By Geoffrey (Kok Heng) See

The Context:

University City describes itself as:

“… one of Philadelphia's most vibrant and diverse neighborhoods. This dynamic, close-knit community is home to college students, artists, and families who coexist amid world-class universities, dining, nightlife and cultural offerings.” [1]

After reading this, it is hard to imagine that West Philadelphia, where University City is situated, holds twice the national average of people living under the poverty threshold. In real-world terms, University City harbors homeless people lying on the streets through the winter months, children going home to houses missing walls or windows, and the perpetual threat of crime and violence looming around every corner.

How is it that University City, a thriving, self-described cultural and economic sanctuary, can hold such starkly different alter egos? As such, I became motivated to contribute my entrepreneurial skills into the formation of EduHealth, a program designed to aid in the integration of healthcare with education, to be initiated at the Sayre Health Center (SHC), based at local Sayre High School.

As a result, a new model for co-delivering education and healthcare emerged, utilizing the synergy present between two different institutions.

Lacking Healthcare and Education, Poverty’s Grasp Tightens

SHC, through the provision of healthcare and educational resources, supports diversity by catering to a predominantly disadvantaged African American community. It serves over 1,100 Sayre High School students, out of which 99.3% are African American, with over 85% coming from low-income families.[3] In addition, Sayre Health Center serves the catchment area for Sayre High School, which has a population of approximately 93,000. Some 24% of families in the service area live in staggeringly poor conditions – up to 200% lower than the federal poverty level.[4]

As is usually the case in areas stricken by such poverty figures, existing supplies of “culturally-sensitive” healthcare services are inadequate. Furthermore, the deviation in health services between University City and the national average is substantial. Merely two federally qualified clinics exist in the service area, both of which remain overwhelmed with inflow. Given their situations, both have provided letters of support as well as open enthusiasm for the establishment and substantiation of the SHC.

Although efforts have been underway to address the critical healthcare issue, existing models of community health centers are oftentimes unable to provide culturally sensitive healthcare in an effective manner. Given the underrepresentation of African Americans in healthcare professions, the presence of racial and cultural differences between healthcare providers and their recipients often results in mistrust and, subsequently, a lower degree of effectiveness of existing health resources.[5]

Additionally, gaps in basic healthcare knowledge among community members results in an inefficient use of already-scant healthcare services. To most Americans, when we’re stricken by a cold or the flu we simply remedy ourselves with Advil, Tylenol, or a cup of tea. Even these solutions, what appear to us as basic and highly attainable healthcare fixes, are typically out of reach for those living in West Philadelphia. Instead, residents flock to the emergency rooms, resulting in a poor allocation of available healthcare services and a misuse of the existing systems in place. This instance stands testament to the relative chaos (or antiquity) gripping this community.[6]

Exposure to real work also improves Sayre students’ interest in education. A lack of economic and educational opportunities in West Philadelphia means that oftentimes the parents of Sayre students are employed in jobs pertaining to lower levels of education. Hence, students fail to associate work with education and, therefore, lack motivation towards their studies. There are limited opportunities for Sayre students to immerse themselves in a professional atmosphere where they can gain the skills and drives necessary to lead a dedicated career.

The Effects of Linking Healthcare and Education

  The SHC model is based on the principles of community-driven development. It is in the interest of this strategy to treat the poor and impoverished, as well as their institutions, as assets and partners in the search for sustainable solutions to developmental challenges.[7]

Students at Sayre High School, where the SHC is based, work with the community health center to deliver preventive healthcare as part of the school’s curriculum. It is through these healthcare classes, linked directly to the Sayre health center, that students acquaint themselves with knowledge of the healthcare industry, all the while delivering it to the surrounding community.

Sayre students involved in the SHC’s operation (including advising, outreach opportunities, evaluation, office management, and clinical operation) gain career exposure, and are provided with hands-on internships at the SHC. Students are even given the chance to assist SHC doctors, for a full hands-on experience.

Healthcare provision has improved substantially through the collaboration between Sayre students and the adjoining healthcare facilities. Fully-trained doctors are often not residents of the West Philadelphia community, and thus unable to relate to their patients as well as they would like to. Students, therefore, serve as the intermediaries between patients and doctors. The students then sync themselves with trained physicians to deliver the necessary healthcare, making the total service more culturally parallel.

Additionally, Sayre students participate in outreach services by traveling around the West Philadelphia community, promoting good health while delivering preventive care (such as monitoring patients in obesity programs) in a more cost-effective manner.

The end result is a program that encourages students to involve themselves with the issues gripping their community, taking ownership for their efforts and pride in their cause.          Students gain invaluable experience in the healthcare industry, gearing them towards careers through either an interest in healthcare or a change in motivation. This program shapes leaders and betters lives for students and patients alike.

Difficulties in Implementing the SHC Model...

  While the co-delivery of education and healthcare is what makes the SHC so unique and beneficial to the surrounding community, its potential is, unfortunately, not fully realized. Organizational complications have marred the program’s draw, hampering its opportunity to make a difference to University City.

Difficulties such as an absence of an implementing agent with integration in mind, lack of resources, or lack of a clear action plan effectively snub the SHC of its momentum to act as an economic and healthcare contributor.

Aside from requiring a formalized board of directors, student-leadership, and personnel devoted exclusively to the program, SHC medical professional and community relations directors are needed to establish and promote the SHC’s connection to the community. This, then, is the major lacking point of the SHC model, a disappointing inhibitor to an otherwise revolutionary program.

SHC will soon hire an executive director, a medical assistant, a half-time receptionist, as well as a half-time accountant at full capacity. At 1.2 FTE physicians, the community health center should handle around 5,200 individual cases a year.

Aside from the some $150,000 that was necessary to renovate the area for use at the Sayre High School, expected annual operating expenditure at capacity is projected to be around $200,000.

Health Centers, thus reducing political resistance to implementing this healthcare solution. As operations only just began in mid-2007, there are no exact revenue figures for reporting.

References:

Kisker, Ellen E., and Brown, Randall S. Do School Based Health Centers Improve Adolescents’ Access to Health Care, Health Status, and Risk Taking? Journal of Adolescent Health 1996:18, p.335-343, 1996.

Philadelphia Health Management Corporation. Household Health Survey. 2002. Quoted in Sayre School-Based School and Community Health Promotion and Disease Prevention Center. Program Narrative. Photocopy, Center for Community Partnership, 2004.

Sayre School-Based School and Community Health Promotion and Disease Prevention Center. Program Narrative. Photocopy, Center for Community Partnership, 2004.

US Census 2000. American Factfinder. http://www.census.gov/main/www/cen2000.html