2013 Myr Draft 4b

1
500 Parnassus Avenue Box 0376, Millberry Union, Room 108 West, San Francisco, CA 94143
(415) 633-MHC1 | info@mabuhayhealthcenter.org | mabuhayhealthcenter.org
facebook.com/mabuhayhealthcenter | twitter.com/mabuhayhc_sf

Mid-Year Report
April 2013
Mabuhay Health Center
The Mabuhay Health Center (MHC) is a free student-run community health clinic that operates
in San Franciscos South of Market (SoMa) district.
Our volunteers. At the Bayanihan Community Center, student volunteers (undergraduate,
post-baccalaureate, graduate, dental, medical, nursing, and pharmacy students) strive to
deliver culturally sensitive health care under the supervision of faculty from UC San Francisco.
Health care services. Patients from the underserved SoMa district, other areas in San
Francisco, San Mateo County, and beyond attend MHCs monthly clinics to receive
measurements of vitals, health screenings (e.g. measurements of blood cholesterol, pressure,
and sugar; testing for hepatitis B and HIV), vaccinations for hepatitis B, health education,
medication counseling, and history and physical examinations.
Health education for youths. MHC also provides services at the Bessie Carmichael / Filipino
Education Center Elementary and Middle School alongside Galing Bata, the nations sole
English-Tagalog bilingual after-school program. We partner with Galing Bata to offer
education regarding such health-related topics as nutrition and physical activity.
Cultural sensitivity. Since an overwhelming majority of MHCs patients are elderly Filipinos,
cultural sensitivity entails navigating around hiya (a sense of embarrassment particular to
Filipino cultures) and having volunteers on-site who are fluent in Filipino dialects (to facilitate
health education and to encourage conversations rather than monologues and
misunderstandings about personal health). We also tailor the content of health education
workshops for youth such that our presentations make sense within the contexts of Filipino
American culture and the South of Market community.

MHC at a Glance
2

Table of Contents
New services 4
Hepatitis B and HIV services
Referrals
Cultural sensitivity 5
Training in health coaching
Training in Mental Health First Aid
Accommodating Tagalog-speaking patients
Measuring cultural sensitivity
Keeping MHC running 11
Recent accomplishments of MHCs Finance Committee
Patient registration and electronic medical records

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Table of Contents (cont.)
Patient demographics 12
Patient turnout at this years clinics 13
Health education in the community 15
Community collaborations 17
The MHC Advisory Board
Community partnerships
Plans for 2013 19
4

New services
Hepatitis B and HIV services
Providing culturally sensitive health care to a largely Filipino patient population (~75% of our
patient population identifies as Filipino) entails addressing such diseases as hepatitis B and HIV
which have disproportionately high incidence rates among Asians and Pacific Islanders. With
the help of UCSF volunteers and the Asian & Pacific Islander Wellness Center, we have
implemented a program to combat these diseases from our SoMa community clinic.
Since the summer of 2012, patients at MHC have had the opportunity to be tested for both of
these viral infections. Hepatitis B screenings check not only for active infection but also for
immunity, and free vaccines are available for non-immune patients. Rapid HIV screening is
also available, producing results within 15 minutes.
Through education about (a) how these diseases are spread, (b) their effect on the API
community, and (c) the power of screenings and vaccinations, MHC strives to diminish the
stigma of getting tested for hepatitis B and HIV.

Referrals
Our community health clinic cannot realistically provide every service that a patient will need
in order to maintain her or his personal health. Thus, if MHC does not offer a service sought by
a patient or recommended by an MHC preceptor, we have equipped ourselves to direct the
patient to a local health care provider who can pick up where MHC left off.
Our commitment to our patients extends not only to their immediate health concerns but also
to the achievement of their long-term health goals. To this end, MHCs referrals station
provides time for (a) sifting through a catalog of free or low-cost local health services as well as
(b) planning future visits to MHC. At the referrals station, patients formalize a plan with their
health coaches, integrating the action plan they developed that day, determining useful
community resources, and scheduling times for health coaches to call and check in. Our
referrals system helps to establish a single and more personal point of contact at MHC for each
patient and makes sure that patients have access to more comprehensive care than we
alone can provide.

