Day 5

Holding our coins from MRC and RADM Moritsugu 

 Last day of the internship started off with our Project Presentations. Most of the interns spent the whole night finalizing and preparing for this presentation. We each had different projects that met our interest. Topics included: Investment Payback, Youth Engagement Guide (both student and advisor perspectives), MRC Mentorship Program, Use of Social Media, as well as Twitter Tracking. Everyone was full of anxiety and excitement. As each of us presented in front of most of the MRC Office of Surgeon General Staff, along with National HOSA on conference call, we were able to give our insight and input to enhancing MRC. At the end, the Office complimented each of our projects and thanked us for making a difference. It surprised all of us how humble the staff members were and respectful. They truly listened to our insights and brainstormed ways to make a better future. Once our presentations were finished, we all came around in a circle to discuss what we liked about the internship program and what we could improve.  One thing for sure that all the interns agreed with is that it is a life changing experience! All of us came expecting to narrow our goals in the health field; however, the internship broadened our perspectives and opened numerous doors of opportunity. If there is one thing we learned from this internship is that always plan, but do not become obsessive over the plan for everything changes and never goes the way you plan. Instead, the process of planning leads you to even more opportunities. After the discussion, each one of the interns were awarded with a certificate signed by Acting Surgeon General Lusniak and Captain Tossato and were given a MRC platinum coin. Then we made a trip to a local Taco Truck. Even then, the learning did not stop. Captain Tossato told us that wherever he gets deployed, he always tries new food. He then told us that one needs to explore and stay open minded in order to succeed. Our adventures did not end at the taco truck. We ended our last two lectures from Officer Greg Davis and Allison Roper from Health People 2020. Roper gave a brief of a program called Healthy Living. It is a program that helps people make healthier choices. She mentioned that this program is not only used in governmental branches, but also corporations and partners- even HOSA can partake in the program! Her brief opened another perspective regarding policy. Many of us think why not change this and that because of studies that we’ve read. However, it is not just about the case study. When deciding to change policy, you have to consider the side effects, social well-being, and even finances. For example, just because studies show that adolescent show improvement in performance if school starts later, doesn’t mean we can just change school start times. The policy contains transportation systems and even family situations-what if the adolescent has to come home before the younger sibling in order to baby-sit them. The family is then placed with a financial burden, if the school times change and the younger child comes home first.  On the other hand, Officer Davis shared with us about policy regarding Uniformed Services, including the new Tobacco Policy- where no one in uniform can smoke cigarettes. Part of this policy is to campaign “actions speak louder than words.” Once all the lectures were finished, we said our last goodbyes with the Office of Surgeon General Staff. We left them a card of appreciation, although it cannot express fully our thankful hearts of all that they have taught us. Everyone felt like family; it was hard to say goodbye. The staff constantly reminded us to reach out to them in times of need, that our internship does not end with this week, but continues for life. Once an OSG intern, you’re always an OSG intern. ENS Trey Draude dropped us off at the hotel and escorted us to the door and saluted goodbye. We want to give a special shout out to him for all that he has done for us. We wish him the best in his journey. All the high-ranked officers were inspirational, but ENS Draude definitely inspired us throughout the week to go and achieve our dreams! His passion for health care and caring manor was truly inspiring. We thank HOSA and the Office of Surgeon General for providing all of us with this unique, life-changing experience. Thank you.

Group photo with Officer Davis

Day 4

Today we started the day with Ensign Trey Draude and rode Metro over to Bethesda, Maryland.  We started with a small walkthrough of Walter Reed Medical Center.  Yes..Walter Reed Medical Center.  What an honor to even step foot into a hospital of that caliber.

We then shuttled over to the USUHS or Uniformed Services University of the Health Sciences.  Or as many call it, the best kept secret in medical schools.  This is a fabulous opportunity for the student who doesn’t want to incur $150,000 to $200,000 in debt going to medical school or graduate nursing school.  Here is the rundown per Dr. Aaron Saguil.  Complete your undergraduate studies, with competencies in science, teamwork, service, ethical behavior, responsibility and reliability, as well as social and psychological stability, a GPA of 3.5ish, MCAT score of 31ish and then apply to USUHS.  They will pay you $57,000 per year to be a full time student with tuition and books completely paid for.  In return, you will pay back 7 years to the uniformed services of our nation, working as an MD or PhD while gaining massive amounts of experience to carry back to private practice upon completion.  I don’t know about you…but that is one major deal for any student looking for a way to pay for medical school.  Oh and by the way, the library is available to you 24 hours a day, the lectures are all recorded and available online and the only requirement on your part is to form study groups, share notes, be helpful and supportive of one another and get involved in the life of the university community.  Which is about the size of the local community college.  We toured their gross anatomy lab and yes they still have a cadaver lab with student access 24 hours a day and residency access from Walter Reed as well. The anatomy lab director was kind enough to let us tour the entire lab. We got to see the "power house", a box full of brains! He explained to us the laboratory process that students have to go trough. Soon after, we took a tour around the Graduate school of Nursing.Our HOSA interns met with several medical students and asked questions and took pictures.  That was the best picture in the bunch. We loved that the graduate students were encouraging us to step up. 

