If it works in Nairobi, could it work in SeaTac and Tukwila? That’s the question behind a new initiative designed to bring health-care innovations that are working in the developing world back home, to the two areas of King County with the greatest disparity between rich and poor.
Swedish Health Services is spearheading the project, which it calls "Global to Local," in partnership with the Washington Global Health Alliance, Public Health-Seattle & King County, and HealthPoint, which operates 12 clinics throughout King County. The core idea is to bring Seattle’s expertise in global health home. The program is expected to launch in the next few months.
One model for how Global to Local would work comes from Africa, where guinea worm disease is being successfully eradicated through the efforts of local nurses who understand the local culture. The caregivers work with village leaders and “influencers” to educate the community about cause and prevention.
Because the disease is caused by a parasitic worm that invades the body through drinking water, then escapes through the skin in an excruciatingly painful process, the key to eradication is teaching villagers not to drink the same water they use for bathing. Health care workers have learned that to succeed, they must engage village leaders first, enlisting their help in changing community behavior.
The same model is being used to get villagers to take essential medications and to fight malaria, using mosquito nets that health-care workers bring to villages as part of the education process.
Like these health programs, Global to Local is based on the idea that good health is dependent on a number of factors. “We believe that you can’t improve and sustain a person’s health without looking at the total environment,” explained Swedish Vice President Dan Dixon. “So Global to Local will provide assistance not just with health and nutrition, but also microloans, immigration issues, language interpretation [there are more than 70 languages spoken in the two target cities], unemployment benefits and even landlord problems."
Key to the success of Global to Local, which is designed as a pilot project that could ultimately go statewide and national, is a new kind of community health worker — a combination health-care specialist and social worker. “This is not necessarily a nurse or doctor,” Dixon said, “but someone with basic medical training who can do simple procedures and who knows the community and the full range of resources available.”
June Altaras, nurse executive at Swedish Health Services, is working with Bellevue College to develop a training curriculum for the new community health workers. She said the African experience provides a conceptual framework that will be used in that curriculum.
“The new community health workers will need to have some level of health-care knowledge but also an understanding of group and family dynamics,” she said, “plus familiarity with the resources in the target communities and how to connect individuals and families to them. If, for instance, a parent isn’t taking an asthmatic child to the doctor because he or she can’t afford transit, we want to be able to help them with bus passes. If they don’t know how to fill out the paperwork for Medicaid or Medicare, we want to do that too.”
Highline Community College has agreed to assist Global to Local in ensuring community acceptance and involvement in the program, and Global to Local partners intend to engage other local colleges and universities as well. In addition, there are plans for legal internships, whereby law students would help residents with legal issues, and for a dental residency program similar to the dental specialty clinics Swedish runs in North Seattle and on First Hill. Global to Local also will consider using technology to send out medical alerts, confirm appointments, and provide some kinds of care that are typically offered only face-to-face.
With $1 million in startup funds from Swedish and another $430,000 from the federal Department of Health and Human Services, Global to Local will begin with a resource center in the south end that will combine health, social services, and economic development programs. Other centers will be added as the program expands. Seattle NW Securities, an investment bank, broker-dealer and asset management firm, has signed on to provide financial and economic development guidance to local residents.
Swedish’s Dixon is clear that Global to Local is a work in progress and that its founding partners don’t have all the answers yet. But he says it’s essential to make a start in addressing health disparities. “So little of what we’ve done for the last 100 years is sustainable,” he says. “What we’re talking about is revolutionary, not evolutionary, and we know we need to come up with first steps that are logical, practical, and successful because we want people to believe the system can change.”
Whether Global to Local achieves its goals remains to be seen. But the partner organizations are counting on Seattle and Washington State’s expertise in global health to make a critical difference in the lives of underserved populations and communities right here in our own backyard.