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.

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Transcript: 

Introduce yourself and talk about what you do at Help Desk:
I’m Amitesh Verma and I’m a senior at Duke Majoring in Neuroscience and minoring in Music and Chemistry. And I joined Help Desk my freshman year in the spring and joined the summer cohort and I joined because I wanted to gain more volunteer experience in a medical setting and not have gotten much patient information before. And I was specifically interested in social determinants of health just witnessing the pandemic pan out and how that had created a lot of inequities for people. I knew putting myself in the setting with Help D can see these inequities first hand and work towards addressing them. 

Responsibilities and what you do:

I initially joined as a community resource navigator which is just a role where you volunteer in the ED and connect patients with unmet social needs with resources that can address them. We will talk to patients face to face and ask them if they’d like to join our program. Over the years, I’ve taken on more of a leadership position as I've gained more experience. So, I’ve been serving as the Program Coordinator of the ED site so I oversee all the community resource navigators in the program, oversee the training, and ensure that the logistical process is going smoothly and making sure they can call their patients on time and overseeing the expansion of the help desk. Recently, we’ve really grown our volunteer base a lot . It comes with a lot of challenges in meeting our patients' needs in the most effective way possible and seeing how other organizations can assist us. We also expanded into the VA hospital in Durham and the heart failure clinic at Duke. 

Volunteer Experience: 

When you apply to HD, you apply as a community resource navigator where you call patients on a weekly basis. HD has three main sites, you have the ED which is the site I oversee and there is the Lincoln COmmunity Site, and Endocrine Site. They all run similarly is how we screen our patients but patient demographics are different. In ED, patients are often in distressing and acute situations and this will bring up challenges in how to provide comfort while also respecting boundaries. LCHC has a high Hispanic population so we have to think about how to adapt culture specific resources. It’s really interesting to morph our program into a program that serves patients in a specific setting. When they apply, they will be assigned to three sites and they will continue volunteering within that site and if they want to switch sites they can switch later on. 

Origins of HD: 

Initially, I wasn’t there during the inception. 4-5 years ago it started as a Bass Connections project there was a student that started this research project in addressing patient unmet needs and started it at the Lincoln Health Center. Dr. ____ is an Emergency Physician at Duke and was interested in bringing it to the ED site. And that’s when it started to implement it as a research program in the ED site as a volunteer program to screen patients. The ED site, especially at Duke,  is where many patients have their primary care and they come to the ED for a lot of medical needs. This is an environment where patients really capture the patients who really need these services the most as they are often plagued by health inequities, don’t have insurance, housing, food, can’t communicate, or have reliable transportation. We nicknamed the ED site the parallel ED site because oftentimes in healthcare settings screening for patient unmet social needs and DOH is challenging to do with physical conditions. Doctors are often focused on physical conditions and symptoms and by allowing volunteers to come in and address social needs it alleviates burden and we do this in parallel we do physical needs from doctors in parallel with social needs. 

Complex cases student training:

It’s honestly quite a challenging process to become really just eloquent in the way you deliver healthcare resources. What we do is we start with a training process where they learn about SDOH why it’s important and we try to help them with motivational interviewing techniques and how to motivate patients to seek help. We often see patients that need help but they have this helplessness where they don’t want to get involved as they feel like they don’t think things can get better. So, we train volunteers to best communicate with these patients to help them in the best way possible. 

We have a lot of assistance in resource directories. We tried to work with organizations with Durhams that are responsive to the needs of patients. In the ED we see a lot of elderly patients so we find organizations that take patients that are on Medicare to streamline the process. We partner with NC care 360 which is a sponsored platform that allows community organizations to directly reach out to patients and meet their needs. Our volunteers will occasionally enter referrals to assist with the process. 

Future directions: 

First of all, it’s important to mention that HD started as a research project. We want to look at patient data to see which needs are most prevalent and how we can modify the program to meet those needs. REcently, we had a lot of patients who are domestic violence and absue survivors or have suicide ideation and we had to change our workflow to address these issues in a timely manner and have volunteers handle this efficiently. So modifying our workflow is an efficient way to address needs ASAP. 

Also, we want to keep expanding our program. We expanded to two new sites and we hope that HD gets expanded to every specialty. It’s not just EDs that are affected by SDOH. Every specialty of healthcare has some kind of link to social needs. By addressing this and working with healthcare workers, we can expand to all these sites. We took inspiration from a model at Stanford originally. Dr. P had some colleagues at Stanford and we took on their workflow. We hope other institutions can also take on this workflow so we can expand this work in addressing SDOH.