Health Progress - Summer 2023

OPENING DOORS

ACCESS TO CARE

CHA’S NEW VISION STATEMENT

Over the past several years, Catholic health care has faced unprecedented challenges. From the start of the COVID pandemic and the severe financial and workforce strains that followed, to the ongoing polarization in society that has led to attacks on our Catholic identity, it became clear that external pressures were thrusting us into a time of transition and much-needed change. With this new reality in mind, CHA’s Board of Trustees and leaders from across our membership recognized that in order to serve in dynamic ways and meet the needs of our patients and community, we must change how we approach our work. There was a strong feeling that in this profound time of transformation, we must let go of what has been while actively embracing what is to come.

Last year, as the CHA board considered a refresh of CHA’s Fiscal Year 2021-23 strategic plan, it decided that a new vision statement was necessary to guide CHA into the future and serve as a compass for our roadmap, a new Fiscal Year 2024-26 strategic plan. During a ninemonth period beginning in the fall, and culminating with the virtual Catholic Health Assembly in June, we engaged in a visioning process that was directed by a six-person committee from the CHA board.

The result of this work is a new vision statement for CHA: We Will Empower Bold Change to Elevate Human Flourishing

This vision statement complements our mission “to advance the Catholic health ministry of the United States in caring for people and communities.” Along with our core values of respect, integrity, stewardship and excellence, this vision reinforces our commitment to the belief that every person is a treasure, every life a sacred gift, every human being a unity of body, mind and spirit. Taken together, our mission, vision and values give us a clarity of purpose, priorities and principles as we continue to advocate for health policy that leaves no one behind.

The vision statement is aspirational, as it calls us to elevate human flourishing.

During the assembly, Laura Kaiser, president and CEO of SSM Health and past chairperson of the CHA Board of Trustees, said, “Human flourishing means standing tall and strong, being blessed with good health, longevity and a thriving

environment. Flourishing is the result of faith and justice — and is much more than just ‘getting by.’” She added, “When we provide compassionate care and protect human dignity, we help all those who suffer to ‘flourish in the courts of our God.’”

Damond Boatwright, president and CEO of Hospital Sisters Health System, who currently serves as CHA’s chairperson, also spoke about the vision statement during the assembly. He called CHA to lead the transformation of care and payment reform, to embrace a spirit of innovation and to lead through the shared values of Catholic health care. He said, “As members of this association and leaders in Catholic health care, let’s not be dismayed by what seems impossible. Our tradition has been a source of love and service for … over 2000 years, and it continues to equip us for the work we need to take on today.” He then called on attendees to join him in “rising with faith and courage to advance a better future — a future where we see improved access to health care for all people; a future where we find new ways of overcoming the challenges in front of us; a future where we continue to advance the tradition of Jesus’ healing ministry.”

The founders of our health ministries had the courage to move beyond their known reality. They responded to God’s call and trusted in God’s abiding presence. Today, we, too, are called to trust God; to embrace what is emerging in Catholic health care; and to have the courage — as we open doors to provide access to care for all — to step through this threshold into a new reality.

I am certain that guided by our vision, the Catholic health ministry will elevate its prophetic voice, and we will help lead the transformation of health care in this country.

SR. MARY HADDAD, RSM

OPENING DOORS: ACCESS TO CARE

43 HOW THE ERDs CAN DEEPEN OUR CATHOLIC IDENTITY

Myles N. Sheehan, SJ, MD

DEPARTMENTS

2 EDITOR’S NOTE BETSY TAYLOR

49 COMMUNITY BENEFIT Community Benefit at CHA: How It Started and Where It’s Headed JULIE TROCCHIO, BSN, MS, and NANCY LIM, RN, MPH

52 THINKING GLOBALLY Mapping Christian Health Assets to Support Global Health Response BRUCE COMPTON, SAMONE FRANZESE, MD, and CAROLYN O’BRIEN, MSPH

56 ETHICS

Water Shapes Our Connection to Life BRIAN M. KANE, PhD

59 HEALTH EQUITY

From the Boardroom to the Bedside: Avera Embraces Diversity Formation Curriculum FAITH MINNICH KJESBO, MAMFT

61 MISSION

Enhancing Access to Care Along the U.S.–Mexican Border Near San Diego DENNIS GONZALES, PhD, and KENDRA BRANDSTEIN, PhD, MPH, MSW

4 CAREFUL UNDERSTANDING OF PATIENT NEEDS LIES AT THE HEART OF CARE Sr. Dorothy Thum, RSM

9 WHAT PATIENTS WITH CHRONIC ILLNESS WANT PROVIDERS TO KNOW Tricia Steele

16 FOR PEOPLE WITH HIV, ‘TEST AND TREAT’ IS KEY Michael J. O’Loughlin

21 COMMUNITY CLINIC DELIVERS CARE WITH DIGNITY FOR THE UNDERSERVED Robert Lippman, DBH, MSW

27 UNDERSTANDING VETERANS’ UNIQUE NEEDS IS CRUCIAL TO THEIR CARE

Christina J. Schauer, MSN, ARNP, ACNS-BC

32 PROTECT WHAT’S PRECIOUS: RETAINING MEDICAID COVERAGE IS VITAL FOR VULNERABLE POPULATIONS

Paulo G. Pontemayor

36 REFLECTION: A JOURNEY TO UKRAINE — THE HUMANITARIAN CRISIS AND THE CATHOLIC RESPONSE Bruce Compton

41 REFLECTION: CATHOLIC HOSPITALS AND THE LOCAL CHURCH — WHY THEY MATTER TO ONE ANOTHER AND TO COMMUNITIES

Sr. Doris Gottemoeller, RSM

15 POPE FRANCIS — FINDING GOD IN DAILY LIFE

64 PRAYER SERVICE

Illustrations by Roy Scott

Jesus’ return to Capernaum where he meets a paralytic person is one of the more interesting health care stories in the Bible; it’s about many things — faith, friendship, holistic healing of body, mind and spirit — but it’s also about health care access.

Crowds gather around Jesus when he returns to this city by the Sea of Galilee, and he preaches to them from the home where he is staying. Because the doorway is packed with a crowd wanting to see him, four men break through the roof and lower a paralytic person down to Jesus, in hopes that he can heal the man. Jesus first forgives his sins — a true balm of spiritual care — and then tells the man to pick up his mat and walk.

It’s striking to me that this person in need of healing had a support network. There were people around him who essentially figured out how to navigate a challenging system — when the men supporting the paralytic person can’t get through the door, they go through the roof — to get him the access to the healing he needed. It’s also a story about how healing is not just a physical process. Jesus tends to the person’s spiritual needs before the physical ones. This Biblical story is visually represented in the national awards CHA gives out, and I think it’s with good reason. The story encompasses so many aspects of care that transcend time.

This issue of Health Progress is themed around Opening Doors: Access to Care, taking a look at some of the complexities involved in finding, paying for and receiving the right care at the right time and in the right place.

Opening doors to this care involves multiple factors. In his article, Paulo Pontemayor, CHA’s senior director of government relations, points to the fact that today health care access is tied to insurance coverage. And that CHA’s membership has long viewed health care as “a basic human right essential to human flourishing.” So, work by CHA and other organizations to educate those on Medicaid about how to “Protect What’s Precious” and keep their coverage is one way to open a door. But, as this issue makes clear, more than one door needs to be opened.

Author Tricia Steele writes about the worries of patients with chronic conditions, how they need timely access to care providers — often including specialists not always located near them. She describes how they need to feel listened to and like a valued part of their own care team. She reminds readers how some days just getting out of bed and navigating a complicated, convoluted system can feel overwhelming for someone with chronic illness.

Elsewhere in this issue, there are articles about ways to meet, communicate and care for populations as varied as those who are poor, those with HIV, those living through wartime, and military veterans. It is true that the barriers to affordable, quality health care can loom large. But I hope these pages will provide some inspiration for what’s working, and what still needs to be worked on.

Regular readers also will enjoy hearing that author Sally J. Altman and the Before Ferguson Beyond Ferguson team were recognized in Atlanta in May for the third installment of the Health Progress articles focused on racial and health equity in the St. Louis region. The American Society of Business Publication Editors’ ASBPE Educational Foundation bestowed the Journalism That Matters award for the piece published in 2022. We usually don’t seek a lot of attention when Health Progress receives recognition, but thought this award merited a little notice, especially as the articles are part of CHA’s resources and ongoing work for health equity through the “We Are Called” campaign.

When Jesus forgave the sins of the paralytic person and performed the miracle that allowed him to walk, the Bible says: “They were all astounded and glorified God, saying, ‘We have never seen anything like this.’” (Mark 2:12) My hope for us all in the continuing work of Catholic health care is that we may be inspired by this tradition, and astound one another and those we care for with a steadfast commitment to bring comfort and healing.

BETSY TAYLOR

®

VICE PRESIDENT, COMMUNICATIONS AND MARKETING BRIAN

P. REARDON EDITOR

BETSY TAYLOR btaylor@chausa.org

MANAGING EDITOR

CHARLOTTE KELLEY ckelley@chausa.org

GRAPHIC DESIGNER NORMA

KLINGSICK

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2023 AWARDS FOR 2022 COVERAGE

Catholic Press Awards: Magazine of the Year — Professional and Special Interest Magazine, First Place; Best Special Section, First Place; Best Layout of Article/Column, First Place; Best Color Cover, Honorable Mention; Best Story and Photo Package, First Place; Best Regular Column — General Commentary, First Place; Best Coverage — Pandemic, Second Place; Best Coverage — Racial Inequities, Third Place; Best Essay, Second and Third Place; Best Feature Article, Second Place; Best Reporting on a Special Age Group, First Place; Best Reporting on Social Justice Issues — Care for God’s Creation, Second Place; Best Reporting on Social Justice Issues — Dignity and Rights of the Workers, First Place; Best Writing — Analysis, Honorable Mention.

American Society of Business Publication Editors Awards: Journalism That Matters Award; All Content — Enterprise News Story, Regional Silver Award; Print — Single Topic Coverage by a Team, Regional Bronze Award.

Produced in USA. Health Progress ISSN 0882-1577. Summer 2023 (Vol. 104, No. 3).

Copyright © by The Catholic Health Association of the United States. Published quarterly by The Catholic Health Association of the United States, 4455 Woodson Road, St. Louis, MO 63134-3797. Periodicals postage paid at St. Louis, MO, and additional mailing offices. Subscription prices per year: CHA members, free; nonmembers, $29 (domestic and foreign); single copies, $10.

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EDITORIAL ADVISORY COUNCIL

Trevor Bonat, MA, MS, chief mission integration officer, Ascension Saint Agnes, Baltimore

Sr. Rosemary Donley, SC, PhD, APRN-BC, professor of nursing, Duquesne University, Pittsburgh

Fr. Joseph J. Driscoll, DMin, director of ministry formation and organizational spirituality, Redeemer Health, Meadowbrook, Pennsylvania

Tracy Neary, regional vice president, mission integration, St. Vincent Healthcare, Billings, Montana

Gabriela Robles, MBA, MAHCM, vice president, community partnerships, Providence St. Joseph Health, Irvine, California

Jennifer Stanley, MD, physician formation leader and regional medical director, Ascension St. Vincent, North Vernon, Indiana

Rachelle Reyes Wenger, MPA, system vice president, public policy and advocacy engagement, CommonSpirit Health, Los Angeles

Nathan Ziegler, PhD, system vice president, diversity, leadership and performance excellence, CommonSpirit Health, Chicago

CHA EDITORIAL CONTRIBUTORS

ADVOCACY AND PUBLIC POLICY: Lisa Smith, MPA

COMMUNITY BENEFIT: Julie Trocchio, BSN, MS

CONTINUUM OF CARE AND AGING SERVICES: Julie Trocchio, BSN, MS

ETHICS: Nathaniel Blanton Hibner, PhD; Brian Kane, PhD

FINANCE: Loren Chandler, CPA, MBA, FACHE

GLOBAL OUTREACH: Bruce Compton

LEADERSHIP AND MINISTRY DEVELOPMENT: Diarmuid Rooney, MSPsych, MTS, DSocAdmin

LEGAL: Catherine A. Hurley, JD

MISSION INTEGRATION: Dennis Gonzales, PhD

Careful Understanding of Patient Needs Lies at the Heart of Care

Aman was brought into the emergency room at Mercy Health — St. Charles Hospital in Oregon, Ohio, suffering from hyperglycemia. He had rapid breathing, confusion, excess sugar in his urine and heart palpitations, and was admitted to the ICU. A migrant worker who came to Ohio to help harvest crops, he had run out of insulin and had no financial means to obtain the medication.

The patient later improved and was transferred to a medical unit until he recovered. He returned to his temporary living situation with medicine from the hospital’s Mercy Health-funded medication outreach program — which provides an initial dose of medication for qualified people who cannot afford it when they are discharged from the hospital — and was supplied with enough to last until he could acquire his own. A hospital community outreach worker conducted a followup visit to determine if he had any further health care needs.

What does it mean to “open doors” to improve access, particularly for those most in need?

It requires health systems to be attentive to the complex needs of our patients beyond the time they are in the hospital. This migrant worker’s difficult situation served as a case study for Mercy Health executives, hospital administration, mission leaders, outreach workers and emergency personnel about three decades ago to determine creative ways to prevent a similar situation in the future. Out of these discussions, the Mercy Health mobile health van program was launched.

The mobile health van program included the

purchase of a 40-foot van that became a clinic on wheels, primarily serving Northwest Ohio. Some participants train to drive the van, and community health nurses and patient care technicians deliver the services needed.

Launching a mobile health van program required raising funds to pay for program costs. Members of Mercy Health Foundation — Greater Toledo took up the challenge and raised funds to purchase the van. Community members understood the need and wanted to be involved in making a difference. Thirty years later, the program continues to help meet the needs of the underserved by going out to where they are located.

Recently, a young woman waited for an opportunity to be seen by one of the mobile van program’s volunteer doctors. As she walked out of the exam room with reassurance and resolution of her issues, she had a wide grin on her face and said, “God bless you” to the mobile van staff.

EXPANDING THE VISION OF CARE

Opening doors to health care access for those who are poor and underserved requires developing a vision of what the care can look like. Health

SR. DOROTHY THUM, RSM Mission Ambassador at Mercy Health — St. Charles Hospital

care is no longer focused solely on the patient, but also attends to the overall health of the community.1 Often, it is difficult to know how to begin. The county community health needs assessment (CHNA) is a good place to start.

For the purpose of the CHNA, Mercy Health — Toledo used Lucas County as the main service area. The most recent Lucas County CHNA was conducted in 2019/2020 by Healthy Lucas County, a coalition of hospitals and community agencies that work together to improve county residents’ health through a strategic planning process. The poverty rate in Lucas County is nearly 20%, with 13% of adults on Medicaid or other assistance.2 Per the CHNA, 17% of adults described their health as fair or poor, increasing to 34% for those with annual household incomes less than $25,000.3

tion guides us on how we should respond to the needs of the poor.

Second, a passion for the poor follows in the footsteps of the founders of our religious congregations who started our healing ministry. Catherine McAuley, the founder of the Sisters of Mercy, walked the streets of Ireland caring for the poor and sick during the cholera epidemic in the early 1830s. The sisters treated the poor respectfully by keeping them warm, fed, clean and comforted. Their presence not only alleviated this situation, but, at a time when nursing was not a recognized profession, it so improved the quality of care of the patients that the death rate was one of the lowest on record.5 Additionally, Pope Francis encourages his bishops to be shepherds who smell like their sheep. By “tending sheep,” this means one welcomes, walks and stays with those in their care.6

The mobile health van program expanded its outreach based on the Lucas County CHNA. It increased its collaboration with other community agencies, including schools, senior centers, 1Matter’s Tent City project, 4 African American Male Wellness Walk and community health events. Health screenings are conducted and abnormal ranges identified. Participants receive results they can share with their physicians, or, for those who don’t have one, help is provided to assist them with finding a primary care provider.

A PATH TO COMPASSIONATE CARE

While we need data to identify the greatest health needs, how we respond is based on the ministry’s mission to provide compassionate care. In my experience, I believe the following elements help to make opening doors for the poor successful.

A Passion to Serve

First, a person needs to have a passion for serving the poor, a passion that follows in the footsteps of Jesus. Jesus went to the poor and marginalized to offer them healing and comfort. He told the story of the Good Samaritan when he was asked, “Who is my neighbor?” The answer to that ques-

Serving the poor continues as a priority in our actions today. An internal medicine physician told me a story of a difficult case he had. The patient was an insulin-dependent diabetic and had trouble staying on his regimen. He often came into the office with an infection at the site of the injections. A social worker suggested it might be helpful if the physician visited the patient at home to see what could be the barrier to compliance. The physician agreed and discovered upon a visit that the patient did not have hot water in his apartment. The physician now understood the reason for the patient’s infections. He realized it was not a compliance matter, but a socioeconomic issue. He switched his medication to an oral one instead, resulting in improved patient outcomes. The patient was connected with other community resources by the social worker. Today, socioeconomic conditions are part of the assessment of each patient during their medical appointment, and the information is integrated into their health chart.

Show Leadership’s Commitment

Third, leadership needs to be involved in developing the priorities for serving the poor — it is not only the responsibility of the frontline workers. A positive shift in organizational commitment occurs when strategies and goals are aligned. For example, a young mom arrives late for her doctor’s appointment after riding the bus on a

Leadership needs to be involved in developing the priorities for serving the poor — it is not only the responsibility of the frontline workers.

rainy day. Can frontline workers fit her into the schedule, or do they have to send her home per policy? Examining policies and procedures is an important element of care for the poor to see how protocols impact vulnerable persons.

Leadership needs to be committed to making a difference in the community. Basic justice demands the “establishment of minimum levels of participation in the life of the human community.”7 Aligning internal targets with the results of the CHNA provides better outcomes for the community. Engaging the board of trustees in an immersion experience is one way to increase the knowledge of board members to the struggles of the poor. It is also a way for the board to understand the significant contribution of the health system to make a positive difference.

Support Community Professionals and Training

Fourth, acknowledge the special skills needed to work with the poor to improve their health. Addressing poverty is everybody’s business in a community. By addressing poverty, better health outcomes can result. Training hospital employees increases the ability of staff to connect with the poor. One approach, Bridges Out of Poverty, is a training program that shifts the way we understand and approach poverty. It shifts seeing individuals as strong, not wrong, and brings people of all different classes to the same table to increase sustainability.8

One group of professionals who can be highly valuable in improving care access for underserved individuals are community health workers. As trained professionals who provide resources and information to individuals who are in poverty, community health workers often come from the same neighborhoods and understand the challenges many people face. The Toledo campus of Mercy College of Ohio offers a training program to become a community health worker, which includes interactive experiences in a variety of community settings, and, upon program completion, a certificate from the Ohio Board of Nursing.

I have witnessed the commitment and dedication of community health workers to help people of all ages, and how their incorporation into ongoing community outreach efforts — like serving as navigators for persons entering the federal health care exchange insurance program — can help individuals overcome complex barriers to meet their health care needs.

