Community outreach to patients with AIDS at the end of life in the inner city: Reflections from the trenches

Abstract

Indigenous community health outreach workers (CHWs), who serve as a bridge between underserved, difficult-to-reach minority populations and health professionals, can play a critical role in bringing palliative care to patients dying of AIDS and other illnesses in the inner city. Although the contribution of CHWs in the delivery of "curative" and preventive services has been well established, little attention has been given to CHWs in palliative care. Integrating the medical literature with experiences of a team providing HIV palliative care in the Bronx, a descriptive typology of critical stages and components in the work of CHWs in end-of-life care in the inner city is presented. A longitudinal case narrative, told from the perspective of the CHW, is used to demonstrate the richness and complexity of the CHW's role. The article concludes with a description of the experience of the CHW, straddling two worlds--the world of the inner city patient and the world of the health care providers--and explores the special characteristics of the individuals who can fill this vital role in palliative care.