The Wright Loop - Winter 2017-18

W I NT E R 2 0 1 7 – 2 0 1 8

Our bold immersion into the behavioral health, addiction and recovery space has been a large step out of our perceived organizational comfort zone. We are actively pursuing true integration of care; building a robust team of behavioral healthcare professionals and support staff; aiming to break down stigma and carving a deliberate path towards resiliency and recovery in our community, together.

MESSAGE FROM THE PRESIDENT

Setting goals is the first step in turning the invisible

into the visible.

—Tony Robbins

Becoming the leading model of community-based healthcare and medical education in America does not happen overnight. The Wright Center unknowingly set out to pursue this destined goal in 1976 as Scranton Temple Residency Program, with an inaugural class of four Internal Medicine residents. A modest program with humble beginnings, our Internal Medicine Residency has paved the way for our mission-driven growth over the past four decades into the vigorous Graduate Medical Education (GME) Safety-Net Health Services Consortium we are today.

Our mission-driven path to success has often been in part due to circumstance, as local and national healthcare crises fundamentally shaped us into a health and workforce needs-responsive organization. Leveraging opportunities like the Teaching Health Center GME program as they presented, while reliably responding to our Community Health Needs Assessment with developments like our newly accredited Psychiatry Residency, has positioned us well. Daily immersion in mission delivery of education and patient care, often without a formalized roadmap or robust infrastructure, has often landed us essentially writing our organizational story as it is unfolding. Serving patients and families, our community and learners continues to fuel our passionate delivery of our mission to continuously enhance patient care and education in a collaborative spirit to enhance outcomes, access and affordability.

With all that we have accomplished to date and much excitement on the horizon, it’s a great time to align around collective thinking and vision; to develop tangible connections between all levels of the organization; and to stimulate further organizational improvements as we continue our iterative, endless journey to excellence. Taking opportunity to reflect after such wonderful growth, notable accomplishments, some failures forward and occasional turmoil, is vital.

The Wright Center’s ten-year target is to be recognized by the President of the United States as THE Health and Human Services (HHS) gold standard, community-based model for primary health care and workforce development by June 30, 2027. Respective of our governing boards’ strategic, mission driven directives and under the mentorship of Entrepreneurial Operating System expert Hank O’Donnell, our Executive Leadership Team took on the task this academic year of defining our ten, three and one year organizational vision and goals. These high-level organizational goals cascade to each branch of The Wright Center, inspiring refined clarity of current mission priorities. Each step forward provides opportunity to promote our short term ambitions, while in deliberate, relentless pursuit of our ten-year target. We are proud to share a few of our ambitious organizational goals and recent progress toward attaining them.

Adding three new, fully-operational clinical learning venues in the past few months has increased primary health services access within our regional community.

We have made meaningful progress in expanding access to comprehensive primary health services by integrating behavioral health and addiction services.

Most faculty providers expanded their skill sets and became certified this year in Medication Assisted Therapy. In February, Dr. Jignesh Sheth, Dr. Jumee Barooah and I proudly became certified by the American Board of Addiction Medicine. In its first year of operations, our Opioid Center of Excellence (COE) touched more than 250 patients and is currently caring for 168 patients in recovery, notably surpassing expected outcomes. Although our journey integrating addiction and recovery services into primary care has not been easy, we know that developing our COE program has cultivated healthier team dynamics and has made all of our providers, learners and team members more compassionate caregivers.

Expanding our geographic, demographic and cultural diversity remains a high organizational priority. As an equal opportunity employer committed to meeting the complex needs of our diverse patients, we are continuing our recruitment efforts to engage faculty, residents and staff of all ethnicities, backgrounds and socioeconomic status. This summer, we will welcome 72 learners, joining our trainees and faculty from 27 countries around the globe. The Wright Center has also committed to supporting the Northeast Pennsylvania Rainbow Alliance, an organization providing education, support and advocacy for LGBTQQIAA individuals and their families, while working to advance equality. This partnership aims to ensure our learners and staff are well-versed on specific healthcare needs of this population as we encourage a safe space for all people to engage in provision and receipt of nondiscriminatory health services.

Opening our West Scranton Intermediate School-Based Health Center to the community has brought high-quality affordable healthcare to a historically underserved area in Lackawanna County. Our first clinical ventures into Luzerne County include our new Patient-Centered Medical Homes within Children’s Service Center and within the established Family Medicine practice of Dr. Joseph Anistranski, a graduate of our Wilkes-Barre Family Medicine Residency.

H G F Although our defined goals keep us focused, we thankfully remain as agile and ready as ever to respond to the immediate needs of the communities we serve. Our next gigantic step forward will be the establishment of a primary health services and workforce development hub at 501 South Washington Avenue in Scranton. Within this hub, we will offer patients accessible and integrated primary health care, including prevention and wellness; nutrition; oral health; family planning; chronic disease management; Ryan White HIV and Hepatitis C; behavioral, addiction and recovery services. Paired with all of the above enhanced clinical training opportunities, The Wright Center’s sponsoring institutional curriculum enhancements this year will intensify focus on integration of socioeconomic determinants of health, responsive care plans for patients and the promotion of care team member and learner wellness and resiliency.

Overall, The Wright Center is thriving because of the tireless contributions of its engaged Boards of Directors, employees, faculty, learners, patients and community partners. We look forward to major strides this year in our journey toward becoming a top rated primary health services provider, medical educator and employer.

Thanks to all of you for everything you do every day to deliver The Wright Center’s mission!

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December 1, 2017—February 28, 2018 Joseph Anistranski Sr., Custodian Dr. Joseph Anistranski, Medical Director/ Physician–Faculty Caitlin Bevvino-Ring, Intern Susan Bowen, Contract & Risk Management Officer Kristy Chapman, Medical Assistant

HAPPENINGS

Welcome, New Hires!

Thomas Comerford, Case Manager Anita DeFluri, Certified Billing/ Coder Specialist Argia Domski, Data Clerk Michele Esgro, Certified Recovery Specialist Tamara Galabinski, Clinical Administrative Assistant Donna Gerard, Clinical Administrative Assistant Michele Holincheck, Certified Registered Nurse Practitioner Rebecca Kenderes, Physician Assistant Sally Korb, Accounting AP/AR Clerk Lauren Molinaro, Clinical Administrative Assistant Tealesha Moore, Medical Assistant Anthony Okolo, Intern Carmen Rodriguez, Clinical Administrative Assistant Diane Sanna, Lead Certified Billing/ Coder Specialist Courtney Santee, Medical Assistant Autumn Smith, Case Manager Helayna Szescila, Governance Officer Jacqueline Yasenchak, Licensed Practical Nurse

Join Our Team!

