By Rita Okoye
Meet Border-ere Fiemotonghan, a dedicated community outreach specialist at the Community Engagement Center within The Jackson Heart Study Office of Preventive Health and Health Equity and the Mississippi State Department of Health. She is a passionate advocate for reducing cardiovascular disease among African Americans in Mississippi. A true daughter of Nigerian origin.
She is a seasoned professional with over seven years of experience working with marginalized and underserved communities, Border-ere’s commitment extends beyond the confines of her official titles. Her research alone delved into the intersection of prison and health policies, reflecting a keen awareness of the broader societal factors influencing health outcomes. Currently pursuing her Ph.D. in public policy with a focus on Health Policy at Jackson State University, Border-ere is not merely an advocate; she is a scholar dedicated to unraveling the complexities in the healthcare gap.
Through conference presentations and published articles addressing Heart Disease, Border-ere’s work delves into health equity, minority health, health disparities, and Health Policy, particularly emphasizing Black Men’s health and cardiovascular disease prevalence.
Her dedication to advancing research in Health Policy not only identifies underlying factors contributing to cardiovascular health disparities among Black Americans but also advocates for evidence-based policy interventions to promote equitable healthcare access.
With a focus on health promotion, education awareness initiatives, and evidenced-based interventions centered on lifestyle changes, Border-ere Fiemotonghan collaborates with barbershops and mayors to promote health behaviors and outcomes through innovative strategies that leverage the unique setting of barbershops as trusted community spaces.
As seen in her work, Barbershops have been recognized as effective venues for positively influencing health behavior and outcomes within African American communities. By partnering with barbershops, Border-ere engages in activities that go beyond traditional health education, utilizing the credibility and open dialogue present in these settings to drive positive health changes.
One successful approach is the BBHOP Model, a community-based initiative targeting prevalent diseases like diabetes, hypertension, and prostate cancer among African American men. This program has reached over 7,000 individuals through barbershop-based health education, screenings, and referrals across multiple states, demonstrating a potentially sustainable way to engage and inspire men around health issues.
Moreover, interventions in barbershops have shown promising results in addressing various health topics such as high blood pressure management and HIV prevention. These interventions not only provide valuable health information but also create a safe space for discussions on sensitive topics that might be challenging in other community settings.
By understanding the dynamics of barbershops, respecting the role of barbers as advocates, and tailoring interventions to different types of shops, Border-ere ensures that these initiatives effectively reach and impact the community. The success of these collaborations highlights the importance of building trust, fostering long-term relationships, and utilizing culturally appropriate messaging to promote positive health behaviors among African American men.
By addressing social determinants of health and advocating for tailored strategies to combat unique challenges faced by Black men, Border-ere’s efforts play a crucial role in improving health equity and fostering positive change within underserved communities.
In this interview with Joseph Sunday from Bridge Africa Technologies LTD about Nigerians making a great impact in their respective fields, she shared insight into her journey and the challenges of being a medical professional with over 7 years of experience in the health sector bridging the gap of what we have in Nigeria health sector and globally.
1. Can you discuss your role as a community outreach specialist and how your efforts in reducing cardiovascular disease burdens among African Americans in Mississippi could be relevant to addressing similar health challenges prevalent in Nigeria?
Thank you for that question, as a community outreach specialist my day to day involves working with various community groups and members. I work with sub grantees to implement and monitor public health programs that educate citizens on cardiovascular risk factors and help them gradually make behavioral changes. The model that I use in Mississippi is quite effective because I work with groups that already have established trust within the community.
For instance, I work with Barbershops and train them as Community Health Advocates. In this training the barbers learn how to not only conduct blood pressure screenings but also educate and offer recommendations for healthy behaviors. The barbers are then able to screen their clients for blood pressure before or after a haircut.
This helps the clients know if they are at risk for hypertension or if they might already be hypertensive which of course only a medical practitioner can diagnose.
We also work with churches to create congregational health ministries, we also work with the Mayors of Towns and Cities to set up health councils, housing complexes, and other groups in the community.
In a nation like Nigeria with a lot of uninsured persons, inflation, and poverty ravaging its people, initiatives like this can offer a beacon of hope for persons who do not have the resources to regularly get screened. In the fight against health disparities, heart disease and even other diseases we are dealing with in our Country Nigeria, we need to meet people where they live, work, play and worship.
