 So, let me begin by introducing Dr. Evan Lyon, who is chief integrated health officer at Heartland Health Outreach, a non-profit organization that provides health care to the homeless and to the sickest and poorest people in Chicago. Until last year, Evan was a hospitalist and assistant professor in the Department of Medicine here at the university. He was also selected as a Bucksbaum Institute faculty scholar. Evan is a faculty member on the Health and Human Rights Project here and continues to serve as director of the Global Health Hospital Medicine Fellowship, a global health training program supported by the section of hospital medicine and the Center for Global Health. Evan has also served as a volunteer physician and a community health worker for partners in health for the past 20 years. I'm happy to say that he's also been my co-conspirator in teaching classes for the BSD. Today, Dr. Lyon will give a talk entitled Global Health at Home, Lessons from Haiti for Chicago. Please join me in giving a warm welcome to Dr. Evan Lyon. Thanks everyone. I will try to be a little bit brief and we're hoping perhaps to have a bit more kind of panel and discussion. Thanks Han for the introduction. You know, I was here on faculty for a number of years in, in, at the medical school and I attended at the hospital where I still do attend from time to time and maintain that affiliation. I also want to thank Susan Zash and the Human Rights Program here as I came to Chicago and started to think about this chapter of, of my life and continuing work after many, many years in Haiti. Having a program like the Human Rights Program and the Posen Center here at the university was really helpful to meet students, to get work done, to work on the trauma center campaign with the community and, and certainly to teach with folks like Renzlo and with, and, and with, with Han. So I'm thrilled to start a conversation about global health with Chicago. We are part of the globe and certainly the kinds of things that now get talked about as global health are all in action here and I wanted to point out a few things that are sort of lessons that I'm taking forward, moving from an academic center to a community based program and I'll highlight a few of our little bits and pieces. But I think approaches and ideas are more important to highlight. Last night we had a fabulous dinner hosted by the McLean's at, at their home and Han made some introductory comments about, you know, kind of Paul and, and putting his old friend on the spot and, and brought up this reality that we as caregivers work for a biopsychosocial reality. My son's often bothering me about not taking care of animals. He says, why doesn't your hospital take care of animals? Why don't you, you know, why don't you have a veterinary hospital at the university? We have just one species that we tried to care for, but I think there's some limitations in the approach and certainly Haiti, you know, has taught me and many others about this. Social, uh, social, psycho, bio doesn't really roll off the tongue like biopsychosocial. Neither does, neither does that need to practice, biopsychosocial. But I wanted to invert the order because in practice, to me, this feels like the right order. Um, biology and the biosciences and what I can do as a medical practitioner, um, feels limited often, um, and certainly comes after many other realities that are brought to the table, to an encounter, to relationships, and so I think grappling with the breadth of human condition and human needs means dealing with social context, dealing with the psychological, interpersonal, and certainly biology has a role. Um, it's been, it's been heartening, you know, I've had the privilege of working with Paul and the team in Haiti for 20 years and, and kind of around this for some short time. Um, there's increasing recognition of social determinants, social determination, um, and that's encouraging. Certainly the idea of social medicine is much older, um, inclusive of a lot of the different disciplines that we, um, work from, whether it's medicine or public health or anthropology, social sciences. Um, but I think, I think a little pause on this for a second is helpful. Um, it's, it's heartening that social determination is being talked about increasingly. I also feel like it's being talked about in ways that are somewhat limiting. So now I meet with people who run clinics or hospitals or care coordination structures or even payers who use the language of social determinants, but are thinking in very small details. And I, I hear this come up over and again, um, we need to work on the social determinants of our patients and, and I say, great, thanks, but we're not talking about poverty reduction, about housing, about safety, about neighborhood inclusiveness, about, um, jobs. Um, and so I think that ball is moving forward, but there's still some very serious limitations and there's a bit of a bureaucratic nature to some of this language that might be setting us back and, um, remembering that social determination, the bio-social, psycho-social reality of what makes people sick or well, um, is really what we're grappling with. And, um, a bit of time ago in the 19th century, you know, the, the prospect that medicine really is a social science, um, maybe Han will have some things to say about this, um, and, and certainly that all we do to give care and to work in communities is an act of political engagement and personal engagement, um, is something we need to work from and, um, and, and keep ourselves oriented. Just a, a bit of a local plug as, um, students of Paul and our friends in Haiti, we've been working to keep in action some of this, uh, some of this work and some of this teaching through a thing we call the social medicine consortium. If folks want to talk about that later, I would love to. We're keeping some momentum here in Chicago to work together, think together, engage in community and, and try to teach each other for, um, medical systems that really, um, or medical education that really does not address most of this. Um, if anyone here has been through clinical training, um, I would be surprised if deep engagement in history, social context, um, inequities, um, are really on the table either as content and certainly as skills, as competencies, um, as caregivers. Um, I promise I'll talk about Haiti in one second. Uh, quick plug for history. Uh, I won't go on long, but first lesson for me coming to Haiti was, wow, I need to understand this place, uh, its history, um, going back as far as possible. And, um, thankfully for a place like Haiti, there's a lot of great, uh, literature and teaching and, and shared memory. People in Haiti talk about the revolution frequently when they're trying to make a point to me as a newcomer or someone who needs to be taught, uh, what, what's going on. Um, there's a long history here, right here on this, you know, piece of ground where we're sitting. We're part of a colonial project that's ongoing. Um, I did house calls on the south side of