ThriveOn, a Community-Centered Collaboration, has Broad-Reaching Focus Areas

 

From the 9/25/2020 newsletter

ThriveOn: A Community-Centered Collaboration has Broad-Reaching Focus Areas

The community-centered collaboration led by the Medical College of Wisconsin (MCW), the Greater Milwaukee Foundation (GMF), and Royal Capital Group has chosen the name of the ThriveOn Collaboration as the organizations continue deep resident and stakeholder engagement together to inform priorities and investments for supporting a thriving King Drive corridor and its connected neighborhoods.

The ThriveOn Collaboration champions a vision for a Milwaukee that is equitable, healthy and thriving for all. Achieving this vision will require durable partnerships with the community, focus on places where investment has been scarce, and supporting people of color, especially African Americans, who are disproportionately affected by health and economic disparities.

The ThriveOn Collaboration is built on the fundamental understanding that where a person lives has a tremendous impact on their health and wellbeing because housing, education, jobs, health resources and social connections are the underpinnings of healthy lives and communities. Consequently, a key component of the ThriveOn Collaboration is a place-based investment in the redevelopment of 2153 N. Martin Luther King Jr. Dr. into a community hub with neighborhood amenities, and offices for key MCW centers, institutes and programs and the Foundation’s new headquarters.

Extensive dialogue with residents, deep analysis of local and national data, and years of expertise in their respective sectors has shaped the collaborators’ approach to identifying priorities and developing thoughtful contributions that will add value to the community. The ThriveOn Collaboration’s corresponding strategies are designed to counter systemic racism and disinvestment that has negatively impacted black and brown communities in Milwaukee for generations.

The ThriveOn Collaboration has identified five priority areas. Many of the priorities directly relate to MCW’s 2025 goal of “Health of Our Community.” The long-term goals under this overarching goal includes ensuring all subsets of our community thrive, enabling the greatest positive engagement with our community to faculty, students and staff and demonstrating improved health of vulnerable populations and overall health of our community by leveraging MCW’s strengths.

The priority areas of the ThriveOn Collaboration are informed by the social determinants of health, factors that contribute significantly to health such as where people live, access to healthy foods and affordable housing, and social support networks. 

• Housing – invest in the availability of safe, quality and affordable housing for area residents. The long-term goal is to increase the number of residents leasing, purchasing, and maintaining homes with a focus on keeping long-time residents in the neighborhood.
• Early Childhood Education – invest in the quality, access and sustainability of early childhood education in the city. The long-term goal is to improve education outcomes for youth.
• Health & Wellness – investing in access to health and wellness facilities, healthy food options and preventive health services in the area. The long- term goal is to reduce rates of chronic disease and increase quality and length of life.
• Social Cohesion – support the community in building positive social and business relationships, celebrating diversity and promoting a sense of belonging among neighbors. The long-term goal is to increase resources for resident-led events and organizations.
• Economic Opportunity – support small business and enhance equitable economic opportunities for entrepreneurs and the local workforce. The long-term goal is to increase the stability of the small business community and increase access to quality jobs.

“Health of our community and moving toward health equity is more important than ever before, as demonstrated during the global pandemic of COVID-19,” said Greg Wesley, Senior Vice President of Strategic Alliances and Business Development for MCW. “By building upon MCW priorities, honoring this community's history, culture and people, and by listening and collaborating every step of the way, we are moving forward with GMF and Royal Capital Group to inspire change and action.”

The ThriveOn Collaboration reflects the values of the community shared through continuous dialogue and participation among residents, the collaborating organizations and other community leaders. The feedback helped shape the collaboration’s goals and how the work moves forward. Community engagement for the ThriveOn Collaboration remains active. Staff members currently are holding virtual office hours, and the team is establishing a Community Advisory Council (CAC). The goal of the CAC is to further integrate community perspective and participation by ensuring residents have additional decision-making power within the collaboration. The role of the CAC is to include a community voice in grantmaking and program initiatives that promote an equitable, healthy and thriving community with a focus on the Harambee, Halyard Park and Brewers Hill neighborhoods.