Do you know someone who would be a good fit at The Visit: Wright Center? We’re hiring! thewrightc enter.org/ Check out our open c a r e e rs positions online!

Above: Students at Valley View High School created amazing artwork for the new Oral Health clinic in Jermyn.

Left: Congratulations to our furriest team member, Josie, for officially graduating from All American Dog Trainers’ Canine Good Citizen and Therapy Dog training programs. The Wright Center’s Auxiliary was instrumental in making this possible.

Below: National Family Medicine residents at Unity Health Care in Washington, DC recently visited Kaiser Permanente Total Health during their local didactics to learn about different medical systems. The residents were able to share their CommunityOriented Primary Care (COPC) projects with Dr. Ted Eytan, medical director of Kaiser Permanente’s Center for Total Health and director in The Permanente Federation, LLC, and discuss the future of family medicine and healthcare.

RESIDENT SPOTLIGHT: DR. RACHEL GOUGIAN National Family Medicine Resident, Washington, DC

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r. Gougian is a second-year resident in The Wright Center’s National Family Medicine Residency program and is currently training at The Wright Center’s partner site, Unity Health Care, in Washington, DC. Together with three of her second-year colleagues, she has already signed on to continue her career with Unity Health Care after she completes training at The Wright Center.

Hometown: Pepperell, MA

a hundred tasks in an efficient and Family: My immediate family includes productive manner, so that you can end my parents, Greg and Susan, and my the day without a messy desk. three sisters Rose, Ruth and Rebecca. My Most rewarding aspect of being a household consists of myself, my boyfriend physician: It’s very rewarding to have Andy, and one adorable cat named JoJo. patients return to clinic in a better state What led you to The Wright Center? of health due to the impact of medical I chose the Wright Center because the interventions. There’s no bigger sigh Teaching Health Center concept fit of relief than when a patient with well with my personal goal to become a uncontrolled diabetes registers an A1c = strong outpatient physician. The Wright 6.5, or when a patient comments that Center’s program at Unity Health Care in your recommended treatment completely Washington, DC was a perfect fit because I resolved their symptoms.

The Wright Center was recently awarded a Listen for Good grant from Rockefeller Philanthropy Advisors and Moses Taylor Foundation. With these funds, The Wright Center will apply a semistandard survey instrument that incorporates the Net Promoter System (NPS®) employed widely in customer feedback circles.

A Reason to Smile Northeast Pennsylvania Health Care Foundation recently awarded The Wright Center $90,000 over three years to develop a dental navigation program. The project will be executed in collaboration with The Scranton Dental Society, harnessing volunteers to do assessments and connect patients with dental offices that provide reduced cost care. The project will consist of a series of daylong oral healthcare clinics for adults in Lackawanna County who lack health insurance or have issues accessing care. Dr. Maria Montoro-Edwards, Brian Whelan and Kathleen Barry showed exceptional leadership in making this project a reality.

wanted an urban lifestyle and a connection Favorite part of Washington, DC: to a diverse patient population.

Museums and events. I especially love all of What led you to study family medicine, the Smithsonian galleries—which are free specifically in a Community Health to enjoy— and I highly recommend a new Center (CHC) setting? I have been local art venue called Artechouse. primarily interested in family medicine since before medical school because of the direct impact primary care can provide patients. For five years, I worked in the health insurance realm (for commercial and later a Medicare/Medicaid only company) and became very aware of the health disparities that exist due to wealth, education and access to care.

What inspired you to accept a position with Unity following residency? For me, the decision was an obvious one. I am committed to serving in National Health Service Corps, which allows me to focus on underserved populations and had the unique opportunity to continue in the community that I’ve been treating throughout residency.

Being a family physician allows the chance to truly impact, educate, encourage and direct patients in a way that a corporate job never could.”

What advice would you give to an aspiring physician? Be committed to your dream and get used to all of the challenges and obstacles you will encounter without letting it weigh you down. Whether it’s a particularly difficult test or a clash with your preceptor, each one of these experiences is temporary. You’ll pass dozens of tests that seemed impossible, and you’ll eventually wave goodbye to every rotation.

It’s all worth it!

Most important lesson you learned while in residency: If medical school teaches you how to memorize and study, residency teaches you how to work. Doing well in residency means starting each day in a structured way and completing

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2017

MILESTONE ANNIVERSARIES 10

YEARS

5

YEARS

1

YEAR

Dr. Susan Baroody

Belinda Morgantini Marianna Eisner Lida Kiefer Kellie Knesis Sylvia Gioupis Elizabeth Reviello Megan Deshaies Keisha Holbeck David VanBuskirk Grace McGrath Nicole Mecca Laura Sweeney Gina Constantini Jenna Dunn Dorene Dymond Dr. Richard English Dr. Maureen Litchman April Novak Dr. Julio Ramos Tracy Sokoloski Dr. Deborah Spring Kathleen Barry Atty. Jennifer Walsh Maria Rachko Jason Swiderski Heidi Cummings Dr. Seleena Rashid Maggie Schlude Maria Adragna Dr. Jumee Barooah Scott Constantini Brittany Mang Kimeth Robinson Rosemary Takacs Sharon Dougherty Aliah Roseman

COMMUNITY INITIATIVES SAVE THE DATE AND SPREAD THE WORD aringpowered Hearts by The Wright Center

The Wright Center Patient Engagement Council (PEC) will be hosting a Caring Hearts Panel Discussion and Dinner on Saturday, April 28 at the Carbondale Grand Hotel (25 S Main St, Carbondale). Our second annual event will be chaired by Dr. Linda Barrasse and moderated by Paola Giangiacomo, host of the popular WVIA television series Call the Doctor. Dr. Linda ThomasHemak will be joined in a panel discussion by Dr. Jumee Barooah, Dr. Pranjal Boruah and Dr. Sukrut Nanavaty.

Joining the event this year is Bridget Feeney, a recent heart transplant recipient and author of the blog “Preppy Prosthetics.” Bridget will present the keynote speech during dinner following the panel discussion. Bridget is a testament the fact that health issues do not define who we are or limit what we can do in our lives. Her resiliency is inspirational and we are honored that she has agreed to share her story with us.

