Editor's note: We share this interview with Health Brigade Executive Director Karen Legato in advance of the Tuesday, Feb. 5, Controversy/History discussion, "Healthy Community: Disease & Disparity." Please join Legato, Diversity Richmond Deputy Director Rodney Lofton, Dialectix founder Matthew Freeman and moderators Bill Martin and Kelli Lemon from 6 to 8 p.m. at The Valentine.
Karen Legato, executive director of Health Brigade (Photo courtesy Health Brigade)
When the Fan Free Clinic brought health care to the streets of Richmond a half-century ago, its volunteers were on a mission to provide access to quality care and information to the poor, the forgotten, the marginalized and the ignored.
In the late 1960s and early 1970s, that first meant access to health care and birth control for students, then also help for the homeless and others who had no health care. With the advent of HIV and AIDS in the 1980s, the clinic worked with the HIV-positive and those with AIDS, providing wraparound services and care teams whose members would cook, clean house and care for people who could no longer provide for themselves. Many had been shunned by family and friends.
“They really kind of wrapped their arms around them,” says Karen Legato, executive director of the nonprofit, which is now named Health Brigade. “The agency stepped up in a big way with that.”
The name has changed, and services have expanded, but there are still people on the margins in need of its services and the knowledge that they have a home for health care in the city.
“Here we are 50 years later, and we’re looking at some of the same things,” Legato says.
Health Brigade provides a range of services from medical and mental health counseling to social work and nutrition. The nonprofit, which has a clinic and offices on North Thompson Street, offers 15 specialties in house, including neurology and rheumatology. It serves about 12,000 people each year across metro Richmond and beyond.
Services include testing for STDs and HIV, and the clinic also provides access to the medication that helps to prevent HIV. Its trans health program provides primary care to about 175 people. Its needle exchange program began in the fall and is the second in the state. There are 20 to 25 people using the service so far, and Health Brigade wants to have a mobile service available this spring to expand the outreach.
The clinic offers basic health care, but also support services, help in navigating the system and prevention services as well. “In terms of serving the whole person, we’ve kind of got that covered,” says Legato.
She is a speaker in a discussion from 6 to 8 p.m. Tuesday, Feb. 5, at The Valentine museum on racial disparities and health care. The event is part of the free Controversy/History community conversation series.
Other participants include Diversity Richmond Deputy Director Rodney Lofton, Kelli Lemon of the podcast “Coffee With Strangers RVA” and Valentine Director Bill Martin. Martin and Lemon will hold a discussion on how bodies of African-Americans were long used for medical experimentation, and on the racial disparities that were evident in how victims were treated in the Flu Pandemic of 1918. Group discussion will be led by Matthew Freeman, founder of Dialectix Consulting of Richmond. Richmond magazine is a partner for the series.
Legato is an advocate for accessible, high-quality health care for all. Disparities often stem from discrimination or deep-seated judgement, she says. Health care shouldn’t be denied or limited because of race or stigmatized because of behavior, yet it is. People dealing with health problems such as a smoker with cancer, someone who is overweight and has diabetes, or a person in the throes of drug dependency are thought to have personality flaws and are condemned for having brought their woes onto themselves.
A patient receives treatment at the Health Brigade medical clinic. (Photo courtesy Health Brigade)
She cites the inequities evident in the history of the ongoing opioid epidemic: Decades of heroin addiction were not seen as a national health priority when it was mostly perceived as a disease affecting people of color, something on the margins of society. But then prescription opioids became part of the problem affecting the more affluent and white America, and perceptions altered. Society began to demand a medical approach instead of a punitive posture of jail time for use.
“The face of the epidemic has changed,” says Legato.
She notes there is a difference between equity and equality. Treat two people equally, and they receive the exact same experience. Provide an equitable experience, however, and you provide each with what they need uniquely.
Legato uses the analogy of giving a full-sized bicycle to an adult, and giving the same-sized bike to a child. Each would have been treated equally, but such a bike would have been of little use to a child.
The goal for her is to provide equitable access to health care.
Social factors also affect health care and must be considered, factors such as safe housing, education, income and access to healthy food. “It’s a pretty complex system we’re now looking at,” says Legato.
It takes a community to begin to address such problems.
At Health Brigade, there are some paid positions, but volunteers are crucial to its operation. This helps them to stretch finances: For every dollar taken in, Health Brigade delivers $8 in services.
“The beauty of what we do is our ability to leverage professional volunteers,” she says. “That’s the only way we can really afford to do it.”
For Legato, its always been about trying to help patients and groups facing disparities, to stand up for them, advocate for them and provide the care they deserve. But that assistance needs to be scaled up as much as possible: Major interventions are needed if we’re going to get our communities healthier.
“We will get there someday,” she says.
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