5

Cultural sensitivity
Training in health coaching
Health coaching is an innovative approach to health care by which a health coach liaises
between patient and health care provider. Health coaches at MHC, who are certified by the
San Francisco Department of Public Health, accompany patients throughout their visit to the
clinic, advocating for our patients, bridging any gaps in their understanding of delivered
services, and empowering them to (continue to) take control of their personal health.
MHCs health coaches strive to demystify for patients the complexities of health and health
care. If, for example, a patient were to ask how a common diabetes medication works, an
MHC health coach might explain that it functions like a key that opens the door for sugar in
the blood to enter the cells of the body. And, since a majority of MHCs patient population is
Filipino (~75%), Tagalog-speaking health coaches are especially equipped to demystify health
care complexities owing to their ability to navigate language barriers.
MHC leadership required health coach certification of all 2012-2013 volunteers. Certification
entailed training over four days in (a) subtly assessing patient understanding of delivered
health services and in (b) offering health education in an empowering fashion. New
volunteers and returning volunteers who were not previously health coach-certified received
this training in September 2012. Mandatory health coach training has optimized the Mabuhay
Health Centers ability to advocate for its patient population.

MHC volunteers learning the art
of health coaching from Amireh
Ghorob and then practicing
what theyve learned
6

Training in Mental Health First Aid
Since the beginning of the current volunteer cycle, MHC has made inroads into the fields of
mental and behavioral health. Under the tutelage of Dr. Jei Africa of San Mateo County
Behavioral Health and Recovery Services, all MHC health coaches became certified in Mental
Health First Aid during the summer of 2012. The impact of this training is two-fold: it has
prepared our health coaches to respond in the event of a mental health crisis and has
immeasurably increased the mental health literacy of our MHC staff.
In September 2012, two of our volunteers Golda Hernandez (Bessie Director) and Berna
Villanueva (a Health Coach Co-Chair) underwent a week-long training to become certified
instructors of Mental Health First Aid. As certified instructors, Golda and Berna can host Mental
Health First Aid trainings for community organizations across the Bay Area.
Accommodating Tagalog-
speaking patients
Between October 2012 and March 2013, Filipino immigrants comprised over three-quarters of
MHCs patient population. In this particular Filipino / Filipino American population, it is common
to find patients who would prefer to express their health-related concerns in their native
languages as well as patients who have encountered language barriers and cultural
understandings in the mainstream health care system. Since Tagalog is the predominant
dialect among our Filipino patients, one major step towards cultural sensitivity is the
accommodation of patients who feel most comfortable speaking in Tagalog.
To this end, we have volunteers on-site who are fluent in Tagalog and other Filipino dialects;
these volunteers are especially equipped to encourage conversations rather than
monologues and misunderstandings about personal health. Also, we make our clinic forms
(e.g. consent forms, patient satisfaction surveys, and flyers) available in Tagalog in order to
facilitate not only (1) Tagalog-speakers understanding of health services provided but also (2)
the collection of their feedback regarding our services.
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Measuring cultural sensitivity
Since three-quarters of the patients who visited MHC between October 2012 and March 2013
identify as Filipino, cultural sensitivity entails navigating around hiya, a sense of embarrassment
particular to Filipino cultures. Those who subscribe to the idea of hiya might not ask for the
things they need for fear of inconveniencing others unnecessarily.
In a Filipino American health care context, hiya might prompt Filipino patients with limited
English skills to conceal any failures to understand what a health care provider has explained in
English; this is because, according to hiya, requesting additional explanation would
unnecessarily inconvenience the health care provider. Potential consequences of hiya-driven
misunderstandings include poor adherence to prescribed regimen and frustration with the
health care system.
Bearing hiya in mind, we framed our post-clinic patient satisfaction survey around patients
ability to ask their questions. Also included in the anonymous survey (available in both English
and Tagalog) are items regarding the patients interactions with clinic staff and spaces for
general comments and suggestions. Findings from this anonymous survey guide our efforts to
refine the services we provide. What follows is a summary of our data from 10/2012 to 04/2013.

You spoke with many people today about your health, but some of your
questions might still be unanswered. Were all of your health concerns
addressed during your visit?

