Doctors from St. Vincent Charity Medical Center’s Graduate Medical Education (GME) program recently explored issues involving trust and trauma with residents of Cleveland's Central neighborhood during a reverse ride-along hosted by the Cleveland Central Promise Neighborhood.

The Reverse Ride-Along project is coordinated by Cleveland Central Promise Neighborhood; Jan Thrope, community activist and founder of Inner Visions Cleveland; Jerry Pena of Neighborhood Connections; and Barbara Anderson, chair of Another Chance of Ohio.

The program is a re-imagining of the traditional police ride along as it reverses roles and enables the community to set the tone and tour stops highlighting people, places and resources they would like to introduce to police, or in this instance physicians. At its inception, the program was focused on relationship building with police officers but it has since grown to include medical professionals and others who work in the Central neighborhood.

“The goal is to highlight the assets of the community as well as uplift some of the challenges,” said Joe Black, engagement manager, Cleveland Central Promise Neighborhood. “If you work in this community, you have a role in the community. Hopefully at the end of this, together, we can embrace the challenges and identify opportunities of our community.”

 St. Vincent Charity draws GME students (physicians currently completing their medical residency or fellowship) from all over the world. The reverse ride-along hosted physicians from California, Brazil, Trinidad and Tobago, Syria and Ghana.

“I really don’t know what this community is like even though every day I see patients who live here,” said Dr. Sarah Boaitey, first year graduate medical education (GME) resident, St. Vincent Charity Medical Center.  

Dr. Vasant Temull, second year graduate medical education (GME) resident at St. Vincent Charity Medical Center, shared that he realizes there are barriers between patients and physicians and by participating in the ride-along he hopes to get a deeper understanding of those boundaries and how to overcome them.

Much of the day’s conversation focused on two main topics: mistrust between community residents and healthcare providers and how trauma impacts the health of the individuals served by St. Vincent Charity.

When speaking of mistrust in the community, Black shared that a significant reason mistrust exists is because of the reactive way many in the community seek out and receive healthcare. Due to many factors, a significant portion of Central community residents do not partake in preventative healthcare visits. Therefore, when they do visit a physician, the patient may experience information overload and confusion.

“In their mind, they went to the doctor for something minor and then leave with a frightening diagnosis. So then they avoid going back,” explains Black. “I’ve also had people say the doctor speaks over them or doesn’t explain how they are supposed to take medication or why certain follow-up care or tests are being prescribed.”

Dr. Boaitey offered the physician’s perspective on this issue explaining that medical practitioners are often aware they may not see this patient again for a while, or ever, and feel an urgency to provide as much information as possible.

“We are trying to help as much as we can in the limited time we have, but I understand that it can be scary and overwhelming. Starting the visit with a conversation about goals and finding a common goal between doctor and  patient seems like a good way to build trust,” said Dr. Boaitey.

“The problem we solved today was not knowing each other,” said Black. “We can continue to work on trauma, food insecurity and reliable transportation, but today is about who you know in your community.” 

The FreshWater e-magazine was there to report about the reverse ride-along. The full text of the article is below or available here.

Talking about trauma: Ride-along in Central gives Cleveland doctors new insight into patients’ lives

“People do not care how much you know until they know how much you care,” Barbara Anderson tells a dozen people squeezed into a van.

The words resonate on this gray November morning, as five doctors and a nurse take a “reverse ride-along” of Cleveland’s Central neighborhood with Anderson and other ride facilitators.

The idea comes from ride-alongs that citizens can take with police to gain a better understanding of their work, says Jan Thrope, executive director of Inner Visions. “After I went on one, I got the idea to reverse things by having police come with us to see neighborhoods through the eyes of community members. The name just stuck, because the experience is designed to help people see things from a reverse perspective.”

The Cleveland Central Promise Neighborhood, a program of the Sisters of Charity Foundation, has hosted a dozen of these ride-alongs since 2017, with about 420 participants, mostly Cleveland police cadets. Recently, the program expanded to include medical professionals. Organizers hope to add new fields in 2020, including teachers and law students.

“When you bring people together from different backgrounds and communities, you see an amazing spark in energy and interaction,” says ride co-leader Joe Black, a Promise Neighborhood engagement manager. “It exposes that we don’t have enough human interaction.”

Equal space

Doctors are invited to the reverse ride-alongs because they possess a degree of privilege and authority, Black says. “The power dynamic is most pervasive in minority and low-income communities, which is why we seek to connect community members and medical professionals in a space where all participants are equal. In this space, we use relationship-building approaches to develop solutions that benefit all parties.”

Themes of trust, listening, trauma, transportation, displacement, health, and wealth are touched upon during the four-hour journey. The carefully planned itinerary includes two stops for dialogues with local residents.

