The Elizabeth West Project: A Health Professional Joins a Literacy Program in Downeast Maine

by Beth Russett
The Elizabeth West Health Literacy Project was named for Elizabeth West, a student at the Sumner Adult Learning Center, who died shortly after the program began. Her friend and teacher, Marty Duncan, wrote the poem in the below box.

The staff of the Sumner Adult Learning Center had concerns that health-related issues were interfering with students' learning. The Center's coordinator, Ann Sargent Slayton, noted that, "health problems contribute to frequent cancellations, decreased energy levels, interrupted learning plans and an overall disruption of education goals. Family health concerns prevent women from being able to focus on their own learning needs." With the help of a grant from Laubach Literacy Action: Women in Literacy, the Center set out to address some of these roadblocks.

The Adult Learning Center is housed in a community center in rural, downeast Maine. Open enrollment services include basic literacy, English for speakers of other languages (ESOL), family literacy, preparation for the tests of General Educational Development (GED) or an adult diploma, and employability and computer training provided on site, at area schools, in homes, and at various community sites. Of the 93 participants who enrolled in the center last year, 73 were women. Close to half of the women who come to the center are unemployed. Those who are employed work in seasonal positions in the fishing, seafood processing, and tourist industries, or in other service jobs.

I had been volunteering at the center with ESOL students for close to a year. I am trained as a family nurse practitioner with a focus on women's health. My previous clinical experience was at a migrant/rural health center where literacy issues (inability to read or write, and language barriers) interfered with people's ability to access health services. The Laubach grant enabled the Center to hire me to work three days a month for a school year, during which time we planned to use health issues as a means of improving learning and literacy skills to improve health. While the staff at the center realized that men's health issues are also important, the program focused on women, as required by the grant.

We had decided that it would be most effective for health education to be offered in a number of settings geared toward different styles of learning and participation. In the course of the 10 months, I surveyed students' health needs, met individually with women for health education appointments, organized a health committee called the Health Action Team, and offered three separate health workshops. I also promoted collaboration between Sumner Adult Education and local health care providers. What follows is a description of the Elizabeth West Health Literacy Project, its impact, and its limitations.

Health Survey

The first step in the project was to identify the students' specific health concerns as well as to measure their general interest in health information. The staff developed a simple, three-question survey. The teachers asked 36 women who were currently enrolled at the center:

• Do health problems sometimes make it difficult for you to come to school? What kinds of problems?
• Do you need information and/or resources to better take care of your health?  What kind would be helpful?
• Would knowing more about your health/your body help you? How?

We learned that the women were concerned with mental and emotional stress, colds, and digestive problems. They were interested in information on issues such as childhood illness, depression, pregnancy, nutrition, and exercise. One woman said, "Women are not informed enough about ways to help them feel better and they are socialized to take care of everyone else besides themselves." The needs and concerns expressed in the survey confirmed the initial concern and laid the foundation for the project.

Health Education Appointments

Every female student at the center was told about the availability of health education appointments.  Any interested student could fill
out a brief form - by herself or with the aid of her teacher - stating her health concern and the best time and place to meet. While teachers had previously included general health information in their classes, many found that students had specific and serious health issues that required a more trained interaction. The ability to refer students to me, an onsite health educator, was noted by staff as one of the most significant benefits of the health literacy project.

During the project, I had the opportunity to meet with 11 women one-on-one to discuss their specific concerns.  The nature of each interaction was as varied as the participants. I conducted two of the meetings in Spanish and the rest in English. Each interaction confirmed the powerful link between health and literacy, as well as the broad definition of both. I worked with women to find creative and realistic solutions to health concerns that were interfering with their learning.

Health Action Team

One of most exciting parts of the project for me was the creation of the Health Action Team, which was designed to bring together any students interested in talking about health. We would also work as a group to put together a presentation for a local health center and two health workshops. The grant included money for stipends for the team.

Four women joined the Health Action Team: Mary, Elaine, Juana, and Gabi. Given my limited schedule, and transportation issues and personal commitments of every student, the staff and I were grateful to have a group of this size. The group was uniquely multicultural; in an area that is more than 97 percent white and English-speaking, two of the four women are Spanish-speaking: one from Honduras and one from Mexico.

Juana and Gabi are advocates for their community: bringing people to the center, helping others with license exams, filling out forms, making telephone calls. Mary and Elaine are also strong advocates for themselves and their families. They both have children with special needs and have years of experience with the medical community. The size and makeup of the team presented certain challenges and infinite possibilities.

In the few months we had, we were able to meet three times. For half of the group, it was a new experience to be in a bilingual activity. Both Juana and Gabi were ESOL students who spoke varying amounts of English. Juana or I translated any conversation that Gabi did not understand.

