Reflections on Serving The Underserved

by Andrea Tartera, UTHSC PharmD Candidate, Class of 2021

In my opinion, one of the greatest assets to a professional career is a broad network of people which you could contact to accomplish a task beyond your spectrum. This is applicable to many aspects of life from trying to obtain your first job to helping a friend with a given task.
Networking provides you with a powerful toolbox full of resources which you can use to
accomplish tasks greater than yourself. Serving the community sounds like a lofty task, but when broken down into smaller tasks divided between skilled people, it becomes feasible.

Now, to best serve your community, you first need to fully understand its needs. Many people see one small need, throw money at it, and consider it fixed. Providing an underserved patient with a name brand glucose meter and $50 box of test strips does nothing for them when
they have no means to afford test strips, lancets, or a new meter. You have simply given the
patient false hope and health for as long as the test strips last, no further. In my opinion, that is
not true service. Serving the community involves giving patients the tools they need to access the proper healthcare. It is showing that patient how to select affordable meter options and how to use that meter properly. It is referring to that patient by their name and treating them in the best way possible according to their lifestyle and means. It is seeing that patient more than once to check progress and support them.


In order to do this well, one healthcare provider is inadequate. A community is vast with many needs that need to be met which requires many skillsets to best meet those needs. To make a significant impact on community healthcare, you need doctors, nurses, pharmacists, dentists,
occupational therapists, physical therapists, and many more people all willing to serve with the
same goal and mindset. I believe that this class provides those tools for students. They are able to meet fellow healthcare providers, who they can contact in the future if they see a patient with that specific need, and learn how to analyze a community to best serve them. Fellow healthcare providers with a passion for service are the resources that should be called upon to serve the community.


There are many healthcare resources around Memphis, which healthcare providers should be aware of so that they can recommend them to patients in need. For example, Good Shepherd
pharmacy takes unopened and unused medications from those who no longer need them to be redispensed to patients who otherwise could not afford them. The Mid South Mission of Mercy is a dental clinic held a few times per year at Bellevue Baptist Church providing comprehensive
dental care to anyone. UTHSC also provides discounted dental care for a limited number of
patients at various clinics. Many churches provide mental support classes and groups to provide people with a support system and resources from others who have had the same problem before. Healthcare providers should be aware of these resources so that they can analyze which would be most beneficial for their patient and recommend that source. Community healthcare encompasses understanding the patient’s life holistically so that treatment is both practical and beneficial. Healthcare providers should work together to support their community by understanding its needs and providing healthcare accordingly.

Reflections on Serving The Underserved

by Stephanie Lancaster, Assistant Professor, Department of Occupational Therapy

There’s been a lot of coverage in the news about hurricanes lately, something that strikes fear in the heart of even those of us who aren’t likely to be in the path of a storm of this magnitude because of where we live. Both of my daughters attended college in New Orleans, and even though they were there post-Katrina they learned a lot there about the long-lasting devastation of a hurricane, especially in the context of areas with demographics as there are in that city. I remember watching the news when Hurricane Katrina was being forecasted, with first the meteorologists and then rain-beaten reporters on the scene talking about the orders for mandatory evacuation of New Orleans and other areas predicted to be in the direct path of this monster storm. When Katrina hit two days later, I heard the news reporters on TV talking about the roughly 200,000 people in New Orleans who did not evacuate, and I couldn’t wrap my brain around their reasoning. Why did they stay when they had been ordered to leave, when the risk of staying had been widely broadcasted? All I could think of was maybe they were in denial, thinking they could literally weather the storm despite the warnings and mandate for evacuation.


