Geisel School of Medicine Student Arvind Suresh Receives Prestigious Public Health Service Award

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This article was written by Susan Green and originally published in the Geisel School of Medicine News on May 27, 2021. The PHC appreciates the opportunity to share this news about Arvind Suresh, who was a key architect of our Fall 2020 Community Flu Vaccine Clinics. The original posting can be found here. — Alice Ely

Arvind Suresh, Geisel ’23

Given annually to medical students in recognition of their commitment to addressing public health issues in their community, the competitive U.S. Public Health Service Excellence in Public Health Award rewards visionary medical students who are advancing initiatives to improve public health. This is the seventh year in a row a Geisel student has received this award.

Second-year medical student Arvind Suresh ’23 has been recognized for his leadership in organizing and managing student-run mobile community influenza vaccination clinics—marshalling fellow medical student volunteers who contributed more than 600 hours of service in administering influenza vaccines throughout the New Hampshire and Vermont Upper Valley region last Fall. And for his commitment to addressing food insecurity in rural Vermont communities.

Leading the Geisel Vaccinator Corps

Citing Suresh’s work, Commander Andrew Geller, MD, co-chair of the U.S. Public Health Service Excellence in Public Health Awards Program, wrote it is a “testament to the education provided by the Geisel School of Medicine at Dartmouth and to the high caliber of your students. We hope that this will encourage your faculty and students to continue their strong work in public health.”
Partnering with the Upper Valley Public Health Council and Dartmouth-Hitchcock, Suresh, along with Isabelle Tersio ’23, Sean Halloran ’23, and Sean Liu ’23, led a team of Geisel student vaccinators in bringing vaccines to rural locations where community members would otherwise need to travel farther distances to access medical care.

Geisel Vaccinator Corps at Bradford, VT, October 2020

“We have recruited and trained more than 170 medical student volunteers as part of the Geisel Vaccinator Corps with the help of our faculty advisor Dr. Annika Brown,” he says. “Since January 2021, we have also been able to work closely with Dartmouth-Hitchcock to staff weekly COVID-19 vaccine clinics for health care workers, teachers, and Upper Valley community members as part of New Hampshire’s vaccine rollout.”

They also staffed clinics at the Upper Valley Haven, an organization that provides services to individuals facing housing instability or homelessness, for both community members and Haven staff.

During the COVID-19 vaccine clinics, the Vaccinator Corps additionally served as public health educators by helping answer questions about the vaccine and clarifying myths vs. facts—in doing so they played a critical role in promoting vaccine safety.

Care and Vaccines Through Project Salud

Suresh has recently collaborated with Stephen Genereaux MED ’87 and Little Rivers Healthcare in Vermont to bring COVID-19 vaccines to migrant dairy farmworkers farms in the Upper Valley. “It has been so gratifying to be able to advocate for these essential workers—and as part of my ongoing work with Project Salud, a student-run mobile clinic that partners with Genereaux to provide medical screening and care to migrant workers—to be able to develop programs that center the voices of farmworkers and support the physical and mental health needs of this underserved population,” he adds.

Tackling Food Insecurity

Last Spring, he and Arhem Barkatullah ’23, both Schweitzer Fellows, turned their attention to addressing food insecurity in Orange County, Vermont, one of the most food insecure regions in that state where many communities are more than 30 minutes away from the nearest grocery store.
Little Rivers Healthcare was already evaluating patients for food insecurity as part of their social determinants of health screening. Suresh and Barkatullah initially planned to pair nutrition counseling with free groceries that patients would pick up at one of the Little Rivers clinics. But because of the COVID-19 pandemic, they adopted a food delivery service and offered nutrition counseling via telehealth. “We created recipe and nutrition cards to help patients make the best use of produce items they may not be familiar with and included them in the food deliveries,” Suresh explains.

The duo is now developing “bite-sized, digestible” podcasts and infographics that patients can access to learn more about nutrition topics specific to community needs. The long-term goal is to build sustainable solutions for food insecurity via “food pharmacies” at Little Rivers where patients can pick up fresh food specific to their health needs, as well as a gardening program on dairy farms to support migrant farmworkers who wish to grow culturally specific foods.
“One of the most meaningful aspects of leading these projects has been the opportunity to collaborate with so many students, healthcare providers, and community leaders in promoting population health,” Suresh says.

“As a future physician, I strongly believe that we have a responsibility to serve as advocates in our community and address the inequities and social determinants that lead to poor health outcomes—as the COVID-19 pandemic has widened many of the existing health disparities across our country and claimed the lives of so many, it is even more important that we do everything we can as medical students to support our community,” he adds.

Extending Physicians Roles Beyond the Doors of the Clinic

In a year that has completely transformed public health and healthcare, community service has allowed Suresh to see the integral role that physicians can play in advancing social justice, a role, he believes, that extends far beyond the doors of the clinic or hospital.

