Virtues of Community-Based Participatory Research Lauded

By Dirk Hoffman

That path recently led Gore back to Buffalo, the city of his birth, to give the keynote address at UB’s Community Health Equity Research Institute’s second annual research day.

Gore grew up in Brooklyn, attended Morehouse College in Atlanta as an undergraduate and received his medical degree from the Jacobs School of Medicine and Biomedical Sciences. He did his residency and chief residency in emergency medicine at Cook County Hospital in Chicago and then went downstate and “back home” to work as an attending physician and clinical associate professor of emergency medicine at Kings County Hospital — SUNY Downstate Medical Center.

In 2009, he founded KAVI (Kings Against Violence Initiative), an in-school, hospital and community nonprofit program that teaches young people how to resolve conflicts peacefully.

Gore was named a 2018 Top 10 CNN Hero, a global honor that celebrates everyday people changing the world. He was also a member of the 2018 Class of Presidential Leadership Scholars.

Gore received UB’s Distinguished Medal Alumni Award earlier in 2022 and he mentioned mentors in the Jacobs School’s Department of Emergency Medicine, such as E. Brooke Lerner, PhD, professor and vice chair for research, and Ronald M. Moscati, MD, clinical associate professor, for giving him his first introduction to emergency medicine-based research.

“I wanted to do research that was tied to the community and they told me about a project involving intimate partner violence,” he said. “It gave me my first opportunity to really look at violence from this public health frame and incorporating education as a way to achieve health equity.”

As a resident physician at Cook County Hospital in Chicago, Gore further delved into the issue.

“Chicago is a very interesting place, to say the least. The hottest days of the summer tend to be the most violent, but I vividly remember a day in August 2005 where it was cold and raining with the temperature in the 50s,” he said.

Gore noted he was on a 24-hour trauma call rotation and one of the other residents expressed that he was bored and “hoped something exciting comes into the ER.”

“A lot of people chimed in because herd mentality being what it was, because exciting means trauma and excitement means you get to go to the operating room,” he said. “But excitement also means mostly likely that a young Black or Hispanic male coming in as a victim of violence.

And I looked around the room and the only people of color in the entire room were me and one of the clerks.”

“I started thinking what if I am in the wrong place at the wrong time on the west side of Chicago,” Gore added. “Are people going to be looking at me as something exciting, as some sort of science experiment? That really got me to thinking. I didn’t want to become a patient.”

He started exploring the work of some other physicians who were the first people who ever talked about intentional violence as a public health issue.

“What if we created a space where people didn’t have to become patients? That’s a noble thought,” Gore said, noting the concept of working to save youth from violence before they ever become ER patients.

“I began going on this path looking at violence as a public health issue, mainly so that if you understand the risk factors and intervene, you could potentially change the course of these risk factors and have a direct impact on patients’ lives; our lives; my life,” he said. “I was definitely being selfish because according to the Centers for Disease Control and Prevention, homicide was the number one cause of death of Black males ages 1 to 44.”

Gore moved back to Brooklyn upon completing his residency training.

“I am very fortunate that I get to practice emergency medicine across the street from the elementary school I attended. I live a couple of miles away. I grew up a couple of miles away. The patients that I take care of are people that I know,” he said. “They are friends, my colleagues, former classmates, neighbors. They are even family.”

But Gore said the idea of intentional violence as a public health issue kept playing in the back of his mind.

“As a physician you see things up close and personal that completely changes your perspective,” he said. “Sometimes on the research side and on the administrative side, we think about projects and engagement purely as work, not really realizing that people’s lives are being impacted by it.”

“I kept seeing young men who were victims and survivors of intentional violence. Things look a little differently when it hits close to home,” Gore added. “These aren’t neighborhoods I just transiently pass through. This is home. I’ve admitted people from families I have known. I have admitted a friend of mine because he got shot in the face around the corner from where I live.”

Gore estimated the direct and indirect cost of intentional violence — hospital bills, lost wages, property values that are impacted — is costing people in the United States $30 billion a year.

“Not to mention the fact that when someone comes into the emergency room, the likelihood of them coming back is pretty high, so this is a problem,” he said.

Since 2008, Gore has been involved with global medicine outreach trips to Haiti and he estimated he has visited the country 14 or 15 times.

He said after a few trips, he realized the work being done in Haiti could translate to the youth he wanted to reach in the United States. KAVI started out as a grassroots organization run by volunteers, but has since been able to secure funding in the form of several grants.

The school/community program works with more than 200 kids in and around the central Brooklyn area.

“Some of the work we have done on school campuses includes an entire curriculum focusing on mediation, conflict resolution and restorative justice practices like understanding power and oppression and really creating a circle for people to be able to process as it relates to the trauma going on in their communities,” Gore said.

Gore said many of the youth the program works with are gang members or gang-affiliated.

“Depending on where you grow up, you’re going to have an affiliation,” he said. “I joined a gang when I was 14 years old. I was valedictorian of my high school, but I carried razor blades on and off between the ages of 11 and 18 because I grew up in pre-gentrified Brooklyn.”

“You have a lot of kids who are smart and are well performing, but because of where they live, they have to process violence in a very different way.”

