FIELD REPORTS Christian healthcare in medically underserved North Philadelphia Amanda Martineza a MS, Fourth-year medical student at Ohio University Heritage College of Osteopathic Medicine in Athens, Ohio Abstract With an unfortunate number of underserved communities throughout the world, it would be remiss to overlook the prevalence of ones located right in the backyards of America. Most residents of these communities suffer disproportionately from health disparities. They are often lower income, non-white residents of dense and diverse urban neighborhoods, like ones located in North Philadelphia. Since 1989, a health center, Esperanza, has been dedicated to serving the members of the North Philadelphia community through an intentional and faith-based approach. Today, its director, Susan Post, has continued to carry out the mission of Esperanza through efforts that highlight purposeful proximity. Key Words: underserved, Philadelphia, health, healthcare, faith-based, Christianity, urban, Esperanza Introduction Most of the residents of North Philadelphia lack basic health care services, live in households with incomes at or below 200% of the poverty level, and nearly one-in-five people lack health insurance, resulting in communities that are designated as Federal Medically Underserved Areas.2 After the migration of Puerto Ricans to Philadelphia grew substantially from the 1940s to the 1970s following the city’s economic decline, several blocks around North Fifth Street known as “El Centro de Oro” or “Center of Gold” became Philadelphia’s growing Latino community.3 Carolyn Klaus, an internist, and other concerned health professionals realized the great unmet need for affordable primary health care in North Philadelphia, and on June 15th, 1989 Esperanza Health Center opened its doors on Fifth Street in “El Centro de Oro.”4 This health center and its current Executive Director, Susan Post, continue to serve the residents of North Philadelphia through a wholistic and intentional approach to healthcare. Dr. Klaus described Susan as “a small women with a big vision and an impressive grasp of the complexities of modern healthcare.”5 Through an interview with Esperanza’s director, Susan Post, we will present more insight on the mission of Esperanza and its director of 17 years; the following text contains her responses to the interview. Interview The Mission of Esperanza At Esperanza, we are hoping to reach those in our community with fullness of health. Health is a word that incorporates a lot, and we are serving a community that has many factors that go against health. So, we start by having enough medical clinicians and sites to try Martinez 112 June 2022. Christian Journal for Global Health 9(1) to allow each person in our community to have a primary care clinician, and to provide primary care services such as mental and dental healthcare in addition to medical care. However, we are also trying to address our goal of improving the overall health of the community. A good deal of that has to do with what happens outside the exam room—how we eat, how we exercise, how we connect with others. So, we are developing our care to include intentional connection with people in the context of their lives— senior programs, prenatal groups, or parenting circles, for example. These are programs that our community has suggested and that make a difference in their lives. We are learning from our community, and we hope to keep moving forward with healthy initiatives in the years to come. The Meaning of Healthcare at Esperanza As I have been at Esperanza and living in my community, my idea of what healthcare means has changed a great deal. I typically thought it was physical, how our body is doing, though I also always knew that poor health can be hard on our mind and spirit. Now, though, I see so much more about how relationships and community play a part in health and health care. Our system in America is sometimes typically that the doctor has all the education and information, and they tell the patient what to do. That might work on one level, but overall ongoing health is about our lifestyle—what we eat, how we sleep, who we love, how we connect, what we hope for, how we manage when in pain or disability. These things are so much greater than what a doctor tells us in the 10 minutes we hear from him or her in the exam room. Healthy lifestyle is important and, maybe, it’s preventative health that needs to be addressed first, for sure. And when someone does get sick or has a medical issue, that’s when deep caring and community is even more important, and I don’t think we consider that enough in our modern health care system. So, at Esperanza we can’t be all that to our patients, but we can be a conduit to that. We can talk to our patients about the assets in their lives and the relationships of people who can help them if they are sick, we can encourage and make space for preventative care and activities that engage people with those around them. We have a program for seniors, and many of those seniors live around me in my neighborhood. They are the ones who help me with my health—inviting me to a healthy life through friendships, walks, sharing life together, hoping for each other. They enrich my life and for that I am extremely grateful. So, it’s not so much what is Esperanza doing but what are we doing with our community together? The Call to the Underserved For me, there was a spiritual component to it. I felt drawn to see the world from God’s perspective, from what I know it to be through the bible. That means seeing people with their God- given dignity and value. It means seeing where God is taking the world in his process of redemption. But whether one is moved by spirituality or not, I think a big part of deciding to put your life into this is the product