Go Fish: The Trouble and Triumph of Work in Public Health

by Teresa Blumenstein

Teresa with Loretto sister Anne Spillane

Teresa is serving as the AmeriCorps Wellness Coordinator at Family Care Health Centers in St. Louis.

Give a fish to a hungry man, and he will eat for a day. Teach a hungry man to fish, and he will eat for a lifetime. Belief in this message is a cornerstone of the philosophy of those working in the fields of public health and health education. What anyone in those fields could tell you, however, is that while this fishing lesson might last a lifetime, teaching it might also take a lifetime. 

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Because there can be so many, varied barriers to positive health outcomes, health education “results” are often barely observable and hardly measurable – which can be uncomfortable for educators, especially those with a background in the scientific method. I have seen this in action in my time as an AmeriCorps Wellness Coordinator for a community health center in south Saint Louis. The team I joined here last August keeps up with the latest research in nutrition, exercise, meditation, interpersonal communication, and behavior modification. They then find new ways to pass this information on to the chronically ill population in their community. Our strategy in health coaching is to meet people in the midst of their chaos, stare down all the barriers between them and a healthier life, and begin making personalized plans to pick those barriers apart one by one. We seek to do so by offering long-term emotional support, practical lifestyle modification guidance, and direction toward other sources of information and expertise.  This is slow work in which visible, positive outcomes are few, minute, and impermanent, and the impact of individual efforts is rarely recognizable. 

One patient with whom I have had the pleasure of working, I will call her Susan, has been a roller coaster to coach. Her barriers to good health include: limited physical mobility, transportation challenges, lack of funds to pay for healthy food, and a slew of health conditions that compound on each other. She is wheelchair-bound due to morbid obesity, and she also suffers from diabetes, chronic lung disease and severe depression, among other health problems. There are some seemingly simple solutions to these problems - start with eating better in order to lose enough weight to become agile enough for basic movement, for example – but implementing those changes is not always that simple.

Since I began working with Susan one-on-one this fall, she has made several attempts to get into a better routine with healthy diet and has contemplated chair-based exercise. While she has only lost a small amount of weight and gained some of it back a few times over, she has fought off several times the loss of hope for improved health. She still wavers between good eating days and bad ones, but it is worth celebrating the persistence of her will to make healthy choices, no matter how many times she gets off track. Health coaching helps keep that hope alive – and ultimately results in fewer days with high blood sugar, days with slightly lower cholesterol accumulation, and days with an ever-so-slightly lower risk of heart attack, stroke, neuropathy, retinopathy, and kidney disease.

Through our regular conversations, she has come to recognize that her depression is a primary trigger for unhealthy food decisions as she uses the pleasure of eating to displace her pain during periods of sadness. Because she was able to complete this enormous task in self-awareness, we have recently begun collaborating on non-food mechanisms by which to alleviate her suffering during her spells of depression. She has set a new goal to push food to a last resort pain-reliever in favor of healthier pleasurable activities that draw on both her passions and talents. In a recent session, we decided on two specific ways she might delve into her creative outlets rather than her favorite foods in order to relieve her stress, depression and anxiety.

Some days, when patients lose their sense of control, knowing they have someone with whom they can talk out their struggles and construct a recovery plan keeps them from giving up on the bigger picture altogether. And Susan knows she has a team in her corner, a team to which she feels accountable when making decisions about her health.  

So to return to the adage about teaching a man to fish, it becomes clear from my service experience that passing on “fishing wisdom” is more complex than I once thought. I have had to face the fact that patients like Susan may never be able to catch all the fish they need every day. Still, through our work together, Susan has accepted that fish are never going to jump into her basket on their own and has begun to construct her own net, to recognize the best places to cast it, to gain a feel for the satisfying tension in it when she is on the right track.

 In this slow progress I find the barely observable, hardly measurable impact for which the science-steeped minds of the public health field thirst: through consistent information, supportive accompaniment, and connection to resources, those on the brink of starvation may be spared from the darkness of losing belief in fish altogether.