Imagine what would happen if you were the last health professional who saw an abused woman alive before her boyfriend beat her to death. In the scenario I described yesterday, imagine that you had said nothing. Imagine that you had said something. Imagine that something had gone terribly wrong. Can you picture the guilt, the remorse?
Health care, education, social work. Where are the boundaries? There is so much responsibility, such great need and resources are few -- the resources of the system, our own personal resources, our own personal strength, our own personal capacity.
When I was reporting on the story on community health workers that appeared in the Philadelphia Inquirer, I asked the director, Paula Stillman, vice president of health care services at Temple University Hospital, about the psychological training given to these workers. Frankly, I wasn't satisfied with the answer. Basically, the answer was, when these workers feel uneasy, when they feel beyond their capacity, they should call their supervisors.
That's great, but it's not enough, especially based on my interviews with some of the workers, who will plan to pour their whole hearts and souls into their jobs. When does responsibility end? How does one cope with a feeling of helplessness?
It's a good question, said Michael "Chris" Gibbons, associate director of the John Hopkins Institute of Urban Health in Baltimore. The Institute has been working with community health workers -- lay professionals -- for a decade.
"The people who are great for this job, they don’t always have the ability to know how to balance this," he said. "They burn out."
As for the idea of calling the supervisor, that's where the rubber hits the road, he said. "The degree of success of your program will be directly correlated to the robustness of your infrastructure," he said. Gibbons, a surgeon, said health programs get excited because of costs. The community health workers "are cheap compared to a nurse at about $90,000."
But, he said, "I don't care how much good they do, how many churches they stand up in and preach [to educate the community and recruit workers], they have to have a good infrastructure."
In other words, the supervisor needs to know what to do, but also how to handle the community health care worker, who, on the front line, is exposed to physically and psychologically difficult situations.
Temple does plan one important strategy to help these workers cope. They plan to convene the group of students who recently completed their training on a weekly basis for several months. They hope that this time of debriefing and mutual support will help forestall this burnout. "We don't want to cast them adrift," said Cheryl Mongillo, who is coordinating Temple's program with Stillman.
• Today: Protecting the heart: Community health worker burnout
• Wednesday: Who gets the savings for community health workers