“My experiences have reinforced how closely tied patient health is to that of the entire community and will strengthen my ability to meet the needs of my future patients,” he says. “I am grateful to be part of such a dedicated community at Geisel. These service projects would not have been possible without the continued support of faculty and classmates.”

Community-Centric Research on Aging Adults

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Community-Centric Research on Aging Adults and Access to Healthcare in the Upper Valley of New Hampshire

We are three Dartmouth students in a spring 2021 class about rural sociology, and we have been conducting research by assessing both data and primary source interviews with community members over the past two months. We are taking a social impact practicum (SIP) class which means that while we study a topic in class, we are simultaneously given the opportunity to work with a local organization or group to gain some firsthand experience in the field. This also allows us to gain a broader perspective on the greater Upper Valley community, its strengths challenges, and idiosyncrasies. The three of us have been privileged to work with the Public Health Council of the Upper Valley (PHC) researching access to healthcare and other resources for the local aging community. We would like to thank the PHC, the Center for Aging Resources at DHMC and all the people who participated in our focus groups and individual interviews for being open, honest, and helpful to us throughout this project. — Hannah Lang, Kate Miller & Katherine Ogden

Town-Specific Findings:

The Upper Valley of New Hampshire consists of 12 towns nestled into the Connecticut river valley. Of the 12 towns in the area, Lebanon has the largest population of people over the age of 65 and has the most centralized senior living establishments. Focus group participants generally spoke very highly of the access to healthcare and other resources in Lebanon. Grafton and Canaan have higher rates of poverty in their elder populations, making these towns potentially ripe for specific affordable or free resources and interventions. Hanover and Lyme on the other hand have wealthier populations but these towns still struggle with social isolation, fall risk and ability to accomplish upkeep tasks around the home. Dorchester has the highest rate of annual ER visits per 1000 people over age 65. While this statistic could be slightly skewed by low population it is still indicative of significant need in the area.

We developed a Data Brief to summarize our findings, which you can download from this post.

Strength of Senior Centers

This map shows Upper Valley towns in New Hampshire. The light purple area indicates areas within a 20 minute drive of the senior center, the dark purple area indicates areas within a 5 minute drive. The Advance Transit bus route is also included on the map. Most areas have a senior center within a relatively short distance, though they may be inaccessible to seniors who are no longer able to drive and do not have a reliable source of transportation. For a live map, see: https://arcg.is/1iCanX

In terms of both culture and community the Upper Valley has some very notable strengths. In our focus groups we found many people feel good about reaching out to neighbors, friends, and family members for help with tasks around the home. We also learned that the Upper Valley has a very strong network of senior centers. Lebanon, specifically, has a senior center that many of the focus group participants both loved and, in many cases, relied on. Senior centers are particularly impactful for providing social spaces for this population as well as medical, nutrition and transportation recourses.

Community Nursing Resources

Many towns in the area also have access to community nurses and community health centers. These are very important resources for people to use while aging in place. Community nurses are able to help their clients without being beholden to insurance regulations because they are funded through either grants, charity or town finances.

Recommendations

One area for intervention in the Upper Valley is providing senior centers in more rural towns or providing access to existing centers in neighboring areas. These centers are hubs of social connection while acting as a safety net to help head off health issues before they become emergencies.

Similarly, many of the towns have access to community nurses but some do not have this recourse. In discussion with a community nurse in Lebanon, it also became apparent that she and her colleagues are both overworked and not always experts in the care they are providing. One place where this problem could be combatted would be access to more mental/cognitive health recourses so that this burden does not fall on community nurses who are untrained in the area. More access to social workers, mental health workers and care coordinators would be very effective for helping to streamline care for individuals who prefer to age in place.

When discussing interventions and increasing accessibility, everything generally comes down to increased funding. One way to create access to more funding for aging resources is just to increase cultural awareness and understanding of the aging population. With more state and federal level funding, it would be easier to make sure that more introverted or isolated seniors do not fall through the cracks. At present the communities are already taxed so it becomes difficult to do the work to extend and advertise existing resources to those who are not actively seeking them out.

Many focus group participants brought up the fact that while they are aware of resources available to them, their less computer savvy or more socially isolated peers could find simply knowing what resources exist to be difficult. Increasing awareness of challenges facing the aging population is an efficient way to help gain funding while also helping to advertise what resources are already organized and functioning.

*One thing to note is that our focus groups were recruited through the Center for Aging Resources. This means those who participated are already engaged within their communities and are outgoing enough to choose to participate in a discussion without any incentive.

Editors Note:

This report focuses on New Hampshire towns in the PHC region because the primary data resource is available only for New Hampshire towns. Comparable data was not readily available for our Vermont towns. Given our experience working in the Upper Valley, we believe the findings that describe the disparities, strengths and resources for older adults are generalizable to many of our Vermont towns as well.