2. How do you think your experience in working with marginalized and underserved communities in Mississippi could inform strategies for addressing health disparities within Nigeria’s diverse population?
To address health disparities in Nigeria, we must employ a multifaceted approach encompassing resource optimization, community empowerment, and collaboration. Firstly, conducting a comprehensive community needs assessment is pivotal to identifying where the burden lies and the specific health challenges and disparities in that region.
This data-driven approach will help us understand people’s needs and ensure effective strategies are developed. When working towards reducing health disparities, empowering the people, and letting them be part of the process is essential. Empowerment encourages ownership and ensures that
messages are culturally sensitive. Additionally, It is pivotal to leverage community groups that already exist and that citizens already trust.
Most underserved communities have a history of exploitation disguised as helping, so it is crucial to work with groups that citizens are comfortable with. In my experience, funding evidence-based initiatives can be challenging, especially in a country like Nigeria, so leveraging existing resources is a practical approach to managing financial constraints. Using what the community already has is an excellent place to begin and can make a huge difference.
3. Could you share some key initiatives or interventions you have implemented in Mississippi that you believe could be adapted or replicated to promote health education and awareness in Nigeria, particularly within underserved communities?
Indeed, as mentioned earlier, one of my programs involves training barbers on blood pressure (BP) risk factors, training them on how accurately to check their client’s BP, and educating them on healthy health behaviors. Barbershops are hubs where men gather and are like safe spaces; some men have known their barbers for years and developed bonds and trust.
Nigeria has churches all over, and every neighborhood has a church. So, starting a health ministry and training pastors and other church leaders to be health advocates and educators could improve health literacy and empower members to take charge of their health.
Churches can host health fairs by collaborating with local hospitals, members with medical degrees, medical centers, or universities/medical students in the area. Nigeria can leverage other hubs like betting and gaming centers where men gather, hair salons, etc. These are all hubs that people visit often and can be leveraged for health education.
This could mean setting up an education station with fact sheets on health topics, having a health education specialist go in to educate on health topics, or having a weekly prostate cancer screening, Breast exams, free HIV testing, etc. For some people, this will be their first time getting screened.
I understand health ministries might sound contrasting to some churches’ belief in healing and protection from God. Still, religious leaders would have to be educated and sensitized on the importance of prevention and that it does not negate the fact that God is the ultimate protector.
Religious leaders are highly trusted in their various communities, so being health advocates can create positive change. By adapting and replicating these initiatives and tailoring to the Nigerian cultural beliefs, I believe we can effectively promote health education and improve health outcomes and disparities.
4. What is one thing you think Nigeria is lacking right now in addressing health disparities?
It is hard to mention only one thing because many hinder addressing health disparities in Nigeria. Firstly, we need to do better with collecting and saving health data. This will help identify where the burden is and help researchers conduct studies and plan interventions.
It is also essential that the government acknowledges that we have a problem and is actively solving it. Interventions need money, expertise, and a lot of time. It is also essential that a proper evaluation plan is put in place; after carrying out an intervention, you must measure impact, you must know if the intervention is doing what it was intended to do, then decide your next move, whether to tweak or not.
More importantly, socioeconomic factors must be addressed when addressing health disparities effectively. Addressing health disparities goes beyond increasing access to healthcare; it also tackles other social determinants of health, such as poverty, education, neighborhood and built environment, and social and community context. It is even more critical to address those predictors of health outcomes for an intervention to be maximized.
For instance, you cannot tell a man who can barely feed his family to eat healthy, exercise, participate in health screenings, etc. According to Maslow’s hierarchy of needs, basic needs must be met first. If the government is committed to fighting health disparities, it must equally be committed to addressing socioeconomic factors that are predictors.
5. Can you share some success stories or positive outcomes from the initiative that you believe could inspire similar initiatives in Nigeria, particularly in the context of routine health screenings and community engagement?
We analyzed data we have been collecting from all our programs for the past four years and looking at the trends, our results show that there was a decrease in undiagnosed hypertension cases, which simply means there was a reduction of people with stage II above numbers not diagnosed by a medical professional.
