Updated 12/12/03
Health and Literacy Weblog
Previous Weblogs
June 10
Completing Our Unit on Medicines
Last Thursday, in order to provide the students with a summary of same basic terms and information concerning medicine and to acquaint the students with PDF files, I had them go on the Internet Site: http://www.esl-images.com. This is a site I had used previously to obtain handouts for the students, but this is the first time they had seen the actual site. I helped the students type in the correct address and then click on lesson plans. There is a section under lesson plans entitled theme lessons and I instructed them to find the ones on health. I introduced them to the entire health unit even though we were currently working on medicines. I wanted them to see the material we had worked on before. I believe this unit is very clearly laid out and has a great deal of easy-to-read texts as well as good exercises; it would also be appropriate for a Level 2 ESOL class.
I showed the students how to read a PDF file-the icons, arrows, and sections. They went through the pages until they reached the reading on Drugs and Medicines. I first had them read the text silently and then we read it aloud, giving different students a chance to read sentences. Afterwards, I had them move to the next page containing exercises. Instead of printing the exercises, we went through them orally. Even though I believe they found it quite easy, I think they gained something from the activity. By understanding the vocabulary and answering the questions correctly, they are adding to self-confidence and competence.
On Friday (the next day), I gave them a short quiz on medicines. Previously, I had planned to give them a sheet that I had made up where they worked on grammar and knowledge of medicines. However, as I was looking through some ESL Textbooks, (SOS and Navigator) I came across some material that I thought related more to the TOFLHA test they had taken as a pre-test and would test whether they understood labels and directions. Well, they found this test exceptionally easy and almost everyone got 100%. I think I should have given them the first test I had planned. Therefore, on Monday, I gave them that to do as an exercise. As I had suspected, although they did well on this, they made more errors. So, now I will leave this unit not having accomplished all that I had hoped. I really wanted to have them do more calculating-perhaps with costs or dosages, but I have to move on as I only have a few weeks left to the term.Introducing the Topic of Insurance
In the United States, is very important to have access to health insurance. Many of my students are ineligible because of their immigration status, but they are all very interested in this topic. I decided to use my colleague's lesson. Ms. Diana Raissis teaches ESL Health Pre-Voc and her students are about the same level as mine. Our school team involved in this project consists of Diana Raissis, Steve Meyerson, and myself. We try to share ideas whenever possible.
On Wednesday, I began this lesson and hope to complete it tomorrow and/or Monday. It begins with three pre-reading questions: (1) How can you get health insurance in the U.S.? (2) In your country, who pays for health care? Individuals? Employers? The government? (3) What system do you think works well?
The students knew that many people in the United States get insurance from their jobs. Some knew that individuals could also pay for their own. We discussed health care in their countries and they said aside from the government hospitals, patients had to pay for health care. Then I had the students read the passage that addresses this subject. After they read it silently, we discussed the following questions: (1) What are the two ways of getting health insurance in the U.S.? (2) Do you think it is better to pay the cost of health insurance or save the money and hope to stay healthy? The students had a little bit of confusion trying to answer the second question. They started to say that it's good to save money and to stay healthy, but then they realized that the question meant that given a could be sure to stay healthy.
We then went over Words to Know that included nouns, verbs, adjectives, and expressions. A few of them were arrangement, insurance carrier, release form, requisition form, HMO, PPO, in-network, out-of-network, to apply, notify, resubmit, owe, update, accurate, confused, frustrated, monthly, rush, otherwise, ASAP, feel free to call me, I'll give you the number. These words relate to the three conversations that follow.
We read the instructions asking the students to listen to the conversations that take place at a medical facility. Carl is a new file clerk in the medical records department and Lisa is a biller. I read the conversations to the students and then had the male students read one part of each and the female students the other part. The first conversation was between the two workers, but the other two were between patients and Lisa. The students seemed to have a lot of fun doing this and asked some questions. Afterwards they had two complete two exercises based on these conversations. The first one was a True or False based on the role of the biller while the second required them to decide who said the statement, biller or patient. Some of the true-false questions were confusing. We had to discuss the reasons for some of the answers.
