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Hampshire College

RHA Campus Health Center Survey 2009

1. General health center questions –Hampshire College Student Health Center

a) What reproductive health services do you offer?

1) Routine well-woman care and pap tests;

2) Sexually transmitted infection testing, treatment and counseling;

3) HPV vaccines (extra charge or covered by private insurance)

4) Pregnancy testing,

5) Pregnancy counseling and referral to abortion, pre-natal care or adoption resources,

6) Transgender health care and hormone prescription in consultation with endocrinologist

7) Evaluation, testing, and treatment for menstrual disorders, polycystic ovary syndrome and other problems. Referral to specialists as needed.

8.) Evaluation and treatment of vulva,vaginal and urinary infections or skin conditions.

9) Contraceptive counseling, prescriptions for birth control, fitting for diaphragms, free condoms

b) What are the costs, both with and without student insurance?

All health care provided by the Hampshire Student Health Center is free, including pregnancy testing and UTI testing done on site. There are extra charges for lab tests and prescriptions but many are covered by student or private health insurance. Vaccines such as HPV are, unfortunately not covered by the current student insurance plan, but are covered by most private insurance plans. HIV testing once a year ($75/test) is paid by Hampshire College. Emergency contraceptive (Plan B) is $13 and available at the Health Center.

b) To what extent are services confidential or anonymous?

All health care, including the clinical visits and testing, is confidential and covered by Federal confidentiality laws which are stricter than laws governing academic records. We do not do any anonymous testing, but all testing is strictly confidential and only released to the patient or another health care provider who is caring for the patient.

d) How should someone go about making an appointment?

Call the Health Center 413 559-5458 on M-F from 8:30-5 for a same day or next day appointment with a nurse, nurse practitioner or doctor.

e) What sort of provider can perform certain services?

We have a registered nurse who does some testing, counseling and treatment and two nurse practitioners and a doctor who do the full range of sexual health care.

f) Where would you refer a student who needed EC when health services is closed?

EC is effective up to 5 days after unprotected sex, so a student can usually wait until the next day and come to the Student Health Center. EC is also available to Hampshire College students at Umass Health Services, Tapestry Health, or retail pharmacies. It is MUCH cheaper here at Hampshire and available for $13 compared to a charge of up to $50 at retail pharmacies.

2. Individual provider questions


a) What is your name and your position/title?

Sara Aierstuck, RN, FNP, Nurse Practitioner and Director of Hampshire College Student Health Services

b) What services do you (personally) provide at Hampshire College Health Services?

I provide the full range of primary health care to college students including: sexual health care, general health care, work with MH clinicians in care of anxiety, depression, and eating disorders. orthopedic and sports injury care, minor surgical procedures such as suturing, incision of abscesses, and wart removal. As the health center director I work with other offices on campus to promote the health and wellness of students.

c) How long have you been working in health care?

21 years, I worked at the Yale Health Plan from 1988-91, UMass Health Services from 1991-2008 and started at Hampshire in 2009.

c) What do you enjoy about working in college health care?

I enjoy the energy and enthusiasm of college-age students. Health practices in college set the stage for health through-out adult life and students often find themselves taking charge of their own health habits such as nutrition, sleep, exercise, and substance use (or not) for the first time in their lives. Students really appreciate someone who takes the time to explain and teach them about their health.

e) What are the biggest difficulties you face?

At Hampshire the Health Center is located FAR from the main part of campus, so we are not conveniently located for students.

e) What do you feel are the most pressing health issues among Hampshire students?

Stress, cold and flu symptoms, anxiety, depression, substance use, smoking, contraception and sexual health concerns including STIs.

Women’s health


a) What does a pelvic exam include? (The information below was borrowed from “Go Ask Alice” a wonderful web site of health information for college students created by Columbia University)

.A “pelvic exam” includes a general examination, as well as some or all of these specific procedures:

You can use this experience to learn more about your body as well as yourself. Let your provider know that this is your first exam and ask her/him to explain each procedure. Routine pelvic examinations include both an external and an internal exam. The health care provider will examine your vulva (inner and outer lips), clitoris, and vaginal opening. After that, s/he will look inside your vagina using a speculum, which may be the most unfamiliar part of the exam. A speculum is an instrument used to hold your vaginal walls apart. It may be a bit uncomfortable — even though this may seem impossible, relax, it does get easier with practice.

The provider will examine your vaginal walls for lesions, inflammation, or unusual discharge, and will also check your cervix for the same. S/he will collect a sample of cells from your cervix using a swab. This part of the internal exam is called a Pap smear. Some women feel a slight cramping when the cells are being gathered. The collected cervical cells are then sent to a lab to check for abnormal cell growth and to screen for cervical cancer. Abnormal cell growth is often caused by human papillomavirus (HPV). If the results of the Pap are inconclusive or abnormal, a follow up test for HPV itself may be done. The Pap smear does not test for pregnancy, STIs, vaginal infections, or other types of gynecological problems.

