Monday, October 13, 2014ROOTSTOWN, Ohio -- As she grew up in Nigeria, Maryam Audu saw a mélange of health issues. Common, she says, were basic issues such as high blood pressure and a lack of prenatal and infant care.
When she was 10, she moved to Cleveland where her father, a doctor, was working. Half a world away from where she was reared, Audu saw that the same health issues prevalent in her home country were just as widespread in Greater Cleveland.
“I’ve watched death in hospitals. I’ve watched sick people in hospitals, especially growing up [in Nigeria] and then coming here to see young people in high school and even [elementary] school with diabetes and high blood pressure.” Her voice trails off. “It’s always piqued my interest because in Nigeria’s case, they don’t have the resources at all. Seeing these kids here, I asked myself, ‘What’s the problem?’ ”
Those health problems are what drove her to the field of medicine, first as a nurse and today as a student at Northeast Ohio Medical University.
More specifically, the health problems she saw in Nigeria that pop up in the neighborhoods of Cleveland are what drove her to the NEOMED-Cleveland State University Partnership for Urban Health.
Started in May 2012, the initiative was created to add diversity to the health professions with the intention of sending students in the program back to serve the communities they’re from. Students take classes focused specifically on urban health. These classes include biomedical ethics, one that looks at how cultural differences influence health care and another that consists of engaging in rudimentary medical work in the less affluent neighborhoods of Cleveland.
“Before those classes, I never was really aware of [urban health issues],” says Jashan Jabbaar-Hill, a student in the program. “Just taking some of those [classes] helped me realize how much those things can play a factor in someone’s health. It really hit home.”
In one class, Jabbaar-Hill says, he and his classmates watched a video that compared the health of two neighborhoods five miles apart. In one, the life expectancy was around 65, the other 68. Knowing how that living just a few miles down the road can have such an impact on health opened his eyes, Jabbaar-Hill adds.
The 18 students in the Partnership for Urban Health have combined for 1,862 hours of community work. Over the summer, Jabbaar-Hill worked with a Cleveland pediatrician.
“Seeing how much his patients like him gave me an idea of the type of position I want to have,” he says. “Seeing that now rather than in medical school when I’m doing rotations has been a plus.”
The program uses community mentors, someone from a Cleveland neighborhood who puts students in touch with local doctors and raises issues in the mentor’s area.
“All year-round, [our mentor] finds things for us to do in the community. She’ll find groups for us to visit or meet daily a physician who’s met with her in the past,” Audu says. “They’re people who live in the community who talk to us about issues they see.”
Among the issues brought up is the length of a wait, one of the biggest challenges facing urban health care, she adds.
“I have seen people sick with simple things like diabetes, high blood pressure, pregnant women with no natal care,” Audu relates. “They’re basic problems we can solve easily and yet people let it fester or aren’t aware of the resources.”
Jabbaar-Hill’s grandfather was diagnosed with diabetes after waiting until he was almost blind before he went to an emergency room for treatment. That stuck in the back of Jabbaar-Hill’s mind, leading toward his decision to become a doctor. Once he graduates, he adds, his plan is to “preach prevention.
“No one really thinks about the things they’re doing now and how it’ll affect them in the future. They only think about their health when it’s an emergency or something goes wrong,” he continues.
Audu cites a distrust of the health system by those living in low-income urban areas, among other factors.
“One, they don’t have insurance or they feel no one cares about them because [they think], ‘I’m poor anyways.’ They have dealt with these issues in the past, so they don’t trust the system,” she elaborates. “Two, because they don’t have the resources to get to health care – whether it’s cars or buses or whatever. Three, it stems from the lifestyle people live.”
These life situations, she continues, could involve someone choosing between buying food and buying medication.
Jabbaar-Hill adds a lack of communication is often present.
“If a doctor says, ‘Take this pill twice a day,’ and doesn’t specify it’s supposed to be one in the morning and one at night, some people will take both in the morning and the medication won’t be effective,” he says. “People not understanding what to do with their health is just as big an issue.”
Dr. Jeffery Susman, dean of the NEOMED College of Medicine, says that by putting doctors back into their communities, some of the mistrust and misunderstanding can be alleviated.
“We know that when physicians look like their communities, understand their communities, the outcomes of health care -- whether it’s care for diabetes, asthma, heart failure -- almost every time it’s been studied, it’s been for the better,” he says.
Being from the community where they practice – or even just living in it – can benefit doctors. They acquire an understanding of the health issues so prominent around them, the food available (and not as available) and how to keep patients coming back.
“If I don’t know what people typically eat in a community or come from one background and a patient’s of another, I may not be able to effectively counsel about diabetes care or lowering their salt intake or treating blood pressure,” Sssman continues.
The 18 students in the partnership come from diverse backgrounds. Audu, born in Nigeria, was reared in Cleveland. Jabbaar-Hill has spent most of his life in the city. One classmate, Audu says, is in his 40s and was a mechanic before he enrolled. Having such a range of knowledge and experiences, both from background and textbooks, allows them to relate better to their patients.
“We’re all from diverse backgrounds and we all learn so much from each other. It’s phenomenal. Everybody has their own unique story. Everybody’s different and we all have one common goal. I love that there’s no competition,” she remarks. “We’re all-in and working for the same thing.”
And having a foot in the door before graduating by working with a community mentor helps students get a better feel for their work and whether they want to carry through.
“It does a good job because if someone finds out they don’t want to do this,” she says, “they can get exposure to it and realize it’s not what they want to do.”
By encompassing all those elements -- the focus on urban health care, the opportunity to reach into Cleveland neighborhoods, the diversity -- the Partnership for Urban Health exists as both a medical program and a reminder for students such as Audu and Jabbaar-Hill.
“It helps us focus on what our goal is and reminds us of what we are doing and who we’re doing it for, especially when we go out into the community,” Audu says. “This is a reminder that this is not just a class, not just a career – and that these are people’s lives and my life.”
Currently, the program is offered only in Cleveland, but talks have begun to expand into other cities including Youngstown.
“The personality of Youngstown has the strong sense of different cultures,” says Dr. Elisabeth Young, a graduate of NEOMED, vice dean of its College of Medicine and a hospice physcian. “The dean of the College of Medicine recognizes the uniqueness of this area and the commitment of the people and the compassion. It’s not a matter of if. We’re going to do it [bring the program to Youngstown] and we’re going to do it right.”
There are also plans to eventually include rural areas in the initiative, according to Susman, because it fits in with the concept behind NEOMED.
“We’ve talked to our colleagues in Youngstown and there is recognition in some ways that it’s a mixture of both urban and rural environments. Because as we go to the border [of the metro area], there’s some very rural towns and communities,” he explains. “We were founded as a community-based medical school and we recognize we need to really address issues that are facing our communities.”
Pictured: Mariya Pogrebetskaya, part of the first class involved in the Partnership for Urban Health, checks a patient’s pulse.
Editor's Note: The October edition of The Business Journal features extensive coverage of NEOMED and its growth over 40 years.
Copyright 2014 The Business Journal, Youngstown, Ohio.
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