Health System staff and faculty ally with African-American church leaders to reach out, build patient trust and improve community health

by Kimberlee Roth  •  Photos by Marie Frost

Not far from the brightly-colored stained-glass, clerestory windows and lavender-cushioned pews of a church sanctuary in Ypsilanti, Michigan, comes music. Rich, resonant music that moves listeners to their feet, connecting them with the past.

But it’s Wednesday not Sunday, the pews are empty, and the melodies aren’t exactly devotional. Instead, the brassy sounds of big band jazz fill the church. And those moving to the beat — on their feet and from their chairs — have not come to pray. Rather they’re here to socialize, to reminisce and even ... to make salsa.

Pastor Jerry Hatter during a Sunday service at Brown Chapel

Twice a week, a small social hall at Brown Chapel African Methodist Episcopal (AME) Church, under the leadership of Pastor Jerry Hatter, about a 20-minute drive from the University of Michigan Health System, serves as the home base for Silver Club, a day program for people in the early and middle stages of memory loss.

Silver Club meets in Ann Arbor the other days of the week and is run in both locations by the U-M Geriatrics Center, working closely with area church leaders. Brown Chapel was involved in the inception of Silver Club, even before the group started meeting there, and was committed to transportation efforts early on. Members of the church volunteer their time to provide daily van service to clients and help out with the rest of the daily activities. Nearly all the clients, currently between 52 and 94 years old, live with their adult children. For many, the van service is what makes it possible to participate in the day program — and to continue living with family. “The church has made a serious commitment to us, and we to them,” says Beth Spencer, a hospital social worker who directs Silver Club activities.

Silver Club member Buford St. Clair and his wife, Earline, who volunteers with the club

Silver Club is just one of the cooperative efforts between the faculty and staff of the Health System and leaders and members of area African-American churches. These partnerships share a central mission: to reach underserved African-Americans in order to improve health and well-being as well as to reduce striking health disparities that put blacks at higher risk of dying from many common — but preventable and treatable — diseases.

The Brown Chapel-Geriatrics Center relationship began more than a decade ago, when a doctoral student was working with Ypsilanti-area African-American churches to understand and address health-related needs of seniors. Elder care emerged as an issue, including family support for Alzheimer’s disease and dementia. Silver Club has been running since 1998 and began meeting at Brown Chapel in 2000.

Partnering with the church has “allowed us to reach out, in ways we couldn’t have otherwise, to older adults with memory loss in the African-American community, and in Ypsilanti and Ypsilanti Township, who were not being reached by other services like this,” Spencer says. Families participating in Silver Club pay according to a sliding scale. The program receives support from the Health System but must raise its own operating funds to provide services to the 18 daily participants.

Oveta Fuller speaks during a meeting of pastors from the Michigan Conference AMEC southern district. Recently appointed health coordinator of the southern district by the AMEC Health Commission, she shares with the group health information that they will in turn pass on to members of their congregations.

Beyond spiritual health
“Black churches have always been more prone to take faith and move it to practical application,” says A. Oveta Fuller, Ph.D., an associate professor of microbiology and immunology in the Medical School. Fuller also serves as science advisor to the global AME Church and as pastor at Bethel AME Church in Adrian, Michigan. The AME Church grew out of a social justice movement in Philadelphia in the 1700s, she explains, where blacks often could not worship at the altars of churches attended by whites. When a yellow fever epidemic hit the city in 1793, AME members and pastors helped care for the sick. AME members like Rosa Parks were prominent in the Civil Rights and other social justice movements.

“Historically, religious organizations have had a major influence with people in the African-American community,” says Fuller. Members may view health efforts in partnership with black churches as more credible — important in light of such past abuses as the Tuskegee Syphilis Study and more subtle but pervasive forms of inequities that result in major health disparities today.  

Although a self-described “person of faith,” Fuller never intended to be a minister; her career goals centered on scientific research. But her father’s death in 1990 caused her to reflect on the relationship between faith and science. She came to realize that for her the two weren’t mutually exclusive; that, in fact, quite the opposite was true. She also came to realize that her relationship with the church could have a direct impact on the health and well-being of others.

As a virologist and an African-American woman, Fuller had written about and was well aware of the disproportionate rates of HIV infection among people of African descent. African-Americans comprise about 13 percent of the U.S. population, but account for nearly half of HIV/AIDS diagnoses. Black teens account for almost three-fourths of new AIDS cases among U.S. teenagers, according to figures from the U.S. Centers for Disease Control and Prevention. In sub-Saharan Africa, more than 25 million people are infected — and millions of others affected — by HIV/AIDS.