Yes. All of my health concerns were addressed today. 95.3%

No. I still have unanswered questions 4.7%

An overwhelming majority of patients reported leaving MHC with no unaddressed health
concerns.
Patients who happen to report having unanswered questions have the opportunity to identify
for us what their questions are about (from a box containing a checklist of potential topics as
well as a Something else: ____ item for unlisted topics). These responses inform where we
concentrate our future health education efforts.
We had hoped to perform t-tests that compare numerical differences between the yes and
no groups; such tests might reveal aspects of a clinic visit that correlate with leaving MHC
with unanswered questions. However, reasonable conclusions from t-tests could not be drawn
since the no group was so small (n = 3). Although the low frequency of patients in the no
group prevented us from making distinctions between the two types of experiences, it did
serve as a positive indicator of our volunteers ability to encourage and field patients
questions.
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How much do you agree or disagree with the statement below?

The clinic staff helped me identify ways to improve my health.

Code Response Percent of responses
1 Strongly disagree 1.5 Average score:
2 Disagree 0.0 4.76
3 Neutral 1.5
4 Agree 15.2 SD:
5 Strongly agree 81.8 0.63

Most patients appeared to believe that we were able to identify ways to improve their health.

When patients complete the satisfaction survey, they may choose to provide demographic
information such as age, gender, and ethnicity. This information could help us identify whether
particular responses are associated with certain demographicsfor example, is one gender
more likely to disagree with the posed statement?

We found that ratings of the statement The clinic staff helped me identify ways to improve my
health were not significantly associated with patient age (p = 0.584), gender (p = 0.738,
Welchs t = 0.336), and ethnicity (p > 0.05). These findings reflect well on MHC because, not
only did most patients reporting having been helped to identify ways to improve their health,
but no one group that we examined was significantly more likely agree with the posed
statement (roughly, everyone was just as likely to agree that they were helped by staff to
identify ways to improve their health).

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I felt uncomfortable with the clinic staff.

1 Strongly disagree 74.2% Average score:
2 Disagree 19.7% 1.37
3 Neutral 1.5%
4 Agree 3.0% SD:
4.5
[Patients who selected both 4 and 5]
1.5% 0.77
5 Strongly agree 0.0%

Few patients reported feeling uncomfortable with MHC volunteers.

We may once again examine demographics which patients have the option to specify on the
survey. Such an examination might indicate if one particular group of MHC patients is more
likely to report feeling uncomfortable with our volunteers.

Ratings of the statement I felt uncomfortable with the clinic staff were not significantly
associated with age (p = 0.524), gender (p = 0.268, Welchs t = 1.119), or ethnicity (p > 0.05).
These findings reflect well on MHC because, not only did few patients reporting feeling
uncomfortable with our volunteers, but no one group that we examined was significantly more
likely disagree with the posed statement (roughly, all patients were just as likely to agree that
they felt comfortable with our volunteers).

It is interesting to note that ratings of the statement I felt uncomfortable with the clinic staff
had a significant negative correlation with ratings of the statement The clinic staff helped me
identify ways to improve my health (p = 0.0025). The correlation, r = -0.3662, is of moderate
strength. Patients who reported feeling comfortable with MHC volunteers were likely to also
report having been helped to identify ways to improve their health.

10


My health coach encouraged me to ask any questions that I had.

1 Strongly disagree 0.0% Average score:
2 Disagree 0.0% 4.81
3 Neutral 0.0%
4 Agree 18.75% SD:
5 Strongly agree 81.25% 0.39

All patients agreed, to some degree, that their health coaches encouraged them to ask
questions. The small standard deviation of 0.39 on the five-point scale reflects the small
amount of variation in patient ratings of this statement.

Ratings of the statement My health coach encouraged me to ask any questions that I had
were not significantly associated with age (p = 0.573), gender (p = 0.173, Welchs t = 1.380),
and ethnicity (p > 0.05).

It is interesting to note that ratings of the statement My health coach encouraged me to ask
any questions that I had were negatively correlated with ratings of the statement I felt
uncomfortable with the clinic staff (p = 0.0004). The correlation, r = -0.4266, is of considerable
strength. Patients who reported being encouraged to ask questions were likely to also report
feeling comfortable with MHC volunteers.

Also remarkable is the significant positive correlation between ratings of the statement My
health coach encouraged me to ask any questions that I had and ratings of the statement
The clinic staff helped me identify ways to improve my health (p rounded to 0.0000). The
correlation, r = 0.5194, is of considerable strength. Patients who reported being encouraged to
ask questions were likely to also report being helped to identify ways to improve their health.

