Taking steps to live healthier is never easy. But UNC School of Medicine Schweitzer Fellows Amanda Gambill and Margo Pray are using the power of community to help diabetic patients manage their disease at Mountain Area Health Education Center’s Cane Creek Practice in the small town of Fletcher and at Celo Health Center in Burnsville.
Project GUIDE (Group visits for the Underserved Improving Diabetes Education), takes a holistic approach to managing a disease that is very affected by a patient’s lifestyle choices and other aspects of their physical and mental health, teaching patients to control their diabetes through exercise, nutrition, and weight loss. But the real secret to Gambill’s and Pray’s success is peer support, which is particularly effective in this tight-knit, rural enclave.
“We wanted to use the community support that is a strength of this community—and rural communities generally—to inspire patients to get involved in their own care,” says Pray, who does the group visits at Cane Creek Practice.
“People come together and lean on one another during difficult times in these communities so it only made sense to use that community spirit for healing of chronic diseases,” adds Gambill, who does visits at Celo Health Center.
An example of this spirit at work is the two patients—one male, one female—in Pray’s group who joined with A1c blood sugar tests that topped an alarming nine percent (the normal range is between four and 5.6 percent). They became friends through the group, supporting each other’s efforts to bring their A1c’s down. Five months into the program, the male patient’s A1c was down to 6.4 percent. “He was off his insulin, and he was so excited,” Pray recalls. His friend, fearing she wasn’t doing as well, asked Pray not to read her test results out loud, so Pray whispered in her ear: she was down to 7.4. The woman was ecstatic. She and her friend high-fived as she shared the result with the group. As the session concluded, the woman vowed, “If he can get his A1c down to 6.4, then so can I. I’ll see you next month!”
“Only a relationship with peers can motivate patients in that way,” Pray says. “A physician lecturing them to lose weight and eat healthy isn’t as effective.”
The bonds patients form during group visits remain even outside of the group, says Gambill, thus reinforcing what patients learn in the visits. “Whether it’s finding a new exercise buddy, making a healthy dinner together, or just seeing a smiling face at the grocery store, patients know they’re no longer alone in the battle against their chronic disease,” she says. (For more insight into just how tight-knit Fletcher is—and how that affects the delivery of healthcare at Cane Creek Practice, check out our post on Fellow for Life Dr. Benjamin Gilmer, who practices there and with whom Pray works on the project.)
The program also empowers providers. “The group visits at Celo have helped change my perspective of medicine,” explains Pray. “I have learned that the art of medicine is not just helping the sick by sitting on a stool and writing a prescription; rather, it is helping those in need by reaching out, taking moments to understand one’s journey more fully. The group visits help providers understand the chronic disease journey in a way 15 min appointments could never allow. I am thankful for the insight, keeping in mind always that the more I understand an individual, the more I can help.”
Plans to sustain Project GUIDE beyond their Fellowship year are already taking shape, say Pray and Gambill. At Celo Health Clinic, the visits are in such demand by patients that our mentor, Dr. Dorothy DeGuzman, is supporting the start two new cycles of group visits—one for diabetic patients and one for those dealing with chronic back pain. Two UNC medical students, Brad Thompson and Lauren Cox, were awarded a 2016-17 Schweitzer Fellowship to sustain and expand the program to Swain County. Plus, UNC medical student Jose Delgado-Robles was awarded a Schweitzer Fellowship to reach the Latino community by providing Project GUIDE in Spanish.
Pray says that the experience of developing, implementing, and evaluating a community service project was invaluable. “The Fellowship teaches us to think through how to measure success, make improvements, adjust to obstacles, and meet the needs of the population you are serving,” she says. “As a future physician, these skills will help me to reach whatever population I am working with. And the connections to other Schweitzer Fellows and to a network of creative ideas, individuals, and projects to continue to inspire us to address the social determinants of health that can’t be fixed with a simple office visit.”
For Gambill, the Fellowship showed her the importance of inter-professional teamwork. “Hosting projects alongside fellow medical students and dental students and incorporating pharmacists, nutritionists, counselors, and so many other providers into our projects teaches us how to work together for the good of our patients,” she says.