THE COMMUNITY HEALTH HUB DRIVING BETTER Tickets: $5 each HEALTH or 3 for $10 IS BACK! INITIATIVE Call Mary at 570.499.8367

The Wright Center’s team cares for all patients, even if they can’t afford healthcare.

With your support, we will be able to provide transportation to our patients in need, to make sure they can get to their doctor’s appointments and stay on the road to better health!

to purchase ticket.

Now is theyour time to enter the 2018 raffle will be announced forWinners a chance to win the grand prize of on April 28, 2018. a treasure chest full of surprises valued at over $1,000! Did Tickets are $5 each or You Know?

More than 15% of people in Lackawanna County live at or below the poverty line.

3 for $10 and all proceeds willCenter,bedesigned used Community Health Hub is a non-profit community partner of The Wright to ensure that non-discriminatory, comprehensive healthcare services are accessible to all patients in our community. to generate creative transportation solutions that enable access to quality, affordable healthcare. Purchase your ticket at the front desk at any Wright Center for Primary Care location or call Betsy at 570.591.5138. Winners will be announced on April 28, 2018.

THE WRIGHT CENTER AUXILIARY’S 4 ANNUAL DESIGNER PURSE BINGO TH

Sunday, May 20 at 1:00pm • St. Michael’s Hall, 403 Delaware Street, Jermyn Tickets: $25 includes admission and Bingo cards Info and Contact: Gerri at 570-230-0019 • Limited Tickets Available

Join Us!

PHYSICIAN ASSISTANT LEADERSHIP IN MEDICATION ASSISTED TREATMENT SUMMIT

Friday, April 20 and Saturday, April 21 • 8am–5pm Four Points By Sheraton Scranton 300 Meadow Ave, Scranton PA Together with industry experts and the Health Resources and Service Administration, we are excited to present a free, two-day leadership experience in Medication Assisted Treatment (MAT) for Physician Assistants (PAs). The PA Leadership in MAT Summit is a two-day, large group learning opportunity focused on ethics, advocacy, leadership and best practices for actively addressing the opioid epidemic, including engagement in sessions regarding Medication Assisted Treatment, from the perspective of a PA. 12.5 total CME units are available for those who attend all sessions.

Space is limited.

Visit thewrightcenter.org/leadership-in-mat/ for details, agenda and to register today!

PHYSICIAN SPOTLIGHT: DR. MIN KANG Pediatrician at The Wright Center for Primary Care Mid Valley

D

r. Min Kang joined The Wright Center for Primary Care Mid Valley care team this fall. She earned her medical degree at St. George’s University School of Medicine and completed her residency in Pediatrics at Icahn School of Medicine. Dr. Kang is dedicated to treating the underserved and especially enjoys working with pediatric patients.

What inspired you to become a doctor? I was a curious child: I would always touch things, and had to explore new things. I always wanted to know why and how things work. For that reason, my favorite subject had been always science, since it satisfied my curiosity for the nature of how things work. I was especially interested in life science, and I enjoyed learning the physiology of how things work in a living organism. I decided to study molecular and cell biology in college, which inspired me to work as a scientist. After college, I went on to work as a molecular lab technician, participating in research in neurological disease. The more I learned about physiology and human disease, the more I wanted to learn the practical part of the human body and disease, which is medicine. That’s when I put my plan of pursuing a PhD aside and decided to pursue a career in medicine.

Why internal medicine? I used to volunteer in an event where we skate with autistic children in Oakland, California. From that experience, I learned that impacting children in positive way is truly rewarding. By further working as a teacher temporarily in Korea, I decided that I want to pick a healthcare field that works with children. Because of this, I pursued a pediatric residency program once I graduated from medical school.

DID YOU KNOW? Did you know that you can see your primary care doctor for your yearly women’s well visit? Did you know that there are short-term and long-term contraceptive options you can access through your primary care doctor without scheduling a separate visit to a gynecologist? If you or a woman you care about could benefit from a yearly well visit, birth control counseling, a first trimester pregnancy visit or an annual Pap test, please get in touch or encourage them to schedule an appointment today.

Left: Our team, pictured, was recently trained on a birth control method, Nexplanon®, that is inserted into the arm and designed to prevent pregnancy for up to 3 years. Patients who choose this method don’t need to see a separate gynecologist or even undress/wear an exam gown.

Most important lesson you learned in medical school: Medical school taught me how to pick up a self-learning discipline. It was a shift from college where I attended lectures and professors spoonfed the information to me. Once residency started, reading on my own to learn more about pathology and reviewing literature for evidence-based medicine became very important.

Why did you decide to join The Wright Center? I wanted to serve a population that would need me the most. The Wright Center is an ideal place to satisfy such a goal, yet it is not too far from Philadelphia, where my husband lives.

Most rewarding part of your job with The Wright Center: When sick patients get better. When those patients say “thank you,” it really touches me.

Read the full article at thewrightcenter.org/min-kang 5

‘TIS THE SEASON FOR CARING AND CELEBRATING Kudos to Luzerne Family Medicine Resident Dr. Jennifer Chen for organizing another successful day of caroling for patients and community members across the area. She was joined by her colleagues and faculty to help make the season bright.

Dr. Meaghan Ruddy Named Director of Medical Education In December, Dr. Meaghan Ruddy was named Director of Medical Education (DME) at The Wright Center for Graduate Medical Education. In her new role, Dr. Ruddy will continue her work with national partners to support our National Family Medicine Residency (NFMR). Her primary goal is to successfully usher the NFMR program into single accreditation status with the Accreditation Council for Graduate Medical Education (ACGME) while providing and supporting faculty, resident, and high-level curriculum development. Additionally, as a BoardCertified Coach through the Center for Credentialing and Education and an Associate Certified Coach through the International Coach Federation, she aims to implement leadership development options for all members of The Wright Center, including social, emotional and conversational intelligence coaching for personal development and team effectiveness.

On Tuesday, December 12, the Auxiliary, led by Gerri McAndrew and Patti Swierbinski, delivered 40 turkeys to Lakeland School Mayfield Elementary for their Faithful Foods program. Teacher Miss Proch said, “Thank you so much! Families were crying!” The Auxiliary team also delivered turkeys to four area senior centers: Mid Valley Senior Center, South Side Scranton Senior Center, West Side Scranton Senior Center and Carbondale Senior Center. The dedicated team distributed 300 turkeys (and additional food items) to community members over the holidays.