And she knows how the virus works. Fuller’s research focuses on the molecular mechanisms by which viruses enter cell membranes, reproduce and spread. She teaches medical, dental and graduate students about pathogenic viruses, including herpes simplex and HIV. “What became clear to me is that what scientists already know about HIV could make a huge difference if it is successfully conveyed to the people most affected.”

So Fuller set about getting the information into communities, collaborating with the AME Church to do so. Given the church’s Episcopal structure, by which information can be disseminated efficiently from bishops through clergy to a membership of some 2 million people, Fuller saw it as a readily available vehicle for preventive medicine.

Thanks in large part to her efforts, at its 2007 bishops’ conference the AME Church issued a policy statement that supports the urgency of HIV/AIDS education, prevention and care. But Fuller wanted to directly and immediately connect policy with practice. Prior to the conference, to be held in Columbus, Ohio, she learned that the meeting dates in June coincided with National HIV Testing Day. She saw an opportunity: make HIV testing available on-site. Doing so meant that the 21 bishops who serve in districts around the world could lead by example rather than by word alone. She worked with church leaders such that four trained counselors provided rapid testing right there at the Greater Columbus Convention Center. “It allowed people to take that first key step,” she says.
 
Both the policy statement and testing represent a fundamental shift in thinking, says Fuller. “It strips away the stigma. It essentially reframes HIV to place it in the realm of pathogenic viruses similar to those that cause influenza, the common cold, chicken pox and measles. HIV should not be thought of as God’s punishment for sin, but as a fragile virus whose transmission to cause the infectious disease AIDS can be prevented.”

“A whole different mindset”
Sunday mornings at Brown Chapel, it’s not unusual for Hatter to espouse from the pulpit, right along with passages from scripture, the virtues of drinking enough water or the benefits of eating whole foods and buying organic. That’s because the church participates in a national wellness program for black churches, called Body & Soul. The U-M Comprehensive Cancer Center, the Program for Multicultural Health and the American Cancer Society’s local office all provide support for Body & Soul to eight Ann Arbor and Ypsilanti churches.

The program promotes eating more fruits and vegetables and living a healthy lifestyle, and it has been part of Brown Chapel’s Health and Wholeness ministry for two years. Hatter says it has sparked some changes among members of his congregation. He now hears church members “talking more of eating the right things and decreasing fast foods. We basically keep and hold each other accountable for the things we see.”

Student volunteer Cheryl Barker (center) laughs with Silver Club members Doris Scerbak and Wylean Smith during a field trip the group took to Lodi Farms Nursery in October.

When one of those things happens to be a bag from a fast-food restaurant, he adds, it’s not unusual to hear good-natured ribbing, such as Oh my God, what are you doing? or What’s up with that? “That accountability makes a big difference,” he says.

Many more formal discussions take place too, such as talks about portion size or cholesterol, and members take tai chi and “gospelcise” classes — exercise to gospel music. Body & Soul also has made its way into the church’s kitchen. “We’re baking chicken now,” says Hatter. “Instead of punch and cake for small gatherings, we have fruit and vegetable trays, and nuts and grains. It’s a cultural change, a whole different mindset.” 

And a leap of faith of sorts. “A healthy body is essential to a healthy individual and spirit,” he adds. “We can live life more abundantly when we eat the right things, exercise and stay on top of health conditions.”

Robert Ackles, Odesser Davie and Catherine Williams play a beanbag toss game during a Silver Club exercise session.

Body & Soul grew out of a decade of church-based health intervention studies, funded by the National Institutes of Health. During the initial phases of this research, Ken Resnicow, Ph.D., now a professor at the U-M School of Public Health, was working at the Emory University Rollins School of Public Health. At the request of the National Cancer Institute and the American Cancer Society, Resnicow and his collaborators combined the most successful elements of each. Body & Soul was born.

When Resnicow joined the faculty four years ago, the University lent its support to the evidence-based program in order to further cultivate relationships with local minority communities. “The great thing is that the program opens the door,” says Aisha Langford, a health educator and minority outreach coordinator with the Comprehensive Cancer Center who often attends Body & Soul and other church events, toting water bottles, health brochures and cookbooks. “It starts with fruits and vegetables to reduce the risk of cancer, but it’s a really good gateway for interest in other healthy behaviors.” 

