They pass a talking radish around the circle sharing stories of food. More than a dozen people have gathered in a circle facilitated by Dr. Kristi Crymes for a biweekly conversation about food and nutrition. One woman found her love of tomatoes—she had never smelled one like that before—and now wants to grow her own. They talk about what to do with fennel; most have never seen it before. And who knew Swiss chard had such a distinctive flavor? Such are among the discoveries in the box of locally sourced produce they pick up weekly as part of the HealthScripts program. For Kristi, this is also living Zen Leadership. “I didn’t want to be the ‘doc-in-charge’ or get in the way of the wisdom of these groups,” she says. “In holding these circles, I use everything I learned in the HEAL programs (i.e., Zen Leadership for healthcare professionals). If people are interested in having a different way to help their patients, here are the skills that help do that.”
At an individual level, the program is changing diets and health outcomes. Perhaps even more surprising is what’s happening at collective levels: from the community of these circles, to the Springfield Community Gardens that gathered the pieces and funding for this project, to the community of farmers who grow the food, to the community of Cox Health professionals who are discovering new ways to care for people, to the community of Springfield that is growing stronger and more resilient as it relocalizes its food supply. Given that Food Is Medicine (FIM) programs are on the rise with the hope that they will save lives and billions of dollars, it’s worth looking at what’s making this one work so well. The answer for HealthScripts is relationships and the leadership ingredients that make them strong: trust, compassion and love.
An Integrator With A Passion For Localized Food Systems
Maile Auterson, the founder and executive director of Springfield Community Gardens, breathes and dreams relocalizing food economies. A 4th generation Ozark farmer, she grew up farming with her father, hearing his stories of how they had no money during the depression, “but ate like kings… eggs and cream and peach ice cream.” That resilience amidst difficulty stayed with her and she wants it for everybody. “Food is the social fabric of a town,” Maile says, and her vision for community gardens is that everyone has access to healthy, local food, from the homeless to those who dine at high-end restaurants.
“Trust” is the first word Maile uses in describing her way of working. She builds trusting relationships by delivering as promised and meeting real needs. She has trusting relationships with local farmers, having worked with them on many projects, including Community Supported Agriculture (CSA) programs. She has trusting relationships with the Springfield community, where people volunteer in the 17 gardens spread across the city, including the one at the hospital run by Cox Health. She has trusting relationships with Cox Health where she was encouraged by Dr. Mark Ellis (who would go on to lead HealthScripts) to speak with some of their doctors about services that might be wrapped around CSA boxes, which package local farm produce for subscribers. What she heard in those conversations was that people were exhausted from the pandemic and what’s not working, and might we turn things around by getting people to eat better? She secured a GusNIP grant (short for Gus Schumacher Nutrition Incentive Program) to implement the HealthScripts project, providing fresh, healthy food and nutritional guidance to people with health risks and low income, while also supporting small, local farms. Once again, Maile delivered for her community. But she is not one to take credit. “Loving kindness is the key,” she says. “Everyone on the project has that at their core.”
A Farmer With Trusting Connections
“Most of my CSA customers are upper-middle class,” says Curtis Milsap. These are people who buy shares in the produce of Milsap Farms so he doesn’t have to take out an operating loan. In exchange, they get the best of everything in the fields. He’s always wanted to get his food into the hands of people who need it and can’t afford it. For him, HealthScripts is a win-win. “I’d give all our food to people who need it, but I need to feed my family. This lets me do both.”
How does it work? “Emma will reach out to me and say ‘I need 68 units of something; what can I get?’” Curtis explains in reference to Emma Freitas, the HealthScripts manager. Emma works for Maile, wearing many hats, including interacting with farmers, aggregating the produce boxes, and getting them to program participants. “If I have a lot of carrots, I’ll put carrots in. Or there might be a standing order of 40 units of thyme.” For years, Curtis and Maile have been building trust, one successful project at a time, and dreaming dreams that led to funding for this project. He’s also a connector among farmers, recognizing it takes a diversity of players to fill all those boxes, from the utility player who always delivers to the farmer who grows “salad in his sleep.” He’s been able to bring in friends who may not trust government programs but trust him. “Every connection as an opportunity to relocalize food from vulnerable state it’s in now to something that’s more sane.” Curits points out. “You can grow carrots in every state of the union.”
Curtis also has a trusting connection with Kristi. Dr. Crymes is the Associate Program Director of the family medicine residency at Cox Health and brings her first-year residents out to Milsap Farms as part of their orientation. From Curtis they learn three principles that apply to farming, doctoring, and the success of this program: (1) Always look at the big picture and beneath the surface; like soil, what’s going on beneath the surface affects everything we can see. (2) Diversity is the key to health. (3) Don’t lose sight of the wonder.
Physicians And Patients Holding Circles Of Wonder
Putting a box of produce into people’s hands would not be enough to make the difference this program is making. Where greater wonder emerges is through the trusting circles held by Kristi or her colleague, Dr. Katie Kabonic Davenport, sharing stories of life, food and nutrition. These conversations “complete so many deficits in what I learned about nutrition growing up,“ says Matt, one of the program participants. “We don’t know enough about food or the impact it has on health. Most of what we get are ads—buy this or that—but we don’t have discussions.” The discussions have given space for a complete rethinking of how Matt approaches nutrition, as well as a second benefit he wasn’t expecting: “I feel much more connected to the community.” The group’s diversity is what makes it so powerful. “Everyone has different areas of expertise.”
What recipe did you try last week? How do we become nourished? How is that different from just eating? If you have $3, how do you spend that on good food? Plenty of laughter, some tears. As Kristi has witnessed the evolution of these circles over several months, she has wonder in her voice. “These people had never met,” she says. “Now they’re bringing eggs to each other. One woman picked up clothes at Walmart for another patient’s son…The food is the active ingredient. The food is grown regeneratively. Many people are involved, doing their part, and it all fits perfectly together.”
The outcomes of this program are starting to come in. Even individual outcomes are “amazing” to use Kristi’s word. For example, one of the participants with diabetes went from a very high A1c (i.e., a measure of average blood sugar) to normal levels within four months, allowing him to come off one of his medications. But Kristi finds the collective shift in the circle even more striking:
“Something happened at this last visit that feels important. The group seemed to take on its own power. They began spontaneously sharing with each other the ways the program has helped them, naturally showing encouragement and caring to a few who were struggling with stressors. One patient told us he wanted to start a group like this in his own neighborhood. There was definitely a shift.”
Kristi wasn’t alone in witnessing the unfolding; she’d been joined by several residents and dieticians. One resident sent her a message the next day saying that attending the HealthScripts circle was an “honor and a beautiful human experience” that made her excited for her next few years at Cox Health. One of the dieticians said she came because she’d heard about this program and didn’t believe it was real. After the visit she told a colleague that it was a dream come true. As Kristi sees it, “These patients are touching people’s hearts and minds.”
How Might This Scale?
Better health outcomes. Stronger communities. Greater resilience in relocalized food economies. More fulfilling healthcare practice. What community would not want such benefits? Maile has spoken to hundreds of people wanting to replicate the success of this program. “It has to stay small,” Maile begins. “Resilience comes in being small and local. Yet every town can do this and there are 175,000 small towns.” It takes an integrator like Maile and opportunities for funding. It calls for a well-connected farmer like Curtis who cares about helping people in the community. It takes physicians like Kristi and Katie, both HEAL-trained, who can hold circles with humble expertise, allowing profound wisdom and compassion to emerge. “If you think about relationships first,” Maile concludes, “you’ll get it right.” If you think about relationships first, grow trust, experience compassion and enact love, you’ll get it especially right.
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