We followed lunch with a meeting with several people from NACCHO (National Association of County and City Health Officials).  This is a non-profit organization that provides resources to health departments all over the nation to strengthen them and support them in so many ways I can never cover it all.  The information received by this group was so varied and extensive.  They help with initiatives from several departments within the government and I think the best one can do to get information on them is to check out their website and look at their connections and ties. When we were done meeting the NACCHO, the program director escorted us to the main lobby. We found out that she had something in common with us, HOSA! She is one out of the 2.2 million alumni that HOSA has. She is from the Florida delegation, so her and Devindra got to talk more about their HOSA experiences at a local level.

The day ended with the interns heading into George Washington University for dinner, and sightseeing. 

 Past National Secondary Board Rep - Nae Won, and Current National PS/C VP -Devindra Persad exploring the study cabins in the Resource Center.

 HOSA Interns meeting with graduate students understanding what life in graduate school is all about.

 HOSA Interns getting ready to study!

 HOSA Interns learning all about the Graduate School of Nursing!

Graduate student Vega was lecturing to the HOSA Interns about the classes offered at the University!

Day 3

This morning we met at the Department of Health and Human Services… the Hubert Humphrey Building.  There was a quote on the wall that he made that I thought was very appropriate.  “The moral test of a government is how that government treats those who are in the dawn of life – the children; the twilight of life – the elderly; and the shadows of life – the sick, the needy and the handicapped.”

We started our tour in the SOC – the Secretary’s Operations Center with Daniel Finnen.  He explained what the operations center did.  It is a communications center manned 24/7/365.  Its purpose is to be a focal point of the US concerning a public health and/or a medical emergency event.  In the event of an emergency, the SOC supports decision making by collecting, analyzing and disseminating information to decision makers. 

There are 4 sections:  The watch officer, information management support, GIS support and Information tech support.  The SOC only deals with federal response.  The watch officers maintain situational awareness of all public health and medical events and incidents with a potential national impact.  The IMS facilitates the information sharing process by generating reports and briefs.  The GIS does geospatial analysis and creates visualization products and ITS provides tech support.

The SOC can connect directly to the Office of Secretary, Assistant Secretary for Preparedness and Response, Office of Emergency Management.  There are many computer applications being used including the WebEOC, GIS map, SOC portal, MedMap, HAvBED.

The National Response Framework makes a single framework to be used by all for codes, communications and processing, so as to pull all groups and agencies together.

The HHS role in this is the coordinator and primary agency for ESF#8 (Emergency Support Functions).  8 is public health and medical services.

The primary resources are MRC, NDMS, PHS, Strategic National Stockpile (meds and supplies in secret locations all over the US), CDC, FDA, NIH.

#8 Responsibilities include mass fatality management, decontamination, victim ID, health surveillance, veterinary medicine support, health and medical support, patient care and evacuation. 

Preparing for incidents and events.  Incidents are unplanned – you prepare if able, and Events are planned – prestaging is done.

Response and recovery can take many, many days to get people back on their feet.

We then met with Dawn Alley, PhD, the Senior Policy Advisor for the Office of the Surgeon General.  She works with strategic partnerships related to initiatives of the OSG.  Much of what affects health is behavior, relationships and the community.  The Affordable Care Act provides leverage to get patients to think beyond the MD’s office to improve health.  To prevent disease, things must happen in the community. 

National Prevention Council – 20 federal departments and agencies to provide coordination and development to improve health from the federal level.  The NPC is beginning to engage other components to improve the populations health. 

The Affordable Care Act now provides opportunity to make that change. 

“Evidence based things turn into policy”

There is evidence that just providing foods to areas do not solve the problems of the relationship between food and health.  (Just because you provide fresh fruit at the grocery store doesn’t mean people will buy it and eat it.)  Access must be coupled with education. 

