Making a meaningful impact in patients’ lives means meeting them where they are — with compassion, respect, creativity, and understanding.
Our region’s underserved populations — across Southeastern Pennsylvania, Central Pennsylvania, and Southern New Jersey — face economic, cultural, and language barriers to care. Homelessness, poverty, substance abuse, and lack of insurance are some of the factors that keep many of our neighbors away from health care and opportunities that could pave the way for them and their families to grow healthier and achieve their goals.
Propelled by our missions of patient care, education, and research, Penn Medicine works with its surrounding communities to foster change by cultivating and growing roots within them. Our community service mission is linked to each of these other domains, infused in everything we do. Our far-reaching programs — in settings from Philadelphia health clinics to Chester County mushroom fields and from Lancaster County bike paths to nature settings in Princeton, New Jersey — bring with them a host of expertise and passion from health professionals and community partners who share the same goal: service.
These highly motivated, creative staff, students, clinicians, and volunteers empower patients to make informed choices about their health and lifestyle — and to teach others around them to do the same. They use research-based approaches to improve services and personalize outreach efforts. And they care for our neighbors in community clinics, churches, streets, and schools... simply because.
Now in its 27th year, Prevention Point is a multi-service public health agency serving the city’s most vulnerable populations. It remains the only syringe-exchange in Philadelphia and the largest in the country, having distributed over three million clean syringes in 2017.
The program is credited with helping drive down the HIV infection rate among injection-drug users in Philadelphia from 50 percent in 1992 to five percent by 2011. More recently, Prevention Point — an independent nonprofit supported in part by Penn Medicine CAREs funding and Penn Medicine volunteers — has made a big impact battling the city’s growing opioid crisis by distributing overdose reversal kits and training many members from the city entities and libraries, and the general population, on how to administer the opioid reversal drug, Naloxone.
“We operate on a harm reduction model, where we meet you where you are at,” says Brian Work, MD, a Prevention Point volunteer physician and board chair who practices at Penn Presbyterian Medical Center. “We don’t judge you. We don’t care if you are using. We will treat you at our clinic or on the street and do it with humanity and respect.”
Case in point: Last year, when the city and the railroad company, Conrail, cleared out a stretch of land in the Kensington section that was home to scores of homeless drug users, not everyone made it to a shelter or treatment facility. That’s when Prevention Point stepped up to meet the challenge by opening two 40-bed homeless shelters. Additionally, it expanded its Streetside Health Clinic program, the nonprofit’s mobile vans equipped to treat infections, wounds, and abscesses, as well as test for HIV and hepatitis C.
“What we can eventually do is build up enough trust to get people to know us from the vans, and then they will hopefully come to our building for more services.”
“We’ve always had our vans, but we redoubled our efforts, to help the homeless that have been pushed elsewhere,” Work says. “It’s very aggressive community outreach that is really necessary in this extremely marginalized population.”
While in need of medical attention and substance abuse treatment, many homeless people roam from spot to spot and stay clear of clinics and hospitals out of fear of mistreatment or rejection. The street vans deliver that care to them.
“There are some chronically homeless folks who won’t go into a building, not even ours,” Work says. “What we can eventually do is build up enough trust to get people to know us from the vans, and then they will hopefully come to our building for more services.”
Bringing health care to communities serves as the foundation for many of Penn Medicine’s outreach programs — from Philadelphia to northern New Jersey to the farms out west in Chester County.
Hitting the ground running in the fight against hepatitis C
Around the same time Kelly Borges started her clinical research position in the Hepatology Clinic at the Hospital of the University of Pennsylvania, she also took up running with a group in her South Philadelphia neighborhood. This wasn’t a typical running club filled with newbies or people training for the Broad Street Run.
“It definitely gets my gears turning on how else I can help with a program that I’m involved with outside of work.”
It was made up of individuals experiencing homelessness, in recovery homes and residential facilities around Philadelphia, who committed to running three mornings a week with the nonprofit organization called Back on My Feet — all there trying to get their life on track through the power of running.
