Using Systems Thinking

“Injustice anywhere is a threat to justice everywhere” Martin Luther King, Jr.

This quote is about a system with bias. A system that can be uneven and unjust. This quote brings to light the fragility of justice and how important it is to work towards justice in all that we do.  So what to do? Where to start?

I have had the experience of working as a summer intern in Miami, Florida at Florida International University, Herbert Wertheim College of Medicine’s Green Family Foundation NeighborhoodHELP Program. This innovative medical school curriculum is changing the “system” of medical education and changing the “system” of delivering medical care, This Program focus not on the clinical diagnosis but focuses on the social determinants of health (SDOH) or barriers to health that create or perpetuate the disease process and cause our society not to deliver quality health care but to only manage the health care crisis.

NeighborhoodHELP challenges students to address complex real-world behavioral, environmental, ethical, medical, legal, and social issues through a household-centered approach in which teams visit medically underserved households in Miami-Dade County, Florida.6 Household members receive services in exchange for helping to educate students. The core team includes students from medicine, nursing, social work, and physician assistant studies; their faculty; and community outreach workers. Teams assess SDOHs related to their health; SDOH include health access, financial, environmental, educational, transportation, food and behavioral issues to name a few.

As an intern, I was a member of the Outreach team whose role was to recruit households, facilitate communication between households and student teams, and most importantly broker services through an extended network of community partners. This academic-community network infrastructure empowers students and faculty to identify and address SDOHs that affect households, to facilitate access to community resources, and to engage in policy analysis and advocacy. The work in the community was to build trust and relationships with community partners and household members; finding commonality instead of focusing on each other’s differences. Cultural diversity, immigration concerns and social justice due to SDOH was being addressed constantly.

I visited homes where households were undocumented, uninsured and very afraid. As part of the Outreach team, I was able to offer these households not only access to free medical care and supportive services (free bus vouchers, food pantry options, behavioral services and child care options) but more importantly hope and trust; hope in knowing that they were not alone and trust that they were being taken care of without bias. I was able to connect with the attorney that works with the Program and assist with filing for permanent residency. I felt the advocacy I was able to offer through this Program was a change in the health care system as we know it. This change in the health system is one that is needed. This household member although he had clinical diagnosis of diabetes and high blood pressure, his primary concern was for food for his family, transportation and child care concerns and it wasn’t until these SDOH concerns were addressed that he was able to focus on his own health concerns. We attended health fairs and I was able to make smoothies demonstrating healthy foods that are tasty and affordable.

The experience I gained in this program, bringing system and policy changes to communities in need made me realize I was part of a change agent system making a difference one household at a time