Christine O’Dea, MD MPH FAAFP
Robert and Myfanwy Smith Chair of Family Medicine
Associate Chair, Department of Family and Community Medicine
Co-Course Director, Medical Spanish/Latino Health Elective
Division of Urban, Underserved and Global Health
Department of Family and Community Medicine
University of Cincinnati College of Medicine
Learning objectives
- Describe three guiding principles of a successful community partnership
2. Identify tools you can utilize to support the success of the partnership
3. Identify ethical issues that may present potential community clinical-community and academic-community partnerships
Please read / view the above readings and then respond to one or both prompts below. As a group, use the page to respond to each other’s posts (at least one response to another student).
Accidentally posted as reply, will repost as comment.
The region I work with is predominantly rural and is served by a single critical access hospital located on the northern edge of the county. Although several hospitals in neighboring counties also provide care for residents, each is located approximately 20 miles beyond the county line in different directions, creating geographic barriers to access. The county is supported by a robust EMS system that plays a pivotal role in healthcare delivery and has recently launched a Mobile Integrated Health (MIH) program. Despite these strengths, the EMS system faces challenges including limited sustainable funding, low community visibility, and a lack of formal collaboration with regional hospitals.
# Power Imbalances# Balancing Advocacy and Neutrality# Managing Conflicts of InterestThere is longstanding friction between the community, EMS providers, and regional hospitals that stems from historical relationships and fragmented healthcare delivery. While all stakeholders share the goal of improving community health, meaningful collaboration has been limited. The region continues to experience shortages in primary care, and many vulnerable residents lack access to essential social determinants of health, including transportation, food security, and preventive services.
Hospital-led initiatives are often developed without meaningful participation from EMS providers and often don’t include a section of the population who is unable to access healthcare at hospitals. Beyond emergency response, through its Mobile Integrated Health program, EMS has begun supporting chronic disease management and connecting patients with community resources in addition to responding to emergencies. My dual role as a prehospital provider who also works closely with regional hospitals places me in a unique position to facilitate collaboration between these groups. At the same time, it requires carefully balancing advocacy for the EMS perspective while maintaining neutrality and navigating differing organizational priorities and potential conflicts of interest.
# Cultural Humility# Respecting Community AutonomyWorking in a rural community whose social, political, and cultural values often differ from my own requires intentional cultural humility. Rather than approaching the community with preconceived solutions, I have learned the importance of listening first and understanding residents’ perspectives, priorities, and lived experiences. Respecting community autonomy means recognizing that effective interventions must be shaped by the community’s own values and goals rather than solely by healthcare professionals’ assumptions. By approaching conversations with openness and curiosity, I have found it easier to build trust, foster meaningful dialogue, and better understand the community’s needs before attempting to address them.
This is a really interesting perspective! As someone who is increasingly interested in EMS, I often wonder what the role of a pre-hospital physician is/can be. I wonder if this rural access issue is the perfect place to have more advanced providers in the pre-hospital setting. Yet, obviously, that doesn’t solve the issue at hand when it comes to facing social determinants of health. I am really interested/excited to hear about how this project goes and what you’re able to do for this population!
Really insightful post. I’m curious about some of those hospital-led initiatives that were developed without EMS protocol, and why the hospital didn’t include EMS, especially given the seemingly profound role the EMS company plays in the area. Wondering how much of those decisions rest on optimizing the bottom line vs. improving pt care.
Agree wholeheartedly with the sentiment on listening first. I think more silence from our end as providers initially can do a lot to help patients, especially more vulnerable patients, feel heard. That was one thing I had to learn to do as someone who really likes to yap. Giving people a voice by simply listening does a lot to build trust and rapport.