Gore explained that KAVI’s hospital program is a bit different, in that it involves working with people who are patients — victims and survivors of violence.

“We want to make sure there is no retaliation and we also want to make sure the patients have advocates,” he said. “We want to make sure they have services that are going to help make them stay alive — and help them tackle the social determinants of health — everything from health care access to education and safety.”

“If you don’t have food, clothing, shelter and security, the odds you are going to be engaging in interpersonal violence once you get back out in the community are a lot higher,” Gore said.

Gore said UB and the Community Health Equity Research Institute is fortunate to have access to all people within the university’s different schools, where everybody has their own unique interests and areas of expertise.

“These multidisciplinary teams can conduct community-based research and create powerful projects,” he said. “Do not be afraid to fail. It is just part of the process.”

Gore encouraged researchers to identify the problems they are trying to solve and incorporate efficiencies in the projects.

“In Japanese, there is a term that is heard a lot in business. It’s called kaizen, which means constant, never-ending improvement,” he said. “In judo, there is something called Seiryoku-Zenyo, which means maximum efficiency and minimum effort. How can we be constantly improving? How do we improve these efforts with minimal energy?”

“If we have more energy, we can solve other problems, so we have to think about if there are other ways of thinking in multidisciplinary fashion to solve these problems that can be dedicated to improving the overall health of our community and well-being.”

Gore closed his talk by noting the special satisfaction that comes with being an emergency room physician, but cautioned about burnout.

“It is one of the most beautiful things in the world — to save a life. There is a special joy that comes from caring for other people, but it can’t come at the expense of caring for ourselves.”

“This work is important, but we don’t need to be martyrs. We need to be human; we need to have healing spaces and to figure out effective ways to do the work that is most important by identifying, practicing, evaluating and even re-evaluating how we process, respond and react to stress. That is just as important as the people we hope to impact.”

Along with research poster presentations, the research day event featured research talks and community presentations moderated by Samuel Abramovich, PhD, of UB’s School of Graduate Education, and Susan Grinslade, PhD, RN, clinical professor of nursing in UB’s School of Nursing and associate director of the Community Health Equity Research Institute.

Among the community presentations were:

• The Erie County Office of Health Equity Community Wellness Survey: From Concept to Collection — by Kelly Wofford of the Erie County Office of Health Equity
  
• Investigating Social Support as a Modifier of Relationship Between Food Insecurity and Telomere Length — by Sarah Marie Lima, MPH, a student in UB’s School of Public Health and Health Professions
• The mPower Program: Advancing Women’s Economic Mobility in East Buffalo — by Brandy Loveland of the WNY Women’s Foundation and Carol Murphy of Harvest House Ministries
• Doing it Right: Authentically Engaging Community Stakeholders in Community-Based Participatory Research — by Susan Grinslade, PhD, RN
• One Federally Qualified Health Center (FQHC) Approach to Reducing Access Disparities — by Allana Marie Krolikowski, MD, clinical assistant professor of family medicine; and Takesha Leonard, EdD, of Jericho Road Community Health Center
• A Model to Increase COVID-19 Vaccine Uptake Among Vaccine-Hesitant Populations in Erie County, NY — by Parveen Attai, MPH, of the Erie County Department of Health
• Improving Diaper Access Through a Community-Based Approach in Outpatient Pediatric Clinics — by Wajiha Jeelani, MBBS, a third-year trainee in the pediatrics residency program in the Jacobs School
• Food-Related Behavior Changes During the COVID-19 Pandemic — by Angelica Dayana Tutasi Lozada, a doctoral student in UB’s School of Public Health and Health Professions

Also featured were panel discussions on the UB School of Nursing’s Mellowing Minds Study, which compared two ways to mitigate the impact of the COVID-19 pandemic on mental health among adults from underserved communities; and the SNUG Outreach Program, an evidence-based violence reduction initiative administered by the New York State Division of Criminal Justice Services.

During his opening remarks, Timothy F. Murphy, MD, director of the Community Health Equity Research Institute, noted the day provided a nice balance of research conducted by university faculty and community partners.

“Our goal is to perform research to understand the root causes of health inequities in our area and to develop innovative solutions,” he said. “In this institute, we work using the principles of community-based participatory research. And those principles are we involve the community right from the beginning, not after we receive the grant.”

“We want the community involved in the planning of it, in the operation and in implementing the plan, working as part of a team,” Murphy said. “That’s a little bit different in the way that many of us have done research over the years.”

Allison Brashear, MD, MBA, UB’s vice president for health sciences and dean of the Jacobs School, said “our goal is not to just parachute in when there is a project, we want to work with our community research partners from the very beginning.”

“My commitment to the region of Western New York and to Buffalo is to increase the health of the community,” she said.  

“The university is firmly committed to eliminating health disparities through engaging with research partners, training the next generation of physicians and nurses and all the other individuals involved in community health care,” Brashear added. “We want to make sure our research in the community is participatory and that we eliminate barriers to health access.”

The research day event was conducted Oct. 26 at the Buffalo Educational Opportunity Center, 555 Ellicott St., Buffalo.