Our Family Medicine and Internal Medicine residents spread some holiday cheer again this year at the St. Vincent DePaul Soup Kitchen. Together, the group spent a Sunday morning preparing and serving meals to almost 100 community members.

Because of our team’s generosity, many members of our Wright Center family had a healthy, happy Thanksgiving. This year's Thanksgiving Food Drive raised enough funds to provide full Thanksgiving dinners for 65 of our patients and their families.

Coordinated by our Ryan White Infectious Disease Clinic Case Managers, the annual drive raised over $1,700—its largest sum to date.

Left: Family Medicine residents took some time out for a holiday lunch and some festive fun.

Right: Our staff, residents and faculty from The Wright Center for Primary Care Mid Valley got in the holiday spirit as they gathered together to celebrate the season.

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KUDOS! Scott Constantini and Dr. Jignesh Sheth presented at Moses Taylor Hospital’s Grand Rounds in December on The Integration Framework of Medication Assisted Treatment into Primary Care. They shared information about addiction, the new Center of Excellence program and presented some relevant case studies. Their presentation was exceptionally well-received.

Dr. Najam Saqib with his fellow guest speaker, Dr. Seth Kaufer, and discussion moderator, WVIA’s Paola Giangiacomo.

You can watch these episodes on WVIA’s On-Demand channel by visiting on-demand.wvia.org/shows

Community Education in Northeast and Central Pa Dr. Najam Saqib, first-year Internal Medicine resident, participated in WVIA’s Call the Doctor series in December, addressing digestive disorders.

Dr. John Sharp, third-year Internal Medicine participated in the episode on fibromyalgia in February, helping to educate the public about the condition.

Thanks to the efforts of Dr. Sanjay Chandragiri and the commitment of our Psychiatry residents, our Psychiatry residency program has attained 100% resident membership enrollment in the American Psychiatric Association. This level of involvement is a testament to Dr. Chandragiri’s commitment to his residents and the American Psychiatric Association and places our residency program in the Gold Level of 100% Club.

Congratulations to our residents who have matched into fellowships!

Dr. John Sharp, Critical Care at Inspira Health, Vineland, NJ

Dr. Gaurav Patel, Cardiology at The Wright Center, Scranton, PA

Dr. Justin Chacko, Critical Care at Inspira Health, Vineland, NJ

Dr. Meenakshi Sambharia, Nephrology/Critical Care at Allegheny Health Network, Pittsburgh, PA

Dr. Gursukhmandeep Sidhu, Cardiology at Tulane Medical Center, New Orleans, LA

Sign Up!

Dr. Sumanth Kacharam, Nephrology at Brown, Providence, RI

Thanks to the hard work of Rosemary Takacs and Karen Papi, The Wright Center’s Diabetes Education program has been re-accredited by the American Association of Diabetes Educators. Call 570-230-0019 to sign up for one of their upcoming classes to be held this spring.

APRIL 3

10am–12:30pm 1–3:30pm

APRIL 4 6–8:30pm

Dr. Jim Nguyen, Nephrology at the University of Southern California, Los Angeles, CA Dr. Shraddha Rayamajhi, Infectious Disease at Medstar Washington Hospital Center, Washington, DC

MAY 2

JUNE 5

6–8:30pm

10am–12:30pm 1–3:30pm

MAY 8

JUNE 6

10am–12:30pm 1–3:30pm

6–8:30pm

Congratulations to Dr. Deborah Spring for being named the incoming President of the Luzerne County Medical Society as of January 1.

ALUMNI SPOTLIGHT: DR. BASSEL NOUMI

A colleague of Dr. Monica Mallik wrote in to praise her saying, “She is extremely knowledgeable, particularly for a first year resident. She has a firm understanding of CPT coding/documentation and applies it into her daily workflow.”

Pulmonologist and Critical Care Physician, Delta Medix

Congratulations to Dr. Reema Andrade for the selection of her abstract for presentation as a poster finalist at the 2018 ACP Internal Medicine Meeting in New Orleans, LA. A patient wrote in to praise Katie Garvey, Medical Assistant, for providing her an excellent experience at the Mid Valley clinic. The patient wrote, “During my visit, Katie Garvey did an excellent job. She knows what she is doing and when the staff know what they are doing, it gives the patient confidence and makes you feel at ease during your visit.”

Dr. Darleen Oleski (pictured) was recently selected as the Chairperson for the Government Relations Committee of the Pennsylvania Dental Association and Jenna Macejkovic recently earned her Public Health Dental Hygienist Certificate.

The Wright Center was recently represented at the Institute for Healthcare Improvement National Forum in Orlando, FL. The team of Tiffany Jaskulski, Dr. Jignesh Sheth and Stephen Davidow from PCPI presented on Closing the Referral Loop: Improving Communication.

Kathleen Barry also attended the conference.

Dr. Zoya Effendi, Dr. Muhammed Liaquat, Dr. Dhaval Patel and Dr. Najam Saqib provided excellent care to a patient who wrote, “You all were very caring, efficient and you took my condition very seriously... I thank you for your dedication and thorough deliberation and fervent search for everything I needed for recovery. P.S. I feel safe.”

CONGRATULATIONS! The team at The Wright Center for Primary Care Clarks Summit achieved the NCQA Level 3 Certification with a score of 91.25!

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ormerly an Internal Medicine resident at The Wright Center, Dr. Bassel Noumi now works as a pulmonologist and critical care doctor with Delta Medix. He says his experience at The Wright Center provided him with a healthy balance of inpatient and outpatient care, allowing him to appreciate both types of practices.

I enjoyed the balance of training in different settings during residency.”

What led you to specialize in pulmonology and critical care? As far as critical care, the delicacy of the clinical situation of patients in ICUs and their need for persistent care and fast decisions, being a part of the decisions that save lives made me choose that field. As far as the pulmonary part, lung cancer has always been my nemesis; I am very involved in lung cancer early diagnosis, detection and treatment.

Why did you choose The Wright Center? The Wright Center offers a very unique balance in training with just the right recipe for inpatient and outpatient as one of the leading Teaching Health Center sites across the nation.

How did your time at The Wright Center shape the way you practice medicine? My residency training made me appreciate the importance of outpatient care and helped me learn how to build productive outpatient practice. The inpatient piece of my residency grew my interest in hospital medicine and taking care of critically ill patients.