Community Collaboration

Fifth, collaboration is essential to long-term success. An example of collaboration in action is CareNet, founded in 2002, which provides access to coordinated health care services for low-income Lucas County residents. In 2002, then Toledo Mayor Jack Ford challenged the health care systems to work together to provide better access to care. Today, through CareNet, all the local health care systems, local government, health department and other agencies work together to provide care. Licensed and certified navigators provide help to enroll individuals in Medicaid and the federal health insurance marketplace. To date, CareNet has helped approximately 29,000 lowincome residents of Lucas County to get access to coordinated health care services.9

Through collaborative efforts like CareNet, I am reminded how Jesus was able to break down barriers and get his apostles and disciples to work together to help others in need.

Experience Joy in Helping Others

Sixth, enjoy the ministry and serve with joy. The ministry is challenging and rewarding. Rewards come in the way of connecting with people and seeing their health improve. Catherine McAuley said our lives need to be centered on God, and that we need to take one small step today and strive to do better tomorrow. She also cared for her sisters and provided them moments of respite, including finding a relaxing place by the sea for them to renew their spirit.10 Paying attention to the needs of our team members gives them an opportunity to experience what provides wellness for them so they can translate similar experiences to those in need.

The Getting Healthy Zone project in Toledo is an example of taking one small daily step and doing better tomorrow. Beginning in August 2018, concerned about the high infant mortality rate in the community, Mercy Health engaged residents to come together to share their insights and experiences. Through these conversations, a plan was developed to support residents to address the social determinants of health and structural racism.

Today, through Getting Healthy Zone, neighborhood goals link residents with resources to increase infant vitality, connect residents with living wage jobs, assist them with credit repair and home ownership, help entrepreneurs with needed

support, and provide community members with a space for outdoor recreation through the creation of a usable park.

Today, the Getting Healthy Zone project is seeing results. In 2018, 12% of the infants who died prior to the age of 1 were in three Lucas County zip codes. By 2022, that number decreased to 5%.11 Getting Healthy Zone’s motto is “Everyone can be a superhero to help prevent poor birth outcomes.” There are currently 25 agencies working together to make this progress become sustainable.

RESPONDING TO OUR CALL TO SERVE

Each of us is called to reach out to those in need. When one is sick, one is in need. A focus on the health of the poor is a special calling, one that I might suggest could lead those called to serve in a new role as mission ambassadors. I began the role of mission ambassador volunteer when I retired from my role as vice president of mission for the Mercy Health — Toledo region in 2022. My role as mission ambassador is to be the face of the ministry to the community. In the future, I envision more people will desire to be a mission ambassador. Qualifications for this role include someone who knows community health or patient care, has worked for the health system for many years, is willing to serve as a volunteer and can meet with diverse groups of people. The role expands the strategic direction of the hospital and draws from the mission to aid those in need.

Responding with compassion brings comfort and healing to the person in poverty as well as to the one being the helper. When we look at the needs of a person from their perspective, we walk in the shoes of God, who loves each person — it gives us an opportunity to love as Jesus did. The image of Jesus as the Good Shepherd from his parable of the lost sheep can be an inspiration. As a Good Shepherd, Jesus left the 99 sheep and went after the one lost sheep until he found it. (Luke 15:4-7) We can trust that God will be with us along the way and carry us forward in our ministry of health care.

SR. DOROTHY THUM, RSM, is mission ambassador volunteer at Mercy Health — St. Charles Hospital in Oregon, Ohio. She retired in 2022 after serving 40 years at Mercy Health — Toledo, including her last role as vice president of mission for the Toledo market.

NOTES

1. Cardinal Joseph Bernardin, A Sign of Hope: A Pastoral Letter on Healthcare (St. Louis: Catholic Health Association, 1995), 8.

2. “2019/2020 Lucas County Community Health Assessment,” Healthy Lucas County, December 8, 2020, https://www.healthylucascounty.org/wp-content/ uploads/sites/2/2020/11/2019-2020-Lucas-CountyCommunity-Health-Assessment.pdf.

3. “2019/2020 Lucas County Community Health Assessment,” Healthy Lucas County.

4. 1Matters, https://www.1matters.org.

5. M. Joanna Regan, RSM, and Isabelle Keiss, RSM, Tender Courage: A Reflection on the Life and Spirit of Catherine McAuley, First Sister of Mercy (Chicago: Franciscan Herald Press, 1988), 85.

6. Pope Francis, The Church of Mercy: A Vision for the Church (Chicago: Loyola Press, 2014), 85.

7. Economic Justice for All: Pastoral Letter on Catholic Social Teaching and the U.S. Economy (National Conference of Catholic Bishops, 1997), 44.

8. “Bridges Out of Poverty,” aha! Process, Inc., https://www.ahaprocess.com/our-services/ #tab-a51176197740d672e83.

9. Care Net Toledo/Lucas County, https:// www.toledocarenet.org.

10. Mary C. Sullivan, ed., The Correspondence of Catherine McAuley, 1818-1841 (Washington, DC: The Catholic University of America Press, 2004), 136.

11. “Getting Healthy Zone Report to the Community,” Mercy Health, 2022, https://www.mercy.com/-/media/ mercy/about-us/community-benefit/ghz-report-tocommunity-2022.ashx.

OPENING DOORS: ACCESS TO CARE

What Patients With Chronic Illness Want Providers To Know

TRICIA STEELE Contributor to Health Progress

When Julie Rehmeyer recently had a sudden flare-up of her complex, chronic conditions, she sought care at her local hospital, a place she goes only for the most urgent emergencies. “I had a pretty horrendous experience just due to a lack of familiarity with my condition and misinterpretation of what was happening,” she shared. “Because of that experience, I feel a certain kind of ongoing peril.”

Rehmeyer explained she often convulses and even becomes unconscious, so she wears a bracelet with important medical information and care instructions, and it’s also quickly accessible on her phone. Hospital staff and other emergency personnel have, in the past, treated her “in a way that makes things worse,” she said, “just because of their lack of familiarity with my conditions.” Following this recent emergency visit, she said she personally coordinated directly with insurance for medical transportation to her specialist neurosurgeon, who then stabilized her condition. While this event was one of the most extreme of her experiences, she has regularly encountered medical personnel who misinterpret the symptoms and flare-ups that result from her chronic conditions.

As a person with multiple chronic conditions myself, I understand Reymeyer’s advocacy, and I sympathize with her fears. While my conditions are different, they have sent me to emergency rooms and surgery tables where I had to educate my providers in some way. After 10 years as a technology provider to health care clients,

I now administer and contribute to multiple large patient support groups — including one for women with endometriosis and another for women with a rare lung condition. Members seek vetted information from scientific resources and support from one another, including discussions on how to navigate their care. For those of us with chronic conditions, accessing care is often beset with barriers both inside and outside the health care system.

More than half of the U.S. population has at least one chronic disease, and more than a third has multiple chronic conditions.1 As of 2020, the data showed that 7 to 8 million people in the U.S. are newly diagnosed every five years.2 All in, noncommunicable chronic disease is considered an epidemic by the World Health Organization that accounts for more than 85% of total U.S. health care spending and nearly 75% of global deaths, statistics that existed before COVID’s arrival and its subset of post-acute Long COVID patients.3, 4 The conclusion of Stanford University Professor of Medicine Halsted Holman in a 2020 ACR Open Rheumatology article is the same as most patients

I know: Chronic disease requires a fundamentally different kind of medical practice than acute care.5

Chronic disease encompasses a wide array of conditions for which there is not yet a cure, from diabetes and heart disease to a broad spectrum of autoimmune diseases and post-infection syndromes. While some conditions are highly manageable with regular medication, the nature of ongoing disease means that there is a life cycle to our responsibilities, treatment changes and emergency needs. Further, many people are chronically sick without having the diagnoses that could unlock the proper treatment options; they are more likely to experience emergencies because of their unknown and unmanaged conditions.

nosis with a code and clear trajectory — this is something we must live with, adapt to and mediate daily for the rest of our lives.6 Work or school attendance may become unpredictable, but financial burdens related to treatment do not stop. Our bodies may increasingly or intermittently interfere with life, including friendships, hobbies, responsibilities and sometimes even basic self-care. From both observation and research, I know that as patients with chronic disease, we often accept limits to “energy, vitality, ability to carry out activities of daily living, and relationships with family and friends.”7 We are processing grief (whether known at the time or not) as functional levels change or fluctuate, all while others may have to accommodate us in some way.

While the particulars vary based on where a patient is on the chronic continuum, I hear similar refrains echoed across research, patient support groups and even casual conversation. Through published studies and my discussions with thousands of patients managing chronic conditions, it seems clear that improving both care and health outcomes is possible. By changing the approach, beliefs and support system, patients with chronic illness and providers can both benefit.

NAVIGATING CARE WITHOUT A GUIDE

Chronic illness often involves complex symptoms caused by several factors (and perhaps affecting multiple organ systems) with little or no guarantee of linear progress or recovery. Because of this, chronically ill patients carry burdens — and even new disabilities due to their condition — which affect us and those around us. While an injury or acute disease may impact life substantially for a time, there is usually a recovery arc supported by traditional medical models and societal expectations.

Yet, due to the nature of these diseases, those of us with chronic illness do not face just a diag-

Amidst the realities of personal burden, we remain the experts on our own lives. “Especially with complex chronic illness, patients develop a level of expertise that is unparalleled,” said Rehmeyer. “The patient’s view of their own illness is so much deeper and broader because they’re living with it 24/7.” Of course, patients don’t have medical degrees or training, which are essential for proper treatment. As patients, we don’t have the same resources of knowledge, technique or process, but we are the ones implementing what any health care provider recommends outside of the hospital or exam room. We are the ones facing all the consequences when something works or doesn’t. In many ways, we are the “primary” care provider, doing the day-to-day work of care. And to be most effective, health care providers need the knowledge that only patients can provide.8 This means that we need to be supported in a way that allows us to better serve in this role.

Patients want to get better, to not need extensive care. But getting what we need involves many basics that could easily become obstacles. For example, providers go to the same places each day and generally know all of their colleagues, but patients put in lots of extra labor: researching, selecting and making appointments with physicians, managing medical records and possibly tolerating long waits, all while accommodating our own work and other responsibilities. For women, the chances are high we will need to consider someone else’s care when planning our own. Like

From both observation and research, I know that as patients with chronic disease, we often accept limits to “energy, vitality, ability to carry out activities of daily living, and relationships with family and friends.”

all people (but perhaps enhanced by our changing physical state) we may have good days and bad, and we may even worry that our appearance or mood might affect how we are perceived in a health care setting and, ultimately, treated.

While the physical, social and financial barriers can start well before the appointment, they also continue long after: handling records, prescriptions, side effects, treatment requirements and test results. Managing these issues is an ongoing reality that holds no guarantee of future relief. For some, even getting to a provider’s office or facility is impossible. “There are extended stretches when I just simply cannot physically get to a doctor’s office,” Rehmeyer explained. “Also, I’ve needed specialized care that just isn’t available locally.”

For Rehmeyer, telehealth is the number one avenue to access care, and she fears that providers and systems may be reverting back to a time when virtual visits were much less available, instead of continuing to consider telehealth a vital tool for chronic care. While Medicare-related telehealth reimbursement remains in effect until the end of 2024, many state emergency waivers — which allowed providers to prescribe and deliver services across state lines — have expired at different times. With patchwork state license requirements and removal of other protections established during the public health emergency, many hospitals and systems may choose to limit telehealth to avoid additional risks. On the ground, patients continue to report that some providers are gradually opting out or removing this option.9

Lastly, despite any internal preparation, as patients we may still struggle to communicate to our providers the very concerns that motivated us to face barriers (especially in emergencies). Even as a “veteran” patient, I still doubt that my own suffering is worth a provider’s precious time, and wonder if I am instead seen as a burden.

Several years ago, I began surveying patients with chronic illness about the ways providers spoke to them to understand how these interactions harmed or helped them. The responses were shocking: While a small percent of the responses were positive, the vast majority were not. Patients recounted personal encounters that included

receiving nonmedical advice, dismissals of selfperceived danger and even downright disrespectful remarks. When our expressed concerns are met with dismissiveness, we experience harm, as mistrust can lead to mistakes in treatment, reluctance to share relevant details or delays in seeking out new care team members who will listen to us.

These struggles do not even include the notorious challenges experienced by patients who require multiple providers across different systems, including managing medical records or health insurance. Who still keeps a fax machine or CD drive at home? As a patient, I’ve often been told by providers and their staff to use outdated technology to track and manage my own conditions, further compounding any frustration. And as a caregiver to others with chronic conditions, I’ve had to retrieve image discs from family members and physically deliver them hundreds of miles to specialists so that loved ones could get required surgeries in a timely fashion. Chronically ill patients often joke that their condition is a costly part-time job, one that comes with colleagues who consider them highly unqualified.

OVERCOMING BARRIERS TO ACCESS CARE

I presume (and a physician even confided to me once) that patients like me can be frustrating or discouraging. After all, most clinicians get into this profession to help others and to heal people. A study published in BMJ confirms what many of us who live with chronic illnesses already sense: Care providers often equate the absence of disease or signs of clear progress as personal success, so chronic cases can make a doctor feel like a failure.10

Jamie Seltzer, the director of Scientific and Medical Outreach at MEAction,11 Stanford Medicine researcher and chronic illness patient, believes that medical providers need to think dif-

When our expressed concerns are met with dismissiveness, we experience harm, as mistrust can lead to mistakes in treatment, reluctance to share relevant details or delays in seeking out new care team members who will listen to us.

ferently, even when working in an acute care environment. “The reality of chronic illness is that it’s not the doctor’s job to cure the patient,” she said, “it’s the doctor’s job to improve the patient’s quality of life, and that’s an imminently achievable goal.”

To many, the unspoken role of the patient is to get better. However, as chronic illness patients, we need slow, methodical care from a range of providers often for the rest of our lives. And even then, better is a relative term. The mismatch between expectations and realities can cause disillusion, resentment and even physician burnout.12 If providers don’t accept or consider the chronic nature of patients’ conditions, then patients may be harmed by inappropriate or unsustainable treatment.

an equal member of the care team, surrounded by medical professionals who act as our expert guides and coaches. “We have different kinds of expertise,” Rehmeyer said. “We’re bringing that expertise together to try to make things better.” What happens when a provider brings that attitude to care? “It is huge,” she sighed. “It makes all the difference.”

EQUAL PARTNERS TO ENSURE A BETTER QUALITY OF LIFE

If we can both accept new roles and shared work — and build systems that support those roles — then real change is possible. When “the physician becomes a partner with the patient,” when the patient with chronic illness “becomes an equal, functioning member of the health care team” and when the health service takes responsibility for “support of these new roles, a task distinct from generating profit,” then results can transpire.13 There is ample evidence that when this occurs, quality of care goes up and costs go down. Patients take better care of themselves and may even face fewer complications from disease or treatment as a result.

“You must assume that whatever you’re prescribing, the patient will need it for the rest of their life,” said Seltzer, when asked the number one thing that providers should know when treating chronic illness. She wants physicians and other care providers to believe patients, to maintain curiosity while diagnosing and to prioritize quality of life in treatment. “Low and slow is the key in chronic illness patients, because you don’t know yet what their sensitivity is.” She also recommends against downplaying remedies or therapies that can provide some relief or improve quality of life. “It’s not less important because it doesn’t require a white coat to administer,” Seltzer said, “and patients need to know that.” Health professionals can advise appropriate diet changes, which can significantly alter certain disease progression, and auxiliary treatments, like physical, occupational and other therapies.

Underneath the practical ways to increase access to care for those living with chronic illness lies the fundamental need to shift the traditional provider-patient role. We must be considered

Through my findings and experiences, I believe that when we are more trusted partners and supported with the education, infrastructure and tools we need, our health progress can become more steady.

TRICIA STEELE is the author of the Sick Person Guide e-book series, which helps chronically ill patients better navigate health care. She previously worked as a technology entrepreneur for 15 years and is currently in the Johns Hopkins University graduate program for science writing.

NOTES

1. “About Chronic Diseases,” Centers for Disease Control and Prevention, July 21, 2022, https://www.cdc.gov/ chronicdisease/about/.

2. Halsted Holman, “The Relation of the Chronic Disease Epidemic to the Health Care Crisis,” ACR Open Rheumatology 2, no. 3 (February 19, 2020): 167–73, https://doi.org/10.1002/acr2.11114.

3. Holman, “The Relation of the Chronic Disease Epidemic.”

4. “Noncommunicable Diseases,” World Health

“The reality of chronic illness is that it’s not the doctor’s job to cure the patient, it’s the doctor’s job to improve the patient’s quality of life, and that’s an imminently achievable goal.”

— JAMIE SELTZER

Organization, September 16, 2022, https:// www.who.int/news-room/fact-sheets/detail/ noncommunicable-diseases.

5. Holman, “The Relation of the Chronic Disease Epidemic.”

6. Ruth A. Anderson et al., “Adaptive Leadership Framework for Chronic Illness,” Advances in Nursing Science 38, no. 2 (April/June 2015): 83–95, https://doi.org/10.1097/ANS.0000000000000063.

7. Anderson, “Adaptive Leadership Framework.”

8. Martha M. Funnell, “Helping Patients Take Charge of Their Chronic Illnesses,” Family Practice Management 7, no. 3 (2000): 47–51, https://www.aafp.org/pubs/fpm/ issues/2000/0300/p47.html#fpm20000300p47-b1.

9. Stephanie Armour and Robbie Whelan, “Telehealth Rollbacks Leave Patients Stranded, Some Doctors Say,” The Wall Street Journal, November 22, 2021, https:// www.wsj.com/articles/telehealth-rollbacks-leavepatients-stranded-some-doctors-say-11637577001;

QUESTIONS FOR DISCUSSION

“Telemedicine Became Easier during COVID-19. Now It’s Reversing.,” CBS News, October 10, 2022, https://www.cbsnews.com/news/telemedicine-newrestrictions-after-covid-19/; Thomas B. Ferrante and Rachel B. Goodman, “Public Health Emergency Ends May 11: What Telehealth Companies Need to Know,” Foley and Lardner LLP, February 7, 2023, https:// www.foley.com/en/insights/publications/2023/02/ public-health-emergency-ends-may-11-telehealth.

10. Colin Campbell and Gill McGauley, “Doctor-Patient Relationships in Chronic Illness: Insights from Forensic Psychiatry,” BMJ 330, no. 7492 (March 17, 2005): 667–70, https://doi.org/10.1136/ bmj.330.7492.667.

11. #MEAction, https://www.meaction.net.

12. Campbell and McGauley, “Doctor-Patient Relationships in Chronic Illness.”

13. Holman, “The Relation of the Chronic Disease Epidemic.”

This article points out that more than half of the U.S. population has at least one chronic disease, and more than a third has multiple chronic conditions. Chronic diseases account for roughly more than three quarters of the country’s health care spending. Author Tricia Steele, who has written about and worked extensively with others with chronic conditions, describes ways that health care systems and providers can rethink care for those with chronic illness.

1. Does your health care system have any care approaches, pathways or educational offerings specific to patients handling a chronic illness or illnesses? What kind of assessment is done to gauge how effective these offerings might be?

2. What does it mean to be part of a care team? Are there true opportunities to gather together to share information, adjust care over time and make joint decisions?

3. Do you feel like patients should be considered part of their own care team? What sort of adjustments are needed in health care frameworks — such as refraining from calling a struggling patient noncompliant — that might shift the approach to providing care to patients with chronic illness?

