By Kristen A. Graham for Saint Joseph's University
A novel health care model at Saint Joseph’s University helps the uninsured and reduces hospital costs
When Sam Schadt saw John enter the clinic, he knew something was wrong. Schadt, then a fellow in the Institute of Clinical Bioethics (ICB) at Saint Joseph’s University (SJU) and the coordinator of the St. Cyprian Health Promoter program in nearby West Philadelphia, was taking patients’ vital signs, alongside others who had been trained to complete health screenings. John was clutching his stomach and showed signs of delirium. Schadt took his height, weight and blood pressure. The pressure reading was so elevated he thought he had made a mistake. He took it again, with a different device, confirming that John’s pressure was skyrocketing. Schadt rushed him to Mercy Philadelphia Hospital, all the while wondering how John would be received. He had emigrated from Nigeria two months prior and didn’t have health insurance.
For Mercy Health System, the Delaware Valley’s largest Catholic health care system, a burgeoning African population in West Philadelphia meant more people arriving in emergency rooms with dire conditions. The men and women, largely poor, lacking health insurance and often undocumented, might go years without a physician’s care, resorting to hospital treatment only as a last resort.
By law, patients who arrive at emergency rooms must be stabilized, regardless of their ability to pay for care. And for a Catholic health care organization operated by the Sisters of Mercy, treating the vulnerable, regardless of their ability to pay, is a given. Mercy admitted John and alleviated his symptoms, providing medication for his hypertension and education about nutrition.
“Mercy took him and gave him the quality of care that everyone deserves,” says Schadt, a 2014 SJU graduate and now a student at Philadelphia College of Osteopathic Medicine.
“The sisters would never turn anyone away,” says 1975 SJU graduate and ICB Director Rev. Peter A. Clark, S.J., a professor of theology and religious studies and health services.
The number of people who arrive in Mercy emergency rooms with conditions that require costly, ongoing care has the potential to affect the health system’s ability to function. Fr. Clark, who also serves as the health system’s bioethicist, sat on the Mercy Hospital Task Force on African Immigration that was charged in 2010 with finding a balance between caring for the needy, a core mission of the Sisters of Mercy, and meeting the bottom line. He brought insights developed during one of his SJU courses, Just Health Care in Developing Nations. On a two-week class trip to the Dominican Republic in 2006, Fr. Clark and his students witnessed firsthand how men and women in the local community received medical training at clinics and were sent into barrios to help people deal with health-related issues.
That model inspired an idea: Could he and others create a similar “Health Promoter” program in the Philadelphia area, a community-based model built by partnering with existing organizations to provide health care, reduce costs and improve the health of people in desperate need?
“We felt this could be something that would be beneficial, both to the city and the health system,” says Fr. Clark.
The Health Promoter pilot program, a joint venture of the ICB and Mercy Health System, began in 2012 with monthly clinics. At first, the program zeroed in on John’s community — the Nigerian population of worshippers at Philadelphia’s St. Cyprian Church. Mercy medical residents educated 10 men and women from the community as Health Promoters, as well as ICB student fellows, focusing on both prevention and management of chronic conditions such as diabetes, HIV, obesity and hypertension. Once trained, the Health Promoters conducted screenings for blood pressure, sugar, cholesterol and oxygen saturation levels, and body mass index. They provided education — including nutritional and lifestyle counseling — and monitored patient health and compliance. When the situation warranted, they helped the people they served get treatment at a hospital or clinic.
Rev. Aloysius Ochasi, ICB assistant director and adjunct faculty member in theology and religious studies at SJU, is a Nigerian native and connected with the community, encouraging local volunteers to ensure the program’s sustainability.
“They have been very receptive,” says Fr. Ochasi, who earned an SJU master’s degree in 2011.
The program started small and grew steadily, spreading to help the French-speaking West African people who also worshipped at St. Cyprian. It then expanded to Living Spring, a nearby Protestant church. The recurring clinics proved popular, and eventually, Mercy asked if the program might extend further.
Suburban Community Hospital in Norristown, Pennsylvania, about 40 minutes from Saint Joseph’s campus, was coping with high care costs from a largely uninsured Spanish-speaking population and looked to the Health Promoter program for help. Fr. Clark and his team agreed to take the model to St. Patrick Church in Norristown, whose congregation includes a large Hispanic population. The monthly clinics are held in the church basement after Sunday Mass.
The numbers bear out the program’s success. In the past two years, Mercy has not paid for any patient in clinic areas to have dialysis, says Fr. Clark; infant mortality at St. Patrick has also improved. But the program’s growing acceptance in its targeted communities is equally as important as the numbers. That’s significant, because suspicion is common among the undocumented population — people are afraid to give their real names for fear of being deported. But they have been made to feel comfortable in their church communities, and now, with their Health Promoters.
Though the three Health Promoter locations keep Fr. Clark and his team fully engaged, the model may continue to expand. If new communities reach out, the ICB stands ready to serve them.
“I really do think we’re putting the Jesuit ideals into action,” says Fr. Clark. “This is one of those areas where the students see firsthand what it means to be a vulnerable person and what it means to do something about it.”
Adapted from an article by Kristen A. Graham in Saint Joseph’s University Magazine, Summer 2016: sju.edu/magazine.