Early in my professional career, I worked as a field researcher for a nutrition program in a low-income area in Atlanta. I was charged with collecting information on the fruit and vegetable consumption of local residents, and in exchange they would receive a small honorarium.
One day I arrived at the home of a single mother of two whose electricity had been disconnected because of a delinquent bill. The apartment windows were partially boarded up, and the only consistent light came through the front door. As I prepared to reschedule my visit, the mother explained that she needed the honorarium to help pay her electric bill.
We sat with the front door open and hurriedly completed the survey, racing against the sunset.
The troubling aspect of this anecdote is not unique to academic centers. I would never want to diminish the worth of research, but at what point do we say, “Enough is enough” and actually do something about the living conditions of such communities?
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People are tired of being studied. We ask residents, “What does this community need?” They express a need for jobs, safer streets, better schools, and we give them research or interns. What do our studies offer people if they continue to remain in despair? When will we make ourselves accountable to the needs expressed by communities?
Two long-standing practices contribute to the problem: first, the lack of a “service in all” approach when working with underserved populations. We need an approach that makes eliminating threats to prosperity — educational attainment, availability of healthcare and social services — a constitutive dimension of any research, internship or planning process.
Second, we need to reconsider how we define success and to whom we are ultimately accountable, the academy or the community.
In Atlanta, we were successful in improving the community’s awareness of the importance of eating fruits and vegetables. Great! Now a greater number of people without electricity, transportation or adequate housing can understand the importance of eating more healthfully as they sit in the darkness of their boarded-up homes. Granting the limits of each profession, the measures for success among professionals are too often focused on the outcomes for the professional rather than tied to the outcomes for the consumer or community.
Despite the trend toward a social responsibility in the health professions, there still are far too many professionals deaf to these concerns.
Today, I serve as the community director for FIU Herbert Wertheim College of Medicine’s flagship community medicine service curriculum — the Green Family Foundation NeighborhoodHELP. To our knowledge, FIU has the only medical school in the country that requires all of its medical students to perform household visits in uninsured or undocumented households.
Medical students are part of a team that includes students from the colleges of law, nursing, social work and education. The approach is simple: They simultaneously address medical, social and structural barriers that hinder optimal health outcomes. Our approach enables students to learn about their chosen profession while also vigorously reinforcing their obligation to act as an agent for good for society at large.
Faisal Rahim, Leonee Thomas and Danny Tobon were perfect examples. This student team grew concerned about a woman whom they regularly visit. One time, she was not available, which was uncharacteristic. The students contacted the program medical director, Dr. Christine McFarlin. Because of their persistence, the woman, who had fallen to the floor a day earlier, was rescued.
A commitment to the community is also reinforced by our mechanism of recruiting household volunteers. To be in our program, you must be referred by one of our community partners or by a participating household. This creates an interesting power shift in the relationship between a university and the community. If our program is not meeting the needs of the households and the community, then community partners are less apt to refer more households. This means that the long-term success of our flagship curriculum is at the mercy of the people we serve.
Academic centers can be more than centers of research. They can be centers for change. Students can be more than service learners, they can be change agents. Today, I am part of team that continues to race against the sunset in households throughout Miami-Dade County; but instead of spending that time merely asking questions, we help create answers.
Luther Brewster is chief of the Division of Policy & Community Development and community director, Green Family Foundation NeighborhoodHELP at Florida International University’s Herbert Wertheim College of Medicine.