Build it and patients will come
When it’s time for Jane Barney to have a physical exam, she gets behind her rolling walker and heads to Ann Arbor’s New Hope Outreach Clinic on foot. Barney is 93, and she has been a patient at the clinic since it opened in 2001. She likes that she can walk to the well-manicured, white clapboard building on her own from her downtown home and, since the clinic occupies the ground floor, she doesn’t have to navigate stairs or elevators with her walker.

But Barney isn’t only a patient — she, along with good friend and devoted New Hope member Dorothy Kirkpatrick — also helped found the clinic, a partnership between the U-M Turner Geriatric Clinic and New Hope Baptist Church. The founding mission of New Hope Outreach Clinic was to offer a point of entry into the U-M Health System where African-Americans over 55 would feel comfortable receiving primary health care, screenings, education and referrals. But the clinic would always be open to and welcome people from all backgrounds.

Jane Barney makes her way through the neighborhood between her house and the New Hope Outreach Clinic.

Barney came to Ann Arbor in the late 1960s with her husband, a clergyman, who was hired by St. Andrew’s Episcopal Church. Their children were grown, and she decided to earn a U-M master’s degree in social work. She worked for the University and became interested in geriatrics and the accessibility of health services.

One day, she was stunned by a snippet of conversation she overheard between two African-American U-M staff members. “At the time,” Barney says, “Turner Geriatric Clinic was going strong, with support groups for older adults with vision loss, hearing loss and other needs and interests.” But the group members were almost exclusively Caucasian.

“I wonder why African-Americans don’t have these kinds of sessions,” she recalls hearing one employee comment to the other. Barney began to wonder the same thing.

She gathered colleagues and undertook a survey of health care for African-Americans in the county. From that exploratory survey grew a black advisory group within the Geriatrics Center, supported by Chief of the Division of Geriatric Medicine Jeffrey Halter, M.D. Among the group’s recommendations was a special clinic that would provide culturally sensitive access to the Geriatrics Center. Members thought a church-based location for the clinic would help reach the patients it hoped to serve.

After much relationship-building over several years, the late Pastor Albert Lightfoot, New Hope Baptist Church’s founding pastor, agreed to provide space for the clinic in a house on church property. The University committed funds to renovate the ground floor of the house and to provide medical and administrative staff to run a clinic there.

It was not an easy road, Barney recalls. “It took a long search to find this place,” she says, and there was some resistance too. “But we just went ahead and did it. We just assumed — we hoped — that if the clinic developed, people would use it.”

People have. A recent prostate cancer screening drew 70 men — an overflow crowd for the small space and a significant one, since the death rate among black men from prostate cancer is double that for white men. “We knew that knowledge of the clinic would spread slowly in the black community by word of mouth,” says Barney. “And indeed, it’s still in the process of becoming known and trusted.”

That trust grows not only from thoughtful touches like the soothing rocking chairs and pictures in the reception area, but also from the dedicated care of a sensitive team. A nurse practitioner, social worker, medical assistant and outreach coordinator together take a holistic, “big-picture” approach to providing care at New Hope Outreach Clinic.

Challenges and rewards
Denese Meadows of Ypsilanti has been caring for her mother, Odesser Davie, who is 91 and has Alzheimer’s disease, since Meadows’ father died in 1999. Meadows works the midnight shift; her husband works days. Caring for her mother all day at home meant Meadows often had to forgo sleep. Services like Silver Club’s day program have helped change that. “If not for Silver Club,” she says, “my mom wouldn’t be able to stay with me and would have to be placed in a nursing home, which I’m hoping not to do.”

Standing in their driveway, Denese Meadows and her mother, Odesser Davie, wave good-bye to the Brown Chapel AME volunteers who provide transportation for Silver Club members.

But it’s not just sleep — and peace of mind — that Meadows has gained. “I knew my mom loved church music,” she says, “but I didn’t know she loved swing music. I’m sure it takes her back to when she was a young woman. And painting — I never saw my mom paint, but she likes to dabble in arts and crafts. There are things Silver Club teaches us about our parents, and we can carry them over at home.”

The learning extends to the seemingly mundane: how to gently redirect conversation when her mother reads Meadows’ horoscope aloud for the 10th time or refuses a much-needed winter coat while the two are shopping. “There are a lot of behavioral pieces that come up that staff and volunteers help you with. ... Sometimes it’s overwhelming and you can’t think it all out by yourself,” says Meadows.

“This journey that I’m on, to care for my mom, it’s hard, very hard. But I wouldn’t trade it. My mom’s always been there for me, and now it’s my time to be there for her.”