The ThriveOn Collaboration has been working to implement its vision and priorities. Its commitments in community have included:

• Helping to prevent resident displacement through partnership in the MKE United Anti-Displacement Fund. Housed at the Foundation, which contributed seed funding, the Fund so far has provided about $37,000 in property tax relief to 114 homeowners in the Harambee, Halyard Park,Brewers Hill and Walker’s Point neighborhoods, the majority of whom were over 60 years old.
• Approving approximately $100 million for joint investment in building improvement and development, including streetscaping and exterior art and green design.
• Providing more than $13.2 million in grants through the Foundation and in support of COVID- 19 relief, response, and recovery related to food, shelter, health, education, economic stabilization and more.

When redeveloped, the collaboration’s corresponding Milwaukee location on King Drive and, adjacent to Dr. Vel Phillips Avenue, will support health and growth, and be a destination where Halyard Park, Harambee and Brewers Hill neighbors can interact, learn and share.

MCW feels this is a return to its roots. For 34 years, from 1898 to 1932, MCW’s predecessor institutions (Wisconsin College of Physicians and Surgeons, which became the Marquette University School of Medicine) were located in Halyard Park in a building located on the southeast corner of Fourth Street and Reservoir Avenue. Next to the medical school was its dispensary (now called outpatient clinics) where medical students observed faculty physicians treated indigent patients. Across the street from the medical school was St. Joseph’s Hospital, the medical school’s primary teaching hospital.

For more information or to get involved with the ThriveOn Collaboration, please visit our website atthriveoncollaboration.org.

Kevin Newell from the Royal Capital Group, Ken Robertson and Ellen Gilligan from the Greater Milwaukee Foundation, and Dr. John Raymond from MCW were instrumental leaders for this initiative.

RBG and Dad

From the 9/25/2020 newsletter

Director’s Corner
 

RBG and Dad

 
Adina Kalet, MD MPH
 
 

In this Director’s Corner, Adina Kalet tries to reconcile the awesome vulnerability of being a patient, the potential transformative power of our profession, and the lessons learned from the life of an American hero.
 
 
This week, the death of Justice Ruth Bader Ginsberg has been on my mind and, as I considered what to share in my column, I realized how important she has been to us. I have benefited from, and been moved by, her critical and prophetic message that, “Women belong in all places where decisions are being made.” For women of my generation, this was not the norm and it is still far from a guarantee. Thanks to the work of RBG and a handful of others, some of us now find ourselves “at the table,” making decisions and expanding our spheres of influence as we attempt to make the world a better place. Her work led directly to transformative change. Many of us who would have otherwise been sidelined are now heard in ways that would never have been possible without her. 
 
Ruth Bader Ginsberg was an American hero and transformational leader, par excellence. People on all points of the political spectrum have noted her uncanny ability to listen, her impact on society, her brilliance and courage, her prophetic legal mind, her ability to see things as they should be for all people, and her perseverance. I have medical colleagues who take on the challenges inherent in medicine the same way.
 
 
This week, the chance to be heard became personal.
 
 
I am writing this column while sitting in a hospital waiting room, the daughter of someone suddenly thrust into the medical system. In my new unwelcome role, I feel vulnerable and less assured of the value of my personal “power and influence.” I had planned to write about RBG’s life and legacy. Instead, I find myself searching for parallels between how she leveraged her knowledge of the legal system for change and my need to exercise my familiarity with the medical system to make certain my father stays safe. Like her, I remain vigilant, paying attention to everything that is happening around us, and advocating on my father’s behalf. It can be exhausting.
 
