Ten years ago, while conducting street outreach to homeless individuals living in Boston, Kara Cohen witnessed firsthand the impact of poor podiatric health on this highly vulnerable population.
“Poor foot health impacted both the physical and emotional well-being of my clients,” Cohen says. “I met clients with severe trench foot, bleeding feet, and those who had not changed their socks in a month.”
Cohen also met James (Jim) O’Connell, MD—founder and president of Boston Health Care for the Homeless Program (and the recipient of our 2012 Schweitzer Prize for Humanitarianism).
“Jim made me believe that my opinion and efforts mattered, and helped show me how no individual action is too small to make a difference,” Cohen says. “In a way, he taught me about the philosophies of Albert Schweitzer before I even knew who Albert Schweitzer was.”
As O’Connell mentioned in his talk at last Saturday’s Schweitzer Leadership Conference, he provided no clinical care in his first two months working with homeless individuals 27 years ago. Instead, he simply connected with these individuals by soaking and washing their feet—building trust and relationships that would ultimately facilitate conversations about health and health care.
Today, Cohen—a University of Pennsylvania School of Nursing student—is doing the same. As a Schweitzer Fellow, Cohen has partnered with the Sunday Breakfast Rescue Mission in Center City, Philadelphia to launch Best Foot Forward—a volunteer-run foot clinic that addresses the podiatric needs of homeless individuals.
ASF: Why did you decide to develop your particular project?
KC: “Best Foot Forward” was inspired both by my previous work with the unsheltered homeless population in Boston and my current position as a home health care nurse in Philadelphia.
In addition to the obvious health consequences of poor podiatric health, there is an emotional and mental health toll as well. A foot soak may seem simple, but it is a restorative act. For individuals who may walk three miles a day in rain or shine, having the opportunity to thoroughly clean their feet and put on clean socks is a fresh start.
The foot clinic also offers a non-threatening avenue to engage people who may normally be reluctant to accept services, and it provides a relaxed atmosphere and safe space to discuss other health care needs and relevant services. This project intersects my passion for helping people experiencing homelessness with the holistic values of nursing.
ASF: What do you hope will be the lasting impact of your project on the community it serves?
KC: Homeless individuals are often an “invisible” population that is pushed to the margins in our society. Even the word homeless as an identifier can carry a grand stigma. My hope for this project’s impact is two-fold. First, I hope this project will succeed in engaging a reticent population and empower individuals experiencing homelessness to take an active interest in their health. Second, I would like to stimulate awareness among the Philadelphia community as to the health disparities that homeless men and women often experience.
ASF: What do you think is the most pressing health-related issue of our time, and how do you think it should be addressed?
KC: I believe the most pressing health-related issue of our time is the lack of patient health literacy. As the health care industry continues to develop and roll out new medications, technologies, and procedures, we will not see the maximal effectiveness of these advancements if patients do not fully understand correct utilization, learn the risks and benefits, and recognize the impact on their health.
As a home health care nurse, I am continually confronted by patients who may be taking upwards of ten medications and don’t know the names of their medicines, their possible side effects and interactions, or even why they are prescribed. According to the American Medical Association, health literacy is an issue that affects all ages, races, economic, and educational levels. Poor health literacy is associated with negative health and safety outcomes, and poses a financial burden to the health system due to additional unanticipated health care costs.
As health care providers, it is essential that we engage and empower our patients to take an active role in their health. This can be addressed by streamlining written materials to making them more accessible to a wider audience, by making an effort to cut down on the use of medical jargon, using the teachback method to ensure patient understanding of new or complicated instructions, and encouraging patient feedback and questions.
ASF: What has been the most surprising element of your experience as a Schweitzer Fellow so far?
KC: What has surprised me the most so far about my Schweitzer Fellowship experience is how much this project has been embraced by such a wide variety of people. I have received incredible support from the staff at my project site, Sunday Breakfast Rescue Mission; my managers and coworkers at my employer, Penn Care at Home; my academic mentor at the U Penn School of Nursing; and from my amazing colleagues, friends, family, and other Schweitzer Fellows.
Furthermore, the volunteer participation has truly exceeded my expectations. We could in theory just fill bins up with soap and water, put them on the ground, set someone up for a foot soak and walk away. But when the volunteers sit down with the clients, listen to them, provide targeted education, or just hear their stories—this is the soul of the project and what I had originally envisioned. It is the care part of health care, and this is why I wanted to become a nurse in the first place. I feel incredibly fortunate to know so many fantastic people who are not only willing to come and volunteer, but to also bring such skill and compassion.
ASF: What does being a Schweitzer Fellow (and ultimately a Schweitzer Fellow for Life) mean to you?
KC: The Albert Schweitzer Fellowship is more than a service project with a finite beginning and end. It symbolizes the integration and demonstration of service in our lives every day. Having this amazing opportunity to design and implement a project that I am truly passionate about has been both challenging and rejuvenating for me.
I consider myself so fortunate to be part of the outstanding group of Greater Philadelphia Schweitzer Fellows. I look forward to the monthly meetings every month, where I am continually awed and inspired by the commitment of the Fellows to addressing health disparities.
About 12 years ago, when I was an Americorps volunteer, I remember one of my colleagues saying, “It’s great to be in a room of people who think big.” Every month at our meetings, as we go around the room and discuss our project updates, I am reminded of the truth in that statement. To quote Albert Schweitzer, “With a little reason and much heart, one can change many things, or move mountains.”
Click here to learn more about the Greater Philadelphia Schweitzer Fellows Program and our work to create change and improve health in vulnerable communities. We are supported entirely by charitable donations and grants.