4. How often do you talk with others in health care about what is helpful, or not, when you can’t cure a condition? Do you focus on the patient’s goals, that is, what they view as success? Do you incorporate measures that may bring the patient some comfort or relief, whether physically, spiritually or mentally?

5. The Ethical and Religious Directives for Catholic Health Care tell us that “A person in need of health care and the professional health care provider who accepts that person as a patient enter into a relationship that requires, among other things, mutual respect, trust, honesty, and appropriate confidentiality.” What implications does this have on the care that the Catholic health care ministry provides to patients with chronic conditions? Do our providers fully understand and appreciate the nature of the professional-patient relationship?

Finding God in Daily Life

— Pope Francis’ address to representatives of the Italian National Federation of Radiographers and the Technical, Rehabilitation and Prevention Health Professions in Clementine Hall in Vatican City on January 16, 2023

“This parable (of the Good Samaritan) ... shows us how a community can be rebuilt by men and women who identify with the vulnerability of others, who reject the creation of a society of exclusion, and act instead as neighbors …”

Vatican Media (EV)/Abaca/Sipa USA

OPENING DOORS: ACCESS TO CARE

For People With HIV, ‘Test and Treat’ Is Key

MICHAEL J. O’LOUGHLIN Contributor to Health Progress

Sam Moore needed help.

Diagnosed with HIV in 1997, the New Orleans native kept his health in check with daily medication, something of a miracle considering the devastation HIV and AIDS unleashed on marginalized communities in the 1980s and 1990s.

Though he initially struggled with his diagnosis — he said he was admitted to a psychiatric ward upon learning the news — Moore adapted. But when he returned home to New Orleans in 2017, following the death of his girlfriend, he turned to once-familiar coping methods, including drugs and alcohol, and was soon living on the streets.

When an outreach worker told Moore about Project Lazarus, which provides temporary housing to people living with HIV, he applied for an apartment and moved in a month later.

Staff at Project Lazarus, supported by the Archdiocese of New Orleans, connected Moore, 59, with medical professionals who ensured he had access to the right medications. They helped him find a job and eventually a permanent home. Last year, when Moore suffered a setback, he returned to Project Lazarus, and is waiting for permanent housing. But the community keeps him upbeat.

“Dealing with HIV, you know, you’ve got the negative people and you’ve got the positive people,” Moore said. “Don’t listen to the negative ones. Follow the positive ones.”

Moore’s story is emblematic of the multiple challenges facing many of the nearly 1.2 million Americans living with HIV.1 While the HIV and AIDS crisis peaked in the mid-1990s, according to federal data, tens of thousands of people are diagnosed with HIV annually.2 About 30,000 people tested positive in 2020, down about 19%

from five years earlier. That is all good news, and while pharmaceutical advances make living with the virus manageable, people from the most marginalized communities continue to struggle with gaining access to appropriate medical care.

At St. Mary’s Health System in Lewiston, Maine, the HIV case management clinic has served their rural community since about 2000. The founder of the clinic, Dale Morrell, recognized at the time that while most nonprofits focused on prevention and education, there were few organizations serving people already living with HIV.

The clinic’s decision to discern how it could be of service to the community was inspired by the spirit set forth by the Sisters of Charity of SaintHyacinthe. They founded the system’s first hospital in 1888, having arrived from Montreal to provide health care to the then-sizable French Canadian population.

Early in the HIV clinic’s work, patients were frustrated that local doctors seemed to know little about HIV care. Stigma was rampant. Today, much of that has changed, and the clinic connects its patients to nursing professionals and case managers.

Mara Larkin, the clinic’s director of care coordination, introduces patients to medical teams and helps them enroll in programs that subsidize their coverage. In terms of accessing care, the clinic considers the whole person, not just their medical realities.

“When you also have transportation issues, when you don’t have housing, when you don’t have access to good food, sometimes it can be challenging to follow a strict medical regimen,” Larkin said. “We try to be a clearinghouse of needs, and when we cannot fulfill them directly, we make referrals to the community.”

With ongoing inequities experienced by people living with HIV in minority and marginalized communities, consideration of all aspects of one’s social determinants of health when providing care remains essential.

ADDRESSING DIVERSE POPULATIONS

Some of the challenges facing an HIV care clinic, like the one at St. Mary’s, may not be entirely apparent when envisioning a rural patient population, such as the one in Maine.

Roughly 6,000 of Lewiston’s 36,000 residents are refugees and asylum-seekers, including many from Angola and Congo.3 St. Mary’s, and its HIV clinic, serve these “new Mainers,” as Larkin calls them, as they adjust to life in a new country. Sometimes, that means helping patients manage the surprise of an HIV diagnosis.

with HIV and AIDS for decades, said he never imagined the efficacy of the drugs available today — and the long lives his patients would go on to lead — when he first started practicing in the 1980s.

“Effective treatment for HIV is one of the great advances of modern medical care,” said Dr. Timothy Flanigan, an infectious diseases doctor at The Miriam Hospital and Rhode Island Hospital and a professor of Medicine at the Alpert Medical School at Brown University.

Flanigan, who is also a Catholic deacon, said an individual with HIV can stop viral replication and actually reverse their disease, allowing the immune system to repair itself. The treatment that makes that possible, Flanigan said, is “highly effective, very straightforward and has very few side effects.”

So does that mean the challenge of HIV is over?

“The answer is no,” Flanigan said, “because individuals with HIV struggle with so many different, overlapping conditions which are so hard to overcome.”

Those challenges form “overlapping epidemics,” he said, and often include substance use disorders, including alcohol dependency, as well as mental health issues and a lack of access to basic necessities.

“It can be impossible to get care if you can’t get enough to eat, and you can’t get a roof over your head,” Flanigan said.

The clinic staff helps patients navigate government bureaucracy to see if they are eligible for financial assistance and tries to lessen the stigma still associated with the virus. Some clients have even been skittish about using translators because of fear that their diagnosis will get out into their community. “So, there’s a huge effort with confidentiality, and we are encouraging access in ways that are not self-evident that this is what individuals are accessing,” Larkin said.

In addition to holistic care, including special attention to mental health, the clinic also focuses on a particular challenge related to HIV that would have been difficult to imagine during the earliest days of the crisis: helping people age well while managing life with the virus, a possibility because of incredible advances in HIV treatment options.

One physician, who has worked with patients

Then there is internalized stigma.

Catholic health care workers serving people with HIV should remember that “one of the great gifts of our faith is that each of us is a child of God,” Flanigan said. “We may have this or that illness, but that doesn’t define who we are.”

Helping patients accept that, however, can be challenging, but it’s essential if access to care is a priority.

“Putting your hand on their shoulder and telling them that our medications are phenomenally good, that we are going to provide care for you, that you are not going to walk this journey alone,” Flanigan said, “gives that person hope.”

Hospitals can help underresourced patients connect with clinics affiliated with the Ryan White HIV/AIDS Program, a federally funded program that serves low-income people with HIV.4

“For anybody providing medical care, it’s

“It can be impossible to get care if you can’t get enough to eat, and you can’t get a roof over your head.”

— DR. TIMOTHY FLANIGAN

important that they feel comfortable providing HIV testing, HIV screening, as well as HIV prevention,” Flanigan said.

Sometimes testing and screening is most effective when it takes place not in a clinic, but out where people live.

Atlanta, like other Southern cities, has struggled to combat stubbornly high rates of HIV.5

Mercy Care, which traces its roots to Catherine McAuley, founder of the Sisters of Mercy, reaches out to residents in Greater Atlanta to provide rapid HIV testing and to connect people newly diagnosed with the virus to proper health care.

Andrea Steward manages the HIV prevention and treatment for Mercy Care. In recent years, she has hosted testing events at music festivals, in retail spaces and at local universities. These included Morehouse College, where Mercy Care offered testing on World AIDS Day, commemorated each December 1.

The mobile testing process is straightforward — completed in about five minutes — but following up with patients who test positive can be difficult. Obstacles include patients who lack cell phones and email addresses; transportation challenges; and maintaining vital education, especially when it comes to medical adherence.

“It’s really important to make sure that they’re taking their medication accurately, because we want to make sure they don’t become resistant to a medication,” Steward said.

UNDERSTANDING VARIED COMMUNITY NEEDS

HIV affects different communities in unique ways. That means hospitals and health systems have to consider how they interact with individuals from particularly marginalized communities.

Helping health care workers understand those communities, and their unique needs, is the goal of Sean Cahill, PhD, the director of health policy research at The Fenway Institute, a secular nonprofit organization based in Boston that focuses on LGBTQ health and those living with HIV.

“Transgender people live in our society, they have health care needs, they need access to health care, just like everybody else,” Cahill said. “And they need care that’s nondiscriminatory, culturally

responsive, affirming and clinically competent.”

According to a 2017 report, coauthored by Cahill, “transgender women of all racial and ethnic backgrounds are 49 times more likely to be HIV-infected than the general population” and they “are less likely than other (HIV-positive) populations to adhere to their antiretroviral medications.”6

Transgender women report high incidences of negative experiences in health care settings, the report states, in part because of decades of social injustice, leading to hesitation when it comes to managing HIV. Those kinds of experiences can be mitigated by training.

Cahill said hospitals can do simple things to help LGBTQ patients feel welcome, like display rainbow or transgender flags in common spaces and advertise in LGBTQ media. But then, Cahill said, institutions have to “walk the talk.” That means asking patients their preferred names and pronouns, for example, to alleviate some anxiety.

One goal must be paramount for health care workers if there is any hope for the epidemic to wind down, according to several HIV experts.

“The most important way to prevent transmission is to get people who are infected on treatment,” said Dr. Jon Fuller, SJ, a Jesuit priest who provided HIV care at Boston Medical Center from 1987 until his retirement in 2021.

Fuller called the advent of modern pharmaceuticals such as pre-exposure prophylaxis (PrEP), medications that reduce the chance of someone contracting HIV through sex or IV drug use, miraculous. But remaining undetectable is the key.

The concept of getting people with HIV onto antiretroviral therapy treatments, to suppress an individual’s viral load to the point where it is undetectable, is referred to as HIV Undetectable=Untransmittable (or U=U). It

With ongoing inequities experienced by people living with HIV in minority and marginalized communities, consideration of all aspects of one’s social determinants of health when providing care remains essential.

means that the person cannot spread the virus, thus making it untransmittable. The results are twofold, protecting a person’s own health and slowing the spread of HIV.7

“If you’ve got HIV suppressed, and you’re otherwise in good shape, with good nutrition and exercise, you can live a life expectancy that’s going to be determined by your other medical conditions, not by HIV,” Fuller said. “Not only will you be taken care of, but the epidemic will stop spreading.”

While longer-lasting injections are now available, most PrEP medications have to be taken daily.8 That can be difficult for people experiencing various crises, especially challenges associated with housing or mental health. And while Fuller is encouraged that PrEP is becoming more accessible and widely used by gay and bisexual men, as well as transgender women, he laments that Black and Hispanic communities are unable to access the medication at the same rate as gay, white men.9

OVERCOMING OBSTACLES FOR BETTER HEALTH OUTCOMES

Back in New Orleans, the executive director of Project Lazarus, Susanne Dietzel, PhD, sees firsthand how similar inequities plague the population she serves, including Moore.

Some are widespread in many communities and can be intertwined, such as not being able to secure appointments with physicians, cognitive disabilities and unstable housing that make taking a daily medication difficult.

Others are more localized, but no less challenging.

“At the beginning of every hurricane season, we always say to our residents, ‘We want to make sure that everyone has at least a 30-day supply of their drugs in hand,’” Dietzel said. “If we have to mandatorily evacuate, we want to make sure that they have all of the necessary information that they need to access their drugs somewhere else.”

But Project Lazarus fills one specific need that nearly everyone interviewed for this story said remains essential to helping people with HIV access care.

“Housing is health care,” Dietzel said. “Stable housing encourages people to have their drugs in a regular place at all times.”

“Housing and nutrition are absolutely critical,”

she said. “You take one of those out of the equation, then someone’s health status declines rather rapidly.”

MICHAEL J. O’LOUGHLIN is the national correspondent for America: The Jesuit Review, author of Hidden Mercy: AIDS, Catholics, and the Untold Stories of Compassion in the Face of Fear and host of America’s podcast series “Plague.”

NOTES

1. “HIV Basics: Basic Statistics,” Centers for Disease Control and Prevention, June 21, 2022, https://www.cdc. gov/hiv/basics/statistics.html.

2. U.S. Statistics, HIV.gov, October 27, 2022, https:// www.hiv.gov/hiv-basics/overview/data-and-trends/ statistics/.

3. Cynthia Anderson, “Refugees Poured into My State. Here’s How It Changed Me,” The Christian Science Monitor, October 28, 2019, https://www.csmonitor.com/ USA/2019/1028/Refugees-poured-into-my-state.Here-s-how-it-changed-me.

4. “The Ryan White HIV/AIDS Program: The Basics,” Kaiser Family Foundation, November 3, 2022, https://www.kff.org/hivaids/fact-sheet/ the-ryan-white-hivaids-program-the-basics/.

5. Ellen Eldridge, “On World AIDS Day, Georgia Leads the Nation in New HIV Cases – And Atlanta Is a Hot Spot,” GPB, December 1, 2022, https://www.gpb.org/ news/2022/12/01/on-world-aids-day-georgia-leadsthe-nation-in-new-hiv-cases-and-atlanta-hot-spot.

6. Connor Volpi and Sean Cahill, “Retaining Transgender Women in HIV Care: Best Practices in the Field,” The Fenway Institute, 2018, https://fenwayhealth.org/ wp-content/uploads/TFIR46_RetainingTransgender WomenInHIVCare_BestPractices_web.pdf.

7. “HIV Undetectable = Untransmittable (U=U), or Treatment as Prevention,” NIH, https://www.niaid.nih.gov/ diseases-conditions/treatment-prevention.

8. “FDA Approves First Injectable Treatment for HIV PreExposure Prevention, U.S. Food and Drug Administration, December 20, 2021, https://www.fda.gov/news-events/ press-announcements/fda-approves-first-injectabletreatment-hiv-pre-exposure-prevention.

9. Benjamin Ryan, “PrEP’s Promise to Change the Course of HIV Has Succeeded — But Only for White Gay Men,” NBC News, March 18, 2023, https://www.nbcnews. com/nbc-out/out-health-and-wellness/preps-promisechange-course-hiv-succeeded-only-white-gay-menrcna75438.

Community Clinic Delivers Care With Dignity for the Underserved

ROBERT LIPPMAN, DBH, MSW

hank you,” the woman said as she entered the clinic. Those two words were the simple prologue to a heartfelt story. She proceeded to tell me that earlier in the year she had come to the clinic as a patient when she was experiencing homelessness and addiction to get a free two-hour bus pass. During her visit, we asked if she would like to use the clinic shower. She still remembered how that water washed off more than a little grime — it empowered her to manifest a new belief in herself. She then used her bus pass to get to a local rehab facility. “Today,” she said, “I am proud that I have been clean for three months and am no longer homeless.”

We passionately believe that our job at the Providence Community Clinic in downtown Spokane, Washington, is to welcome people and meet them where they are in their lives, regardless of their circumstances. From there we look to God. This woman’s story illustrates a powerful expression of God’s healing love, which is central to Providence’s service as a Catholic health care organization.

OPENING DOORS TO CARE

Providence Community Clinic was the first free medical clinic in Washington state when it opened in 1976.1 Our patients include people who are uninsured or underinsured, most of whom are experiencing chronic homelessness. Providence’s investments in community benefit covers the cost of care for people who cannot afford it.2 This opens the door for many people who put off care or have gone without it. Our philosophy is to gain trust and develop lasting relationships with those we serve, recognizing that the only

common denominator in all homelessness is lost relationships.

Homeless individuals have few people to rely on, often leading them to be very distrustful. The continuity of the program’s staff helps to build trust. Being greeted at the clinic by familiar individuals who understand the patient’s situation helps us to better support them.

We have a few different ways to build this trust. For example, we take photos of each of our patients to include in their private files. That way, we can greet them by name when they walk through our doors. For those who have experienced generational trauma resulting in mistrust in people and systems, we’ve created a safe space in the clinic for patients to leave their pets while they see our care teams. This is not an option at most health care facilities, but we felt it was important to offer this option because, for many patients, these animals are their best friends and most trusted supporters.

We recognize that homeless individuals struggle with access to medical care due to lack of

Providence Community Clinic Operations Manager and Behavioral Health Provider Chair of Spokane Homeless Coalition and Co-Chair of Spokane Regional Continuum of Care Board

insurance, transportation and necessary funds to cover health care costs. Because their needs often do not fit the constructs of the health care system, we make Providence Community Clinic more accessible with walk-in care and extended appointment times so that we can assess complex issues with a person’s medical and mental health. We offer everything from basic medical exams to consultations with specialists, immunizations, screenings and mental health evaluations. For more urgent concerns, we may triage to local medical facilities, arranging for transportation and care coordination.

For example, a woman named Carol came to our clinic with severe arthritis and carpal tunnel syndrome in her wrist. Not only did we treat her medical issues, but our team helped sign her up for medical coverage and connected her with affordable housing resources.

Within a few visits, Carol had the medication and brace she needed for her chronic pain. I’m excited to share that through our referral to other community resources, she found the housing support she needed, too. She now has her own place to call home.

protect their privacy.

Providence Community Clinic also has an outreach program that makes visits to homeless shelters and encampments to ensure these individuals receive care even if they don’t have the means to visit the clinic. This outreach program is made possible by volunteers who are active or retired medical health care providers who treat minor illness, provide wound care and serve as conduits to community resources.

This outreach creates an additional touch point to reach people in need. During one of our visits to a day center for homeless people earlier this year, we met a man whose prescription medicine had been stolen. By the end of his visit, we were able to provide him with a short-term prescription and create a new bond that we believe will bring him into our clinic for additional care.

“The time was taken to make sure I was comfortable and cared for,” he told us.

THE NATIONAL SCOPE OF HOMELESSNESS AND HEALTH

“Providence Community Clinic went over and beyond,” Carol said. “They’re truly here to help us.” Carol’s full name and the names of some other patients in this article are not being disclosed to

Homelessness takes many forms, and can encompass people living on the streets, in encampments or shelters, in transitional housing programs or doubled up with family and friends. The federal government found that more than 580,000 people were experiencing homelessness on a single night in January 2022. 3 Estimates show homelessness has increased every year since 2017.4 There also continues to be an overrepresentation of Black people and Indigenous people (including Native Americans and Pacific Islanders) among the homeless population, when compared to their proportion of the total U.S. population, according to the U.S. Department of Housing and Urban Development. 5 For example, Black people are estimated at 39% of all individuals experiencing homelessness in the country and 53% of those experiencing homelessness in families with children, however are only 12% of the total U.S. population.6

Health risks associated with homelessness can

The Providence Community Clinic team, left to right, Angela Chapman, PCC, Wendy Smith, ARNP, Robert Lippman, DBH, MSW, and Sarah Isakson, CMA. Volunteers also assist at the clinic.

Photo courtesy of Providence

lead to a broad range of adverse health outcomes. Those experiencing homelessness have much higher rates of diabetes, hypertension, tuberculosis, asthma, HIV/AIDS and mental health disorders.7 The barriers that unhoused people face

lead to greater use of emergency services and higher rates of medical hospitalizations for serious conditions. In addition, homeless individuals are often discharged with minimal resources into settings inappropriate for recovery, leading to higher rates of readmittance and adverse health outcomes.