Our results across all programs show that just routinely screening community members, providing educational materials with health education, and providing follow up calls to participants with elevated BP numbers and encouraging them to follow up with their physician made a difference in undiagnosed and controlled hypertension.
On a more individual level, it is always a win when a participant got diagnosed and is receiving the care they need because we screened them, or when we screen a participant and realize they are in crisis and was able to convince them to go to the emergency room for care.
Sometimes it is the little wins that make a huge difference. Overall, the results show that our intervention led to improved detection and management of high blood pressure within the communities we serve.
6. After conducting these screenings with your various partners, what follow-up measures do you take with clients, and could the same be adopted in Nigeria?
Follow-up is critical to any successful intervention, so before we conduct screenings, we first present our participants with consent forms; this form goes over privacy/confidentiality, the time needed for screening, and, most importantly, asks for demographics and some health information. These consent forms are collected, and participants with high BP numbers will receive follow-up calls in three days if in crisis or 14 days if not in crisis.
This call is pivotal because it serves as a reminder to participants and an opportunity to offer additional resources like clinics in their area and programs that might benefit them. It can be adopted in Nigeria if funding is available. Partners are not charged with making follow-up calls, but in Nigeria, partners could support making those follow-up calls, although this might be unrealistic due to time constraints.
Realistically, a community health worker will be needed to call participants. Also, funding could create an intervention for those with elevated numbers to participate. In the US, most of these initiatives I speak about are funded with staff on grounds to lead and assist subgrantees, so for this to work in Nigeria, funds will be needed from private or government funding agencies.
7. Could you discuss the potential for implementing health fairs in barbershops or other community hubs in Nigeria, and what specific adaptations might be necessary to make these events successful within the Nigerian context?
Implementing health fairs in community hubs like barbershops holds significant potential for reaching underserved populations in Nigeria. As a people, we love to come out, we love to party, and we love music and food, so health fairs in places like barbershops and other community hubs would work. However, several factors need to be considered to ensure events like these are successful.
First and foremost, the key is collaboration, planning, publicity, and providing incentives for people to come out. The incentive could be food; who doesn’t want a nice party jollof? Haha! cash prizes, vouchers to get a free haircut, etc. I also want to mention that I am not oblivious to the unique challenges Nigerians face, and these types of events would need financial and labor support to succeed.
With the number of physicians moving out of the country, our healthcare system is already struggling with the physician-to-patient ratio.
However, without funding, for events like these to succeed, there must be strategic collaborations with religious institutions, individuals who can offer screenings, businesses that can provide accessible spaces, and even neighboring restaurants willing to give back by donating some refreshments.
Additionally, providing transportation support by collaborating with local transport services ensures inclusivity. Nigerians are very supportive and would rally around a cause they believe in, but first, they must believe in it.
8. How do you envision collaborating with healthcare professionals, community organizations, and local businesses in Nigeria to ensure the success of health promotion initiatives and the delivery of culturally appropriate health information?
It is a massive project, but it will be rewarding. Research has shown that only about 20% of cardiovascular diseases are unavoidable; the other 80% are due to socioeconomic status, environmental factors, and behavioral factors like smoking, not exercising, eating unhealthily, etc.
So, the government must shift its focus to evidence-based public initiatives that involve that community more. Clinical interventions are significant, but we all know we don’t experience many in a society like Nigeria. Community-led initiatives like those I have discussed are sustainable, with occasional check-ins and training.
I don’t remember seeing any health fairs as a kid growing up in Nigeria; I only remember seeing immunization people, as I would call them, with uniforms and a white box conducting door-to-door vaccination drives, which helped with reaching rural communities.
The fight against polio was quite successful as Nigeria made significant strides in eradicating it with door-to-door vaccination; this echoes the point that we sometimes must meet people where they are.
9. How do you plan to address cultural nuances and sensitivities specific to Nigeria when disseminating health information and implementing health interventions, and what strategies do you anticipate employing to ensure the effectiveness of these efforts?
Firstly, it is essential that whatever information or materials given to participants reflect your target population. Although small, it could draw or distance people from your message. People like to be relatable and want to be able to relate to your message.
