Case Study: Community Emission

My community or population implementation paper is about McDougald Terrace in Durham North Carolina. McDougald Terrace is a multifamily community that was established in the 1950s and it is the largest conventional public housing community in Durham. The community has 360 apartments. It was named after the late R. L. McDougald who was an outstanding Durham pioneer and community leader. McDougald Terrace is located in the southeast section of Durham (Durham Housing Authority). The community is minutes away from North Carolina Central University, one of the historically black colleges and universities in the nation.

I performed a windshield survey in the neighborhood one Saturday afternoon. It was a beautiful day and I noticed kids playing,

riding bicycles and running around outside of the apartments. There were several women watching the children. I saw young men just walking around in the streets and some hanging out with women. I saw a few older people sitting on the front porches of the apartments. I saw a few young men in wheelchair and it appears to be gunshot injuries since domestic violence and substance abuse is prevalent in this neighborhood. The community is mainly made up single women with school-aged children. Most of the people in the neighborhood use public transport.
McDougald Terrace community has health issues just like any other community in America. Most of the health issues faced by the community are obesity, heart disease, diabetes, sexually transmitted diseases, substance abuse and chemical dependence. Some of the health issues are contributed by lack of preventive care, lack of health insurance, lack of income to buy healthy foods, lack of free clinics, lack of awareness of lifestyles and health practices and delay in seeking medical help.
Cultural and social beliefs are other reasons why most of the residents at McDougald Terrace community delay seeking help. Culture affects all aspects of health and illness, including the perception of it, the explanations for it, and the behavioral options to promote health or relieve suffering. In African American culture seeking help can be viewed as a sign of weakness. Symptoms of distress or illness can be interpreted as indicating signs of moral weakness, physical frailty, or failure to carry out important social roles. Illnesses may be evaluated negatively when they signify that a person (or a family member) has failed in some important social role. When people evaluate their distress or illness as negative, they will have emotional responses of shame, humiliation, anxiety, or fear. These people will avoid disclosing it out of fear of the social consequences (Saint Arnault). Delays in seeking care when experiencing symptoms may increase morbidity and mortality.
McDougald Terrace is one mile away from Lincoln Community Health Center. The health center is a provider of primary and preventive healthcare to Durham residents to decrease health disparities and assuring health access to all residents. The health center has several clinics throughout Durham. At the main Lincoln health center, specialty and dental services are available. 24 hour emergency on-call, Asthma, Behavioral Health Care Services, Blood Pressure Monitoring, Cancer Screening, Case Management/Social Services, Chronic Bronchitis/Emphysema, Contraceptives (issued w/counseling, Diabetes Testing/Care, Electronic Medical Records, Family Planning, Flu Vaccinations, Gynecology, Health/Nutritional Education, Hepatitis C screening/treatment, HIV/AIDS screening/education, Immunizations, Labs, Medications/Prescription, Mental Health Counseling, Pharmacy, Physical Exams, Pneumococcal vaccine, Primary Health Care, Referrals for Specialty Care, Smoking Cessation, Treatment of Acute Illness and Treatment of Chronic Illness (Lincoln Community Health Center)
Obesity has become a public health crisis in the United States.

Nationally representative survey data show that the prevalence has steadily increased over the past three decades although there are large disparities between population groups and continuing changes in the associated pattern (Wang, Beydoun, Liang, Caballero and Kumanyika). The community is aware of the problem as evidenced by walking trails through the community. Residents are aware that exercise, especially walking can help decrease obesity and can lower medical bills. According to Wolf and Colditz, medical costs associated with overweight and obesity may involve direct and indirect costs. Direct medical costs may include preventive, diagnostic, and treatment services related to obesity. Indirect costs relate to morbidity and mortality. Morbidity costs are defined as the value of income lost from decreased productivity, restricted activity, absenteeism, and bed days.

If obesity is not addressed in this community, many residents will suffer from chronic illness such as hypertension, diabetes and heart diseases. During my windshield survey I witnessed several older looking men in wheelchairs and I assumed it is related to amputation due to

diabetes.
There are a number of barriers in this community in changing health conditions. First, most of the residents have low education. It will take a lot of education in the community encouraging them to return to school in order to gain higher education. Even though the community is located blocks away from North Carolina Central University and Durham Community College most of the residents are high school drop outs. Education will help residents in this community in finding better paying jobs. Some of the health problems can be alleviated by health promotion and disease prevention. A combination of primary, secondary and tertiary prevention is needed at McDougald Terrace to achieve a meaningful degree of prevention and protection. Primary prevention targets general health promotion and specific promotion. Secondary prevention refers to early detection and prompt intervention during the period of early disease and tertiary prevention targets populations that have experienced disease or injury and focuses on limitation of disability and rehabilitation (Nies and McEwen, 2011).
Since the community is aware of obesity my goal for the community is to increase the awareness of health risks associated with obesity, physical inactivity and poor nutrition. I will encourage the community to increase physical activity by walking 30 – 60 minutes three to four days a week at the beginning and increasing to 60 minutes daily. I will teach how obesity can add years of chronic illness and shorten life expectancy in the community. Lastly, I will encourage the community in choosing healthy foods and beverages. I increase awareness in the importance of starting a fruit and vegetable garden.
I will team up with nursing students at North Carolina Central University in conducting educational sessions on obesity. I will invite all residents including children and adults. Sessions will be age appropriate. I will meet with children, adolescents and adult sessions on different days of the week. At the beginning of each session will discuss good eating habits and how to incorporate physical activities in their daily lives and we will also discuss chronic illnesses related to obesity. At the end of the meeting the group will participate in physical activities.
After a month of meeting with all age groups I will evaluate the residents by administering questionnaires to evaluate if the group sessions and exercises have helped the community to understand the dangers associated with obesity.

I am aware that change will not happen overnight in this community but, with time I hope people of McDougald Terrace will understand the importance of healthy weight, healthy eating habits, the importance of increasing physical activity and seeking medical help on time to decrease morbidity and mortality.

References:

Nies, M., & McEwen, M. (2011). Community/Public health nursing: Promoting the health of populations (5th ed.). St. Louis: Mosby Elsevier

Saint Arnault, Denise, PhD, RN. (2009). Cultural determinants of help seeking: A model for research and practice. Research and Theory for Nursing Practice, 23(4), 259-78. Retrieved from http://search.proquest.com/docview/207664067?accountid=6143

Wang, Y., Beydoun, M. A., Liang, L., Caballero, B. and Kumanyika, S. K. (2008), Will All Americans Become Overweight or Obese? Estimating the Progression and Cost of the US Obesity Epidemic. Obesity, 16: 2323–2330. doi: 10.1038/oby.2008.351

Wolf, A. M. and Colditz, G. A. (1998), Current Estimates of the Economic Cost of Obesity in the United States. Obesity Research, 6: 97–106. doi:

10.1002/j.1550-8528.1998.tb00322.x