinations April 2.

“He’s our kid and we always put him first. If we’re hungry, the dog eats first.”

That sort of attitude goes a long way with Amber Howarth, who spearheads Wandering Paws, a mobile veterinarian clinic that has partnered with the Arizona Humane Society and services animals for the homeless and underserved.

Howarth, a 22-year-old ASU senior majoring in biological scienceHowarth is a student in the College of Liberal Arts and Sciences., has a soft spot for animals. She’s developing a similar attitude towards the homeless population.

“I got involved with SHOW when my friend took me to one of their meetings and noting they serviced the homeless population. I thought, ‘Oh, I could add to this,’” said Howarth, who started the eight-week pilot program last month. “I’ve seen a lot of homeless people with pets and felt I could add a veterinary component to the clinic.”

A woman holds her dog at a pet clinic.

Shirley Gibson listens to veterinary advice during a free clinic on April 2 in downtown Phoenix. For the month of April, the Student Health Outreach for Wellness clinic offers pet-health services in addition to the human care it provides year-round. Top photo: Volunteer Lauren Meadows (left) examines Corry Stewart for an audiology checkup that same day. Photos by Ben Moffat/ASU Now

The addition is welcome, and may help bring more notice to the human side of the clinic.

SHOW is a student-run, interdisciplinary team of volunteers from Arizona’s three state universities: Arizona State University, Northern Arizona University and the University of Arizona. Its mission is to provide holistic, client-centered health care for the homeless and underserved and operates in collaboration with the ASU Foundation. More than 150 students from 16 professional programs across the three universities worked together with faculty and community partners on the design, implementation and evaluation of the SHOW program.

The clinic, which has been open every Saturday since last August, has served more than 900 patients in its eight months of operation. Recent evaluations estimate that more than 27,000 Arizona residents experience homelessness each year.

SHOW operates out of Health Care for Homeless on the 12-acre Human Services Campus in downtown Phoenix to combat the weekend gap in health services while giving students real-world experience. Services are free to any individual meeting the medical or social-service criteria.

Students are supervised by licensed clinical faculty from the university and community providers, which includes ASU’s Dr. Liz HarrellHarrell is a clinical associate professor in the College of Nursing and Health Innovation., program director and psychiatric nurse.

“In 2001, The Institute of Medicine reviewed United States health care and reported that it needed to fundamentally change in order to provide quality health care,” Harrell said. “If you don’t have an employer that offers health care or you’re out of a job, you’re also out of luck. Those struggling with social disparities such as the homeless experience even poorer quality of care.”

Harrell said the World Health Organization (WHO) came up with three recommendations to improve health outcomes in this country: focus on the entire health-care population, improve cost and improve the patient experience. The WHO suggested interdisciplinary, or team-based care, was the best way to tackle all three.

“As educators we thought, ‘If this is the direction that health care is heading, then we need to teach that model,’” Harrell said. “The other question was, ‘How do you do that?’ SHOW really filled that practice place, and our patients are receiving a level of care they’ve never been privileged to have before and that’s incredibly meaningful.”

SHOW’s clinical health students range from nursing, social work, nutrition, medicine and pharmacy to audiology, speech pathology, physical therapy, business, journalism and computer science. They are responsible for the assessment, diagnosis, treatment and follow-up care delivery for patients, and have implemented many innovative ideas in their program, including an electronic whiteboard filled with a patient’s information, combination of professionals from different medical fields, and a greeting from a “patient navigator.”

Medical personnel examine a man's hearing.

ASU clinical professor of audiology
Ingrid McBride (left) and volunteers
Lauren Meadows, Colton Clayton
and Ashley Geske consult with
Corry Stewart during a checkup
April 2.

“The navigator is the patient’s health advocate and stays with them through their entire visit,” said Sukhdeep Singh, SHOW student director and ASU senior in finance premedSingh is a student in the W. P. Carey School of Business and in Barrett, The Honors College.. “They are willing to get on a personal level with the patients. When I was a navigator, I bonded with patients by talking about my favorite food — Chinese. We don’t want this to be a demeaning environment because our goal is to treat them as human beings.”

That’s exactly how Taline Aydinian, a 21-year-old exercise and wellness junior, connects with her patients — on the human level.

“A lot of patients have told me they were abused when they were kids and other sad stuff that I imagine contributed to them being homeless and having health issues,” Aydinian said. “When they receive respect, they are more willing to open up to you because they don't get it that often. Everybody here in the clinic respects them and treats them as human beings.”

