A popular HOD course mobilizes students to make a difference among Nashville's diverse populations

by Kara Furlong
photography by John Russell

This month, things will change for the better in the Edgehill community, a neighborhood located a few blocks from the Vanderbilt campus. Healthy food will be more readily available to Edgehill’s low-income residents, thanks to an innovative “mobile grocery store” developed by second-year medical student Ravi Patel and initially inspired by his experience in an undergraduate Human and Organizational Development class.

The summer following his sophomore year, Patel spent a month in Uganda working with HIV and AIDS patients through the Kampala Project, an initiative of Vanderbilt’s Office of Active Citizenship and Service. His time in the East African nation was a definitive experience for the then pre-medicine major with a keen interest in global health. But it wasn’t until he was back in Nashville that Patel was exposed to a wholly different epidemic. That fall he enrolled in HOD 2510, a class known as Health Service Delivery to Diverse Populations, and learned about “food deserts,” a distinctly urban health concern linked to a host of preventable diseases. Food deserts are city neighborhoods without full-fledged grocery stores, limiting residents’ access to fresh, healthy foods.

“In Uganda I saw people who were dying from HIV and AIDS, so it was a totally different perspective to see people who were struggling with obesity and life-threatening diseases like diabetes, hypertension and high cholesterol,” Patel said.

HOD 2510 – taught by Human and Organizational Development professors Sharon Shields and Leigh Gilchrist in conjunction with Liz Aleman, manager of the Healthy Children outreach program at Monroe Carell Jr. Children’s Hospital at Vanderbilt – gives students going into the public health, direct medical care, social work or counseling fields foundational information about health care policy and health service agencies and delivery systems. The class demonstrates how various influences affect health risk and disease reduction among diverse populations.

“There are four core concepts that we want students to focus on – diversity, advocacy, social justice and compassion – and to use these as a lens through which to view the delivery of health service in this country,” Shields said. The class does this so effectively by putting a human face on the issue: Advocates from the community come to the classroom to share their stories and lead discussion, and students participate in site visits to see community needs first-hand.

“The students’ experiences in the class and through service learning make them part of a larger network,” Aleman said. “They gain critical connections in the community.”

Making It Personal

One of the site visits is a community tour taken by bus to familiarize students with the social and economic disparities of Nashville’s neighborhoods. The tour starts in Edgehill, where the primary food retailers are convenience stores, and eventually travels to upscale Belle Meade, where three or four full-scale grocery stores can be found within blocks of one another. The tour tends to leave a big impression on students – as it did Patel.

“We followed the route that someone from Edgehill using public transportation would take to get to the grocery store,” he explained. “We calculated how long it would take, including switching buses, and how much it would cost someone on a limited income – and it really adds up.

“Another thing is, how do you carry a week’s worth of groceries from store to bus stop to home?” Patel said. “It opened my eyes to the fact that being able to get food conveniently or even in a reasonable manner is a factor in people not having access to healthy foods.” As an assignment for the class, Patel wrote a memorandum describing a plan to combat food deserts in Nashville.

Writing the memorandum was a valuable exercise – though completely theoretical – until Patel, now a Vanderbilt medical student, began volunteering at Shade Tree Clinic in East Nashville. There he routinely sees patients facing chronic diseases due to poor diets who say that healthy food is simply out of their reach.

“Hearing that for the first time was a slap in the face,” Patel said. Not only did it reinforce what he learned about food deserts as an undergrad, but “it really hit home that I can do all of the education in the world and try to get these people the medications they need, but if they don’t eat what they’re supposed to, at the end of the day medicine can’t help them.”

Going Mobile

Robert Miller, Shade Tree’s medical director and associate professor of clinical medicine at Vanderbilt, encouraged Patel to explore the feasibility of opening a fresh foods grocery store near the clinic as part of Patel’s medical school emphasis project, a research requirement of all first- and second-year students. He dove in, even taking professor Jim Schorr’s Social Enterprise and Entrepreneurship course at the Owen Graduate School of Management to learn how to create a business plan.

Ultimately, Patel found, a stand-alone grocery store wouldn’t be profitable and was therefore unsustainable. He next looked to community agencies with the help of his emphasis project adviser, Barbara Clinton, and rediscovered the same network of service providers he first encountered in HOD 2510.

“I went to Community Food Advocates, a group I was introduced to through HOD 2510, and they connected me with Organized Neighbors of Edgehill, who shared their idea: a mobile grocery store,” Patel said. “I created a business plan for the model and found it could be profitable. So I started running with it, and the Nashville Mobile Market was born.”

Patel sought help from fellow student leaders, including seniors Alex Arnold, Emily Zern, Nicole Gunasekera and Alex Ernst. With their assistance, he formed a student executive board that could begin to search for funding, create an operations base and start community outreach educational efforts.

Funded by a $65,000 grant from the Frist Foundation, the mobile market is a 28-foot trailer that transports fresh produce, dairy and other refrigerated items to five stops in the Edgehill neighborhood each Friday, Saturday and Sunday. Customers walk through the trailer as they would a grocery store aisle. Food is priced competitively with that at Kroger supermarkets in town, and the mobile market accepts Electronic Benefit Transfer cards (i.e. Food Stamp assistance) along with other forms of payment. The market is run by volunteers from across the Vanderbilt campus, as well as two full-time employees.