Before medical school, I was in the Jesuit Volunteer Corps working at a wraparound social services agency in inner-city Detroit. I was proud of the support our office provided the community, but I remember thinking that there three areas of immense need that our office could support very little: rent and utility assistance, and case management. We have a well-stocked food pantry, a clothing closet that rivaled most TJ Maxx and Marshalls, a pretty good soup kitchen. Working the front desk and connecting guests with services, I found that many people needed food and clothing, IN ADDITION to housing, case management, or help paying a Detroit Edison bill. I was always flummoxed why we didn’t have more funding for such support when I saw the need for it every day. Looking back, it made me question who was involved in conversations when setting up an organization here. I think our agency did a lot of good, and I think including community members in the development discussion and in the funding proposals could have made an even bigger impact.
One of the things that stood out to me in the first article was how researched communities grow tired of transient volunteers, researchers, workers, etc. It must be exhausting to tell the same story over and over to different groups coming through. I can’t image how disheartening it is to finally find one of those visitors to trust, only to have them leave at work’s end. Trusting relationships take time to build. Familiarity and this idea of accompaniment are longitudinal. This has been on my mind a ton as I have worked with the street med team. I am absolutely. a visitor, asking complete strangers in even more vulnerable positions to share their lives intimate details with me. I am not sure if this is much different from taking care of an unhoused person in an emergency room or PCP clinic, but it feels different for sure, especially when visiting folks at their camps, a much more intimate space.
I liked how at the end of the first article there was an emphasis on sharing the “un-academic” results of work with relevant stakeholders/the community at large. I think I will consider this further as I progress through my project.
I appreciate your reflection about your time with the street med team. I tend to agree with your assessment on the nature of building trusting relationships, especially within communities that might have reasons for distrusting medical professionals. I also need to keep this thought in mind as I continue working with the community garden in Walnut Hills.
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I think this is a really interesting question and one I’ve been wrestling with as I work with my community partner. When we talk about advocacy, the most important thing is interacting with the community we hope to serve. Working with people who use intravenous drugs and having open conversations about how to serve them can be challenging, especially from the stand point of getting objective data. I want to be able to get data to support them but also don’t want them to feel like their privacy is being violated or like I’m only in it for the research.
We also really struggle with follow-up. Community members are meant to come and go depending on how much they need from the organization so if I were to implement an intervention, it would be super difficult to keep the same group of people/cohort around for long enough to complete a follow-up survey or something of the sort.
In the spirit of transparency, the other struggle, which is admittedly more my problem than a community problem, is that there might not be a place for the emergency room to work with a community partner. In my mind, I thought “how awesome would it be for there to be a connection for EM docs can take care of people beyond their toxidromes?” and ultimately, when speaking with ED docs and the community partner, it almost seems like the more disconnected they are the better. If community members don’t need the ED, that’s a largely good thing. If community members wouldn’t be receptive to ED folks coming out to meet them, what would the value be of trying to create a bridge between the two? Certainly highlights the importance of asking the community what THEY need vs. telling them what would be good.
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I think ultimately, if I recognize that I might not get data, and just approach the community without ulterior motives, I think I’ll be able to have more honest conversations. I also think building relationships first will help a lot.
In terms of follow-up, I am hoping to reach out to some authors of successful publications with this population. I wonder what methods they used to get good data, whether subjective or objective. I think it will be a good first step at least. I also think just leveling with the community and above all being humble in the space will really help. I don’t want this to be a token project for me, I want for it to make a genuine lasting impact.
If anyone has any ideas or has run into similar concerns, how did you workshop it? I’m all ears!
Laura, I agree with you about feeling some of the struggles of an effective community partnership. I agree that follow-up is especially difficult for us with our partners. We have this prescribed time to attempt a highly specific goal, and it is difficult to both integrate into a community beforehand and fully realize the impact of the projects we complete. Also, it is hard not to feel like we have an ulterior motive with our work. I feel like as long as we proceed with our projects with sincere hopes to positively improve our community partners, good will be done regardless of how large the impact may seem. We’re constrained by time and other things, but we will either make changes or open others to improve on what we’ve done later.