“This isn't a ‘poverty tour’ where spectators peer through vehicle windows at the community,” Trope says. “In our relationship-building ride-alongs, community members are riding with us as we go from place to place, stopping to share conversations.”

The trip starts in the lobby of St. Vincent Charity Medical Center. “This is new for us, but we’re willing to experience some new stuff,” says Dr. Vasant Temull, a third-year chief medical resident from Trinidad and Tobago. He is looking forward to meeting people outside the walls of the hospital, which chiefly serves Central.

“We really want you to see the assets that exist in this neighborhood,” Black says as people pile into the van. He asks everyone to share why they are taking the trip, then goes first. “I’m here motivated to bring people together, to learn more deeply about our community, and why and how we can work together to make it a better place.”

Talk to each other

Anderson, founder of Another Chance of Ohio, adds, “The only way we're going to ever know each other is to talk to each other, to meet each other and to be open to the fact that some people are not us, some people are different, based on their life experiences.”

The van passes a federally subsidized public housing estate, built in 1935. Three fourths of Cuyahoga County’s public housing is in the Central neighborhood, Black says, “which suggests the significance of concentrated poverty in our community.”

Turning onto East 36th Street, Black says, “We have community members who have come to me and said, ‘Living in this community, I've been diagnosed with PTSD, just based on my experiences.’ Some of that is related to violence. Some of that is related to limited access to food.”

As the van nears the massive Northern Ohio Food Terminal on Woodland Avenue, Thrope points out that Central has no grocery store. “So the irony is there’s all this fresh, good food coming into the terminal, right in the neighborhood, yet they can’t get access to it, because it’s shipped out to the grocery stores.”

Transportation troubles

The discussion shifts to doctor visits. Getting to and from appointments can be challenging if you need a ride. This becomes a problem when doctors are delayed and patients have to wait, says Dr. Luana Hearn, a third-year medical resident from Brazil. “They get so stressed out, and they leave, because otherwise they don't have a way to go home. So I’d say transportation is a big issue.”

Anderson describes a previous ride-along when police cadets in uniform visited a daycare center. “Two young girls didn't mean to but became afraid and cried and moved away, wanting to be somewhere they thought was safe, in somebody's arms. They wanted to definitely be away from those police officers.”

It was difficult for Anderson to watch. “You knew they had experienced some kind of trauma, that once they saw those police officers, they became immediately afraid. And it took them back to that experience.”

Central is filled with trauma, Black says. “So what is our responsibility, or what opportunities exist when traumatic experiences are shared?”

“What do you do with it when the trauma is brought to you, when someone shares their story of trauma?” Thrope says. “I don't know that there's a universal answer. ... It's important for them to talk about the trauma, but only in the safety of knowing that right now, they're not in current trauma.”

Trauma hits home

The conversation continues during a stop at the Friendly Inn settlement house. “How has other people's trauma transferred to you and your practice?” Black asks the doctors. 

“I have one example,” Hearn says. She tells how a patient with diabetes had trouble taking insulin. So she scheduled monthly visits, hoping he’d eventually learn. Finally, his blood sugar levels improved. She was relieved that he was getting better.

“And then I asked him, ‘What did you do different?’ And he’s like, ‘I don't think I did anything different,’ so we kept talking. He actually lost his food stamps. He was starving at home. That's why he was controlling sugars. He lost a lot of weight. I just felt devastated. That took me a long time to actually ... [her voice cracks] … Yeah, I'm sorry. ... That was crazy.”

Temull jumps in to rescue his colleague. “So we experience a lot of trauma, you know, working in a health care institution,” he says. “But I must say ... it has made us closer to our community. And sometimes I think we're better able to communicate with those around us. ... We try to help them ... to tell us what exactly is going on, because it takes some time, just like with this guy ... for us to get to know each other and for us to figure out what's the problem.”

Life and death situations are a daily part of their job. “It’s very traumatic to us,” he says. “I wouldn't say everyone deals with it perfectly. But it's part of what we do, and we try to use it in a positive way to make us stronger, better capable of dealing with the next person.”

Numerous partners support the reverse ride-alongs, including Third Federal Savings and Loan, the city of Cleveland and the Better Health Partnership. The NFL Network series “Indivisible,” hosted by Nate Boyer, recently filmed a segment on the ride-alongs that will air during the playoffs.

Calls to Action:

• To participate in the next reverse ride-along, please email Reverseridealong@gmail.com or call 440-490-7539.
• Volunteer opportunities include experience facilitator, group participant, data analysis, and logistics coordinator.
• Learn about health and wellness services in your community by checking out Healthy Cleveland.