Public Health in Flint: Bringing MSU to the Community

Tarek Yaqub, Serena Zhou, Adiraj Singh, Huda Afaneh, and Bernadene Jayasundera volunteer at a health fair held September 6, 2014, at Our Savior Lutheran, Flint, one of the Partners in Health participating churches.

"If you wait for people to come, they will come later rather than sooner." This statement, made by Dr. Laura Carravallah, refers to the hurdles—such as cost and lack of transportation—often faced by those living in underserved areas when it comes to visiting the doctor's office.

"Preventative medicine gets right back to public health and helps prevent misery before it gets started."

Dr. Laura Carravallah

"A number of people never make it to the doctor's office, in an underserved area," said Carravallah. And since populations in these areas can be at greater risk for various health-related factors, such as diabetes and high blood pressure, the need for public health programs that disseminate preventative information and training is essential. "Preventative medicine gets right back to public health and helps prevent misery before it gets started," she said.

Since the 1960s, MSU College of Human Medicine has partnered with three Genesee area hospitals, including Hurley Medical Center, through the MSU Flint Area Medical Education (MSU-FAME) program. The program provides community-based training to medical students, as well as increased health care access and awareness to Flint-area communities.

Carravallah, herself a graduate of the MSU-FAME program ('89), has a deep love for the Flint community and an equally deep-seated concern for training medical students to be engaged with their communities in culturally relevant ways. "You have to be able to deliver culturally competent care, which includes knowing what environment people face when they go home," she said. "You have to know what to ask."

Meredith Good (center) and Laura Carravallah (right) demonstrate hand-washing techniques to Yvonne Lewis (left) of the Kidney Foundation at the September 6 health fair.

While at Hurley, Carravallah served in many capacities— including director of Hurley Medical Center's Combined Internal Medicine-Pediatric (Med-Peds) residency program, director of MSU-FAME's Core Competency Clerkship, and leader in a number of community organizations—before becoming fully employed by MSU this fall. Throughout these roles, she has been a persistent advocate for health care access for the underserved, as well as a role model for many of MSU-FAME's third- and fourth-year medical students and Hurley's residents, helping them find ways to participate in the communities in which they may someday serve.

Partners in Heart

Carravallah helped coordinate several collaborative outreach activities with Flint communities, including Hurley's Partners in Heart, a self-sustaining partnership with churches in Flint through which health professionals and students train church members to screen for high blood pressure. These members then train other church members, with the goal of helping those with high blood pressure gain information about cardiovascular risks, and if necessary, seek treatment.

"We designed it so the health professional would train church volunteers about [measuring] blood pressure and the importance of it," said Carravallah. "We gave them blood pressure cuffs, guidelines, educational and tracking materials, and we trained them."

Kay Taylor, Ph.D., director of Hurley's Research Center, designed the research component and helped guide the project through its review by Hurley's institutional review board. Taylor also oversees training in the churches, which involves students, residents, and volunteers. According to Taylor, the students serve in various capacities to help with the training. "Sometimes they are the observers, watching as the monitoring is being done," she said.

According to Carravallah, pastors in the area approached Hurley to collaborate on putting together the initiative. The group of pastors, originally representing 10 churches, was headed by Superintendent Quintin Marshall, founder and pastor of New Life Tabernacle Ministries.

Marshall worked for a year to secure funding for the initiative before he approached Hurley. "Then I went to a luncheon with Hurley," he explained, "and they said, "We'd like to partner with you." So they put blood pressure kits into the churches and we started monitoring and sending reports back to them."

Prior to being approached by Marshall, Hurley received funding from an anonymous donor who had an interest in kidney health, for which hypertension (high blood pressure) is a risk factor. According to Taylor, "The churches also had an interest in blood pressure, so we asked the administrators if this would work, and they said OK."

Hurley provided detailed guidelines for the church aides

Results

• 240 church members completed a pre-intervention knowledge and attitude survey.
  • 47% definitely thought they might be at increased risk for hypertension.
  • 84% thought they could make lifestyle changes to improve their blood pressure.
• 538 total blood-pressure screenings over the six-month pilot period.
  • Members screened: 263
  • Members screened more than once: 90
  • Members WITHOUT diagnosis of hypertension with BP in higher range more than twice: 60

Laura Carravallah with MSU-FAME students and Hurley residents.

Marshall believes that previous partnerships with MSU Extension (MSUE), which increased health capacity through nutrition-related classes, helped to "seal the deal" with Hurley. "These classes were part of the whole package that we presented to Hurley," said Marshall. "MSU has been a good partner with the nutrition and cooking classes, and we want to keep going on with these programs. You have to keep doing repetition; otherwise we won't get them energized to keep going on the program."

Keeping his church members energized on this issue is a high priority for Pastor Marshall, who is concerned about both their spiritual and their physical well-being. He is personally aware of the serious health concerns in his community. "In the black community, hypertension is a serious problem," said Marshall, who is himself undergoing dialysis because of blood pressure. "This has been a catalyst for getting our people to look at this issue. Some people don't know they have high blood pressure."

For Marshall, maintaining a strong partnership with MSU is an important aspect of the initiative. "I would like to continue that relationship with MSU to bring better health to the community," he said. "If we work together, we can make it happen."

Working together, the partners have helped the project expand from its original 10 churches into 20 churches, and according to Taylor, the churches also want to expand the project's focus.

"They said we need to do other things, such as screen for diabetes with blood glucose tests," she said. "This will take more supplies and more money, so we have a grant application out, and are waiting to hear whether it will come through."

Carravallah believes a key factor in the program's growth is that the churches don't need constant supervision from the health professionals. "The beauty of it is they didn't need us anymore," said Carravallah. "We developed a sustainable program not dependent on the health care professionals."

The Public Health Certificate Program

Now that she is working directly for MSU's College of Human Medicine, Dr. Carravallah has been tasked with creating and directing a Public Health Certificate Program for medical students placed in Flint. Her goal of preparing medical students to be engaged within communities remains strong. "For physicians to be effective, they need to get out of their examining rooms and get to know the people they're working with," she said.

Funded by the Mott Foundation as part of the expansion of public health in Flint, the certificate program will boost MSU's outreach to Flint communities. MSU's overall public health focus in Flint will also draw national-class researchers from many disciplines, such as epidemiology, biostatistics, environmental health, health policy, and health education, which, according to Carravallah, "presents an opportunity to bring a lot of different perspectives to bear."

Working on the Public Health Certificate Program expands her commitment to student and community involvement, while deepening her roots in the college. "I come from the College of Human Medicine. I believe in its human service element, and it's really exciting to continue this," explained Carravallah. "I have a strong resonance with MSU's commitment to the community. You can't effectively teach these things without coupling them with community service."

While her goal is to inspire medical students to become engaged with their communities, she is equally inspired by them. "The students come from all areas, and they feel called to this work. They bring different perspectives and an enthusiasm that brightens things up!"