As a busy general internist, Marty Bohnenkamp, M.D., finds that much of his patient interaction comes in 15-minute increments, either as he sees patients in Cooper Green Mercy Hospital’s (CGMH) internal medicine clinic or as he evaluates them to be admitted. As Jefferson County, Alabama’s only county-owned, safety net hospital, CGMH plays an important role in the care of several diverse communities. More than 60 percent of the patients have incomes that fall at or below 200 percent of the federal poverty guidelines and no one is denied care.
Concerned for his patients but unsure how to make a difference, Bohnenkamp often found a few spare moments to chat with them, but he realized he could not always offer the guidance that he felt they needed to take charge of their health. “Not only are patients in this community often isolated from a social standpoint,” Bohnenkamp says, “they need support with their health issues. They often don’t have access to healthy food or a model of healthy food choices or a healthy lifestyle available.”
In an effort to learn how he could bring CGMH’s patients and the surrounding community members together in a way that would improve their health, Bohnenkamp participated in the Robert Wood Johnson Foundation Ladder to Leadership: Developing the Next Generation of Community Health Leaders program in 2009. Once he joined his class for the 16-month Ladder training period, he became part of a group focused on spurring community engagement around issues of health and health care in vulnerable populations. Bohnenkamp joined four other Ladder to Leadership fellows from Birmingham to sow the seeds that would become a community garden at CGMH that is now about to enter its second, full growing season.
Grass Roots Garden
Unlike many community gardens that are built to simply provide fresh produce to underserved neighborhoods, Cooper Green Acres (the group’s name for their garden plot) set out to do much more. The central goal was to create a health-centered project that allows folks from all parts of the community to participate. Once Bohnenkamp and the rest of the Ladder to Leadership team came up with the idea, they enlisted support from the hospital administration and started holding weekly planning meetings.
The team included: Judy Prince, L.C.S.W., who treats patients in CGMH’s Pain and Psychiatry Clinic; gardening expert Rachel Reinhart of Jones Valley Urban Farm, a Birmingham nonprofit; Genesis Player, head of the School of Social Work at Miles College in Birmingham; and Allison McGuire, of the University of Alabama at Birmingham’s (UAB) Division of Preventive Medicine. To encourage collaboration, they reached out to hospital staff, physicians, nurses and volunteers, with an emphasis on engaging patients and community members.
In March 2010, the group planted their first seeds—herbs nestled in 18-inch pots near the hospital’s entrance. Next, they added tomatoes, peppers, okra, watermelon, beets and other plants. By April 2010, the team moved their little crop to a temporary garden space—two 15-by-10-foot plots at either end of a driveway median that led into the hospital grounds, says Reinhart.
“The result was remarkable,” she says, “Between ten and 30 people would show up every time we had a garden workday: staff, nurses, doctors, and lots and lots of patients.” More than 120 people have participated in the project so far. Even under less than ideal growing conditions, the garden produced more than 100 lbs. of organic produce, which the steering committee proudly bagged and labeled “Cooper Green Acres,” before giving it out to patients and community members.
By all accounts, the garden has accomplished far more than encouraging healthy eating. Joining the steering committee and tending the garden has helped Roy Mosley, a retired father of five who has lived most of his life in Birmingham, deal with some of the confusion and withdrawal he felt in dealing with HIV/AIDS. “Becoming a part of the garden gave me a new hope and a sense of new direction,” says Mosley, a patient at St. George’s Clinic at the hospital. “Everybody had a say-so in what direction [the garden] would go in.”
Mosley also appreciated the garden’s ability to bring back childhood memories. As a boy, his dad taught him how to raise tomatoes, okra and corn in a small plot. “I enjoy passing along that knowledge,” he says.
The project has also built bridges between the patient community and the hospital staff. “[The garden project] brought me closer to other patients but also the faculty,” says Barbara Wilkins, a patient volunteer in the Cooper Green Pain Management Clinic. “I can work with people different from me. I can encourage them by saying, ‘you can come do this.’” Physical and occupational therapists have also brought patients into the garden to work on their rehabilitation in a real-life setting.
A Rich, Fertile Future
Because CGMH is in an urban area built on county property, one of the biggest challenges was finding space and getting approval for the project. But now plans are underway to make Cooper Green Acres a fixture in Birmingham. A landscape architect has donated the plans for a new, permanent garden, a full city block long with raised beds accessible to those with disabilities. A contractor has agreed to do the work for a reduced fee. And the Ladder for Leadership team has raised more than $20,000 in grants and donations for the project.
Though the garden has produced a bounty of healthy food, it has also succeeded at the Ladder to Leadership teams underlying goal—to boost community participation and engagement. “This wasn’t just about whether we had plants in the ground,” McGuire says. “It was always centered on whether we got this community involved in something they would be happy with and proud of.”
McGuire has also applied the community engagement skills learned during the garden project to her work at UAB’s Center for Preventive Medicine. To promote breast and cervical cancer screening among low-income women, particularly Latinas, McGuire enlists community health advisers who encourage women to get mammograms and Pap smears. “We spend the majority our time on recruiting community health advisers and empowering them based on what they see as the needs of their community,” she says.
“The skills learned in Ladder to Leadership have been invaluable,” McGuire says. The active learning strategies, for example, encouraged the team to step back and allow the community-based steering committee to take the lead on the garden project. In addition, the network built among the Birmingham Ladder to Leadership cohort has helped McGuire as she seeks funding for other projects and looks for community partners to support those projects. She adds, “It’s great to be able to call people I know and trust.”
In addition to helping patients, Cooper Green Acres has also improved relationships among all levels of hospital staff—executive leadership, doctors, nurses and others, Bohnenkamp says. “It’s proved to be a win-win, both for the hospital and the community that we serve.”
Ladder to Leadership: Developing the Next Generation of Community Health Leaders is a collaborative initiative of the Robert Wood Johnson Foundation and the Center for Creative Leadership. The program works to enhance the leadership capacity of community-based nonprofit health and health-related organizations serving vulnerable populations. Ladder to Leadership focuses on developing critical leadership competencies through an innovative leadership development curriculum. The program focuses on eight priority communities around the country.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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