Medicine is often perceived as a linear path from diagnosis to treatment. However, medicine often consists of a complex set of determinants of health that can impede healthcare access and quality. From structural policy-related barriers such as inadequate coverage from health insurance to more immediate barriers such as lack of transportation, health outcomes extend beyond simply diagnosis and treatment. In 2023, North Carolina had over 965,000 uninsured residents, accounting for 9.2% of the state’s population, exceeding the national average. Without reliable healthcare access, hundreds of thousands of North Carolinians face barriers in seeking necessary treatments and high-quality care. 

Given the marked disparity in healthcare access in North Carolina, examining healthcare access in a more local context is critical. Durham, NC serves as a central hub for healthcare delivery, with Duke University Hospital providing care to 41,549 patients in 2023 alone. With such a large scope of care delivered by Duke University, an important question emerges: how are Duke systems working to alleviate pressing health inequities in our local community? 

‍Duke Help Desk—an undergraduate-led initiative—aims to answer this question. Launched in the 2018-2019 academic school year as a Bass Connections program, Help Desk was originally founded by students at the Lincoln Community Health Center to address patients’ unmet social needs. Student volunteers called patients and referred them to local organizations that provide critical services ranging from housing to transportation. As the program progressed, the faculty advisor of the program Dr. John Purakal, an emergency medicine physician, expanded the program to additional healthcare providers throughout Durham.

Since its inception, Help Desk has expanded to Duke University Health systems through the emergency department (ED) and endocrinology unit. More recently, Help Desk has expanded its efforts to the Durham Veterans Affairs Health Care System, including the hospital and heart failure clinic. As the volunteer base grows and diversifies, Help Desk is better equipped to address the unique needs of each department’s diverse patient population.

“Though all the units run similarly in how we screen our patients, we adjust to the differing patient demographics,” said Amitesh Verma (Trinity ’25), Help Desk ED Program Coordinator. “In the ED, patients are often in distressing and acute situations and this will bring up challenges in how to provide comfort while also respecting boundaries.”  

As the ED Program Coordinator, Verma not only facilitates the resource navigation process for patients but also acts as a liaison, overseeing community resource navigators, managing new volunteer training, handling logistics, and supporting the expansion of Help Desk. As Help Desk expands to new locations, the program must tailor its approach to address the unique needs of each location. Even at a community level, patients face a diverse range of unmet social needs. Help Desk plays a critical role in connecting patients not only to local resources and organizations but also to their healthcare providers. 

Verma refers to this critical connection particularly at the ED as the “parallel ED.” “We nicknamed the ED site the parallel ED site, as doctors are often focused on physical conditions and symptoms. By allowing volunteers to address social needs, we alleviate the burden on healthcare providers and address social needs in parallel with physical care,” Verma said. 

This parallel care bridges the gap between physicians and patients by providing a continuum of care that promotes wellness outside of the hospital setting. In fact, according to Help Desks’s website, “20% of a person's health is determined by healthcare, while 80% is determined by a mix of socioeconomic factors, the surrounding environment, and health behaviors.” 

By equipping patients with resources that can address barriers to care such as transportation costs or access to local food banks, organizations like Help Desk empower patients to improve their wellbeing in tandem with the healthcare they receive from healthcare providers. 

In addition to supporting patients, Help Desk offers a valuable perspective for students interested in medicine, providing them with a deeper understanding of the complex set of health determinants and the dynamic nature of health equity.

Verma originally joined Help Desk not only to gain additional patient experience but also to better understand how social determinants of care can impact health outcomes. “Witnessing how the pandemic panned out and how that had created a lot of inequities for people, I knew that joining a setting like Help Desk—where I could engage directly with these issues—would allow me to better understand and contribute to addressing them,” Verma recalled. 

As Help Desk has expanded, new volunteers with similar motivations to Verma have joined the program. With this growth, Verma reflects on the next steps for the organization. Staying true to Help Desks’s origin as a research project, Verma emphasizes the importance of collecting and using data to adapt the program to meet patients’ constantly evolving needs. “Recently, we’ve had a lot of patients who are survivors of domestic violence or present with suicidal ideation. We had to change our workflow to address these issues in a timely manner and have volunteers handle this efficiently,” Verma explained.

Looking ahead, Verma hopes that Help Desk will expand to all units at Duke University Hospital and that other institutions will adopt a similar workflow to integrate social care into their healthcare settings. 

Across healthcare settings, patients face a wide range of barriers to care and the first step is providing a platform for patients to access resources catered to their specific needs. “It’s not just EDs that are affected by social determinants of health,” Verma said. “Every specialty of healthcare has some kind of link to social needs.”

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Above: Help Desk’s logo. Image courtesy of Duke Global Health Institute.