When working with BLOC Ministries Hispanic and Latino Outreach Ministry both as a volunteer and as an intern through Urban Health Project, there were several instances where ethical challenges arose. First, I was challenged by the Director not to view my position as a volunteer and an intern as someone who was “just helping” the students in the after school program or families in the food bank. He asked me to learn something from them and about them as opposed to feeling good about doing something for them. When working with other community partners, I often heard prideful remarks about how many people were served this month or how many boxes of food were given away. These are good things, to be sure, but they aren’t ends in themselves. Feeling good about serving others is natural – it likely inspires many of us to pursue medicine. However, we should also consider how the people being served feel. Do they want us to keep giving them boxes of food week after week with the same smile on our face? Or do they want us to help them improve their lives by helping them find work or learn a new skill?
If we stay in the “feeling good about helping others” mode, it can quickly create a savior complex, which ultimately undermines the work you feel so good about. It’s the old adage of giving someone a fish versus teaching them to fish. One satisfies an immediate need, which is often necessary at first. The second involves building a relationship with someone long enough that their future might change for the better, thereby empowering them to help themselves and others.
It’s been said by others, but to overcome the challenge of relating to communities in a beneficial way, we must ask them what they want and need before we even offer a solution. If we don’t know what drives a community, what their values are, and what outcomes they want to see, then we can’t ensure that we’re offering a sustainable solution. We can’t walk into a community and tell them what their problems are, we need to hear it from them.
I agree with what was said about the savior complex, and this is seen in a lot of volunteering. For example, when people travel abroad to developing countries for medical care, etc., and leave suddenly. This can notoriously create an environment in which volunteers develop a “savior complex.” Especially if the people they are serving are in dire need, it is great to challenge this complex and recognize that it is a problem.
This complex also creates an environment where the community members’ opinion is not valued when it comes to their care. If someone believes they are a “savior” or above the ones they are helping, it is easy to dismiss their input and believe they always know what’s best for the patient or community, even if they are not a part of it. This ties into what you mentioned: you need to ask the community and pay attention to what they say before offering a solution.
I like the idea that instead of focusing on things like the number of people an organization interacted with or boxes of food that were donated, we should instead thing about the actual people. The goal really shouldn’t be to increase the amount of donations that are given, though of course this is not inherently a bad thing, but rather to decrease the amount of people in need. The end goal for a charitable organization should ideally be to eventually become obsolete. That’s not to say there isn’t a need for some more immediate, short-term solutions. Systemic changes take time and people still need a roof over their heads and food on the table, so there is always a difficult balance between trying to meet immediate needs and working towards a sustainable future. I think something as simple as having an open line of communication with the community you are trying to help makes all the difference. Instead of imposing what we think they might need, we can just ask how they think we could be the most useful and go from there.
How we can best address challenges to create healthy and equitable partnerships with communities includes working collaboratively with the community in order to address their specific concerns and best help them. It is important to involve the community in interventions to best serve them. The article about pediatricians contributing to poverty through clinical-community partnerships also highlights making sure to identify and collaborate with minority communities, which may often get overlooked or whose input is ignored, which will also address equity concerns. Through engaging with the community, partners will be able to identify the most pressing social determinants of health or needs that should be prioritized. In addition, interventions can be co-designed with community members to better tailor interventions to that specific community. These strategies help ensure that resources are not being wasted or used inappropriately because they are being directed towards what the community actually needs, build trust, and promote health equity.
Hi Mariama!
I agree that meaningful community engagement is the key for equitable partnerships. Your point about involving community members throughout the planning and implementation process is especially important because it helps ensure interventions are meaningful, relevant, and sustainable.
I also liked your emphasis on intentionally collaborating with minority communities! Their perspectives are underrepresented despite experiencing many of the greatest health disparities and having the least number of resources to advocate for themselves.
Mariama, I completely agree with you! It is critical that interventions be based on a collaborative approach with the community. This collaboration should amplify the voices of community members who have the most insight into the needs and challenges of their community. This is how we implement changes that actually provide benefit for a real problem the community is facing. You mention this as a way to ensure resources aren’t wasted which is true as well. I think this goes for both sides – not wasting resources on projects/changes that won’t actually address community needs, as well as not wasting community resources including time and energy to engage in a partnership if the intervention won’t ultimately provide them a useful benefit.
