Category: Alumni at Work, Alumni Stories, Campus & Community, Community Health, Health Magazine

Title:Care with a community focus

Author: By Jane Varner Malhotra and Bhriana Smith
Date Published: June 20, 2022

Mutsa Nyakabau

“With fewer resources you have to be creative as the provider in how you’re able to advocate and facilitate care for your patients, so it takes a lot of initiative, mental effort, and courage.”

—Mutsa Nyakabau, MD, MPH (M’15)

With community health so closely tied to Georgetown’s emphasis on cura personalis, or care for the whole person, Georgetown alumni are well-represented in the field, approaching health care with an eye toward social factors, the environment, and overall population health.

Here we tell the stories of just three of the thousands of Georgetown alumni in the community health field, making an impact in different ways to meet patients where they are.

Creating a medical home

For pediatrician Mutsa Nyakabau, MD, MPH (M’15), a passion for community health grew out of his experiences living in Zimbabwe, his home country.

“The socioeconomic environment back home is very challenging, so I’ve always been oriented towards an approach to health care that incorporates not just an individual’s health but the public health element, too,” he says. Today he offers holistic care that considers the social determinants of health for his patients and their families.

He practices at Family Healthcare of Hagerstown, Maryland, a mid-sized town in a semi-rural area about an hour and half from Washington, D.C. The federally qualified health center serves a population that is under-resourced, with many on Medicaid and some uninsured. The patients include a large number of struggling immigrant families facing serious economic hardship. The center offers family medicine and pediatric care under one roof, including pediatric psychiatry and dentistry.

“We try to provide a medical home for underserved communities in the Hagerstown area,” says Nyakabau. “It was my job to start the pediatric practice. It’s been a gradual evolution, but we’ve brought in this spectrum of care and we’re seeing the benefits for our patients and the population.”

Both in the pediatric and the adult patient community, he sees a persistent need for mental health care due to adverse childhood experiences.

“I see a lot of depression and suicidality, a lot of ADHD and autism spectrum disorders,” he notes, adding that certain afflictions occur in the perinatal history or developmental phases of a child’s life, which can exacerbate these issues. By offering one centralized medical home for a person’s diverse health needs, the providers foster whole patient care. “That’s why it’s essential that you have all these things in place— primary care, mental health, and dentistry—because if one is missing, it eventually leads to a lapse in effective delivery of care to our patients.”

For him, community health integrates the individual aspect of patient care with the health of the population at large.

“Community health is a perspective and a delivery of health care that takes into account the many challenges that an individual faces within their respective community, so it is not just a static way of looking at health. It’s a fluid and dynamic perspective that adapts to the changing environment that an individual lives in. It is meeting the health care needs of an individual where they are.”

Nyakabau completed his undergraduate degree at George Mason University in Fairfax, Virginia, then applied to medical schools. He got into Georgetown but planned to turn down the offer and study in Malawi instead because he could not afford the tuition. Then he received an email that would change the course of his life: he had been awarded a Pedro Arrupe, S.J., Scholarship for Peace, which would cover his Georgetown tuition.

Senior Associate Dean of International Programs Irma Frank, DDS, had nominated him for the scholarship, which enables international students with financial need, especially those from socially conflicted areas of the world, to attend Georgetown. “That was a life-changing moment for me, and speaks to Georgetown’s commitment to individuals who desire the opportunity to be an influence in the world for the better,” Nyakabau says.

He continues to pay this generosity forward. “You never can truly appreciate how an act of kindness, however small, might have an impact in a multiplicative fashion,” he says.

“I encourage all my alumni colleagues who, even in the throes of COVID-19 might feel their work is insignificant, to continue to embody what we learned at Georgetown. Because ultimately, who knows—you might be helping a young individual like myself from a disadvantaged population achieve their goal, whether it’s a patient who just needs that kind or gentle word, or a colleague who is disheartened and thinking about quitting the profession. These small acts of kindness go a long way towards being life-changing for others.”

He hopes to entice more individuals to be interested in community health, noting the challenges of recruiting into the field. “We serve a challenging population both from a medical standpoint and from a social standpoint,” he explains. “With fewer resources you have to be creative as the provider in how you’re able to advocate and facilitate care for your patients, so it takes a lot of initiative, mental effort, and courage.

“It’s a vocation within your practice of medicine to care for individuals where they’re needed most,” he says, adding that he hopes to see more Georgetown alumni in the field. “The best and the brightest!”

Advocating for community support

When Juliette Carr (G’21) wanted to find a master’s program that could encompass her passion for social justice work as it relates to health and health care access, she decided on the online Family Nurse Practitioner (FNP) program with Georgetown’s School of Nursing & Health Studies.

“Georgetown was a good fit,” says Carr. “The program’s emphasis on social justice in health care is a big part of how I see my role, not just as a family nurse practitioner but specifically my role in my rural Vermont community that serves primarily lower socioeconomic and marginalized people.”

The online master’s program at Georgetown allowed Carr to remain in her community to continue providing care and advocating for improvements to the system. At the time, she worked in labor, delivery, and postpartum and newborn nurseries in varying health centers and critical access hospitals in Vermont.

“It’s really satisfying work,” says Carr. “You’re often present for the most important moments in people’s lives.”

Carr notes that community health care requires a truly holistic approach.

