Julie Smithwick is bringing health care to South Carolina’s hardest-to-reach populations through an approach she learned early on in her career: mobilizing community health workers. 

Smithwick first trained as a community health worker herself in the Peace Corps and became an expert in that model — whereby individual, trusted members of a community are trained to educate and provide resources to their own neighbors. 

As director at the Center for Community Health Alignment, Smithwick aims to engage with families who aren’t receiving care — whether the barrier is quarantine, distance, language or trust — by meeting them where they are, even now when that means connecting virtually. Given the massive disparities in oral health care for minority populations, Smithwick's endless work to provide preventive services makes her a true Preventist. 

Are there stories from the community health workers you work with that resonate with you most?

I ran a community-based organization for 14 years that worked with South Carolina’s growing Hispanic population, and we prioritized oral health because that population had the highest rate of childhood tooth decay and the lowest rate of access to pediatric dentists in our area. We partnered with the state health department’s oral health division to equip one community health worker — who was Spanish-speaking and an immigrant herself — with information on basic oral health, and she would go into families’ homes and get to know them and connect on shared values. 

As she built trust with the families and listened to their goals, she provided them education about oral health along the way. She found families where everyone in the family was sharing one toothbrush, whose babies were going to bed with bottles of sugary drinks, families who’d never seen a dentist. Those stories are emotional and powerful — of families who wanted the best for their children, but just needed to learn the facts and receive support with accessing resources.

Does the personalized role of the community health worker ever extend beyond health care?

We have one community health care worker who’s working with a rural African American population on a mobile dental clinic, which is operating during the pandemic, but only for emergency patients. She connects communities with the clinic and let’s them know it’s available and helps them set up appointments. But she also provides a lot of wraparound services: Individuals may come in for dental help, but they have other underlying health issues. Some are struggling with food insecurity or unemployment. She’s there to be their partner as they handle their specific dental needs, but she’s also there for them beyond those - and connections like hers with the community are especially important. 

How has your team responded to the Coronavirus outbreak?

We are sending resources to a listserv of community health workers, and working to develop a virtual platform for community health workers so they can connect with one another. They’re already trusted members of their community, so even if they’re not doing home visits, they’re being contacted for things like, “My husband was laid off and he’s our sole income so we can’t afford rent or food — what should we do?” So it’s important that the community health workers understand what’s out there and how to answer questions and provide support. 

Community health workers will have different knowledge that they can share with one another...one may have experience with how to navigate stimulus checks and unemployment support, and another will know exactly where to get fresh fruits and vegetables. We can also post information in different languages they can share with their communities: what social distancing means, how to get to the food bank and more.

What efforts would close the health care gaps you witness in your work every day?

I’d like to see community health workers sustainably employed across the country, supporting all vulnerable populations. Community health workers should be supported by Medicaid, Medicare and other coverage providers because the evidence is there — the model works. They are filling such large gaps in care, and they’re supporting people who our current health care system typically cannot — people who are truly experiencing the worst health inequities and who need support in a sustainable way.