Just Health Care, Just in Time
by Kristen A. Graham
A novel health care model helps the uninsured and reduces hospital costs.
When Sam Schadt ’14 (B.S.) saw John enter the clinic, he knew something was wrong. Schadt, coordinator of the St. Cyprian Health Promoter program, was taking patients’ vital signs, alongside others who had been trained to complete health screenings. John was clutching his stomach and showed signs of delirium. He complained of not feeling well as Schadt carefully took his height, weight and blood pressure. The pressure reading was so elevated Schadt thought he had made a mistake. He took it again, with a different device, confirming that John’s pressure was skyrocketing. He needed immediate medical attention.
Schadt rushed him to Mercy Philadelphia Hospital, all the while wondering how John would be received. He had emigrated from Nigeria two months prior and didn’t have health insurance.
• • •
For Mercy Health System, the largest Catholic health care system in the Delaware Valley, a burgeoning African population in West Philadelphia that began a decade ago meant a growing number of needy people arriving in emergency rooms with dire conditions. The men and women, largely poor, lacking health insurance and often undocumented, might go years without a physician’s care, resorting to hospital treatment only when their health status was grave.
By law, patients who arrive at emergency rooms must be stabilized, regardless of their ability to pay for care. And for a Catholic health care organization operated by the Sisters of Mercy, treating the vulnerable, regardless of their ability to pay, is a given.
Mercy admitted John and alleviated his symptoms, providing medication for his hypertension and education about nutrition.
“Mercy took him and gave him the quality of care that everyone deserves,” says Schadt, who believes there are thousands just like him in West Philadelphia.
“The sisters would never turn anyone away,” says Peter A. Clark, S.J. ’75 (B.A.), professor of theology and religious studies and health services.
But the number of people who arrive in a Mercy emergency room with conditions that require costly, ongoing care has the potential to affect the health system’s ability to function.
Fr. Clark, who also serves as the health system’s bioethicist, sat on the Mercy Hospital Task Force on African Immigration that was charged in 2010 with finding a balance between caring for the needy, a core mission of the Sisters of Mercy, and meeting the bottom line. Fr. Clark brought insights and ideas he developed during one of his SJU courses, Just Health Care in Developing Nations. On a two-week class trip to the Dominican Republic in 2006, Fr. Clark and his students witnessed firsthand how trusted men and women in the local community received medical training at clinics and were sent into barrios to help people deal with health-related issues.
That model inspired an idea: Could he and others create a similar “Health Promoter” program in the Philadelphia area, a community-based model built by partnering with existing organizations to provide health care, reduce costs and improve the health of people in desperate need? The paradigm would focus on preventing serious conditions and managing chronic ones, with a heavy emphasis on education and basic screenings. In this way, patients like John would learn how to manage their blood pressure, instead of waiting to seek help until they required emergency care.
“We felt this could be something that would be beneficial, both to the city and the health system,” says Fr. Clark.
Air Force Capt. Luke Surry, M.D. ’07 (B.S.), a former student of Fr. Clark who was in the 2006 class and is now based at the San Antonio Military Medical Center, was also inspired by the work he saw Health Promoters performing in the Dominican Republic.
“It really seemed the Health Promoters were fit for the purpose of engaging the community,” says Surry, who attended Georgetown University School of Medicine. “They were helping engage populations that were on the margins.”
Back in the United States, Fr. Clark and others, including Surry, tailored the program they had seen in Latin America to the situation in Philadelphia.
The Health Promoter pilot program, a joint venture of Saint Joseph’s Institute of Clinical Bioethics (ICB), which Fr. Clark leads, and the Mercy Health System, began in 2012 with monthly clinics. At first, the program zeroed in on John’s community — the Nigerian population of worshippers at St. Cyprian Church in Philadelphia’s Cobbs Creek section. Mercy residents educated 10 men and women from the community as Health Promoters, focusing on both prevention and management of chronic conditions such as diabetes, HIV, obesity and hypertension. Once trained, the Health Promoters conducted screenings for blood pressure, sugar, cholesterol and oxygen saturation levels, and body mass index. They provided education — including nutritional and lifestyle counseling — and monitored patient health and compliance. When the situation warranted, they helped the people they served get treatment at a hospital or clinic.
Rev. Aloysius Ochasi ’11 (M.S.), ICB assistant director and adjunct faculty member in theology and religious studies, is a Nigerian native and connected with the community. The program started small and grew steadily, spreading to help the French-speaking West African people who also worshipped at St. Cyprian.
It then expanded to Living Spring, a Protestant church close to St. Cyprian. The recurring clinics that fulfilled community members’ basic health care needs proved popular, and eventually, Mercy asked if the program might extend further.
Mercy Suburban Hospital in Norristown, Pennsylvania, then run by the health system (renamed Suburban Community Hospital, as of February 2016), was coping with high care costs from a largely uninsured Spanish-speaking population and looked to the Health Promoter program for help. Fr. Clark and his team agreed to take the model to St. Patrick Church in Norristown, whose congregation includes a large Hispanic population. With a $65,000 grant last year from Mercy Suburban Hospital, the clinic at St. Patrick now offers basic dental care and vision services in addition to health services, and the church has dedicated medical exam and meeting rooms.
A major and relatively new component of the St. Patrick clinic is a Healthy Moms, Healthy Babies program run by a Mercy midwife with assistance from two ICB fellows. Prior to the clinic’s origin, the church’s congregation had 300 births a year, and had recently lost five babies who may have been saved if the women had sought medical attention during their pregnancies.