The USDA has recipes that meet dietary guidelines at a low cost.  But getting people to access these and follow them comes with education.

We then met with Ted Kennedy, the head of response operations…not the Ted Kennedy you may be thinking of…the “other” Ted Kennedy…not relation to the Kennedy clan.  He had a fabulous PPT with so much info I could not keep up. 

“All bleeding eventually stops and fires go out…it is about how that process happens.”

It used to be resources, but now its about coordination and communication.

Organizations that functioned very well individually failed when working together. 

The NIMS philosophy:  Words mean something, incidents should be managed, standardization helps.  NIMS was created for the safety of the responders and accomplishment of objectives.

TEDS RULES:  Don’t become a victim, Be self sufficient and self sustainable, Speak the language and Get engaged.

“The disaster site is not the place to exchange business cards”  Get to know each other before the disaster.  The Feds will support, but never supplant the local authorities.  All disasters are local and to get federal support, the governor must request help and president my declare an emergency. 

“We deploy assets and the field applies them”

“Lets go in and chat death and save lives”

The challenge is to get the right asset or resource to the right place at the right time with the right support.

After lunch, we went to the three senator’s offices.  The senate was not in session so we met with each of their aides.  We were escorted by Natalie Torentinos who is part of Washington HOSA (a lobbyist basically).   We presented to each of the aides what HOSA was, how it operates at the chapter, area, state and national level, the benefits for students to be a part of the HOSA CTSO, how it connects to HSTE and CTE and the importance of academic achievement for HOSA students, as well as the benefit of professionalism that is gained through HOSA activities.  Only one of the three had heard of HOSA.  We also discussed with each aide the Affordable Care Act. We discussed with each the need for continued education at the high school and collegiate level in the area of health care professions and the need for federal support to ensure this need is met, as the population is aging and health care needs are rising.  

First Senator Ted Cruz (R) from Texas.  Aide Kenny Stein. We spoke about what the Senator was doing to support Career and Technical Education at the local level. Kenny informed us that most of these decisions were made at the state level. He did go on to inform us that Senator Cruz is a huge supporter of education in the senate, and is working on getting more funding for students.

Second Senator Marco Rubio (R) from Florida.  Aide Maggie Dougherty. She informed us that career and technical education should be state based, but at least stated that there needs to be stronger dialogue regarding the solutions to ACA issues. She informed us that Senator Rubio has a strong passion for students who have a goal set for their future. His family is dealing with some health problems, and the Senator has a huge interest in our nations health care and its health care providers. Intern Devindra Persad, resident of Rubio's state, informed the Legislative Assistant on how HOSA is impacting the Miami community. He also shared his HOSA story with the representative. In return, the assistant gave Devindra information about local offices that he can visit to better represent HOSA. 

Third Senator Kay Hagen (D) from North Carolina.  Aide Josh Teitelbaum.  This aide was very familiar with the ACA, as Senator Hagen voted “for” it.  He obviously had read it and had answers to most of our questions as to how it would operate.  He stated Hagen was the chair of the sub-committee on children and families and active in Title 7 and 8 funding regarding nursing education.  He stated the Senator works with an emphasis on primary care with an expanding pool of health care professionals.  Also that she is supportive of the core provisions, including access for all, tax credits and improved Diabetes care, but there are still some areas she disagrees with.  All must be gotten into the health insurance pool.  Tax credits will help people buy insurance.  To pay back the government for the credits, the AMA, nursing associations and hospitals who were in support of the bill we willing to accept decrease in profit from current insured as there would be a greater customer base which would increase profits over time.  HOSA could be used to educate on the need for everyone to sign up for insurance.  Go to the available exchanges to get insurance if you are not offered affordable insurance by your employer.  To help ensure physicians don’t abuse the system, there will be penalties for hospital re admissions.  The way to prevent re admissions is to do preventive care up front through nurse phone calls and through discharge planning on admission.  Also bonus payments would be given to PCP’s so as to get them to go into an area of need – PCP rather than specialty. 

We ended our evening by having dinner with the interns, ENS Draude, Captain Tosatto, and HOSA representative Nancy Allen. The interns then had the chance to embark on a breathtaking tour of our nations capital with Captain Tosatto and ENS Draude.

 HOSA interns with ENS Draude at the Lincoln Memorial

 HOSA Interns at the Lincoln Memorial

 HOSA Interns infront of Senator Marco Rubio(FL) office.

 HOSA Interns infront of Senator Kay Hagen(NC) office.

