Hello, our names are Ashley and Brooke Barlow and we are 3rd year pharmacy students at Thomas Jefferson College of Pharmacy. On Tuesday August 8th, we were honored to join the JEFFDESIGN team to impact underserved communities in Philadelphia as a part of the Health Insights 215 initiative. Our role as student pharmacy volunteers was to perform blood pressure screenings, and to educate patients on the importance of a healthy lifestyle. Community members who stopped at our booth expressed immense gratitude for all they have learned, but what we realized was that we truly have them to thank for what they taught us in turn. As we packed up our tents and parted our way, we sat back and had to REFLECT on the impact this had on our role as a health care providers that day.
Recognizing the problem:
As the first few patients approached our booth during the day, we used our typical "classroom" screening questions to determine their knowledge about their blood pressure, to soon find out that was to our dismay. In contrast to the typical standardized patient responses we expect to hear in our counseling labs in school, we were unprepared for what answers these patients had in store. Receiving responses such as "160/96? That's my normal blood pressure so it can't be that bad right?", "my doctor gave me medications but I don't have any symptoms of high blood pressure so I don't take them", and "medications are too expensive and I don't have insurance", opened our eyes to the barriers in knowledge and access that this community has to obtaining optimal health. Out of the hundreds of community members spanning from teenagers to elderly for whom we performed blood pressure screenings that day, only a handful had a blood pressure in their target goal range. Recognizing the multi-factorial problem that this unserved community faces, gave us a healthful insight of our true role as student pharmacists that day.
Our takeaway: *Recognize your role as a healthcare provider to engage in underserved communities*
With a unique population at our hands, our first goal to establish an understanding of the communities personal barriers to achieving a healthy lifestyle. With this goal in mind, we removed our white coats and placed our feet into their shoes to listen and understand the needs of the community. Whether the challenge they faced was financial, ethical, lingual, or educational, we tailored our advice to meet the needs of each patient, to overcome their personal barriers. As the community shared their stories about their struggles, fears, and challenges, we kept our ears open to listen, but more importantly our hearts open to feel. As students from a sheltered home, we can often become blinded to the true hardships underserved communities face to survive on a day to day basis. As student pharmacists, we often find ourselves confronting the problems of adherence with a pillbox as the “fix it all type of solution”. However the true answer lies with opening our eyes and ears to the needs and struggles of each individual patient to overcome their personal challenge.
Our takeaway: *Take the time to understand the needs of your patients*
Food for thought:
A major highlight of this special event was the fruit-ful environment filled with healthy food from the "Nourishd" food truck, a local produce stand, and free cooking demonstrations. The community members greatly appreciated the free food tokens and recipe cards provided through joining our event, and thanked us endlessly for establishing a healthy environment in their community.
As pharmacists, we can often approach uncontrolled diseases with piling on prescriptions, without asking patients what they are piling on their plate. At the first sight of high blood pressure readings, instead of focusing on medications (although so tempting as pharmacists) we approached our encounters to assess their understanding of what it means to eat healthy. Sharing our insights on salt contributing to high blood pressure, or excessive sugar content contributing to diabetes, helped to educate the community on easy modifications to improve their health status.
When it came to educating the community, a seemingly challenging population were the young children who presented at our booth that day. The typical approach of "it's important to eat you fruits, veggies and whole grains" or "stay away from refined foods" was one that quickly gave us a blank stare. In overcoming this barrier, we developed a create approach by utilizing the "My Plate" method, and encouraging young children to fill their plate by eating the color of the rainbow.
Our takeaway: The provide the perfect prescription, is to start with filing a healthy plate.
Lack of Access:
Prior to blood pressure screenings we started off each encounter by questioning about recent tobacco or caffeine use, and assessing if they are on any medications for blood pressure. To much of our surprise, many patients were aware they had high blood pressure and were prescribed medications, however over 90% of them reported they were not currently taking what they were prescribed. Although as pharmacy students, it made us cringe coupled with seeing blood pressures in the 170/100 range, we recognized the root of the problem lied in lack of access to appropriate healthcare resources. Many members expressed financial struggles, lack of transportation, or insurance coverage as their biggest limitation to obtaining their healthcare needs.
As future pharmacists, we felt it was our duty to help these members find access to their medications needs with resources that are accessible and cost effective. With community pharmacy skills and knowledge by our sides, we informed patients about prescription discount programs that offer monthly refills for as low as three dollars at their local chain pharmacies. Provided with this information, several community members shared their immense gratitude for opening an a window of opportunity to access their medications that were not once affordable. As future health care providers, we realized the importance of sharing our knowledge to help bridge the gaps in assisting patients access their health care needs.
Our takeaway:* Be proactive in your community and help share your knowledge to bridge the gaps to healthcare in underserved communities.*
Encouraging lifestyle changes
Although we spent a lot of time on counseling patients about how to find ways to access their medications, we realized the most successful prescription is not one that would empty their pockets. As we built rapport with these patients, they expressed they were not able to afford healthy food or gym memberships, due to the expenses of their poor life style habits. We utilized tactful counseling skills to inform them that looking fine does not have to cost a single dime. Instead, removing a few cigarettes a day can help them afford the utilities to shed the pounds away. Informing patients about the dangers of secondhand smoking helped put into perspective not only the consequences this has to their health, but also to their community. We helped them to connect the goals they wished to seek in their community to those of which they could change themselves such as smoking cessation to clean their environment. We informed them that the first step to a healthy community, is building a healthy you.
Our take away: Be the change you wish to see in the world.
of care as we packed up our tent and began pack up for the day, community members asked when we would be back their way. As we informed them that the answer to this question was unknown, we put aside their fears and provided them tips for local access to blood pressure monitoring and counseling at their local pharmacies. Just as we helped create their pathway to better health, we realized our vital role as stepping stones to help them achieve their goals.
Our takeaway: There is always time to spare, to engage in your community to help provide continuous care.
"Tell me and I forget, teach me and I remember, involve me and I learn." - Ben Franklin
Looking back at the endless thanks we received for our time and knowledge for all they learned, what they did not realize is what this experience provided us in turn. This experience helped us to recognize the importance of community outreach to help bridge the gaps in underserved communities to achieving adequate healthcare. This helped us to develop character and skills outside of those taught in the classroom to make a true impact on our local community. As future pharmacists, we make an oath to apply our knowledge, skills and experience to assure optimal outcomes to our community, and in achieving this we have Health Insights 215 to thank.
“We serve to motivate our patients that the answer to every problem is not always finding the perfect medicine, that the best prescription is finding the motivation and strength that comes from within.”
-- Ashley + Brooke Barlowe