How did I feel about the lesson?
To be honest, I was very disappointed that only twelve students came to class that day. Two of these students had to leave early. The program is supposed to be for all my students, of which I have 19 or 20 and I don't wish to repeat this material again on Friday. Now that it's June, attendance isn't as good as before, but I still wish to finish the project and do an adequate job. The students were quite involved and I believe they were able to do a good job with the reading, conversations and exercises. I wish it weren't June and that I had more time.
Tomorrow, I have to give them a spelling test unrelated to the health-literacy project, but I also hope to continue this lesson. The next activity involves choosing vocabulary to match definitions. Diana told me that her students had some trouble with it. Afterwards, the students will read a sample medical insurance policy and answer questions. In addition to Diana's lesson, I was able to obtain a very useful book from the Governor's Commission of Women in Mopntpelier, VT, entitled Manage Care and You. It is very easy to read and covers basic and important information about Managed Care. I read some definitions from this book to the students on Wednesday, but tomorrow, I hope to give them some handouts comparing Managed Care Health Plans and Fee-For-Service Insurance Plans.
In the next two weeks, I plan to finish insurance and complete a short unit on "Patient Rights and Responsibilities." I have also been informed that Harlem Hospital is inviting the remainder of our students back for some tours. Well, again, I wish I had more time, but I do believe this project has been a success.
Tilla Elahi
June 3
UNDERSTANDING MEDICINE
After completing our unit on "Communicating with Health Professionals", I decided to start one on "Medicines." I had to forgo many of my previous plans which were present in my ambitious "Implementation Plan," due to the lack of time. It was now the end of May and I have only one month left to complete the project. One of my major problems has been that every lesson took longer than I had originally expected. I didn't want to rush through the material and activities. Also, as I may have stated previously, I have another curriculum for which I'm responsible and my students had chosen my particular class based on this curriculum.
In the previous Weblog, I mentioned that one of my students toured the pharmacy department. She gave a very interesting speech on her visit and also wrote an article for our class newsletter which motivated me to do this unit at this time. I began the lesson with a brainstorm session. I wrote OTC on the board and tried to elicit its meaning; finally, one student came up with "Over the Counter." Then I wrote the word "prescription" on the board. When I asked them what the difference is, they were able to say that you don't need to go to the doctor for over the counter drugs. I elicited from the students several OTC's that they have used and they said, 'Tylenol, Advil, Vicks Cough Syrup, TUMS." We discussed that we have to pay close attention to the directions on the package and that these medicines can be unsafe if taken improperly. I decided to use handouts and brochures from the FDA . I downloaded two of them, "Use Medicines Safely" and "How to Give Medicine to Children," but on the first day I used the first.
These FDA brochures are very user-friendly with simple explanations and pictures that correspond to the short text. I had the students take turns reading sentences aloud. We discussed the information when clarification was needed. The brochure emphasizes asking questions of your doctor and/or pharmacist, speaking to them about medicines you are taking, and letting them know if you had ever had any problems with medication. The brochure encourages people to make a list of their medications (something which Dr. Trowers had mentioned at the hospital), and bring the list to the doctor or pharmacy. The students found it interesting that some medicines even if taken properly can cause side-effects. I focused on the part that stated that you must know about your medicine before taking it: what it is, why you are taking it, if it could make you sleepy or cause some other problem for you, when, how much, and for how long to take it, what you should not have while taking your medicine. We also read and discussed "My Medicines." I think it was good for the students to read similar information (though not entirely the same) in different formats.
I'd like to know if any teachers have used these materials and how your students responded. I thought the lesson went okay, but perhaps, it would have been better if I had a specific activity for the students to do afterwards. My students did seem to enjoy reading and discussing the material.
At the next session, I brought in a considerable quantity of realia, empty prescription bottles & packages, and several over-the-counter medications. It just so happened that over the weekend, I developed a cold and was currently taking one of the medications. I think that brought some added humor and interest to the class. I paired off the students and gave each pair one medication. I told them that they were to read the labels, directions and any other material written on the bottles or boxes and answer the following questions.
