New Breed of Health Worker Fills Gap in Medical Services

When Gonda Shows retired from nursing a year ago, she thought her days of attending to local health needs had ended. But when she heard her pastor's wife speak about creating a new congregation-based community health network, she jumped back in with both feet. Despite hip surgery, Shows roves her northeast Atlanta neighborhood giving chemotherapy shots, rides to clinics and sound advice. "There are a lot of seniors in our congregation," explains Shows, 66, who also posts the latest health news on church bulletin boards, administers blood pressure screenings and helps organize forums on everything from spirituality to prostate cancer to proper nutrition. "If they're willing to open up and tell us what their needs are, we'll help them." A second member of Shows' Clairmont Baptist church, a racially mixed but predominantly white congregation, attends to church members' needs when she isn't preparing taxes or working in a nearby bowling alley. The lay efforts are part of a growing movement that is using church networks to bring health care to the grassroots in underserved areas. "These programs have exploded," said Nell Brownstein, an expert on lay health promoters at the Centers for Disease Control and Prevention in Atlanta, "partly because there are more poor people, partly because there are more immigrants and partly because resources for health have been cut. More and more clinics, hospitals and local governments are turning to this strategy." The area where Shows lives -- a mix of Vietnamese, Korean, Hispanic, African-American and other recent immigrant populations -- is one of three city neighborhoods identified by the Carter Center's Atlanta Interfaith Health Program as being low-income and poorly served by health care resources. The area is so diverse that more than 100 languages are spoken by the students in a single school district, making health education outreach especially difficult. Shows is one of 35 lay health workers sent out by congregations aligned with the Carter Center's AIHP to change this. These community health promoters, as they are called, include parish nurses who are fully trained, licensed and paid as nurses. All the health promoters make referrals, give simple tests and educate their fellow congregation members. "We serve many more people this way," says Sam Bandela, who directs the ministry center that coordinates local health promoters from a vacant church building. "We have had cases where people were diagnosed with blood pressure very much higher than they thought. Somebody was also diagnosed as a diabetic (by a promoter). These are the sort of things that people would never have taken to a doctor until the symptoms were very advanced." After training, the 35 health promoters in Shows' area give health education on the flu vaccine, arrange blood pressure and blood sugar screenings and educate hundreds of congregation members in 19 local churches. They also plan events. This past spring, for example, nearly 1,000 area residents turned out on a rainy day for a ministry center-sponsored health fair that featured immunizations; vision, hearing and dental checkups; mammograms; and HIV testing -- all available in four languages. A small local pregnancy center, the Doraville Pregnancy Resource Center, was established in June by the community.[ED: OPTIONAL TRIM NEXT 4 GRAFS]The AIHP's original push for lay nurse training sprang from a task force of community leaders, educators and health care professionals. Together, they designed a program that would cross denominational lines and train one to two members of each participating congregation. A key to the program's success, say organizers, has been the AIHP task force's initial belief that communities could choose their own best leaders rather than have them picked by outsiders. "It was a belief in the participatory process. What that meant is that we basically moved away from prescribed lesson plans and went directly to the people," said Fran Wenger, who coordinates the health promoters' training and directs multicultural programs at Emory University's Nell Hodgson Woodruff School of Nursing in east Atlanta. Health promoters could be health professionals or not, but the important thing was that the congregations themselves chose them. Then the congregations each helped set agendas for their own training, according to whatever their particular health concerns were, Wenger said.[END OPTIONAL TRIM]Tapping community networks, especially religious congregations, is key to this strategy. "There is simply no way the public health department can reach out to all the different cultures at once. They don't have the resources," said Brownstein of the Centers for Disease Control. As a result, hundreds of programs similar to the Carter Center's AIHP have sprung up around the nation in poor urban and rural areas alike, according to those monitoring the trend. The Robert Wood Johnson foundation has launched a Faith in Action project that awards grants of up to $25,000 and technical assistance to interfaith health projects for the elderly and disabled. Many of the participating promoters are volunteers like Shows. Others, especially the licensed nurses, are paid, receiving an average of $50 to $90 weekly for their part-time work. Most are women, says the Rev. Tom Droege, of the Carter Center's AIHP. Among the more successful promoters noted by experts are: * A group of East Baltimore lay health promoters who have helped reduce hypertension, smoking and alcohol consumption among that city's African-American population, achieving a decrease in mortality rates; * A Mississippi program known as CHAN (Community Health Advisory Network) that fights poor nutritional habits in that state; * A nursing program based at University of Alabama in Tuscaloosa that educates local African-American residents about lower-fat diets, heart disease and other health matters; * Kentucky Homeplace's lay health program, which targets nutritional deficiencies, occupational hazards, and pre- and postnatal education in Appalachian Kentucky. "Once local populations learn to navigate the health care system, they become empowered to take care of their own health and request things they never had before," said Brownstein. For example, lay health promoters have helped obtain after-work hours at public health clinics, a common request by community residents. Promoters in Arizona, in another instance, noticed local Hispanic and Native American women weren't scheduling regular pap smears or mammograms to screen for cancer. The reason? Most area doctors were male -- but it was culturally unacceptable for the women to be examined by men. At the urging of lay promoters, female physicians were brought in, dramatically increasing the numbers of women who are screened. "These promoters do not replace professionals," said Brownstein. "Most of the work they do is very basic: It's education and perhaps a very simple test such as a blood pressure check. "But this concept -- it's almost like the village health care worker model in Africa -- has been a very cost-effective way to reach these populations."ANS.8/2-9-96) END © COPYRIGHT THE AMERICAN NEWS SERVICE This article is copyrighted by The American News Service. Permission is granted to republish, reproduce or transmit American News Service articles under two conditions: (1) the material must be clearly identified by the words "The American News Service" and (2) tear sheets, tapes or videotapes of all articles or programs produced as a result of this material must be sent within 30 days to The American News Service, 289 Fox Farm Road, Brattleboro, VT 05301. For further information, please call 1-800-654-NEWS or e-mail info@americannews.com.Paul Karr is a prize-winning journalist and essayist who divides his time between Maine and Georgia. His work has appeared in Sports Illustrated, E Magazine and other publications.Contacts: Sam Bandela, CHP coordinator, contact for Gonda Shows, Chamblee-Doraville Ministry Center, Atlanta, Ga., 770-451-1030. Dr. Nell Brownstein, Centers for Disease Control and Prevention, Atlanta, Ga., 404-639-3286. Fran Wenger, director, Transcultural and International Nursing, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Ga., 404-727-7972, nursefzw@nurse.emory.edu. The Rev. Tom Droege, associate director, The Atlanta Interfaith Health Program, The Carter Center, Atlanta Ga., 404-420-3846, tdroege@emory.edu. AIHP training manual, www.interaccess.com/ihpnet.Background: Jean Murphy, CHP/parish nurse coordinator, contact Katherine Wilson, Technical Information Services Branch, Centers for Disease Control and Prevention, Atlanta, Ga., 770-488-5080, kxw@ccdcpc1.em.cdc.gov. Robert Wood Johnson Foundation, Faith in Action project, Interfaith Caregivers Program, Kingston N.Y., 914-331-0016. Programs offer grants and technical assistance to new and existing interfaith volunteer projects of caregiving in local communities around the country. Contact (for both programs): Kenneth Johnson.