Twenty-two-year-old patient navigator Erika Alcantera, who is a public service and public policy majorAlcantera is a student in the College of Public Service and Community Solutions. at ASU, said she was initially weary about interacting with the homeless but has overcome that fear.

“I know now they’re just human beings and won’t bother you or do you any harm,” she said. “They’re very grateful for what we do, even the littlest things.”

“When other providers come here on the weekends to check us out, it just clicks for them. I heard one health professional say, ‘I’ve been practicing for 20 years, and I’ve never seen it done this way. And when I go back to the hospital, I’ll think about doing it this way.’”
— Sukhdeep Singh, SHOW student director and ASU senior

Patient Corry Stewart was grateful for the service he received recently. He came in for a routine wellness checkup, and the four-member team detected something out of the ordinary.

“They checked my blood pressure, sight, vision and hearing, and all was good until a doctor came and put a stethoscope up to my chest,” said Stewart, who is a pawn broker in Phoenix. “They told me that I have an irregular heartbeat. But other than that, I think I’m pretty healthy.”

The future of the clinic is also looking healthy, and many health-care organizations are looking at SHOW as a pioneer model, including the National Data Repository, which is collecting information from the clinic and dispensing it to interested clients.

“We get calls from people in other states curious about what we’re doing here and what is working. When other providers come here on the weekends to check us out, it just clicks for them,” said Singh. “I heard one health professional say, ‘I’ve been practicing for 20 years, and I’ve never seen it done this way. And when I go back to the hospital, I’ll think about doing it this way.’ It’s interesting to see them buy into this model.”

Harrell said SHOW is succeeding because the clinic is a “flattened hierarchy” where the students’ opinions matter just as much as the supervisors.

“Part of the problem in health care is that it’s traditionally been physician-focused, with that physician as the head of the team. No one person knows all,” Harrell said. “Part of interdisciplinary care is decision making is shared equally amongst the disciplines allowing for a more holistic care plan, thus improved quality care and greater provider satisfaction. We work very hard to make sure everybody is equal.”

And all things being equal, SHOW is emerging as a new health-care model around the country.

“Because SHOW isn’t constrained with the typical red tape associated with health care, we can try new ideas when it comes to patient care,” Harrell said. “We all know the recommendation is for us to do this, but who else can do this?

“The answer is ‘We can do this!’”

Wandering Paws will operate 9 a.m.-1 p.m. Saturdays through April. The human clinic, SHOW, runs 9 a.m. to noon Saturdays year-round. Both are at the Human Services Campus, 230 S 12th Ave., Phoenix.

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A pragmatic approach to extreme weather

ASU report: We must make common-sense moves now to protect lives, property.
Elevated parks, flexible civic plans among the adaptations that are working.
April 8, 2016

ASU report argues that efforts to reverse climate change not fast-acting enough, so we must take practical steps now to blunt disasters

When a super cyclone slammed into the northeast coast of India in October 1999, winds with top speeds of 160 miles per hour and tidal surges of 26 feet battered the coast, killing almost 10,000 people and destroying the homes of millions more.

Flash-forward 14 years. In 2013, another massive cyclone developed off the east coast of India, in the Bay of Bengal. It was disturbingly similar to the 1999 event, with sustained winds of 160 miles per hour, tidal surges that destroyed fishing boats, and heavy rains that caused extensive flooding. However, remarkably, of the 13 million people affected by the cyclone, only 44 people died.

India simply decided mass deaths because of cyclones were unacceptable. The nation built cyclone-proof shelters that doubled as schools when not used for emergencies, developed contingency plans for evacuating and housing storm refugees, and improved the national weather service’s storm tracking and predictions.

Mankind is going to have to make adaptations like these to extreme weather events, according to a report issued late last month by the Consortium for Science, Policy and Outcomes, a unit of the School for the Future of Innovation in Society at Arizona State University, and the Breakthrough Institute, an Oakland-based think tank focused on modernizing environmentalism.

“Adaptation for a High Energy Planet: A Climate Pragmatism Project” argues that efforts to combat climate change won’t produce results quickly, so people need to come up with solutions to blunt disasters.