The national organization, which originated in Philadelphia over 10 years ago, helps people gain independence and life skills by connecting them with essential resources and employment.
Not too long after joining the organization, something dawned on Borges.
“My first few studies here at Penn that I coordinated were hepatitis C studies, so I learned about the disease and who is at risk,” Borges says. “I didn’t really make the connection at first that the group I was running with is a high-risk group in and of itself: people battling substance abuse, formerly incarcerated, and baby boomers.”
Approximately 45,000 Philadelphians today are living with hepatitis C, and most are asymptomatic. Even more individuals may be infected but are unaware.
Borges partnered with Philadelphia FIGHT, a health services nonprofit, to develop an initiative she called “Back on My Feet to C a Difference” that provides resources for those in the program who may have hepatitis C or HIV.
Through this initiative, she aims to organize free education and testing sessions and links to care at Penn Medicine and the John Bell Health Center. With the help of the CAREs grant, she held the first hepatitis C and HIV education session last summer at the Perelman Center for Advanced Medicine.
Many of the runners had not pursued treatment because of the costs and side effects associated with older drugs. And most weren’t aware of the newer, antiviral drugs — which not only have fewer side effects, but also are much more effective in curing the virus. “Now that we have safe and effective treatment options, the next step to eradicating the virus is providing access to all who are infected.”
At the education event, presenters from Philadelphia FIGHT talked about their experience with hepatitis C and HIV transmission modes, and treatments. At the event, leaders of Penn’s Exercise is Medicine chapter discussed strategies for living an overall healthier lifestyle. Exercise is Medicine is a global initiative of the American College of Sports Medicine focused on encouraging health care providers to incorporate physical activity into treatment plans. As an EIM Ambassador, Borges encourages her coworkers, co-volunteers, and classmates to find a form of exercise they enjoy and do it consistently.
“I’m thankful that Penn is willing to support a program like this,” Borges says. “It definitely gets my gears turning on how else I can help with a program that I’m involved with outside of work.”
Debbie Millar, RN, received a phone call one day she’ll never forget. “I just want to let you know that you helped me save my son’s life,” the person on the other end of the line said. The voice belonged to a mother who had taken a free CPR class taught by Millar, the director of Community Wellness at Princeton Health.
It all happened so fast. Her son went missing, only to be spotted at the bottom of a hotel pool. They pulled him out, and she quickly jumped into action.
“She said ‘I just remember hearing your voice: Do this, do this. And because of it, I saved my son,’” Millar says. “I thought right then, it’s 100 percent worth it. We have to keep offering it every year.”
Sudden cardiac arrest remains a leading cause of death, but immediate, effective CPR can double or triple a victim’s chance of survival. Given that 88 percent of cardiac arrests occur in the home, it’s important for everyone to know it, Millar says.
“Normally, when the public has to do CPR, it’s usually on someone they know, someone they love,” she says. “They are the first link in the chain of survival.”
The free CPR classes started in 2010 as part of CPR Week, an American Heart Association (AHA) effort to raise awareness around cardiac arrest, and have grown significantly since. In 2018, they trained 1,555 community members over a two-week period — a 72 percent increase from 2017.
Every year, Millar and about 10 other volunteers go out into the community — to schools, churches, or wherever they’re needed — to conduct the trainings for people of different backgrounds and socioeconomic statuses. They’ve also taught classes in Spanish and Mandarin.
“To train the community and get this out, it’s just something so valuable and so important”
“To train the community and get this out, it’s just something so valuable and so important,” Millar says. “We care about our community, and we want to make sure that people can help others in it.”
Penn Medicine’s Mobile CPR Project follows a similar mission by hosting free-of-charge hands-only CPR training sessions. The Mobile CPR team has trained over 7,700 people at more than 250 locations throughout Philadelphia since 2016. Hands-only CPR (a simple but effective form of CPR without mouth-to-mouth breaths) can double or triple a cardiac arrest victim’s chance of survival, and proper technique can be taught in under 30 minutes. The team travels to training sessions in the Mobile CPR van, bringing all of the presentation materials necessary to train members of the public.
