June 15th was an unusually chilly spring morning. After a week in the 80s and 90s, the temperatures dipped 30 degrees overnight, a bracing welcome to Boston for Brigham's newest medical interns, rising out of their warm beds and stepping over unpacked boxes to attend their second day of orientation at Brigham and Women's Hospital. Just days after their momentous move from their home towns, medical schools and the comfort of familiar things, the 2005-2006 intern class were already rushing to the hospital. Today, they were rushing to the Brigham Urban Intern Learning Day (BUILD).

Piloted in 2003, BUILD is a one-day program designed and implemented by internal medicine residents, including Alexandra Molnar, MD, Chief Primary Care Resident and recipient of the 2004 Support for Excellence in Educational Development (SEED) Grant. They launched the BUILD program with the hope to provide fellow residents with the knowledge they need to become physicians who understand the cultural and societal issues that affect their patients' health. This yearly event starts with panel discussions by leaders from the Dorchester, Roxbury, Mission Hill, and Jamaica Plain communities, who address the new interns on the history and culture of their neighborhoods. The goal is to make interns better "community oriented physicians," said Dr. Molnar. Afterwards, interns get a first-hand look into their future patients' lives through walking tours and service projects.

To lighten the "first day of school" apprehension still lingering in the air, Dr. Sarah Kaplan, this year's resident coordinator, kicked off the day with a warm welcome to the interns and introduction to the community panelists. This year's panelists, included Jeffrey Sanchez, the Massachusetts State Representative for Jamaica Plain and Mission Hill; Jacque Furtado, a community health worker and former resident of Jamaica Plain; and Ana Reyes, a health promoter with the BWH Division of Social Medicine and Inequalities PACT Project. Each panelist offered the unique perspectives of their different organizational roles, but all shared from personal experiences, with the same message: Cultural, language and socio-economic barriers have life-long affects on the health of Brigham's surrounding communities. Interns were faced with the challenge that will meet them each day as they leave the hospital to go home: Boston may have the highest concentration of health centers in the country with 16 hospitals and 26 community health centers, but this has not decreased the high rate of obesity, diabetes, asthma and the lack of health insurance.

Jeffrey Sanchez grew up in the Mission Main housing development, where its residents called Huntington Avenue the "great divide." As Brigham and Women's Hospital grew, Sanchez remembers, his community felt increasingly "sandwiched in" between the Brigham and Northeastern University. With students and redevelopments inflating housing costs, struggling families like his own faced financial difficulties directly related to these local "improvements."

Jacque Furtado has devoted much of her career to working with inner city women who struggle with inadequate resources to maintain health or obtain proper healthcare. "Their own health gets put in the back burner when their children are involved in gangs and violence," says Furtado. She also noted the irony of food prices in the lives of those struggling with poverty, as she described the results of the Boston’s Reach 2010 Breast and Cervical Cancer Program activity to compare supermarket prices in low and high-income neighborhoods. She and her fellow community health workers found that supermarkets in poorer areas, such as Roslindale and Jamaica Plain, tended to higher prices than supermarkets in West Roxbury or Brookline. Low-income communities also tend to lack fresh produce, organic foods and salad bars. This means, Furtado reminded the interns, that many low-income BWH patients, especially diabetics, lack the resources to maintain the healthy diet they need, simply because they live in the wrong part of the city.

Ana Reyes' greatest concern for our physicians is the language barrier. "Many of my clients will leave their doctors appointments without having understood anything that their physician have said," she emphasized. "The Latino community highly respects and are intimidated by doctors and the healthcare system," she went on. "As a result, they shy away from asking questions to better understand their illness and how to take care of themselves at home." Reyes encouraged the interns to take extra time to build a relationship with their patients, earn their trust, and seek an interpreter when needed.

JudyAnn Bigby, MD, Director of the Community Health Programs at Brigham and Women's Hospital organized the panel and was integral in helping BUILD get started. She gave interns some of the hard facts on Boston's biggest health issues, with statistics that visibly astonished some in the audience. For example, Dr. Bigby said, there is a disproportionate number of Latinos and African Americans with a high school diploma in Boston.. Hispanics are the fastest growing community in Boston, yet they, along with the African American community, have the highest uninsured rates. African Americans lead the city in obesity, depression and diabetes. Click here to view Dr. Bigby's presentation.

It was thus a thoughtful group of interns, their eyes now wide open despite the cold day, who separated into three walking tours to see the communities first-hand. Those on the tour to Roxbury and Jamaica Plain piled into vans, while the Mission Hill group, along with Your Medicine Online reporter, began their tour as soon as they walked outside One Brigham Circle. We were privileged to have Jeffrey Sanchez lead us through his home neighborhood. Walking along Huntington Avenue, through the Mission Main housing development, and inside Mission Church, Sanchez would often stop and say hello to people, many of them "like family; they watched me grow up." For every stop in the tour, Sanchez had a personal story. He told us that Mission Church, commonly known as the "Healing Church" was a place for the poor to seek healing. Residents believed that praying in front of the shrine brought healing to those who faced disease but could not afford to see a doctor. He reminded the interns that Brigham is a community hospital; it is imperative to be aware and sensitive to the diversity and intricacies of the neighborhood's cultures, ethnicities and socio-economic backgrounds.

After lunch, the interns took part in service projects. Some taught a science class at the Farragut School; others pulled weeds at the Mission Park apartments; still others entertained the elderly at the McCrohon House, or lent a helping hand at the Re-Vision Urban Farm or Community Servings. Representatives from each service project spoke about the organizations' role in the community and its collaborative history with the Brigham and Women's Hospital. As the interns helped out, got a little dirty, and had fun, they also got a glimpse of the variety of ways they will spend the next few years working together.

At day's end, the interns dispersed to sort out residual "new school" details. A few hurried to the Department of Motor Vehicles to get their Massachusetts drivers license; some were off to pick up their white coats; and others headed home to unpack boxes. All knew that they would enter the Brigham the next day better equipped to understand their patients' lives, committed anew to serve these neighbors at the door.

This year, BUILD was a coordinated by Sarah Kaplan, MD, a senior year, internal medicine resident. "For someone who was coming from outside of Boston, I found that BUILD was a great opportunity for me to find out about the issues my patients face," says Dr. Kaplan as she reflected on her own introduction as an intern. "During our service project at the Farragut School, we learned that many of the children's parents, or other family members, have jobs at the Brigham. It was amazing to realize that the Brigham has an enormous presence in this community; we need to be culturally sensitive to their needs."

And Dr. Molnar concludes, this was "the best BUILD yet!" " It's wonderful to pass the torch along to Sarah who has a truly inspiring commitment for connecting the housestaff to the community. I'm thrilled that BUILD will continue for future years."

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