My dad is a remarkably fit 84-year-old retired engineer who presented this past Tuesday to his internist with classic symptoms of exertional angina in a crescendo pattern. Dad’s EKG had developed non-specific T-waves that suggested something amiss. He was walked down the hall to the cardiologist who then called the interventional cardiologist who scheduled a cardiac catheterization. He was admitted to the ER for monitoring. His first troponin levels (an indicator of heart muscle cell damage) were equivocal, suggesting heart muscle cells were spilling their contents but he didn’t appear to be having a full-blown heart attack. 
 
For context, my dad sees a doctor in the large academic medical center where I did my residency training and spent the first thirty years of my career. I know this place and these people – warts, glory, and all. Even though I had confidence in his care team, I was terrified. I knew too much. I never left his side because, over the years, I have seen all of the things that can go wrong even when everyone is well meaning and highly qualified. 
 
From the patient’s (and the daughter’s) perspective, hospital care separates individuals from everything familiar. There are endless streams of humans with uncertain duties, repeated handoffs between nurses, physicians, and other staff, long (ten hour!) waits in the ER until a “clean bed” becomes available, no proffered food, malfunctioning cardiac monitors for a patient with a heart problem, a mix of disturbingly poor and remarkably skillful communications, and moments of caring and compassion juxtaposed with moments of “ghosting.” Even as someone who knows medicine and trained in the hospital where we now sat, the experience was dehumanizing.  
 
Further, I could see the contrast between the technical, sophisticated wonders of modern medicine – cardiac catheterization suites with cutting-edge technology and physicians with impeccable expertise – and the troubling implications of the corporate commodification of healing in healthcare systems. Some patients in the city are offered luxurious private rooms with gourmet meals and spectacular views of the river while others – in the public hospital down the street – are offered no amenities. The public hospital’s professional expertise is, fortunately, comparable, but is also distinguished by the staff’s ability to offer excellent care despite their lack of resources. 
 
What’s the bigger picture here? How might we make healthcare more equitable? RBG had a wider vision of society, and she pushed the legal system to treat everyone equally no matter their gender or status. In the same way, visionaries in medicine envision a future where every person is entitled to safe, high quality, compassionate, cost-effective healthcare. We must include the most vulnerable patients, even as she fiercely advocated for all members of society. We will face challenges along the way, just as she experienced blatant interpersonal and institutional sexism during her career. 
 
She demonstrated that to be transformational, we need to be persistent. There was a moment, early in her time at Harvard, when RGB and the small group of women classmates were challenged by the law school dean to defend why she “took” a man’s spot in law school. They demonstrated their value with their actions and dedication. They showedthat they belonged. Later, despite graduating at the top of her class and being part of the law review, she could not get a clerkship or even a job with a law firm. She chose an alternative path, doing comparative international law research, joining a law school faculty, and creating her own way forward. She ended up changing the world. 
 
To achieve transformation, we will need to engage – like RBG did – in necessary, nuanced, and difficult conversations. She had a clear moral compass. She was able to change her mind, to be influenced by others, and to learn deep and abiding truths about human dignity from those whom she loved and especially from those she didn’t know. With these character traits, it is possible to engage in respectful, caring, civically responsible, and sometimes fierce dialogues on contentious issues, including the inequities in health care and society. “You can disagree without being disagreeable,”she said. “Fight for the things that you care about but do it in a way that will lead others to join you.” Although being patient enough to work through issues can be a huge challenge, her long view of history allowed her to dissent while remaining part of rich, mutually respectful, humble relationships with those with whom she fundamentally disagreed. Her ability to persuade without fracturing human connections is one of her most important legacies and lessons. 
 
 
I accompanied my dad on his journey this week. Happily, he had the best possible care and had a wonderful outcome despite the frightening situation. I advocated for him, speaking up and influencing the system when it faltered. But mostly, we realized that the outcome was a result of the fundamental commitment of his medical professionals to care for someone in need. 
 
RBG, too, depended largely on the goodness of people working in the legal system, although she did not allow that faith to keep her from being a vigilant advocate when she felt it was needed. She believed in the goodness of others, but also that she had the responsibility to drive the change. She persisted and the world is a better place because of it. May we all be inspired by her courage and passion. 
 