11

Keeping MHC running
Recent accomplishments of
MHCs Finance Committee
Accounting. Our Finance Committee has developed a requisitions and reimbursements system
that (1) renders documents for each MHC transaction secure and electronically accessible
and (2) organizes expenses by funding source and expense type. This system not only
streamlines accounting but also enhances its transparency.
Fundraising. The MHC Finance Committee has consistently held monthly fundraising activities.
For example, a fundraiser at San Franciscos The Fishbowl Bar & Grill raised over $150, funds
raised in collaboration with Chevys, Jamba Juice, and Phils Sliders of Berkeley totaled over
$225, and MHCs Season of Giving fundraiser through Restaurant.com raised over $175.
Inventory. The Finance Committees dedication to organizing MHCs supplies (1) informs the
Board of Directors of available resources and (2) reveals which supplies should soon be
replenished. MHCs delivery of health care services would be far less efficient without the work
of the Finance Committee.

Electronic
medical records
MHC uses OpenEMR to update patient files in
real-time and to store patient information. At
our clinics, as soon as our receptionists use
OpenEMR to log a patients arrival and enter
the patients chief complaint, volunteers and
preceptors at our various clinic stages can
instantaneously learn which patients are here
and what health concerns they have. We
also use OpenEMR to store patient information
such as demographic data, chief complaints,
vital signs, and SOAP notes. All of this
information is secured by several levels of
encryption.

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Patient demographics
Knowledge of our patient populations demographic composition enhances MHCs ability to
tailor its services to local SoMa community members. MHC has attempted to characterize its
patient community in terms of age, gender, primary care provider (PCP) status, and health
insurance status. The following summaries of these demographic variables were based on
information that patients from 10/2012 to 03/2013 contributed to registration forms.
Age

Average age: 66.38 (SD: 15.34 years)
Range: 12 to 89
25
th
percentile: 40
50
th
percentile: 65
75
th
percentile: 79

Age and gender. One gender is not
significantly older than the other (p = 0.299).

Age and PCP status. Patients with PCPs are
older than patients without PCPs (p = 0.016).

Age and health insurance status. Although
we expect the insured segment of our
patient population to be statistically older
than the uninsured segment, the relationship
between age and health insurance status is
only borderline significant (p = 0.088).

Gender

No patients reported a gender other than
female or male.

45 females (54.9%)
37 males (45.1%)

The frequencies are not statistically different;
i.e. females do not significantly outnumber
males in our patient population (p = 0.440).

Gender and age. One gender is not
significantly older than the other (p = 0.299).

Gender and PCP status. One gender is not
more likely to have a PCP than is the other (p
= 0.522).

Gender and health insurance status. One
gender is not more likely to have health
insurance than is the other (p = 0.193).

13

0
5
10
15
20
25
Oct '12 Nov '12 Jan '13 Feb '13 Mar '13 Apr '13
Patient turnout at this
year's clinics
Returning patients New patients

PCP status

36 patients lack a PCP (45%
without)
44 patients report having a PCP
(55% with)

PCP status and age. Patients
with PCPs are older than
patients without PCPs (p =
0.016).

PCP status and gender. One
gender is not more likely to
have a PCP than is the other (p
= 0.522).

PCP status and health insurance
status. There are more (a)
uninsured patients without PCPs
and (b) insured patients with
PCPs than are predicted by
chance (p rounded to 0.000, V
= 0.5188).
Health insurance status

We defined health insurance as including private
insurance, Medicare, and Medi-Cal but excluding
programs such as Healthy San Francisco and Health Plan
of San Mateo.

36.2% reported no form of insurance (as defined above)
63.8% reported some type of insurance

Health insurance status and age. Although we expect the
insured segment of our patient population to be
statistically older than the uninsured segment, the
relationship between age and health insurance status is
only borderline significant (p = 0.088).

Health insurance status and gender. One gender is not
more likely to have health insurance than is the other (p =
0.193).

Health insurance status and PCP status. There are more
(a) uninsured patients without PCPs and (b) insured
patients with PCPs than are predicted by chance (p
rounded to 0.000, V = 0.5188).