For instance, if you are having a children’s event, the wording must be on their reading level, and you must avoid acronyms and whatever pictorial materials are needed to reflect your target population.
Representation in public health is significant and tailoring your message to your audience can make a huge difference in your effectiveness. For instance, Nigeria has different tribes, so if you are going into a community, it is always essential to have an interpreter available to help translate.
10. What goals or milestones do you hope to achieve in the coming years that would contribute to improving health outcomes and healthcare access in Nigeria, drawing from your experiences and expertise gained in Mississippi?
I am currently the vice president of the Moms and Infant Care Network (MICN). We have a health fair on March 16, 2024, in Ekerenkoko, a village in Delta State. The health fair will feature free dental, ear, eyes, blood pressure, blood sugar, breast exams, and HIV testing, and several other health vendors will be present. We also have a foundation launching and community baby shower in Warri on March 22, 2024. Additionally, we are offering academic scholarships to five women in the health sciences and mentoring them as they advance in their academic journeys.
Furthermore, I firmly believe in using resources around us to facilitate change. One initiative I am passionate about is conducting training for barbers and hair stylists to be health advocates.
By providing them with not only training but free blood pressure machines and tables to conduct blood pressure screenings and raise awareness on hypertension and other prevalent diseases in Nigeria.
Additionally, I am actively working on a campaign to encourage religious institutions to establish health ministries. By assisting them in creating these health ministries, we will clamor for a culture of health within religious communities and expand access to preventive screenings.
As we draw this interview to a close, it is evident that Border-ere Fiemotonghan’s life journey serves as a beacon of inspiration and empowerment for Nigerians aspiring to make meaningful contributions in the fields of public health, communication, and community outreach. Born and raised in Nigeria, Border-ere’s deep connection to her cultural roots has infused her professional endeavors with resilience, determination, and a profound sense of purpose.
From her early experiences as a Health Communication and Outreach Specialist at Redeem Christian Church in Columbus, Ohio, to her current role as a Program Specialist III at the Mississippi State Department of Health, Border-ere has consistently demonstrated a commitment to improving health equity and promoting wellness in underserved communities. Her multifaceted expertise spans public health program management, health communication, policy advocacy, and community engagement, reflecting her versatility and effectiveness in addressing complex health challenges.
Border-ere’s dedication to community health is further exemplified by her role as a Community Health Outreach Specialist at Haggai Food Bank in Birmingham, Alabama, where she conducted outreach programs for homeless individuals and implemented substance abuse programs. Through her tireless efforts, she has made tangible impacts on the lives of those most in need, embodying the principles of compassion, empathy, and service.
In addition to her professional achievements, Border-ere’s academic pursuits underscore her commitment to continuous learning and growth. Currently pursuing a Ph.D. in Public Policy with a focus on Health Policy at Jackson State University, she seeks to deepen her understanding of the systemic factors influencing health outcomes and drive evidence-based policy interventions to address health disparities.
Border-ere’s journey serves as a testament to the power of education, determination, and resilience in overcoming obstacles and effecting positive change. Her ability to navigate complex environments, build meaningful partnerships, and advocate for marginalized communities offers valuable lessons for Nigerians seeking to carve out their own paths in similar fields.
Moreover, Border-ere’s success highlights the importance of cultural identity and heritage in shaping one’s professional trajectory. Despite residing in the United States, she remains deeply connected to her Nigerian roots, drawing strength and inspiration from her upbringing. Her story serves as a reminder that embracing one’s cultural heritage can serve as a source of strength and resilience, empowering individuals to navigate diverse cultural landscapes and make meaningful contributions to society.
As Nigerians contemplate their own career paths, Border-ere’s journey offers invaluable insights and lessons. Her dedication to service, commitment to continuous learning, and unwavering determination to effect positive change serve as guiding principles for aspiring professionals. By following in Border-ere’s footsteps, Nigerians can aspire to make meaningful impacts in their respective fields, championing causes that promote health equity, social justice, and community empowerment. In doing so, they honor not only their own potential but also the rich legacy of Nigerian excellence and resilience. Border-ere Fiemotonghan’s life is a testament to the transformative power of passion, perseverance, and purpose, inspiring generations to come to embrace their dreams and strive for greatness.