Expanded Special Needs Information Program

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Hanover Police Department and Special Needs Support Center Announce Expansion of SNIP

The Public Health Council works with our partners to ensure all people in the Upper Valley community have the supports they need along their life span to reach optimal mental wellness, including prevention and education, early detection and intervention, and all stigma-free. This includes promoting ways to keep our most vulnerable neighbors safe in times of crisis. This Special Needs Information Program is one example of our local law enforcement agencies stepping up to help. We are pleased to share information about this program.

The Hanover Police Department and the Special Needs Support Center (SNSC) announce the expansion of the Special Needs Information Program (SNIP), a program to help emergency responders identify and respond to vulnerable residents with special needs.

This is a voluntary program in which special needs community members of any age, or their family members, submit information such as triggers, special accommodations, emergency contacts and a photograph. The information is entered into a database in which the Police Officers and Dispatch Team have access.  This is an expansion of the pilot project launched by SNSC and Lebanon Police Department two years ago and recently launched in Hartford, VT.

A New Safety Tool for Our Community

“Estimates show that as many as 80% of people who become involved with law enforcement are individuals affected by autism, Down syndrome, dementia or another form of developmental or mental impairment” said Laura Perez, SNSC Executive Director. “The benefits of the program to our most vulnerable citizens and to law enforcement make it an invaluable safety tool for our community. The tool is free to residents and provides local law enforcement with essential information prior to an emergency.”

“Our implementation of the Special Needs Information Program (SNIP) into the Hanover Police Department will allow individuals, family members, or caregivers to provide information about individuals with special needs into a database that can provide first responders with important information during a response on how best to prepare for an individual’s needs.” said Charlie Dennis, Chief of Police of the Hanover Police Department. “The addition of SNIP into our department will also open the program up to all twenty-six entities we dispatch for through our Hanover Regional Communications Center. SNIP will be a great asset in helping us better serve our community.”

Many New Hampshire and Vermont Towns Covered

This partnership between SNSC and Hanover Police Department expands the program to residents of the New Hampshire towns of Hanover, Etna, Canaan, Cornish, Enfield, Lyme, Orford, Plainfield, Piermont, Meriden, Grafton, Grantham, Springfield, Dorchester, and Orange as well as the Vermont towns of Norwich, Thetford, Fairlee, Bradford, Strafford, Vershire, W. Fairlee, Corinth, Orange, and Topsham.

To register for the Hanover Special Needs Information Program:

  • Complete the form by visiting https://www.hanovernh.org/hanover-police-department or www.snsc-uv.org;
  • Call the Hanover Police Department at 603-643-2222 and request an officer be dispatched to your residence to assist you in completing the form; or
  • Call the Special Needs Support Center at 603-448-6311 and a team member will help you complete the form over the phone or in the office.

Keys to the Valley Publishes Assessment of Homes

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The Public Health Council serves on the Keys to the Valley Steering Committee to advocate for housing as a public health issue. This newsletter is reposted with permission to spread the news of this tremendous new resource for our community. I hope you find it as helpful as I do. – Alice Ely

Keys to the Valley Publishes Assessment of Homes and Toolbox of Solutions on Interactive Website

We are excited and humbled to announce that the findings and resources from this initiative are now publicly available on the new Keys to the Valley website (www.keystothevalley.com). We are glad to share these resources for your contemplation, conversation, and active use when considering the many challenges facing our region’s homes.

The website includes 4 major sections:

  • Our Housing Challenge: A series of analyses on the current condition and need for homes – from affordability, equity, and impact of the pandemic to demographics, public opinion, and 2030 projections.
  • Toolbox: Strategies and policies to promote safe and affordable homes while strengthening our communities. Organized in six action areas, these tools are intended for a variety of community partners. To support these efforts, resources are provided to advance specific strategies – including those specific to land use regulations, visualizing new homes, housing models, and an open data portal.
  • Library: Definitions of terms and types of homes, suggested resources from other organizations, regional news, and more.
  • Get Involved: View a calendar of events and sign up for updates delivered to your email.

We look forward to discussing and planning together for the homes our region needs in the coming months and years. A sincere thank you to our volunteers, advisors and funders, without whom this initiative would not have been possible!

In a Nutshell

The Keys to the Valley project documents our need for homes across a bi-state, 67-town region, and presents a roadmap for tackling this crisis at the local, regional, and statewide level. The scale of this challenge calls for both immediate action as well as further study and conversations.

During this project, we have come to understand several critical concepts, or what we are calling Key Understandings:

  • First key understanding: Our region’s housing problem is a crisis.
  • Second key understanding: This is not just a private problem with a private solution.
  • Third key understanding: It is a tough problem that requires many different solutions in tandem that are fit to each place and its people.
  • Fourth key understanding: New solutions and approaches are needed.
  • Fifth key understanding: Solving housing needs must also solve other problems.