I’ve done a lot of reading, listening, talking, and thinking about this subject since that time, and the things I have come to realize have changed my reaction when I have heard similar stories since then about people in the path of a hurricane who have not left their homes despite orders to do so by their cities or governmental agencies. I know now that leaving – getting out – was not nearly as much a move of agency as it was opportunity. I now know that more than a quarter of the people living in New Orleans before the storm hit were living below the poverty line. At least a quarter of those did not own or have access to a car. Many of the individuals who stayed behind had lived in that area their whole lives, with that often extending into generations far up the family tree, resulting in their being less likely to have family or friends outside of the area with whom they could shelter. Timing was not on the side of those who were living paycheck-to-paycheck or relying on government assistance as the storm hit at the end of the month; those with children in school had very likely had to spend extra money on school supplies as their kids went back to school after the summer break. At least two-thirds of those who did not evacuate had no money in the bank and no credit card to use as a back-up. Those living in poverty were much more likely not to be able to evacuate because they were dealing with poor health or disability, if not personally then in the role of a caregiver for a family member, neighbor, or friend. In essence, it wasn’t at all related to denial of what was happening that caused those who stayed to do so; in fact, it was just the opposite: it was their acute awareness of their circumstances that led to their staying.


This is something that relates in many ways to what goes on in the healthcare system in our nation. It sometimes appears that those who are underserved are in that category at least in
part because of the choices they have made, but in actuality it is the circumstances they are in – and sometimes the decisions made by others in political and other arenas, that is at the root.

The Effects of Prayer on Heart Rate

by Jonathan Lewis

When I first saw him, he was in a bed in the Emergency Department, but he was trying not to be.

He was ready to leave that bed and storm out of the hospital, and if he got the chance to give someone a piece of his mind on the way out, he probably would have.  He had been through a tough day. 

He was having problems with his breathing – bad problems, barely able to catch his breath when I came in the room – and he had been in the hospital bed since early in the morning.  When I arrived, it was late in the afternoon, and he was sick – not only sick of feeling bad, but also sick of the hospital.    

He had complaints to list for me.  He didn’t like the food he was served.  He didn’t like the noise and busyness of the ED.  He was not able to rest.  His shortness of breath was not improving the way he hoped.  He couldn’t get comfortable in his bed.  Staff took too long to respond to calls.  These and other complaints added up, and the cumulative effect was taking its toll.  He was sick, he was angry, he was agitated, and it was getting worse every moment.    

I did my best to listen well, doing little talking.  The man seemed more than content to have me stay in the room with him and receive his list of grievances.  I did not have the sense that he was interested in hearing suggestions from me or anyone else for solving his problems, so I tried my best to patiently go along for the ride. 

This went on for a few minutes, and then, as though he suddenly remembered that I had introduced myself as the chaplain, he began to talk a little about his spirituality.  He said that he had always been a spiritual person but had never really liked church much, especially as an adult.  He said that he sometimes prayed about his life and his illness, but other times he would try to pray and couldn’t find the words.  I asked him if he thought a prayer would be helpful now, and he nodded his head.

And then, we prayed together…

As we did, a visible transformation took place, and being in a hospital, I had a great vantage point to witness the changes. 

When we started the prayer, he was sitting up in bed, sweating, breathing heavily and shortly, looking tense and angry, and his heart rate, which I could see on the monitor behind his bed, was about 125 – higher than you would like it to be. 

By the end of the short prayer, maybe 3 minutes later, he was lying completely flat on his back, calmer, quiet, breathing more slowly and deeply, and his heart rate was around 105 – better. 

It was like he had been given medicine.

Of course, he hadn’t been given anything in the pharmaceutical sense.  Prayer is not medicine in any scientific way, but at least in this case, it had an observable medicinal effect.  We finished the prayer and he thanked me, and as he suddenly looked ready for a nap, I asked if there was anything else I could do for him.  He said “No thanks,” and I excused myself from the room.  Before I left, he said that he would look forward to my next visit.    

Prayer is no replacement for medical treatment.  In fact, in most of the prayers that I offer as a hospital chaplain, I am deliberate about praying for the medicine to be used by God, praying that God watches over the doctors and nurses and therapists, praying that God surrounds our patients with caring, skilled, and effective healthcare providers. 

Of course, prayer is only part of good spiritual care.  There are many other methods of caring for the spiritual needs of our patients, families, and associates, and each of these have their own stories.

I have seen it work in my life, both personal and professional.  I have seen it work in relationships and arguments, I have seen it work in hospitals during some of the bleakest times, and I saw it work with this particular patient.  I know that they work, prayer and spiritual care.  I can say from personal experience that prayer is a difference maker in almost any situation. 

I even happen to know that it can lower your heart rate.

