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From Haiti To Harvard: Crucial Foot Soldiers Of Health Make Housecalls

Fernanda Pereira, a native of Brazil, had some basic misunderstandings about the U.S. health care system. Here are two:

1. She used to take her asthmatic son, Ycaro, to the emergency room every time he needed a refill for his inhaler. She didn’t know she could simply call the doctor for a prescription and pick it up at the pharmacy.

2. She was confused and anxious when Ycaro, 11, was diagnosed with childhood depression. “Here, it’s normal for kids to be in therapy; in Brazil it’s not normal, ” Fernanda said. So, she cancelled or skipped 10 pediatric therapy appointments.

Enter Erica Guimaraes, a community health worker, and part of an ambitious program here to provide better, more effective care to poor, chronically ill patients — some who cost more than $200,000 a year to treat.

Since October, Erica has visited the Pereira’s home at least twice a month to help them deal with their medical problems, mental health struggles, cultural challenges, and anything else that comes up. On a recent visit to the family’s tidy brick apartment above a pizza place in Medford, Erica taught Ycaro how to properly use his inhaler. She explained to his mom, once again, the difference between Flovent and Albuterol. And she set up in-home therapy sessions for Ycaro. The boy has not been to the ER since Erica started visiting. “This winter, with Erica, it’s better,” Fernanda says.

Low-Tech Lessons in a High-Tech City

Here in this wealthy medical mecca of high-tech hospitals, Erica is part of an experiment to use low-tech lessons learned in the poorest of countries, Haiti. As Massachusetts, and the nation, begin to revamp a broken health care system, the need for these health workers, who fill a critical gap by supporting families in their homes, is clearer than ever before, says Partners In Health co-founder Paul Farmer, the doctor famed for developing a cadre of such workers in Haiti. “There has been more discussion about the need for innovation in this arena this year than ever before,” he said. We are finally acknowledging that “it is very expensive to give bad medical care to poor people in a rich country.”

While Fernanda’s daughter Katherine, 4, watches a Dora video, Erica and Fernanda chat in Portuguese, intimately, like sisters (they are from the same state in central Brazil) about the challenges of dealing with the new 4-month-old baby. Continue reading