According to the National Health Care for the Homeless Council, homeless people, on aver -

age, experience shorter life expectancies by 12 years compared to the general U.S. population.8 Living on the streets and in homeless shelters pose unique health risks to homeless individuals, including exposure to communicable diseases, harmful weather conditions, violence, drug use and malnutrition. These issues are then intensified by the emotional and mental stressors inherent to the state of homelessness. Stable housing provides privacy and safety, and it is also a place to rest and recuperate from surgery, illness and other ailments without worry about where to sleep and find a meal, or how to balance those needs with obtaining health care and social services.

So, what is the state of homelessness in Spokane? A recent 2022 Point in Time Census of Spokane County’s homeless populations, conducted under the umbrella of the U.S. Housing and Urban

Providence Community Clinic Operations Manager Robert Lippman, DBH, MSW, shows the inside of the clinic’s donation closet, stocked with items for patients, like blankets, clothing and hygiene kits.

Photo courtesy of Providence

Homeless individuals have few people to rely on, often leading them to be very distrustful. The continuity of the program’s staff helps to build trust.

Development Department, indicated an approximate 13% rise in homelessness over the last complete tally conducted two years prior.9 The growth of “outdoor encampments” more than doubled in the two years between 2020 and 2022.10

COVID’S IMPACT ON HOMELESSNESS

COVID changed everything almost overnight. In Spokane, shelters slashed their occupancy by half to accommodate social distancing,11 community partners shut their doors, and other providers to homeless people decreased access at an alarming level. Case workers felt like they were “sailing in the nighttime” with everyone simply frozen, unsure how to chart a course through choppy seas.

Providence Community Clinic was one of the few organizations that did not shut its doors. I am proud to say that our clinic did not close for one

day throughout the entire pandemic. We quickly established protocols and precautions for testing and provided separate spaces for symptomatic and nonsymptomatic patients. We provided clinic lunches because many of the homeless outreach food sources were closed.

We distributed hygiene kits as well. While that was a difficult time, it also highlighted the persistent needs of our community, which revealed an opportunity for growth in outreach or field medicine. With the support of volunteer providers, we expanded our services into some of our local shelter systems, allowing us to help even more people.

PLANNING AHEAD

Providence has cared for our community in numerous ways and for many people since the Sisters of Providence arrived in Spokane more than 135 years ago. Providence Community Clinic

Wendy Smith, ARNP, listens to a patient during his visit in March at the Providence Community Clinic in downtown Spokane, Washington.

Photo courtesy of Providence

continues that tradition of improving the health and well-being of our community, thanks to support from Providence Inland Northwest Foundation donors. Past gifts helped us update our clinic space, supplied new medical equipment and provided supportive services, such as bus passes and warm clothing.

OPENING DOORS: ACCESS TO CARE

patient who regularly visits, and when he does, we let him use our phone. He uses it to call his mom. Another patient, named Matthew, is working hard to find a steady job. While our clinicians helped him with concerns he has about pain in his feet, I looked over his resumé, and, before a big interview this year, I helped him prepare by leading him through a mock interview.

The staff at Providence Community Clinic also engages in applying for grants and identifying new collaborations with regional partners and resources. Our hope is to increase our outreach capacity to help the vulnerable with expanded services. That includes recruiting and training volunteers who have a commitment to consistency. Because we know that trust is built through consistent interactions between patients and staff, we look for specialty providers who are regularly available, whether weekly or monthly. Through these volunteer relationships, we also have psychiatry residency support and dermatology and podiatry care for our patients in Spokane.

It takes the right type of personality and a deep commitment to join a team of providers caring for people experiencing homelessness. The marginalization of homeless individuals as being “less” is a barrier for many people. I spent seven years working with hospice before joining Providence Community Clinic and found a unique similarity between the two. There is a vulnerability associated with working in situations where you can’t control the outcomes for the patients. That is why caregivers who work within these specialized health care fields must lead from their heart, not just their head.

I see this with my team every day. We have a

As a behavioralist, I believe that exposures in childhood mold the future and create neural pathways that help you think in certain ways. My childhood was influenced by a single mother who opened her house to family and friends who were facing difficult situations — an uncle in hospice, a friend who was facing loss and many others. My own room was often given up to someone who needed shelter. My mother passed away after a brief time in the workforce after completing her formal education in social work, but her legacy as a community advocate was embedded in me to speak up for those who are viewed as “less.”

Today, I am dedicated to enhancing the value of relationships among the people we serve and helping them heal in whatever way possible. The Providence Community Clinic has a long history in our community. Sister Peter Claver, MSBT, the leader and builder of Providence Sacred Heart Medical Center and Catholic Charities Eastern Washington, shared a desire to provide people experiencing homelessness in our community access to health care. In 1976, this dream became a reality with the House of Charity Medical Clinic. It has served thousands of patients for more than 40 years with volunteer doctors and nurses. The success of the clinic grew through the decades, and it now stands as Providence Community Clinic, embodying the heart of the Providence mission: As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

It takes the right type of personality and a deep commitment to join a team of providers caring for people experiencing homelessness. The marginalization of homeless individuals as being “less” is a barrier for many people.

Watch a video about the day-to-day work of Providence Community Clinic in Spokane, Washington.

ROBERT LIPPMAN is chair of the Spokane Homeless Coalition and co-chair of Spokane Regional Continuum of Care Board. He is clinic operations manager and behavioral health provider for Providence Community Clinic in Spokane, Washington.

NOTES

1. “Providence Community Clinic,” Providence, https://www.providence.org/our-services/wa/ providence-community-clinic.

2. “Annual Report to Our Communities,” Providence, https://www.providence.org/about/annual-report.

3. “HUD Releases 2022 Annual Homeless Assessment Report,” U.S. Department of Housing and Urban Development, December 19, 2022, https://www.hud.gov/press/ press_releases_media_advisories/HUD_No_22_253.

4. Tanya de Sousa et al., “The 2022 Annual Homelessness Assessment Report (AHAR) to Congress,” The U.S. Department of Housing and Urban Development, December 2022, https://www.huduser.gov/portal/sites/

QUESTIONS FOR DISCUSSION

default/files/pdf/2022-AHAR-Part-1.pdf.

5. Tanya de Sousa et al., “The 2022 Annual Homelessness Assessment Report.”

6. Tanya de Sousa et al., “The 2022 Annual Homelessness Assessment Report.”

7. “Homelessness & Health: What’s the Connection?,” National Health Care for the Homeless Council, February 2019, https://nhchc.org/wp-content/uploads/2019/08/ homelessness-and-health.pdf.

8. “Homelessness & Health,” National Health Care for the Homeless Council.

9. “Point-in-Time Count 2022: Homelessness and Housing in Spokane, WA,” ArcGIS StoryMaps, May 19, 2022, https://storymaps.arcgis.com/stories/ cfa1af9e03d14501b95f2fce6e8c1197.

10. “Point-in-Time Count 2022,” ArcGIS StoryMaps.

11. Adam Shanks, “Coronavirus Measures to Cut Shelter Capacity in Half; Officials Looking for Alternative Sites,” Coeur d’Alene Press, March 16, 2020, https://cdapress.com/news/2020/mar/16/ coronavirus-measures-to-cut-shelter-capacity-5/.

The Providence Community Clinic in Spokane, Washington, provides a number of ways to make sure those who are impoverished or do not have housing feel valued and appreciated when they come into the clinic.

1. What struck you about some of the approaches staffers and volunteers take to make people feel welcome and at ease? Could you incorporate any of these ideas into your own health care practice or environment? What alternate steps can be taken to recognize and remember each individual patient? Why is this important to their care?

2. Often, environments that help those most in need have limited resources that can’t keep up with demands. How do you plan for procurement and allocation of resources? What do you do if resources run out, or if you don’t have something that would aid in someone’s care? If your organization makes a referral for resources or additional care, does anyone follow up with the patient or client to see if they received the assistance they were seeking?

3. Caring for those greatly in need can sometimes take an emotional toll, especially if you feel those you are caring for have been marginalized by society, or if their needs are significant and complex. What approaches do you take to manage this? Do you help the person set short-term goals? Do you look for “little victories”? Do you try to focus on doing the best you can for that person in the moment?

4. Author Robert Lippman says that “caregivers who work within these specialized health care fields must lead from their heart, not just their head.” As a Catholic health care ministry, how might we be ideally positioned to provide care and support to marginalized communities? What connections can you make between this statement and your own mission, vision and values?

Understanding Veterans’ Unique Needs Is Crucial to Their Care

CHRISTINA J. SCHAUER, MSN, ARNP, ACNS-BC Director of Clinical and Professional Development at MercyOne Dubuque Medical Center

When I joined the U.S. Army in 1999, I never envisioned myself being sent to war. However, on September 11, 2001, the world drastically changed, and by May of 2003, I was boarding a plane to Southwest Asia. That year — as a combat medic with the 389th Engineer Battalion in Baghdad, Iraq — was the part of my military experience, if not of my life, that led me to some deep realizations.

More than anything, that time taught me how to evolve. The year was full of challenges, and some of those issues still continue today. But my time in Iraq taught me how to intentionally use those difficult experiences to learn and drive change that may help others, and possibly myself, in the process. It is through this lens that I approach my work as a medical provider, particularly when working with veterans at MercyOne in Iowa. Understanding and responding to the health concerns and challenges specific to the military community is critical in providing personalized care to our veteran patients. As a veteran, I know I have a unique opportunity, and I hold a unique sense of commitment to ensure our veterans receive excellent care.

CLOSING HEALTH CARE GAPS FOR VETERANS

One of the biggest misconceptions of community health organizations is that all veterans primarily rely on the U.S. Department of Veterans Affairs (VA) for their health care needs. In reality, not all veterans are eligible for VA benefits, and about half of VA enrollees report using at least some health care services that are provided and paid for outside the VA.1 A little more than 45% of

veterans are enrolled in the VA system,2 and only about 30% report that they rely on the VA as their sole source of health care.3 Also, about 80% of VA enrollees report having some type of public or private insurance coverage in addition to VA benefits, such as employer-provided private insurance, TRICARE or Medicare, which allows them to choose whether they want to receive health care through the VA or local providers. 4 Since most veterans rely on the community for at least some, if not all, of their health care, it’s crucial that community health care workers are prepared to meet these veterans’ unique health needs.

MercyOne’s Military and Veterans Health Care, commonly called MILVET, is one way that the health system is driving change and closing gaps between veterans and health care by having processes in place to initially help our team identify veterans. All patients are asked about their military status when they visit our hospitals, which allows us to identify veterans and understand the military’s impact on their health history, an important aspect which might otherwise have gone unrecognized.

Additionally, all our patient-facing staff are educated on specific military and veteran health

needs within their first days in the organization. This one-and-a-half-hour training is presented live on the second day of orientation by two veterans, Gerald Meyers, business support specialist at MercyOne Dubuque Medical Center and U.S. Army veteran, and myself. Together, we use our personal experiences to complement the data and engage colleagues in this important mission. The awareness training covers:

Understanding of military culture, including the nuances of various military branches.

Common diseases, illnesses, injuries and exposures associated with military service and military deployments.

Effects of military service and deployments on family members.

A UNIQUE APPROACH TO CARE FOR VETERANS

Military experiences affect veterans in multiple ways, therefore it’s beneficial for health care workers to draw from this knowledge to provide

appropriate care. For those who interact with and treat patients who served in the military, it’s helpful to know:

Veterans’ experiences and where they served geographically are key to understanding medical issues they could be facing, and learning more about these aspects of someone’s life may help with diagnoses and treatment decisions. For example, veterans who served in Vietnam may have been exposed to Agent Orange, a chemical herbicide, which can cause cancer and life-threatening health complications.

Post-traumatic stress disorder (PTSD) is prevalent in the veteran community, and not only due to combat. Sexual trauma and traumatic head injuries can also cause PTSD and can be a key factor in the high rates of alcohol use or misuse among veterans.

“Moral injury” can take a toll on veterans. According to the VA, moral injury, in the context of war, comes from participation in actions related to combat warfare where one feels they may have violated their conscience or moral compass. Returning from combat and having to adjust to a new moral system in a noncombat environment can sometimes prove challenging for veterans, and therefore requires special care.

MY PERSONAL PATH TO CARE

It wasn’t until we started our Military and Veterans Health Care in 2019 that I realized the significance of these health care gaps for veterans, and how important this initiative could be in eliminating those disparities. Even as a credentialed nurse and veteran, I was overwhelmed with new knowledge when we started learning about the health implications of military service, as very little is taught about veterans in standard health care curriculum.

Not only did this education help me provide better care for patients, I was also personally affected by the program. Though my service was fulfilling and honorable, I began having breathing issues when I returned home in 2004. Running became more challenging, and I struggled to take a deep breath anywhere from several hours to several days after a run. I scheduled an appointment with the VA at that time, and they ran several tests. When everything came back normal, they suggested that the issue could be a result of anxiety. As a college sophomore who recently returned from war, I accepted that as the cause. For many

Photo by Ian Herbst — IAVA All-Star Advocate

Christina J. Schauer

years, I worked to calm myself down whenever I had difficulty breathing, and I thought I was managing the issue as best I could.

It wasn’t until I learned through MercyOne’s program for veterans about the high rates of respiratory issues in veterans returning from Iraq and Afghanistan 5 — a trend that was not yet identified during my initial 2004 visit to the VA — that I started wondering if anxiety was not the source of my breathing issues. When the air hunger and coughing turned to wheezing, I finally returned to my physician and was eventually placed on a steroid inhaler. The change in my breathing was incredible, and I was able to tolerate exercise once again.

After my diagnosis, I knew I had to share my experience and ensure that I could help remove some of the barriers veterans have accessing health care. One of the ways I help is through my community outreach work with the Military and Veterans Health Care.

The program partners with the VA and other community organizations to advocate for veterans through frequent community health education sessions and building connections. In early 2021, we partnered with the Dubuque County Veterans Affairs office to provide hundreds of veterans aged 65 and older with their first and second doses of the COVID-19 vaccine. MercyOne’s mobile medical unit also plays a key role in our outreach efforts by meeting veterans where they are, including the Veteran’s Freedom Center and farmers markets, and through administering vaccines or providing resources to help connect them to their earned health care or benefits.

THE JOYS OF SERVING WOMEN VETERANS

One of my favorite aspects of the community out-

OPENING DOORS: ACCESS TO CARE

reach work I facilitate through Military and Veterans Health Care is working with other women veterans. I am personally most committed to: Improving community peer support for women veterans, who often struggle connecting

with others after discharge. Many also report not feeling a sense of belonging in traditional veteran communities, as most veteran communities are predominantly male and have been developed for a demographic with significantly different needs and interests. While I can’t speak for all women, I have always been welcomed into these communities. But being allowed into a group that was made for someone so unlike me carries a much different feeling than entering a community that

U.S. Coast Guard veterans Domonique Chames and Brandi Herring at a planting party in March hosted by Tri-State Women Warriors, a peer support network for women veterans. The Dubuque County VA and Planted in Dubuque, Iowa, sponsored the event.

Photo courtesy of Christina Schauer

was tailored for me. Creating local peer support networks that promote belonging for women can help connect them to resources, and more importantly, to other women veterans.

Advocating for increased research on the impact of military deployments on reproductive health, specifically birth defects. In 1998, approximately 25 years after the Vietnam War ended, the VA published the “The State of Reproductive Health in Women Veterans.” 6 The study found that women who served in Vietnam were significantly more likely to have children with moderate to severe birth defects than women who served in the same era and did not go to Vietnam. While this is a useful resource, I believe there should be more funding and research to better understand how military deployments affect the reproductive health of women veterans and subsequent correlations to birth defects.

Some of the greatest successes that come from veteran-focused initiatives like MercyOne’s program are the connections made with other veterans. I didn’t realize this was a void in my life until I returned to the veteran circles. Interestingly, I joined these circles to help others, and ended up helping myself in the process. As a veteran, you don’t realize sometimes how much you’re “faking it” to fit in with the rest of society — but having a community of people that have shared these unique experiences, both good and bad, is incredibly important. Some of the strongest connections I’ve made have been with other women veterans in our tri-state area through a peer support network we have created called the Tri-State Women Warriors. This has turned into a dynamic and growing community focused on supporting and empowering veterans everywhere.

HOW WE CAN HELP

In health care, one of the ways that we can provide necessary support and care for veterans seeking medical attention is educating our staff members to ask veterans about their military experiences.

Military and Veterans Health Care helps colleagues better understand the physical, emotional and spiritual impact of operational deployments

on service members and their families. With this enhanced awareness of patients’ military experiences, MercyOne positions itself to provide a more comprehensive health care experience for its military community.

MercyOne Clinton Medical Center, MercyOne Dubuque Medical Center, MercyOne Siouxland and MercyOne Waterloo Medical Center provide Military and Veterans Health Care. To find out more about the program and MercyOne’s community benefits for veterans, visit the Military and Veterans Health Care webpage at https:// www.mercyone.org/military-and-veterans-care/.

CHRISTINA J. SCHAUER is director of clinical and professional development at MercyOne Dubuque Medical Center in Dubuque, Iowa, and leads MercyOne’s Military and Veterans Health Care for the health system’s Eastern Iowa Region. Schauer served in the U.S. Army during Operation Iraqi Freedom as a combat medic, which included a one-year deployment in 2003 to Baghdad, Iraq. She is also an advocate for veterans through the Iraq and Afghanistan Veterans of America.

NOTES

1. Z. Joan Wang et al., “2021 Survey of Veteran Enrollees’ Health and Use of Health Care,” Advanced Survey Design, September 24, 2021, https://www.va.gov/ VHASTRATEGY/SOE2021/2021_Enrollee_Data_ Findings_Report-508_Compliant.pdf.

2. “Veterans as a Percent of County Population (FY2019),” U.S. Department of Veterans Affairs, https:// www.datahub.va.gov/stories/s/7g2p-v3sr.

3. Wang et al., “2021 Survey of Veteran Enrollees’ Health.”

4. Wang et al., “2021 Survey of Veteran Enrollees’ Health.”

5. “Study: Iraq, Afghanistan Veterans at Increased Risk of Respiratory Illness,” U.S. Department of Veterans Affairs, August 26, 2014, https://www.research.va.gov/ currents/summer2014/summer2014-24.cfm#.

6. Laurie C. Zephyrin et al., “The State of Reproductive Health in Women Veterans,” Women Veterans Health Care, February 2014, https://www.womenshealth. va.gov/docs/SRH_FINAL.pdf.

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Protect What’s Precious Retaining Medicaid Coverage Is Vital for Vulnerable Populations

PAULO G. PONTEMAYOR Senior Director of Government Relations, Catholic Health Association

The early days of the COVID-19 pandemic posed numerous challenges to society, as communities and governments around the world worked to mitigate the health and economic fallout from the virus. We can remember how, in 2020, states began to shut down schools, restaurants and places of worship to help prevent its spread. We can probably even remember the fateful day of January 31, 2020, when Alex Azar, the secretary of the U.S. Department of Health and Human Services, declared COVID-19 a public health emergency. Immediately after this declaration, the Centers for Disease Control and Prevention, National Institutes of Health and other federal entities began to coordinate a response, developing testing, researching therapeutics and working to make vaccines available.