Students on Serving The Underserved; Week 6

Anonymous Author

Patient centered care, in my opinion, should be the only kind of care we deliver as doctors,
nurses, PTs/OTs, dentists, pharmacists, etc. It is their life, their body after all and we are only
stewards of their health. Instead of always thinking of ourselves as the leaders in a patient
encounter, I think it is important to step back at times and let the patients lead us or at the very least be our co-pilots.


I had a very eye-opening realization my second year of medical school while trying to create
a course for parents of young pre-school children to help them feel better prepared to raise their children to be healthy and safe. The other students and I had all these great plans for what we wanted to teach and what we thought the parents would want to learn. It was not until a thoughtful, caring, young doctor at Church Health (Dr. Z!) sat down with us to discuss our strategies for launching this project that we realized we were going about it in all the wrong ways. She wisely pointed out to us that the best way to help people learn is to ask them what they do not know. Ask them what they want to learn. I remember thinking how brilliant that was. Of course we would not want to waste time teaching the parents topics about which they were already knowledgeable. It was so simple, yet so groundbreaking for me. So, instead of deciding what topics we would teach the parents, we asked them what they wanted to learn and we were amazed. While many of the parents did request topics we originally wanted to teach, there were multiple suggestions for topics we had not even considered. By taking the time to ask and focusing on the needs of our patient population, we were able to better serve them while also respecting their intelligence and unique input. Ever since then I have used this tool to refocus myself in a lot of clinical situations, and I encourage all of you to try it in your daily practice, too.


On clinicals, I have seen patient-centered care go very well, but I have also seen people
attempt it and make situations worse. It is a very delicate balance. For example, I had one
attending who brought all of his team (including residents, pharmacists, and students) into my
patient’s room to tell her she had a new diagnosis of breast cancer. Yes, we were all standing in a circle around her bed at which she was in the center, but that was not what someone practicing patient-centered medicine should have done in that situation. Half of those people had little or nothing directly to do with her care. I felt that someone practicing patient-centered medicine would have stopped to think about what they would have wanted the doctor to do if they had been in that same situation. I believe most people would have chosen to have only the necessary caregivers in the room. In the end, I think that while we should not assume what our patients want (as I mentioned in the above story), I think it can be very valuable to put yourself in the patient’s position in order to give them the best care you can.

Students on Serving The Underserved; Week 6

by Laura Meyer, UTHSC College of Pharmacy, Class of 2020

To me patient centered care means that we as health care providers take a step back and put our patients in charge of their own health and wellness. When people feel empowered they are more likely to follow through on a commitment than when someone else tells them to do something just because. I think that instead of going to the doctor to ‘solve’ a medical problem, patients really just want someone knowledgeable that they can have a personal relationship with, communicate and ask the unaskable questions to, and for someone to give them empathy. When these things happen, I think the patient becomes more invested in taking care of their health conditions. This is the ideal relationship to promote health, improve clinical outcomes, and increase satisfaction of care.


Not every person values the same things when it comes to health care and treatment. Patient centered care means that you take this into account and respect the patients’ autonomy regarding the choices they make governing their body. This can be especially important when we talk about underserved populations who may not have the financial means to afford treatment for all of their comorbidities. In this situation, some patients may be forced to pick and choose what medical conditions need the most attention and financial resources, while others get put on the back burner. In this type of scenario, it is so important to have the patient front and center in the decision-making process. This gives the patient respect and dignity and shows that their values are recognized.


Putting the patient in the driver’s seat when it comes to health care means that the patients
understanding of their condition and prognosis is of the up most importance. As health care
professionals, sometimes we get caught up in diagnosing, prescribing, and moving on to the next patient. However, the reason we are all here is to serve our patients, and the best way to do so is through patient education and allowing them access to information regarding their health. Spending time on patient education is patient centered care and can make a huge difference in the promotion of health, especially in underserved patient populations where medical literacy tends to be low.