What led you back to Northeast Pennsylvania? Northeast Pennsylvania has always been very welcoming to me and my family. Knowing the demand for my specialty in this community made me come back without hesitation. Lung cancer in our area is flourishing and I took an oath to help change this. Here I see familiar faces and friends which make me feel like I am surrounded by family.

Best and most challenging parts of your new position: The change from being a resident to an attending was challenging.

Seeing co-attendings as peers was also different at first, but they were all helpful and supportive as I made that transition. I really enjoy teaching rounds with The Wright Center residents at Moses Taylor. It is an honor to give back to The Wright Center through teaching the up and coming residents.

Read the full article at thewrightcenter.org/bassel-noumi

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FEATURES

Q& Gay A beginner’s guide to those questioning their path to ally-hood.

WRITTEN BY KERRI PRICE

What is an Ally?

By definition, an ally is a person who associates or cooperates with another; a supporter. Allies of the LGBTQQIAA community are those who accept their diversity and support their inclusion.

Being inclusive of the LGBTQQIAA community doesn’t seem like a radical idea—but in rural communities like ours in Northeast PA, it’s more innovative than we’d like to admit. The hard truth is, though it is 2018, LGBTQ+ members of our community still face an uphill battle and sometimes overt discriminatory practices when it comes to basics including employment, housing and healthcare.

It is for this reason that The Wright Center has partnered with the Northeast Pennsylvania Rainbow Alliance, a local non-profit organization dedicated to providing resources, events and support to the LGBTQ+ population in our region. Together, we have opened a line of conversation and volunteer opportunities for our team members—including the Rainbow Alliance’s annual Pride on the Mountain, where over 25 Wright Center volunteers brought health education and activities to participants, but most importantly, we brought ourselves. Event-goers had the chance to meet and connect with providers who they learned they could trust to manage their healthcare.

They chatted with members of our team from all levels and departments and learned more about what The Wright Center can do

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1 today—and hopes to be able to do in the future—for the LGBTQ+ population. We are making many meaningful steps forward, but we are not there yet.

Whether we know it or not, we each have the opportunity to make a difference for the LGBTQ+ community. Where I know I and my colleagues can have an impact is in creating safe, accessible spaces for the LGBTQ+ population to receive healthcare. I know that our providers, residents, faculty and staff are all capable of helping us get there, even if they may not yet know where to start. As an ally, I try to find ways to open the conversation and create a more inclusive community for my LGBTQ+ friends and family. Throughout the years, I’ve learned that one thing is certain: being an ally is simple. For those who are new to Ally-hood, welcome and thank you.

Maria Montoro-Edwards, PhD Vice President of Strategic Initiatives and Grants at The Wright Center and Co-Chair of NEPA Rainbow Alliance

LGBTQQIAA: Why are there so many letters?!

The acronym for the straight but not narrow community is admittedly long! Let’s break it down: LGBTQQIAA stands for: Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex, Ally and Asexual. While some of the terms in this acronym have been in use for decades, others are considerably newer.

As our understanding of sexual orientation and gender identity have grown, so too has the acronym that encompasses them.

The full LGBTQQIAA acronym is often shortened to LGBTQ+.2

Wait. Isn’t ‘queer’ a bad word?

Like many, it depends on how you use it.

Once considered a judgmental word used to diminish those in the LGBT+ community, ‘queer’ has been making a comeback since the early 1990s. Now, ‘queer’ is used to define a subset of identities within the LGBTQ+ spectrum. When in doubt, if you are afraid something you are considering saying may hurt someone, don’t say it. If you have the opportunity, learn more about the word and its history and ask a friend within the community to tell you more about it.

Community? Like Northeast Pennsylvania?

Yes, and no. NEPA is full of amazing people, many of whom are LGBTQ+.

Those who are LGBTQ+ — no matter their physical location—often refer to one another as a community.

“That’s so gay.”

Really? Is it?

I’m not comfortable standing on the front lines of the fight for equality. Does that make me a bad ally?

No. Not at all. LGBTQ+ issues aside, not everyone has an inner activist. If rallying for marriage equality and other legal rights isn’t your scene, don’t fret—you’re still an ally. Did you once, long ago, use the word ‘gay’ in a derogatory manner and regret it (see above)? Don’t worry, you’re still an ally.

Make an honest mistake about someone’s pronouns and correct yourself? Still an ally.

Never been to pride? Ally. Been to a million prides? Ally. Think a pride is a group of lions and somewhat confused? Ally who’s probably excellent at trivia.

The point is, your knowledge of the ins and outs of the LGBTQ+ community and experience (and willingness) to be an LGBTQ+ activist does not define you as an ally. Case Manager, Aliah Roseman, says it best, “Being an ally is simple, I will stand by my friends and strangers alike to offer unconditional love and support so they can be who they are meant to be.”

The world’s become a lot more accepting. Isn’t that enough?

“Hello” is a great start. Ask them how their day is—if they have plans for the weekend.

Chat about a local sports team, default to the weather. Really, anything besides bedroom preferences. How would you feel if they brought up yours? Like all others, LGBTQ+ people exist beyond their preferences.

It has, and it isn’t. We can always be better— both to ourselves and to others. Accepting the progress we’ve made in all aspects of civil liberties is doing us all an injustice. Education is always a great place to start. If you have a trusted friend in the LGBTQ+ community, ask them to explain something to you that you are unsure of. If you don’t, what a great opportunity to get involved in a local LGBTQ+ event! The Northeast Pennsylvania Rainbow Alliance will be hosting Pride on the Mountain in September. The Wright Center is the premiere sponsor of the event and will be looking for volunteers—we hope you can join us!

How can I respond to a homophobic joke?

Is transgender a sexual orientation?

I think my coworker is LGBTQ+.

What do I say?

Don’t. Humoring a bully with attention— positive or negative—will only encourage their behavior. Walk away, take a deep breath and send some good vibes their way. Bullies need love too—especially the ones who are missing out on all of the fabulous LGBTQ+ people out there.

No. Sexuality and gender identity are often grouped together, but they are two completely different parts of a person’s identity. Transgender is a gender identity— one in which a person identifies with the opposite gender than that which they were assigned at birth. Those who identify with

the gender that they were assigned at birth are cisgender.