As more jurisdictions imposed lockdowns in an effort to stop the spread of COVID-19, businesses and organizations had to reorient to this new reality and initiate closings. Many people lost their jobs and, in doing so, their access to employersponsored health insurance. As the virus continued to infect larger swaths of the population, including those in vulnerable communities, access to health coverage proved to be an important factor for individuals and families to access treatments to battle the disease. The early days of the pandemic were a time of great uncertainty and a test of how government could respond to public health emergencies. Thankfully, the Medicaid program was there to ensure health care coverage for those who would be most affected by the economic and health consequences of the COVID-19 pandemic.

While the executive branch of the federal government was leading the emergency response, Congress was also called into action to legislate and appropriate the necessary resources. CHA’s advocacy and public policy department saw firsthand the impact that the pandemic had on communities that our members serve and the importance that any legislation would have to bolster and protect access to coverage. In early 2020, we wrote to Congress outlining that since our early history, Catholic health care has answered the call to serve populations affected by disasters, influenza pandemics and the opioid epidemic. We urged Congress to include continuous eligibility and enrollment in Medicaid and the Children’s Health Insurance Program with an enhanced federal medical assistance percentage to ensure that low-income and vulnerable

children, individuals and families maintain their health care coverage through this crisis.1

In the span of a month, Congress passed two important bills that were signed into law by President Donald Trump: the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, which provided emergency funding relief for domestic and global efforts, and the Families First Coronavirus Response Act, which included numerous policies like emergency family leave and supplemental nutrition assistance. Most importantly, it included the continuous coverage requirement for the Medicaid program that protected enrollees from losing their coverage as long as the public health emergency was in place.2 A Kaiser Family Foundation analysis that studied the uninsurance rate in 2020 found that “despite a public health crisis that caused significant economic turmoil, the CPS [Current Population Survey] data indicate that health coverage during 2020 was relatively stable compared to before the pandemic.”3

dignity can be protected and healthy communities can flourish.

KEEPING PEOPLE COVERED

CHA’s commitment to Medicaid is a longstanding one. For decades, CHA and our members have carried the message that health care is a basic human right essential to human flourishing, and we have advocated policies to ensure that everyone has access to affordable health care. We are inspired by the wisdom of the social doctrine of the Church, which teaches that each person is created in the image of God; that each human life is sacred and possesses inalienable worth; and that health care is essential to promoting and protecting the inherent dignity of every individual.

The first principle in CHA’s Vision for U.S. Health Care affirms our call to pay special attention to the needs of those who are poor and vulnerable — those most likely to lack access to health care — in our work toward affordable, accessible health care for all. This commitment is why the Catholic health ministry has strongly supported public health care programs like Medicaid and the Children’s Health Insurance Program.4 Together, we must ensure health care for all so that human

Even into 2022, the nation continued to grapple with the COVID-19 pandemic — there were new tests, therapeutics and several vaccines to fight the virus’ spread. Additionally, states and localities began to reverse restrictions on public gatherings, allowing for greater returns to schools and workplaces, while also relaxing masking mandates. Could the public health emergency be ending soon as well? Our members approached us with this question and asked what this would mean for the Medicaid continuous coverage requirement. Further, our work with national organizations and stakeholders also led us to these same questions. At the same time, several studies modeled estimates of the potential effects of Medicaid unwinding, showing that as many as 14 million Americans would lose coverage, with 6.8 million losing Medicaid because of “paperwork hurdles.”5 The disproportionate effect on communities of color potentially losing coverage — including 64% of enrolled Latinos; over half of Asian, Native Hawaiian and Pacific Islander enrollees; and 47% of Black enrollees — showcased how addressing health inequity is crucial in any Medicaid unwinding plan.6 We knew we needed to act to prepare for the resuming annual Medicaid renewals, given how important this program was to the vulnerable populations our members serve. In May 2022, CHA convened one of the first national discussions by a health care provider association on this topic. Titled “Preparing for Medicaid Unwinding: Medicaid Redeterminations — What Catholic Health Care Can Do To Prevent Coverage Loss for Beneficiaries,” we invited our colleagues from Trinity Health and Providence to share their thoughts, experiences and planned strategies. The success of this first webinar allowed us to record a podcast on Medicaid redetermination for CHA’s “Health Calls” podcast,7 in addition to a follow-up webinar, called “Preparing for Medicaid Unwinding After the Public Health Emergency: Working With Partners,” where we heard from Georgetown University’s Center for Children and Families and learned how CHA members could better partner with their local affiliates of Catho-

Together, we must ensure health care for all so that human dignity can be protected and healthy communities can flourish.

lic Charities USA.

The most recent development occurred at the end of 2022, when Congress enacted changes to the Medicaid unwinding process by including a provision in the Consolidated Appropriations Act, 2023. As part of this massive bill, states may begin disenrolling Medicaid enrollees who are no longer eligible after they conduct and complete renewals. This decoupled the continuous coverage provision from the public health emergency for COVID, giving state governments the ability to plan their state budgets in a way that would meet the needs of those who truly need Medicaid.

Our work with our members, national organizations and the federal government culminated in the launch of a new campaign, “Protect What’s Precious: Secure Your Medicaid Coverage Today.” The campaign’s goal was to help prevent Americans from losing their Medicaid or Children’s Health Insurance Program coverage by educating them to promptly either update their contact information or complete their renewal forms with their state’s Medicaid agency by its specific deadlines. We rebranded our existing “Medicaid Makes It Possible” microsite to house our new campaign.8 We unveiled resources, videos, social media and customizable posters for our members in January, nearly three years after the public health emergency declaration that began this process. We included a QR code that allowed for convenient access to the campaign’s posters, videos and postcards that linked to a webpage listing every single Medicaid state agency so our members could easily share the information with Medicaid enrollees in their facilities. This enabled any patient-facing employee of Catholic health care to be an effective advocate.

ADVANCING HUMAN DIGNITY TOGETHER

Our work continues as states embark on the massive process of Medicaid unwinding, which touches the eligibility for all 90 million people in the program. Not since the enactment of the Affordable Care Act’s coverage expansions a decade ago has there been the potential of such large-scale health coverage transitions in America. We know that through the committed dedication of our members and partners, the resources

OPENING DOORS: ACCESS TO CARE

in our Protect What’s Precious materials, and the continued focus of CHA in promoting affordable and accessible health care for all, we can make a difference in the lives of our neighbors who rely on the Medicaid program.

PAULO G. PONTEMAYOR is senior director of government relations for the Catholic Health Association, Washington, D.C.

NOTES

1. Sr. Mary Haddad to U.S. House of Representatives, Catholic Health Association, Washington, D.C., March 12, 2020, https://www.chausa.org/docs/default-source/ advocacy/031220-cha-letter-on-coronavirus-supportbill.pdf?sfvrsn=2.

2. Kellie Moss et al., “The Families First Coronavirus Response Act: Summary of Key Provisions,” Kaiser Family Foundation, March 23, 2020, https://www.kff. org/coronavirus-covid-19/issue-brief/the-families-firstcoronavirus-response-act-summary-of-key-provisions/.

3. Jennifer Tolbert, Kendal Orgera, and Anthony Damico, “What Does the CPS Tell Us About Health Insurance Coverage in 2020?,” Kaiser Family Foundation, September 23, 2021, https://www.kff.org/uninsured/issue-brief/ what-does-the-cps-tell-us-about-health-insurancecoverage-in-2020/.

4. “Enhancing Medicaid and Ensuring a Strong Safety Net,” Catholic Health Association, https:// www.chausa.org/advocacy/policy-briefs/ enhancing-medicaid-and-ensuring-a-strong-safety-net.

5. Alan Yu, “6.8 Million Expected to Lose Medicaid When Paperwork Hurdles Return,” NPR, January 24, 2023, https://www.npr.org/sections/healthshots/2023/01/24/1150798086/6-8-million-expectedto-lose-medicaid-when-paperwork-hurdles-return.

6. “Congressional Tri-Caucus Call for HHS Secretary Becerra to Protect Medicaid Coverage and Access to Health Care during ‘Unwinding,’” Congressional Hispanic Caucus, March 20, 2023, https://chc.house.gov/mediacenter/press-releases/congressional-tri-caucus-call-forhhs-secretary-becerra-to-protect.

7. Paulo Pontemayor and Corey Surber, “Medicaid Priorities in 2022: Medicaid Redetermination,” Health Calls, Catholic Health Association, September 12, 2022, https://www.chausa.org/podcast.

8. “Medicaid Makes It Possible,” Catholic Health Association, https://www.chausa.org/medicaid.

A Journey to Ukraine

The Humanitarian Crisis and the Catholic Response

BRUCE COMPTON Senior Director, Global Health, Catholic Health Association

As the world watched events unfold during Russia’s 2022 invasion of Ukraine, many CHA members inquired about the most effective ways to provide humanitarian support. CHA hosted multiple networking events to share best practices and hear and connect with members and those already on the ground working in Ukraine and surrounding countries.

Among those connections was Monsignor Robert Vitillo, Secretary General of the International Catholic Migration Commission, with whom CHA has a longstanding relationship. We learned the commission had been tasked with convening Catholic Response for Ukraine, a working group assembled at the prompting of the Vatican’s Dicastery for Promoting Integral Human Development, to cultivate dialogue among the first-line actors and provide insights to Catholic organizations around the globe.1

CHA and our members worked closely with Catholic Response for Ukraine, connecting and contributing to projects. As a result, CHA was invited to become part of the working group and subsequently, invited to join a solidarity trip to Poland and Ukraine in March. I joined Monsignor Vitillo and his Catholic Response for Ukraine colleague, Christian Kostko, in visiting several projects throughout Ukraine to see firsthand the depth of the Catholic Church’s impact.

The trip was one of my most life-changing experiences. As I continue to process what I experienced, I offer this reflection and invite you to consider your efforts and how best to continue to support our brothers and sisters in Ukraine.

THE HUMAN TOLL OF WAR: LIVES FOREVER CHANGED BY THE CONFLICT IN UKRAINE

On our first full day in Ukraine, we visited a cemetery where the graves of soldiers from Lviv, a city far from the front lines, were much too plentiful. Watching families and friends grieve at the graves of their loved ones set a tone for the trip. What I saw that day will forever be etched in my mind as a stark reminder of the death and destruction being caused by this unjust war.

Several days later, we visited a small town 10 miles outside of the city of Kyiv, where a woman named Olga Shatylo shared the pain and trauma she and her family have experienced since the start of the war. We walked with her as she showed us the house and surrounding area where she stayed for two weeks in the early days of the invasion. She told us where the Russians were located, just one block away, and where the Ukrainian soldiers were, one block in the opposite direction. While she and several others holed up in a house directly between the two, the soldiers and tanks fired at each other in the streets. She showed us the craters in the ground where shells had hit just yards from the house. Each day, she said, when they would go out to get water, Russian snipers would shoot at them. They were innocent civilians caught in the middle of a firefight. She was bold, and it seemed as if it was therapeutic for her

to tell us the story. Olga took us around the neighborhood, and it was nearly impossible to find a surface without bullet holes or demolished by bombings.

As we continued, Olga took us to see another family whose property had been destroyed. There, the matriarch of the family told us her husband’s family had lived there for four generations and that all three houses on the small site were destroyed. As a result of the war, their family is now scattered throughout the world — in neighboring countries, as well as in South and North America. The matriarch and her husband were living in a neighbor’s home nearby, allowing them to try and rebuild so that their family could one day be reunited. She told us the rebuilding went slowly due to the war and a lack of resources, but that they were committed to the long journey. Her final messages were “thank you” and “please tell the world what they have done to us!”

❖ ❖

I ask for God’s blessing on Olga, her family, friends, neighbors and all who have suffered devastating losses. May they one day be reunited with their loved ones, just as I was with mine upon returning home from my short visit to Ukraine. May we never forget their stories as we tell the world what this war has done to them.

LEARNING FROM UKRAINIAN HOSPITALS: THE IMPORTANCE OF SUPPORTING SKILLED MEDICAL PROFESSIONALS

On our trip, we had the opportunity to visit a Catholic hospital as well as a state one. We heard repeatedly throughout the visits that their medical professionals need our continued support, but not our junk. As we visited with the head of orthopedics at the state hospital, I asked how we might be of help. He responded by saying that they could likely teach us about trauma care, and he led

CHA’s Senior Director of Global Health Bruce Compton, foreground, visits a cemetery in Lviv where loved ones leave flowers and pictures at soldiers’ graves in early March 2023. Compton was among representatives visiting Ukraine and Poland to learn more about the Church’s aid efforts in the region since a major escalation by Russia about a year prior. The woman in the photo has not been identified.

Photo by Christian Kostko

us to his office where his computer monitor was filled with live video of their skilled surgeons and nurses caring for patients at the hospital. From his office, he was monitoring six of their surgical suites and multiple recovery rooms. This encounter reminded me of our guiding principles for global health activity: patience, prudence, humility, excellence, authenticity and honesty.

❖ ❖

I pray for those who are injured or traumatized and being cared for by the amazing health care professionals of Ukraine, for the professionals themselves and their well-being, and for all who hope to help moving forward. The lessons I learned are a reminder of why our guiding principles are important in fulfilling the mission of Catholic health care.

WITNESSING THE WORK OF THE CHURCH IN UKRAINE: SERVING NEIGHBORS AND SUPPORTING VETERANS

As the trip continued, we had many opportunities to witness Ukrainian lay people, priests and religious sisters working diligently and with great passion to help meet their neighbors’ needs. In a rural village, we visited a parish that operated a day care for children with disabilities, a farm and several other ministries. In another town, we visited a diocesan House of Mercy that cared for children, families, men and women, most of them internally displaced due to the war.

In that same community, we visited a diocesansupported foster home with 10 children run by a religious sister who cared for them in a “family-like” environment. Later that day, in another city, we visited a priest with the Ukrainian Greek Catholic Church and his wife, a psychologist. The couple used puppet therapy with internally displaced persons traumatized by the war’s effects.

OPENING DOORS: ACCESS TO CARE

I pray in gratitude for the infrastructure, talent, education, formation and community that enables the Church to accompany and care for those experiencing the devastating impacts of this war. I give thanks to God for the opportunity to travel safely throughout Ukraine to see the amazing work of the Church.

As we continued our journey, we saw a military museum in the basement of a parish in Khmelnytskyi in western Ukraine, where soldiers are invited to bring items from the front lines and leave them for visitors to see. The team operating the parish-based museum included a priest, psychologist, social worker, lay people and a military chaplain who regularly visit with soldiers both at the parish and on the front lines. They talk with soldiers about the items they bring as a way to open discussions on their experiences as they work toward healing. The team explained when soldiers relay the stories of their “items from the front,” they also leave behind some of the trauma from the experience.

On our final full day in Ukraine, we observed

Monsignor Robert Vitillo, right, secretary general of the International Catholic Migration Commission, listens as Ukrainian Olga Shatylo points out a crater from shelling near Bucha in north central Ukraine. She said she and others holed up in the house in the background for about two weeks, as Russians and Ukrainians fought with guns and heavy artillery in the streets just outside.

Photo by Bruce Compton

Compton spotted these wildflowers when leaving a retreat planned by the Knights of Columbus for veterans and their spouses. On the tail end of an event seeking to bring people some solace, the flowers reminded him that during the inhumanity of war, people could still engage in beautiful acts of humanity toward one another.

a retreat for returned veterans and their spouses put on by the Knights of Columbus. We were told these retreats came about because of a conversation between a member of the Knights of Columbus, who is also a psychologist and professor from a nearby university, and a priest who helped start the Knights of Columbus in Ukraine. The psychologist discussed statistics regarding the toll of the Vietnam War on returned U.S. military. They concluded that they had to do something to help prevent suicides, homelessness and broken families among returned Ukrainian veterans. We witnessed one result of that conversation, a retreat

for returned veterans and their spouses traumatized by war. This took place in a beautiful resort nestled in the mountains in rural Ukraine.

❖ ❖

I pray for peace, and for the well-being and support of the soldiers, social workers and all our brothers and sisters who are readjusting and dealing with the traumas and effects of war.

As our time at the retreat came to an end on that final day of our trip, I told Monsignor Vitillo and Christian that I would walk down the hill and wait for them. As I walked, contemplating all that I had experienced, I passed a beautiful stream rushing down the mountainside. Along my path, I saw a wildflower growing. I stopped to take a picture and noticed it had emerged through dormant grass and was surrounded by dead leaves. On that cold mountainside, where conditions didn’t yet seem appropriate, was this beautiful flower.

The analogy of that flower to all we had experienced was a fitting close to the trip. We saw the remnants of war and the ongoing activities surrounding it contrasted with the beauty and humanity of the Ukrainians who responded so generously in helping their neighbors. It was so evident and beautiful at every stop along the way, and yet, horrifying that it was necessary. There were so many more contrasts — I only wish I had space to share them all. However, the final contrast — the way our actions can help or harm one another — has already left a mark on my life, and it is one that I will continue to grapple with.

❖ ❖

I went to Ukraine not knowing what I would see or how it would affect me personally. I left feeling blessed to have had the opportunity to see the Church in action at various projects throughout the country and very fortunate to work with and for a church that truly cares.

BRUCE COMPTON is senior director, global health, for the Catholic Health Association, St. Louis.

NOTE

1. Catholic Response for Ukraine (CR4U), https://www. cr4u.info.

Photo by Bruce Compton

Catholic Hospitals and the Local Church

Why They Matter to One Another and to Communities

SR. DORIS GOTTEMOELLER, RSM Former CHA Board Chair

Years ago, I was scheduled to present a breakout session on Catholic health care at a national meeting for the heads of diocesan priests’ councils. I took my place in front of the group, poised to share my presentation and prepared remarks. But before I could speak, one of the priests called out, “I think we should sell all the Catholic hospitals and give the money to the poor.” Amidst a rumble of laughter and some raised eyebrows, I retorted, “And I’m here to tell you why you’re wrong!” I’m not sure how many converts I made that day, but the challenge has never left me.

In some ways the challenge has grown stronger as hospitals and health care systems have consolidated into increasingly large corporations whose finances exceed all but the most sizable of dioceses, let alone a parish. How is a big “business” with thousands of employees — many or most of whom are not Catholic — and possibly directed from headquarters in a distant city, part of the local church? And, conversely, how does the local church contribute to the ministry of institutional health care? Why maintain Catholic hospitals when there are many other high-quality ones in most cities?

Let me begin with some working definitions. Health care, of course, can include anything from caring for a family member at home to the mission of a multistate system. My focus here is on the Catholic institutions — primarily hospitals — in a given locale and, by extension, on the systems to

which they belong. By “local church,” I mean the People of God who are members of the diocese and of the parishes in which the institutions are located.

How do Catholic hospitals extend the mission of the local church, and how do members of the local church support these institutions? In short, why is “selling the hospitals and giving the money to the poor” a bad idea?

For starters, everyone would agree that caring for the sick is one of the corporal works of mercy expected of all Christians. What the hospital contributes to that universal obligation is specialized care delivered by trained clinicians, including through the use of complex and specialized equipment. Furthermore, in a Catholic hospital, that care is provided in compliance with the Church’s ethical teachings. When we refer to this doctrine, the first thing that comes to mind is that the

hospital does not provide abortions or euthanasia. However, the teachings are far deeper and richer than these prohibitions. They commit the hospital to provide spiritual care appropriate to the patient’s condition and religious beliefs, to promote a commitment to the mission among all employees, and, in particular, to serve all who come for care, whatever their financial resources.1

tion of the value of stability and continuity. The sale of a building and its contents would yield a one-time corpus of money that could be distributed to the needy. In the end, however, people would still get sick and need hospital services delivered in a compassionate way on behalf of the faith community: the local church. As generations succeed one another, the hospital remains a symbol of the Church’s continuing commitment to healing the sick.