“We term it Plan A, actually,” said Daniel Sarewitz, professorSarewitz is also a senior sustainability scientist in the Julie Ann Wrigley Global Institute of Sustainability and an advisory board member for the Center for Biodiversity Outcomes in the Julie Ann Wrigley Global Institute of Sustainability. of science and society in the School for the Future of Innovation in Society and co-founder and co-director of the Consortium for Science, Policy and Outcomes, one of the report’s co-authors. “We think that’s part of the whole problem, that adaptation hasn’t been seen as inevitable and necessary. ... Reducing emissions is a great idea, but we’ve all seen how that is.”

A multipurpose cyclone shelter in India.

A multipurpose shelter like this one protected citizens of Odisha, India, from the worst effects of Cyclone Phailin in 2013. Photo by ADRA India

Even if actions like those taken at December’s climate talks in Paris are wildly successful, “the world is stuck with at least some warming and the consequent impacts,” the authors wrote. “Even dramatic reductions in emissions today will not significantly manifest in terms of either global temperature trends or sea level rise until late this century or early in the next.”

“There’s lot of things that can be done, and we know how to do them,” Sarewitz said. “If you lead with adaptation, you’re protecting people against climate now, plus changes in the climate in the future.”

The report examined solutions being implemented in four countries around the world. Most of them are cheap and simple.

“There’s so much arguing about climate change, but a lot of these things that can protect lives and property are not rocket science; they’re common sense,” Sarewitz said. “It feeds hope and the sense that you can deal with the problem.”

Most notably, the Dutch have been dealing with vulnerability to the natural world since the 13th century. They build flexibility into policies and infrastructure so adaptations can be adjusted to future conditions. Levees are constructed or strengthened to withstand existing flood predictions, but are also designed to be heightened in the future. The Dutch also systematically lower river levels by creating bypasses, or “room for the river.”

“There’s so much arguing about climate change, but a lot of these things that can protect lives and property are not rocket science; they’re common sense,” Sarewitz said. “It feeds hope and the sense that you can deal with the problem.”
— ASU professor Daniel Sarewitz

The Netherlands are far wealthier than the other countries discussed in the study — India, Nepal and Indonesia. Global death rates from natural disasters plummeted in the 20th century, a chart in the report illustrates. Wealth is a component of that, Sarewitz said.

“The more economically developed countries are, the more protected they are from natural disasters,” he said, citing better housing, stringent building and land-use codes, more comprehensive emergency management and response, and simply more economic wherewithal to protect themselves. “The fact is we’re much better prepared because of the wealth of industrialized society, and that’s what the numbers are showing.”

When the 2004 Indian Ocean tsunami hit, inhabitants of one Indonesian island knew to head into the mountains when they saw the ocean retreat. That life-saving knowledge had been passed down from generation to generation since a similar event in 1907.

“Several programs since then have sought to educate coastal communities about what to do for the next tsunami, using social networks and institutions to provide information, rather than high-tech measures that fail to reach everyone and have proven to be unreliable,” the report read.

However, it could be impossible for coastal residents to reach higher ground, especially if they’re living in a densely populated city. So, Indonesian authorities in one city decided to bring the higher ground to them.

“A half-dozen elevated parks in the Indonesian city of Padang could save as many as 100,000 people from the threat of inundation,” the report noted. “Simple, relatively inexpensive, and reassuring to the city’s inhabitants, this innovation depends more on knowledge of a particular social and institutional context than of the science of tsunamis or complex models of how they work.”

An artist rendering of an elevated park and evacuation area in Indonesia.

The conceptual drawing for
an elevated Tsunami
Evacuation Park in Padang,

Image by Kornberg Associates

Shaped like pyramids, the elevated parks are home to soccer fields and other amenities.

“It’s important to be clear about the kinds of things humans can accomplish,” Sarewitz said. “You don’t have to be rich to get this stuff right.”

Nepal suffers from a highly variable climate. The government partnered with farmers and researchers in a collaboration to enhance rice plant breeding and seed production. The result was the development of hardy rice varieties in a region of Nepal that has had historically poor production because of climate swings.

“These arrangements are crucial contributors to Nepal’s capacity to recover from the tremendous destruction of the 2015 earthquakes,” the report read.

“There’s all sorts of aspects to this; it’s not just a technological problem,” Sarewitz said. “What we’d really like to see is policymakers and the media realize that there is a different, more hopeful way to look at the problem, and it points the way towards solutions.”

Top photo: Aceh in Indonesia, the most devastated region struck by the 2004 tsunami. Photo by U.S. Navy