MHCs 2012-2013 volunteer cycle
began in October 2012, and this
cycles six clinics so far have had
an average patient turnout of
16.17 patients (n = 6, SD = 4.17).
This cycles clinics have a greater
average turnout than do all MHC
clinics before October 2012 (past
mean = 9.68 patients, n = 31 past
clinics, SD = 4.81) (p = 0.0020).
This statistically significant increase
in patient turnout (p = 0.0020)
could be ascribed to the return of
satisfied patients and / or perhaps
to MHCs growing visibility within
the local community.

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Two other informative variables are ethnicity and city of residence.
Ethnicity
Filipino 75.6%
Non-Filipino Asian 8.5%
African American 6.1%
Caucasian 6.1%
Pacific Islander 2.4%
Chicano, Hispanic, Latino 1.2%
Native American 0.0%
South Asian 0.0%
City of residence
San Francisco 83.8%
Daly City 6.3%
Concord 5.0%
San Mateo 5.0%

An enlightening exercise would be to see whether belonging to the largest ethnic group,
Filipinos, or residing in the most popular city, San Francisco, is associated with any other
demographic variables we have already investigated. We will name these two new variables
Filipino and San Francisco.
Filipino
Filipino and age. Filipino patients do not
differ significantly in age from non-Filipino
patients (p = 0.098).

Filipino and gender. There are more (a)
non-Filipino male patients and (b) Filipino
female patients than are predicted by
chance (p rounded to 0.000, V = 0.3981).

Filipino and PCP status. There are more (a)
non-Filipino patients without PCPs and (b)
Filipino patients with PCPs than are
predicted by chance (p = 0.038, V =
0.2321).

Filipino and health insurance status. Our
Filipino patients are no more likely to have
health insurance than are our non-Filipino
patients (p = 0.767, Fishers exact).

San Francisco
San Francisco and age. The relationship
between San Francisco and age is borderline
significant (p = 0.066; mean SF age = 67.8;
mean non-SF age = 58.9).

San Francisco and gender. No relationship
exists between San Francisco and gender (p =
0.763, Fishers exact).

San Francisco and PCP status. There are more
(a) non-San Franciscan patients without PCPs
and (b) San Franciscan patients with PCPs
than are predicted by chance (p = 0.015,
Fishers exact, V = 0.2827).

San Francisco and health insurance status.
There are more (a) uninsured non-San
Franciscan patients and (b) insured San
Franciscan patients than are predicted by
chance (p = 0.001, Fishers exact, V = 0.4130).

Filipino and San Francisco. No relationship exists between the variables Filipino and San
Francisco (p = 0.167).

15

Health Education in
the Community
Family Fun Day (September 2012)
Last September, MHC participated in Family
Fun Day, an event held at the SoMas Victoria
Manalo Draves Park and hosted by Bessie
Carmichael/Filipino Education Center K-8
School. Families were invited to engage with
community organizations, gather resources,
and play games. Games led by MHC
volunteers taught about the skeletal system
and healthful daily dental care.
Nutrition workshop (October 2012)
In collaboration with the SoMa Family
Resource Center, two volunteers Rosauro
Hernandez and Kristine Tulio presented a
nutrition workshop to about 20 SoMa
community members regarding balanced
meals and portion control. Rosauro and
Kristine (a) gauged their audiences
knowledge of food groups, (b) helped
community members recognize food groups
in cultural foods, (c) explained outcomes of
unbalanced meals and poor portion control,
and (d) explained how steps towards more
healthful eating habits could prevent these
unfavorable outcomes. Community
members in attendance received placemats
with visuals of healthful portion sizes.
Physical activity workshop (February
2013)
Last February, MHC volunteers presented
a physical activity workshop for the
students of the Galing Bata after-school
program. Planned workshop activities
(e.g. playing the video game Just
Dance) demonstrated the importance
of exercise and encouraged the
incorporation of physical activity into
daily life. Students in attendance
received pedometers to keep track of
their number of steps. Our volunteers
challenged the students to take 5,000
steps a day, which students could
measure using their new pedometers.
16

