How a Nurse Leader Took on the Social Determinants of Health

Mar 17, 2022, 11:45 AM, Posted by

Trailblazing nurse and recently retired CEO of a community health center reflects on her legacy of providing care that prioritizes the social determinants of health.

Doctor and patient illustration.

Maria Gomez was 13 years old when she immigrated to the United States with her widowed mother to escape violent political turmoil in Colombia. They landed in Virginia on a snowy day with no boots, no coat, and not speaking a word of English. Together, they faced many challenges while navigating their new life. In spite of them, Maria’s gratitude and drive to give back led her to a nursing career. She ultimately joined a group of advocates in launching Mary’s Center to address gaps in access to healthcare and structural barriers that many immigrants face.

Today, Mary’s Center uses an integrated model of healthcare, education, and social services to serve patients at five clinics and two senior wellness centers in Washington, D.C. and Maryland. In 2012, President Obama presented Maria with the Presidential Citizens Medal, the second highest civilian honor in the United States.

After an illustrious career, Maria retired in December of 2021. She shared reflections on how she has led efforts to serve a diverse population and insights into the challenges our healthcare system and nation face. In this interview, Maria discusses how she shaped a system of care that aims to build trust with patients and provide integrated care that addresses more than medical needs.

Mary’s Center started out as a community health center that primarily served pregnant women and infants. Can you describe what that work has entailed and how you’ve continued serving pregnant immigrant women?

Mary’s Center started out caring for pregnant women from Central America who were fleeing war and violence, and who struggled to find care for a variety of reasons, including insurance status and language barriers. These challenges put them and their babies at risk for poor maternal and infant outcomes.

Today, many of our patients grapple with conditions beyond the pregnancy itself. Their lives are shaped by social determinants of health—the social, economic, and environmental factors that influence health. For instance, they may live in an apartment with occupancy limits, so the addition of a baby brings fear of being evicted. They may fear the pregnancy will cost them their jobs. Potential job loss and the additional mouth to feed makes new mothers worry about their finances. And there are constant concerns about family members being deported. As if these stresses aren’t enough, the brutal toll of domestic violence often begins or escalates around pregnancy and can lead to homelessness.

Some women have all of those stressors in one family. It’s why we have focused on the full set of circumstances that ultimately affect maternal health. Our services have included home visits by culturally humble providers. This helps build trust with women who are hesitant to seek care because of past negative interactions with the healthcare system. We are also proponents of telemedicine which has been lifesaving for women on bedrest who can’t visit their providers in person.

You clearly found a way to address needs that are unmet in a traditional healthcare setting. Thanks to your leadership, Mary’s Center has grown from initially serving 200 patients in a basement, to now serving 60,000 patients per year at five clinics and two senior wellness centers. How did your guiding principles help Mary’s Center evolve and expand services?

The work I’ve led has been grounded in the perspective that treating physical health in isolation from individual, family, and community contexts falls short. We listen to the community. The healthcare, social services, and education we provide address the challenges our patients face.

Maria Gomez discusses Mary’s Center school-based mental health program which aims to support students, their families and educators.

For example, we recognize the importance of multi-generational education. My mother didn’t know how to get an ID, what to do if I missed the school bus, how to use a bank, or how to negotiate with the landlord when she fell behind on rent. She didn’t learn conversational English, which made it difficult to navigate these daily needs and move up the economic ladder.

We started a teen program because many young people have no idea how to enter careers that are different from their parents, who may be cleaners or construction workers. Those are good, honest jobs, but we also want teens to understand how they can apply for college and pursue careers that offer opportunities to advance and pay a liveable wage.

For our elderly population, we understood how damaging loneliness and isolation can be. So we aimed to keep them engaged and socializing through in-home social support by peer volunteers, as well as nutrition and health education through our senior wellness centers.

How have you developed trust and relationships with patients during your career? 

Building trust begins with hiring staff who resemble the community they serve. That trust is further strengthened by being open to humbly listening and learning about their cultures. We must understand who our patients are beyond their physical state and the burdens they carry that can affect overall well-being.

For instance, years ago, one of our patients disclosed that she appreciated her provider. But she wished the provider would have asked about her native Ethiopia, which she could not stop thinking about since her people there were suffering due to famine. Her words hit me hard. It drove home just how important it is for providers to be aware of how trauma and stress are affecting a patient’s mental health.

It’s also why we have trained our staff around trauma-informed care. We acknowledge that many people have faced trauma, even our providers. That trauma in turn influences how a provider responds to patients. Acknowledging past trauma and understanding related triggers ultimately influences how providers treat their patient’s trauma and brings compassion and sensitivity to care.  

To build trust, we also seek those who truly embrace our mission when hiring staff. We make sure they understand our model of integrated health, education, and social services and recognize that the more interaction patients have within our own system, the better their outcomes. We mentor and encourage our team to be mission-driven in their work. Unfortunately, this is not an activity reimbursed by payers. There’s still not an understanding of the direct correlation that employees who embrace the mission of their workplace deliver better and more empathetic care.

Maria Gomez is a recipient of the RWJF Award for Health Equity. Learn more about how winners like her are implementing systems-level solutions to advance health equity and transform lives within in their own communities.

 

About the Author

Najaf Ahmad

Najaf Ahmad is managing editor of the Culture of Health Blog where she highlights perspectives about how the Foundation is advancing health equity in communities across the nation.