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Community-based care saves lives

December 5, 2017

An ASU assistant professor's work to establish strong connections with local refugee communities pays off

Doctors have myriad life-saving technologies at their fingertips, but they can all be rendered useless without human warmth and community connection.

That’s what drives the work of Crista Johnson-Agbakwu, an assistant research professor in Arizona State University’s School of Social Work and clinical research affiliate with the Southwest Interdisciplinary Research Center (SIRC). She’s also a doctor of obstetrics and gynecology. 

“We are examining challenges and barriers to care in vulnerable, underserved and hidden populations,” Johnson-Agbakwu said. “It’s essential to have this kind of community-based care that builds trust.”

Case in point: A Somali mother-to-be developed a life-threatening pregnancy complication a few months after arriving in Phoenix as a refugee. It required immediate delivery of her child.

Exhausted from spending years of her life in one of the world’s largest refugee camps and unable to speak the language of her newly adopted country, she was fearful and intimidated by a healthcare system completely foreign to her.

Despite extensive counseling and education, and even when faced with the likelihood both she and her baby would die as a result, the woman refused.

“She was terrified,” Johnson-Agbakwu said. “We tried to explain it to her for two weeks, but we were getting nowhere.”

The question was why.

Where some might scorn the expectant mother’s seeming disregard for herself and her child or throw up their hands in despair at a patient resolved to act against medical advice, Johnson-Agbakwu and others saw an obstacle requiring extra care, warmth and connection.

As director of the Refugee Women’s Health Clinic, part of Maricopa Integrated Health System, Johnson-Agbakwu and her staff felt confident they could still help this patient and her unborn baby.

They began mobilizing their contacts in the local Somali community along with the patient’s refugee resettlement case manager. They brought in a local community advocate as well as a sheikh (the premier Islamic religious authority for the Somali community in Arizona), who met with the woman and provided religious clarity, encouragement and support. With her anxieties alleviated, she felt empowered to make an informed decision, and she opted to move forward with the delivery.

The result? The clinic’s obstetrics team successfully delivered a healthy newborn and saved the life of the mother.

The Refugee Women’s Health Clinic was founded by Johnson-Agbakwu in 2008. She also leads Community-Based Participatory Research (CBPR) in the Office of Refugee Health at SIRC, one of two dozen research units in the College of Public Service and Community Solutions.

“There needed to be a safe space where people could speak their native language while navigating an intimidating healthcare system,” said Johnson-Agbakwu.

The clinic has grown tremendously in the nine years since its inception, caring for more than 5,000 women speaking 41 languages from over 51 countries across Sub-Saharan Africa, Southeast Asia and the Middle East. Its multilingual staff includes refugee women who serve as cultural health navigators. Together, they speak 13 languages fluently and offer a team-based approach to health care.

Johnson-Agbakwu built up the clinic from scratch by working with Maricopa Integrated Health System, the state’s only safety net hospital for the most vulnerable in our society. This allowed her to seamlessly integrate the community-based model of CBPR every step of the way. By fostering connections and partnerships within the communities they serve, the staff built that most essential and elusive quality into their practice: trust.

“Being out in the community, pounding the pavement, letting the people know they have your full support — it takes a significant investment,” Johnson-Agbakwu said. “But it’s necessary. Their views matter, and our initiative is focused on a shared vision and shared goals with the very people we serve. Without the relationships built through our research at SIRC, the outcome with the Somali mother would not have been possible.” 

Top photo: Crista Johnson-Agbakwu meets with one of her patients at the Refugee Women's Health Clinic housed in Maricopa Integrated Health System.

Lisa Rolland-Keith

Communications Specialist , College of Public Service and Community Solutions

602-496-0130

ASU partners with EPA on sustainable purchasing website


December 5, 2017

The Environmental Protection Agency is partnering with Arizona State University’s Sustainable Purchasing Research Initiative, or SPRI, on a website designed to help organizations interested in eco-friendly purchasing. Sustainablepurchasing.issuelab.org features a searchable database of research articles related to “servicizing,” a concept that is catching on worldwide and is endorsed by the United Nations Environmental Programme.

“Servicizing” promotes a more environmentally responsible way for businesses, nonprofits, governments and individuals to meet their purchasing needs. For example, instead of buying carpet, a “servicizing” approach would involve hiring a carpet leasing company to provide carpet as needed. This approach would eliminate overhead and disposal costs. Plus, the carpet leasing company would maintain control of its supply chain so that carpet that has reached the end of its “life” can be remanufactured and re-leased thus reducing waste sent to landfills.   ASU professor Nicole Darnall ASU Professor Nicole Darnall is the lead researcher with the Sustainable Purchasing Research Initiative, a project that helps organizations adopt more eco-friendly purchasing policies and practices. Download Full Image

"This new ‘servicizing’ approach offers and charges customers for the function of a product rather than the product itself,” said Lily Hsueh, an assistant professor in the ASU School of Public Affairs and researcher with the Center for Organization Research and Design. “Producers or vendors are the ‘owners’ of the products and consumers pay to be ‘users’ of the products.”

SPRI is a research initiative within ASU’s Center for Organization Research and Design (CORD).

“We are committed to helping organizations advance sustainable purchasing,” said SPRI’s lead researcher Nicole Darnall, a management and public policy professor. Earlier this year SPRI researchers examined the purchasing practices of local governments throughout the United States. The project promoted best practices using a website, video tips, social media, and webinars.

“The EPA partnership expands SPRI’s reach in an important way by highlighting the importance of service models as a means for organizations to advance sustainable purchasing,” Darnall said.

The EPA’s Office of Policy had been working on a similar website but opted to join forces with ASU because of changing administrative priorities. 

“The project for us was about research — understanding the use of such a site as well as understanding environmental outcomes and financial implications of servicing approaches,” said Shari Grossarth, an environmental protection specialist at the EPA. “The whole project was about learning; SPRI’s mission is about learning and understanding, so SPRI seemed like a great home for the work.” 

The SPRI website features a keyword search and allows for users to narrow searches by selecting an institution type or product category such as IT, medical or office management.

A screen capture of the Servicizing website shows the ability to search by subtopic or keyword.

“The servicizing website is an information clearinghouse,” Darnall said. “It is relevant to anyone who is interested in the topic. It sidesteps typical approaches to information gathering, such as the random internet searches.”

The EPA contracted with Industrial Economics, a public policy consulting firm, to conduct an initial review of the literature to populate the site. 

As the website continues to develop, crowd-sourced information will be provided to users. It allows anyone to share knowledge or information about servicizing or recommend other resources to be added to the database using a simple online form.

Written by Bryce Newberry, contributing writer

Paul Atkinson

assistant director, College of Public Service and Community Solutions

602-496-0001