One of the articles we read discussed community-based research and asked this question, “How can we ensure that research is capacity-building, and not just taking of community members’ energy and resources?” We can ask the same question regarding project implementation vs research. We need to be sure that our work is designed to add more benefit than burden to our community partners.
The first ethical challenge I can think of is checking your own privilege and motivations for volunteering in certain communities. An example I can think of is during high school students dropping a couple bands traveling to South America to help the communities there only to build a dank shed or two. The funds for travel would be better utilized by directly investing in those communities and the resources being used by locals who know what their needs are. There is nothing fundamentally wrong with undertaking travel to helping out impoverished communities, but acknowledging it is for self-experience as much as service is important.
I believe knowing the community in and out and finding solutions that will have the best cost to benefit ratio takes time and immersion. This is a huge challenge especially as an outsider to both the area, cultural background, and socioeconomic status of the community members. Forming relationships from those in the community and vital and letting them lead discussions about ways to help and then using your talents and connections to make those tasks happen is what makes for great partnerships.
Anish, I think you raise a great underlying theme of the differences between communities providing and seeking aid and the ethical challenges, differences and barriers that this phenomenon can create. I absolutely agree that giving the control of communities to the members of the community fulfills a greater purpose than an outsider providing a sort of aid they think is helpful.
A big ethical challenge that has always stood out to me when it comes to volunteer work/community service, is that sometimes it can become more about the volunteers themselves rather than the people they are meant to serve. This can be illustrated in various mission trips where Americans travel to various countries to do some type of service work there. These can be positive, meaningful experiences for all parties if done the correct way, but they also come with the risk of leaning into this idea of being a “savior”. A good way to address this is recognizing that, with the right resources and opportunities, many communities are capable of bettering themselves. The focus should become re-allocating money and resources to areas that are lacking. This also addresses the issue of the lack of permanence when it comes to volunteer work. Even when the people move on after their required hours, the resources stay for the community to reap their benefits.
This is a really good point and makes me think of how social media has had an affect on meaningful volunteering as well, particularly regarding mission trips. On one end of the spectrum, it’s helpful to share the experience in hopes of motivating others to volunteer as well. On the other hand, it can be seen as performative and something that people do to receive praise from their peers as well as intrinsic motivations. While it’s impossible to dictate people’s motivations for doing good, you make a great point that viewing these communities in a different light may help with the “savior” aspect of this work.
I agree that sometimes community service can seem like a way to make the volunteers look or feel better about themselves. I have heard the term “voluntourism” used to describe vacations disguised as service trips, and it definitely seems like if all the money spent on plane tickets, food, and accommodations had just been sent to the community, it would have done a lot more good. I wonder if an issue with this approach might be that people are likely to be less interested in supporting people/causes they don’t feel connected to; visiting and actually meeting the people might be a big motivating factor to get involved in the first place.
While reading through the first article, I felt struck by the idea of “drive-by” research and how I have seen that in community partnerships and research projects, specifically with those involving students. It happens particularly often where a project, research, or service initiative will be started and run before being promptly dropped once students matriculate through the program. The community partner is left with whatever was completed at the time without input or revision. It does not seem fair for the partners to be the subject of the project and an object to be altered or assessed. On the other hand, students are limited in their ability to thoroughly engage in and affect a community. They are limited by both time and the scope of a reasonable project. Becoming fully engaged with a community takes time and effort, so that the community partner can be heard, understood, and have input into the project. They must also use time to build trust with the community partner, which better engages them and leads to longer lasting impact. Students and student projects, in essence, are only there for so much time.
