What happens when you travel north from Manhattan’s downtown and Midtown, away from the eye-catching commercial billboards and throngs of office dwellers? You abandon the visual rush for a new intensity: cerebral, emotional, raw. The buildings remain nearly as tall, nearly as crowded, still grouped together for a purpose. In East Harlem, that purpose is often affordable housing. And in the spot belonging to Mount Sinai Hospital, situated between East Harlem’s 98th and 102nd Streets, the purpose is prevention, healing, research.
Despite the implicit distance between residential and work settings, that purpose—medicine—also unites those who spend their days in these sets of buildings. Many faculty and students at Mount Sinai are deeply engaged in serving their community. The notion of unidirectional service does not, however, adequately capture the relationship between hospital and neighborhood. Dr. Yasmin Meah, founder of Mount Sinai’s East Harlem Health Outreach Program, told the HPR that “there was a definite degree of skepticism” regarding EHHOP free clinic. The clinic, which is student-run, provides primary care as well as connection with other medical resources and social services to over 250 patients. The initial pushback came not from patients but from other groups that already existed in East Harlem. These organizations, namely Boriken and Settlement Health, “were the pillars in East Harlem of healthcare for the uninsured,” Dr. Meah said. They were frustrated in part because EHHOP, by virtue of its direct ties to Mount Sinai, had easier access to medications and other forms of treatment that only a hospital can provide.
To avoid offering services “redundant with what already existed in the community,” she explained, it was incumbent upon EHHOP to take an approach that brought the program into even closer engagement with East Harlem. The group visited community meetings, explaining that they hoped “to partner with all of the other institutions.” Dr. Meah recognized that EHHOP’s greatest asset would be to coordinate the work that these institutions already performed. She recalled, “It wasn’t until we sort of advertised ourselves that way and didn’t advertise ourselves as a clinic that was going to be the end-all or a savior, we were part of a network, that’s really when we started gaining respect.” This respect, rooted in the reality that service is more complex than the medical world bringing “superior knowledge” into the residential world, is as vital in institutional engagement as it is in the personal relationship between physician and patient.
A Neighborhood and Its Hospital
As a hospital, Mount Sinai came into existence on January 15, 1852, several blocks west and 70 blocks south of its current principal location. Named Jews’ Hospital until 1866, it was born of ideals, the creation of nine representatives from several Jewish charities. These nine men hoped that their 45-bed hospital would provide “free medical care for indigent Jews in New York City,” though they also accepted non-Jewish patients in emergency situations. Most patients of the hospital—which became a secular institution with its 1866 name change—were immigrants. The institution remains, says its website, committed to “patient care” and “social concern.”
These days, Mount Sinai is situated amidst apartment buildings, small businesses, and elementary and middle schools. Across the street from the main hospital complex are the George Washington Carver Houses, managed by the New York City Housing Authority and named for the famed Tuskegee Institute agricultural scientist born into slavery in the 1860s. On the day I walked through in late May, Carver Houses’ gardens were in full bloom, their tiny, fenced-off lawns a vibrant shade of green. An FDNY ambulance remained at a standstill on an adjacent road. It faced the wrong direction down a one-way street, a quiet metaphor for the seeming incongruity of a bustling research center and a stolid housing complex, silent in the midmorning heat.
East Harlem faces greater socioeconomic challenges than are typical of the neighborhoods around it in Manhattan, a New York borough in which 18.3 percent of the population lives below the poverty line and a full 59.5 percent of adults are college graduates. Meanwhile, 38 percent of East Harlem residents live below the poverty line. Just 13 percent of residents above age 25 have a college degree.
The demographic profile of Mount Sinai’s medical school, like Manhattan’s, does not map neatly onto the neighborhood’s patterns. Fifty-five percent of East Harlem residents are Hispanic and 33 percent are Black. At Mount Sinai’s Icahn School of Medicine, 17.4 percent of students qualify as “underrepresented minorities.” Prior to 2003, the Association of American Medical Colleges employed the term “underrepresented minority” to assess the diversity of its schools. The term encompasses, in the words of the AAMC, “Blacks, Mexican-Americans, Native Americans (that is, American Indians, Alaska Natives, and Native Hawaiians), and mainland Puerto Ricans.” By this metric, which is sometimes still used, roughly 17.9 percent of all American medical school students are underrepresented minorities—placing Mount Sinai precisely in line with the national average but out of step with the surrounding community.
