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  F E A T U R E S  
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  Improving Health-Care Access, Quality for All  
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FEATURES
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THINKING OUTSIDE THE EXAM ROOM

Pediatric residents chip away, at childhood problems outside the exam room. One program aims to take bite out of dog encounters

"" PHOTO — Sacramento student R.J. Colburn Jr. learns dog-handling skills from UC Davis pediatrician Stephanie Flaherty.
 
Sacramento student R.J. Colburn Jr. learns dog-handling skills from UC Davis pediatrician Stephanie Flaherty.
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Many kids do not know how to greet a dog. Stephanie Flaherty, chief resident and pediatrician with the UC Davis Medical Center, is working hard to change that.

As part of her medical training in the emergency room, Flaherty found herself caring for too many dog-bite victims. The medical center treated more than 100 last year. A dog owner herself, Flaherty had an idea as to why the kids were getting hurt.

"My dog, a Siberian husky, has markings just like Demon in the children's film 'Snow Dogs'," Flaherty said. "When kids see him they think he's the dog from the movie, and they get excited. They'll run to him, scream, wave a hand in his face and poke him. These are behaviors that can aggravate even the most well-behaved dog."

To reduce the numbers of children who are bitten, Flaherty and Sacramento's Tahoe Colonial Collaborative developed a short, interactive training session for neighborhood children on how they should approach and respond to a dog.

One of Flaherty's graduates, 10-year-old Robert (R.J.) Colburn Jr., suffered a dog bite while riding his bike a couple of years ago. He joined one of Flaherty's sessions to gain dog-greeting skills. Among the points young Colburn picked up: "If it's a wild-looking dog, just don't go near it," he said.

"All kids are going to encounter dogs at some point in their daily lives, just like Robert did," Flaherty said. "They're often exposed to dogs, but rarely receive any education about them. My goal is to change that and keep them safer."

Grassroots efforts

Flaherty developed the educational session as part of UC Davis' unique advocacy program, Communities and Physicians Together. UC Davis partners with community advocacy groups in Sacramento and outlying rural counties that are less affluent and are medically underserved to improve their residents' health and well-being.

PHOTO — UC Davis pediatrics associate professor Richard Pan received the American Medical Association's 2005 Young Physicians Section Community Service Award for the pediatric residents' advocacy training program, Communities and Physicians Together, that he oversees. ""

UC Davis pediatrics associate professor Richard Pan received the American Medical Association's 2005 Young Physicians Section Community Service Award for the pediatric residents' advocacy training program, Communities and Physicians Together, that he oversees.
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The program also trains future pediatricians to think outside the box to improve children's health in an entire community, rather than treating children one by one in the exam room, said Richard Pan, associate professor and pediatrician in UC Davis' Department of Pediatrics.

"We are teaching how to build partnerships between grassroots community organizations and health-care professionals, particularly our pediatric residents," said Pan, the program's director.

Pan said he encourages participating pediatric residents to experience the communities they serve as members, not observers.

"We have our doctors ride buses — something many busy medical professionals don't do on a frequent basis — and think about where people buy groceries, or where they bank," he said. Many less affluent neighborhoods don't have big grocery stores or bank branches easily accessible to them.

"The old concept is that the government pays an expert to come in with the answers … that's kind of paternalistic," Pan said. "That attitude has evolved into 'my role is to help support the community'."

Targeting obesity

Many of the projects that the pediatric residents and community advocates have developed address the pervasive issue of childhood obesity.

At Frontier Elementary School in Sacramento's Rio Linda school district, pediatric residents worked with families from the Sacramento Head Start Alumni Association to develop practical ways to encourage healthful diets.

The effort began with "Home Run 4 Health," a baseball-themed program for fourth-graders. It included a school assembly about healthy nutrition, followed by a family component of tracking food and exercise.

"We kept a chart on the refrigerator at home," said Frontier parent Theresa Bradley, whose son Alden took part. "We logged how many helpings of fruits and veggies and how many dairy foods he ate, how much exercise he got, and so on."

"The exercise was 30 minutes by yourself, and 30 minutes with a family member," 11-year-old Alden added.

Students who stayed with the program for the full seven weeks got a treat — tickets to a Sacramento River Cats game at Raley Field.

Six months later, a salad bar became part of the lunch routine at Frontier Elementary. Uyen Truong, a third-year pediatric resident, helped advise.

"Several pediatric residents have been focusing on childhood obesity," said Truong. "I looked at a salad bar at nearby Madison Elementary, then talked with the principal at Frontier. I also went to a meeting with PTA leaders to talk about it. And the PTA decided to fund it."

"It's got lettuce, carrots, also cheese. And orange slices and pineapple," said Alden of the salad bar.

Individual approaches

"" PHOTO — Alden Bradley, with help from his mother, Theresa Bradley, has incorporate more salads into his diet as the result of a UC Davis healthy nutrition initiative at his school.
 
Alden Bradley, with help from his mother, Theresa Bradley, has incorporate more salads into his diet as the result of a UC Davis healthy nutrition initiative at his school.
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"There are many pediatric residents who do very cool projects like this," Truong said. For instance, another collaborative effort produced a community garden, located in a formerly underused park that was the site of alleged drug deals. By networking with the Hmong community in that neighborhood, the pediatric residents and community advocates helped the Hmong families plant a garden that provides food, encourages community cohesion and builds valuable links between the neighborhood's families and health-care providers.

Another project encourages families living in apartment buildings in poor neighborhoods to assist their children in growing tomatoes in planter boxes. Pediatric residents also work with a large Slavic community in a Sacramento suburb comprised of many recent immigrants unfamiliar with American medical routines to teach the community through a radio program about health issues.

While many of the projects address immediate problems, Pan says he hopes for long-term benefits as well. "One of our goals is to persuade some of our pediatric residents to stay involved in the community they've served."

For UC Davis pediatricians-in-training, the first residency program of its kind in the country helps new physicians develop an expanded, community perspective on attacking the health problems that plague children today.

"It's amazing how much time you spend trying to make a difference in a child's life in the clinics," Truong said. "You don't realize how much of a difference you can make just by investing a couple of hours in the community where she is growing up."

Communities and Physicians Together members

The Children first-flats Network is located in the downtown area of Sacramento County and serves children and families in the Alkali Flats and Mansion Flats communities. The primary focus of the collaborative is to create a sense of community to improve children's health.

The Cordova Community Collaborative for Healthy Children and Families is a nonprofit program of the Folsom Cordova Schools Foundation. The collaborative's mission is to strengthen families and link them to community resources that enhance self-reliance and promote community involvement.

The Sacramento Head Start Alumni Association utilizes the talents of past Head Start parents and staff to help current parents with kindergarten transition, promoting advocacy on their children's behalf, and to provide a network of resources and referrals.

The Tahoe/Colonial Collaborative for Healthy Children serves children and families in Sacramento's Tahoe Park, Colonial Park and Oak Park communities. The collaborative is comprised of parents, educators, youth, professionals and neighbors.

The Yuba Community Collaborative for Healthy Children includes parents, community members, collaborative staff and representatives of local agencies and associations with one thing in common: They all want children in Yuba County to be safe, healthy and happy.

Funded by the Anne E. Dyson Community Pediatrics Training Initiative, Dyson Foundation

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  "It's amazing how much time you spend trying to make a difference in a child's life in the clinics. You don't realize how much of a difference you can make just by investing a couple of hours in the community where  she is growing up." — Uyen Truong  
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