Earlier this month, the American Medical News reported that “85% of primary care physicians and pediatricians say their patients have health concerns caused by unmet social needs” — but only 20% of physicians feel equipped to address those needs.
That gap is a big part of the reason that The Albert Schweitzer Fellowship (ASF) is so passionate about developing health professionals who have the skills and confidence to address not only clinical health issues, but also the social determinants of health (like poverty, the environment, and education).
And that gap is exactly what University of Texas Medical Branch student David Darrow faced as he helped to run St. Vincent’s Student Clinic in Galveston, Texas.
“Since Hurricane Ike in 2008, we’ve seen see an exorbitant number of diabetic patients,” Darrow says. “I found myself growing increasingly frustrated as I watched my patients suffer enormously—we’d struggle for months to normalize blood sugar, but most of the time the root of the issue remained hidden behind layers of social barriers.”
So Darrow took action to break down those social barriers—through community gardening. With the support of the Houston-Galveston Schweitzer Fellows Program and other friends and allies in the Galveston community, Darrow has established two gardens in Galveston’s low-income neighborhoods that will serve as the lynchpin of an interactive, culturally competent curriculum and training program on nutrition and health behaviors—and that will, he hopes, ultimately reverberate back to the examination rooms at St. Vincent’s Clinic.
Why did you decide to develop your particular project?
In 2008, three weeks into my first year of medical school, Hurricane Ike struck and our world was turned upside-down. We have been adapting and struggling to keep pace with the community’s rapidly changing needs ever since.
As a provider [at St. Vincent’s Clinic], you want to be encouraging about maintaining a healthy diet and reducing total caloric intake—but many Galveston families find themselves struggling as they deal with the wake of a natural disaster, large-scale layoffs, and a depressed job market. Trying to lose weight moves to the bottom of the priority list when a person is worrying about how to pay the bills in the coming months.
And even if providers can get their patients excited about improving their diets, the social barriers are often too unforgiving. In Galveston, a majority of low-income neighborhoods are food deserts. All of the local grocery stores are miles away, and local corner stores full of non-perishable foods dominate the marketplace for most of my patients. Since many of them have no transportation, obtaining fresh fruits or vegetables requires a taxi service or reliance on a limited public transportation system.
With Galveston still recovering from the hurricane, I really wanted to bring both gardening and a health curriculum to the population that I serve at the St. Vincent’s free clinic. I wanted to start chipping away at that history of nutritional oppression by helping to support local gardeners to erect teaching gardens, where neighbors could come discover the joys of raised bed gardening, while taking advantage of a culturally-sensitive curriculum created to inspire dialogue. Most importantly, I wanted to create a space where people could grow, learn, heal, eat, and commune with nature and each other.
Gardens can provide everything necessary for maintaining good health. Exercise is simply a requirement of community gardens, including everything from construction and maintenance to turning compost. Each morning when you head out to water, you either find yourself alone in the midst of the beautiful life cycle of different species of plants or taking advantage of a wonderful opportunity to communicate with neighbors that you never “had time” to get to know in the past. I have found that gardening crosses all political and social lines. The simple fact is that everyone looks the same covered in dirt. The inherent complexity of gardens fills all of the awkward pauses and unites everyone in awe.
In a garden, you are surrounded by food, but it is fresh, delicious, healthy food that offers many opportunities to address issues like proper fiber intake, caloric density, or even vitamin D absorption from being outdoors. From nutrition, it is just a short hop to health goals, a skip to tying in cultural roots, and a jump to community-building.
What do you hope will be the lasting impact of your project on the community it serves?
I have lofty goals for my project, but I am realistic enough to understand that there are roadblocks around every corner. I am fortunate to have a great set of mentors and the support of key people in the community. In the long run, I am hoping to have two community gardens set up in the most economically disadvantaged sections of Galveston. At this point, both of them are approximately half-complete, one with 21 of 43 4×8 beds, and the other much smaller garden with about 8 of 11 beds finished.
Once both gardens are complete, planted, and being run by community members, I will begin a joint effort to bring together experts and community members to talk about health concerns and goals through a series of workshops. It is important to address the issues that the community is most worried about. There is a great deal of evidence demonstrating how health behaviors directly affect long and short term health outcomes, but if there is no passion coming from within the community, then generating interest must be the first step.
This project is a small piece of what should eventually be a large-scale, locally supported, national movement. Imagine what could be achieved if neighborhoods shared a common goal of eating healthy, locally grown foods, and the more fortunate members of the community provided the necessary but minimal capital required to create gardens and resources which the entire community could enjoy! For community members tormented by oppression and struggling in the present economy, a community garden can act as a life-preserver for health, pulling people away from the comfort and distraction of televisions with enough engagement and a proper foundation to address long-term goals.
What do you think is the most pressing health-related issue of our time, and how do you think it should be addressed?
Our diet and popular behaviors surrounding eating. Portion control and calorie counting are still the gold standard for bringing a conscious desire to lose weight into reality. But unfortunately, weight loss has become a big business and everyone is looking for the ultimate panacea. It is easy to lose sight of the one essential thing that is missing. In a world of abundance, a conscientious approach combined with a supportive social environment is paramount. Obesity and our social-cultural condition have become recursively intertwined, and when one looks at the trajectory of medicine, it appears that many people are looking to clinical research in addiction and psychiatry as hopeful end-game solutions. The facts have remained the same, however. I believe that obesity is the result of abundance, most of which we have subsidized into existence, and it is more important now than ever before to come together as communities to create activities that support a healthy lifestyle.
What has been the most surprising element of your experience as a Schweitzer Fellow?
As a Schweitzer Fellow, I have been most surprised by the cyclical nature of my experience. There can be periods of time where nothing seems to be going right, followed by long periods when multiple opportunities line up to make your project work. It is a great feeling when the planning finally pays off in the end, somehow leveraging each success to garner another. Finding community resources and juggling a budget while coordinating large groups of volunteers and trying to focus on the real people in the community can become overwhelming fast, but it is worth it when I get to see one of my major goals come to fruition.
What does being a Schweitzer Fellow (and, ultimately, Fellow for Life) mean to you?
Once I heard about the program, becoming a Schweitzer Fellow meant a life long journey of prioritizing serving others outside of the clinic. I firmly believe that if you want to serve others, then the optimal time to start is during school. While the thought of sometimes having to choose between school and one’s ultimate ambitions to serve can be daunting, it is much more difficult to make service a priority once your professional life unfolds.
I had to apply to the Fellowship twice in order to be accepted, and I was and am incredibly happy to have the privilege to participate while I am still in medical school. Simply preparing my application took me down a rewarding path of meeting people who have become an essential part of my life. I have learned so much since I began that process, and I look forward to the day when I can serve as that crucial link for another ambitious student looking to change the world. I was so lucky to find mentors who were not cynical but emphatically optimistic. Empowering others is a skill that is a priceless quality, and I hope to both learn it and pass it on to future generations.
David Darrow is a Houston-Galveston Schweitzer Fellow. Click here to read more about The Albert Schweitzer Fellowship (ASF)’s Houston-Galveston Schweitzer Fellows Program and the Fellows like Darrow it supports in creating and carrying out yearlong direct service projects that improve the health and well-being of vulnerable people and communities. To make a gift to in honor of Darrow, click here.
Each week, Beyond Boulders delivers a new installment of “Five Questions for a Fellow” – an interview series with Schweitzer Fellows across the country and in Gabon, Africa who are leading the movement to eliminate health disparities. For an archive of previous “Five Questions for a Fellow” interviews, click here.