A Letter from Our CEO: Reflections on a Sabbatical and the International Community Health Center Movement

By Ross Brooks, Chief Executive Officer

When I present at our new employee orientation each month I always ask the smiling new staff the same question: “Raise your hand if you’re part of an international movement.” A few brave souls raise an eyebrow. On occasion, a hand will tentatively raise. Most new staff try to avoid eye contact with me and hope I won’t call on them.

With preacher-like conviction and broken-record consistency, I’ll evangelize with the following speech:

“At Mountain Family Health Centers, you are now part of an international movement of Community Health Centers (CHCs), born from apartheid era South Africa in the 1940s, and which spread to the United States during President Lyndon B. Johnson’s “war on poverty” in the 1960s. The first CHCs in our nation took root in Boston, Mound Bayou, Mississippi, and Denver at the integrated health system now known as Denver Health. At Mountain Family Health Centers, we trace our origins back to the vision of the Gilpin County Public Health Nurses Association, who started our community health center in 1978 to serve the mining and tourism industry workers of Black Hawk, Colorado.”

I typically then share the growth of our organization over the past 40 years from humble community roots to a robust system of integrated medical, dental, and behavioral healthcare teams serving 21,000 people in Western Colorado.

I’ve shared this history story so often that the Mountain Family Health Centers Executive Team and Board of Directors are starting to mock me. A sign, I’m told, that the message has been received. 

As it turns out, the story I’ve been telling is only partly true. My family and I were blessed to take a three-month sabbatical in South Africa, defined as a “break from work.” Taking a sabbatical was an opportunity to return to the country I lived and studied in during 1998, soon after Nelson Mandela became the first democratically elected President following the fall of apartheid. This summer was my family’s first experience in South Africa. 

We quickly re-connected with the Kinnear family that had hosted me in 1998 and started enjoying the pleasures of eating meals as a family together, sharing our “gratitoods” daily, vigorously debating the merits of the South African Springboks vs. the New Zealand All Blacks rugby teams, introducing our kids to the best 80s movies (“Goonies,” “Ghostbusters,” “Back to the Future,” “Three Amigos,” “Spaceballs”?), hiking Table Mountain and stopping to smell the protea flowers, and losing track of time at the endless confluence of the South Atlantic and Indian oceans at the southern tip of the African continent.

We also did some hard re-learning about the brutalities of apartheid and the power of truth and reconciliation over racism and hatred. We discussed politics, democracy, health, education, and access to clean water as a human right, in between getting comfortable with two-minute showers due to Cape Town’s ongoing water crisis. We laughed at robots (traffic lights), “buy-a-donkey” (the best way to say thank you very much in Afrikaans), and our inability to remember which direction the cars were coming from when crossing the road.

I didn’t work in the traditional CEO sense. I didn’t check email, didn’t call into meetings, didn’t do any strategic planning, and didn’t wake up early perseverating on solving Mountain Family’s challenges. The Mountain Family Executive Team and talented staff did an amazing job leading Mountain Family in my absence. I did work on deep connection with my wife, children, and South African family; connecting with the planet, animals, and plants that feed us; and listening in silence to the wisdom of God’s Light.  That was the most meaningful, and fun, work of my life.  

As we traveled around South Africa it was hard not to notice the ongoing economic inequality in every neighborhood, town, and city in the country, a legacy that persists 25 years after the fall of apartheid. I also started to notice I wasn’t seeing many Community Health Centers. I saw some hospitals, a few tattered family practices in the townships where people of color had been forcibly sent during apartheid, high-end specialty care in the high-income areas of the city, but very few Community Health Centers. I tried to google Community Health Centers in Cape Town.  I started asking around about Community Health Centers. The reply was usually “Community Health Centers? Outlook hazy, ask again later.” It seemed most South Africans hadn’t heard about Community Health Centers. I started worrying that the stories I’d been telling for the past decade about our CHC roots in apartheid-era South Africa were at best inflated, or at worst, untrue.

So, I started reading more about the International Community Health Center movement, wondering where South Africa’s Community Health Centers had gone. Thanks to an International Federation of Community Health Centre’s May 2019 publication, I discovered the earliest known Community Health Center project was piloted in Beijing, China in 1925. CHC projects in Canada and England followed soon thereafter. In the 1940s, Drs. Sidney and Emily Kark established the Pholela Health Centre in rural South Africa. South African CHCs were one of the, but not the, first CHCs on the planet.

At the Pholela Health Center, primary care was delivered from a house converted into a clinic, using a team-based model of care with nurses, medical aides, and physicians. Community Health Workers (CHWs) were deployed to do screening and health assessments in the community and diverse community stakeholders were engaged in development of health promotion services (Kautzkyi K, Tollman SM (2008). A Perspective on Primary Health Care in South Africa. School of Public Health, University of Witwatersrand, 2008).

The Pholela CHC model became very popular and by the end of the 1940s there were more than 40 CHCs across South Africa. Dr. Jack Geiger interned with the Kark family and ultimately used his learnings from South Africa to launch the first pilot CHCs in the United States during the Johnson Administration in the 1960s. Today, CHCs in this country serve the integrated health and social needs of more than 28 million Americans, and the U.S CHC model is generally regarded as one of the most robust CHC movements internationally. 

But where had the South African CHCs gone? Unfortunately, I discovered that decades of apartheid ultimately dismantled the community-oriented primary care CHC model. While post-apartheid governments have sought to reinvigorate CHCs across the country, the results have been slow and have generated more narrow biomedical services as opposed to community-oriented primary care CHC practices. However, there are some recent signs of CHC rebirth in South Africa. One example is the Chiawelo Community Practice, which aims to reclaim the CHC model of care using teams of physicians, nurses, and community health workers to serve the health and social needs of Soweto, Johannesburg.    

My disappointment with the relative dismantling of the South African CHC system has had an upside, in that it’s given me an appreciation and perspective on Community Health Centers in the U.S. and internationally. While I’d be hard pressed the call the U.S. health care system a “system” with a straight face, and I’m often disappointed by the slow pace of pursuing universal healthcare coverage and access for all, I am proud of what and who Community Health Centers stand for, serve and where we come from. 

The heart of Community Health Centers is in our first name: Community. Across the globe, the core strength of the CHC model is that we are grounded in our local communities. At Mountain Family, as at every other American CHCs, we are governed by a patient-majority Board of Directors. I work for Mountain Family’s patients and communities in Western Colorado, as do all of Mountain Family’s talented employees. We are committed to serving our community’s most pressing health and social needs. And we endeavor to serve our patients with teams of interprofessional medical, dental, behavioral health, community health and social health staff.

We are not alone. We are linked to Community Health Center families across the planet. From Australia to China, from Belgium to Canada, from Mauritius to Slovenia, from Glenwood Springs, Colorado to Pholela, South Africa. We share the same first name: Community. For more on Mountain Family Health Centers, visit www.mountainfamily.org.