A Community Solution to Improved Health Care
In 1982 a recession had gripped the country as a significant change occurred at the presidential level. In Richmond, Virginia concerned Christians gathered to address the social needs of the urban poor. This is where Cross-Over Ministry, Inc. was born. The mustard seed planted then has blossomed into a network of three free clinics in three local jurisdictions.
Like most small, faith based nonprofit organizations, we have had organizational ups and downs. In the early 1990s our main clinic abruptly became homeless and was reestablished in Richmond’s south side. It was during this uncertain time, when everything was new again, that my coworker Myrna McLaughlin, RN, provided the insight that not everyone coming in for clinic visits needed to see a physician. Many people suffered from ailments that could be addressed by basic preventive and wellness measures.
A problem we recognized in many of our marginalized patients was the generational effect of poverty. Basic health knowledge was not taught and disease prevention was not modeled to the next generation. Instead, many passed down misinformation and distrust of the medical establishment. Additionally, our culture endorsed the idea of fixing a problem with a pill or surgery rather than being proactive in preventing a problem. Myrna also wanted to import a concept from developing countries: lay or village health workers. These workers strive to address the lack of knowledge in the community and to give individuals the dignity of making choices regarding the prevention and management of chronic disease.
Since 1994, Cross-Over has strategically invested in wellness and preventative health education. Our primary tool is the Lay Health Promoter (LHP) program. The LHP program trains ordinary citizens and invites them to be involved in the process of improving their health and the health of their families, neighbors, and friends. Our mission at Cross-Over is to provide health care, promote wellness, and connect community talents and resources with people who are in need, all in the name of Jesus Christ. Training LHPs is congruent with our mission of promoting wellness and utilizing the resources which are embedded within our community.
Over the years we have discovered the benefits of engaging LHPs to cross barriers and reach individuals in ways health professionals may not be able. Volunteer LHPs are as valuable to our organization as the volunteer doctors and nurses who serve patients in the health center. In fact, our LHPs often initiate a patient’s first visit to the center. Having LHPs rooted in our community has also given credibility to our service. These LHPs have a rapport with the community, which has served to assure it of our good intentions. By partnering with LHPs and focusing on the link between prevention and wellness and the medical treatment of acute and chronic illnesses, Cross-Over Ministry has become a medical home for the poor and uninsured.
Following three years of mission service in East Africa, I joined the Cross-Over staff as the Health Education Director in 1996. Prior to spending time in Africa, my nursing experience was with direct patient care. I loved the gratification of “doing” care for people. However, in Africa I saw the reality of Hosea 4:6, “My people die from lack of knowledge,” lived out before me on a daily basis. Suddenly there was a paradigm shift in my views on health care. I knew that people were dying from lack of knowledge in my community as well.
As I prepared to return to the United States, I made a conscious decision to seek employment that would allow me to be involved in addressing health disparities. Empowering others to make choices that enable them to live their physical, emotional, and spiritual lives more fully was my heart’s desire. The opportunity to train and learn from LHPs through my employment at Cross-Over has been life changing for me.
Cross-Over Ministry’s LHP program is offered without charge to people interested in becoming a volunteer health advocate in at-risk communities. From our client base, we identify those with natural inclinations toward helping others and target them for participation. We also use other means of recruitment, such as fliers, radio time, or speaking engagements at tenant council meetings and inner city churches. But our most powerful recruitment tool is our previous graduates spreading the word.
The training is presented through a 40 hour course taught over a ten week period in a classroom format. Content ranges from basic information (medical resources in the community, hand washing, healthy eating habits) to prevention and management of more specific diseases such as: hypertension, cardiovascular disease, cancer, diabetes, HIV/AIDS, and asthma. The course also covers health issues such as prenatal care, home safety, dental care, domestic violence, substance abuse, and positive parenting. Classes are structured to encourage participation and sharing of experiences. The link between healthy living and spiritual development is explored. Participants receive a notebook of materials and multiple handouts. They are also given a thermometer, stethoscope, and blood pressure cuff, with training in how to use them, in order to perform screenings in the community.
A significant course requirement is the three health education visits LHP participants are asked to complete following each class session. These community health visits are the heart of the program, allowing the LHPs to become teachers and trainers. These hands on experiences reinforce the LHP’s traning, and of course, they get the LHP into the community.
A recent graduate commented, “The visits made me realize that I didn’t need to be a health expert in order to save lives.” Another said, “Helping other people helps me!” Through these visits, hundreds of referrals to health providers or other appropriate community agencies have occurred. Early detection of hypertension, hyperlipemia, diabetes, breast and cervical cancer, asthma, and strokes resulted from these health visits.
LHPs are valuable resources for their churches, work places, and neighborhoods. Some provide regular blood pressure screenings, teach nutritional classes, or lead exercise groups. Many community health fairs throughout the year are initiated and supported by LHPs. In addition, LHPs are often champions of community-wide events, such as World AIDS Day, Breast Cancer Awareness Month, and Heart Health Month. It is amazing the empowerment a 40 hour course brings.
Primarily courses are taught in various inner city churches, community centers, and recreational centers. Additionally, two courses each year are taught at the Women’s Richmond City Jail to impart value, knowledge, and hope to those suffering under the weight of poor choices.
In 2006 at the growing request from our Hispanic clients, we adapted the English LHP curriculum and began the Promotores de Salud program under the leadership of Karen Bunn. A recent Hispanic graduate stated, “Becoming a Promotor de Salud is like therapy for me.” This is just one of the graduates benefiting from the increased self-esteem and self-worth expressed by so many LHPs as they freely share the knowledge they have been given.
When Myrna shared her vision in 1994, no one anticipated that fourteen years later we would have graduated 942 lay health promoter volunteers through 67 English and eight Spanish courses. Our graduates have documented 76,535 health education visits in the community. Perhaps an even greater surprise is the large waiting list of individuals who want to become LHPs and churches and community centers desiring to host courses.
These tremendous numbers clearly show that many ordinary, everyday citizens are ready to be empowered, ready to make improved life choices, ready to advocate for themselves and those they love. We are called to help our neighbors play a role in the health care solution! We are called to teach others to fish, which includes giving them access to the pond of our resources and knowledge. In turn, they will teach others to fish!
Daniel M. Jannuzzi, M.D., a family physician, has served at Cross-Over Ministry as medical director since 1989.
Marilyn Metzler, RN, BSN, became acquainted with Cross-Over Ministry through CCHF. In her position as Health Education Director, she has been teaching and learning from Lay Health Promoters since 1996.