Sexual orientation is who a person finds themselves attracted to (or doesn’t in the case of those who are asexual). New York-based poet, Denice Frohman says it best. “Sexuality and gender? Two different things, combined in many different ways. If you mismatch your socks, you understand.”

What if I am not sure what pronouns someone prefers?

Gender-neutral pronouns are a wonderful thing! If you are unsure of the way someone identifies, don’t assume. Instead, use genderneutral pronouns like they/their/they’re or better, their actual name! While asking what they prefer to go by is a step in the right direction from blatantly misgendering them, it also puts them in the position of coming out as trans* or gender nonconforming or lying to protect themselves or their identity.

If someone is comfortable using a certain pronoun over the other, let them tell you.

Chances are, this is not their first pronoun rodeo.

What can I say to someone who’s afraid of contracting HIV/AIDS from someone who is LGBTQ+?

Let’s start with the basics and ask one of our resident experts, Case Management Supervisor, Carina Havenstrite. She says, “HIV/AIDS cannot be shared through casual contact (aka hand-holding, hugs, sharing food, etc.) and neither disease is any quicker spread by the LGBTQ+ population. HIV/ AIDS is spread through sexual contact and can be passed from or to anyone who is sexually active.”3

What is something I can do right now to be a better ally?

You’re already doing it—stay educated, open conversations, support your peers, ask questions, make mistakes and learn from them. We are all human—gay, straight or otherwise. The more we ask of ourselves, the more progress we will make, together.

1

dictionary.com/browse/ally

2

For a full list of terminology and definitions, visit: amherst.edu/campuslife/our-community/queerresource-center/terms-definitions

3

If you or someone you know would like to better understand HIV/AIDS, visit: poz.com/

FEATURES THE TEACHING HEALTH CENTER GRADUATE MEDICAL EDUCATION INITIATIVE:

Successfully Fueling America’s Future Physician Workforce O

ver the past few months, The Wright Center has spent a significant amount of time on solidifying federal funding to support our Graduate Medical Education Consortium’s robust regional and national primary care residency training programs.

We recently learned that the Teaching Health Center Graduate Medical Education program sponsored by Health Resources and Services Administration (HRSA) has been refunded for academic years 2017–2019 at a sustainable amount.

This vital federal funding will allow us to continue our important, mission-oriented work to continuously improve education and patient care in a collaborative spirit to enhance outcomes, access and affordability.

These federal resources specifically address our national physician shortage, misdistribution and related health disparities.

As the largest Teaching Health Center Consortium in the nation, we are privileged to train physician leaders who are interested in making a genuine difference in the lives of their patients and their communities. Teaching Health Center programs across the nation—59 in all—have answered the call to train physicians in the areas that need them most with over 740 residents in training this academic year.

The Teaching Health Center program has helped establish the community based GME Consortium foundation necessary for sustainable workforce development solutions at local and national levels. In fact, Teaching Health Center residents will provide more than 1 million primary care medical visits annually to underserved communities and a recent validating report confirmed that 82% of Teaching Health Center graduates remain in public health oriented primary care practice after training completion.

This recent approval of continued Teaching Health Center GME funding is a vital federal investment in The Wright Center’s mission.

President and CEO, Dr. Linda ThomasHemak states, “HRSA’s THCGME program has proved to be an incredibly effective vehicle to address our national physician shortage, misdistribution and related health disparities.

The program has successfully ignited and leveraged clinical educational environments in numerous community-based venues across America, while delivering competent, public health minded physician leaders. The practice patterns of THCGME graduates demonstrate a

definite inclination to serve the most vulnerable communities and populations. The transparent financial methodologies of the program highlight educational costs and opportunities for enhancing efficiency and synergy of these resources with clinical care revenues. All of this is crucial for our larger federal conversation about transformation of the medical care delivery and educational systems in America. It’s a catalyst for solutions to our national healthcare debacle.”

Dr. Doug Spegman, Chief Clinical Officer at El Rio Community Health Center, one of our National Family Medicine Residency sites, adds, “The continued funding of our Teaching Health Center Family Medicine Residency program at El Rio Health Center in Tucson, AZ means that we will be able to continue to train and retain tomorrow’s clinical workforce to serve our greater than 100,000 patients. To date, 50% of our graduating residents have stayed at El Rio providing healthcare to all in our community including the most vulnerable and furthering the health center movement legacy, to overcome healthcare disparity and promote healthcare equity throughout our community.”

Thank you to all who participated in the organization’s social media and change.org efforts to bring this vital piece of legislation to the front of our representatives’ minds.

To learn more about the Teaching Health Center initiative, visit aathc.org 12

F

Helping Individuals and Communities Reach their Fullest Potential

or over 50 years, AmeriCorps has been living their mission of lifting people out of poverty.

The Wright Center has been awarded sponsorship of four Volunteers in Service to America (VISTA) members annually for a period of three years. VISTAs will contribute to various service lines within the organization, with the goal of improving and expanding our service offerings and access to quality healthcare for our underserved communities that need it most.

One of the program’s core focus areas is The Wright Center for Primary Care’s Opioid Use Disorder Center of Excellence initiative—a new take on recovery founded in 2016 by Governor Tom Wolf and his administration.

MEET MICHAEL LILLY Hometown: Nazareth, PA

Education: Bachelor of Science (BS), Muhlenberg College Master of Business Administration (MBA) in Healthcare Management, The University of Scranton MD, Geisinger Commonwealth School of Medicine Master of Public Health (MPH), East Stroudsburg University MD and MPH degree to be conferred in May ’18 when MPH degree is completed

Why did you apply to become a VISTA member? Becoming a VISTA allowed me to support current coursework in public health. It also allows me to continue to work in healthcare and contribute to my future career. I was not aware of this position until my mentor, Dr. Linda Thomas-Hemak, mentioned it would be a good opportunity

to pursue while completing my public health degree. Working as an AmeriCorps VISTA member in our Center of Excellence (COE) has provided me with many ways to learn and grow as a person, while learning more about addiction and the people struggling with addiction.

What does a typical day as a VISTA look like? In a word, “dynamic.” My overall goal is to better understand the background and logistics of the COE so that I can help to improve the way we deliver care and increase the capacity of our operations. As in most positions, the tasks that fall under the umbrella of the position are varied and many. Responding to such tasks is what a typical day encompasses. Along the way I get to meet and interact with a variety of people that teach me more.