of proximity, being close to the community. That might be from growing up here yourself, or from having a friend from this community, or 113 Martinez June 2022. Christian Journal for Global Health 9(1) from going to church here, as I originally did, or just being close enough to see, really see the community and its needs, its inherent beauty and value, and wanting to see that beauty have its full effect on the lives of people who live here. For me, that’s a God thing. I want to be doing things that God had in mind when He made each person who lives here. I guess the motivation can come from different places, but ultimately it is a desire to see this place become what it was meant to be. Living in Intentional Proximity From my studies, I saw the benefit of people who are different socio- economically, living in proximity to each other. Beneficial for all involved. But it was when that moved from book knowledge to transformation of my heart to want to know and understand this community and myself; and for me, with a desire to have God’s heart, I sensed it would be good to move here. Once I decided to move, I sensed a commitment and a connection with the people who were to be my neighbors. I am grateful for the time I have had living within my community—it has been life-changing to me, life-bringing, and there is no better way to grow with others than to be identified with them in community. Empowerment Through Collaboration Listening to my community has been life-changing to me. It has allowed me to question assumptions and pre- conceived notions that I lived with my whole life from the perspective of my growing up world. But there is a much bigger perspective and picture for me than that, and it starts with listening to my community. I’m not quite sure how much listening has empowered my community but likely it has. Mainly it has helped me to grow in my perspective and that larger perspective has affected all that I do at Esperanza. There is a tendency for people like me to come into a community and try to change it with the expectation that I might know more of what the community needs than they do, because I am educated, etc. But that’s not true. The community knows their needs and they need me to listen and identify with them so with this combined bigger perspective, we can make our community a better place. The Community’s Impact It’s funny, people often say that I have made an impact, or maybe ask me how the community has changed since I’ve been here, but what is on my mind usually is how the community has made an impact on me. It has changed so much about me. It has shown me aspects of joy I hadn’t known in my own culture. What it means to celebrate even while suffering. It has shown me a bigger picture of God. I have learned about connectedness, that I belong to them and they belong to me, and it is meant to be that way but somehow in my world I haven’t understood the importance of community. We are built for it, we need it, grow from it, it is vital, but we sometimes live so individualistically and alone, it can be sad to think about sometimes. I have seen how health care is tied into relationships with others: your family, your community, helping you know how to be healthy. Martinez 114 June 2022. Christian Journal for Global Health 9(1) Discussion Proximity Since its founding in 1989, Esperanza has done just what its English translation suggests, give hope to its community. Its mission is “to not only provide excellent, compassionate care in Jesus’ name for all patients, but also to reach outside of the exam room walls for a healthier community.”4 After 30 years, Esperanza now has three sites: Kensington, Hunting Park, and Fifth Street, allowing clinicians to practice “neighborhood-engaged care” with the central goal of mitigating disparities.1 With over 215 employees, it prides itself on employing individuals who are committed to advancing their mission. A large percentage of Esperanza’s current staff members have taken personal stake in the development of the neighborhood they serve because they themselves are North Philadelphia residents, who are proud to call this community their home. This includes its own Executive Director of 17 years, Susan Post. The teachings of John Perkins, an evangelist and civil rights activist, reiterates that living out the gospel means bettering the quality of other people’s lives spiritually, physically, socially, and emotionally as one betters one’s own.6 This viewpoint embodies how Christian Community Development is committed to listening to the community residents and hearing their dreams, ideas, and thoughts, and is important, as the people of the community are the vested treasures of the future.7 As a Federally Qualified Health Center (FQHC), Esperanza ensures that care is available and affordable to all, regardless of economic or social status. With thousands of patients being either uninsured or underinsured, no patient is turned away because of the inability to pay, and patients are also offered payment on a sliding scale based on income.8 Esperanza additionally operates under a governing board where the majority of members receive care as patients at Esperanza. With board members being residents and patients of the community, this aspect of proximity has greatly assisted Esperanza’s implementation of efforts that aim to address the specific needs of the community. Relocation results in transforming “you, them, and theirs” to “we, us, and ours” and this is reflected in numerous ways. The proximity and voices that the board allows patients to have has been essential, as according to research by Virginia Commonwealth University’s Center on Society and Health, the overall life expectancy in Esperanza’s communities of service is 10 to 17 years shorter than life in Philadelphia’s more prosperous