In doing so, they promote the common good, a bedrock of Catholic social teaching.

While many of the faithful in the local church may not be aware of these requirements for Catholic health care, the local bishop certainly is. In fact, the bishop should be briefed on a regular basis about the hospital’s activities and strategies. If the hospital has made a difficult decision about a critical pregnancy or an end-of-life care situation, the bishop should be the first to know about it.

Regular communication provides the bishop with information so he can be confident that Catholic health care institutions are a valuable part of the local church’s ministry and can, when appropriate, support the diocese’s community outreach.

The hospital’s efforts to address the underlying causes of local health disparities often involve collaborating with local church groups, such as Catholic Charities and the Society of St. Vincent de Paul. Together, they might address such issues as inadequate housing, food insecurity and public safety.

Reversing the focus, the local church can contribute to the hospital’s ministry. The hospital’s mission to provide spiritual care usually involves the ministry of an employed chaplain. However, visits from a patient’s pastor are also welcomed. Additionally, hospitals provide venues for community volunteers in various capacities.

What about my long-ago interlocutor’s suggestion of selling the hospitals and giving the money to the poor? What that view lacks is an apprecia-

One suggestion to promote the Church’s understanding of the mission and values of Catholic health care would be to provide some education to those preparing for ministry, for example, seminarians and other ministry students. It might be a single lecture given by a health care representative or panel. Following up, those who are willing might be given an opportunity to temporarily volunteer in a hospital so that they can experience firsthand the staff’s dedication. Another suggestion would be for the hospital or health system to provide regular news items for inclusion in diocesan publications. This would provide a sense of pride in, or “ownership” of, the hospital’s mission on the part of the faithful.

Finally, let us hope that an appreciation for the Church’s ministry of healing, as provided within its institutions, will grow and flourish among all the faithful, including among the clergy. The work of Catholic health care organizations remains a way for people, regardless of faith tradition, to experience the Church’s commitment to honor the dignity and well-being of all persons.

SR. DORIS GOTTEMOELLER has held leadership, sponsorship and governance positions with health care, education, housing and religious organizations, including recent roles with Cincinnati-based Bon Secours Mercy Health. She is a prior chair of the CHA board of trustees and received the organization’s 2008 Sister Concilia Moran Award and the 2021 Lifetime Achievement Award.

NOTE

1. For a fuller presentation of the Church’s teachings, see Ethical and Religious Directives for Catholic Health Care Services, Sixth Edition, promulgated by the United States Conference of Catholic Bishops.

As generations succeed one another, the hospital remains a symbol of the Church’s continuing commitment to healing the sick.

How the ERDs Can Deepen Our Catholic Identity

MYLES N. SHEEHAN, SJ, MD Director of the Edmund D. Pellegrino Center for Clinical Bioethics at Georgetown University

Over my many years in Catholic health care, both as a physician and as someone working in Catholic health care ethics, it has been my responsibility to explain the Ethical and Religious Directives for Catholic Health Care Services (ERDs) to coworkers, students and others. One of the clearest lessons I have learned is that to jump into a discussion of an individual directive — especially with people who have little or no awareness of the ERDs — can often result in confusion and a sense that it is some arbitrary Catholic rule book that appears to say “no” most of the time.

To help clear any possible misunderstandings when having discussions around the ERDs, I suggest some strategies I use in my work in Catholic health care. I know that many of you reading will have your own wisdom, probably much deeper than mine, and I do not want to suggest my ideas are the best. But the key insight I follow, and one from which my other strategies flow, is that good teaching and discussions about the ERDs can help a hospital and health care system communicate what it means to be Catholic in a way that is authentic, faithful, respectful of other voices and can deepen the commitment of those who work in the ministry.

A GUIDE TO THE MINISTRY’S MISSION

For those of you who might not know much about the ERDs, or who are looking to do your own study, here are a few basic facts:

The ERDs are developed by the United States Conference of Catholic Bishops in consultation with health care professionals, theologians and other competent individuals in the areas covered by the document.

The ERDs are currently in their sixth edition. After each edition is developed, it is reviewed in Rome by the Congregation for the Doctrine of the Faith for suggestions, revisions and, ultimately, approval. It serves as a basis for under-

standing what it means for Catholic health care services to be considered Catholic and provides a point of contact for the diocesan bishop in his role to ensure that health care is provided in a way that reflects the Church’s understanding and teachings.

The document is divided into six sections and, additionally, includes a preamble, general introduction and conclusion. Each section begins with an introduction and is then followed by a list of prescriptive directives that provide detail and explanation to the introductory material.

Understanding the individual directives requires spending time with the material in the introduction. Otherwise, it is easy to inappropriately assume the meaning of a particular directive or miss its point.

My suggestion is that individual Catholic institutions use the ERDs as a roadmap to consider locally what makes their hospital or system authentically Catholic. There is a profound vision contained in the ERDs that is countercultural to aspects of contemporary American society. What do you do with that, and how do you work with people in your institution to make this document not just a rule book, but the starting point for how your hospital lives out its mission? Most Catholic hospitals have their own mission and vision

statements that can provide an excellent way to begin and further this discussion. The lived witness of generations of Catholic religious, mostly women, animates our present day, and the ERDs can be a way to deepen the local charism of a particular hospital.

A TESTAMENT TO THE COMMON GOOD

The ERDs are based on our Catholic understanding that our faith rests on our reason as expressed in the natural law, the revelation we have from Scripture — especially the example of Jesus in the Gospels — and the Church’s traditions expressed in official magisterial documents and papal teachings. A challenge in our society is that phrases like natural law, revelation, tradition and magisterial teaching are not understood by many of those with whom we work. That challenge is also an opportunity to express the reality that Catholic health care views human reason and science as critical and nothing to be feared.

Another opportunity is to present the compelling ministry of Jesus in caring for those who are sick, forgotten, on the margins of society or viewed by others as sinners or wayward people. The ERDs emphasize human dignity, but that expression may not be readily understood. In keeping with Jesus’ ministry, the simplest way to explain human dignity is that every life counts and is valuable because of God’s love and our shared humanity. Our expression of respect for human dignity means that we care for life from the moment of conception to the moment of natural death. This includes not just the unborn, but the woman who is carrying a pregnancy she may not want to continue, or the person with a lifethreatening illness who, even with good pain and symptom control, seeks the means to end his or her life. ERD #3 states these thoughts:

In accord with its mission, Catholic health care should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable to discrimination: the poor; the uninsured and the underinsured; children and the unborn; single parents; the elderly; those with incurable diseases and chemical dependencies; racial minorities; immigrants and refugees. In particular, the person with mental or physical disabilities, regardless of the cause or

severity, must be treated as a unique person of incomparable worth, with the same right to life and to adequate health care as all other persons.1

Living the spirit of our faith that is contained in the ERDs requires that we seek excellence in helping every person who feels that the life they carry or the life they live is untenable to continue. We work to help those in difficulty to recognize the value of life even in tough times.

A MISSION FOR SPIRITUAL CARE

A distinctive feature of Catholic health care is the recognition that health is not limited to the biological. We prioritize the spiritual care of those who come to our institutions as part of our witness to Jesus’ ministry as well as our belief that wholeness requires a holistic response. As the introduction to Part Two of the ERDs states, quoting from the 1981 U.S. Bishops’ pastoral letter titled Health and Health Care:

Since a Catholic health care institution is a community of healing and compassion, the care offered is not limited to the treatment of a disease or bodily ailment but embraces the physical, psychological, social, and spiritual dimensions of the human person. The medical expertise offered through Catholic health care is combined with other forms of care to promote health and relieve human suffering. For this reason, Catholic health care extends to the spiritual nature of the person. “Without health of the spirit, high technology focused strictly on the body offers limited hope for healing the whole person.”2

In a time of financial constraints, it is worth emphasizing the importance of having robust pastoral care services to attend to the needs of our patients that cannot be met by strictly medical and nursing care, as a lack of spiritual care may well be a significant part of the suffering or illness they are experiencing. The availability of the sacraments is an essential part of Catholic health care. Although the skills of the doctors, nurses and other health care professionals are obviously essential as well, the presence of Christ in the Eucharist, the power of forgiveness in the sacrament of Reconciliation and the healing available in the sacrament of the Anointing of the Sick all

give real presence to the role of Christ as divine physician working alongside our other caregivers. For those patients who are not Catholic, the presence of spiritual care that respects their traditions is also critical. All the technology and advanced science in the world cannot bring healing alone; our emphasis on spiritual care serves as a witness to this reality.

RESPECT FOR THE PROFESSIONAL-PATIENT RELATIONSHIP

Along with pastoral care, Catholic health care obviously relies on the skilled work and compassion of the doctors, nurses and other health care professionals who directly care for our patients. Part Three of the ERDs deals specifically with the health care professional-patient relationship. It covers a number of topics related to the patient’s right to information about their condition, the importance of confidentiality, the patient’s ability to defer or refuse treatment considered overly burdensome, and, among other topics, the care for patients who agree to participate in clinical research. A specific directive in Part Three, ERD #36, considers care of women who suffer sexual assault and permits, with appropriate safeguards, contraceptive efforts for women in this situation:

Compassionate and understanding care should be given to a person who is the victim of sexual assault. Health care providers should cooperate with law enforcement officials and offer the person psychological and spiritual support as well as accurate medical information. A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation, or fertilization.3

The work of health care professionals in Cath-

olic health care services is often a source of misinformation and confusion. Sharing the content of this section of the ERDs can help with inaccurate opinions about how patients are meant to be treated. Unfortunately, the pro-life teachings of the Church can be misconstrued, and people wrongly believe that the Church always requires aggressive care or is not willing to assist sexual assault victims. That is simply not true.

CARE FOR THE SERIOUSLY ILL AND DYING

Another area where people are often poorly informed about the ERDs and Catholic health care concerns people with life-threatening illness and at the end of life. Part Five of the ERDs, “Issues in Care for the Seriously Ill and Dying,” highlights the importance of pain control, well-informed choices about life-sustaining therapy and caution regarding the overzealous use of technology. Some will be surprised that individuals can refuse life-sustaining technology and request withdrawal when the burdens of treatment overwhelm the likely benefit:

The task of medicine is to care even when it cannot cure. Physicians and their patients must evaluate the use of the technology at their disposal. Reflection on the innate dignity of human life in all its dimensions and on the purpose of medical care is indispensable for formulating a true moral judgment about the use of technology to maintain life. The use of life-sustaining technology is judged in light of the Christian meaning of life, suffering, and death. In this way two extremes are avoided: on the one hand, an insistence on useless or burdensome technology even when a patient may legitimately wish to forgo it and, on the other hand, the withdrawal of technology with the intention of causing death.4

The Church is opposed to euthanasia and assisted suicide. The emphasis in Part Five of the ERDs on care for the dying, effective pain treat-

All the technology and advanced science in the world cannot bring healing alone; our emphasis on spiritual care serves as a witness to this reality.

ment and creating a community where the gift of life and human dignity is respected ensures that this refusal to kill is embedded in a culture of deep care and compassionate treatment.

PROCREATION AND RESPECT FOR LIFE

Some may find Part Four of the ERDs, “Issues in Care for the Beginning of Life,” especially challenging in contemporary American society. Indeed, it presents a countercultural vision of sexuality, marriage and human reproduction. It is one that respects marriage as the commitment made before the creation of new life and defends the dignity of the unborn, women and children. The teaching is one of respect for life at every stage:

The Church’s commitment to human dignity inspires an abiding concern for the sanctity of human life from its very beginning, and with the dignity of marriage and of the marriage act by which human life is transmitted. The Church cannot approve medical practices that undermine the biological, psychological, and moral bonds on which the strength of marriage and the family depends.

Catholic health care ministry witnesses to the sanctity of life “from the moment of conception until death.” The Church’s defense of life encompasses the unborn and the care of women and their children during and after pregnancy. The Church’s commitment to life is seen in its willingness to collaborate with others to alleviate the causes of the high infant mortality rate and to provide adequate health care to mothers and their children before and after birth.5

I believe the best way to present challenging items from this part of the ERDs is to be clear about what your health system does to care for women and children, including the unborn, that demonstrates the commitment to providing witness to the dignity of human life. This includes programs that help women and children, especially women who have difficult pregnancies or whose human flourishing is threatened by social privation and lack of opportunity.

ENACTING POSITIVE CHANGE THROUGH THE ERDs

The key to effective teaching of the ERDs is being

very clear in describing and showcasing the positive ways in which following the example of Jesus and the tradition of the Church results in concrete actions and programs devoted to healing, less suffering, improvement of peoples’ lives and the demonstration of special concern for those whom society neglects or devalues. Making the ERDs a way to promote a distinctly Catholic identity for your hospital or system means that what can sometimes be perceived as a dry list of regulations actually serves as a blueprint that follows the spirit of the document and not just dry attention to the letter.

As you think about how to present the ERDs and use them as a resource for positive change, there are some questions that can be helpful to consider:

1. How does your hospital or health system distinguish itself in the care of people who are poor or marginalized?

2. Is the health care professional and patient relationship respected, and do demands for productivity and increased patient volumes not threaten the development and maintenance of meaningful, caring relationships?

3. Are pastoral care services front and center? Or, do chaplains operate a bit in the shadows, with doctors and nurses perceived as doing “the real work,” while pastoral care is considered supplemental and not essential? In a time of fiscal tightening, is the commitment to spiritual care expressed in the ERDs respected, or are the cuts too deep?

4. What does your institution do that promotes family health, women’s ability to access resources to continue a pregnancy despite pressures, and support for women and children? Do you have enough services to help counteract the negative sentiment that Catholic health care is not friendly to women?

5. Remembering that care of the seriously ill and dying is grounded in our faith that life continues after death and the meaning of our life is our destiny with God, does your hospital have palliative care and hospice services readily available? Are there resources, like ethics consult services, that can work with patients, families, doctors and nurses in difficult cases to ensure that appropriate care — neither too little or too much — is provided?

Finally, the point of this article is for you to make the ERDs a living document that reflects

the particular charism of your hospital or system’s founders, shows how the faith of those founders continues in the actions and programs in place today, and creates a health care environment that is respectful and welcoming to a diverse patient population and workforce while honoring our own tradition.6 These words from the conclusion of the ERDs emphasize that vision:

Sickness speaks to us of our limitations and human frailty. … Yet the follower of Jesus faces illness and the consequences of the human condition aware that our Lord always shows compassion toward the infirm. … Catholic health care is a response to the challenge of Jesus to go and do likewise. Catholic health care services rejoice in the challenge to be Christ’s healing compassion in the world and see their ministry not only as an effort to restore and preserve health but also as a spiritual service and a sign of that final healing that will one day bring about the new creation that is the ultimate fruit of Jesus’ ministry and God’s love for us.7

Peace in Anxiety

DR. MYLES N. SHEEHAN, SJ, is director of the Edmund D. Pellegrino Center for Clinical Bioethics, a professor of medicine and the David Lauler chair of Catholic Health Care Ethics at Georgetown University Medical Center, Washington, D.C.

NOTES

1. Ethical and Religious Directives for Catholic Health Care Services: Sixth Edition (Washington, DC: United States Conference of Catholic Bishops, 2018), 9.

2. Ethical and Religious Directives, 10.

3. Ethical and Religious Directives, 15.

4. Ethical and Religious Directives, 20.

5. Ethical and Religious Directives, 16.

6. I have not mentioned Part Six of the ERDs, “Collaborative Arrangements with Other Health Care Organizations and Providers.” This is an important part of the ERDs, but I usually present this only in the setting of a particular question and concern, and, ideally, after those involved have a basic grasp of the rest of the document.

7. Ethical and Religious Directives, 27.

For just this moment, bring your attention to your breath.

INHALE deeply and settle yourself into your body.

EXHALE the stress and tension you feel.

In these days of anxiety, a moment to pause is both a gift and a necessity.

GENTLE YOUR BREATHING, your gaze and your heart as you consider:

Where have I found peace in the past days?

THINK FOR A MOMENT.

In these days of anxiety where have I found peace?

[Pause to consider]

DWELL in the peace you have found and bring it with you into the rest of your day.

Even now, God is with you, as near to you as your breath. Continue giving yourself the gift to pause, breathe and heal, knowing you are not alone.

Peace I leave with you; my peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled and do not be afraid. JOHN 14:27

© Catholic Health Association of the United States

COMMUNITY BENEFIT AT CHA: HOW IT STARTED AND WHERE IT’S HEADED

CHA developed as the go-to resource for community benefit reporting and compliance in the 1980s, and the organization continues to lead the field today. This work includes creating the conditions for whole-person health and improving care access and outcomes for all people, with focus on integrating equity throughout our systems and communities. Community benefit work is done across the continuum of health care, including addressing the social determinants of health, and we tell the story of nonprofit health care and monitor our work using data.

CHA’S COMMUNITY BENEFIT HISTORY

In the ’80s, when nonprofit hospitals were being questioned on whether they deserved to be exempt from federal taxes, CHA decided to take on the challenge to outline what makes nonprofit hospitals distinct from for-profit hospitals.1

There had been a sharp increase in the number of for-profit hospitals, a relatively new phenomenon. For-profit and nonprofit hospitals looked alike in many ways and some scholars and policymakers were asking if they were, in fact, the same and whether federal tax-exemption should be eliminated for the nonprofits.

This was a great issue of concern to CHA’s board of trustees. Tax exemption not only meant not paying federal taxes, but also meant being recognized as a charitable, community benefit organization.2 “Charitable” to CHA leaders meant “mission-driven,” suggesting that the question was more than “Are nonprofit hospitals the same as for-profits?” Instead, it was actually, “Are Catholic hospitals businesses or ministries?”

Adding to their concern was the move by some for-profit hospital systems to try to purchase Catholic hospitals. All this was taking place against a deep appreciation of the history and tradition of Catholic health care organizations, which had

been conceived out of community need and often founded at great sacrifice.

Another backdrop at the time was the recent introduction of Medicare’s prospective payment system. No longer would hospitals be reimbursed based on their reported costs, but by a new system using Severity Diagnosis Related Groups, which classified a Medicare patient’s hospital stay into various groups to arrange payment for provided services. Some CHA leaders worried that the new payment system, while encouraging efficiency, would prompt hospitals to limit their charitable activities.

To advocate for tax-exempt hospitals, health policy expert Larry Lewin and others wrote an article in The New England Journal of Medicine called “Setting the Record Straight.”3 They argued that nonprofit hospitals distinguished themselves through their involvement in health professional education, by subsidizing needed services and through their activities that improve the health of communities.