While CPR can save a life in an emergency, community health and wellness takes center stage in the battle against obesity in all communities across America. Consider the city of Lancaster.
As part of its obesity prevention strategy, the city and its partners, including Lancaster General Health, developed a bicycle-sharing program that not only provides a greener mode of transportation, but also a healthier one. Now with six docking stations and 10 miles of new bike lanes (up from just a quarter of a mile when it started in 2017), the Bike It program is soaring.
“There’s a lot of research that shows we make choices based on the environment,” says Brenda L. Buescher, MPH, health promotion specialist at LG Health. “When we live in communities that have resources to support health, people tend to be healthier. And when you live in a place that is safe and enjoyable to bike, people are more likely to bike. So, we try to do things that help make the community a better place to be physically active.”
That meant working with the city and other partners to get the program off the ground, as well as creating LancasterBikes.org, a site that serves as the educational arm for bike efforts in Lancaster. The website engages with the public about bike initiatives, how to get involved, and health and safety tips.
Today, at $2.50 an hour or a $25 annual membership, residents and tourists can cruise around the city to shop, sightsee, commute to work, or just exercise.
From domestic violence survivor to a force for change
Three years ago, Tarskia Chase started “Sisters In Service To Edify, Restore & Support (SISTERS),” an educational workshop for others affected by domestic violence, at her place of worship, Beloved St. John Evangelistic Church in the Logan section of North Philadelphia.
The program teaches people about the different types of abuse, as well as safety and support systems available in the community for those in need, and features talks from survivors.
“I am completely passionate about SISTERS because I can put myself in women’s shoes”
“This all got started based on my own background of being a victim of domestic abuse, and just not really speaking about it,” says Chase, who works as an administrative assistant in the Emergency Administration Office at Penn Presbyterian Medical Center. “I put myself in a position working daily as a single mother, while wearing a mask. To interact with me, you would never know that I carried the weight of domestic abuse in my life.”
Twelve years ago, Chase found the courage to leave the situation, together with her two young children, in pursuit of a happier, safer life — and to speak up to help others.
It was later, during her time working toward her Urban Ministry Leadership degree at Lancaster Bible College, that she developed the workshop. She then presented it to her church’s senior pastor.
“I thought it was something that was needed because it’s not a topic commonly discussed within most churches,” Chase says. “The church serves to be a lighthouse in the community in itself.”
That led Chase to present her first workshop, where she and other women in her church shared their stories. “It materialized into really being able to aid more women,” she says.
Every year, the Philadelphia Police Department receives more than 100,000 domestic emergency calls. Over the past 10 years, more than 1,600 people have died in domestic violence incidents in Pennsylvania.
Today, a Penn Medicine CAREs grant supports SISTERS — which Chase plans to use to provide emergency shelter and transportation, toiletries, food vouchers, counseling, and other basic necessities to help women toward a new life.
Chase’s latest workshop took place in October, during Domestic Violence Awareness Month. It featured three speakers (all domestic abuse survivors), as well as a clinical educator of Women Against Abuse who provided a domestic violence training to the women and men who attended.
Tarskia Chase is now six years happily married to Eric Chase, with a blended family that includes their six children.
“I am completely passionate about SISTERS because I can put myself in women’s shoes,” Chase says. “I speak life into a situation and let them know that there is a light at the end of the tunnel.”
IMPROVING SERVICE WITH SCIENCE
Research drives many of our outreach EFFORTS to the right place — and steers them along the way way.
Laura Henry’s journey to medicine began on Wall Street. She left a finance job to volunteer in a medical clinic for the homeless where she solidified her passion for health care and was first introduced to low-resource medicine. Shortly after, she found herself at the Perelman School of Medicine pursuing that passion to help people.
