City Health Works
Taking inspiration from Africa to bring healthcare to the people of Harlem
In sub-Saharan Africa, community health workers have long formed the backbone of health systems, filling in gaps where doctors and nurses are scarce. But they are a relatively new concept to the people of Harlem, New York City. City Health Works, inspired by the experience of their founder, Manmeet Kaur, in South Africa, has brought the community health worker model to US soil and is challenging the way we traditionally think of healthcare.
City Health Works targets populations in poor communities struggling with multiple chronic illnesses such as diabetes, hypertension and asthma. Many of the patients they visit suffer isolation as a result of their conditions. City Health Works’ locally hired Health Coaches come from the same community that they serve, they speak the same language and many have hand first-hand experience of the health challenges their patients face. Health Coaches visit patients at home, monitoring their conditions so that impending crises are picked up on before they require a visit to the emergency room. They are able to assist patients to look at their entire lifestyle, including managing medication, diet and exercise, so that they can take care of themselves in the long-run.
For 62-year-old Ramon Jimenez, a month without being hospitalised is a huge triumph. Without ever having learned to effectively self-care or navigate the complex US healthcare system, he had been on a 20-year downhill spiral. He has heart disease, which has disabled him, meaning he can no longer work. He also has diabetes that was uncontrolled for years, leading to the amputation of both of his feet. His small living room is crowded with medical equipment, medication, a walking aid and a wheelchair. But in the month since he’s been visited by Marisilis Tejeda – a health coach from City Health Works, things have markedly improved. She goes over his medication list with him, making sure he’s taking it correctly and consistently. She also checks that he’s properly limiting and monitoring sodium and fluids, essential for a patient with congestive heart failure. She will also accompany him to any doctor’s visits, to help him understand what they’re saying and vice versa. For doctors, this is a vital service that bridges the gap between the hospital and home. “It unburdens us,” said Dr. Gary Burke. “They come from the community, with a different perspective …. They speak the language. And they can look in the refrigerator.”
50% of healthcare spending in the US is spent on 5% of the population. Responding to a health condition that has become critical, costs far more than providing effective support to manage the condition from its outset. For 50% of patients, City Health Works identified a medical issue that was unknown to their medical provider, before it became a crisis. City Health Works is therefore proving that community-based primary care not only saves lives but also saves money. Through their Health Coaches, they are reaching those who have previously been failed by the healthcare system, proving that a model that works in Africa can also work wonders in the USA.