The CHA board invited Lewin to help us categorize the activities he had described in his article that distinguish Catholic and other nonprofit hospitals, and to develop a way to account for and report these services. A task force led by then-CHA board secretary-treasurer Sr. Bernice Coreil, DC, was formed to oversee the work. During a task force meeting, a member said he had a large family, and explained, “If we only gave to charity what we had left over at the end of the year, we wouldn’t give anything. If hospitals are going to continue their charitable tradition, they need to budget for it.” Thinking like that led to CHA’s first guide

for nonprofit hospitals on how to provide, track and report community benefit services. It was published in 1989, and called Social Accountability Budget: A Process for Planning and Reporting Community Service in a Time of Fiscal Constraint 4

Over the years, CHA’s board, prophetic in the ’80s, continued to support community benefit as integral to the mission and identity of Catholic health care. Community benefit continued to be part of CHA’s strategic plans and budgets, whether or not tax-exemption was a hot-button policy issue.

When the issue rose again nearly two decades later, CHA was ready. In 2006, Sen. Chuck Grassley, R-Iowa, chair of the Senate Finance Committee, asked if hospitals deserved tax-exemption and if the requirement for providing community benefit was strong enough. CHA responded, showing him our widely used system of defining and reporting community benefits. Subsequently, Grassley instructed the Internal Revenue Service to incorporate CHA’s community benefit reporting system into a tax form for exempt hospitals — the IRS Form 990, Schedule H — first issued in 2008.

GOING FORWARD

Today, CHA’s original Social Accountability Budget is now the Guide for Planning and Reporting Community Benefit. 5 It was updated to incorporate new requirements from the Affordable Care Act and subsequent IRS rules, and most recently to address equity and health disparities.

In the future, CHA’s community benefit work will focus on creating conditions for whole-person health and improving health outcomes for all, with a focus on integrating equity throughout our systems and communities. We will continue to do this through our work across the continuum of health care — including addressing the social determinants of health,6 confronting structural racism, reducing disparities and working to build trust with all of our communities through effective and collaborative partnerships. Through new and more accurate data sources, our efforts will lead to better strategies to improve community

health and new ways to monitor community benefit practices. Community health improvement programs will continue the trend of going beyond reportable activities and strive to improve the economic status of struggling communities through anchor strategies, including purchasing, investing and hiring.7

The emphasis on social determinants of health will also dominate community benefit programs for years to come. COVID reminded us that housing instability and food insecurity are a hair’s breath away for too many people in our communities. We must find new ways to work with community partners and government agencies to ensure that all in our communities have what they need to thrive. Hospitals are facing new challenges, with some recent reports and articles criticizing hospitals. Some states and organizations are trying to redefine community benefit to exclude such vital programs as medical education, research and even Medicaid shortfalls. Our hospitals must be more vigilant than ever in telling our community benefit story.

Community benefit — in our past, present and future — is grounded in our Shared Statement of Identity for the Catholic Health Ministry. Through this work, it states, we will continue to “… answer God’s call to foster healing, act with compassion, and promote wellness for all persons and communities, with special attention to our neighbors who are poor, underserved, and most vulnerable.” We are excited to continue our journey.

JULIE TROCCHIO, BSN, MS, is senior director of community benefit and continuing care for

COVID reminded us that housing instability and food insecurity are a hair’s breath away for too many people in our communities. We must find new ways to work with community partners and government agencies to ensure that all in our communities have what they need to thrive.

the Catholic Health Association, Washington, D.C. NANCY LIM, RN, MPH, is director of community health improvement for the Catholic Health Association, Washington, D.C.

NOTES

1. Julie Trocchio, “CHA’s Community Benefit Evolution Reaps Health Care Results,” Health Progress 100, no. 4 (July/August 2019): 64-68.

2. “Revenue Ruling 69-545,” IRS, https:// www.irs.gov/pub/irs-tege/rr69-545.pdf.

3. Lawrence S. Lewin, Timothy J. Eckels, and Linda B. Miller, “Setting the Record Straight,” The New England Journal of Medicine 318, no. 18 (May 5, 1988): 1212-15.

4. Catholic Health Association, Social Accountability Budget: A Process for Planning and Reporting Community Service in a Time of Fiscal Constraint (St. Louis: Catholic Health Association, 1989).

5. Julie Trocchio, “CHA Guide Incorporates Equity Into All Aspects of Community Benefit,” Health Progress 104, no. 1 (Winter 2023): 58-60.

6. “Social Determinants of Health,” U.S. Department of Health and Human Services, https://health.gov/healthypeople/ priority-areas/social-determinants-health.

7. Bich Ha Pham and David Zuckerman, “Health Anchors Invest to Build Community Wealth, Improve Well-Being,” Health Progress 102, no. 3 (Summer 2021): 72-75; Bich Ha Pham and David Zuckerman, “Health Care Organizations Expand Anchor Role,” Health Progress 101, no. 3 (Summer 2020): 101-103.

THINKING GLOBALLY MAPPING CHRISTIAN HEALTH ASSETS TO SUPPORT GLOBAL HEALTH RESPONSE

Around the world, Christian organizations provide a significant portion of health care services, helping to protect and maintain the health of community members in underserved populations. To create a better understanding of the nature, scope and location of Christian health assets in low- and middle-income countries, CHA and five other founding organizations are working in collaboration to help accurately reflect this data. Together, through the recently established Christian Health Asset Mapping Consortium (CHAMC), the alliance seeks to develop a metadata platform (or “database of databases”) that can be used and shared publicly; to disseminate information around Christian health services; and to evaluate current resources on Christian health assets to improve their access so that stakeholders — and decision-making around policies — can be better informed.1

In this column, Carolyn O’Brien, program advisor at Christian Connections for International Health, a founding organization of the Christian Health Asset Mapping Consortium, and Dr. Samone Franzese, family medicine physician with the U.S. Army and Johns Hopkins Master of Public Health candidate, where she became involved in this work, outline the consortium’s unique position in emphasizing the importance of the quality,

reporting and sharing of all types of health assets in the Christian health landscape, not just those services provided in facilities and hospitals.

Having a more comprehensive understanding of these faith-based health care assets will assist health leaders and funders as they address the limitations and gaps in local, regional, national and global health systems. This understanding will also enable faith-based health providers to more appropriately highlight their strengths and better serve their communities.

UNCOVERING THE BREADTH OF THE CHRISTIAN HEALTH ASSET LANDSCAPE

SAMONE FRANZESE, MD, and CAROLYN O’BRIEN, MSPH

The Christian Health Asset Mapping Consortium was established in 2022 with the objective of gaining a deeper insight into the capabilities, limitations and roles of faithbased organizations in low- and middle-income

countries. The consortium’s six founding organizations, aside from CHA and Christian Connections for International Health, include the Africa Christian Health Associations Platform, International Christian Medical and Dental Association,

The Dalton Foundation and the World Council of Churches. By quantifying health care services, the alliance aims to enhance the understanding of the operations and infrastructure of Christian health assets and services and to foster the collaboration, learning and sharing of its resources in low- and middle-income countries.

What are the elements of the Christian health landscape?

Faith-based organizations deliver health care services through various channels, such as faithowned health facilities, congregations, community-based organizations and national and international organizations.2 These services cover a wide range of areas, including clinical care at different levels, preventive care like immunization campaigns and cancer screenings, facilities for older adults, early diagnosis and treatment for Hansen’s disease, HIV/AIDS education, maternal and newborn care, emergency care, family planning services and more. Faith-based organizations also operate training institutions to educate health care workers and allied professionals. A unique aspect of this initiative is that the Christian Health Asset Mapping Consortium focuses on documenting all types of health assets within the Christian health landscape, including those that are not easy to quantify, such as community health programs. Figure 1 on this page illustrates the elements of this landscape.

What do we know about Christian health care services already?

Given their remote locations, long-term commitments, influential roles in communities, and ability to reach and connect with hard-to-reach populations, faith-based organizations are positioned to continue playing a substantial role and making a profound impact through their provision of health care services in low- and middleincome countries. For instance, faith-based organizations often operate in underserved areas and sometimes are the only point of entry for rural populations.3 However, determining the proportion of health services they provide is challenging, as it varies considerably from urban to rural areas. In sub-Saharan Africa, this proportion can be much higher in rural areas where faith-based organizations sometimes run the only available

hospital or clinic. 4 Additionally, they are frequently deeply rooted in the communities they serve, allowing them to implement interventions that consider local customs and culture. Moreover, religious actors, such as Catholic leaders, have influential voices in their communities and help promote health and wellness in such areas as vaccine education and family planning services.5

What limits our understanding of Catholic health care’s global reach and impact specifically?

While the Vatican tracks the estimated number of Catholic hospitals and dispensaries around the world, there is not a centralized resource to find clinics, community health centers and the number of community health programs — among other metrics — that are provided by Catholic health organizations.6 It is important to not only comprehend the extent of Catholic health organizations’ secondary and tertiary level services, but also the number and location of community-based health programs, preventive services, health worker training institutions and the status of supply chains that serve them.

Figure 1: Christian Health Assets Landscape Christian Health Facilities

Drug/ Medical Supply Health Networks International Support Partners

Congregational or Other Church-Run Health Programs

Christian Community Health Programs

Health Worker Training

Source: Christian Health Asset Mapping Consortium

Although Catholic health organizations are estimated to account for 26% of health care services globally, 7 it is uncertain whether this captures Catholic health assets that are integrated into other types of faith-based or public health networks. Christian denominational plurality — which is misunderstood by many outside church communities — introduces another layer of complexity to health asset mapping efforts, especially given the centuries-long divisions and fragmentation of various denominations.

Apart from a centralized location to access services provided by faith-based organizations, there is a need for a unified method to quantify the care provided. The analysis is inconsistent, as there is no clear distinction between the types of service offered, its rural or urban locations, the organizational structure of each location and how to access these services. This lack of understanding was further exposed at the onset of the COVID-19 pandemic, when responses from health systems were fragmented. Additionally, the number of faith-based health care facilities is dynamic, with facilities closing and opening daily around the world.

Understanding the limitations and gaps in faith-based health care services will enable us to address them and ultimately strengthen health systems. Faith-based organizations serve a significant proportion of the population in many countries and should have a say in health system governance and decision-making that promotes self-sustainability and collaboration. However, to advocate for their participation, we must clearly demonstrate the impact that they make.

How is the consortium taking this work forward?

At its launch, CHAMC established three initial objectives. First, it aims to develop a metadata platform accessible to organizations and

individuals to enhance their understanding of known data sets. Second, it seeks to disseminate information about Christian health services by providing summary reports and databases to inform stakeholders and policies. And third, CHAMC aims to evaluate current available resources on Christian health assets and develop plans to improve how members can access these resources. In working towards its objectives, the consortium published a data brief in April 2022 that examined the scale of Christian health services in 15 sub-Saharan African countries, identifying more than 8,000 health assets, including national-level hospitals and community-level programs. 8 Although this is a promising starting point, the report acknowledges that some health assets were not captured, and the scale and scope of health assets in the remaining countries of the continent must be documented.

By quantifying Christian health care services in low- and middle-income countries, the consortium hopes to better understand where and how Christian health assets operate within their diverse and dynamic contexts and systems. This initiative is critical in showing the impact of faithbased organizations and advocating for their seat at the table for health system governance and collaborative decision-making with local leaders and partners.

If you or your organization are interested in engaging with the Christian Health Asset Mapping Consortium, please reach out to mapping. consortium@ccih.org.

CAROLYN O’BRIEN serves as program advisor for Christian Connections for International Health, where she manages its efforts on the Christian Health Asset Mapping Consortium and supports the organization’s global health programs.

DR. SAMONE FRANZESE is a family medicine physician in the U.S. Army, currently stationed at Madigan Army Medical Center at Joint Base Lewis-McChord in Washington. She is a Master of Public Health candidate at Johns Hopkins Bloomberg School of Public Health.

Understanding the limitations and gaps in faith-based health care services will enable us to address them and ultimately strengthen health systems.

NOTES

1. “Christian Health Asset Mapping Consortium,” Christian Connections for International Health, https://www.ccih.org/ christian-health-asset-mappingconsortium/.

2. Jill Olivier et al., “Understanding the Roles of Faith-Based Health-Care Providers in Africa: Review of the Evidence with a Focus on Magnitude, Reach, Cost, and Satisfaction,” The Lancet 386, no. 10005 (October 31, 2015): 1765-75, https://doi.org/10.1016/ S0140-6736(15)60251-3.

3. Phesheya Ndumiso Vilakati et al., “The Neglected Role of Faith-Based Organizations in Prevention and Control of COVID-19 in Africa,” Transactions of The Royal Society of Tropical Medicine & Hygiene 114, no. 10 (October 2020): 784–786, https://doi.org/ 10.1093/trstmh/traa073.

4. Barbara Schmid et al., “The Contribution of Religious Entities to Health in

Sub-Saharan Africa,” African Religious Health Assets Programme, 2008, https://www.researchgate.net/ publication/237090449.

5. Allison Ruark et al., “Increasing Family Planning Access in Kenya through Engagement of Faith-Based Health Facilities, Religious Leaders, and Community Health Volunteers,” Global Health: Science and Practice 7, no. 3 (September 2019): 478-490, https://doi.org/10.9745/ GHSP-D-19-00107.

6. “Catholic Health Care,” GoodLands, https://catholic-geo-hub-cgisc.hub. arcgis.com/pages/catholic-healthcare.

7. “Catholic Health Care.”

8. “Summary Report from 16 Africa Christian Health Association Platform Members,” Christian Health Asset Mapping Consortium, April 2022, http://ccih.org/wp-content/ uploads/2022/05/ACHAP-Member-DataSummary-April-2022_final_final.pdf.

Upcoming Events

from The Catholic Health Association

Catholic Ethics for Health Care Leaders Virtual Program

Sept. 5 – Oct. 17 | 1 – 3 p.m. ET

Mission in Long-Term Care Networking Zoom Call (Members Only)

Sept. 6 | 1 – 2 p.m. ET

Deans of Catholic Colleges of Nursing Networking Zoom Call

Oct. 3 | 1 – 2 p.m. ET

United Against Human Trafficking Networking Zoom Call

Oct. 4 | Noon — 1 p.m. ET

Community Benefit 101: The Nuts and Bolts of Planning and Reporting Community Benefit Virtual Program

Oct. 24 — 26 | 2 - 5 p.m. ET each day

chausa.org/calendar

WATER SHAPES OUR CONNECTION TO LIFE

Twenty years ago, the Pontifical Council for Justice and Peace issued the document, “Water, an Essential Element for Life.” It outlines the Catholic Church’s position on water, stating that “The management of water and sanitation must address the needs of all, and particularly of persons living in poverty. Inadequate access to safe drinking water affects the well-being of over one billion persons and more than twice that number have no adequate sanitation. This all too often is the cause of disease, unnecessary suffering, conflicts, poverty and even death. This situation is characterized by countless unacceptable injustices.”1

In the document, the Pontifical Council also wrote about the connection of water to spiritual needs: “Water has a central place in the practices and beliefs of many religions of the world. This significance manifests itself differently in various religions and beliefs. Yet two particular qualities of water underlie its central place in religions: water is a primary building block of life, a creative force; water cleanses by washing away impurities, purifying objects for ritual use as well as making a person clean, externally and spiritually, ready to come into the presence of the focus of worship.”2

Catholic ethics on water are ground ed in a rich and diverse tradition that spans centuries of theological reflection and practical experience. At the heart of Catholic ethics on water is its recognition as a precious gift from God, one that is intimately connected to the natural world and to human community. This understanding of water shapes Catholic teaching on a range of issues related to it, including water’s access, management and conservation.

ACCESS TO CLEAN AND SAFE WATER

First, Catholic teaching emphasizes the importance of ensuring access to clean and safe drink-

ing water for all people. Access to water is a basic human right, and it is essential for the realization of other human rights such as the rights to life and to quality and affordable health services.3 Access to water is particularly important for vulnerable and marginalized communities, such as people who are poor, sick or living in areas affected by drought or water scarcity. Many people around the world lack access to clean and safe drinking water, leading to conflicts over access to water resources. This can be a source of tension between different communities and countries that share water sources.4

Pope Francis has repeatedly highlighted the importance of water and the human right to safe and clean access to it.5 In his encyclical Laudato Si’, he mentions water nearly 50 times. In the second paragraph of this document, he states: “We have forgotten that we ourselves are dust of the earth (Genesis 2:7); our very bodies are made up of her elements, we breathe her air and we receive life and refreshment from her waters.”6 One example of an important Vatican effort to ensure access to safe and clean water is the WASH (Water, Sanitation and Hygiene) project, an effort to improve water and sanitation measures in Catholic health care facilities around the globe.7

RESPONSIBLE WATER MANAGEMENT

Catholic ethics on water also emphasizes the importance of managing it responsibly. This

BRIAN KANE

involves knowing about the interconnectedness of the natural world and the need to balance human needs with those of other species and ecosystems. Water resources should be used in a sustainable and just manner in order to ensure that future generations will have access to this vital resource. Climate change has made droughts and water scarcity more common in many parts of the world. This can lead to conflicts over the use of water resources, particularly in areas where it is already scarce. We are just beginning to see these changes in the United States, particularly in the West. Many rivers and lakes cross state and international borders, leading to conflicts between states and countries over the use and management of water resources. Examples include the Colorado River, the Nile River in Africa, the Indus River between India and Pakistan, and the Mekong River in Southeast Asia.

WATER CONSERVATION

Catholic ethics on water also emphasize the importance of water conservation. Recognizing the value of water as a precious resource and taking steps to reduce its waste and promote its conservation is essential. Catholic teaching emphasizes the need to adopt more sustainable practices in agriculture, industry and other areas that require large amounts of water.

In Laudato Si’, Pope Francis called for a “global ecological conversion” that would involve a “profound interior conversion.” 8 This conversion would involve a shift away from a consumerist mentality that values material possessions and economic growth above all else, and toward a more sustainable and just way of living. This would promote a “culture of care” that values the natural world.

CARE FOR CREATION AND OUR FUTURE

Catholic ethics on water are grounded in a rich and diverse tradition that emphasizes the importance of water’s access, responsible management and conservation. Catholic teaching recognizes the value of water as a precious gift from God and emphasizes the need to use this resource in a more ecologically sound and just manner. By promoting a culture of care and recognizing the interconnectedness of all species, Catholic ethics

on water offer a powerful vision for a more equitable and sustainable future.

BRIAN M. KANE, PhD, is senior director, ethics, for the Catholic Health Association, St. Louis.

NOTES

1. “A Contribution of the Delegation of the Holy See on the Occasion of the Third World Water Forum,” The Holy See, March 2003, https://www.vatican.va/roman_curia/ pontifical_councils/justpeace/documents/rc_pc_ justpeace_doc_20030322_kyoto-water_en.html.

2. “A Contribution of the Delegation of the Holy See.”

3. Pope Francis, Laudato Si’, sections 27-31, https:// www.vatican.va/content/francesco/en/encyclicals/ documents/papa-francesco_20150524_ enciclica-laudato-si.html.

4. The Dicastery for Promoting Integral Human Development (the successor to the Pontifical Council for Justice and Peace) continues to be a leader in water concerns.

“Aqua Fons Vitae–Orientations on Water: Symbol of the Cry of the Poor and the Cry of the Earth,” Dicastery for Promoting Integral Human Development, March 2020, https://www.humandevelopment.va/content/dam/ sviluppoumano/documenti/Aqua%20fons%20 vitae%20_%2003%202020.pdf.