Mary called me following our first meeting. She felt left out, suspicious that we were talking about her, and uncomfortable with the amount of Spanish I had used in our discussion. Elaine felt the same way, she told me. This provided an opportunity for us to begin to talk about our own bias and the challenges faced by ESOL students everyday.  She considered leaving the group, but voicing her discomfort made it easier for her
to stay.

Many of the activities in our meetings were adapted from Beyond Prescriptions - Meeting Your Health Needs - A Plain Language Workbook About Health. This is an excellent resource that addresses the personal and political aspects of health literacy. We focused on the discussion of health rights and responsibilities.
It was much more difficult for team members to voice health rights than responsibilities, but we came up with a good working list. The group also shared ideas about barriers and resources. The participants had all experienced some common barriers to health care. Elaine was able to inform Juana and Gabi about free transportation services, which are a valuable resource in a rural area. These group discussions provided the framework for our clinic presentation.

Mary, Elaine, and I went to the local health clinic to talk to the staff about health literacy. I talked about the need to link health and literacy work. Mary shared our list of health rights and responsibilities. Elaine shared a list of recommendations that the team felt would improve access and make patients feel more comfortable seeking care at the clinic. These lists are in boxes on this page and the next.

After the talk, the staff completed evaluations. They all expressed appreciation. Some stated that it was the first time they had the opportunity to hear from the people who use the clinic, in a non-clinical setting. The clinic manager said, "These are voices we do not generally hear. We need to pay attention to them." She also talked about ways to start a child care morning so that women could visit with their health care provider alone. It seemed to be a positive experience for everyone.

The Health Action Team was the part of the Elizabeth West Project most directly affected by the temporary nature of the grant. The team had the potential to have a more significant impact on each individual member and the broader community, but could not be sustained without the initial effort of a designated staff member for a longer period of time.

Health Workshops

The workshops were prepared with help from the four members of the Health Action Team. They chose the topic most interesting to them, worked on the agenda, and prepared class materials. My goal was to have them co-facilitate each workshop. This only happened once, in part because of the limited time and flexibility inherent in short-term funding.

The first in the series of health workshops, "It's Cold Season Again!" looked at what does and does not work to cure the common cold. It was one session and five people attended. We waded through the myriad over-the-counter medications, discussed the need for antibiotics, shared home remedies, and made cough syrup (see recipe above).

"Stress Management for Women" was a three-part class that relied heavily on the Deep Breathing while Doing it All curriculum developed by the Tobacco Free Greater Franklin County Coalition's Stress Management Task Force (turn to the Blackboard for information on how to get this curriculum). I also invited a local massage therapist and yoga instructor to share techniques with the class. Participants left with practical skills to use to deal with tension. In the evaluations, written or discussed with their teachers, one participant expressed a common theme: "Just having the chance to spend time with other women talking about stress was a stress relief itself. When can we do it again?"

The final workshop was on "Domestic Violence: How to Help a Friend." Although violence was not explicitly mentioned as a concern in the initial survey, we felt it to be a contributing factor in many health problems. Juana co-facilitated this session with me. All of the material was provided in Spanish and English, although Juana was the only ESOL student in attendance. There were nine other participants. This workshop was unique in that both staff and students attended it. Months later a participant called to talk about a new relationship. She recognized some of the behaviors we had discussed in her new partner. With courage and support, she ended the relationship.

Afterwards

Close to a year after the Elizabeth West Health Literacy Project ended, I returned to the Sumner Adult Learning Center. Two of the women I worked with have since received their GEDs, and one is home full-time caring for her new baby. The ESOL students are taking classes closer to home. Many of the women continue to come to the Center for help with reading, parenting, and college preparation. There are no workshops on health issues and no Health Action Team. The connection with the local clinic has weakened. During the course of the grant, 12 referrals were made to the health clinic and six referrals were made from the clinic to us. This was evidence of a heightened awareness of community resources on the part of the clinic. However, without continuing personal interaction - a face and a name -  these have dropped off in the last year. Lacking the funds for a coordinator, no one is right there to turn to with questions or referrals, which is most difficult for the staff.

In all the areas where students work are brochures on stress management, childhood illnesses, exercise, pregnancy, high blood pressure, and other health issues. An entire bookshelf is dedicated to in-depth health material. These references are a reminder of the Elizabeth West Project. They are not interactive, they are not personal, they are not bilingual. They are evidence of the staff's continuing commitment to keeping health issues a visible part of their literacy work and of the difficulties in doing so without adequate support.

About the Author

Beth Russett lives on the coast of downeast Maine with her husband and two boys. She worked as a family nurse practitioner with a focus on women's health in a migrant/community clinic in North Carolina.