The Delta Grassroots Caucus (DGC) is a broad coalition of grassroots leaders in the eight-state Delta region. DGC is also a founding partner of the Economic Equality Caucus,
which advocates for economic equality across the USA.

Health Houses: A Superb Response to Health Issues of the Gulf Oil Disaster

Posted on July 05, 2010 at 03:29 PM

SOUTHERN LOUISIANA: The Communithy Health House Network is an innovative health care delivery initiative that holds great promise for improving health care throughout the Greater Delta Region, and makes an excellent fit in responding to the oil disaster in southern Louisiana as well as areas in Mississippi and Alabama threatened by the oil blowout.

The Delta Caucus partners have received substantial interest from local leaders in southern Louisiana in setting up a series of Community Health Houses here to deal with the health care problems caused by the oil disaster as well as long-term recovery after Hurricane Katrina.

We have had communications with Dr. Kevin Stephens, a medical doctor in New Orleans who was head of the New Orleans health department before, during and after Katrina and won accolades for his Congressional testimony regarding rebuilding New Orleans after the hurricane and is now a strong advocate for the Health Houses; we have met with the New Orleans office of the Children’s Defense Fund; Lutheran Social Services Disaster Reponse in Louisiana; Rev. Dwight Webster, senior pastor of Christian Unity Baptist Church in New Orleans, a Katrina survivor and eloquent advocate for constructive causes.

We have also consulted with some business leaders in the area; local government officials in Plaquemines and LaFourche parishes, two areas already directly hit by the oil blowout; U.S. Rep. Joseph Cao, who represents the New Orleans Congressional District, and are in the process of following up with other members of the Lousiana Congressional delegation; and many others. All have expressed interest in the network’s potential for dealing with the health care problems that existed even before the oil disaster, which will aggravate those problems.

Congressman Bennie Thompson of Mississippi, chairman of the Homeland Security Committee, is already an enthusiastic supporter for the Health House network.

Dr. Aaron Shirley of the Jackson Medical Mall Foundation, James Miller of the Oxford International Development Group, Lee Powell of the Delta Caucus have held a series of meetings about the Community Health Houses concept in southern Louisiana. Dr. Shirley and James Miller will be the main speakers at a meeting at New Orleans University on July 8, held in cooperation with many local nonprofits headed by Mary Joseph, director of the New Orleans office of the Children’s Defense Fund.

SEPT. 23 FUNDRAISER FOR OIL DISASTER VICTIMS– As part of the Sept. 21-23 Delta conference in Washington, DC, the Delta Caucus will hold a fund-raiser/issues forum for victims of the oil disaster and Hurricane Katrina at the sanctuary of the historic Lutheran Church of the Reformation on Capitol Hill near the US Supreme Court, Thursday morning, Sept. 23, 8:30 a.m. to 12:30. The Sept. 23 fundraiser’s proceeds will go to nonprofits working in the Gulf region.

Tentatively we are planning for two major recipients of the fund-raiser to be the Every Child Is Ours Foundation, which has done work in New Orleans in the past after Katrina and is headed by Jan Paschal, a former high-ranking Clinton administration appointee in the US Department of Education. Those proceeds tentatively will go toward hunger and nutrition efforts for oil disaster and Katrina victims. The other major recipient will be the network of Lutheran philanthropic organizations to be used as they see fit to aid those suffering in the Louisiana coast. The Lutherans are highly regarded for their philanthropic work in the region and their connection is logical since the fundraiser will be held at the Lutheran Church of the Reformation in DC.

The first two Health Houses have already been established in Jackson and Greenwood, Mississippi, with 12 other communities in Mississippi in the process of starting up new ones. In addition to the substantial interest in southern Louisiana, local leaders in Desha County, Arkansas and Covington, Tennessee have expressed interest in this innovative concept. An integrated health care delivery network has long been needed throughout the Delta, and the oil disaster’s impact on southern Louisiana is right now a poignant example of how badly such a network is needed.

We are exploring a number of sites to serve as Health Houses. These facilities only require 2,000 square feet or so, with enough space for an initial room for receiving people, a couple of examination rooms, a lab center. One site is a church in downtown New Orleans that was flooded by Katrina and will not be reopened because so many parishioners will not be coming back. Part of the church is now being used as a day care center, and there are negotiations about possibly using the rest of it as a Health House. A vacant storefront in one of the already existing sites in Mississippi was donated at a nominal cost.

