community health workers

RECENT POSTS

When Health Care Moves Out Of The Doctor’s Office

Check out Martha Bebinger’s piece today on a critically important idea slowly taking hold in health care called “total health” — an intuitive concept which basically means that health care should take into account a person’s whole life situation, not just their medical status — as a determinant of true health.

That means making sure families have food in the fridge and a safe place to live, and, as Martha notes, the right type of cleaning supplies if the household includes an asthmatic child:

Angila Griffin made this discovery a few months ago when a community health worker stopped by to check on her kids, who have asthma. Jean Figaro came armed with vinegar and baking soda. They’re cleaning products, he explained.

“Who would think to use vinegar to clean a household?” laughed Griffin as she told the story.

Griffin loves scented disinfectants and perfumed air fresheners. But she tossed them to help her son and daughter avoid asthma attacks.

“If I’m using the perfume and stuff, their asthma is acting up, their eyes are bloating up,” Griffin said.

Figaro, who works out of an asthma clinic at Boston Medical Center (BMC), said “we complete the work the doctor starts at the hospital.” Continue reading

In Case You Missed It: Foot Soldiers Of Health Make Housecalls

A health worker visits a young boy at home to remind him how to use his asthma medications

I wrote a piece Friday about an ambitious new program that deploys community health workers to the homes of poor, chronically sick people in order to improve these patients overall health — mental, physical and otherwise. (And since many of our loyal followers appear to check out on Fridays, I’m revisiting it here, in case you missed it.)

These health workers, part nagging mom, part medical fixer, part guide through daunting insurance and social service bureacracies, do what ever it takes to connect patients to better health: they help with transportation and child care, advise on mental health problems and promote asthma and diabetes management. They can feel like a close aunt, or sister, talking to a new mom about post-partum depression, for instance, and when necessary, a health worker might even pick up a sponge, to help a patient learn how to clean the house.

The goal of the program, Network Health Alliance, is clear: better care for the patient and lower cost to the system by reducing expensive emergency room visits and hospitalizations and enveloping people more fully into a primary care setting.

In an odd twist, the concept of community health workers originated in poor countries like Haiti, as part of a more integrated health system promoted by the renowned doctor, Paul Farmer:

Here in Massachusetts, this wealthy medical mecca of high-tech hospitals, community health workers are part of an experiment to use low-tech lessons learned in the poorest of countries, Haiti. As the state, and the nation, begin to revamp broken parts of the health care system, the need for these health workers, who fill a critical gap by supporting families in their homes, is clearer than ever before, says Partners In Health co-founder Paul Farmer, the doctor famed for developing a cadre of such workers in Haiti. “There has been more discussion about the need for innovation in this arena this year than ever before,” he said. We are finally acknowledging that “it is very expensive to give bad medical care to poor people in a rich country.”

If you want to learn more, read Atul Gawande’s excellent story on “Hot Spotters” in The New Yorker, and Tina Rosenbeg’s piece in The New York Times about a program that uses health workers to support AIDS patients in New York City.

And listen to Radio Boston, which is planning to air a segment on community health workers Tuesday at 3.

From Haiti To Harvard: Crucial Foot Soldiers Of Health Make Housecalls

Fernanda Pereira, a native of Brazil, had some basic misunderstandings about the U.S. health care system. Here are two:

1. She used to take her asthmatic son, Ycaro, to the emergency room every time he needed a refill for his inhaler. She didn’t know she could simply call the doctor for a prescription and pick it up at the pharmacy.

2. She was confused and anxious when Ycaro, 11, was diagnosed with childhood depression. “Here, it’s normal for kids to be in therapy; in Brazil it’s not normal, ” Fernanda said. So, she cancelled or skipped 10 pediatric therapy appointments.

Enter Erica Guimaraes, a community health worker, and part of an ambitious program here to provide better, more effective care to poor, chronically ill patients — some who cost more than $200,000 a year to treat.

Since October, Erica has visited the Pereira’s home at least twice a month to help them deal with their medical problems, mental health struggles, cultural challenges, and anything else that comes up. On a recent visit to the family’s tidy brick apartment above a pizza place in Medford, Erica taught Ycaro how to properly use his inhaler. She explained to his mom, once again, the difference between Flovent and Albuterol. And she set up in-home therapy sessions for Ycaro. The boy has not been to the ER since Erica started visiting. “This winter, with Erica, it’s better,” Fernanda says.

Low-Tech Lessons in a High-Tech City

Here in this wealthy medical mecca of high-tech hospitals, Erica is part of an experiment to use low-tech lessons learned in the poorest of countries, Haiti. As Massachusetts, and the nation, begin to revamp a broken health care system, the need for these health workers, who fill a critical gap by supporting families in their homes, is clearer than ever before, says Partners In Health co-founder Paul Farmer, the doctor famed for developing a cadre of such workers in Haiti. “There has been more discussion about the need for innovation in this arena this year than ever before,” he said. We are finally acknowledging that “it is very expensive to give bad medical care to poor people in a rich country.”

While Fernanda’s daughter Katherine, 4, watches a Dora video, Erica and Fernanda chat in Portuguese, intimately, like sisters (they are from the same state in central Brazil) about the challenges of dealing with the new 4-month-old baby. Continue reading