“Ravi did a phenomenal job of really thinking through every aspect of the project and bringing all of the key players to the table, from the General Counsel’s office to Risk Management to the medical center to the Provost’s office,” said Gilchrist, who serves as the mobile market’s faculty adviser. Not only did this lend legitimacy to the project, it raised awareness of food deserts as a long-time need in the community, she said.

The Nashville Mobile Market launches Feb. 4 in Edgehill, “the neighborhood that one, introduced me to the problem of food deserts, and two, put its very heart and soul into this idea,” said Patel, who with the help of a community advisory board hopes to expand the mobile market to East and North Nashville neighborhoods.

“Ravi is a great example of a student who has done the critical thinking that HOD 2510 can inspire and has utilized the class as a platform for moving forward with his own advocacy of an issue,” Shields said.

Patel gives credit back to the class.

“The whole concept of a community-based approach to health service delivery is something that I first learned there,” he said. When the community identifies the need, he said, a project has greater merit and generates stronger, more lasting solutions.

“Foundations and grantors are willing to put money behind these kinds of projects because this approach sustains the model.”

First Steps

While the Nashville Mobile Market is the product of several years’ gestation and addresses food security on a large scale, each session of HOD 2510 has only 16 weeks to complete a smaller-scale service learning project that meets a community need and enhances the academic understanding of its students.

“The service learning project gives students an opportunity to get their hands around health service delivery,” said Aleman, who works in the Vanderbilt Children’s Health Improvement and Prevention (VCHIP) office at the Children’s Hospital and helps the teaching team identify a need around which to structure the project each semester.

“We talk about a lot of different issues in the class, and one of the frustrations that students express is, ‘Now that we’ve talked about these problems, what are we going to do about them?’” she said. “The service learning project gives them the tools and a place to start.”

Past projects have seen students create interactive presentations on childhood obesity that professionals from VCHIP have used at health fairs across Middle Tennessee. More recently, students wrote and illustrated two dozen unique safety-themed activity books that will be distributed to children ages 4-6 in the community. For the spring semester, students will develop a new safety training curriculum for early childhood caregivers in Nashville, as well as educational booklets those caregivers can use with children in their centers.

The objective is to get the Vanderbilt students thinking critically about how to produce materials that convey a clear health message and are developmentally appropriate for a young audience. The students do research and submit drafts of their projects to experts at the Children’s Hospital, who provide valuable feedback and help them fine-tune their work.

“By the end of the class, the students understand what it takes to create a quality product that will be disseminated to the community and the type of review that it goes through, plus they build their expertise in how to work with children,” Shields said. “Our hope is that those skills are transferred when they’re in a public health setting or health agency or working with patients in their careers.”

The finished projects are a boon to VCHIP, which will use them for educational purposes in the community for years to come. The health presentations alone have reached more than 64,000 children and their families across the state.

And having Aleman, a former graduate assistant in HOD 2510 and an adjunct instructor at Peabody, as a liaison to the Children’s Hospital and the broader community is a boon to the class.

“That’s why this has been so successful and sustainable – because Liz has her feet in both places, the community side and the academic side,” Shields said. “She understands the needs of the community, and how to integrate those with the academic needs we have in the class.”

Bridging the Gap

These lessons are translating loud and clear for students like Anna Alexander, a senior Medicine, Health and Society major who took HOD 2510 last semester.

“What I took away from the class was an understanding that you have to know what’s going on in your community before you can make a difference,” she said. “You can’t go in blind, without the facts, and think that you can change the world. You need to experience different neighborhoods and different populations hands-on before you can impact them with your work.” Alexander has made an impact over the last two years working on the Glencliff High School community garden project, among other initiatives.

“I’ve learned that many limitations come together to create poor health,” she continued. “It’s not just a personal decision – your health can be affected by aspects of your life that you don’t have much control over.”

Giving students a broader awareness of the community they serve leads to more compassionate caregivers and better delivery of health services, both explicit goals of HOD 2510.

“Too often we talk about ‘them,’ ‘out there,’ ‘the community’ – and we fail to see that their issues are the same ones impacting our classroom,” Gilchrist said. “There are students here dealing with substance abuse, mental illness, chronic or severe health conditions either directly or through a family member, and it’s important not only to put a face on these issues out in the community, but to realize that they also affect us here at home.

“Doing so bridges the gap between us and others,” Gilchrist said. “It says, ‘We are one and the same.’”

Making an Impact

The growing web of partnerships generated through the class “has not only impacted our teaching, but also our capacity for service as members of the Vanderbilt community,” Shields said. “It has impacted research initiatives and the scholarship of discovery.”

The Nashville Mobile Market is a prime example of this, as measures of the market’s success will be firmly rooted in research.

“We’ve done the market analysis and identified three main factors that contribute to food deserts: financial, educational and physical,” Patel said. “We’re removing the physical barrier by creating access to fresh foods through the mobile market. We’re addressing the educational piece by offering classes alongside the truck that will teach people how to use the food. The only thing we’re not changing is what people pay for the food. The goal is to see if creating access actually changes eating habits.

“We want to have some concrete research come out of the project, because you can only sustain something if you know that it works,” Patel said. “The whole idea is to create a brand new measure for preventative health that hasn’t really existed before in Nashville. So we’ll see.”

For more information on the Nashville Mobile Market or to see a schedule of stops, visit www.nashvillemobilemarket.org.

Posted 02/01/11