Adonis Diaries

Archive for May 23rd, 2011

Clinical medicine versus public health? What Dr. Bechara Choucair said?

From the Commissioner of public health of the city of Chicago in his Commencement Address at Feinberg School of Medicine at Northwestern University on May 4, 2011

Any intersection between clinical medicine and public health?

Clinical medicine and public health are often seen separate.

We often understand these two words as different disciplinary silos in which many of us spend entire careers. Ted Schettler, the Science Director of the Science and Environmental Health Network, frames both disciplines with respect to focus, scale, ethics, education and the nature of the science.

1. Focus: Clinical medicine focuses primarily on the individual, while public health focuses on the community.

2. Time frame: Relevant time frames in Clinical Medicine are usually single lifetimes, while public health thinks in terms of generations.

3. Ethics: From an ethics perspective, clinicians advocate for individual people. Public health practitioners advocate for the community, for a group of people.

4. Rights: In clinical medicine we focus on individual rights of a patient. In public health, we think about human rights, social justice, and environmental justice.

5. Education: From an education perspective, in clinical medicine we focus on the biomedical model with more emphasis on cure than prevention (although this is shifting now). In public health, we learn more about sociology, epidemiology, cultural anthropology, economics and more.

Think for a moment about the evidence of the science.

In clinical medicine we love to talk about controlled, double-blind clinical trials. We don’t find that type of approach often in public health.

Clearly, there are differences: differences in focus, differences in scale, differences in ethics, differences in education and differences in the nature of science.

But the reality is that the health of the individual and the health of the community are inter-related and inter-dependent. Maintaining two disciplinary silos is NOT the answer.

Bridging the gap is critical if we are serious about improving the quality of life of our residents.

Bridging the gap starts with education.

We have to enhance the understanding of public health principles among our students in the clinical field and we have to enhance the understanding of clinical medicine principles among our public health students.

Bridging the gap happens in research. We have to expand our research portfolio to focus on health disparities and other population level research.

Bridging the gap will not be successful unless we translate what we learn in research all the way into public policy.

And finally, it is people like you, like the faculty here and like me, who will take the lead in bridging this gap.

The good news is that here in Chicago, there are great people who have done great work in bridging this gap. I am forever grateful for their contributions.

At the Chicago Department of Public Health, we are exploring how to fully exploit the intersection of public health and medicine. We are excited about having the opportunity to use, as the foundation of such efforts, the proliferation of HIT initiatives, particularly in under served communities.

A major federally-funded initiative to help us achieve this goal is CHITREC, housed here at Feinberg and funded through stimulus funds (American Recovery & Reinvestment Act).

CHITREC (Chicago Health Information Technology Regional Extension Center) provides technical assistance to primary care providers serving predominantly uninsured, under insured, and medically under served populations in developing an Electronic Health Records system that will improve health outcomes.

CHITREC is collaboration between Northwestern University and the Alliance of Chicago Health Center Services, a health center-controlled network. It builds upon extensive collective Electronic Health Records implementation and clinical informatics experience.

We anticipate that as the participating providers come on line, there will be wonderful opportunities to use the wealth of data available through an Electronic Health Record to measure population health and be able to pinpoint where particular interventions are needed to improve outcomes.

Other federal funding, including the 2010 Patient Protection and Affordable Care Act, has provided additional opportunities for investments in the electronic data infrastructure supporting population health. Chicago Department of Public Health (CDPH) is positioned to become a leader in the public health applications of Health Information Technology. Current CDPH activities include:

  •  Funding of 26 acute care hospitals in Chicago to assist in their efforts toward establishing capacity to transmit data of public health significance to CDPH;
  • Partnering with the Centers for Disease Control and Prevention (CDC), GE Healthcare and the Alliance of Chicago in a pilot evaluation the feasibility of targeted, pubic health-oriented clinical decision support for ambulatory providers, delivered at the point of care through Electronic Health Records;
  • Supporting Stroger Hospital of Cook County and two major Federally Qualified Healthcare Center (FQHC) networks (ACCESS Community Health Network and the Alliance of Chicago) in their efforts to establish robust transmission of immunization administration data to the Illinois immunization registry;
  • Engaging with the Illinois Office of Health Information Technology in statewide efforts to build a sustainable Health Information Exchange (HIE);

Feinberg PPH: Commencement Address given by Bechara Choucair, May 4, 2011

Note: Dr. Bechara Choucair is Commissioner of public health of the city of Chicago.  I liked his Commencement Address at Feinberg School of Medicine at Northwestern University and decided to publish the speech and three sections of the speech on

This speech covered all the grounds and it is impressive.  I found it acceptable to edit out sentences that are not closely related to the subject matter in order to shorten the message.

Communication technology activists: The challenge to the Syrians secret services

The Irish NGO Frontline, located in Jordan, trained Syrian activists on how to erase data at long distance, secretly exchanging e-mails, and saving sensible database (videos, pictures…). 