Now a fourth-year medical student, Henry feels like she has come full circle with a new program she created called ListenUp! aimed at helping underserved youth suffering from hearing impairments and adults with risk factors for head and neck cancer.
She came up with it while working with the ear, nose, and throat (ENT) teams in the department of Otorhinolaryngology – Head and Neck Surgery. That experience put her in the thick of top-level care, but it also opened her eyes to the disparities affecting populations in the hospitals’ backyards.
“What does ENT care look like on the borders of the hospital?” Henry asked. “Do these problems affect minority groups across West Philadelphia?”
She started talking to school nurses about their hearing tests and found either a lack of resources or that children were falling through the cracks because nurses didn’t know what to do with students after they failed the tests. Many were likely mislabeled or misdiagnosed with a behavioral disorder, Henry says.
She first began working with an audiologist at the Children’s Hospital of Philadelphia to put together a fact sheet on how schools could screen children for hearing loss, and what to do if they fail. Henry then trained
50 medical students to perform audiology assessments using two of the medical school’s audiometers. Now clinics are armed with the equipment for Penn students to do hearing tests on the spot. According to Henry, mentors within the ENT department, Steve Cannady, MD, and Michael Ruckenstein, MD, and CHOP pediatric attending, Cindy Christian, MD, have been integral in bringing this project to fruition.
A second phase focuses on adult head and neck cancer, which also disproportionately affects minority groups living in West Philadelphia. Medical students learn about the risk factors, like smoking, alcohol use, and HPV-positive status, and how to do a proper head and neck exam in the clinics to catch it.
“I have come to really love research during my time at Penn. I was aiming to combine my interests in research and community service in moving this project forward. As such, I used the literature to choose areas of care that disproportionally affect low-resource populations,” Henry says. “I also wanted to tackle issues that once diagnosed, we could do something about it.”
Henry says that as the project continues to expand, they will collect data on the program’s utility for using resources most effectively in the community clinic setting.
That same approach informs many of the free health service clinics and programs across Philadelphia, like the Homeless Health Initiative and University City Hospitality Coalition Clinic.
Data doesn’t just help guide patient care in underserved communities. It directs education efforts too.
“That combination of shared identity and intrinsic altruism is incredibly powerful”
There’s an imbalance of African-Americans and other minority groups in medicine today. They represent
more than 25 percent of the total population, yet only 10 percent of health professionals. And while the percentage of African-American women graduating from medical school has increased since the late 1980s, the number of men has significantly declined, according to the Association of American Medical Colleges.
Helping to close that gap in Philadelphia, the Penn Medicine Academy’s High School Pipeline Program aims to give underserved students a better chance at pursuing a career in medicine and health care. It places students from high schools in West Philadelphia in paid positions throughout Penn Medicine over two years to help them work toward a career in health care, while taking college-level courses along the way.
The program is supported by Penn Medicine, as well as outside partners, including the Lenfest Foundation and Howley Foundation. Since it began in 2010, more than 270 students have participated in the program, and 100 percent of them have graduated high school.
The lessons learned from Penn’s IMPaCT (Individualized Management for Patient-Centered Targets) program have not only guided outreach work in the Philadelphia area but across the country. IMPaCT trains community health workers (CHWs) to help high-risk patients navigate the health care system and address key health barriers, such as housing instability, trauma, or food insecurity.
Developed in 2011 by Shreya Kangovi, MD, MS, an assistant professor of Medicine and executive director of the Penn Center for Community Health Workers, the model has been accessed by over 1,000 unique organizations and institutions. And for good reason: Studies have shown that IMPaCT improves both patient experiences and health outcomes, while reducing total hospital days by 65 percent.
“For me, as a doctor, coming from middle class background, I didn’t really know what it was like out there to face some of the struggles [many people in the community experience],” Kangovi says. “I thought it would be silly for me to pretend that I did or lecture them on how to address those issues. Instead, it would be more logical to put community members in the lead position.”
