Mind and Body

An unexpected challenge

An injury required Dr. Nicole Alexander-Scott to get around using a scooter and crutches, providing her with a new perspective about mobility challenges

Photo by Peter Goldberg, courtesy of Rhode Island Kids Count

Elizabeth Burke Bryant welcomes Dr. Nicole Alexander-Scott, on her scooter, to speak at the Rhode Island Kids Count annual luncheon celebrating children in November of 2018.

By Dr. Nicole Alexander-Scott
Posted 1/21/19
When Dr. Nicole Alexander-Scott was injured playing volleyball last fall, the resulting mobility challenges provided her with new insights about accessibility as an important part of health equity.
How will designs around increasing access and mobility become part of the plans for the Providence Innovation and Design District in the former Jewelry District? When will the repair of sidewalks in many urban neighborhoods become a priority? Will the current rash of problems with the new state contractor, Medical Transportation Management, Inc., which began a three-year, $115-million contract on Jan. 1, 2019, to serve as the state’s transportation broker for travel to medical appointments for Medicaid members and the elderly, serve as an opportunity to rethink what is needed in terms of meeting the needs of people with mobility challenges?
The need for speed is often celebrated as a cultural imperative, as everyone seems to be in rush, with the clock always ticking, under the presumption that time is money, where seizing the day and taking action are valued traits. That is, until, you are forced to slow down, often by an injury, and you find yourself dependent on the kindness of both friends and strangers.
In my own life, I have spent months on crutches, recovering from knee and ankle surgeries, as well as engaged in long-term physical therapy following back surgeries. What I have learned from my own experiences with limited mobility is the importance of finding a slower pace, moving slower, paying more attention to the natural world around us, a different kind of mindfulness.

PROVIDENCE – As readers may have seen or heard, I spent the better part of last fall getting around using a scooter and crutches because of an injury that I experienced while playing volleyball at the R.I. Department of Health’s first annual Family Outing.

This experience required great humility and patience of me. For example, I could not drive for several weeks, and I needed to ask for help much more often than usual. But the experience also brought with it the unexpected blessing of a new perspective on living, working, and traveling in a world that is not always the most accommodating to people with mobility challenges.

Most people are genuinely sensitive to the challenges experienced by those with special needs. But the reality is that most of the built environment that we all navigate every day was constructed during a time when we paid much less attention to the needs of all members of our communities.

Navigating the built environment
I saw, for example, that many buildings that are clearly in compliance with the Americans with Disabilities Act are, all the same, difficult to access. They often have doors that are too heavy or that close too quickly. Curb cuts are sometimes not in locations that encourage someone to take the safest route into a building, and parking spaces aren’t always wide enough for the equipment that people need.

Once inside buildings, I noticed that certain types of carpets are not as easy to roll on as others. I was not using a wheelchair during this time, but there were many moments when I found myself wondering how much harder that all different types of travel would have been if I were using a wheelchair.

I found myself wondering how much harder it would have been to get over uneven pavement in a wheelchair, especially since there were moments when I felt as though I could have fallen while doing so using my scooter.

I found myself wondering how many other experiences that I had previously taken for granted create challenges for those with limited mobility every single day.

Team work

It is important to note that I benefited from many advantages during this time. I had a wonderfully supportive team around me at RIDOH that was helping to coordinate my transportation from one place to the next, helping carry my bags, and calling ahead to make sure that I would be able to get in and out of my next appointment as smoothly as possible.

And, when I did arrive places, I was usually greeted with smiles and gratitude for the effort that my travel entailed. Studies show, on the contrary, that people with limited mobility are sometimes not made to feel that same sense of connectedness. The reasons why feelings of loneliness and social isolation are elevated among people with limited mobility are complex. However, what is abundantly clear is that when we have conversations about building healthier, more resilient, more connected communities, it is critical that we take proactive steps to ensure that people with special needs are heard.

Policies and interventions
At the heart of our public health vision at the Department of Health is prioritizing opportunities for communities that are most affected by health issues to steer the policies and interventions aimed at addressing those issues. When it comes to improving our built environment, we must listen to people with limited mobility, in addition to people who are visually and hearing impaired, people who don’t have adequate access to parks and other recreational spaces, people whose ZIP codes result in overexposure to car emissions, and many other populations.

No matter how well intentioned or empathetic that a policy professional is, there is no substitute for a community member bearing witness to their own experience in their own skin and their own shoes. There is no substitute for genuine, representative diversity in a decision-making process.

Having genuine diversity in these conversations would result in us moving toward Universal Design, which is the concept that environments should be composed so they can be accessed, understood, and used to the greatest extent possible by all people, regardless of their age, size, ability, or disability. Put another way, an environment should meet the needs of all people who wish to use it.

Complete Streets
A related design principle is Complete Streets. Complete Streets are roadways that are designed to enable safe access for all users, including pedestrians, bicyclists, motorists, and transit riders of all ages and abilities. These are not just abstract ideas. Communities in Rhode Island are embracing these approaches now to make their neighborhoods healthier and more accessible for all.

For example, last year the Pawtucket and Central Falls Health Equity Zone partnered with the City of Central Falls Planning Department to develop Rhode Island’s first Complete and Green Streets ordinance.

There are currently nine Health Equity Zones, or HEZs, operating in Rhode Island. They are collaboratives of residents, educators, business people, health professionals, transportation experts, and people in many other fields who are coming together in their self-defined communities to address the most pressing health concerns in their neighborhoods.

At the R.I. Department of Health, we are looking to expand this model and help as many communities as possible establish the infrastructure and capacity they need to give all their residents an equal opportunity to be as healthy as possible.

Thanks to the help of my family, friends, doctors, and colleagues, I am healing well and am walking again on my own two feet. And I am carrying with me the new outlook that I’ve gained.

Nicole Alexander-Scott, MD, MPH, is the director of the R.I. Department of Health.

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