For example, the Iranians have provided the Syrian security forces GSM antennas that can expand (balloon) the reach of signals and thus, capture the coordinates of anyone using performing satellite mobiles.

Fidaa al-Sayed, communication Syrian specialist and activist, located in Sweden, countered that breach in security by asking his “operators” on the ground to shut down automatic mode and using solely the manual mode.

Since March 15, If you are caught in Syria publishing images and videos on YouTubes or sending videos to Al-Jazeera channel, you are more likely to be beaten silly or killed in prison.

Transmitting, emitting news from Syria is resembling to activities engaged in Radio London during the occupation of Nazi Germany to France.

Usama Monajed, 31 of age and residing in London since 2005, is one of the precursors for clandestinely supplying communication equipments into Syria.  Usuma had assimilated the “non-violence tactics” of Gene Sharp.  Usama held seminars on communication technologies to Syrian activists, able to visit Turkey, Jordan, and Lebanon without visas.

The sophisticated equipments included satellite modems, smartphones, and portable computer. Usama manages the network “Shaam News”, a site based in the USA and functioning since February, three weeks before the start of the Syrian uprising on March 15.

On March 15, 2011, two dozens of young activists demonstrated in the Souk of Damascus, by the Great Mosque.  They shouted: “Syrians, where are you?”  They shot a video of their demonstration that made the tour of foreign news media.  All these youth were detained, and not a single one has emerged from prison since then.

The Syrian regime tactics are to close-off a city, cut electricity and internet connections.  In Daraa, the activists recharged their mobiles using electric generators: They filmed the repression, particularly the beating to death of marchers by the security services, the “Mukhabarat”.  The activists vacated Daraa in the night, walked to nearby villages by the borders with Jordan, and remitted their communication equipments to their contacts.  The videos were transmitted on Al Jazeera.

The “authorities” or the 4th brigade of Maher Al Assad, brother of Bashar, ordered a few neighborhoods to either hand-over the activists or face occupation.  The neighborhoods opted for the second alternative. Maher Al Assad is on top of the wanted list for crimes against humanity.

Amrou is a Syrian activists residing in Paris.  He is 29 of age and has been transmitting live videos to Al Jazeera.  Amrou had smuggled to the activists in Banias quality communication equipments and explained to them how to use the software Bambuster. Bambuster can transmit high quality images directly from a phone. On Skype, the operator in Banias relayed the news: “It is done.  He is on the roof. The manifestation is starting.”  Amrou calls his contact in Al Jazeera in Doha and tells him: “All is in place”.  Three seconds later the live video is on TV stations.

The operator on the ground has to cut filming within 30 minutes, lest he is localized by the Syrian communication specialists to the regime.  Amrou prefers the Iridium satellite phone instead of Thuraya, because it is far secure.   Amrou suggests to his operators to use the software YouSendIT to post on YouTubes: It leaves “no trace on your portable computer.”

The Syrian activist Firas Atassi, residing in Riyadh (Saudi Arabia), is in charge of the “communicators” in Homs.  Ammar Abdulhamid of Silver Spring (USA) is managing the activists in Damascus. Syrian communication leaders overseas are centered in Germany, Turkey, Lebanon, Kuwait, and Australia; every where there are heavy Syrian immigrants.

Note 1:  Since March 15, over 15,000 Syrians have gone throught the prisons revolving doors, after suffering harsh and savage torture.  More than a thousands have been assassinated, even within the prisons.  Bashar Al Assad has called upon the retired old guards in the secret and intelligence services to join in the efforts of taming the revolts.  Most probably, things are getting out of hand and Bashar has to pay for not demonstrating firm control over his brutish oligarchies.

Note 2: Most of these information were taken from the French weekly “Le Nouvel Observateur”

And you dare look me in the eyes, and censure me?

What a whirlwind of constant matter,

Never increasing or diminishing.

This constant matter, filling the vast void,

Transforming, emitting, recycling

Into forms, sounds, lights, animates, and inanimates…

What is this ridiculous probability

To be who I am?

And you dare blame my huge vanity!

Is the spirit eternal?

How should I know?

Why should I care?

Is one eternity not good enough?

Have you been by a dying person?

Have you heard anyone on his deathbed, looking straight at you and say:

“I know one thing to be absolutely true!”

Had you the guts to go on adventures?

Had you learned to read, and read all that came under your hands?

Had you written down your reflections?

Had you shared your thought, and listened carefully to feedback

Before you claim to form an opinion?

I may then disagree with your position,

But you got my respect.

Are you such a coward, and never left your hometown?

Do you want to believe that the world turns around you?

Were you pressured to learn to read

So that you may read in a single book?

Have you lived so long

Just to end up believing that all knowledge and wisdoms are found

In a single book?

And you dare look me in the eyes

And censure me?!




May 2011

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