A Cut, A Shave, and a Blood Pressure Check
To get people to take some ownership of their health, you have to be willing to listen to them.

C. Bailey Sr. (seated) has worked to con-
trol his high blood pressure for 29 of his
69 years. He knows he must be vigilant:
his mother died of a heart attack, and his
father died of a stroke. Now the Lithonia
resident gets his blood pressure checked
regularly when he gets his hair cut.

by Lillian Lee Kim

Walk into Nick's Barber Shop in Stone Mountain, and Vance Harper will wave you into a chair, swivel you around to face the mirror, and give your head a critical once-over.

Then he'll ask if you'd like him to take your blood pressure.

"It's convenient and less stressful because it's not in a doctor's office or a hospital environment," he says.

Harper is among a number of local barbers, hair stylists, and nail technicians trained to take blood pressure as part of the Barber and Beauty Shop Program, an Emory Healthcare initiative aimed at diagnosing hypertension in African-Americans. The idea for the program arose during a 1997 conference on cardiovascular health co-sponsored by Emory Healthcare. Called "The Heart of a Brother," the day-long conference targeted African-American men and their partners and families, educating them about heart disease risk factors and preventive health practices.

In discussing the latter, many people complained that going to the doctor for routine health screenings such as blood pressure checks was impractical for a number of reasons, including inconvenience and cost. Not surprisingly, many said they'd rather not visit the doctor unless it was absolutely necessary. By their definition, absolutely necessary meant point of death.

Then one man said he'd get his blood pressure checked if it was part of something else he had to do regularly. Like get his hair cut.

And a light went on in Don Speaks' head.

Closing the gap

You can build facilities and provide services to address a problem. But if the people with the problem don't acknowledge it, you're not going to get anywhere.

His Emory Healthcare business card reads director, office of community affairs and market development. Don't be confused by the corporate-speak. What Don Speaks does is help Emory find new ways to work with its communities to improve their health -- especially the health of African-Americans, a population that historically has had significantly poorer health outcomes than other racial or ethnic groups.

The keystone of his efforts has been the Brothers Health Issues Conference Series for African-American men, now in its fourth year. The annual conference, which is free and open to the public, focuses each year on a different health problem that disproportionately affects black men.

The choices, unfortunately, are virtually limitless. African-Americans are more likely to develop cancer and die of it than people of any other racial or ethnic background. They also experience the highest rates of infant mortality, diabetes, hypertension, stroke, and HIV infection.

Such disparities in the health outcomes of black and white Americans have long been documented. For decades, though, they were regarded simply as a function of the genetic, social, and behavioral differences between racial and ethnic groups in the population.

Only within the past decade has the government as well as the health care private sector fully grasped the magnitude of the problem - in people and in dollars - and adopted the stance that racial and ethnic health disparities must be eliminated. In 1998, President Clinton announced an ambitious new initiative to close the health status gap between white and minority populations by the year 2010.

"For the first time, the federal government set national goals for all Americans," says Stephen Thomas, former director of the Institute for Minority Health Research at the Rollins School of Public Health at Emory. "The science clearly shows that the gap is unacceptable in the world's most advanced nation."

Rx for attitude

Last year's Brothers conference on vio-
lence led to creation of a program that
teaches elementary school students how
to manage anger and prevent violent inci-
dents. In addition to working with at-risk
kids and their parents, Don Speaks shares
information about opportunities in health
care during schools' career day programs.

One obvious remedy is to improve African-Americans' access to quality health care, especially preventive services, which are the key to long-term health. When he came to Emory in 1994, one of Speaks' first projects was developing The Emory Clinic's satellite primary care operations, including a new facility in south DeKalb County.

"It's 13,000 square feet, and the most modern primary health care facility anywhere where a majority of minorities live in the state of Georgia," Speaks says proudly.

But making health services available to the underserved is only the first half of the equation, as Speaks, who holds a master's degree in public health from Boston University, knows well. Arguably, getting people to use those services is even more challenging.