Tell us about a memorable experience: I had the opportunity to work on the Pennsylvania Coordinated Medication Assisted Treatment (PacMAT) grant. I was introduced to the prospect of this grant by Dr. Maria Montoro-Edwards and found out that The Wright Center decided to pursue the grant—but with a catch. We had four days to create and submit a high-caliber grant application—something that would typically take a few months to work on! What made this memorable is the way our team of people pulled together to create the grant submission.

Ultimately, it was submitted on time and we later found out that The Wright Center was selected as one of the grant recipients. This was a memorable testament to the ability of The Wright Center’s team and organization.

Read the full article at thewrightcenter.org/michael-lilly

You’re not alone and neither are we.

Start life in recovery today by contacting an

Opioid Use Disorder Center of Excellence in NEPA The Wright Center

Clarks Summit, Jermyn and Scranton

570.230.0019 Habit OPCO Dunmore

570.795.5139 Clean Slate Scranton

570.904.6000 Wilkes-Barre

570.846.2720 Miners Medical Ashley

570.822.5145 Geisinger South Wilkes-Barre Wilkes-Barre

570.808.3700 Mt. Pocono Medical Mt. Pocono

570.839.7246 When visiting a Center of Excellence, you will find supportive addiction and recovery specialists, social workers and medical providers who can help you break the cycle of addiction and reshape your lifestyle.

We do recover, together. thewrightcenter.org/coe

FEATURES

Heartland, Pa

In 2010, The Wright Center successfully integrated a Fellowship in Cardiovascular Disease into our existing Graduate Medical Education offerings.

M

uch like our residencies, the Cardiology fellowship would differ from others by training aspiring cardiologists in communitybased settings while immersing them in a variety of organizational cultures, electronic medical record systems and new team dynamics. In 2013, what began as a stretch goal became actualized reality when we celebrated our first graduating class of two cardiologists—Dr. Arjinder Sethi, a practicing cardiologist who also now serves as the Recruitment Director for The Wright Center, and Dr. Haitham Abughnia, who, after completing his fellowship training, joined Cardiology fellowship Program Director, Dr. Samir Pancholy, as a partner in practice in Clarks Summit.

Now, a few short years later, we find ourselves celebrating another milestone: Four of our Cardiology fellowship graduates—two who will graduate this June and two who graduated years ago and recently decided to return to Northeast Pennsylvania—have recently signed on with Geisinger. These four physicians join the growing list of cardiologists who have trained under the exceptional leadership of Dr. Samir Pancholy and dedicated regional faculty, and have set their roots in northeast Pennsylvania (NEPA). These cardiologists are vital to the health of our area, choosing to care for patients in private practice or within one of the region’s various hospital systems after completing a fellowship with The Wright Center.

DR. PRANJAL BORUAH (CLASS OF ’14) AND DR. KEYUR MAVANI (CLASS OF ’15): Both doctors initially relocated following their graduation from The Wright Center’s fellowship program and recently brought their talents back to the region. Drs. Boruah and Mavani are practicing at Geisinger Community Medical Center, Scranton, and intend on setting their roots here with their families. Not only have these two graduates returned to serve our community, but they are doing so as teachers, coming full circle to help train the next generation of cardiologists.

We have past graduates teaching the new generation of future cardiologists and we anticipate that one day, they’ll be taking care of us too.”

—DR. STEPHEN VOYCE

DR. SUKRUT NANAVATY (CLASS OF ’18) AND DR. NAYANJYOTI KAUSHIK (CLASS OF ’18): Both completed their Internal Medicine residency with The Wright Center and are now cardiology fellows within The Wright Center’s program. Months ago, they both committed to practicing within the Geisinger system upon completing their cardiology training in June. Dr. Nanavaty will care for patients at Geisinger Holy Spirit and Dr. Kaushik will practice at Geisinger Community Medical Center.

The Wright Center’s partnerships with a variety of regional training environments—including the VA, Commonwealth Health System and Geisinger—have made the goal of creating a pipeline for physician renewal in NEPA a reality. When residents and fellows train within a variety of settings, they learn about other organizations and systems, get familiar with different cultures and team dynamics, and become connected with possible opportunities they may not have otherwise been exposed to.

Although every cardiologist who chooses to practice medicine in NEPA has their own story, they all share a common thread. Time and time again, they credit their faculty, their familiarity with training environments and their connection to the region for fueling their passion to help our NEPA community stay heart-healthy.

To read more about our Cardiology graduates and fellows, visit thewrightcenter.org/Cardiologist-Stories Dr. Stephen Voyce, Associate Program Director of The Wright Center’s Fellowship in Cardiovascular Disease and Chief of Cardiology at Geisinger Community Medical Center, hits the pulse of the teaching partnership between Geisinger and The Wright Center. Just like a heart in perfect rhythm, the collaboration helps prepare new physicians to meet the critical care needs of heart patients in our communities today.

Why did you choose The Wright Center for your residency/fellowship?

The philosophy of The Wright Center is one of the things led me to choose this program. I saw that The Wright Center’s residents and fellows get opportunities to work in many different environments, learning a variety of healthcare practices. These environments include the VA Medical Center, private hospitals such as CHS facilities, and not-for-profit hospital systems.

The quality of education was also on the top, even though the name of the program was not as well known when I joined.”

—DR. KEYUR MAVANI, CLASS OF ’15

What led you to take a position at Geisinger?

I see values and ideological virtues within the Geisinger system that are similar to those I acquired during my time spent at The Wright Center. I was convinced that I can deliver better care to the community staying within that system and I was also drawn to the appeal of Geisinger’s competitive education and research wing.”

What’s your advice for aspiring physicians?

You need to work hard, be honest and take care of your patients. If you treat patients like family, you’re likely to be a better physician and a better person.”

—DR. PRANJAL BOROUAH, CLASS OF ’14

How did your time at The Wright Center shape the way you practice medicine?

During six years of training at The Wright Center, I developed a strong work ethic, flexibility, desire for research and a pursuit towards the advancement of medicine and cardiology. Amazing leadership and mentorship by Dr. Pancholy has made me a confident cardiologist and I am sure that I can perform on any stage, be it an academic institute or a private setting as a well-trained cardiologist.”

—DR. SUKRUT NANAVATY, CLASS OF ’18

—DR. NAYANJYOTI KAUSHIK, CLASS OF ’18

I love the interaction I get to have with the fellows. I’m also learning a lot while I teach. The fellows we work with want to learn and they are very energetic.

