Medical residents from Barnes-Jewish Hospital are working to reduce health disparities by visiting what has long been trusted places to freely share stories and receive advice 鈥 the neighborhood barber shop and beauty parlor.
The new doctors are spending their Saturdays checking patrons鈥 blood pressure and weight and providing information on everything from nutrition to heart disease to how to stop smoking.
The unique outreach program began three years ago, but the grant that funded the effort ran out. The new doctors have taken it upon themselves to continue the barber shop and salon visits because of the success similar programs have shown locally and nationwide.
鈥淭he main reason I do this is to try and break down barriers that exist between a community and those that take care of a community,鈥 said Dr. Sanjay Maniar, an internal medicine resident leading the effort. 鈥淲e are letting people know that we are part of this community, and we do care.鈥
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One shop Maniar鈥檚 group visited on a recent weekend was Shack鈥檚 Barber and Beauty Salon downtown. Owner Keith Shackleford said many of his clients, like him, grew up without health insurance and that annual check-ups were never an option.
鈥淵ou get accustomed to not having insurance, and you get accustomed to not going to the doctor except when you feel you have to go,鈥 said Shackleford, 47. 鈥淚t鈥檚 just not being educated on the benefits of having a primary care doctor. You don鈥檛 worry about it until it鈥檚 too late.鈥
When one client sees another talking to the physicians, they see the benefits. 鈥淧eople say, 鈥楬ey, he鈥檚 doing it, so I鈥檒l do it too,鈥欌 Shackleford said.
Bringing health care to inner-city barber shops has gained in popularity over the five years as a way to reach their main clientele 鈥 black men.
With the highest rates of heart disease, diabetes, high blood pressure and prostate cancer, African-American men suffer the worst health outcomes of any other racial group in the U.S.
They are also the least likely to see a doctor. Various studies have pointed to several reasons why: distrust of the medical community, lack of insurance and few doctors who share their culture (only 3 percent of doctors and medical students in the U.S. are African-American).
Dr. Bill Releford, an L.A. podiatrist who six years ago started the Black Barbershop Health Outreach Program, pointed to another reason: Health care advertising and federal health programs overwhelmingly target women and children.
鈥淚f you don鈥檛 market to me, you are telling me you have no value,鈥 Releford said. 鈥淲hen we go into barber shops, people are like, 鈥榃ow, you care.鈥 We have not demonstrated that we care about black men鈥檚 health.鈥
Releford said the idea of taking health care into a place where black men feel comfortable came while he was sitting in a barber shop鈥檚 chair. 鈥淚n a way, it鈥檚 the black men鈥檚 country club,鈥 he said. 鈥淚t鈥檚 where they talk about politics, they brag about their kids, discuss their relationships, whatever, we do it in the barber shop.鈥
After starting in 2007 with volunteers visiting barber shops in L.A., Releford鈥檚 outreach program has spread to 42 cities nationwide. Nearly 30,000 men have been screened for diabetes and blood pressure. The program came to St. Louis more than a year ago, organizing volunteers to visit about a dozen barber shops, and another effort is planned in St. Louis sometime this fall, Releford said.
鈥淭hese efforts are so important because, really, it sends a message that health care reform begins in your house and not the White House,鈥 he said. 鈥淵ou can pass all the legislation you want, but if you go out and eat a chili dog and a soda you are still going to have a heart attack.鈥
Inspired by organizations like Releford鈥檚, local social service provider Better Family used a grant from the St. Louis County Department of Health three years ago to provide health screenings and education at barber shops in the city and county. Nurses, medical residents and residents trained as 鈥渉ealth advocates鈥 visited 42 barber shops over a two-year period, reaching nearly 1,000 people, said Norman Miller, who coordinated the program for Better Family Life. Clients needing follow-up care also received a card for an appointment with a doctor at participating health clinics.
In the first year, Miller said, 65 percent of the clients seen in the spring had high blood pressure readings. When returning to the same barber shops in the fall, the number had dropped to 50 percent. 鈥淲hen we came back, people wanted to tell us how they changed,鈥 he said.
Maniar began volunteering with the Better Family Life program and saw how grateful people were for the information. He also enjoyed the change from only seeing very sick patients in rushed settings.
鈥淚 feel like I have much more time to educate patients and talk to them, and they feel like they can ask as many questions as they want,鈥 he said.
With funding for the program ending last summer, Maniar is leading the effort to continue the barber shop visits with four other medical residents over several Saturdays this winter and spring. 鈥淚t鈥檚 just me with a bunch of fliers and a blood pressure cuff and a scale and that鈥檚 it,鈥 he said.
But a little can go a long way. Studies of similar programs that trained barbers to promote health screenings and follow-up care with physicians showed that their patrons had better control of their hypertension. Before beginning the barber shop visits, Better Family Life also trained more than 30 barbers as health educators.
鈥淪ometimes it鈥檚 not always about building a new clinic or a new hospital but making what we have work better,鈥 Releford said. 鈥淲ho would鈥檝e thought that a barber shop was a place to find out what was wrong with you?鈥
Miller said he is thankful Maniar is continuing the outreach. 鈥淚t shows people in the barber shops (the volunteers) are not coming out for research or part of a program to help themselves, but they really are coming to help,鈥 he said. 鈥淲hen the funding goes out, they are still coming. It really does show them that it鈥檚 about the people.鈥
It鈥檚 not clear what will happen to the barber shop visits after Maniar鈥檚 residency training ends this summer and he heads to Boston. 鈥淗opefully people with continue on when I graduate,鈥 he said.