 HOSA Interns with Ted Kenny at the U.S Department of Health and Human Services.

 HOSA Interns in front of the White House.

 HOSA Interns inside the Secretary's Operations Center at the U.S Department of Health and Human Services.

 HOSA Interns ending their long day with an amazing dinner at Matchbox, Washington D.C.

 HOSA Interns with OSG Policy Advisor Dawn Alley.

 HOSA Interns outside Senator Ted Cruz(TX) office.

 HOSA Interns on Capitol Hill!

 Chinatown!

 HOSA Intern Devindra Persad visiting the Vietnam Nurse Memorial.

 HOSA members visiting the amazing Albert Einstein Monument.

 HOSA members taking in the amazing view of the Washington Monument, and the National Mall.

Inside the SOC!

Day 2

This morning we were privileged to meet the Acting Surgeon General Boris Lushniak and the Acting Deputy Surgeon General Scott Giberson.  It was a round table setting and we were able to speak freely and openly with questions and comments.  IT WAS AMAZING!

RADM Scott Giberson initiated the dialogue.  With a background in pharmacy and international health, overseas experiences in 23 countries, and leadership in bioterrorism of a unit in 2002 and later 5 states, RADM Giberson clearly spoke from the heart when he offered us valuable pieces of advice, including his recipe for success, whose ingredients include “hard work, timing, luck and never saying no.”  He reminded us that we should pace ourselves and not be afraid when trying to advance our portfolio, that  often we find success and immense potential in areas in which we were previously uncomfortable.

Interestingly enough, RADM Boris Lushniak had achieved his success and position through a very different route but using a very similar personal philosophy. After completing a 6-year medical program, obtaining his master’s degree in public health, and completing a residency in family practice, followed by work in the Epidemic Intelligence Service, CDC, dermatology, occupational medicine, counter terrorism, and FDA, and eventually becoming the ASG, Lushniak had learned that “the key to moving forward is to never think that once you become something, that is it.”  One has to reassess himself every 5 years and continue with life and goals.

ASG Lushniak also talked about the importance of camaraderie and support structures, which are needed in stressful situations to dilute and share some of the burdens of overwhelming stress. At other times, it may be necessary to be the support structure for someone else as well.

About the USPHS specifically, he reminded us that the United States is the only nation to have a uniformed service in public health, and it deserves to be so because these forces are just as proud to serve and protect their nation using hypodermic needles instead of missiles and vaccines instead of bombs.  It humbles him to serve his officers.  When asked about entry into the PHS, he stated some requirements:  One must be younger than 44 upon entry, with at least a  Master’s or Doctorate level degree, having served the underserved and/or vulnerable, physically fit and medically clear.  There is NOT a shortage of people meeting these qualifications, so that all prospective employees are forced to step up their game.

He left us with some final golden advice: "Life is the ability to tell stories about what you have done. Live your life like a story book, filled with excitement."

We then were able to attend the Office of the Surgeon General Promotion and Awards Ceremony.  This was a ceremony that recognized officers moving up in rank and others with special commendations and certificates of appreciation from RADM Boris Lushniak.  There were many officers present as well as their families and their work was being recognized in a very special way.   This occasion also allowed all to reminisce on the fact that the USPHS was a very different, unorganized entity only 20 years before- “people in costumes,” as was once described by a friend of Lushniak.  Now, it has evolved into an organization of people with “dedication and mission.”

The promotions, awards and certificates were given and we all had an opportunity to get our picture taken with the ASG.  He was so humble and willing.  It was truly a great morning.  The most amazing part of it was that when we would shake his hand to thank him, he would thank US!  He thanked Mrs. Lisa Cranford for being a mentor to students, which greatly stunned her but inspired her to keep changing lives, one at a time.

We then got to meet with Captain Reed.  He spent many years as a Navy Pediatrician.  His background included an advisory committee overseeing cases of child abuse with the Family Advocacy Program, years in pediatric rheumatology, years as the administrator of a pediatric unit in Bethesda, and finally humanitarian assistance and disaster response in the USPHS.

He told us that we are often called to do things that we are not trained to do, but through these we find that we have the capacity we never imagined we have. 

His main topic of conversation, however, was about Strategic Development.  Dwight Eisenhower once said that “planning is everything and a plan is nothing.”  He talked about how circumstances are never what they are planned to be, about looking over the horizon instead of at all the deficits to be fixed.  Bottom line: Use Future Based Thinking.  This creates methods and approaches to get out of the here and now and to what we could be.  Ask…”so what?” meaning “what is the essence, meaning, nad value of this?”   This encourages Strategic thought. 