Lastly, I feel that patient centered care means that the patients have access to care when they need it. This means they are able to get to the offices, it is easy to make appointments, and patients are able to easily find information on how to seek out specialty services. When patients feel they have access to health care this is ideal for promoting health because if it is easy to access, patients have the power to make it happen. Patient centered care is the ideal relationship for promoting health especially among underserved populations because it gives patients autonomy in meeting their health care needs, it puts patient education at the center of the health care professionals purpose, and allows for ease of access to health care services. As health care professionals, we should all strive to provide patient centered care.

Students on Serving The Underserved; Week 6

by Kelsey Caffy, UTHSC College of Medicine, Class of 2017

At the end of last week’s Serving the Underserved session, several members in the course voiced questions that centered on how can we as healthcare providers find practical and sustainable solutions to healthcare disparities that our patients face. While these questions were invigorating and emboldening, they were also somewhat frustrating because it can be difficult to know where to start when you want to change outcomes at a systems level.

 

I am on the Admissions Committee for UTHSC and this question, of how we can actually change healthcare disparities, was asked to an applicant who was interviewing for a scholarship. She thoughtfully alluded to the fact that healthcare providers still aren’t where they need to be in their understanding of healthcare disparities. I full heartedly agree with her. We still make assumptions about what is best for our patients. We presume to know what they need, value, and want for their own future, rather than simply asking them.

 

About a year ago, I was on my Internal Medicine rotation and my team was taking care of a young woman that was repeatedly admitted to the hospital for asthma exacerbations which were secondary to crack cocaine use. She was caught in this cycle of being admitted to the hospital, treated for her asthma symptoms, and then returning a week later. To make matters worse, she was homeless. One morning, after she was admitted the prior evening, our new attending sat at her bedside and asked what it was like to be homeless. She shared her experiences from where she slept and what she ate, to what it was like to ask people for money. Our attending also asked her about her hopes and goals for the future. She shared that she wanted to reach out to her family in a different state so that she could have support for getting off of drugs and getting off the streets.

 

I was touched and moved by this conversation with our patient. How easy it could have been to think we knew what was best for her in that encounter. By hearing her story, we were better able to understand the challenges she faced and to provide support and encouragement in her personal goals.

 

I have frequently contemplated how I can let my patients know that I am an ally. Often, I encounter patients who must wonder how we will possibly relate to one another. Whether it’s a veteran with PTSD, a victim of sexual assault, or a young woman who is living on the streets, sometimes the divide seems too wide to overcome. However, my experience on my Internal Medicine rotation, as well as countless other interactions with patients have taught me that human experiences, such as joy, guilt, shame, loneliness, love, and forgiveness, transcend basic constructs of society such as gender, race, socioeconomic status, and educational background. To change outcomes on a systems level, we have to continue initiatives like Serving the Underserved and incorporate more medical school programming geared toward helping us become better allies with our patients. We also have to learn to trust that that our patients know what is best for themselves, and oftentimes it’s a matter of asking  to find out how we can create shared goals for their future.

 

Students on Serving The Underserved; Week 5

by Anne Zachry, UTHSC Assistant Professor, Occupational Therapy

What is patient-centered care? To provide patient-centered care, it is important to first determine the needs of the patient. When I have the initial meeting with a family, I always ask the parent (and child - if he or she is old enough and able to communicate), “What is important to you? What do you want to be able to do? What is your child having difficulty with on a daily basis? What is your goal for your child?" Gathering this information provides a solid foundation for patient-centered care.


Sometimes, as healthcare providers, we think we are delivering patient-centered care, but that is not always the case. For example, as part of a grant award, I’ve been providing free developmental screenings at a pediatric practice in Whitehaven for the past three years. The families in this area have limited access to such services, so this is a wonderful program. If an infant or child does poorly on the screening, I refer the child to therapy services through Tennessee Early Intervention Services (TEIS). When I first started providing the screenings, I would follow up with the parents six to eight weeks after the referral was made, and I discovered that the children were often on waiting lists, and the waiting periods averaged from 4 to 6 months. That’s a long time for a 12- or 18-month old who is struggling with fine or gross motor skill development! I realized that carrying out the screenings alone was not solving the problem and being patient-centered, so I decided to add a parenting education session after the screening. In these educational sessions, I share a number of games and activities that the parents can carry out with their children to improve the skill areas that have been identified as weak. Parental involvement is absolutely necessary for a child to make progress in therapy, and this is the perfect way to get parents involved…through play!