Based on input and assessed need, there need to be a series of sites in New Orleans and southern Louisiana: Lafourche Parish (2) Terrebonne Parish (2) Plaquemines Parish (3) St. Bernard Parish (2) Jefferson Parish (2) Orleans Parish (3 in New Orleans)

There could also be individual sites set up as demonstration projects. This is urgent to get these up and running as soon as possible.

Institute of Medicine conference in New Orleans emphasized problems of local suspicion of the federal government and other “outsiders,” which is a problem the Health Houses can address: At the recent Institute of Medicine (IOM) conference in late June in New Orleans regarding the health impact of the oil blowout, many of the experts constantly emphasized the problem that Gulf Coast residents are suspicious of the federal government and other “outsiders” who are coming here to help with responses. This is understandable after the inept federal response by FEMA and other government responses during and after Katrina.

The Community Health Houses are ideally suited to deal with this problem, because the health workers at the site are residents of the community who are chosen by local people. They have the trust of the community because they live there and are well known locally. This will be a key issue, because information about what the risks are needs to be disseminated widely and rapidly. There will need to be a central coordinator, with the Centers for Disease Control, HHS, state agencies, local government and others all playing a role.

Once the central repository of information has disseminated the information, there is the problem of how to get it to the receiving end–those in all the local communities and neighborhoods–and get them to understand it, have confidence in it, and utilize the information–a series of community health houses would be ideally suited to do that. A Health House typically has two Certified Nursing Assistants, two community health workers and an administrative staffer who are connected to existing providers throughout the area. The Health Houses provide cost-effective primary and preventive health care services and address social determinants of health factors in the community.

Dr. Irwin Redlener of the Columbia University of Public Health and Surgeon General Regina Benjamin are familiar with Dr. Aaron Shirley and the Community Health House Network and agreed that it would be a good way to surmount the suspicion of federals and other outsiders.

Disseminating health information expeditiously to the community: The Community Health House Network is helpful in getting the cooperation and confidence of the communities. The community empowerment, preventive care and cost reduction advantages of this approach are paramount. For the large numbers of Hispanic and Vietnamese communities in the region, the language barrier would be overcome because the local health workers already speak the language. Getting information out at times of storms will be important, as will the long-term, day by day process of disseminating information about how to reduce the health risks of chemical exposure and the economic impact of the disaster on health in terms of stress, mental health problems, and job losses that will make it difficult for many to keep up their health insurance.

The Community Health Houses will be highly valuable in dealing with not only the environmental but the stress and mental health issues caused by the oil disaster. Having local, trusted residents monitoring the depression, substance abuse, domestic violence and other stress-related fallout from the job losses and economic impact will be highly useful. If federal experts and medical professionals do not have the confidence of the local people they will not follow prescriptions, resulting in constant missed opportunities to engage in preventive care, excessive use of emergency rooms, unnecessary re-hospitalizations from failure to understand and/or follow medical recommendations for recovery, and there will be similar missed opportunities in prenatal care, nutrition, early detection of chemical exposure and a wide range of other issues.

The Health Houses preventive approach is valuable in reducing the damage from substance abuse, especially in catching such problems at an early stage before they have reached the more intractable later stages of abuse. This is a clear example where having trusted residents providing preventive care is invaluable.

The Institute of Medicine is an independent nonprofit agency that is not connected to the government and thus has no ax to grind, and their conference was certainly a plus–a detailed message was sent out about their conference last week. They were urged at the conference to hold additional sessions following up.

Need for IOM to include more community organizations at future conferences: In the spirit of constructive criticism, one point where the IOM should expand its range at future meetings would be to include local nonprofit and community leaders much more prominently in the program. Many of the speakers were scientific and technical experts from other parts of the country or the federal government, and certainly those leaders are essential to play an important role. However, the people who can most authoritatively address the issues of gaining the full trust and cooperation of the local communities are groups like the Louisiana chapter of the Children’s Defense Fund, Lutheran Social Services and other faith-based organizations, churches like Christian Unity Baptist Church and leaders like Dr. Kevin Stephens, the Mississippi Coast Inter-faith Disaster Task Force, and many other groups who live and work in southern Louisiana.

Unfortunately, many of the scientists, technical experts, and federal government people who live outside the region and were emphasizing the problem of getting “buy-in” from the local communities who are suspicious of “outsiders” will themselves be considered “outsiders.” Thus the importance of major inclusion of grassroots leaders who live in southern Louisiana and the other local areas hit by the oil disaster.