He then continued to explain how to make The Elevator Speech, a 30 to 45 second introduction meant to not only make an impression, but leave an impression and make someone seek out the information you carry.  How do we do this?  Answer:  Speak sincerely!  Share something personal related to the subject and then drive it home.  Say it from the heart.  It shows you believe in what you are saying.  You won’t hook someone with facts.  First relate personally, then they will ask you for the facts.  Talk about what you love and the things that mean something to you.   Perhaps use a vision statement, one which creates an image in the mind

CAPT Reed’s final word of advice- “Realize you are going to fail.”

We then met with LCDR Tracy Branch with the Office of Minority Health.  She gave us many statistics and factual information on her office, their work with the community and populations, and their initiatives.  She had a wealth of information about research and assistance for students as well.  She discussed the Affordable Care Act and clarified many aspects of it for us. 

All in all, today was an inspirational day for us all, full of varied and humble advice.  Of course, it was an extreme honor to meet those who have achieved ranks that truly reflect the quality of service they have provided us, our nation, and humanity.

 HOSA Interns with Acting Surgeon General Lushniak

 HOSA Interns preparing for the USPHS promotion award ceremony.

 HOSA Interns having dinner in Georgetown, Washington D.C.

 HOSA Interns meeting with the Office of Minority Health.

 HOSA Interns got to taste the delicacy of Washington D.C at Georgetown Cupcake!

HOSA Interns saying goodbye to Commander Denis, and thanking him for all of his great information he had to share.

Day 1

Today, was filled with excitement as we started our first day at the Office of the Surgeon General. 

When we arrived, we were greeted by ENS Draude who took us to a room where LCDR Skip Payne presented to us about the US Public Health Service. He shared his story about how he became an epidemiologist and told us that we can try to plan our future, but it often changes spontaneously. LCDR Payne gave us insight on the JRCOSTEP and Senior COSTEP internship opportunities through the USPHS. The JRCOSTEP is paid internships that last from 30 days to 4 months where you can choose from clinical or administrative health fields. The Senior COSTEP is an internship with an 18 month obligation to the USPHS. To find out more information about the internships you can see the student opportunities and training tab at USPHS.gov. 

Next we heard from CAPT Robert Tosatto about the Division of the Civilian Volunteer Medical Reserve Corps (DCVMRC). CAPT Tosatto told us about how he started off with 42 MRC units nationwide and nearly 10 years later, the number of MRC units have almost reached to 1,000 units! He told us that MRC is about the hands in and not asking hands out- that the MRC is there to help other partners not other partners give to the MRC. 

We got the pleasure to meet Retired Acting Surgeon General, RADM Kennith P. Moritsugu, who was a very humble and personable inspiration.  He sat and talked a bit about his experiences as a former Acting Surgeon General, being fortunate with the experiences of being in both democratic and republican administration during the 10 years he was in office. He listened to our dreams and ambitions and personalized feedback to each of the interns by advice about advancing our futures. The most important advice he gave us was how we need to gather our information and "connecting the dots" in figuring out our future goals. He also shared that prevention isn't just about preventing disease, but that there are three stages of prevention; Primary, Secondary and Tertiary (Primary is preventing the disease from happening, Secondary is prevent further spread of disease with a person who already had the disease and Tertiary is preventing the long term complications). RADM Moritsugu continued to then share his experience as being the chairman of the diabetes institute for Johnson and Johnson, an inspiration from being a diabetic himself. He said the most important concept of health care is health literacy. He gave the example of how 23 million people have diabetes and 75 million have pre-diabetes and many people cannot understand what the means... and then simplified that 1 in every 3 people have diabetes. Health literacy is about making it understandable to the general public, not using health jargon that only makes you sound intelligent. This only causes three fingers to point back at you when blaming the person for not understanding you. When it was time for him to leave, he showed humility by holding the door for us as we walked into the lobby to take a photo. 

We then proceed to a Thai restaurant where we celebrated one of the members, Dagayla Burks, who just received her master's! Congrats!

After lunch we heard from CDR Patrick Denis, an accountant, then a nurse and finally deputy Director for Training and Support Services in the Division of the Civilian Volunteer Medical Reserve Corps. He taught us the importance of "sniffing" those you meet, to help you get a feel of how other people think and can help you succeed. 

Today was a great day and we look forward to the excitement of the rest of the week! :)