I met Adam* in December of 2019. Adam was a new patient at our clinic. He was my age and had recently been diagnosed with diabetes after a visit to the ER. We spoke casually for a little while, talking about how to find an affordable gym membership. Adam had already made losing weight and exercising regularly a priority since his diagnosis. I admired his commitment and motivation for making sustainable lifestyle changes he would need for a long journey with diabetes. We discussed nutrition and how various food groups impact blood sugar for a long time before I asked him if he was experiencing any side effects related to his new diabetes medications. That’s when he disclosed that he didn’t believe in taking medications at all and that he hadn’t been for the past month since he had been diagnosed. I spent about an hour with Adam that day, he told me about how his mom had passed away from complications of diabetes, and how he took care of her in the months before she passed. He believed it was her medications which killed her. We took a deep dive into long-held beliefs that the healthcare system is a machine that exploits people living in poverty and people of color.
This is a short example of learning from the bottom up about the systemic inequalities which exist in our healthcare system. It takes much longer than an hour to build a relationship with a patient who has a barrier built on a long history of macro and microaggressions which led to this point. Being an NHC member gives you privileges not available to clinicians with even the purest of motives, such as spending long amounts of time with patients. In the weeks following that initial session, I collaborated with the social worker at our clinic to get insurance for Adam. The next step was facilitating access to affordable healthy food, this time by partnering with Just Harvest to assist Adam in signing up for SNAP benefits and finding a local Produce to People (through the Greater Pittsburgh Community Food Bank) distribution near his home. After several telephone follow up sessions and a few chats with his primary care physician, we were able to create, through shared-decision making, a medication regimen which complemented his lifestyle changes and did not cause significant side effects.
I checked in on Adam a couple of weeks ago, to see how he and his family were coping with the pandemic and to offer my assistance with any social resources they might need. He told me that he has been able to afford all of his medications and that they have continued to be able to access affordable healthy food. He then excitedly told me about his new home exercise routine and that his blood sugar measurements had markedly improved. This is the strength of collaborative healthcare and the National Health Corps. Providing education and resources to patients helps to bridge some of the most crucial gaps that exist in our healthcare system and equips members with vital experiences which will allow them to become the leaders of healthcare in the future.
*Patient name changed for privacy and their story was used with their permission.
This blog post was written by NHC member Caroline Cummings
Caroline serves at UPMC Shadyside Family Health Center as a Diabetes Quality Improvement Coordinator