Chicago for a couple of years from the university. Two thirds of my patients were born in the south and migrated north. Understanding and enjoying that history is, I think, an important clinical skill, certainly in terms of communication and often practically to think about people's families and, and the way they've come to, uh, come to this part of the world. And then the ongoing pressures of slavery segregation, um, Jim Crow and, and increasingly or continuing the new Jim Crow of, uh, industrial strength incarceration is stuff we have to keep, keep in mind. Um, just this year, um, uh, the, the, um, number of people in Chicago who primarily speaks Spanish or mostly, um, either first, second or third or more generations from Mexico mostly, um, has surpassed the number of, uh, African American folks in our city. So understanding that history and getting to know that community is vital. Um, the first thing I learned in Haiti from seeing patients was to listen and I realized that's not terribly practical advice, but, um, it really was a lesson in clinic. We would see 30, 40, 50 people a day. And as I was taught, I often will start with a very simple question. How are you? How are you doing? Almost everyone would answer something like bagging my mom, bagging papa, back up. I don't have a mother. I don't have a father. I can't plant anything. The earth is dry. And often this was five minutes, 10 minutes of their concerns. That is their complaint. And we try to come around to something physical, something that I might lend a hand on, something that might give me a good reason to offer diagnostics or therapeutics. But really the story over and again of why someone came, why these folks came to our hospital because of these conditions of not having a mother, not having a father. What does that mean? I think that means I'm poor. I don't have anyone watching for me. I feel alone. Um, so listening from there and starting to think about clinical practice, starting to think about how to address these issues, um, was reinforced daily. Um, and I try to continue that here, um, in Chicago and all the kind of work that we're doing. Certainly community health work approaches are, um, work that I learned in Haiti. Again, that wasn't, um, very much on the curriculum at the medical school where I, where I went. Um, but, um, working through community partnerships and I won't talk about that too much. Well, I think I skipped something. Um, the other, the other thing that, that I learned in Haiti and practiced here and continue to practice is the work of, um, seeing people in their homes. Um, I would estimate many of us have not been in poor people's homes here in Chicago. Um, certainly not repeatedly. Um, but to really understand social determinants and the social pressures that make people sick, being in someone's home, sitting down with them, seeing four rickety stairs as the social determinant of someone's health. If they can't get out of the house, then their healthcare is deeply compromised. Or if their, their corner is a little bit active with, um, uh, too, too much, uh, uh, going on that they fear going out of the house, access to food, et cetera, et cetera. Knowing those social determinants physically by visiting people in their homes, um, I think it's something that could teach all of us and, um, again, that those are, those are practices that my Haitian friends, you know, taught us over the years. Um, and even more plainly, I think one limitation here is that we don't live in the places that we work. There's about a 12 year life expectancy gap between Hyde Park and Washington Park. And in a place like Haiti, welcomed in by the communities and taught by, uh, friends there, we did for some time, you know, our privileges are the same, but we did live together and we did live in a place that could let us understand what's actually going on. I think we lack that here and it's a solvable problem by building structures, by employing community members, by moving out. Um, let me, let me stop with just a, a few things, um, partially out of local concern. So I, I went from the university to join, uh, Heartland Health Outreach, which is a, uh, a non-profit organization taking care of people experiencing homelessness. We do both primary care, dental care. Our oral health director is here today. Um, uh, psychiatric care and behavioral health work. Um, we're a community behavioral health center in addition to these other primary care resources. And what's to me most exciting about it is the community health work that happens from this platform. We have outreach workers who are every day on the street, under a bridge, meeting people, engaging with people, solving their problems, not as a technical intervention, but as a human intervention to reach people and try to pull them into care. Often the barrier between housing and not housing is something like an identification, some official identification. Maybe it's getting, um, their criminal record expunged so they can move into housing. These basic things that need to be supported and worked through. Um, community treatment for mental illness in this city is very inspiring. We have a team of eight people now that supports about 70 people in the community living with serious mental illness. They see them always away from the center, um, at least three times a week, sometimes seven and eight times a week. Some of it is medication assistance. Some of it is connecting to the nurse or primary care person, but a lot of it is just taking a walk, thinking through a problem, going to the grocery, paying a bill, little, uh, or not little, um, important human things that are done. And the, the effect of that, um, is, uh, you know, well beyond what we can offer in terms of medications. Um, and I wanted to highlight two, two small projects and then I'll get off the stage. Um, with the University of Chicago, um, we opened a place called the supportive release centers just outside the Cook County Jail. You may know that this, the Cook County Jail is the largest mental health institution in the country. Um, this center allows a space for people coming out of incarceration to land with us, get connected to services, clothes, food, shelter, and primary care. So every Friday morning, this is where I go and practice. We're putting resources toward the people that need them and trying to slow some of the pressures that are keeping these people in a cycle of, of impoverishment and vulnerability. And, and this work is coming up with the University of Chicago Urban Labs. Last thing I'll mention as an invitation, we're going to open a health center at 55th and Halstead. So just down the block. Um, we feel very confident we can do primary care and mental health care and we're going to need friends. So we are moving to the neighborhood with a very fine medical institution. It'll be great to continue collaboration and to work on some of these, some of these community, uh, community needs through that kind of partnership. So I'll look forward to that and pass it on to Renslow.