 
 
Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.
 
 
 
 

The Unsolvable Tension Behind Good Intentions: Confronting Sincerity and its Shadow

From the 9/18/2020 newsletter
 
Student Perspective/Personal opinion 
 
 
The Unsolvable Tension Behind Good Intentions: Confronting Sincerity and its Shadow 
 
 

Jess Sachs, M3, explores the complex relationship between intentions and actions as she seeks to understand anti-racism and navigate her way toward being a consistent, effective ally. 
 
 
Like many, I have become increasingly motivated to step up and advocate for justice and equity. Also, like many, I struggle to determine where I am most needed and how to strike the delicate balance between white savior and white ally. So, when advocating for Black lives became “trendy” again in May after the death of George Floyd, I decided to do what plenty of other people started doing, which is committing to learning about social justice and anti-racism work and then...posting about it online. Otherwise known as “performative allyship,” or “slacktivism” in colloquial terms, this trend is something that white people like myself have an embarrassing history of participating in—that is, temporarily caring, and engaging in the work of reading, listening to, and advocating for Black people until our own lives become too “important” to continue pursuing meaningful activism. Nevertheless, I was drawn into this engagement, but this time I committed to doing it “right.” This would not be another time loop, another performance of the same pieties we have played out time and time again. What I ultimately intended to learn about was the death of Breonna Taylor. 
 
If you haven’t heard about Breonna Taylor, hers is the story of a Black woman losing her life to police brutality, a tragically common occurrence. Breonna was an EMT who was fatally shot by police officers attempting to serve a no-knock warrant on her home on March 13, 2020. (Brown & Duvall, 2020). The chronicle of her death is senseless, tragic, and heartbreaking. Why I became particularly attached to this specific tragedy, I am unsure. Perhaps it was because of the similarities between Breonna and me. We are the same age and working in the same professional field. Perhaps it was also because the case continues to evolve as new information leaks out - information that is often contradictory and confusing. 
 
Regardless, her story has become a source of painful preoccupation. Much of my time is spent searching twitter and Instagram with the hashtags #Breonnataylor, #justiceforbreonnataylor, #breonnaslaw, in an effort to absorb and learn everything I can about her. I attend Zoom Call to Action meetings. I read stories written by her sister and her mother. I donate to the Louisiana Until Freedom organization. I aim to become an expert in her case, because for the sake of our humanity, I did not want this to be another example of futile action. I vowed that my involvement would be one of the many steps in the proper direction of acknowledging systemic racism and advocating for justice. 
 
Recently, however, I read an article exploring how Breonna Taylor’s trending name has gone from a call to action to an oversimplified meme. Zeba Blay, the author of the piece writes, “Turning Breonna Taylor into a meme, then, risks turning the conversation around what justice looks like for her into a temporary fad.” This was my biggest fear. By reading and posting everyday, perhaps her story and her name were ultimately losing meaning. I questioned if I was becoming desensitized to the true goal of this work and blindly following a fashionable fad that looked like, but had nothing to do with, justice. This was never my intention, I kept thinking. And herein lies the complexity and confusion with our intentions. Below the surface of our rational minds lies a traffic intersection of contradictions, within which we ask this question: Is what we do substantive or simply another manifestation of our hopeless hypocrisy? Were my efforts simply designed to temporarily absolve my own white guilt? Was this true allyship, and is that even the goal? 
 
