To treat a community, we must understand its needs

Op-ed" "Why didn't you obtain a mammogram," I asked one woman. "Because I did not want to be a burden to my fa

Recently, a health van offered complimentary health screenings, including mammograms, to a congregation in Baltimore. The priest raved about the turnout; I was less enthusiastic, and I wasn't the only one who felt this way. Many providers and volunteers with the program raised concerns that the community came to receive information, but rarely followed through with something as simple as getting a blood pressure screening or cholesterol check.

I returned to the congregation the following week and spoke with a few participants. "Why didn't you obtain a mammogram?" I asked one woman. "Because I did not want to be a burden to my family," she replied. She said that finding out she has a disease is worse than death to her because it would inconvenience her family if she were a patient.

I have engaged in medical-community partnerships for the past five years. Sometimes these relationships are as simple as distributing health information at schools or during Sunday services. Other times, it's organizing a health fair or providing a lecture. No matter how complex the partnership, there is always one common goal — to improve the health of the community.

Developing such medical-community partnerships involves a great deal of support and an algorithm that cannot be duplicated in a medical laboratory. When my colleagues and I first started this particular venture, we identified communities in Baltimore City that were at risk of early deaths or cardiovascular disease, or with high rates of violence. Then, we broke those communities down by ZIP code and approached congregations in those areas. Congregations made sense because they were faith-based with a leader or leaders, community-oriented and the foundation of many neighborhoods.

Truth be told, my first visit to a parish did not go well. Because we were doing something that would benefit the health of the congregation, I thought they would welcome us with open arms. The parish leaders actually had to teach me something — something I didn't learn in medical school. They gave me a history lesson about minorities and their experiences with health care, including ethically questionable experiments and poor access to treatment and screening. It was clear that health, while important, was trumped by something more: the identity of a culture, life circumstance and hard lessons learned in the past.

At a recent nutrition talk, free produce was supplied by local farmers' markets, but a lot was left behind. Now I understand that for some, cooking the fruits and vegetables represented a drain on their one source of heat: their ovens. Taking the complimentary produce was more of an inconvenience than a help for this population.

I firmly believe that 21st century medicine needs to implement successful medical-community partnerships. But success will only come when all sides are engaged.

Providers must have the right medical education, where social justice, socioeconomic barriers of health and an understanding of health literacy are emphasized as much as pathology and physiology. We should know the science but also know our patients and what barriers keep them from caring for themselves.

Community members must also request interventions that would best meet their needs. We might recognize reducing elevated blood pressures is important, yet, this may not be a goal for the community in discussion. As the prevalence of patients grows, the community must be allowed to raise their own concerns of their health identity to the medical world that wishes to help them. While medicine is asked to show results and outcomes, it still must maintain its human side — achieved best by partnering with and entering the community. Thus, ensuring that medicine is, and will remain, a public trust for the greater good.

Dr. Panagis Galiatsatos (mgg@jhmi.edu) is an internist and co-director of Medicine for the Greater Good at Johns Hopkins Bayview Medical Center.

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