These “natural helpers” share common backgrounds with patients, like race, ethnicity, income, education, and language, she says.
“That combination of shared identity and intrinsic altruism is incredibly powerful,” she adds.
Since 2011, over 7,500 high-risk patients in the Philadelphia area have been helped by the program. The Penn Center for Community Health Workers employs about 55 people, most of whom are CHWs living in the same neighborhoods as the patients they serve.
In the past year, the program has expanded within Penn Medicine to include patients with a broader array of chronic health conditions, including infectious diseases, sickle cell and depression, and also added CHWs to care teams at Pennsylvania Hospital.
The sky is the limit for future growth of the program, Kangovi says.
“We are really doing a lot to make sure we are well integrated with the clinical teams, serving their needs, and being responsive to the health care system and the community.”
Closing the lung cancer screening gap
For Carmen Guerra, MD, MSCE, a problem is always the starting point from which to build.
It was a shocking statistic on lung cancer screening rates that set her into motion: Just four percent of the seven million heavy smokers eligible for screening were screened two years after a 2013 U.S. Preventive Services Task Force recommendation. And the numbers haven’t budged much since.
“You can see we have a long way to go, so for me that was the problem that needs solving,” she says.
Guerra, an associate professor of Medicine at Penn and associate director for Diversity and Outreach in the Abramson Cancer Center, is creating a Lung Cancer Screening Navigation program for underserved neighborhoods in West Philadelphia to help close that gap locally. But first she needs to address a barrier faced by many in this community: the shared decision-making mandate. To cover the cost, payers, including Medicare, require doctors to first discuss the benefits and harms of screening with a patient.
“The truth is, that has been really difficult to implement in real life,” Guerra says. “Many doctors haven’t been trained on it, and may not know how to do this well, like how to convey the right amount of information to the right patient at the right level.”
Or it doesn’t happen at all.
To help initiate a more efficient and effective conversation, Guerra sought out and studied a tool called ShouldIScreen.com developed by researchers at the University of Michigan. Patients engage with the tool before seeing their clinician to learn more about screening and lung cancer.
“We like this online tool because it’s very visual and not a piece of paper, which helps overcome literacy issues,” Guerra says. “It actually gives you a very personalized risk of lung cancer, and not an average risk.”
“The truth is, that has been really difficult to implement in real life,”
Using a Penn Medicine CAREs grant, the researchers tested the tool in 40 underserved patients from the Penn Lung Center, and found that it increased knowledge about lung cancer screening and decreased decision conflict. “Whichever decision they choose, we think it’s the right answer for them,” she says.
The next phase of the project will expand the number of patients and study the tool’s impact on screening rates. The program also aims to assist patients with appointments, SEPTA fare, or a translator, if need be.
“The shared decision-making tool is one step towards building our vision,” Guerra says, “which is to build a navigation program for helping to guide more people who decide to be screened.”
About Penn Medicine CAREs
Penn Medicine faculty, staff, and students throughout the organization donate their time and expertise to provide countless hours of work to improve the health and well-being of the communities we serve. The Penn Medicine CAREs grant program was established in 2011 to offer institutional support to these individuals and programs in the form of grants — awarded quarterly — that can be used for the purchase of supplies and other resources needed to perform this important work in the community. To date, more than 400 projects have received funding. For information on additional outreach initiatives at Penn Medicine, click here.
By the numbers
- $ 279.7 M Charity and underfunded care for Medicaid families
- $116.1 M Physician training support
- $129.7 M Research support and community health
- $1.75 M Raised by Penn’s Way campaign
- FY18 Total $527.25 M
Emergency department visits
- 62,309 Hospital of the University of Pennsylvania
- 38,002 Pennsylvania Hospital
- 47,184 Penn Presbyterian Medical Center
- 45,161 Chester County Hospital
- 117,591 Lancaster General Health
- 49,321 Penn Medicine Princeton Health
- FY18 Total 359,568