The answer to these questions? I still don’t know. What I do know is that my intentional actions to dismantle white supremacy will never be enough. What I do know is that my unintentional actions have maintained a culture of oppression and racism. Our personal truth is always far amore complicated than it seems, and reflection is necessary as we confront these feelings of guilt, discomfort, and confusion. But we continue to commit to meaningful causes, even if our motivation remains imperfect and clumsily emerges from a welter of conflicting impulses. It is of little value to attempt to fully reconcile our own emotions and intent after 400 years of unreconcilable damage done to Black people. Writer Tre Johnson says it best when he comments, “The confusing, perhaps contradictory advice on what white people should do probably feels maddening. To be told to step up, no step back, read, no listen, protest, don’t protest, check on black friends, leave us alone, ask for help or do the work — it probably feels contradictory at times. And yet, you’ll figure it out. Black people have been similarly exhausted making the case for jobs, freedom, happiness, justice, equality and the like. It’s made us dizzy, but we’ve managed to find the means to walk straight.” My ncertainty regarding the best pathway to follow in the direction of social justice is of little importance when compared with the uncertainty of not knowing whether calling the police will end in your safety or in your murder. Thinking critically and listening to those who have been doing this work for decades and centuries is indeed necessary when it comes to broadening and deepening the conversation about how to best move our nation towards a more just and equitable society. 
 
I wouldn’t be my father’s daughter if I didn’t mention a Jewish tale that comes to mind as I write this. Once, a wealthy disciple came to the Alter Rabbi, R. Schneur Zalman of Liadi, and said that he had been contemplating opening an orphanage, but had since abandoned the idea. Having mulled over the project, he came to the conclusion that he was only doing it to gain more respect in his community. The Rabbi lifted his eyes and told him firmly to go ahead with the orphanage, reasoning that, “While perhaps you may not mean this sincerely, the poor young orphans who will eat hot meals and sleep in comfortable beds will certainly do so sincerely.” The Rabbi understands that his disciple’s motivations are not entirely “pure”, yet the Rabbi also understands that there is still value to motivations that have a higher purpose even if they are partially spurred by energy that is not entirely rooted in ethical rectitude. Moral aimmaculacy is not a pre-requisite for moral action. Good intentions will not solve the problems of systemic racism and police brutality. Regardless, we commit to action because our lives depend on it and because we must take on the issue of racism as our own. As I continue to reflect on my efforts to pursue this particular summons to action, one point has never shifted-- Breonna’s Taylor life mattered. While it might take more time for all the facts surrounding her death to be revealed, it is an honor to learn her story, and with every action that I take, be it right or wrong, intentional or unintentional, I refuse to let her name and her story be forgotten. 
 
 
References: 
Brown, M., & Duvall, T. (2020, June 30). Fact check: Louisville Police had a 'no-knock' warrant for Breonna Taylor's apartment. Retrieved September 16, 2020, from https://www.usatoday.com/story/news/factcheck/2020/06/30/fact-check-police-had-no- knock-warrant-breonna-taylor-apartment/3235029001/ 
 

The Life Bus Project: How two MCW Medical Students engaged in Social Innovation

From the 9/18/2020 newsletter

Student Perspective

The Life Bus Project: How two MCW Medical Students engaged in Social Innovation

Medical Students Kelli Cole & Gopika SenthilKumar describe how they partnered and utilized their passion, ingenuity, entrepreneurial mindsets, and community support to design a real-world public health solution which gave them a transformative learning experience.

We remember March 2020 clearly. The two of us, were looking forward to getting started on our Kern Institute TI2 project and finalizing our summer lab rotations. Suddenly, there were constant news updates about rising death tolls around the world and an incoming sense of doom as the pandemic spread to the US. As we watched the initial responses, we could not help but notice all the ways that our healthcare systems were not prepared - personal protective equipment (PPE) shortages, disproportionate impact on vulnerable and low-income communities, intensifying health disparities, fear amongst frontline healthcare workers. In an effort to help, we put together a grassroots team of students, physicians, scientists, and engineers for the Johns Hopkins COVID19 Design Challenge held in early April. Life Bus, the solution that sprouted from the competition and evolved since, has not only allowed us to persist towards improving healthcare delivery and access starting in our own MKE community, but has also been an incredible opportunity for growth and reflection.

In this article, we hope to share our story and reflect on our key takeaways/learnings thus far.