Communication is an extremely important part of patient-centered care. I truly believe that the cornerstone of effective communication is the ability to listen! It’s so important to take the other person’s perspective and do your best to put yourself in their shoes! It can be difficult, but it is necessary to resist the urge to talk. This allows you to gain important information about your client. Collaboration is also a key part of patient-centered care. It’s important to make connections in the community and know your resources so that you can refer a patient when needed. One individual can’t do everything or fix everything. It takes a team!


I’m just one person, and I realize that I can’t change the world, but the bottom line is that it’s the little things that really matter in life. I’m so thankful to have the opportunity to give and try and make a difference. Giving to others makes my life meaningful.

Students on Serving The Underserved; Week 4

Anonymous Author

Early in medical school, I remember a professor saying that she enjoyed working with 1st
and 2nd year medical students because, while still in their pre-clinical training, they had not yet
made the transition from identifying with patients to identifying with physicians. At the time,
this made only partial sense to me, but as I am on the verge of finishing my 3rd year, I am
beginning to understand her point. Throughout this year, as I have worked in a variety of
clinical settings, I have noticed myself identifying more and more as a physician than as a
patient. This is a natural process for each health professional student, but the downside of it is
that our ability to see through the eyes of our patients is dulled. As a 3rd year student, care for
the patient with congestive heart failure, asthma, COPD, sinusitis, diabetes, and a myriad of
other diseases has begun to feel routine. As a health care provider, I will diagnose the same
diseases, prescribe the same medications, and perform the same types of surgery numerous
times.


For the patient though, these diseases, medications, and procedures are anything but
commonplace. For instance, although the dermatologist may diagnose and treat skin cancer
thousands of times during his career, it can be a life-altering and distressing experience for the
patient. The slowly building fear of a suspicious looking spot. The catch of one’s breath as the
physician agrees that this one looks bad. The strange experience of the tissue biopsy. The
waiting for the phone call. The moment when the doctor’s office calls and one’s heart seems to
skip a beat. The shock of the diagnosis of cancer. The fear of what happens next and the quiet
conversations with loved ones. The anxious waiting for the scheduled surgery. The surgical
drape being laid across your face. The sting of the lidocaine. The pressure of the blade. The pull of the sutures. The slow healing of the wound into a new scar. The joy felt when the tissue
margins are declared to be clear.


These experiences may be once in a lifetime for the patient, and each patient will
respond differently throughout the journey. As physicians, it is our job to strive for empathy
with each patient as we consider how the disease is affecting them. We must get to know them
and foster open conversation so that we may work together with them to find the treatment
plan that is best suited for their situation. There are no one-size-fits-all plans in medicine.
Patient-centered care requires that the uniqueness of each patient be appreciated and kept in
view as the plan is developed. It requires that the physician relinquish the stereotyped role as
the “captain of the ship” who unilaterally gives orders for the patient to follow. Instead, the
physician must become a steadfast guide who walks alongside her patient, lending her
expertise to help the patient sift through the latest evidence and apply it to the patient’s
unique situation.

Students on Serving The Underserved; Week 4

by Aisha Dotson, UTHSC College of Medicine, Class of 2018

Attacking poverty and community health issues in any city, especially in the city of Memphis, is
going to take input from several facets of the community; no one can tackle this alone. Poverty is a huge issue that affects a large portion of the city in comparison to other cities. Although poverty affects members of all racial communities, the Black and Latino communities bear the largest of its burden. As a result, these are the main groups of underserved people who we see most affected by health disparities. If we want to address community health issues in Memphis, we would make the greatest impact if we began in these communities.


Many health issues stem from the simple fact that some people cannot afford healthy foods, do not live near a grocery store with fresh produce, and/or do not have transportation to reach stores or health care facilities. In Memphis, there are several pockets of the city with abandoned buildings in the poorer communities. Many businesses that once flourished in these areas have either closed for good or moved to other areas. There is a vast need for businesses that can provide affordable and beneficial services in these areas, such as groceries, health care, etc. – like what Crosstown Concourse is offering its surrounding communities. There are several locations within Memphis that would benefit from community centers that provide the basics of food and health care options to its citizens at prices they could afford.