The current recommendation is for most women to see a gynecologist or health care provider within three years of the onset of sexual activity or when they turn 21, whichever comes first.  After a woman has had sex with a partner, it is important for her to have a full gynecological exam at least every three years. Depending on your personal health history, your health care provider may recommend having an exam every year

Young women need routine gynecological exams because they may be particularly vulnerable to cervical infection since the surface of their cervixes contains relatively immature, less resistant cells. Early detection and treatment can reduce future complications. The HPV vaccine released in 2006 is recommended for young women ages 9-26 to protect against cervical cancer. It’s most effective if administered before you’re sexually active, but it can be helpful if you haven’t been exposed to the strains of HPV against which it protects.

b) What information do you provide to the students during this procedure? (see above)

c) If this were a student’s first time having a pelvic exam, what would you do to make her feel comfortable, safe, and informed?

Many of the pelvic exams we do are the first pelvic for our patients. To ensure a positive experience the first time, we ensure the exam is not rushed, the room and examining equipment are warm, all questions are answered, and that the pelvic exam is only done if absolutely necessary.

d) What precautions are taken in case a student is in a situation in which she might feel particularly stressed or triggered by the procedure?

We offer a student the opportunity to stop the exam at any point if she feels uncomfortable or stressed. We have access to counselors who could talk to any student who feel particularly stressed by the procedure.

Men’s health

a) How do you address the role of men in reproductive health?

We offer sexual health services to men as including STI testing and treatment, evaluation of sexual dysfunction, counseling re birth control options for pregnancy prevention if desired, and wellness care such as testicular self exam.

b) What male-specific services, such as a prostate exam, do you provide?

(see above) Routine prostate exams are not indicated for men under age 50; however, testicular cancer is the most common cause of cancer in men under age 25 so we teach and recommend regular testicular self exam (TSE).

STI/HIV testing

a) How do you assess a student’s HIV/STI risk?

A complete medical and sexual history including personal and partner risk factors for HIV infection.

b) What sort of information do you need from the student?

Past medical history, current and past medications, sexual history, substance use history.

c) Are there specific tests that you wouldn’t recommend to students who are in certain groups (in terms of their identities or practices)?

All STI/HIV testing is individualized and testing recommendations are based upon sexual/medical history and the patient’s reported sexual practices. STI testing is based upon sexual practices and not sexual orientation or gender identity.

d) Which STIs do you test for in general screenings?

There is not any “general screening” for STIs; all testing is based upon the individualized patient history. The most common STI test done is for chlamydia and gonorrhea because the testing is inexpensive and non-invasive. Patients can have chlamydia or gonorrhea with no symptoms and a single dose antibiotic cures it.

e) Which STIs are not tested for in a general screening, and why not?

This is a complicated question which is beyond the scope of this survey. I’d be happy to answer this in an interview or phone call. In short, testing is complicated and there are a variety of different tests, costs, and treatments. All patients deserve an individualized risk assessment and personalized treatment.

f) Where do you refer students who test positive for STIs or HIV?

We treat most STIs here, but may refer depending upon the severity and complexity of the situation. For example, a student who tests positive for Hepatitis A needs an evaluation with a liver specialist to delay progression of this chronic infection. A student with extensive anal warts may need to see a surgeon. A student with a positive HIV test would need evaluation and monitoring from a center with specialized knowledge in the care of chronic HIV infection to stay healthy.

Family planning

a) For which forms of birth control do you offer prescriptions?

Combination birth control pills in both monthly and extended treatments, progestin only pills, contraceptive patch, contraceptive ring, diaphragms, medroxyprogesterone injection. We do consultation re copper and progestin IUDs, but referral to gynecologist for insertion. We don’t do cervical cap fitting because there has been no demand for it and special training is required.

b) How would you advise a student who found she was pregnant, but wasn’t sure what she wanted to do?

Counseling session with nurse practitioner or nurse to review her options: surgical or medical abortion, adoption, or continuing pregnancy and prenatal care. We would also offer referral for partner, psychological, or spiritual counseling if she felt the need.

b) Where do you refer students for abortions, adoptions, or prenatal care?

We have a variety of referral sources which we continually update; listing them is beyond the scope of this survey. Students can talk to us about their individual situation if when necessary.

Sensitivity

a) How would you help a transgender or transsexual student feel comfortable?

Gender neutral forms, experienced clinicians and office staff, welcoming attitude and office environment.

b) What would you do in a situation where a student reported a recent sexual assault or rape? Involve community mental health and legal resources such as CAs, Everywomen’s Center, HC MH staff. Take care of the immediate medical needs for medication and STI testing and refer student for other medical, mental health, or legal help.

c) How would you help a student who has experienced sexual violence feel comfortable receiving reproductive health services?

1) Welcoming and non-judgmental clinicians and office staff.

2) Repeat visits with a trusted clinician until he/she feels comfortable getting the needed care. Review the exam and equipment to de-sensitize to the medical office.

3) Referral to other agencies/specialists if desired.

d) What would you do to address cultural barriers that particular students may face in seeking reproductive healthcare?

Invite students to share their concerns/suggestions and make any needed changes to make the Student Health Center accessible to all students. Work with the Cultural Center on campus to overcome any real or perceived barriers to health care for students. Make sure our staff has the correct training and equipment to accommodate all students for routine primary care.

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