To avoid performing “drive-by” community partnership projects, certain things must be done. First, there must be longitudinal figureheads to maintain long-term relationships with the community partners. They can serve as facilitators of projects as they’re familiar with the community members and the wants and needs of the community. It also helps to create a period for the temporary student participants to be with the community, whether through volunteering or just meeting community members. This helps integrate the students to a certain extent, at least to build their understanding of the community and allow the community partners to be with the eventual project runners. Also, to make sure projects reach the community partner, there must be active discussion during the creation of the initiative and after results have been started. There has to be collaboration and integration with the community members. This way, the project is not done without the advice of the people it is meant to impact most.
For my project, I hope to use my existing relationship and leadership within my community partner as a way to build my rapport and create a lasting impact on others.
1) The first ethical challenge I think of is the concept of “checking off a box”. As medical students, we are no strangers to activities and involvements that “boost” our application, and one of those activities is meaningful volunteer experience. Especially during high school and undergrad, I recognized many peers (and even myself at times) participating in volunteer experiences simply to check off a box. When we get involved with experiences solely for this purpose without an underlying passion for the work or desire to help others, the help we provide can fall flat. While it can be argued that “any help is good help”, I believe that volunteers should be truly passionate about the community or partnership they’re serving, especially if it is patient/community-facing, as this has a downstream effect on the people themselves.
2) While there is no hour requirement for volunteer experiences when applying to medical school, this unwritten requirement may pressure students into participating in as many volunteer experiences that they can without being truly passionate about the work, and subsequently giving partial effort to the community partner. This in turn hurts the recipients of that volunteer work. This is a difficult conversation, because I think if we removed volunteer requirements along various stages of education, we may see less volunteering as a whole, which is not the goal. On the other side of the argument, we would probably see higher quality volunteering for those who are truly passionate and not seeking it out to check off a box. It is truly an argument of quality versus quantity, and I can definitely see how either end of the spectrum can have its benefits. One thing during M1 that I really appreciated was matching us to LCs based on our individuals interests. This allowed us to volunteer for community partners that we connected with and ultimately, I believe, created higher quality volunteering. I think any hour requirement that offers this tailored experience could be helpful to provide better outcomes for community partners in terms of the quality of volunteer work they receive.
Hi Micaiah, I totally agree with your point about moving beyond “any help is good help” and making sure volunteers are truly passionate about the community and partnership. I wrote something similar in my post about how I have noticed a power imbalance between volunteers and communities that can create an attitude that communities should be grateful for whatever they can get. I think you bring up an important point that the service requirements, whether from schools or scholarships or professional organizations. I feel like it really highlights the way volunteers stand to gain more from the experience than the communities themselves.
From my experiences serving with AmeriCorps in college as well as through our service projects and community partnerships in M1, I think one of the biggest challenges I saw in building community partnerships was related to preconceived notions. We all come to partnerships with our own histories, backgrounds, and expectations of one another and what the partnership will look like. We come in full of ideas which are often well-intentioned but may not match what the community we are trying to connect with expects and wants/needs from the partnership. I have seen this play out somewhat during my work with Meals on Wheels as well as we’ve been working through the project planning process. I came in with a very specific image of what I thought the organization was and did. I had many ideas about how I could be helpful to the organization and potential projects that I could be involved with. However, throughout all my discussions and planning, I’ve learned so much more about all the amazing work this organization does. I’ve also had the opportunity to take time and listen to what their actual needs and wants are right now which has taken my project in a direction I hadn’t anticipated. Listening is key to building health community partnerships – being intentional and taking the time to truly listen. We have to remember that while we come in eager to help and make a difference that we are still often outsiders to these communities and cannot understand them or their unique needs from the outside. It is critical to hear the voice of those involved in order to develop effective community-based interventions.