1. What is the name of the medicine?
2. Is it an OTC or prescription medication?
3. What ailment does it treat?
4. When should you take it?
5. What is the usual dosage?-How much should you take?
6. Is it safe for children? How much should children take?
7. How long should you take it?
8. What are some warnings?
9. What are some side effects?I think this activity went much better and they spent a lot of time working with their partners. After the pairs had finished, I asked several students to come up front to talk about their medicine. As they spoke, I wrote several points on the board. The students applauded each other and seemed to have a very good time. My intention was that the students would type this material in the computer room, but we really didn't have time the next day because it was "Student Movement Day" and I had visiting students from other schools coming in to see the "Clerical Program." I thought I would have them type up the information on Thursday.
On Wednesday evening, as I was surfing the Net, I noticed that Susan Gaer had a very similar lesson entitled, "Buying Medicine." This would be a great activity for Thursday's computer class as it utilizes the Internet (drugstore.com) and works on the material we had previously discussed. I wrote the directions to the model on the board: Type in the web address, Press enter, Click on Medicine Cabinet, In the white box type the name of your medicine. She suggests that we use an overhead. However, my school doesn't have such equipment, so I had to make due. I'm used to walking around the room, helping each student at the computer. My class has some experience going to different Internet sites and clicking on different sections of the sites, so they seemed to be able to do the activity fairly well and I didn't do it exactly the way Susan had suggested. I did write the handout questions on the whiteboard. They are:
1. What is the name of the medicine?
2. Why do you take the medicine?
3. How much medicine do adults take?
4. How much medicine do children take?
5. How much does it cost?These questions were similar to those we had on Monday, but they were worded a bit differently. Previously, we had not addressed the issue of cost.
We went on the site: www.drugstore.com together. I made sure everyone had the correct page and then I instructed them to click "Medicine Cabinet." I walked around and gave each student pair a different problem or ailment. Then I suggested that they choose a medicine in their category. I made copies of the handout and asked them to write in the answers on these sheets. I had also asked them to print some of the material they found out about their medicine.
How did it go? Well, the students cooperated well with each other and this was one of the few times, I had asked them to work together (1 computer, 2 students). Some of them still used their own computer which was next to their partner's, but they filled out the answer sheet together. A few students needed help in finding out the details of their medicines and getting to print the pictures of their medicines. I walked around the room as they worked. I believe that the reason they did so well was because this wasn't the first time they were reading information about medicines. I collected their sheets, I haven't yet corrected and returned them. I felt rather good after this lesson.
Tomorrow, we have computer class again and I'd like to go on ESL-Images.com/ESL-Xpress.com where I will ask my students to read "Reading 2-Drugstores and Medicines and do the related worksheet." The material should be fairly easy for them, but I think it will be valuable as there is some new vocabulary. Something I think I need to focus on and didn't as yet is using numeracy skills; perhaps, having the students calculate costs of medicines. I will try to look into this tomorrow. If anyone has suggestions, they would be appreciated.
May 28th
Navigation Skills
As the focus of our project is "Navigation Skills," I was concerned about my students' problems and experiences with the U.S. Healthcare System and how it was different from that of their countries. So, I began by using some of Hillary Gardner's ideas from the health literacy special collection. More specifically, I had the students work in pairs and write a question on a post-it. They discussed their questions in pairs and then put them on the board. Some problems and questions that were included in the list were: "Why is health care in the United States so expensive? Why don't doctors always know the correct diagnosis? How do you speak with the doctor if you don’t speak English?"
To further give the students an adequate background to the project, they viewed the video, " In Plain English," developed by Rima Rudd. (See the movie.)Topics I chose afterwards were based on my student’s questions and needs. Above everything else, I want to continue to work on their listening, speaking, reading and writing skills. Many of them have expressed problems in telephoning health professionals, either to ask for an appointment or describing a particular health problem, so I began with "Making an Appointment," then I provided lessons on "Communicating with the doctor, nurse or other health professional."
