Kelly Orringer, MD: Reaching out
Outreach opportunities give med students exposure to learning about and caring for the most vulnerable patients
Kelly Orringer, M.D. is an assistant clinical professor of Pediatrics and serves as the Division Director for General Pediatrics. For the past 20 years, Dr. Orringer has led the UMMS clinic outreach to migrant farmworkers (MFW) in Lenawee County. Michigan has the fourth largest population of migrant farmworkers in the country. One night each week in the summer, Dr. Orringer along with Drs. Cathy Kim and Eleanor Sun and other faculty colleagues in Internal Medicine, Pediatrics and Family Medicine carpool with our medical students and residents to various farms in Lenawee County to participate in mobile clinics at a rotating group of local farms where migrant farm workers are housed. Here, Dr. Orringer answers 11 questions about how she got started caring for underserved patients and why it’s important to train the next generation of physician leaders to do the same.
I was first exposed to MFW in 1996 during my community health rotation. Dr. Terry Joiner sent me out with a public health nurse to DuRussell Potato Farm in Manchester. They had a longstanding partnership with the federally qualified migrant health center in Saginaw to host a weekly clinic. Then a couple years later I joined with a faculty mentor to launch a new outreach in Lenawee County, partnering with Community Action Agency in Adrian.
It is a mobile low-resource clinic. We rely on student, resident and faculty volunteers. The faculty bring a lot of the medications, supplies and books for the clients. We aim to deliver basic health and nutrition information, do screenings for diabetes and high blood pressure, manage acute and chronic conditions as best we can, and identify the rare farmworker with a serious condition that needs to be seen in a local clinic or hospital for more detailed diagnostic evaluation. In the past, it was a mix of families and young men and women. In the past three years, it’s been almost exclusively young men coming on work visas from Mexico to work at one specific farm. The workers are not actually migrant any longer but that may change again in the future.
We have a longstanding partnership with LANAMA, and each year the new leaders of this group meet with the faculty preceptors to generate the calendar and set up for the summer clinic season. Word of mouth is how many students learn about this. We also present at a lunch series and are part of the Second Look Weekend volunteer fair.
It is variable how many volunteer. We like to have about four students each evening. It’s great if you speak Spanish but not required. The students pair up with a resident (medicine, family med, med/peds, peds) and work as a team. It’s a good opportunity to practice history taking, basic examination skills, and using your medical Spanish if you have the capability.
I completed a two-year fellowship in general academic pediatrics with a focus on underserved children and advocacy. This training really sharpened my interest in and passion for caring for immigrant and migrant children, which remains really essential to my pediatric practice now. It helped give me a broader vision of health, to recognize how language, culture, economics, politics and geography impact child health and the role of the pediatrician as an advocate for all children.
I am very excited about this and really hope it will come to fruition soon. Dr. Michelle Riba in psychiatry and I have been meeting with staff from two agencies that care for the large number of unaccompanied immigrant and refugee children and young adults. The agencies, Samaritas and Bethany Christian Services, are caring for several hundred children in Michigan. Many of them lack a medical home and their medical coverage is challenging to work with. We are trying to work with the agencies, the Office of Refugee Resettlement, and the children’s health care insurers, to get some of our pediatric and psychiatry faculty set up to care for these young people. At the same time, Dr. Layla Mohammed and colleagues at Ypsilanti Health Center are launching a child refugee health clinic in collaboration with Jewish Family Services.
I enjoy working with students who are developing a similar passion to care for these populations. They bring a lot of great ideas for improving clinical care and partnering with other U-M departments and schools, which is really necessary if we hope to effectively address the various social determinants of health that impact these populations.
I think it’s important for students to see that this type of outreach for underserved care and advocacy is as important as lab research and clinical trials. U-M med students have so many options for their future careers. I am just a small piece of the puzzle that together shows them all the options open to them.
Their energy, enthusiasm, optimism and willingness to try new things, get out of their comfort zone. Also their generosity in participating so actively in this outreach year after year.
Spend time with my family (my husband Jeff is a professor of dermatology, my son is an M1 at UCSF, my daughter is a junior at Williams college) and my three dogs. Travel to Lake Michigan and British Columbia. Read. Exercise.
I would encourage students who are interested in outreach opportunities to talk to current students and faculty about all the wonderful volunteer and free clinics that we have at UMMS. There are so many great opportunities and also support to create new ones. The partnerships with the Ford School of Public Policy, the School of Public Health, and the Law School also allow students to bridge medicine with social justice in very unique and meaningful ways.