With poverty usually comes lower education levels, which then can lead to lack of knowledge about the importance of health and wellness. Any efforts to help provide better health care to members of these communities would have an even larger impact if it incorporates educational tools as well. People could not only get the health care they need but also become more aware of the importance of health and potentially be motivated to seek medical attention when necessary in the future. Information about common conditions such as high blood pressure, diabetes, stroke prevention, as well as basic wellness information could be provided via pamphlets or even as videos on a phone application. A phone application would be helpful for several reasons – it would be user friendly, people could access the info at their own pace on their own time, videos and images would be helpful for those who may be illiterate or have English as a second language, and it would be provided free of charge. The app could also be individualized to each user’s geographic location and provide phone numbers and addresses to local health clinics that provide care to those with minimal or no insurance.


Lastly, another important approach to addressing community health issues and poverty involves discovering each component that may be causing decreased access to resources for members of communities. Are their poor eating habits due to minimal access to a grocery store with fresh produce? Is their poor health due to working multiple jobs and not have time to take off to visit the doctor? Do they not have any means of transportation? Can they not afford their prescription medications? To successfully address health issues and poverty in these communities, it is important to address each barrier to an individual’s health, and tackle these one at a time.

Students on Serving The Underserved; Week 4

Anonymous Author

I remember first learning about Patient-Centered medical care during the very early months of my medical school training. We had classes and online study modules that taught us about this method of healthcare that focused on the specific needs and wishes of the patient. I remember thinking to myself, “Well of course that make sense! Why would any health care worker not wish to provide patient-centered care?” Almost every medical student goes into medicine because they want to help people. The idea of patient centered care (PCC) is an intentional technique to assist physicians in helping their patients in the best way possible.


When a healthcare provider is practicing PCC, they begin by listening to the patient. Truly listening. Not just “hearing” the patient speak while the doctor catches up on notes from the last patient. And not just letting the patient get half of a sentence in before their provider interrupts. PCC begins with the physician sitting down with the patient, removing all distractions, making eye contact, and letting them speak. Allowing your patient to speak
will reveal so much more of what is really going on with the patient than any OLDCARTS questions will ever disclose.


In addition, patient-centered care involves building a relationship with the patient and walking alongside them in their care. Rather than the physician alone deciding what is best for the patient and telling the patient what is going to be done, PCC involves the physician and the patient coming to a treatment plan together, based on the values and needs of the individual
patient. The team approach is used to help coordinate care among physicians, nurses, pharmacists, physical therapists, occupational therapists, etc. One of the best examples of PCC I have seen during my clinical rotations is the Multi-Disciplinary Cystic Fibrosis clinic at LeBonheur. At this clinic, a patient can come to one office at one appointment time and will be seen by their pulmonologist, a pharmacist, a dietician, a respiratory therapist, and more. This type of clinic puts the patient first by moving 5+ different appointments into one morning or afternoon session.


As a healthcare provider, it can be very difficult at times to prevent oneself from getting caught up in the busyness surrounding them, and thus forgetting the whole reason he or she went into medicine. PCC acts as a reminder to physicians that we are not here to complete another task or write another patient note – we are here to care for people in the way that we would wish others would care for us. PCC reminds us to slow down and listen to our patients, to get to know them and their values and goals and allow that to direct their care. A patient who feels like their doctor truly cares about them is more likely to comply with their treatment plan and return for future visits. A patient who feels like their voice was heard when designing his or her treatment plan with the doctor is much more likely to take an active role in their own care. Patient-centered healthcare reminds us, as healthcare providers, that we are here to put our patients first.

Students on Serving The Underserved; Week 3

by Lauren Nguyen, UTHSC BSN Student

When I think about practical steps to serving the underserved, it is hard for me to know where to begin.  It seems that health care disparity is so deeply built into our system that each individual effort feels miniscule. However, I know that though I as an individual may not change the entire system, I can still impact individuals’ lives who are underserved and overlooked. And even further, we can all help underserved populations by advocating for them and having open conversations about why health care disparity exists.