“There was a general lack of knowledge about prenatal care,” says Jenny Schadt ’17 (Sam Schadt’s cousin), a chemical biology major, who leads the Healthy Moms, Healthy Babies initiative. “Women didn’t even know they needed prenatal vitamins. We wanted to respond to that need.”
The monthly clinics are held in the church basement on Sundays after Mass. At the liturgy’s conclusion, a doctor speaks to the congregation, with translator Francisco Lopez-Font ’18, to invite families to visit the clinic. There, Jenny Schadt and the other Health Promoters collect and distribute prenatal vitamins to women of childbearing age, reminding them that it’s important to start taking the vitamins before they become pregnant. A Rutkowski Family Medical Research Grant pays for some of the vitamins; others have been donated.
As clinic attendance slowly builds, Schadt has been humbled by the trust she’s been able to gain.
“The first few times, we didn’t have many women, but as we keep coming back, I’m beginning to see the same women,” she says. “They say, ‘Oh, I’ll tell my friend.’ And we’re starting to hand out pediatric vitamins now, too. They’re bringing their kids.”
Lopez-Font, a history major, says, “The work has given me a different perspective on the world. We really take for granted health insurance, and it’s empowering to me that I’m able to help people who are undocumented. Everyone deserves health care.”
The numbers bear out the program’s success. In the past two years, Mercy has not had to pay for any patient in clinic areas to have dialysis, says Fr. Clark; infant mortality at St. Patrick has also improved. But the program’s growing acceptance in its targeted communities is equally as important as the numbers.
That’s significant, because suspicion is common among the undocumented population — people are afraid to give their real names for fear of being deported. But they have been made to feel comfortable in their church communities, and now, with their Health Promoters.
For Sam Schadt, his experience with the St. Cyprian Health Promoter program as an undergraduate was transformative. Now a Philadelphia College of Osteopathic Medicine student, he says the medical knowledge he gained was invaluable. But also important were the softer skills — learning how to reach out to a new community with sensitivity and how to empower others.
“It was challenging, but it made me a better person,” says Schadt, who wants to eventually do medical work in developing nations. “And it reaffirmed my passion for medicine.”
Michael Barkowski ’15 (M.A.), who worked as an ICB graduate assistant and is now a third-year medical student at the Philadelphia College of Osteopathic Medicine, agrees. He says, “The Health Promoter program opened my eyes to the diversity within the American health system. Serving as a physician, how do you build community with your patients who can be from anywhere, who can speak any language, who can profess any faith? The Health Promoter program is a great case study on how that’s done.”
Current Saint Joseph’s students have discovered meaning in the program, too. Many who become involved with the ICB and Health Promoter program dream of a career in medicine.
“It’s a distinguishing characteristic for them,” Fr. Clark says. “When they go for interviews, they have practical experience.”
Brant Edmonds ’17, a biology major minoring in health care ethics, is an ICB fellow, with extensive responsibilities for managing part of the Health Promoter program.
“‘Rewarding’ is the best way to put it,” he says. “It’s a way to give someone advice as a way to better themselves with regard to their health. That’s what I want to do with the rest of my life.”
Early into her work with the program, chemical biology major Mary Kate Dougherty ’19 feels that the work has been meaningful. “We’re contributing what we can to people, but they’re helping us, too,” she says.
The students in the Interdisciplinary Health Services capstone course of Assistant Professor Eileen Sullivan, Pharm.D., have also gotten involved with the Health Promoter program, creating brochures and videos that help educate patients.
“Many times, our projects end in the classroom, but I knew that the students would love to be involved in something that went beyond that,” says Sullivan, who served on the SJU Health Professions Advisory Committee with Fr. Clark and was struck by the Health Promoter concept. “The students feel they’ve been able to contribute a lot.”
• • •
Though the three Health Promoter locations keep Fr. Clark and his team fully engaged, the model may continue to expand. If new communities reach out, the ICB stands ready to serve them.
“The plan is to make these communities self-sustainable,” says Fr. Ochasi.
The ideal situation would be for the team to set up a Health Promoter model, stabilize it and withdraw, allowing the community to own its program.
“I really do think we’re putting the Jesuit ideals into action,” says Fr. Clark. “This is one of those areas where the students see firsthand what it means to be a vulnerable person and what it means to do something about it.”
Institute of Clinical Bioethics
Established in 2006, the Saint Joseph’s University Institute of Clinical Bioethics (ICB, formerly the Institute of Catholic Bioethics) promotes interdisciplinary research, educational programs, academic courses, clinical consultation and policy development in the field of bioethics. The ICB serves the SJU academic community, the Philadelphia-area medical establishment and the Archdiocese of Philadelphia.
SJU professor and bioethicist Peter A. Clark, S.J. ’75 (B.A.), directs the Institute, which aims to educate health care professionals to be effective leaders. A core part of its mission is understanding and respecting the role of religious and spiritual traditions, particularly Roman Catholicism, in health care decision-making. The ICB exposes students to the growing field of biomedical ethics through its support of the University’s interdisciplinary health care ethics minor and involvement in the Allen and Dolores Gustafson Distinguished Research Fellows Program.
The Institute’s many professional affiliations include Inglis House and the Shriners Hospital for Children in Philadelphia, and Mercy Health Services, the Saint Agnes Hospital and Catholic Charities in Maryland. On behalf of the Mercy Health System, the Institute operates an Ethics Consult Service, conferring 24 hours a day, seven days a week, on clinical cases that staff, patients, family and others find morally troubling.
Saint Joseph’s University Magazine contributor Kristen Graham is a freelance writer.