SoMa Community Picnic Day (April 2013)
MHC recently organized SoMa Community Picnic Day at the South of Market / Gene
Friend Recreation Center.
Picnic Day enabled community members in attendance to build relations with an array
of local community-based organizations. These CBOs, whom we invited to table at
Picnic Day, included San Francisco Hep B Free, SOMA Family Resource Center, South of
Market Health Center, and West Bay Pilipino Multi-Service Center
In addition, MHC and UCSF volunteers provided health screenings, and UCSF students
ran health education exhibits.
Picnic Day also offered our neighbors opportunities for physical activity, which included
Zumba and a basketball tournament. Each member of Picnic Days first-place
basketball team received two tickets to a Warriors-Spurs basketball game, which were
donated by the Golden State Warriors.
Picnic Day not only allowed MHC to provide resources to the SoMa community but also
permitted us to develop our relationships with local organizations. MHC hopes to
organize this community event again in 2014.

17

Community Collaborations
The MHC Advisory Board
MHC is committed to tailoring its services to the needs of the community. One efficient
method for gathering input from the community has been the establishment of the MHC
Advisory Board. Patients familiar with MHCs services, past MHC leadership, and leaders
representing various community-based organizations comprise this panel (of currently 12
members), which meets regularly to discuss the roles that MHC should / could play within the
SoMa community. The establishment of the MHC Advisory Board has allowed us to seek
guidance regarding MHC projects and to sustain our awareness of the SoMa communitys
voice(s).
Community-based organizations represented in the MHC Advisory Board include the
following:
Asian and Pacific Islander American
Health Forum

The Bayanihan Community Center

Bessie Carmichael / Filipino
Education Center Elementary and
Middle School

Citywide Linkage Team

Planning for Elders / Senior Action
Network

The South of Market Community
Action Network (SOMCAN)

The South of Market / Gene Friend
Recreation Center

United Playaz

Community partnerships
We are thrilled to have worked with the following organizations in our efforts to offer culturally
sensitive health care and to diminish disparities in access to health-related resources.
The Asian & Pacific Islander Wellness Center. Representatives from the API Wellness Center
attend MHCs clinics to provide any interested patients with HIV rapid testing and counseling.
The Bayanihan Community Center. This community space is the venue for MHCs monthly
clinics and other MHC events (e.g. health education workshops and volunteer orientations).
The Bessie Carmichael / Filipino Education Center Elementary and Middle School & Galing
Bata. At the Bessie Carmichael / FEC K-8, we partner with Galing Bata, the nations sole
English-Tagalog bilingual after-school program, to offer health education workshops. This
partnership allows MHC to direct services to younger community members and their families,
permitting MHC to serve a broader range of age groups within the SoMa community.

18

The Filipino American Development Foundation (FADF). FADF strives to maintain the
economic, physical, and social well-being of the Filipino American and SoMa communities.
The Filipino American Development Foundation established the Bayanihan Community Center
(now central to the local Filipino community), which provides a space for community events
hosted by local organizations.
The San Francisco County Health Insurance Counseling & Advocacy Program (HICAP).
Although the majority of our patients are eligible for health insurance benefits, many
encounter barriers to optimizing their health care coverage. A HICAP representative regularly
lends her efforts to our monthly clinics to connect patients with resources for appropriate
health coverage programs.
The San Francisco Hepatitis B Collaborative (SFHBC). This UCSF-affiliated organization provides
hepatitis B screenings, disclosures, and vaccines. Under the supervision of UCSF faculty, SFHBC
volunteers receive clinical experience at MHCs monthly clinics. This partnership has helped to
expand hepatitis B awareness within the MHC patient population.
The South of Market / Gene Friend Recreation Center. The SoMa / Gene Friend Rec Center
has been the venue for several events this year, including our fourth annual MHC Day (see
flyer below) as well as our SoMa Community Picnic Day (see p. 16).

Community partnerships (cont.)
19

Plans for 2013:
Mental Health Services
With the help of Dr. Jei Africa and volunteers who have been contributing to our Behavioral
Health Initiative, we hope to (a) provide counseling to those who need it and (b) connect
these community members with local mental health resources. To this end, we are working on
(a) integrating mental health services into our clinic flow and (b) establishing connections with
mental health professionals and community organizations.
In April 2013, we welcomed Dr. Africa as a preceptor who would lend her guidance and
behavioral health expertise to our volunteers during our monthly clinics.
Our goal is the seamless integration of mental health services into the MHC repertoire by the
beginning of the 2013-2014 volunteer cycle.

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