in Barcelona

Studying How Public Transit Brings Healthcare to Communities in Need

BY MATT KIANPOUR ’24

Matt Kianpour ’24 is a science-computing major with minors in compassionate care in medicine, European studies, and poverty studies. Over spring break in 2022, he received a grant from the Nanovic Institute to conduct research in Barcelona for his capstone essay. I love public transportation. Even in South Bend, a small midwestern city that could best be described as public transit-lite, I have the Transpo schedule memorized. On campus, I am known for boarding my entire friend group on bus number seven for excursions to the mall, coffee shops, and Mexican restaurants. While public transportation is my hobby, my professional interests lie firmly in the realm of healthcare. My career goal is to become a primary care physician, one whose philosophy aligns with the World Health Organization’s definition of health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

I believe we must view healthcare as a sociological institution. For me to be an excellent primary care physician, I need to be aware of the discriminatory social forces that erect barriers and prevent certain people, particularly those at the margins of society, from accessing responsive and quality healthcare. As a science-computing major, I am eager to apply quantitative analysis to qualitative issues, especially through the use of geographic information systems (GIS) technology, which can be used to portray a community’s experiences, narratives, and in particular, challenges, in code and on maps.

My research considers how public transportation can facilitate or present a barrier to healthcare. Researchers in the U.S. have observed that a lack of reliable transportation can act as a roadblock to accessing healthcare facilities, resulting in missed visits and rescheduled appointments, delaying adequate care for patients, especially those who are economically disadvantaged. My work aims to discover whether such barriers to healthcare exist in Barcelona, which, unlike cities in this country, has a universal healthcare system and a robust public transportation network. My research seeks to understand, in particular, how well Barcelona’s public transportation system makes healthcare accessible for the city’s low socioeconomic status populations.

Prior to my field research in Spain, I spent the fall 2021 semester working with the Navari Family Center for Digital Scholarship to complete a spatial analysis of Barcelona health care facilities using GIS software. I created a model to identify healthcare facilities that are located within a low-income region and within a walkable distance – 0.25 miles or less – from one of the Transports Metropolitans de Barcelona’s (TMB) 165 train stations. This model provided a sampling frame for phase two of my project: ethnographic research conducted in Barcelona.

When I arrived in Barcelona, I vowed to only travel by metro, no matter my destination. This gave me an opportunity to see and experience the full scope of the population served by the city’s main transit system. I rode the metro with school teachers, doctors, corporate workers, and even a group of FC Barcelona fútbol fans on their way to a match. I rode the train at 5 a.m. and took it home again at 5 p.m. after a day of visiting clinics, experiencing a train system that, with its modern technology and frequent service, certainly helps promote access to the city’s healthcare facilities.

Over the week, I conducted semi-structured interviews with patients at clinics that met my sampling criteria and asked them about how transportation affected their access to healthcare. One encounter has stayed with me: a man in his 60s who had a transfemoral (above the knee) amputation to his left leg due to diabetes. We discussed his quality of life and pain management, and he explained that he uses a walker, which he feels gives him better mobility than a wheelchair. His wife and family are unable to provide transportation to his appointments, so he relies on the metro system. His visits to the clinic are vital: pain management is a constant challenge and his diabetes puts him at risk of developing diabetic neuropathy, a type of nerve damage that could lead to the amputation of his other leg. Because of the TMB’s frequent service and disability-accessible trains and platforms, he can receive the care and monitoring he needs to protect his health and achieve a greater quality of life.

As an aspiring primary care physician, conversations like these excite me to build longitudinal relationships with my future patients. Conversations like these also underscore the ways we can learn in Europe and from Europe, and how, when we seek to enact change in our own communities, such as by improving public transportation services to provide greater access to healthcare, we should speak directly to the people those services would support. GIS is an important tool for understanding, though without conversation something may be lost in translation: that people are so much more than dots on a map. ◆

“When I arrived in Barcelona, I vowed to only travel by metro, no matter my destination. This gave me an opportunity to see and experience the full scope of the population served by the city’s main transit system.”

BARCELONA

ABOVE: Metro stop outside Barcelona’s Bascílica de la Sagrada Família. LEFT: Barcelona Metro Rail system (red triangles) overlayed by city health facilities, indicated with blue, green, and brown dots.