Down in the Delta: Community health workers and the rural poor

About 150 miles away from Philadelphia, Mississippi, the Delta Health Alliance in Washington County, Mississippi uses community health workers to handle some of the same problems found in our Philadelphia. (Read my article in today's Inquirer here.)

"The Mississippi Delta is one of the poorest areas in the country," said Jane Calhoun, an official with the health care organization. "We're a very impoverished area. We have a low literacy level, a lot of uninsured among our population, obesity, diabetes. We’re in the stroke belt. There's a lot of cardiovascular disease and hypertension."

Unlike our Philadelphia, where there's almost a hospital on every corner, health care facilities are a few and far between and there's a chronic shortage of providers. It's so bad, Calhoun said, that until they trained community health workers, there was no one to talk over diabetes care with the diabetics themselves. "They may have been told how to do the insulation injection and then hope that they grasped it." Health education for diabetics consisted of a printed handout, sometimes written in medical legalese by the pharmaceutical companies selling the insulin, not in language that someone with an elementary school education could understand.

"We had two patients who were totally overdosing themselves," Calhoun recalled. They really didn't understand the instructions. Their lives were saved by the community health workers, she said.

Calhoun said patients told the Delta Alliance staff that nobody had ever explained to them how to handle their condition. "No one had the time," she said.

Like the situation described in my article in the Philadelphia Inquirer,  justifying the cost of these workers, even though they are low-paid, is a challenge in today's funding of health care. But, Calhoun said, when the workers focus on reducing no-shows, the savings are immediate and obvious. And, when the funding is based on a per-patient allocation instead of a per-procedure method, it makes sense to fund these workers.

Calhoun had one other interesting observation: Over the years, they've come to a better understanding of the type of person that is most successful in the job. While there is a lot of focus nationally on finding people who are natural leaders in their communities, the ones who fare the best are those who have had prior experience in a medical environment, "the experience working with a medical team."   

For the rest of this work week and then next week, I'll be blogging more about this topic. Please keep checking back each day.

• Today: Down in the Delta: Community health workers and the rural poor 

• Friday: Domestic abuse: Should community health workers intervene?

• Monday: Protecting the heart: Community health worker burnout

• Tuesday: Flavor of the month funding for community health workers

• Wednesday: Who gets the savings for community health workers

• Thursday: Temple's big ambition: Setting a standard for community health workers