“Community health takes a bird’s eye view on health and health care, to help us think about the multifactorial influences on health,” she says. “Not just your medical diagnoses and ‘How is your body working today?’ but psychologically, psychosocially, evaluating emotional health and determining access to essential resources.”

Social determinants of health are the variety of influences that make a person healthy, she says. In her rural area, people face financial challenges and many are elderly— factors that influence the health of the wider community.

“And it’s not just income and age. It’s also transportation and access to heat. The temperature can get to negative 20 degrees in Vermont,” says Carr.

juliette carr

“Community health takes a bird’s eye view on health and health care, to help us think about the multifactorial influences on health.”

—Juliette Carr (G’21)

“Working at a rural health center is an incredible privilege to help fill these gaps. It feels like community service at times. It’s health care, but it’s also all of the psychosocial support and resource knowledge. I have to be really on top of my community’s resources, knowing who can help, but the fact of the matter is that we don’t have a lot of community resources. We don’t have medical specialists. We have very few psychiatric providers. We are very limited.”

She also uses appointments to connect patients who have critical needs with support services.

I recently referred a patient to a food bank via one of my personal connections,” she says. “This is stuff that I do as part of an annual physical, because the food insecurity is bad enough, and there is a transportation barrier that prevents the patient from physically going to the food bank.”

This kind of care is what community health is all about, she says.

In addition to her nursing, Carr is a dedicated herbalist, and her farm is a registered Botanical Sanctuary through United Plant Savers, an organization that works to protect at-risk plants, especially medicinal plants. She maintains teaching gardens, and has obtained grant funding to restore the forest habitat and protect endangered plants in Vermont. She sees a real synchronicity between her work with plants and her work with people, noting that “nursing makes me
a much better herbalist, and herbalism makes me a much better nurse.”

Reflecting on her time at Georgetown, Carr names two professors who particularly influenced her path: Lois Wessel (G’97) and Tracy Zvenyach.

“They were so engaged and committed to their topics. Dr. Zvenyach taught my Health Care Policy & Advocacy class,” says Carr. “She completely changed my understanding of what my impact could be at the state level. Because of her class, I am now a co-chair of the Legislative Advocacy Committee of the American Nurses Association in Vermont, and I wrote a bill that is currently being reviewed in the state legislature.

“Dr. Wessel is very committed to justice in health care and health care access. Seeing someone at her level able to hold that commitment and teach about it showed me how to channel my passion.”

In addition to providing care, Carr advocates for policy change to help her patients. Her small town in Vermont used to have more critical access hospitals and other federally funded facilities in the area, but their numbers are shrinking, she says. She also cites reform of the health insurance system and autonomy for nurse practitioners as critical policy issues to address. “Nurse practitioners are widely recognized as providing high-quality health care at a low price point,” she notes.

Providing high-quality, low-cost care

Carl Whittaker, MD (M’04) is a family physician who practices full spectrum family medicine and obstetrics at the Central City Clinic in Salt Lake City, Utah, part of a group of federally qualified community health centers in the region.

He grew up in Corona, California, a smaller city in the southern part of the state. The son of a family physician, he knew from an early age that he wanted to practice medicine. After college at Brigham Young University, where he was an American Studies major, he came to Georgetown to study medicine.

“I really enjoyed surgery and other specialties, but I came back to the idea, probably from my dad, of focusing on prevention. I wanted to take care of people in a family setting and not be limited to one specific part of the body,” he says.

whittaker family

“We try to make it affordable, caring for the higher risk, marginalized population that would otherwise not have anywhere else to go.”

—Carl Whittaker, MD (M’04)

He did his residency at the University of Utah in Salt Lake City, drawn to its unique blend of offering all the specialties of an academic center but with much of the inpatient work taking place at a community hospital.

“A lot of places are either academic or community-based, but this was kind of a hybrid, which I found pretty attractive because there were benefits to both programs,” he says. “The community health center clinics are very interesting. They have a lot of diseases that you may not see in a university setting and a great population to work with, not just the patients but also other physicians and mentors in family medicine.”

He went on to complete an obstetrics fellowship at the University of Utah, and now cares for OB patients with higher risks including C-section deliveries. For the past 12 years, he has been the family medicine OB fellowship director at the University of Utah through a partnership between the university and Community Health Centers, Inc.

“The concept of community health centers began as a movement over 50 years ago as part of President Lyndon B. Johnson’s war on poverty,” says Whittaker. “The idea was to give good health care—evidence-based, cost effective care— to everybody. These centers often care for those who are uninsured or underinsured and marginalized by society.”

His clinic serves this population in urban Salt Lake City, where many patients are either uninsured or on Medicaid. “Our motto is that we’re here to take care of patients, regardless of their ability to pay,” he says, noting that “It’s a really low-cost facility. A normal visit, for whatever reason, would be $35 with us and that covers everything—the visit, labs, any imaging. We try to make it affordable, caring for the higher risk, marginalized population that would otherwise not have anywhere else to go.”

Whittaker sees a close connection between his work today and the values that were part of his medical education at Georgetown. He remembers the collegiality he felt with his classmates, and gets together with a group of them once a year in Utah to reconnect.

“The Jesuit foundation and the idea of cura personalis— caring for the whole person—comes through at Georgetown. It sneaks in and seems to permeate everywhere. In community health we try to take care of the whole person and take care of society. Even though it’s hard work and some days exhausting, it’s rewarding.”

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