Maternal and Child Health Leadership Conference (Chicago: April 27-29, 2003)

Naomi Morris:  Now, it’s my pleasure to introduce the dean of our School of Public Health, Dr. Susan Scrimshaw.  She’s a very special person to me in so many ways, and I told her that if I got to introduce her, I was going to be bad and talk about her.  From the time that she was about 13 years old, because at that point her father and I were in the same class, working towards our MPH, but her father was already a person with a large reputation as a nutritionist, and he’s still out there doing his thing and it’s really quite amazing, because he’s a few years older than I am.  And in the meantime, his little daughter that I remember so clearly has become a very important national figure, and we’re very proud that she’s our dean.  So, Susan, it’s your turn.  

Dr. Susan Scrimshaw:  (Inaudible) this on.  Thank you, Naomi.  Now, I’m Susan Scrimshaw, and I’m Dean of the School of Public Health here at UIC, and I do get these stories a lot of people saying, “I knew you when you were this high.”  I did, in a sense, grow up in maternal and child health.  My father’s in international nutrition, and when I was about four or five, I can remember Dad saying, “Let’s go out and do a nutrition survey,” or “Let’s go do a *goiter survey,” putting us in the Jeep, and then I’d help.  We’d go out to the villages in Guatemala, and I would help line the children up and tell them not to be scared because it was my father examining them, and then Dad would say to me, “Now, you want to see what second degree malnutrition looks like?” and I was five or six years old, and I would get a little lesson in how fortunate I was, and how difficult things were for so many people in the rest of the world.  So I of course rebelled by not going to medical school and becoming an anthropologist and couldn’t stay away from public health anyway.  But I have worked in maternal and child health, really, throughout my career, and that makes this a very, very special workshop for me.  These are tough times for us, and they’re tough times not only because of the normal budget problems that the states are going through, and I think it’s very easy for the state policymakers; in an odd way, it’s easy for them to forget the children, the moms and the children.  You would think this would be Mom and apple pie, but it’s not.  Moms and children don’t make the right kind of noise at the policy levels.  So it is a tough time, but what’s making it even tougher is the issues surrounding bioterrorism preparedness so that there’s funding diverted there, and then for this state in particular but in general for the region, West Nile, money that got diverted from local health protection grants to pay for covering things like spraying and surveillance of West Nile, and now SARS.  One of the things that I’ve been pointing out to the policymakers is that our surveillance system and our basic primary health protection system has some really big holes in it, and those holes have to do with the theme of this conference on health disparities, and that is that there are many people who don’t access health care because they don’t have health insurance, or they are not here legally and are now even more afraid to access the health care system.  So these are people who, if we begin to see an increase in SARS in this country, and so far, I think our surveillance system has worked really well, these are the people who are less likely to go seek care when they develop the symptoms.  They are more likely to self-manage or to try and manage at home.  I pointed this out to policymakers.  I’ve also, because of the gift my parents gave me of growing up in Guatemala, I’ve been working a lot with our local and national television and radio networks in Spanish.  So I’ve been in Spanish saying to the community, “First of all, don’t panic.”  There are fewer than 50 cases still in the U.S., but second, "You must seek care if you notice these symptoms," and then I’ve also been talking about some precautions like the frequent hand washing, especially for people working in the travel industry, which a lot of Latinos do.  But I think this issue of our allowing there to be holes in our system, and particularly holes for some of our most vulnerable populations, is one that we have to pay attention to.  If we can’t get the policymakers to listen on the basis of justice and on the basis of the fact that it’s the right and the fair thing to do, and even if we can’t get them to listen on the basis of the fact that it is penny-wise to do prevention and basic protection, maybe we can get them to listen on the basis of the fact that it is safer for everybody if people have basic access to care and are going in when they develop symptoms.  I don’t know.  We’re working on it, and we’re working on it a variety of ways, through the membership of our faculty, local boards of health and local committees, through the Association of Schools and Public Health nationally, through the support that we can give to CDC and to HRSA, so we’re doing everything we can to bring this to the attention of the policymakers.  I think the second sort of final thing I’d like to say is that in this area that we’re talking about in this workshop of health disparities, there are a lot of things behind health disparities, and I’ve talked about a couple of them:  the issue of the lack of access to care, the issue of the lack of insurance.  But there’s also a lack, and we know this has been documented in the literature, and you all know this, of sort of cultural access to care.  You know, “How will people treat me?  Will people speak my language?” and “Will people pay attention to the concerns that I have?”  And that’s an area that we need to spend time on as well.  One thing that I’ve been working on lately and has really sort of heightened my awareness, and I think it’s very important in maternal and child health, is the whole issue of health literacy, and not just health literacy in a traditional sense of, “Can somebody read a prescription?” which, by the way, is pretty crucial, and a lot of people can’t, including--I’m on Institute of Medicine Health Literacy Committee, and when we went around the table and said, “Has anybody in this room ever made a mistake in how you took medication or followed doctor’s orders?” we all raised our hands.  Health literacy is not that simple, and I think that’s one issue.  But the other issue is what about cultural literacy, in a sense?  What about linguistic, in the sense of different languages?  The health literacy field has virtually nothing on language differences, and you probably know the “ER” episode that takes the word in English, “once,” “once-a-day,” and has an example of a woman who was a native Spanish speaker, and what does “once” mean in Spanish?  “Once,” 11, okay, and so she took some medication 11 times in one day instead of one time in one day.  The word is spelled exactly the same way.  There’s a recent article in January “Journal of Pediatrics” that talks about pediatric visits in a clinic in California with Latino patients.  It talks about an average of 31 medical errors per patient visit, and some of these were significant errors.  An example of one of them was the instructions from the physician, this was treating an ear infection in a baby, was amoxicillin, three teaspoons a day, for the baby’s infection.  It was translated as, “Put three teaspoons a day in the baby’s ear,” instead of taking it orally.  That’s a fairly important medical error, and it’s a communications error.  So this whole issue of understanding communications--are we reaching people, are we listening to people--is absolutely crucial to get to this issue of health disparities.  Questions about how people identify illness; when they identify it; how they communicate; what, in a encounter with a nurse, a social worker, a physician, a clerk, is supportive and helpful; and what is hurtful and offensive, sometimes without people even knowing it?  So I hope over the next couple of days, as you do this workshop, that you are thinking beyond the clinical.  We’re thinking about the policy.  I know we’re all thinking about the policy, but that we’re also thinking about the cultural and the linguistic barriers, and the health literacy issues.  I guess one final thought on health literacy, early on I was working at UCLA on pregnancy and childbirth in women of Mexican origin and descent, and we found out that there was a tremendous disagreement between staff and Latino women about what happens when a woman comes in thinking she’s in labor, and women come in with contractions that are bad enough to scare them and make them think the baby’s coming very quickly, and the staff think, “Well, this is a long latent first phase, it’s Braxton Hicks, it’s too soon,” and because of language and *barriers and because of what people think labor is like in the medical culture and in the Latino woman culture, you had tremendous conflicts.  But when I tried to develop an algorithm for how to know you’re in labor, which, by the way, took 31 pages of this booklet, it’s not easy, they would not let me, initially, use the Spanish word for “labor,” which is “Dolor,” pain.  They said, “Oh, no.  You have to say “Trabajo de parto,” because that’s the correct language, and “Trabajo de parto” means “the work of birthing,” and it’s what physicians say; it’s not what pregnant women say.  Finally, we compromised and we put one or the other of them, I forget which, in parentheses.  But this whole issue of, “Well, no.  Our pamphlets all have to be high school English.”  Well, maybe our patients aren’t all high school English, and by the way, not just of different languages.  So just to give you a few things to think about, and really echo Dr. Morris’ appreciation of your being here.  I mean given the travel constraints that most of us have now in our organizations, given the financial constraints, the fact that you’re able to come here, that we’re able to be together and work on these common issues, as I said, these neglected issues of maternal and child health, is to me very encouraging, and we will keep doing everything we can at every level of the system to make sure that maternal and child health does stay in the forefront.  So thank you very much.