This fellowship has become a well-known pipeline for cultivating cardiologists who want to stay within our local healthcare systems, which was our goal. We, as a community, should be very proud of that.” —DR. SAMIR PANCHOLY Dr. Samir Pancholy is the Program Director of Fellowship in Cardiovascular Disease at The Wright Center. When considering prospective fellows, Dr. Pancholy looks for candidates who have the necessary combination of energy, knowledge, intelligence, quick decision-making and the ability to multi-task.

FEATURES

Hello, Wyoming Valley!

We recently opened our first Wright Center for Primary Care locations in Luzerne County, solidifying our commitment to providing non-discriminatory primary care services across the region been operating multiple Wright W e’ve Center for Primary Care locations

in Lackawanna County for more than 15 years and as a mission-oriented nonprofit, our organization is committed to delivering high-quality, non-discriminatory, comprehensive care to all, regardless of ability to pay. In this exciting time of expansion, we have secured exceptional healthcare leadership to care for patients and educate Family Medicine residents at these two new Wright Center locations.

New patients of all ages are welcome at both locations and all insurances, including Blue Cross, Geisinger, Medical Assistance, Medicare and more, are accepted.

Establishing and nurturing partnerships with like-minded organizations like Children’s Service Center will further strengthen our regional care delivery system. Our team is really looking forward to serving the Greater Wilkes-Barre area and surrounding communities in Luzerne County.”

—DR. LINDA THOMAS-HEMAK

16

Rebecca Kenderes

Wilkes-Barre

335 South Franklin Street, Wilkes-Barre

In Family Medicine, also commonly referred to as Family Practice, providers can see individuals of all ages and their family members, including parents, aunts/uncles, grandparents and siblings.

For me, seeing multiple family members allows me really get into the family history and understand family dynamics.”

—REBECCA KENDERES

OPENED:

Monday, January 15, 2018

DETAILS: This five-room primary care clinic is housed on the second floor of Children Service Center’s newly expanded 17,622-square-foot Outpatient Clinic Building. While the practice is located on the Children Service Center campus, it is open to the public and new patients are welcome.

Physician Assistant Rebecca Kenderes sees patients of all ages Monday–Friday and our Family Medicine faculty—Dr. Maureen Litchman, Dr. Deborah Spring and Dr. Richard English—mentor residents at this location as well.

HOURS:

Monday through Friday, 8:30am to 5:00pm

CONTACT:

570-591-5283

thewrightcenter.org/wilkes-barre

Dr. Joseph Anistranski

Old River Road 250 Old River Road, Wilkes-Barre

I’ve spent my entire career caring for patients in the Wyoming Valley.

Joining The Wright Center presents a unique opportunity for me to work with our up-andcoming physicians and I’m really looking forward to that.” ­— DR. JOSEPH ANISTRANSKI

OPENED:

Monday, February 5, 2018.

DETAILS: Led by Family Medicine physician Dr. Joseph Anistranski, a longtime resident of the Wyoming Valley, this clinic co-locates with Harrold’s Pharmacy on Old River Road to provide an extra convenience to patients who choose to fill their prescriptions at Harrold’s.

Dr. Anistranski was previously affiliated with Commonwealth Health System’s InterMountain Medical Group and all parties were committed to ensuring this change was seamless as possible for existing patients. Along with Dr. Anistranski’s continued role as Family Medicine physician, he will also serve as Wright Center faculty, educating residents and interprofessional learners at this location.

HOURS:

Monday, Wednesday and Friday from 8:30am to 5:00pm and Tuesday and Thursday from 7:30am to 4:00pm.

CONTACT:

570-826-5038

thewrightcenter.org/old-river-road

Alliance Board Susan Duckworth Joseph Ferrario James Gavin Gerard Geoffroy John Kearney Mary Marrara

Jeff Metz Carlon Preate Judith Price Dr. Jignesh Sheth Ed Staback Dr. Linda Thomas-Hemak

Graduate Medical Education Board Harold Baillie Dr. Douglas Coslett Dr. Vithal Dhaduk Joseph Ferrario James Gavin Gerard Geoffroy Sr. Mary Alice Jacquinot John Kearney

Mary Marrara Carlon Preate Dr. Julio Ramos Lia Richards-Palmiter Dr. Mary Sewatsky Dr. Jignesh Sheth Dr. Linda Thomas-Hemak

Community Health Hub Board Bryan Adkins Jim Allan Carol Chaykosky Mary Ann Chindemi Gail Cicerini Patricia DeSouza LeAnn Eshbach Gerard Geoffroy Charles Hemak Kellen Kraky

Lorraine Lupini Mary Marrara Sally Quinlin-Sheridan Bette Saxton Elaine Shepard Cara Sherman Dr. Jignesh Sheth Dr. Linda Thomas-Hemak Ellen Walko William Waters

Thank You to our Board Members who Unselfishly Dedicate their Time to The Wright Center’s Mission and Vision

The Wright Center Boards of Directors

Did you know your body changes within minutes, hours, days and years after you quit using tobacco?

After just one year of quitting tobacco your risk of heart disease is lowered to half that of a smoker. Your healthcare provider can help you make a plan that works for you; connect you with resources including individual and group coaching; and even provide Nicotine Replacement Therapy. When you are ready to quit, we are ready to back you up. Get in touch with your healthcare provider or call our Smoking Cessation Lead, Sharon Dougherty, at 570.591.5179, for more information on how we can help you get on the path to a tobacco-free lifestyle today.

Patient Engagement Council Board John Baldino Alicia Cole Dave Bieri LeeAnn Eshbach Gerard Geoffroy

Kellen Kraky Mary Marrara Carol Rubel Dr. Linda Thomas-Hemak

Medical Group Board Dr. Jumee Barooah Dr. Timothy Burke Alycia Coar Dr. William Dempsey Allyson Favuzza

Get Social With Us

Jack Walsh

Dr. Mladen Jecmenica Dr. Bojana Milekic Dr. Julio Ramos Dr. Jignesh Sheth Dr. Linda Thomas-Hemak

The Wright Loop is published four times per year for employees, residents and friends of The Wright Center. If you have a suggestion for an article or would like to submit photos, please email news@thewrightcenter.org.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grants T91HP25793, T91HP25794, and T91HP21546 of the Affordable Care Act Teaching Health Center (THC) Graduate Medical Education (GME) Payment Program. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.