Duke program aims to build community trust in healthcare system by meeting patients where they're at
This summer, I took a bus tour with Duke University’s REACH Equity Summer Undergraduate Research Program (RESURP), which is designed for undergraduate and graduate students in the healthcare field. One of the stops on the tour included Durham, where Dr. Nadine Barrett and Kenisha Bethea walked students through the communities they might work in once they enter the medical and research fields.
“When we want to come in, we're thinking that the community needs us,” Bethea said. “And there may be instances where they don't have enough resources for things, but by far, they are very much ‘resource-rich.’ They have a lot of expertise, a lot of talent, and a lot of know-how that researchers, clinicians, and health professionals can benefit from.”
The goal of the tour is to show students the community they are serving and help them understand the issues that are most important to community members. Bethea explained how the overall goal is to build trust between marginalized communities and healthcare professionals by recognizing the strengths communities have and meeting them where they’re at.
“When you're working (in) health, it’s a collaborative effort," Bethea said. "And so, you can't come in and save a community without the community working with you to help save themselves.”
On the tour, we visited El Centro, and discussed the history of the Lincoln Health Center and other community initiatives to build the inequity gap. PBS reported that nearly a third of Americans lack access to primary care services, including routine checkups, while 40% of U.S. adults said they're delaying care or going without because of the financial costs.
Dr. Nadine Barrett wants to change that. After the tour, Barrett — an associate professor in the Department of Family Medicine and Community Health at Duke University — talked about what pushed her to be a medical professional and how to build trust with the community.
“The term 'cultural competence' — the idea of people being able to build their awareness, their knowledge, and their skills, and competencies, in this case, culture — I think, is great,” she says. “I think the challenge with it, however, is that sometimes, if we don't have a foundational component to that, that's based on humility, then you've just learned another skill set, just like you've learned how to use a scalpel.”
Barrett said the humanity and humility needed in the healthcare field isn't something you can teach. She knows from first-hand experience. Her mom had trouble with doctors who stereotyped and misdiagnosed her until she went to a sarcoidosis specialist who took the time to get to know her.
“What was different is that, when we walked in, he instantly recognized us as people," Barrett said. "You know, he knew (we were) his patients, (but) we became partners in Mom's health before he even knew anything more."
After talking to close members of my family, I found that this wasn't a rare occurrence. My mom, Dr. LaTricia Townsend, gave her account of her experiences with healthcare professionals.
“I feel like I've had trouble finding a good healthcare professional that felt like it was a partnership," she said. “Being talked down to and being spoken to as if I am not smart enough to understand when things are being explained to me. And so, it just sets up this weird power dynamic that has often made me feel uncomfortable.”
Throughout her life, she has seen multiple family members, including her mom, pass away due to blood pressure-related problems and kidney disease. She worries about her future with every appointment.
“There are times when I go in, I am just so nervous," my mom told me. "My heart is beating a mile a minute while I'm waiting for those readings.”
Growing up, I wasn’t the biggest fan of doctors. I felt uncomfortable and I hated shots, which led to me to not visit the doctor often. It's been a running joke in my family that folks wouldn't go to the doctor until they were really sick, but then I noticed that this joke was actually a pattern — a dangerous one.
Dr. Kenyon Railey, a primary care doctor at Duke’s Family Medicine Center, believes that the community and healthcare system are at a stalemate.
“We have worse outcomes for many preventable illnesses," Railey said. "And so, sometimes the reason that individuals don't end up getting those health screenings or getting those interventions is because they don't trust the providers that they take care of.”
He said one of the reasons communities of color lack trust is because they have been historically marginalized in the healthcare system.
“There are many reasons for that and most of all, is a kind of history in this country, particularly of racism and distrust, both in science and in healthcare," Railey said. "And so, patients that see me, there's an opportunity because there's some familiarity, just based upon the fact that I'm also a person of color.”
But being a person of color doesn't solve all his problems. He's dealt with these same stereotypes, and even his own oversight in practicing medicine.
“I made a lot of mistakes in my career as it relates to communication and connection with patients. Going through life as a man of color, I've navigated many instances of discrimination, marginalization, and racism." Railey explained. "I thought that that would have been enough for me to connect with all people. Because of those instances, what I actually discovered is that ... those things didn't make me qualified enough to necessarily connect with all patients, because I had my own blind spots, with assumptions, with bias, and with marginalization.”
Railey has seen both sides of the coin. While caring for his dad, who was also a doctor, they experienced mistreatment and belittlement by healthcare providers. It was frustrating to his family, but it showed him that representation could be a tool to bridge the gap between providers and the community.
“I realized, I need to get better at connecting with all patients, no matter if they look like me or not," he said.
The need for more culturally competent healthcare officials coincides with Railey’s desire to inspire the youth to explore different avenues of life.
“I have so many instances of young folks that I take care of in this community, where I walk in the room and their eyes light up, not because I'm anything special, but because they look like me," he said. "And they never seen somebody as a doctor that looks like them.”
He hopes the future of medicine will keep improving, especially in Black representation among medical professionals.
“I think it's really important in medicine, particularly in healthcare, as we try to improve our numbers, to think about the impacts of representation," Railey said. "I'm proud of when I'm walking into my community and seeing young boys and girls, and me with my white coat. Because that's what happened [to] me. I saw my dad like that, I saw my medical provider like that. And so I'm like, I can do that, too.”