Chester, VT. Photo by Braxton Freeman.

With these understandings of our housing crisis in mind, our committee has identified a series of actions and related tools to address the challenges facing our region’s homes.

  • Action Area A: Spread knowledge of the region’s housing needs
  • Action Area B: Ensure access to a safe home
  • Action Area C: Sustain existing primary homes
  • Action Area D: Make it easier to build homes
  • Action Area E: Create the types of homes the region needs
  • Action Area F: Build smart for economic health

Join the Conversation – Spring 2021 Public Events

As part of the Initiative’s launch, we will be hosting a series of virtual public presentations and conversations. We hope you will join us!

Building Smart for Stronger Communities

Wednesday, May 5, Noon – 1PM: To address our region’s housing crisis, many new homes are needed. Through thoughtful planning, we can tackle this challenge in a way that strengthens community bonds, bolsters local tax bases, and ensures quality of life for residents. This workshop will cover a variety of planning tools available to communities, including strategies around land use, transportation, infrastructure, and conservation.

Land Use Regulations

Wednesday, May 12, Noon – 130PM: Land use regulations can help our communities provide the homes needed for resident health and economic vitality; however, they can also be barriers to a community’s ability to respond to specific needs and adapt to change. Come learn about how land use regulations impact our region’s homes and strategies to better provide the homes we need now and In the future.

Homes to Get or Stay out of Crisis and Homelessness

Wednesday, May 19, Noon – 1PM: Do we have adequate housing options for our homeless? How can we do better at providing the social supports many need to maintain a stable, safe home? Come learn, share, and hear directly from our region’s social service providers.

Employer Assisted Housing

Wednesday, May 26, Noon – 1PM: A shortage of affordable homes creates many challenges for employers seeking to attract a workforce. Some employers have responded to this challenge by developing new homes themselves or investing in new home creation. Learn about strategies that employers of all sizes have undertaken to address this challenge, and how your business or organization could get involved.

Housing Breakfast

Tuesday, June 11, 730 – 9AM: Are you ready to be part of the effort to improve home availability and affordability? Join residents, employers, officials, and other leaders … Learn about exciting housing approaches being used in the region … Help unveil “Keys to the Valley,” an online information tool for organizing and encouraging dozens of different strategies and tools that will help us meet this regional challenge! (Hosted by Vital Communities)

Event recordings will be made publicly on the Initiative’s YouTube.

Interested? Find out more on our website and Register for those you would like to attend.

Interested in a topic not listed? We are considering additional events for June 2021 and would like your opinion on topics. Please take this quick survey to share your interests with us.

Lead poisons people - especially children

Childhood Lead Poisoning Prevention Web Page Launched

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Did you know it only takes this much lead to poison a child - a pin headThe Public Health Council recently launched a new web page with childhood lead poisoning prevention resources. The page contains information for parents, caregivers, property owners, and landlords. It provides links to the best state, regional, and national resources to learn about childhood lead poisoning prevention.

Lead poisoning is entirely preventable. However, nearly 1 million children living in the United States have blood levels high enough to impair their ability to think, learn, and concentrate. In 2019, 10 children (0 − 72 months old) in the Upper Valley Region of New Hampshire were identified with elevated blood lead levels of 5 ug/dL or higher.

The Public Health Council has conducted childhood lead poisoning prevention in the Upper Valley since September 2019. Then, we hosted an educational session with over 25 local partners. Our efforts are supported by a grant from the NH Healthy Homes and Lead Poisoning Prevention Program.

Upper Valley Goals

One of our goals has been to expand training and certification opportunities for local homeowners, contractors, landlords, property managers and town building inspectors on lead-safe practices. We trained nearly 30 people in the EPA’s Renovate, Repair, and Paint program. Training was provided by Lead-Edu. We are pleased that online training opportunities will continue to be available to people in our region. Contact Lead-Edu to learn more about their training calendar and programs.

Our second goal was to collaborate with the Mascoma Valley Regional School District (MVRSD). We planned to provide education to the community and school personnel, promote lead screening, and adopt school policy to make identifying children with lead exposure easier. However, the COVID-19 pandemic and it’s impact on our local schools made this a significant challenge at this time. Instead, we shifted gears to provide more community education about childhood lead poisoning prevention

Mascoma Bank sponsored a bank statement stuffer in March 2021 that went out in over 40,000 bank statements. In April, we launched a new website to provide resources and information to community members. Throughout the past 18 months, we have created strong relationships with individuals and organizations interested in continuing to address this complex problem. We expect to pursue additional funding with some of these partners to support more work to protect our region’s vulnerable children.

Please reach out to Alice Ely (alice.ely@uvpublichealth.org) at the Public Health Council is you are interested in joining our Childhood Lead Poisoning Prevention Working Group.