5. Pope Francis has repeatedly raised this issue: “Message of the Holy Father Francis to the Participants in the International Conference ‘The Management of a Common Asset: Access to Drinkable Water for All,’” The Holy See, November 8, 2018, https://press.vatican.va/content/salastampa/en/ bollettino/pubblico/2018/11/08/181108a.html; “The Pope Speaks at Seminar on ‘The Human Right to Water,’” The Holy See, February 24, 2017, https:// press.vatican.va/content/salastampa/en/bollettino/ pubblico/2017/02/24/170224a.html; “Message of His Holiness Pope Francis on the Occasion of ‘World Water Day 2019,’” The Holy See, March 22, 2019, https://www. vatican.va/content/francesco/en/messages/pontmessages/2019/documents/papa-francesco_ 20190322_messaggio-giornatamondiale-acqua.html.

6. Pope Francis, Laudato Si’, section 2.

7. “WASH in Healthcare in L’Osservatore Romano, the Official Vatican Newspaper,” WASH in Health Care Facilities, https://www.washinhcf.org/latest_news/ article-on-wash-in-health-care-facilities-publishedin-losservatore-romano-the-official-vatican-newspaper/.

8. Pope Francis, Laudato Si’, sections 5 and 217.

AVAILABLE ON- DEMAND AND LIVE

Leaders in Catholic health care recognize the crucial importance of formation in ensuring the Catholic identity of our ministries. In response to member needs, CHA is offering Foundations On-Demand as a sister program to Foundations Live.

Foundations On-Demand

ALWAYS AVAILABLE

✦ Ideal for new leaders who miss scheduled formation opportunities. The program is also for those who have difficulty getting away from their work to attend a scheduled program.

DIALOGUE PARTNER

✦ A local dialogue partner supports On-Demand participants as they work at their own pace.

Foundations Live

JANUARY 30 — MARCH 21, 2024

✦ Foundations Live is an interactive eight-week (virtual) program with sessions each Thursday from 1–3:30 p.m. ET

BUILD COMMUNITY

✦ Engage in meaningful dialogue with ministry colleagues from your system and across the country.

LEARN MORE ABOUT BOTH PROGRAMS AND REGISTER AT CHAUSA.ORG/FOUNDATIONS

FROM THE BOARDROOM TO THE BEDSIDE: AVERA EMBRACES DIVERSITY FORMATION CURRICULUM

In early 2021, Avera — along with other Catholic health systems throughout the country — joined CHA’s We Are Called initiative. 1 As Avera’s service region in five states continues to reflect greater cultural and religious diversity, ongoing education and formation around diversity, equity and inclusion (DEI) is essential to faithfully live our identity, demonstrating Christ’s healing compassion in the world. Knowing that good intentions are not sufficient to ensure positive outcomes, Avera’s boards and employees need up-to-date information to guide decision-making and effective action.

In light of this, Avera’s fiscal year 2023 formation curriculum — including board formation — focuses on DEI. As explained by Bob Sutton, Avera’s president and CEO, “By becoming more aware and culturally competent through DEI formation, we honor the legacy of our sponsors who extended Christ’s healing compassion and served all without distinction.”

The curriculum was designed to support and instill a culture of diversity, equity and inclusion as the ministry continues to work toward overcoming “all forms of racism, of intolerance and of the instrumentalization of the human person.”2

IMPORTANCE OF BOARD FORMATION

Because culture starts at the top, board formation has occurred since Avera’s inception in 2000. Prior to 2015, formation of board members happened at board orientation and during Avera’s semiannual leadership conference. In 2015, Avera began integrating quarterly board formation throughout the year both at the regional and system levels. Mission leaders now facilitate 10- to 30-minute formation discussions at the beginning of their respective board meetings every three months to help set the context for deliberations. The quarterly cadence allows for real-time discussions

about current issues impacting the ministry and the communities where board members live and work.

A curriculum committee of mission leaders develops the formation materials and questions used in these discussions from a variety of sources, including CHA’s Health Progress articles and its Framework for Ministry Formation,3 Vatican documents, USCCB content and other relevant sources. Formation materials are distributed to board members so they have an opportunity to engage with the content prior to a meeting. Questions are structured in a way that allows board members to meaningfully participate in formation discussions even if they have not had a chance to read the materials in advance of the gathering.

This year’s DEI-related board formation curriculum has stimulated thought-provoking and fruitful discussion among Avera board members, both personally and professionally. Board

The quarterly cadence allows for real-time discussions about current issues impacting the ministry and the communities where board members live and work.

FAITH MINNICH KJESBO, MAMFT

members are invited to share from their own experiences, including where they’d like to see more growth, as well as thinking from an organization, business or community perspective. Topics explored include DEI terminology; culture, power and privilege; bias; equity, equality and justice; and the ways Catholic health care is called to respond. These issues are complex, yet feedback from board members has been very positive. Avera Sacred Heart Hospital Board Chair Brian Steward said the DEI formation carries “great weight as it has a direct impact on the health of our patients and the welfare of our employees.”

FORMATION OF PHYSICIANS, LEADERS AND FRONTLINE EMPLOYEES

In addition to board formation, Avera’s clinical and administrative leaders, as well as frontline employees, participate in ongoing formation. Quarterly clinical service line meetings operate much like board meetings, so formation is similar in that mission leaders facilitate discussions of the curriculum, which is more clinically focused than that of board formation. All other Avera leaders participate yearly in an eight-month formation series through the Mission Leadership Development program and resource guide. These peerfacilitated sessions are offered both in-person and virtually to accommodate leaders’ schedules and work locations. After the monthly sessions, leaders then cascade the learnings to their teams through the program’s takeaways designed for staff huddles, department meetings and as opening reflections for meetings.

SETTING THE STANDARD FOR DEI FORMATION

During a recent Joint Commission survey at Avera St. Luke’s Hospital in Aberdeen, South Dakota, the board chair and executive team spoke about this formation curriculum in response to surveyors’ questions regarding DEI education and health equity initiatives. The surveyors asked for a copy of the curriculum to share with their colleagues and other health systems as a practice supporting the Centers for Medicare & Medicaid Services’ new health equity strategic pillar4 and The Joint Commission’s health equity standards. Similarly, the DEI formation curriculum has been provided to granting and regulatory agencies, which now require evidence of health systems’ commitment to DEI.

At the conclusion of fiscal year 2023, Avera’s board members and employees will be surveyed about the impact of DEI formation on their personal and professional experiences. In the meantime, unsolicited feedback about the curriculum has been positive. Many shared that although the conversations were sometimes uncomfortable, the curriculum has increased their awareness around diversity and inclusion and provided practical tools for becoming more culturally competent. For example, one clinician shared that they began to recognize their own biases, resulting in a change of practice to better meet the unique social and cultural needs of their patients.

UNCONDITIONAL ACCEPTANCE AND LOVE

During his life Jesus taught, befriended and ministered to persons from every sector of society, then commissioned us to, “Go and do likewise.” Catholic health care is a response to that challenge. Providing Avera’s board members and employees with relevant and timely DEI formation helps to ensure that our positive intentions will yield positive outcomes and expresses our love for God — the author of diversity — and each other.

For more information and/or to obtain supporting materials on Avera’s DEI formation curriculum, please contact Faith Minnich Kjesbo at faith.minnichkjesbo@avera.org.

FAITH MINNICH KJESBO is manager of formation and cultural competence for Avera in Sioux Falls, South Dakota. MARY L. HILL, BSN, MA, JD, and KARA PAYER, MBA, MS, are contributors to this article. Mary L. Hill is chief mission officer for Avera in Sioux Falls, South Dakota. Kara Payer is vice president of mission for Avera Sacred Heart Hospital in Yankton, South Dakota.

NOTES

1. “We Are Called,” Catholic Health Association, https://www.chausa.org/we-are-called.

2. Pope Francis’ tweet: “We must overcome all forms of racism, of intolerance and of the instrumentalization of the human person” (@Pontifex, July 18, 2017).

3. Framework for Ministry Formation (St. Louis: Catholic Health Association, 2020), https://www.chausa.org/ store/products/product?id=4363.

4. “Pillar: Health Equity,” Centers for Medicare & Medicaid Services, https://www.cms.gov/files/ document/health-equity-fact-sheet.pdf.

ENHANCING ACCESS TO CARE ALONG THE U.S.–MEXICAN BORDER NEAR SAN DIEGO

One of the things I love most about my work at CHA is the opportunity to meet a multitude of colleagues from across the Catholic health care ministry. It never ceases to amaze me when I see the great work so many are doing across the country in extending the healing ministry of Jesus in our communities, especially for those who are underserved and vulnerable. I encountered one such example on a recent visit I made to San Diego. The mission team at Scripps Mercy Hospital, led by Mark Zangrando, extended a generous welcome as I toured their facilities and met a wide variety of staff.

Part of the Scripps Health system, Scripps Mercy Hospital was founded by the Sisters of Mercy and has served San Diego since 1890. As part of its community-driven approach, one of the hospital’s goals is to collaborate with area leaders and agencies to offer programs that promote access to care and health education.

DENNIS GONZALES

As Kendra Brandstein, PhD, director

of com-

munity benefit for the hospital, explained during my visit, two key initiatives are helping to make the advancement of this critical goal possible: the Scripps Mercy Hospital Chula Vista Well-Being Center and the Scripps Family Medicine Residency. By working collaboratively with community members, these programs help to address health disparities for those who are medically underserved along the California/Baja California border regions.

MEETING PATIENTS WHERE THEY ARE

KENDRA BRANDSTEIN, PhD, MPH, MSW

Providing opportunities for residents to make a difference in the California/Baja California area while also gaining handson experience, the Family Medicine Residency Program at Scripps Mercy Hospital Chula Vista embeds community medicine experiences in its curriculum. Training family medicine physicians to provide comprehensive medical care, the program also educates physicians to work in underserved communities. Many of these physicians today now hold leadership roles in local community clinics.

“As a program, we strive to not only train our residents to work within the walls of the clinic, but also learn how to work together to partner in the schools and community organizations in order to provide more effective care for communities. Our residents learn to understand that life outside the clinic affects how they (community members) take their medications, what types of food they eat and how they access care,” said Melissa Campos, MD, associate program director and alumna of the program.

For residents and medical students, having this

work embedded in the program provides them with an opportunity to learn through diverse community experiences. “Working here in very close proximity to the U.S.-Mexico border ... gives us the opportunity to provide high-quality and equitable binational care to our medically underserved community,” particularly a Latino Spanish-speaking medically underserved community, said Miguel Alvarez-Estrada, MD, a program alumnus who today is on its faculty. He said he also appreciated the program’s close community ties, noting that he has always wanted to be a physician who could serve people like his parents and their neighbors.

COMMUNITY HEALTH IN ACTION

In collaboration with the Scripps Family Medicine Residency Program, Chula Vista Community Collaborative1 and the Scripps Mercy Hospital Chula Vista Well-Being Center offer community education programs for nearly 20 community health workers (or, commonly known in Spanish as promotores) who are community members. Through the Promotores in Action: Prevention, Education and Wellness program, promotores are trained in health promotion and education and work to disseminate information concerning health and wellness to individuals and groups in San Diego’s

South Bay community.

Scripps Mercy Hospital Chula Vista WellBeing Center offers monthly community educational sessions on topics focused on critical community health needs, including mental health, burnout, chronic disease prevention, hypertension and diabetes. Working closely with Scripps Family Medicine residents who often present the topics, the center works collaboratively with the promotores to develop and deliver educational content tailored to the needs and interests of the community. This approach provides the community with accurate and reliable information about health and wellness, empowers them to make informed decisions about their health, and enables them to disseminate the education they receive to others. As expressed by one of the program’s participants, “What I have learned today will help me to seek medical care and be informed about symptoms and how to improve my life.”

Scripps Mercy Hospital Chula Vista WellBeing Center also helps to meet the needs of older adults through its Health Chats: Teaching Seniors about Health and Prevention Program. Established more than 20 years ago, the program is centered around topics chosen by community seniors, ensuring that the content is relevant and

Scripps Mercy Hospital Chula Vista Family Medicine residents collaborate with Scripps Mercy Hospital Chula Vista Well-Being Center in 2023 to offer education programs to community members to support health prevention, education and access to care.

Photo courtesy of Scripps Health

meaningful to their lives. The goal is to promote a culture of learning and sharing among the senior community by providing them with health education and a better understanding of access to care; empowering them to take control of their health and well-being; and encouraging them to share what they learn with their peers.

Since the start of the year, the program — which is offered at multiple community locations and covers topics from heart health to food and nutrition to fall prevention — has served nearly 150 seniors, and knowledge on the educational topics among participants has increased by an average of 15%. Comments from participating seniors include, “Every time I attend the presentations, I feel that I know more on how to protect myself and my loved ones,” and, “This is important, especially since I can’t get out that much anymore, and people like me are very appreciative.”

NAVIGATING SYSTEMS, IMPROVING CARE AFTER DISCHARGE

Efforts at Scripps Mercy Hospital Chula Vista Well-Being Center are also underway to address the numerous social determinants of health for chronic disease patients and their families after they are discharged in order to help them manage their condition through a supportive intervention called Helping Patients Navigate Services and Support Post-Discharge. The program’s key focus areas are to: improve patients access to primary and specialty care; help patients navigate the health care system; and connect them with health care providers and necessary services, including those for supporting mental health or management of chronic conditions. The support services are referral-based and provide assistance with a wide range of needs, helping to decrease the risks of readmission and to increase patient continuity. Addressing social determinants of health — such as housing, food and transportation — can also be critical for patients with chronic diseases. The program is developing ways to improve coordination and communication among health care providers, community organizations and social service agencies. In the previous year alone, nearly 800 patients were referred, and outreach was done for more than 500 patients to support them in scheduling follow-up medical appointments and providing emotional support, supportive services and community resources (including those to address food and housing needs) during challenging times.

Improvement in these patients’ conditions has been evident from these efforts as those who have been communicated with consistently over time are 1.3 times less likely to be readmitted compared to those who are not contacted. Patients have expressed gratitude for the assistance provided through the program, one saying it is “so comforting to know that someone cares,” and another expressing that the outreach “helped me improve my life and I am forever grateful.”

Of these patients, 80% had a follow-up appointment with a physician within two weeks posthospital discharge, 97% were compliant with their medication, and more than 90 supportive services and community resources were provided.

GOOD COLLABORATION IS KEY

These interventions at Scripps Mercy Hospital Chula Vista aim to create a more holistic and patient-centered approach to health care, one that recognizes the importance of social determinants of health and provides support to help patients manage chronic disease and improve their overall health and well-being. As described by Debra McQuillen, vice president and chief operations executive at Scripps Mercy Hospital, “The collaborative efforts and commitment of the health care professionals and providers in our Family Medicine Residency Program and Well-Being Center brings our Scripps Health mission and the legacy of the Sisters of Mercy to our patients every day, creating a stronger and more healthy community.”

Addressing the underlying factors contributing to poor health outcomes can help reduce health care costs and improve patient outcomes over the long-term. Through the hospital’s communitybased health care initiatives, these efforts provide an excellent example of how collaboration among health care providers, community organizations and social service agencies can promote access to care, health education and improved patient outcomes.

KENDRA BRANDSTEIN is director of community benefit at Scripps Mercy Hospital Chula Vista and director of the San Diego Border Area Health Education Center at the Chula Vista campus of Scripps Mercy Hospital.

NOTE

1. Chula Vista Community Collaborative, https:// www.chulavistacc.org.

The Way of Love: A Prayer for Compassion and Understanding of Transgender Patients and Their Families

JILL FISK, MATM, and KARLA KEPPEL, MA CHA DIRECTOR, MISSION SERVICES, and CHA MISSION PROJECT COORDINATOR

“But I shall show you a still more excellent way.” (1 Corinthians 12:31)

INTRODUCTION

At the heart of Catholic health care lies our call to embrace the sacredness of every person who comes to us for care. We exist to extend a community of healing and compassion as Jesus did, so that all people can be brought to life physically, mentally and spiritually — particularly those who are poor and vulnerable.

As a ministry of the Church, we are committed to understanding the needs of our marginalized and vulnerable patients so that caregivers can serve with empathy and excellence. We recognize the barriers to care that exist for our LGBTQ family. As we continue to serve transgender patients with the compassionate care which is our hallmark, we will share guidance and resources throughout the ministry, highlighting the importance of spiritual care and education. We extend the promise of wholeperson care to all patients who walk through our doors. In our actions, love will be our guide.

REFLECTION

Let us pause and consider the work before us as we gather together. Then, prayerfully consider these words from Pope Francis:

“God is Father and does not deny

any of His children … And God’s style is closeness, mercy, and tenderness. Not judgment and marginalization. God draws near with love to each of His children, to each and every one of them. His heart is open to each and every one. He is Father. Love does not divide but unites.”1

(Pause for silent reflection and/or group discussion.)

Consider:

How have you experienced God drawing “near with love”?

What obstacles are there to knowing God’s closeness?

What, in your experience, causes division?

CLOSING PRAYER

God of tenderness, God of mercy:

We pray for our patients who feel invisible, who feel eyes avert as they are passed in the hall.

When it is easier to look away, give us eyes like Yours so that we can clearly see their pain and walk tenderly alongside them.

We pray for our patients who live in fear, who have experienced places of care as places of harm.

When we feel ill-equipped, give us the courage to ask for help so that we may work to understand how best to hold those in our care.

We pray for our patients whose

identity is misunderstood or misrepresented.

When we are afraid of getting it wrong, grant us the humility to ask for their forgiveness, so that we can meet them in their full humanity. We pray for our patients who feel desperately alone amid spiritual crisis.

When we feel powerless to mend one’s troubles or offer comfort, give us hearts like Yours to acknowledge their suffering, ensuring no one is forced to grieve alone.

God who is “longer than the earth in measure,”

God who is “broader than the sea,”2 God who is Maker of all persons, God who whispers into silence: Speak Your way of love into the depths of our being.

For who but You can fathom the depths of the intricacies of the human person?

Who can fathom the depths of Your love?

Amen.

NOTES

1. “Pope Speaks to Italian Psychologist for Book Entitled ‘Fear as a Gift,’” Vatican News, Jan. 21, 2023, https://www.vaticannews.va/en/pope/news/2023-01/popespeaks-to-italian-psychologist-for-bookfear-as-a-gift.html.

2. Job 11:9

Congratulations to All the Award Winners

ACHIEVEMENT CITATION WINNER

COVID @ Home Spiritual Care, Mercy

LIFETIME ACHIEVEMENT AWARD

Sr. Linda Werthman, RSM, PhD | Trinity Health

SISTER CAROL KEEHAN AWARD

Rod Hochman, MD | Providence St. Joseph Health

SISTER CONCILIA MORAN AWARD

Sr. Catherine O’Connor, CSB, PhD | Covenant Health

Thanks to Our Sponsors

Thanks to our Friends of Assembly for generously supporting Assembly 2023.

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TOMORROW’S LEADERS HONOREES

Dzenan Berberovic, MA, CFRE | Avera Health

Brian Li | CommonSpirit Health

John R. Albright, Jr. | St. Joseph’s/Candler Health System, Inc.

Jessica Darnell, MSN, RN, CENP | Ascension Saint Thomas Hospital Midtown

Elliott Bedford, PhD | Ascension St. Vincent, Ascension Via Christi

John Kohler, Sr., MD, MBA | SSM Health

Zachary Melick | PeaceHealth

Tyler Limbaugh | Ascension Florida and Gulf Coast

Lauren King | Ascension

Ratish Kumar Mohan | Hospital Sisters Health System

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