The Health and Wellbeing Bus, an Ethnicity and Diversity Initiative
Yasi Noori, a final year medical student at King’s College London shares her experience working with the Health and Wellbeing Bus which aims to tackle health inequalities in Lambeth.
King´s College London in partnership with Lambeth Together started an opportunity for King’s medical students to undertake a community-based placement with an aim to increase awareness and understanding of health inequalities within the borough. This is especially pertinent in a region where a large proportion of subject’s hail from non-white backgrounds. Health inequalities leading to suboptimal care, as well as poor participation in research trials from these ethnic minority backgrounds have been widely reported. This stark negative experience was covered extensively by media during the COVID-19 pandemic, particularly concerning the “mistrust” of medical communities over COVID-19 vaccination, as well as research as a whole. One medical student, from King’s College London, was selected after an application process to participate in this unique new experience supervised by Prof K Ray Chaudhuri leading research EDI initiatives at King’s College Hospital along with Simon O’Donoghue from the Trust EDI team, Dr Mubasher Qamar (Clinical Physician for Research) and Dhaval Trivedi (EDI student coordinator) and here we present her initial experience.
Yasi Noori, a final year medical student at King’s College London, was successful in her application in joining the team on the Lambeth Together Health and Wellbeing Bus. The bus, which is stationed in various locations in the community on weekdays, provides health and wellbeing information, as well as vaccinations and blood pressure checks. The borough statistics of 2022, outline Lambeth borough to have an ethnically diverse community (see figure 1). Below is an account of Yasi’s experience and what she learnt.
Figure 1: Ethnicity distribution of Lambeth Borough population for the year 2022 (data set from State of the Borough, Lambeth 2022 report).
My experience at the Lambeth Bus Initiative, by Yasi Noori
One of the aims of the bus initiative was to provide COVID-19 vaccinations. I found that while the majority of clients were happy to be vaccinated (or had already been), it was clear that many, especially from Asian, and Afro-Caribbean backgrounds were sceptical and held strong negative beliefs about vaccinations. A common theme that emerged was the notion of the COVID-19 vaccine being an ‘experiment’. The lack of understanding of how the vaccine was researched and developed, leaves many asking why other treatments and cures take longer, which in turns is keeping them doubtful of the vaccines. However, team members spoke about how endorsement from community leaders such as Pastors and Imams as well as clinical ambassadors and representatives proved to be pivotal in changing these views and has led to increased vaccination uptake in certain sites. From this I learned about the importance of having the involvement of pillars of the community, either by joining the bus initiative or by directing community members to us with their endorsement, in helping fight long-standing medical scepticism and concerns around research being ‘experimentation’, in order to improve health inequalities.
I found the clients who approached the team to have their blood pressure readings taken, either had a pre-existing hypertension diagnosis needing monitoring, or personal concerns leading them to check their blood pressure. Given the national drive to monitor blood pressure and weight due to the risk of stroke, diabetes and cardiovascular disease, the communities are becoming more health aware. This opportunity was optimised by giving free health education on controlling their blood pressure, including lifestyle advice, and directing them to visit their GP if there were any concerns. This provided an opportunity to discuss the importance of how related research shapes our clinical care and management, for example, blood pressure checks being important for monitoring the risk of cardiovascular disease. Furthermore, many clients were also unaware that they can have blood pressure readings taken at local pharmacies, and also learned that they can be signposted to relevant clinics in local hospitals where research is being undertaken to aid the uptake of diverse research populations and aid in the improvement of long-term health outcomes. Therefore, the interaction was beneficial in improving their long-term access to healthcare, especially at a time when many patients struggle to get GP appointments.
Language barriers remain a key aspect of tackling health inequalities. Fortunately, there was a Spanish-speaking health ambassador on board who was able to translate for the Spanish-speaking clients who entered the bus. However, it was noted that there has been a recent influx of refugees from Iran/Afghanistan due to recent unrest. Most of them are concentrated around South Lambeth (i.e. Norwood), with many of them not having been able to sign up for GPs, given the language barrier. Given my ability to speak Farsi, I was able to assist clients in registering with GPs and advising them on how to access resources in the community. Refugees are some of the most vulnerable members of society who often are missed when conducting research. Research works to capture the community it serves, yet with an ever-changing society, it’s important to ensure we include these diverse ethnicities in our research work. Following my experience on the Health and Well-being Bus, I was able to reflect on the importance of these community drives to access some of these individuals who may have never been able to reach primary care, and how the work currently being done aids in improving health inequalities.
I found this experience very insightful, as most medical student placements are wards-based learning. With the medical curriculum of future doctors being focused on community care and problem-based learning approaches, providing an opportunity to be out in the community talking about healthcare and research is essential. Being able to interact with hard-to-reach members of the community provided a unique opportunity to reflect on methods to improve access to healthcare and health-seeking behaviours. Accessible healthcare involves daily multidisciplinary communication. Therefore, the opportunity for other healthcare professionals across various disciplines to conduct placements on this type of initiative would be extremely beneficial in training our future doctors, nurses, and other healthcare professionals.
In a time when there is difficulty in reaching primary healthcare and the burden on emergency services, community-based projects such as these provide an effective method to provide efficient care more locally. Research topics remain to be an enigma for many at first, but our communities are eager to learn and be involved, provided we take the time to explain, educate and provide opportunities for them to take part.
Overall, I have been able to reflect and take home several key points which I hope to translate into future practise. The initiative has broadened my understanding of the challenges faced in community-care and exposed me to a subset of the population I may have not met in standard medical school placements.
Y Noori, MA Qamar, D Trivedi, S O’Donoghue, K Ray Chaudhuri
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