A NEIGHBORHOOD'S NEW HEALTH OUTLOOK
WORDS BY MARY ANN LITTELL / PHOTOGRAPH BY JOHN EMERSON
he Ironbound section is home to the latest expansion of UMDNJ's health care initiatives in the city of Newark. UMDNJ's School of Nursing recently opened a community health center to serve three public housing developments located in the Ironbound — Hyatt Court, Pennington Court and Terrell Homes. They are home to approximately 3,000 residents, many of whom face serious health issues, including obesity, diabetes, high blood pressure and asthma.
Cindy Sickora, DNP, RN, assistant professor of prelicensure programs at UMDNJ's School of Nursing (SN), has been working hard for the past five years to improve the lives and health of the residents of these developments. Her mission began simply — a nurse measuring blood pressure. But she wanted to do more. "There's a disconnect between health care professionals and the community, and that's why some people don't get the care they need," she explains. "We're here to bridge that gap."
Sickora received a $900,000 grant from the
U.S. Department of Health and Human Services, Health Resources and Services Administration, to launch the Jordan & Harris Community Health
Center in the Ironbound. Centrally located at Hyatt
Court and named for longtime Hyatt residents Lillie Jordan and Esther Harris McArthur, the center is staffed by a full-time nurse and other UMDNJ health professionals. They offer comprehensive health services to the residents of the three housing developments, including physical exams, home visits for the elderly and housebound, HIV testing, screenings for hypertension, asthma and diabetes, and vaccinations. Sickora is director of the center and Hosseinali Shahidi, MD, MPH, assistant professor of emergency medicine at New Jersey Medical School (NJMS), is medical director. NJMS and UMDNJ's School of Health Related Professions are collaborating with SN on the program.
As a complement to the center's activities, UMDNJ has also started a community health worker program. A collaboration between SN and NJMS, it is funded by a $135,000 grant from the Healthcare Foundation of New Jersey. The program trains residents of the housing developments to educate their peers about the most common health problems affecting underserved urban populations. "So much of disease management is lifestyle," says Shahidi. "By providing health information, we're empowering people to improve their health."
At first glance it's hard to figure out how Shahidi and Sickora, total opposites in personality, came together to pursue their common goals. Shahidi is soft-spoken, courtly and precise. Sickora talks a mile a minute. She's in constant motion, her cellphone vibrating nonstop with calls from students and community health worker trainees. "This is the most rewarding experience I've had in my 35-year career as a nurse," she states.
The community health center is the direct result of Sickora's doctoral project, which she started in 2008 when she enrolled in SN's Doctor of Nursing Practice (DNP) program. As part of her project she was assigned to the Ironbound — specifically, to Hyatt Court. "It was a neighborhood I didn't know much about. In the beginning, I found it intimidating," she recalls. "People would look at me strangely and I'm sure they were thinking, ‘What's she doing here?'"
Sickora was assigned to care for 84-year-old Agnes Younger, a stroke survivor. "She was feisty — she kept a baseball bat by her door. I saw her every week for years and we became close. She was the inspiration for this center." As other residents would see Sickora day in and day out, they'd ask to have their blood pressure checked, and relationships blossomed. Eventually Sickora set up shop in the recreation room at Hyatt Court to offer blood pressure readings and other services. At first, residents trickled in slowly. But as they got to know her, they returned for follow-up, bringing their friends, neighbors and relatives. Then, the federal grant enabled Sickora to hire staff and establish the new center in renovated housing authority space.
Sickora invited key stakeholders to create a Community Advisory Board for the center, a step she said was crucial. Influential residents from all three housing developments were elected to the board. Over time, she involved more of the nursing school staff and faculty and continued to bring SN students for training. One of them, Damaris Grossman, a recent graduate of the accelerated BSN program, found the experience invaluable and continues to volunteer there. "We do health assessments, home visits, head-to-toe examinations," she says. "A lot of the work is routine, but sometimes we have a patient who needs specialized care, so we call in one of the nurse practitioners or Dr. Shahidi. Many of these residents don't have physicians and they don't look for help. You have to go to them."
SHE ENVISIONS THE COMMUNITY HEALTH WORKERS
eventually providing services in collaboration with physicians, medical students, physical therapy and respiratory therapy students.
That's where the community health workers come in, explains Shahidi. A native of Iran, he did his obligatory military service in the 1970s and later was part of an initiative launched by the Iranian government to improve the country's health care. He spent several months in the countryside, traveling with nomads. There, he observed the community health model in action. "Groups of nomads moved around constantly with their tents and animals, making it impossible to provide medical services," he says. "So a plan was developed in which community members were trained to provide basic care. We worked with many great educators and the program really took off. In fact, 17,000 of the people who were trained and went on to train others are still doing this work in Iran." The notion of community health workers is not new. The World Health Organization estimates there are over 1.3 million of them worldwide. In addition to large-scale implementation by countries such as China, Brazil and Iran, many countries have implemented CHW programs on a smaller scale for a variety of health issues.
Shahidi has met for the past four years with a small group of UMDNJ colleagues to brainstorm ways to bring a community health program to Newark. "Our health system doesn't work right," he observes. "We wait until people get sick, and then we help them. My goal is to prevent them from getting sick in the first place. You do that through education. People eat unhealthy food, don't exercise, smoke, drink and use drugs. If we can change those behaviors, we improve health."
In April, the first group of community health workers com- pleted 12 weeks of intensive training in basic health information, know her, they returned for follow-up, bringing their friends, neighbors and relatives. Then, the federal grant enabled Sickora to hire staff and establish the new center in renovated housing authority space. Sickora invited key stakeholders to create a Community Advisory Board for the center, a step she said was crucial. Influential residents from all three housing developments were elected to the board. Over time, she involved more of the nursing overseen by Shahidi and Sickora. They learned about diabetes, hypertension, asthma, healthy eating and the importance of exercise. The project's goal is to have the health workers visit the homes of all 3,000 residents. "They will knock on doors, call on friends and neighbors, take blood pressure, talk about diabetes, asthma and other health issues," says Shahidi. All the visits will be documented and data on health outcomes will be compiled.
What these projects offer is outreach and coordination of care,explains Sickora. "If someone needs medical treatment, we'll be sure they see a nurse practitioner or physician. We'll check to see that they get their medications and take them. We will follow them every step of the way." She envisons the community health workers collaborating with the nurses and nursing students as well as physicians, medical students, physical therapy and respiratory therapy students.
Already, success stories abound. Sickora tells about one man with diabetes who lost his job and his health insurance. "He came to us with his blood sugar out of control," she says. "We connected him to services provided by the American Diabetes Foundation and within a week he had medication and was stabilized." Another man, coughing and wheezing, sought help with his severe asthma. Shahidi came to the center and successfully treated him. A third young man came for hypertension treatment and later returned with his three children for additional services. "You get to know people and develop relationships, and trust is built," says Sickora.
In the five years she's been spending in the housing complexes, Sickora notices some real changes. "The environment seems safer here now," she says. "Yes, part of the reason is more police presence. They got rid of some drug dealers and crime is down. But the center has also played a role in the rehabilitation of this neighborhood. When you put nurses in a housing project, it changes things."