Bringing Healthcare to the People

Located within walking distance of four medically underserved housing developments in north Philadelphia, Eleventh Street Family Health Services stands out as a clean, bright, and friendly place. According to the plans of founder, Patricia Gerrity, RN, PhD, FAAN, Eleventh Street is more than a primary care clinic, it is a wellness center and, possibly, an oasis of hope.

In all respects, the center seems to be thriving, with enrollment in its programs growing steadily since it opened on September 20, 2002. But according to registered nurse Fran Gelo, who is responsible for leading the three-person outreach team, made up of herself, a college student, and a high school student, it wasn't that way in the beginning.

Getting the People to Come

Put a brand-new wellness center (a term totally foreign to the locals) in the middle of an area with one of the worst health profiles in Philadelphia, and you can hardly expect the residents to think the impressive facilities are meant for them.

Before the center opened, the (95%) African American population of the local housing development had access only to a public health clinic and the emergency rooms of the local hospitals. "The population [we] serve is used to fainting on the street and going to the ER and getting some pills," says Gelo. One can conclude that getting patched up and turned out again, with a prescription you can't afford, would make anyone suspicious of the medical community. And when you can barely feed your family, taking, say, an aerobics class would seem as frivolous and remote as it would be for most people to wear a diamond tiara to work.

Empowerment is a hard sell to those who, in the past, haven't felt respected much by the healthcare community. But the center's aim is to change that attitude – to foster self respect, self-esteem, and, therefore, teach people that they can have an impact on their own health. Even calling Eleventh Street a center rather than a clinic promotes the fact that it offers many other activities in addition to primary healthcare.

Innovation

The center is staffed by three nurse practitioners, one registered nurse, two psychologists (one child specialist and one family practice specialist), three therapists (music, art, and dance) and three students. (As well, a dental unit will be opened in early 2004 and will be staffed by dental faculty from another university.) The center's staff has developed many innovative programs tailored to the community they serve: 35% of attending adults suffer from chronic conditions such as diabetes and high blood pressure. The center offers a wide range of programs, such as obesity prevention and behavioral health. There is a kitchen classroom for support and recipe sharing as well as courses in cooking for special diets (for those with diabetes and high blood pressure). And, at the gym, they conduct women's exercise classes twice each week, with the objective of reducing participants' chances of cardiac disease. (Most of those who attend the classes have never worked out before.) The classes also provide group encouragement, and some women lost up to 30 pounds in eight months.

The Art for the Soul classes not only allow people a chance to do something new and, previously, unattainable but also have health benefits. Participants take their blood pressure before and after the class, and the participants' blood pressure is always 10 to 15 points lower at the after-class reading.

There is also a dental service, a creative arts/youth therapy room for teens, a lab, conference rooms, a room for group and family therapy, a laundry room, a main waiting area with a computer, and a children's waiting room with toys and books.

Last winter, the staff solicited donations of coats from people in the surrounding area and ended up with "tons and tons" for people to choose from. And they operate a Vegetable Van, which provides free transportation to the closest grocery store, three-and-a-half-miles away. Transportation is a major issue in the community, and, without the van, many people wouldn't have access to fresh fruits and vegetables.

Even with its increasing success, the center continues to reaffirm and promote its position in the community. In September 2003, both as a promotion tool and to provide access to fresh, healthy foods, the center along with Philabundance (a nonprofit organization that collects food for distribution to the needy) began hosting a free weekly farmers' market in their parking lot. With 13 pallets of fresh vegetables, fruits, and baked goods available, people just have to bring bags and take what they want.

Also, in fall 2003, the center took the opportunity to advertise itself to a larger audience: The Tom Joyner Morning Show, a popular syndicated African American radio program, used Eleventh Street as one of their four broadcast centers for Take a Loved One to the Doctor Day. The center used the publicity to showcase what nurse practitioners can do for a community.

All of these programs and innovations are done with community input and support. Says Gelo, nurses approach healthcare differently than doctors, "We are more holistic. Nurses worry about things other than disease."

The Woman with the Vision

Somewhat behind the scenes is center founder and director, Patricia Gerrity, who is also associate dean of community programs at Drexel University College of Nursing and Health Professions. Gerrity didn't start her career in public health – she worked in pediatric emergency medicine, ophthalmic OR, and surgical ICU. However, while taking a course in public health nursing, she realized how much bigger an impact she could have if she switched her focus to that field – targeting groups, not individuals.

To foster this impact, Gerrity decided to do a Master's program in public health and to earn a PhD in health planning. Her PhD health planning courses included information on how all aspects of a community and its systems, such as services and transportation, affect health. Her dissertation was an ethnographic study of self-care in the elderly, and her subjects were primarily isolated elderly persons living in high-rises. When these individuals had a health problem, they had to call 911 and were taken to a hospital where they received specialist care, which they didn't want or need. What they wanted and needed, Gerrity found, was basic nursing care in their own neighborhood. This knowledge gave Gerrity the idea for neighborhood-based nursing services. She felt that what was most needed was disease prevention and health promotion, rather than illness care.

In 1991, while teaching at Philadelphia's La Salle University, Gerrity started successful public health nursing projects with graduate students. Indeed, people liked the care so much they wanted to receive it on an ongoing basis and not just when classes were in session. When Gerrity moved on to Drexel, she created Eleventh Street Family Health Services from nothing: moving from programs for health promotion and disease prevention, in 1996, to primary care offered out of temporary quarters in a community center, in 1998, to a brand-new, nurse-managed, multi-service facility, in September 2002.

On the Horizon

Persistent and passionate about her devotion to the community, Gerrity wants her center to prosper for the long-term. She is teaching her methods to a new generation and working on new programs. Because they can bring real-life examples to their course work and research, her public health graduate students appreciate working at the center. And Gerrity seeks participation from students in other programs at Drexel, such as arranging for students from the faculty of interior design to work on the center.

Gerrity is currently in discussions about the best way to expand Eleventh Street's facilities to add more services, such as a food pantry where people would have access to the fresh and packaged goods they need at the end of the month when their money runs out.

According to her dean, Dr. Gloria Donnelly, when it comes to Eleventh Street, Gerrity is "a dog with a bone." Gerrity planned space for facilities at the center, which she did not yet have funding for. Within one year of operation, all of the formerly empty rooms were equipped through money from federal, state, and county governments and private foundations – just as Gerrity had planned.

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