"That's where education comes in," Speaks says. "The data can tell you that there's a problem. You can build facilities and provide services to address that problem. But if the people with the problem don't acknowledge it, you're not going to get anywhere."

William Cleveland, an African-American nephrologist who has practiced in southwest Atlanta for 21 years, echoes this sentiment.

"We're finding a lot of health issues that aren't being addressed," Cleveland says. "The first step is knowledge and information. So I think the most important activity in our community is spreading information."

That information need not be purely scientific in order to accomplish its objective. During this year's Brothers conference, which dealt with tissue and organ donation, science comfortably shared the floor with religion as workshop panels featured both transplant specialists and ministers from local black churches. The doctors explained donation policies and transplantation procedures, while the clerics dispelled common myths regarding religious taboos against organ donation.

A somewhat unconventional approach to health education, perhaps, but heads nodded in agreement and approval throughout the meeting. Speaks is a pragmatist: If people tend to see things from a certain point of view, he makes sure he puts things where they can see them.

Still, sometimes it's hard to grab the public's interest, as illustrated by the low attendance at this year's conference. Fewer than 300 people participated, a large drop from last year's record high of more than 800 attendees.

Well aware that the need for blood and organ donors is not perceived to be as urgent a health issue as prostate cancer or heart disease, Speaks had predicted a low turnout weeks before the May event. Many people are queasy about giving blood, he says. And the idea of donating organs brings the unwelcome thought of one's own mortality (although the kidney and, more recently, parts of the liver can come from living donors).

"People don't like to face their own mortality," Speaks says. "But we just have to hope that the people who came went home and told other people what they learned."

Not for a moment, however, does Speaks regret choosing to focus on tissue and organ donation. "The message needed to be delivered," he says firmly.

Black and paranoid

They say we're elitist and standoffish. That's exactly why this is a great opportunity to assert ourselves by reaching out to the community.

Then there's another issue, one specific to African-Americans. Ambassador Andrew Young, who was unable to attend the conference in person but addressed the gathering via a taped interview, summed up the problem: "Organ donation is a difficult issue for black folk, simply because of the experience we have had with the medical community. If you're black, you're paranoid."

Unspoken but understood was the single word that has come to represent this paranoia: Tuskegee. In the infamous Tuskegee syphilis study, the Public Health Service deliberately withheld treatment for 40 years from hundreds of black men with syphilis, in order to study the long-term effects of the disease. The men never were informed that they were infected. Instead, they were misled into believing their maladies were caused by "bad blood."

Today, many African-Americans still fear government malevolence behind the AIDS epidemic and other diseases that disproportionately strike blacks.

"The bottom line is, all our advanced medical technology and all we know about prevention will not work unless we address the underlying issues of racism and lack of trust in the health care delivery system on the part of far too many people of color in this nation," Thomas says.

Speaks acknowledges the persistent, pervasive influence of the Tuskegee legacy, even among medically savvy blacks like himself.

"Hey, I don't like going to the doctor either," he admits. "I won't go unless I'm seriously ill. And I work in the health care industry, for crying out loud. So I know where these people are coming from and how much work we have to do."

In a way, though, Speaks is most concerned about the opinions of those who don't subscribe to conspiracy theories, yet say they have not felt warmly embraced by the health care system.

"When you ask African-American people what they think of Emory, the first thing they say is that we're the best. We are the platinum card," Speaks says. "But when you ask them what else they think about us, they say we're elitist and standoffish. That is exactly why I say there's a great opportunity for us to assert ourselves by reaching out to the community. It can only further solidify the respect and support we are given by African-Americans and the overall minority community."

Active listening

Dentist Walter Young, American consul to
Liberia and brother of Ambassador Andrew
Young, is one of more than 100 African-
American men on the steering committee
of the Brothers Health Series.