Arden Handler:  Hi.  I’m Arden Handler, and I’m a Maternal and Child Health faculty member, and I want to be the third person to welcome all of you to our 16^th annual MCH Leadership Conference.  As Dr. Morris already said, this is the second in a part of a three-year project, conferences focused on translating research into practice, and we’ll be welcoming your input for our year three.  There’ll be a planning meeting tomorrow night.  Those of you on the planning committee know about that dinner already, and speaking of the planning committee, I want to take this opportunity to thank all of those members of the planning committee, and all of the MCH staff, particularly Kris Gupta and Joan Chow, *Jan *Bow, all the students who've worked with Kris and *Jan to make this conference possible.  We do know that there's fewer people here than the past years, and we know it’s because of travel restrictions.  We got so many phone calls where people said, “We really want to come to the conference.  I can come.  I can take the time, but nobody will let me come.”  So because of that, we’ve gone out of our way to make sure that many of the main sessions are being webcast.  So I want to say this is a webcast session.  Welcome to all of our webcast participants.  There'll be several other webcast sessions during the course of the conference.  Unfortunately, the webcast folks cannot ask questions, but they can view this and this information also will eventually be available on our web site with the PowerPoint slides, et cetera.  A couple other details, just to let you know that physicians, dieticians, nurses, social workers and health educators are eligible for CE credit, and the appropriate forms are available at the registration desk.  We also have, as Dr. Morris mentioned, a conference list serve.  We had a little trouble getting it going earlier in the year, but we send weekly updates related to the issues, related to the conference, so one conference leads into the next conference.  I hope some of you are using it.  We’d like your feedback about it.  Those of you who are not on it, please feel free to join.  There’s information in your program about how to join, and it’s also important for you to fill out the evaluation forms for the program as we go through the conference.  For those of you who are attending “The Lion King” next door tonight at 6:30, if you don’t already have your tickets, you can pick them up at the registration desk.  We also want to let you know that we have lists for people who want to get together for dinner but don’t know anyone; they just came from out of town.  You can go to the registration desk, sign up, and then a group will meet together and ask the concierge what the best place for dinner is.  So without any further ado, I want to introduce my friend and colleague Joan Kennelly, who will introduce the speakers, and thank you all very much for coming.