One practical idea I have seen to connect the underserved to health care is a free medical clinic set up for a determined amount of time where people can come and receive essential care. I think it is a marvelous idea to just allow people to come as they are and provide them with some basic yet critical healthcare services. Something as simple as getting a tooth pulled or receiving a pair of glasses can dramatically increase an individual’s quality of life. There is a limit to how far this can reach, though, and it still misses the opportunity for individuals to form a more long term relationship with a primary care provider.


Beside the barrier of cost, underserved populations often also face the barrier of time. Perhaps a single mother works more than one job on top of caring for her children. In cases such as these, it may be difficult for an individual to even find time to go to a clinic, even if it is free. I think it would be great for workplaces to have more initiative to provide healthcare for their employees. It would be great if somehow companies could work in certain hours that employees could see a primary care provider for a yearly checkup, etc. during work hours, without losing pay. I believe this would not only benefit workers, but ultimately the company, also. If employees are taken care of, they will most likely have better performance.


Along these same lines, people who live in a community without many clinics or hospitals nearby may not have the time or means to travel to a clinic ten or more miles away. For this issue, perhaps larger, successful health care facilities could make an effort to move into these communities to provide health care in their own neighborhood.


Another initiative I think would be beneficial is providing health information in high-school education.  Not just your typical health class, but a class that explains who is eligible for certain health insurances and how to enroll in those. I have spoken with individuals on several occasions who did not have health insurance simply because the process was too confusing and they did not have time to figure it out.


I would love to hear from residents of Memphis to learn more about their own perceived barriers to health care. I think simply taking the time to listen to concerns is a huge first step toward making progress. Though it seems like a long road toward equal care for all, every effort made sets a standard for those following behind us and I believe we can make some great advancements to decrease health care disparity in our communities.

students on Serving The Underserved; Week 3

by Jennifer Bassett, UTHSC College of Medicine, Class of 2017

Our next session of the Serving the Underserved course is entitled “Community Health
Strategies,” and focuses on the practical aspects of how we can serve the underserved. I’ve been asked to lend my thoughts on the matter. So on a community-wide level, what can we do?


I am not an expert in public health; however, I have become extremely interested in the
upcoming proposals for additional bike lanes throughout the city. My significant other is an
avid biker; consequently, I have started riding more. I see the obvious health and
environmental benefits of such measures, and question why some citizens would be so
adamantly opposed. Obviously, bike lanes would encourage more citizens to be physically
active, while protecting those who currently rely on bicycles for transportation. Unfortunately,
this debate highlights a sizable hurdle in addressing the health of the community: negative
attitudes towards historically poor neighborhoods.


As I read through the daily threads in my community group on social media this morning, I saw
one outlining differing opinions on the upcoming bike lane proposals. It was mostly civil
discourse until one particular comment echoed a popular sentiment of the group. It read, “I
especially like the bike lanes at [historically poor neighborhood]. Now hookers can ride their
bikes to the hotels and won’t have to walk on those dangerous streets.”


At first, I was enraged. The implication was that the people who live and work in that area are
immoral and undeserving. After I calmed down, I requested the thread to be shut-down. The
author of the comment later quipped, “It’s called humor.” Though my social media threads are
often filled with discussion of equal treatment and respect for all, it appears that negative
attitudes towards the Memphis poor still exist, sometimes innocently disguised. I would be
remiss if I did not admit that I have found myself partaking in these inappropriate “jokes” from
time to time.


However, I would argue that these sentiments are often the biggest hurdle in approving any
community-wide measure that would improve the health of the city. I wish I was wrong on this
matter, but the author of this Commercial Appeal editorial apparently agrees, at least on this
particular measure.


“To some people, spending money in distressed areas to create bike lanes and convert an abandoned railroad beds into paved walking and bike trails may seem frivolous when there are more pressing needs.

But the residents in those neighborhoods deserved to have the same kinds of amenities near their homes as residents in other parts of the city.”


Going forward, I think our work is clearly outlined. Supporting community health initiatives is
not good enough anymore. We must be willing to confront our neighbors and friends when they “jokingly” cross the line and lovingly redirect any underlying negativity. In order to do this, we have to police our own thoughts as well.  Finally, we must lend our voices when community-wide measures are proposed that would improve the health of the city, and we have to ensure such measures represent the interests of the underserved. I would argue that we have a moral duty to vote appropriately when such measures are introduced.

