In this month's feature interview, we speak with Kristen Brewer, PhD, MPA is an Assistant Professor in the Department of Public Health. Dr. Brewer has experience in community-building, teaching, and research in the field of sexual and reproductive health education. She is a co-founder of Ruth's Army, serving the Clarksburg area of Tennessee.

You recently spoke at the Society Of Public Health Education conference; how was that? Could you tell us a bit about what you were there to present?

It was a lot of fun! The audience is generally a wide range of people focused on public health education. I am involved as a co-founder with a no-cost clinic called REACH through a small Tennessee-focused organization called Ruth’s Army, so my friend and fellow co-founder of Ruth’s Army, Tracy Coffey from Queen City Women's Health Clinic, and I were there to present the process we went through in order to get the clinic set-up and running in the Clarksville-Montgomery County area of Tennessee. In order to offer the clinic at no cost to patients, we had to weave together as many regional resources and organizations as we could.

I’m glad you brought that up. In reading up for our conversation, I was struck by how many different types of folks and organizations were involved, as far as different health focuses and types of specialization.

Because we wanted to offer the full spectrum of sexual and reproductive health we had to think bigger than just our small budget and current resources. We had to look at how to do things with no cost and also see what other people might be offering at no cost, in an effort to ultimately get everyone all in one place. This way a visiting patient can access everything they might need in one stop. We had the idea in June of 2023 and opened in January of 2024, so while it felt like it was taking forever at the time, it came together a lot faster than we were imagining it would have when we started.

That’s great to hear. Sometimes parts of the public health universe can require a lot of patience. What was the work over those months mostly made up of?

Through Ruth’s Army and through our network of contacts, we were able to put together a pretty specific list of local people who we could reach out to about our idea. After that it primarily became a matter of getting everyone on board and then coordinating schedules to make it come together.

The clinic is in Clarksville, which is maybe 30 minutes outside of Nashville. What would you tell folks about that part of the state or of the country even?

Clarksville is the fifth largest city in Tennessee, on its way to becoming the fourth, and we joke that it's the biggest small town in the world. It doesn't know how big it's gotten and now finds itself under-resourced across the board, including reproductive health. The city is surrounded by a number of very rural counties that are maternal health deserts. And even though Nashville might be closer for some of these folks, there can be some worries related to the big city aspects of Nashville. These surrounding counties end up putting a lot of pressure on the reproductive and sexual health offerings in Clarksville but the city plans are not drawn up this way at all.

Are there any other tips you might give to public health students about working with rural communities or communities they might just be personally unfamiliar with?

[In my work,] I tend to focus on a lot of community building or community organizing. I’ve found that in public health it can be pretty easy to go into a community and proclaim that “this is what’s wrong and this is how I can help fix it.” There [can be] a tendency to look at health outcomes and then make assumptions about what may be feeding into [those outcomes]. But if we’re an outsider, we can’t know that community. We can’t really know what other factors might be at play or what more pressing needs might be present. So [the folks I collaborate with and I] talk a lot about spending time and building rapport as a way to listen to the community and see what they have to say and what they think the problems are. This tends to create more trust and build community capacity for issues that arise down the road.

That makes a lot of sense. In a rural community setting, someone with an advanced public health degree and a lot of, like, “book learning” I guess you could call it, really could tend to run the risk of coming off like an interloper, even if intentions are appropriate. 

When I taught in Kentucky, the number one producer of tobacco, going in and just saying “hey you shouldn’t dip,” doesn’t work. For many, that is their livelihood and might have been in the family for generations. Also, educational interventions are often the first thing that tends to come to mind, but that’s also not typically enough to actually change behaviors. Tools, resources and considering what their environment might allow for are important things to explore, beyond just education alone and calling it a day.

I was wondering if you could talk a little bit about the grant aspect of the REACH clinic and tell us a little bit more about the coalition building aspect.

Someone important to the process was Chaz Uffleman here in Tennessee, who is on the board of Clarksville Q and someone who ran in the same circles as myself and Dr. Coffey who I run the clinic with. Fortunately, in sharing with him what we were looking to do, he let us know that there was a grant opportunity available through Clarksville Q. The grant was designed to focus on funding projects helping to further healthcare access and education for the LGBTQ+ community in the area, so we ended up being 100% aligned with what they were looking to fund. Dr. Coffey is part of a private practice with some other partners and so they agreed to stay open on Saturdays. The grant allowed us to cover those costs as well as marketing around the clinic offering and bringing in some other partners as well, like Music City Prep.