DUTIES OF HEALTH HOUSES–The staff is recruited from the community they will serve, with input from local leaders as to who would be best suited for these positions. They receive special training developed specifically for the Health House model, certification (including CNA certification), and continuous learning opportunities as Community Health Workers (CHWs). The CHWs engage with their community ro promote wellness, help coordinate patient care throughout the network, emphasize preventive care, and help the community confront long-term health challenges due to environmental issues.

The Community Health Houses (CHHs) follow guidelines of the World Health Organization that advocate implementation of integrated delivery service networks as a system model that delivers primary and preventive care services.

The Community Health Workers serve as accessible, basic health information and assessment resources for the local area. They organize early prenatal care, conduct home visits and facilitate family planning. The CHWs conduct screening and referral for hypertension, diabetis and other conditions prevalent in the Delta. Other duties include: –Assuring that the home environment is properly prepared when a patient is discharged from the hospital;

–Providing education and counseling related to asthma, sickle disease, HIV and other problems;

–Assess social determinants of health disparities, participate in intervention strategies, and support research to measure outcomes

–Track proper Emergency Room utilization, teen pregnancies, birth weight;

–Monitor Medicaid/CHIP annual eligibility requirements;

–Conduct foot screening for community residents who have diabetes.

Urgency of getting started NOW: These health care improvements were long overdue anyway, and the oil disaster has dumped another ton of severe issues on our plight. The Health Houses are a tried and true model that can be started up now.

Funding for setting up the Health Houses is being sought now through the preventive care provision of the new health care reform law, or better yet to move more quickly, corporations and foundations that can get the funding flowing in short order.

As soon as funding is there and a community indicates that it wishes to work with the Community Health House Network in setting up a site, a team of trained specialists could go there immediately. They would identify the community health workers in consultation with local leaders, begin training and start the care immediately. James Miller that a team that could go to southern Louisiana would include a doctor and three registered nurses who would work with multiple community stake-holders in getting the site started up.

The relationship between the Health House Community Centers and Community Hospitals: Each Health House (Level 1) will be formally affiliated with the existing community health center or private practice (Level 2) that are staffed by physicians and Certified Nurse Practitioners for back-up, referral and follow-up. Level 2 provides a greater level of care that the Community Health Workers are not trained to performed. The next level is the Community Hospital (Level 3).

Patients in need of hospitalization will be admitted and treated at the Level 3 Community Hospital. Although the patient is hospitalized at Level 3, the patient remains a responsibility of the entire network, meaning that all resources of the Health House and the community clinic remains available to the patient. Thus, when the patient leaves the hospital the health house community worker is there to assure compliance with discharge instructions, which will help reduce re-admissions for the same health problems.

The latter point is very important, because we have found that in many cases the patient will be discharged and given detailed instructions, but they do not understand or are not focused on the importance of carefully following the instructions and fail to do so, and shortly thereafter have a relapse and are back in the hospital again. The Community Health Workers will explain, track and follow up with these patients to make sure they follow the instructions about medication, diet, etc.

FUNDING SOURCES: An important subject is for the health houses to qualify for federal funds already in the system, e.g., Medicaid and other programs. The pot of funding for preventive care in the new health care reform law is a a major and logical source of funding.

Another idea is that corporations could fund individual health houses and place their logos on them, thus receiving justified credit for helping the community – plus their employees could volunteer to help out from time to time. Instead of putting so much into lobbying and advertising, the corporations could do directly do a great deal of good in local communities with their money by directly helping provide primary care.

Operations will move forward based on money in the bank or firm commitments, so that each facility is sustainable for the long term. Donations are always somewhat unpredictable, but could be used for special services, or for things like buying refrigerators for people who need to store insulin, blood pressure monitors, exercise machines for people who come to the health house, or similar uses.

Concluding point–the need for changes in health care in the Delta: What we have been doing in the past in the entire Delta region regarding health care is not working, and we need a new approach. The adage that the definition of insanity is doing the same thing over and over again and expecting different results applies perfectly to the dilemma of health care in the Delta. There are many highly qualified and knowledgeable professionals in the region who believe that Dr. Aaron Shirley is right: the Community Health House Network is an idea whose time has come.

We hope these reports are useful in getting people better informed about the oil disaster and its impact on economic and health care issues in the Greater Delta Region. Thanks–Lee Powell, executive director, MDGC (202) 360-6347