Since our project involves collaborating with Harlem Hospital, a few meetings were set up to discuss how we would accomplish this. It was agreed that we would have a professional create a video based on our collaboration. All three classes visited the Harlem Hospital with the heads of approximately seven departments. The hospital staff treated our students with dignity and respect, speaking to them about their departments to give them an overview. Our students took notes and asked the staff very good questions. Later, six of my students visited the Emergency and Admissions Departments and spoke in depth to the directors of these departments. At this time, our video specialist, Carolina Kroon, videotaped some of the sessions and tours. The responses of the students were overwhelming; this visit put new meaning to our lessons. Many of them changed their negative attitudes toward health care workers and hospitals. When it was fresh in their minds, I had the students speak about Tuesday's visit. Vicky said, "Now I understand that patients are seen in the emergency room according to their level of urgency." Oumou said, "I was moved by the speakers, especially the director of nursing, the way she explained how to become a nurse." Marya said, "I liked how the nurse spoke, especially why you can't be a nurse only for the money. You have to feel it inside your heart. You have to think that the patient could be your parent, relative or friend."
Later, I had the students who went on a tour, teach the other students what they learned. I put them in groups of three or four, each with one student who toured. I handed that student a form that I made up "Guidelines for Instruction," which included some questions for them to answer based on what was discussed the day before, such as, "What kinds of cases are seen first in the emergency room? Why? What kinds of hospital employees work in the emergency room? Describe the trauma room? I first gave only the other students a "student response sheet." I constructed it in the form of a two column table; on the left were some statements which they were to complete on the right. They included the following: Two things I learned about the procedures in the admitting room; Some forms that we have to fill out in the admitting room; What important information should you know or have written down that the doctors need to know?; What determines the amount of time one has to wait to be seen in the emergency room?; Two new things I learned about the emergency room; Some questions I still have about the admitting or emergency departments. Then I asked them to respond to the following: "Were the students clear in explaining these departments to you?"Tilla
May 26th
My Class
I teach two classes of ESL Clerical Pre-Voc, though only my morning is officially involved in the project. However, I have also been doing a great deal (but not as much) of health literacy with the afternoon class. My morning students are from several countries including: Senegal, Ivory Coast, Guinea, Mali, Ecuador, the Dominican Republic, Mexico, Haiti, Guatemala, Peru and Honduras. Many of them are high school graduates and some of them had finished college in their countries. They are at the intermediate level; they can understand English fairly well and can make themselves understood, yet their grammar, writing skills, reading comprehension level, and pronunciation need quite a bit of work in order for most of them to enter college, another type of program, or secure an office job. In order to advance they must have a grade reading level higher than 8.0.
Main Purpose of the Class
The class was designed to prepare students for an office career, but many of our students wish to pursue other areas and us our class to improve English and computer skills. We meet five mornings per week from 9 a.m. to noon. Two days are spent in a computer lab while the other three days are in our regular ESL classroom.How I Planned to Incorporate the Health Literacy Curriculum Into the Program
From the onset, I desired to incorporate the health literacy curriculum in both types of class settings and so far, I believe it has really worked out well. Contrary to the other classes involved, I could use the Internet and the computer to supplement my lessons. After composing written material via pen and paper, the students then have the opportunity to type and save their documents on Microsoft Word. They also can learn more about the program and editing techniques. Tilla
May 24th
Health and Literacy Pilot Program
I am an ESL Clerical Pre-Voc Instructor at the Mid-Manhattan Adult Learning Center. Three of our classes are fortunate to be involved in the Health Literacy Pilot Program coordinated by Dr. Winston Lawrence of the Literacy Assistance Center in New York City. This health initiative is the idea of Dr. Rima Rudd of the Harvard School of Public Health and mainly concerns "Navigation Skills." As part of this project, we are partnering with Harlem Hospital. We began the project with our study groups that took place from December to the end of February. Our formal project began in March and will last until the end of June. There are also 3 other learning centers involved in this project and we all are being supervised by MAGI, an educational evaluation agency. This project, though very time-consuming, has been rewarding for my students and myself. In the next few weeks, I will try to give you a clear and hopefully enlightening picture of what we're doing.
Tilla Elahi