Students on Serving The Underserved; Week 1

by Aubrey Flowers, UTHSC College of Medicine, M1

Though I was unable to attend the first course session, I’m thankful for the opportunity to
express my views on the first topic “Why Are We Here,” and the importance of this course,
both for our profession and personally for the development of my own career goals. In
response to the importance of this course generally for our profession, I think working with
underserved communities is actually fundamental to the values of the medical profession, and
that it is difficult to fully and responsibly practice medicine without grappling with this topic.
Our commitment as physicians is to promote health and do our best to alleviate the suffering of
the sick, and the poor and underserved are disproportionately sick. With that in mind, I think
it’s also difficult as a medical student to undertake a thoughtful exploration of this topic in the
context of our current education. As a first year student, we’ve spent countless hours
memorizing esoteric biochemical pathways. I know I don’t yet have the perspective to know
whether we’ll use this information and how much is actually important but doesn’t seem so
now, but I know for a fact that understanding how to work with the underserved and the huge
segment of our population they represent is undeniably critical to our ability as physicians to
support healthy communities, and yet this is entirely left out of our established curriculum. So I
think this course is vital in bridging that gap and promoting the importance of this topic in
overall medical education.


From a personal and professional standpoint, I’m drawn to this course because it gives me an
opportunity to pursue one of my career goals of improving health and healthcare delivery for
underserved communities. I think this will be a great chance to explore effective, ethical ways
of doing so by learning from community leaders engaged in this work. My interest in this career
comes primarily from my experience working and interning at Church Health, an affordable
health organization for the working uninsured here in town. My time there has given me the
chance to see the difference dedicated doctors can make in the lives of the underserved, and I
look forward to continuing to learn the best ways of doing so through this course.

STudents on Serving The Underserved; Week 1

by Liz Karolczuk, UTHSC College of Medicine, M1

When I applied to medical school, I had participated in a number of experiences that helped
solidify my desire to serve the underserved as a major part of my career as a doctor. As an
undergraduate student, I received the Bonner Community Service Fellowship to attend Rhodes
College. Through this fellowship, I was exposed to the ideas of social justice, structural violence, and ethical service for the first time.

My understanding of these concepts continued to develop as I progressed through my college career. Through Bonner and a number of grants, I had the opportunity to volunteer and conduct community research in Ghana and Nicaragua. Developing relationships with community members in these countries instilled in me a deep desire to serve
the most vulnerable populations as a physician.


After graduation, I worked at Church Health coordinating the gynecology and pain management clinics. I was reminded each day in the clinic how multifaceted one’s health truly is, and how important it is as healthcare providers to address the health of our patients on a holistic level. I then spent the following year working in hospital administration at Methodist University Hospital, and learned how essential it is to keep patients healthy at the community level before/after their hospital stays.


Now, reflecting back to the first seven months of medical school, I remember how they have
been filled with endless hours of learning gross anatomy, biomolecular pathways, Hematoxylin
and Eosin stain interpretations, and a myriad of other hard science material. At this point in our
medical education, with so much importance placed on trying to understand the wealth of
science curriculum, it can be difficult to make time to focus on our future patients.


I applied to this course in poverty medicine because I want to start learning practical ways to best treat my future patients before I am assigned real patients in my 3rd year. I have a good idea about the population of patients I want to work with in the future, but sometimes I feel
overwhelmed when I think about effectively treating the health of the patients in front of me
while also addressing a number of structural and societal factors that also play a role in their
health. So many questions run through my head, like ‘how do I get connected to organizations
serving patients most in need of treatment?’ ‘Can I still support my family and pay off my
mounting student loan debt when working with patients who may not be able to afford care?’
‘How can I get involved in political advocacy work for my patients?’…the list continues on and
on.


I am so privileged to be in a position right now where I am training to become a future doctor.
With this knowledge and these skills, it is my duty to give back to my community both locally
and globally. I hope the next few weeks in this Serving the Underserved course will start to lay
the groundwork that will help provide practical ways to serve patients who need healthcare the most.