By Neil Offen
noffen@heraldsun.com; 419-6646
DURHAM -- N.C. Central University and Lincoln Community Health Center are in the very early stages of a potential collaboration that could bring lay health workers to underserved neighborhoods in the city.
The idea is to train well-known and respected community members to help work with patients suffering from chronic diseases, coaching them on how to check their blood sugar, for instance, or reminding them to take their medications or arranging transportation to a clinic for an examination.
"What we're talking about is people who are popular opinion leaders in their communities, people who others go to for information, whom people listen to," said La Verne Reid, interim associate dean of public health education at NCCU. "With just a bit of training they could really help advance good health in their communities."
The actual role that such lay health workers would serve is "still very much being worked out," said Brian Bramson, chief of adult medicine at Lincoln. "It's important to realize that all of this is in very preliminary discussions, and is very crucially contingent on us obtaining funding for the program, which we don't have at the current time. But we've very excited at this point in pursuing the idea."
Lay health workers have been widely used for many years, particularly in areas that have a dearth of traditional health care providers, such as inner cities and developing nations. A recent peer-reviewed paper on their effectiveness, compared to usual health care services, found that they "provide promising benefits in promoting immunization uptake and breastfeeding, improving TB treatment outcomes and reducing child morbidity and mortality."
Bramsom, who had experience with the concept while working as a physician in the African nation of Malawi, said it was easy to imagine the benefits for Durham.
"At the health center, we are seeing a lot of patients with chronic diseases, like diabetes and hypertension," he said. "We have a very, very good health care staff, who are doing a very good job, but we're not always seeing good disease outcomes. A lot of that is because many of our patients don't spend a lot of time within our four walls.
"If we want to see disease outcomes improve, the place where there's the greatest bang for the buck is to try to improve what happens when the patients are not in our four walls. And that means getting people in the community involved."
Bramsom recently came to NCCU with the idea.
Under the possible collaboration, the university would provide the actual training for the lay workers, perhaps resulting in the granting of a certificate.
"It would need to be interdisciplinary, covering public health, psychology, nursing, biology and more," Reid said. The certificate, she explained, would say to an employer, for instance, that the individual has training in anatomy, physiology or chronic disease prevention. "We've thought about it for a long time. The concept has been of interest to us for any number of years."
Reid and Bramsom have already met once to discuss the possibility and have scheduled another meeting for next month. They both acknowledge that there's a long way to go before anything substantial emerges.
But while there is much work to still do, both sides are excited about the possibilities.
"I would envision that there is definitely a role for this type of individual although we have not yet processed how it would work," Reid said. "We've often thought we could do more for the health of the community, and this would be a way to do that."
The concept "certainly has seen drastically improved outcomes in other parts of the world, and I would think it would work here," Bramson said. "I'm confident in our context it would improve disease outcomes. We don't know how it will be worked out in practice and whether we can afford this is very much in question. But we're excited at this very, very very preliminary stage."