Thus, the Brothers Health Issues Conference Series was designed not only to educate people but also to provide a forum for exchanging ideas.

"To get people to take some ownership, you have to be willing to listen to them," Speaks says. "What are their health beliefs? Where did they get those beliefs? What do they want from health care? What can we do to increase their utilization of the health care system?"

Suggestions made at the Brothers conferences have sparked ideas for innovative community-based initiatives, such as the Barber and Beauty Shop Program, through which participating shops identify clients with dangerously high blood pressure and encourage them to promptly seek medical care.

"We've had situations where we've detected high blood pressure in individuals, and they've gone straight to the doctor," Harper says. The 41-year-old has become more conscientious about his own health too since becoming involved in the program. "I've been power walking," he quips.

As a result of the 1998 Brothers conference on prostate cancer, the office of community affairs is establishing several sites in predominantly black neighborhoods where men can undergo testing to measure their blood levels of prostate-specific antigen, an indicator of disease. With 230 cases per 100,000, black men are at least 50% more likely to develop prostate cancer than men of any other racial or ethnic group, according to the American Cancer Society.

Speaks hopes to expand his office's follow-up efforts by taking further advantage of the resources within the Woodruff Health Sciences Center. For the Barber and Beauty Shop Program, for instance, nursing students from the Nell Hodgson Woodruff School of Nursing trained the participants to take blood pressure.

"Fostering partnerships is one of the most important ways that a school and university can model social responsibility and service. These values are the hallmarks of our profession," says Marla Salmon, dean of the school of nursing. "Don offers an invaluable service in helping us develop and strengthen our ties with communities. He is a wonderful leader, colleague, and advocate, and he believes in the power of working together."

Hunting out resources is what Speaks does best. He has a rare gift for creating an instant rapport with people, regardless of their gender, ethnicity, or social status, and instilling in them the belief that they, too, can contribute.

"He pulls together people who know him and says, 'Let's do this for the community.' And they do it," says Yung Krall, director of multinational relations for Emory Northlake Regional Medical Center. He worked with Speaks during his 13-year tenure in public health with the Georgia Department of Human Resources.

Speaks, who briefly played football for the Dallas Cowboys, still exudes the physical command of a former athlete. But his resonant voice, with the timbre of an educated black man who has not forgotten his roots for the sake of sophistication, is one of his most powerful assets. It is the kind of voice politicians envy, and, in fact, in the early 1970s, Speaks worked on the staff of Boston Mayor Kevin White.

Speaks credits that stint in politics with teaching him the art of engaging people. He now uses his community organizing skills to build a vast support network through all levels of Atlanta's African-American community.

"Don would be at home with a person who lives on the street, a gang member, a church bishop, a corporate officer," says James Pace, an associate clinical professor of nursing at Emory. Pace is working with Speaks on the 2001 Brothers conference on HIV/AIDS, for which Speaks expects a record turnout.

In this Issue

From the Director  /  Letters

Imitation of Nature

A Cut, a Shave, and a
Blood Pressure Check

Medical Mistakes:
Human Error or System Failure?

Moving Forward  /  Noteworthy

Putting on the Ritz, Part Two

Speaks' egalitarianism is the driving force behind the Brothers series steering committee, comprised of more than 100 African-American men from all walks of life. The committee boasts the customary CEOs, noted politicians, and accomplished doctors and academics but also includes regular civic-minded citizens and even a few homeless men. The group, which meets three or four times each year, chooses the conference topics and helps spread the word throughout the community.

"Street by street, block by block, you look for people you can work with, people who can do something within their small sphere of influence," says Speaks, who continues to keep his ears - and mind - wide open.

"I'm hearing people change the way they talk about Emory," he says. "They're saying warm, friendly things. If Emory continues to assert itself, what we may be able to achieve is hard to even speculate."

Lillian Lee Kim is assistant director of news and information in health sciences communications.


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Web version by Jaime Henriquez.