One of the biggest ethical challenges I have witnessed in building relationships and partnerships with communities is the power imbalance that can develop between volunteers or service organizations and the communities they aim to support. Service organizations with resources hold the financial and political power and often have the final say over funding and program design. I think this power creates an attitude that communities should be grateful for whatever they can get. This allows for interventions to be designed that do not include the voices or input of the community they aim to serve. Although many volunteers may be well-meaning, they often come into communities and disrupt local systems to provide short term benefits. I think a similar idea is brought up from the research perspective in the point raised in Su’s where they ask “how can we ensure that research is capacity-building, and not just taking of community members’ energy and resources?” The article points out how ethical community-based research depends on relationships, trust, and power-sharing, not just the typical IRB compliance needed for biomedical research. Ultimately I think we have to find ways of sharing power and knowledge in order to build strong, lasting, and effective partnerships with communities.
Hi Sandy, I like this perspective of how to create equal stakeholders when one party is inevitably giving more than the other, and one is the recipient of that relationship. I feel like the former has to approach the situation with as much abject transparency and humility as possible. Some setting where I have seen this work is when the providing party is lacking something other than monetary resources/labor, such as knowledge, which ensures some form of mutually beneficial exchange can still occur. I think this sentiment is why so many volunteer organizations are moving beyond the traditional “mission trips” and actually attempting to form longitudinal, year round partnerships with certain communities who have their trust.
The most profound example of a challenge in building community that I have encountered revolves around mistrust. I think learning about various populations or minority groups gives people the nuance required to approach different communities in the correct manner. Something that has come up frequently while working on this project at PWC is the mistrust of social services entering the home.
The most significant barrier in uptake of home repair services is that parents are immediately apprehensive at the idea of social worker’s recommending a group of people entering their living facilities. This fear is largely rooted in the misconception that we work with the government or are an arm of CPS/social services and could take their child away from them if we find mold/damage/anything that endangers the child’s health. In reality, this is the opposite, where PWC is an independent volunteer organization that does free home repairs from donation, and has no connection to the government and just a collaboration with Children’s with the shared goal of improving health outcomes which ideally decrease burden on the healthcare system.
We have discussed ideas to address this misunderstanding and foster positive relationships and stronger brand recognition/goodwill, but there is no easy solution. Having a new unfamiliar face come and discuss this with patients in clinic is surely off-putting, but it is unrealistic to place the onus on already overburdened clinic staff and physicians.
I feel this is a vary important consideration to have when the work revolves around “helping” individuals/communities. When people need help, it is often in a place of vulnerability. It can be hard to balance the earnestness of “wanting to help” and making those in need feel ashamed or distrustful. Especially it seems like in PWC’s case, you are entering into people’s homes which are their most private places. It seems like a difficult situation, but as we are learning, relationships take time and PWC will need to build trust in the community.
As part of UHP, I worked with the Community Relations department of Network for Hope (our region’s organ procurement organization). Organ donation is a taboo subject, especially in communities of colors that have historically and systematically been mistreated by the medical system. Unfortunately, there is a massive disparity in the need and availability of transplants for these communities fueled by both higher disease risk and fewer compatible donors. Our goal was to raise awareness of this disparity and increase organ donor registrations in predominantly African American Cincinnati communities. It would be inappropriate for Network for Hope employees to just walk in “asking for organs” given the history. Like many health initiatives working with communities that have been systematically medically mistreated, it is essential to address that history and build up the trust again. Network for Hope organized “Barbershop Talks” where liaisons went to community hubs, often barbershops, and a community member who was impacted by organ donation/recipient told their story and led a discussion. Like Dr. O’Dea spoke about, starting the relationship by listening with mutual respect was critical, especially in this case, hearing the unfiltered fears and worries was important for us to hear while we worked towards a shared mission, solidarity, and empowerment.
I would also like to write about the Pediatrician Poverty Reduction reading. I have always marveled at the resources available at Cincinnati Children’s that were mentioned (in clinic legal, financial, food pantry), but I have always wondered how this can be applied in smaller clinics. As someone who is hoping to practice pediatric primary care, this reading really made me think of how I can do my part to target underlying causes for health disparities (poverty, ect.). I have recently learned more about Ohio’s HeadStart program and similarly, wherever I end up practicing, I will seek out what programming/resources are available in the community even if they can not be in-clinic. I personally have never been involved with legislation, but I am now very interested as it is a way to help children/families that do not interface often with medical system.