During the competition, our team (click our link here) conducted a rapid needs assessment and identified three key needs:

1. Protecting frontline healthcare providers 
2. Reaching vulnerable populations
3. Conserving PPE

Our solution was designed to meet all three of those needs by temporarily repurposing city buses into mobile COVID19 testing and triage centers. Life Bus incorporated key design solutions (physical barriers with gloves to overcome PPE shortage, indoor/outdoor models, creative vital sign collection, existing infrastructure/routes of city buses) that were truly made possible because of the multidisciplinary nature of our team and mentors. The 5-day challenge opened our eyes to the impact of the pandemic on various aspects of our society and uncovered avenues for improvement/change.

The Kern Institute provided invaluable support and local connections to further the project.

After the competition, we showed our idea to front-line providers, healthcare administration, and the Kern Institute. Given the overwhelmingly positive response and incredible support from the Kern Institute, our team decided to continue working on Life Bus. For the rest of the spring semester, we improved our design, added valuable team members, and identified other key stakeholders who could help refine and implement Life Bus. Balancing our roles as early-career professionals in this project while also juggling medical school courses challenged us to improve practice in these areas that we may not have otherwise gotten this early in our medical education.

Over the summer and at the beginning of our second year of medical school, the two of us participated in the National Science Foundation I-Corps program to develop a sustainable business model for Life Bus. We conducted 50 interviews with community partners, Wisconsin’s COVID19 testing committee, students, physicians, transit companies, outreach organizations, manufacturers, and private and public health systems. We are beyond grateful for the time and advice from everyone we interviewed and are honored that many of them are still involved and supportive of our initiative. Our conversations helped confirm the need for sustainable (i.e. not depleting PPE or straining our healthcare workforce) mobile healthcare and highlighted the feasibility of our project. Through this process, we developed entrepreneurial skills such as hypothesis-driven interviewing, synthesizing subjective feedback into tangible ideas, and asking for buy-in from higher-level executives. This opportunity taught us how to vet an idea based on customer discovery and pivot based on the information learned to create a refined solution. Moreover, we were mentored by inspiring local entrepreneurs who continue to provide us with constructive feedback and guidance as we move forward.

Life Bus is addressing ‘real-time’ issues from the pandemic in Milwaukee

All through this project, a common theme that kept arising was how ‘healthcare access has been a long-standing challenge in the Milwaukee community, and the pandemic merely intensified the problem.’ It became clear to us that Life Bus needed to not only provide COVID19 testing and triage but also focus on addressing basic health needs, building sustainable mobile care, and establishing a model for long-term continuity of care. This way, Life Bus is not just a “band-aid” for the time being, but rather a solution to the underlying etiology. We now envision our work as a necessary extension of our current healthcare delivery model, and we view it as a sustainable method for bringing care to the patients rather than relying on their ability to come to us.

There is still a lot of work to be done before Life Bus becomes a reality in MKE and beyond, but we are excited to see what the future holds. Our work has further exposed us to the innovation, engineering, public health, and business sides of medicine. It has allowed us to integrate our individual backgrounds (in basic science and education for Kelli, and in engineering and design thinking for Gopika) as well as our passion for medicine and public health, into a cohesive initiative that has the potential to tackle some of the challenges in healthcare delivery that have been exacerbated by the COVID19 pandemic. Someday, we hope contributing to real-world challenges becomes a part of our medical education. Not only does it expand our understanding of the numerous aspects of healthcare and its impact on our patients, but it also allows us to hang on to a sense of meaning and purpose even when feeling overwhelmed with coursework.

These few months have opened our eyes to the extent of health disparities and access deserts plaguing the Milwaukee community. As we move forward in our medical education, we plan to do our part in helping increase sustainable healthcare access in our community - through Life Bus and beyond. We would like to thank everyone who has contributed to our work thus far; it truly takes a village! This project would not be possible without all of your hard work, support, and mentorship! Please visit our website for more information on the project and team: https://covidlifebus.wixsite.com/website.

Kelli Cole & Gopika SenthilKumar are both M2 students in MCW’s MD/PhD Program.