Giving back

“It was the instant soup that caused the high blood pressure,” said Dr. Yvonne Commodore-Mensah, referring to a recently retired man who had started enjoying a cup of noodles while binge-watching his favorite daily show. Although fit, his blood pressure started to rise, which he could initially not explain to himself. Commodore-Mensah, who is an associate professor at the Johns Hopkins School of Nursing, met the pensioner at one of the screening sessions organized as part of Engage with Heart – a Baltimore-based heart health outreach program led by the Global Coalition on Aging and sponsored by Novartis. His case, she said, confirmed that there is still significant work ahead in educating people about risk factors associated with cardiovascular disease. “He noticed that his blood pressure started creeping up after he retired. We talked, and together we found the cause after taking a close look at the nutritional value label of his daily treat, which showed that the high level of sodium was responsible for his blood pressure,” she said. The information had a lasting effect: When he appeared at the next screening session, his condition had improved.

Dr. Yvonne Commodore-Mensah

Rapid results As part of Engage with Heart, Commodore-Mensah oversees a healthcare team working on the screening events in churches and senior centers. Along with blood pressure measurements, the group of student-volunteers measures blood glucose and cholesterol. Convenience is key: Test results are provided in less than 10 minutes, giving participants a chance to immediately discuss the findings. “This education right after screening is a critical component,” Commodore-Mensah said. The discussions also give the team an insight into the realities of maintaining cardiovascular health in Baltimore city, which has one of the highest cardiovascular death rates among the Black community in the United States.

Many African Americans here remain reluctant to approach the healthcare system, as “some events from the past are still described as an open wound,” Commodore-Mensah said. Historical instances of unethical medical experiments on Black patients have created an entrenched mistrust towards medical institutions, contributing to poorer health outcomes. Institutions, such as the Johns Hopkins University, are working on acknowledging the burdened past. The planned construction of a multidisciplinary building named for Henrietta Lacks, whose cells were used for medical research without her consent, seeks to commemorate her legacy and contribute to advancing science. But reaching out to individuals is vital for overcoming systemic barriers to ensure their access to quality healthcare. Rebuilding trust To set up paths for giving back in a meaningful way to community members, Engage with Heart focuses on reconnecting them with healthcare. “Heart disease remains one of the leading causes of death, and what is discouraging is that it is largely pre­ventable. We need to be more visible and present in the community to change that,” said Commodore-Mensah, “and regaining the trust is what is going to make a difference.” The team worked on establishing a framework where healthcare providers are embedded in the community to conduct screening sessions in central hubs for the Black community – in senior centers and churches. “We knew that there are people who never miss church but can go for months without seeing a healthcare provider,” Commodore-Mensah said.

Collaborating with faith-based communities and “working on regaining trust is a continuous process,” explained Commodore-Mensah. “We have to understand how they want things done. Even as a Black person, I am showing up as a part of an institution that has to work on earning trust. I don’t just assume that I will be welcomed with open arms.” Commodore-Mensah also takes a very considered approach when it comes to recruiting the volunteers to work on the screening events. “They don’t just represent the program, but also the Johns Hopkins University,” she said, “and we want to make sure we don’t perpetuate some of the past harms.”

Vulnerable questions The program has revealed the need for a shift in educating the next generations of healthcare professionals. Though medical and nursing schools teach about ethics and the institutions’ history with the community, Engage with Heart volunteers are further sensitized to grassroots realities for working on the ground. Many of the student-volunteers are part of the Baltimore community – a key to cultural sensitivity and understanding the history. They dedicate four or five hours of their time on a Sunday to work at the screening sessions, seeing it as an opportunity to give back by applying their skills. Faith Metlock, a Ph.D. student at Johns Hopkins School of Nursing, is leading the student volunteer group. A third-generation nurse, Metlock is set on finding people who need help to “take proactive measures on their health, before issues lead to exasperations.”

Faith Metlock, Ph.D. student at Johns Hopkins School of Nursing

Metlock told us that she gets most fulfillment from meeting people at these screening events, and motivating them to make healthier lifestyle choices, both for themselves and their families. “Knowing your blood pressure, your weight, your cholesterol and glucose levels can help address any issues you might have. The first step is knowing your numbers,” Metlock added. The group is also designing educational mate­rials and working on surveys. “With community-engaged work, there is no one-size-fits-all approach,” Metlock said, remembering conversations with local representatives about a questionnaire. “There were some vulnerable questions, related to finances, mental health, safety, transportation and so on,” Metlock remembered, “and community members were not sure why we were asking them.” Many even found the queries offensive. But this offered a chance to the team to explain how these social factors influence the way people manage their health. Going back to the drawing board to reduce the number of questions and rephrase them took time, but ensured the survey was easy to complete for participants. Gaining confidence Regular screening is not only a chance for the community members to find out if there are concerns with their blood work values. They are also instrumental in helping increase trust in healthcare and helping individuals gain confidence to engage in discussions with practitioners.

“We learned that many people are not comfortable talking about their cholesterol or blood pressure to their healthcare providers,” said Commodore-Mensah. “The primary care system is not ideal. Physicians often don’t have enough time within a typical 15-minute visit. We are empowering people to advocate for themselves and ask what can be done if their numbers are not good,” she explained. Still, translating knowledge gained at screening events into lifestyle changes is not an easy task in many parts of Baltimore. And it is not just the African American community that is suffering from health disparities. The changing demographics of the United States are posing further challenges. “Public health education relating to cardiovascular disease could be improved significantly, also by taking into account the Hispanic and other immigrant communities, and finding ways of approaching them in languages they understand,” Commodore-Mensah concluded. The Engage with Heart program is hoping to provide a blueprint for other bespoke community outreach initiatives, even beyond cardiovascular health.