neighborhoods.2 This glaring difference is the result of the cumulative effects of deep poverty, high crime, repeated trauma, and lack of access to affordable, quality healthcare that directly impacts residents.2 With this unfortunate reality, the access to quality healthcare and diverse resources that Esperanza provides North Philadelphia are efforts that aim to address these unfortunate disparities. Spirituality The spiritual component that Esperanza has embodied since its inception brings patients and employees in proximity in intangible but significant ways. To some, medicine and religion may be opposites, but a holistic approach to medicine has increased greatly throughout the recent decades. Although spiritual well-being may be regularly inquired about during medical assessments, Esperanza continues to meet the spiritual needs of patients in one space.9 Esperanza partners with patients, the Church, and local organizations to bring healing and wholeness to their community. At Esperanza, praying for or with a patient is just as common as taking their blood pressure, something not commonly seen throughout the traditional healthcare system. With significant research indicating a strong linkage between a patient’s spiritual care and their overall well-being, since its founding, Esperanza aimed to meet the needs of their patients beyond their physical health. Their patients frequently express the desire to discuss spiritual concerns or to pray with someone during their visit.9 115 Martinez June 2022. Christian Journal for Global Health 9(1) Spanish Language Proficiency The spiritual foundation that sets Esperanza apart is only as successful as it is because of another aspect of proximity that the health center has incorporated since day one; cohesive and intentional proficiency of the Spanish language. This proximity component of communication is crucial in settings like North Philadelphia, where individuals may solely speak and understand the Spanish language. Esperanza has responded to the overwhelming need for Spanish-speaking services in their community, as its primary medical care providers and clinical support staff are competent in English and Spanish.2 In 2018, Esperanza provided bilingual primary healthcare services for over 14,000 patients of all ages through over 64,500 patient visits.2 The health center has made effective and comfortable communication with their patients a priority, since language barriers can be an obstacle that prevents many from obtaining basic healthcare services. Information can be lost in translation, which unfortunately can result in a misunderstanding of patient concerns and information conveyed by healthcare providers. The intentionality of bilingual proficiency that allows for a proximal connection between healthcare providers and patients is another stride that Esperanza makes to break down potential barriers to accommodate their patients to the best of their abilities. Conclusion Through its leadership and mission, Esperanza continues to work towards a society that reflects true equity. The dedication Esperanza and Susan Post have shown to their North Philadelphia community is reflected by them continuing to embody “we” and “ours” instead of “them” and “theirs” by attributing their work to something much deeper than themselves. Susan, herself, describes her work to be that of what resembles the execution of the love that Jesus has for everyone no matter their zip code or identifying demographics. The efforts of Esperanza began in 1989, and today the health center and its director continue to bring a new meaning to the definition of the City of Brotherly Love. Go to the People, Live among them, Learn from them, Love them. Start with what they know, Build on what they have: But of the best leaders, when their task is done, The people will remark, “We have done it ourselves.” -Lau Tzu10 References 1. 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CCDA Philosophy. Into The Neighborhood [Internet]. 2013 Oct 1 [cited 2021 Jan 16]. Available from: https://intotheneighborhood.org/about-into- the-hood/ccda-philosophy/ 8. Payment and Insurance | Esperanza Health Center [Internet]. 2021 [cited 2021 Feb 3]. Available from: https://esperanzahealth.com/patients/payment/ https://doi.org/10.1007/s11524-016-0057-6 https://doi.org/10.1007/s11524-016-0057-6 https://esperanzahealth.com/about/impact/ https://esperanzahealth.com/about/community/ https://esperanzahealth.com/about/history/ https://www.christianitytoday.com/ct/people/p/john-perkins/ https://www.christianitytoday.com/ct/people/p/john-perkins/ https://intotheneighborhood.org/about-into-the-hood/ccda-philosophy/ https://intotheneighborhood.org/about-into-the-hood/ccda-philosophy/ https://esperanzahealth.com/patients/payment/ Martinez 116 June 2022. Christian Journal for Global Health 9(1) 9. Spiritual Care | Esperanza Health Center. [Internet]. 2021 [cited 2021 Feb 3]. Available from: https://esperanzahealth.com/services/spiritual-care/ 10. CCD Philosophy » Christian Community Development Association. Christian Community Development Association [Internet]. 2021 [cited 2021 Feb 2]. Available from: https://ccda.org/about/philosophy/ Peer Reviewed: Submitted 22 Feb 2021, accepted 14 Jun 2022, published 20 Jun 2022 Competing Interests: None declared. Correspondence: Amanda Martinez, Philadelphia, PA, USA am467317@ohio.edu Cite this article as: Martinez A. Christian healthcare in medically underserved North Philadelphia. Christ J Global Health. June 2022; 9(1):111-116. https://doi.org/10.15566/cjgh.v9i1.633 © Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/ www.cjgh.org https://esperanzahealth.com/services/spiritual-care/ https://ccda.org/about/philosophy/ mailto:am467317@ohio.edu https://doi.org/10.15566/cjgh.v9i1.633 about:blank Abstract Introduction References