The Emergency Room as a Place of Change

"If airports can become shopping malls and McDonalds can become a local playground, surely we can reinvent the clinic waiting room."

Above is a Ted Talk by Rebecca Onie, founder of Health Leads. The goal of Health Leads is to connect low-income hospital patients to basic needs and resources such as food, housing and health insurance. The idea behind Health Leeds is to put "health" back into the healthcare system by viewing it in a holistic. In her Ted Talk, Rebecca Onie discusses using a hospital waiting room as place of social change and cites a man named Dr. Jack Gieger as her primary influence. In 1965, Dr. Gieger founded one of the first two community health centers in the United States, located in some of the poorest areas of the country and he noticed that although many of his patients came in with a variety of symptoms and ailments, most were suffering from malnutrition. He began to notice that the root causes of most of their illnesses went back to being starving; he began prescribing food as a result. The patients would then take these prescriptions to the grocery store and the pharmacy budget would be charged to cover the cost. After his funders got upset and told him he was supposed to use the budget for medical purposes only, Gieger responded "Last time I checked my medical textbooks, I read that the cure for malnutrition was food." Dr. Gieger's powerful words laid the foundation for Health Leads: that good health health starts at basic needs and hospital visits should be about more than making basic clinical diagnoses.

Health Leads as it exists today trains doctors and other healthcare professionals to recognize the social determinants of health and incorporate them into traditional models of care. When physicians treat someone that has health needs that go beyond the parameters of biomedicine, they refer them to the Help Desk that situated in the hospital waiting room. This way the patients can work with a volunteer advocate at the Help Desk to get other aspects of their health situated while they’re waiting for their "traditional" prescriptions to be filled. The volunteers, typically undergraduates interested in a career in health care, connect the patients out to the existing landscape of community resources. For example, doctors might treat asthma by prescribing a medication for it but people at the Help Desk would try to instead identify a cause; perhaps the patient has mold in the walls of their apartment, so in response we would try to find them better housing and get them a lawyer to advocate for their tenant rights. These sorts of Help Desks exist as a two-fold: to make a positive impact on people's lives in the waiting room, and also to train the next generation of healthcare professionals to recognize health needs beyond a basic clinical diagnosis. Help Desks aim to treat the cause, not the illness. Health Leads is currently working on providing a business case as to why the healthcare system as at large should pay for this type of care in addition to what they already provide in addition to policy work.

Help Desks like Health Leads are gaining ground across the country and more and more every year are being incorporated into traditional models of care. My PE at Highland Hospital is modeled after Health Leads except it is run on a purely volunteer basis, whereas Health Leads has paid employees as overseers. Berkeley students reached out to Health Leads in 2012 to start help desks in the Bay Area, but at that time Health Leads was not ready to expand so the Berkeley students did it themselves through Big Ideas at Berkeley [http://bigideas.berkeley.edu/winners/highland-health-advocates/]  Highland Health Advocates is just a part of the Bay Area Regional Health Consortium, which is a team of doctors, lawyers nad undergrads devoted to helping those in poverty acheive good health. According to their Big Ideas at Berkeley page,"The goal of this interdisciplinary approach is to improve the health of low-income patients, enhance the patient experience, reduce emergency room utilization by high frequency patients and ultimately lower healthcare costs in outpatient clinics and the emergency department." The pilot Help Desk through the Consortium was founded at Highland Hospital in Fall 2012 with 8 undergraduate volunteers and has since grown to over 60 undergraduate volunteers in Highland Hospital, Oakland Children’s Hospital, and San Francisco General Hospital.

If anyone is interested in volunteering with us, let me know! We require a minimum of one semester. We’re also looking for summer research interns.

Urban Agriculture in the Bay Area - Documentary

For my PE I will be working with urban farmers in the Dakar region of Senegal. My curiosity, interest, and passion for food and the system it lies within has been ever-growing as a student in Berkeley, and as a resident in the Bay Area - rightly accredited as one of the epicenters of the food movement in the United States. Being able to see urban agriculture in the works and how even a small farm can make a difference in an entire community gives me a lot of real hope for changes in our food system so that a more just system can, and will happen.

This documentary, though reminiscent of other food documentaries in the beginning, developed into a very good representation of all the different kinds of efforts around the Bay Area, while also showing how all of them were aiming towards a common goal - to get food, healthy and yummy food, to people, especially to those that don't have access to it because of various political, economic, and social factors. It is a well-edited film about the urban food movement, where it is, and where it intends to go.

It's inspiring to see how many different people - in regards to their age, their race and ethnicities, their class, their gender, their backgrounds, their experience in farming - can fight for a common cause. From   food and environment all-star scholars such as Miguel Altieri and Nathan Gimenez-Holt, to young kids and teenagers from poor communities that have to go to special schools for not being able to handle/"behave" well in a typical school, people have united to fight for a better food system, to fight for access, and to take change into their own hands when change doesn't happen. This movement is active participation.

Even though there are similarities between the Bay and Dakar, such as guerilla urban farming (farming on land that one doesn't own because they don't have the power or resources to buy the land, or the land is open and would be otherwise neglected) and urban farming to lower food insecurity, it has been perspective-opening to me to learn about urban farming in another region of the world. Here in the Bay it is very much a social movement of access to the community and equality, whereas in Dakar, much of urban agriculture is aimed towards economic support of farmers. Unlike in the Bay where many people in the community are learning how to farm from a few experience gardeners to do urban farming, in Dakar, people who are farmers by trade, or subsistence farmers by necessity, are working to keep a living.

And as a trailing off final though... I've been pondering the pattern to return to traditional farming features as a solution to modern day problems of the food system. It really makes me question "development" that has occurred in regards the the food system, who was driving this "development," the intentions behind it, and how much it was thought through.