This demographic mismatch can create a barrier between patient and physician, as Dr. Mark A. Attiah has written. After entering medical school at the University of Pennsylvania, Attiah recalled, “During my pediatrics rotation, the mother of a patient waited until the attending physician had left the room before she lowered her voice, smiled, and asked, ‘Are you wearing your hoodie for Trayvon?’ She didn’t know what city I was from, what faith I belonged to, or what tax bracket I was in. She just knew that I was black, like her. This race-based camaraderie between patient and physician can improve patient satisfaction, and patients from racial minority groups tend to seek out physicians of their own race if given a choice.” Sources of “camaraderie” are indeed integral to treatment—as has been studied repeatedly, patients are far more likely to disclose necessary information when they feel comfortable.
Engagement and Education
Mount Sinai students have sought to join the medical and residential communities by teaching underserved minority high school students about the cardiovascular and pulmonary systems. They hope to inspire the students to become physicians and guide them toward this goal. This program, Medical Discovery of Careers, works with Mount Sinai’s larger Center for Excellence in Youth Education, a set of educational programs for students beginning in seventh grade and continuing through college. CEYE, housed under the Center for Multicultural and Community Affairs, focuses on serving youth who are—as discussed above—demographically “underrepresented in medicine.”
MedDOCS is featured on the website for PS/IS 171 Patrick Henry Preparatory School, located a few blocks north of Mount Sinai’s medical school that educates students from preschool through eighth grade. Patrick Henry, which resembles a medieval European monastery, enrolls a student body that is 100 percent at or below the poverty line. Ninety percent of its students fall under that same AAMC definition of medically underrepresented minorities.
Education, however, constitutes only one piece of Mount Sinai’s engagement in East Harlem. Dr. Meah is also involved with the Mount Sinai Visiting Doctors Program, a program she told the HPR has become America’s “go-to model program” for home-based primary and palliative care. It is the nation’s largest academic home-based primary care program and serves the homebound in East Harlem and other Manhattan neighborhoods. However, despite Mount Sinai’s early history of free medical care, Dr. Meah explained to the HPR, “The actual stated mission doesn’t actually have service. It’s much more research, education, and clinical care.” In fact, she added, the current service “emanates from an institution that historically actually wasn’t very connected with East Harlem.”
She created EHHOP while still a junior faculty member, and Visiting Docs was established by physicians who were only residents at the time. Dr. Meah has seen a change in Mount Sinai over her career there. She attributes the shift to her and others’ progressions, as individuals committed to service, from relatively low in the hospital and medical school ranks to more senior positions. “Certainly in the past 25 years,” she told the HPR, “[service has] clearly been one of the major priorities.” These days, EHHOP enjoys a great deal of institutional support, says Dr. Meah; many faculty members—in fields such as primary care, mental health, and cardiology—and between 60 and 80 percent of the medical student body are involved in its operation.
Ann Rauch, a social worker at Mount Sinai who leads the Resource, Entitlement and Advocacy Program has found the same support from the hospital, working especially closely with the Department of Finance and with Ambulatory Care. Her program, as she told the HPR, serves residents of East Harlem, Harlem, and Yorkville, whether or not they are Mount Sinai patients, as well as Mount Sinai patients across the hospital’s citywide system of clinics and other facilities. R.E.A.P.’s work extends beyond the strictly medical. Rauch explained to the HPR, “We also serve as a centralized source of information and assistance regarding application and advocacy for all kinds of government programs, like Medicaid and Child Health Plus and programs through the New York State of Health insurance marketplace, cash programs like Temporary Assistance to Needy Families, food stamps, all of that. We take a holistic approach.”
In terms of integrating that institutional support and the needs and desires of East Harlem residents, Dr. Meah told the HPR, “We needed to make connections. That was facilitated by a number of things, not just what was going on in EHHOP but what was also going on in the medical school. Students were now watching programs and wished to network with community organizations in a meaningful way.”
“There was a program called the Human Rights and Social Justice Program and, when it first launched, people were also very skeptical,” Dr. Meah recalls. “They were like, ‘Why are we doing this for you, medical students? What are you giving to us?’ But then you sort of develop that trust because the medical students were actually providing services to these community organizations that they could not afford. Our students were doing free research for them or free organizing for them, free advocacy for them.”
“And,” she adds, “we were really getting major results.”
Image Source: Olivia Herrington