***reposting as a comment instead of reply
Hello Megan,
This is so insightful and thanks for sharing such interesting and impactful organizations. I love the idea of solidarity through empowerment and the concept that unity serves as the foundation for building lasting and meaningful change. It’s also very inspiring to hear about your future commitment to serving in legislation. I think a physician’s role in the civic sphere has felt challenging, given the strings attached towards being a public figure. However, I agree that experiences in the wards and on the field are a direct pulse on how the community is experiencing their basic needs. We serve a unique role in society, as servant leaders and as advocates. I look forward to seeing how we can best tap into that role.
While working with OTR Community Housing, it stood out to me that the people living in the Jimmy Heath house were a true community, not just neighbors. Many of them had faced similar challenges in life, especially poverty and substance use. These are things that I have thankfully never experienced. And while I believe it is important to recognize our own privilege, I think at times it did make me feel a bit disconnected or outside the group. This likely could have been overcome with time – but like many volunteers, I did not have years to build up a relationship with this community. They were probably very used to seeing volunteers like me come and go over time, and that might have made them feel even more disconnected too.
I think one way to address this issue is to be upfront with community partners; don’t promise more than you can deliver. Additionally (and more importantly), listen to the community partners and the people they serve. It was when I really got to talk with individuals living at the Jimmy Heath house and listen to their stories that I truly felt connected to them; giving them respect and a space to share and be vulnerable was valuable to both them and me. I think that approaching communities with a “listening” mindset is crucial to making an equitable partnership.
Through experiences in service in the past, I have found that the challenges with building partnerships with the community falls under misaligned definitions of need, power asymmetries, and the concept of tokenism related to representation. Oftentimes I notice that institutions or funders decide what a community needs based on external metrics or assumptions, rather than asking the community to define its own priorities. This causes a disconnect between the values of the community and the intention of the organization. Examples of these types of imbalances occur through lack of appropriate channels of communication and relaying information. However, it may also occur due to asymmetry between power structures, such as when communities that have histories of being harmed by institutions are not trusting of partnerships. This is the key towards building lasting relationships is building a foundation of trust that is based in consistent and intentional planning over time. Investing in a community starts with humility.
I think that these barriers can be addressed through shared power in decision making, transparency, and long term relationship investment. Community members should be at the center of setting goals, allocating resources, and evaluating success. This can only be done if there are accurate metrics that evaluate the needs of the community at large. Likewise, through transparency about constraints, it helps build realistic expectations about what is able to be accomplished and leverages community voices to troubleshoot. Finally, through long term investment, it further deepens trust. By demonstrating through committed and intentional relationship building, it offers a two way channel of communication, where the community and the organization are in agreement of a shared goal.
Being partnered with a free clinic sponsored by UC, there are a lot of regulations that restrict us from providing care to everyone in the community. For one thing, we are unable to provide healthcare to those with insurance or those under the age of 18, which can make it challenging for patients who come to our weekend clinics with hopes of receiving care. Further, accessibility can be a big challenge when partnering with the community. As a free clinic, we are grateful to have a partnership with the Healing Center and have a dedicated space to host our clinics weekly. However, this also means that we are restricting care to only those who can travel and attend our clinics at our scheduled weekly time. We are also limited in the care that we can provide at this time outside of acute care visits. While we have a partnership with Lincoln Heights Health Center for continuity of care and to establish primary care services, they do charge a fee for their services, which can be a barrier for patients who are unable to afford further care. While there will always be ethical challenges when building partnerships with communities, I think that it is important to acknowledge that we may never be able to fully combat them. However, as long as we recognize that these challenges exist and try our best to mitigate them, we can ensure that we are building an equitable partnership to the best of our abilities.
Hello Megha, I think you make a great point about doing the best we can do as healthcare providers given the challenges that the community and we as providers have to face. I agree that recognizing that these challenges exist and activily working towards ensuring that they do not actively harm a population is the first step in overcoming them.