September: National Cholesterol Education Month

Our bodies need cholesterol to function properly, but too much can lead to an increased risk of heart disease.

The American Heart Association recommends adults have their cholesterol checked every 4-6 years, and yearly if diagnosed with high cholesterol, diabetes, or heart disease.

Here’s what you should aim for:


HDL, "Good Cholesterol":

  • Men > 40

  • Women > 50

  • Need to raise your HDL? Exercise!

  • Adults should aim to get 150 minute of moderate physical activity weekly

LDL, "Bad Cholesterol":

  • Less than 130

  • Need to lower your LDL?  Diet change!  

  • More fruits and vegetables, whole grains and lean meats

Ideal Foods:

  • Omega 3 fatty acids, such as salmon, walnuts, and flax seeds

  • Soluble Fiber, such as oatmeal, kidney beans, Brussels sprouts, apples, pears, eggplant, okra and barley

Addressing Social Determinants of Health: Megg Rader, Executive Director

  Transportation is often a hurdle individuals face that negatively impact their healthcare. A partnership with Wheels4Hope allows qualifying patients to receive a vehicle.

Transportation is often a hurdle individuals face that negatively impact their healthcare. A partnership with Wheels4Hope allows qualifying patients to receive a vehicle.

Providing comprehensive primary care to working uninsured adults is the core of what we do at Alliance Medical Ministry. 

However, we know that providing medical care and medication is not enough. A deep connection exists between physical heath and mental health, and between social issues and health outcomes.

Alliance has a strong history of addressing mental health and social barriers.

Over the years, Alliance has built a robust Pastoral Care and Counseling Program, providing prayer, psychotherapy, marriage and family therapy, and counseling for individuals and families. As the program grew, we began connecting patients to community resources for issues like substance abuse, addiction, and intimate partner violence. 

While addressing immediate health concerns is paramount to improving health outcomes, Alliance places an emphasis on prevention and healthy behaviors. In 2009 and 2010, we conducted patient surveys to identify patient needs and concerns, and heard loud and clear that patients wanted access to fresh, healthy food, and educational opportunities that would lead to improved eating and lifestyles. 


With the support of Inter-Faith Food Shuttle, we built our Community Garden in 2010, and began addressing food insecurity by offering fresh produce to patients in the clinic. Over time, we have developed a thriving wellness program, engaging patients and their families in on-site cooking and nutrition education, gardening, and exercise opportunities to prevent and manage chronic illnesses. Our garden now grows more than 2,000 pounds of produce for patients.

We are strengthening our partnership with southeast Raleigh non-profit Passage Home, also working alongside Fertile Ground Food Cooperative, and Wake County Department of Health & Human Services to address race equity around our shared work with food insecurity, healthcare and workforce development.

Alliance patient and StepUp Ministry graduate James Ivey discusses how our partnership changed his life.

Economic stability has been identified by Alliance patients as one of their biggest concerns and greatest cause of stress. Although patients are required to be working or living in a working household to be eligible for care at Alliance, they struggle to make ends meet.  Many patients work in part-time, seasonal or contract jobs and do not have steady, consistent income.

Alliance has partnered with StepUp Ministry for many years, working together to cross refer patients and clients to each other's programming.

Building upon this partnership, we helped initiate The Family Table, a collaborative funded by United Way of the Greater Triangle. Together with Catholic Parrish Outreach, StepUp Ministry, Dress for Success, NC Works, Boys & Girls Club, and Childcare Resource and Referral Services, we have hired a Care Coordinator to identify and case manage families, place them in job training programs and assist with job placement, navigating food access, and enrolling in healthcare at AMM. Once Family Table clients become employed, they have access to childcare resources and after-school care.  

  Via Healthy People 2020

Via Healthy People 2020

Today, the practice of addressing social issues is called "working upstream" to address "Social Determinants of Health" (SDOH). SDOH include non-medical barriers to health, including food insecurity, housing, transportation, employment, childcare and intimate partner violence. 

Clinical care contributes to only 20% of overall health outcomes; the remaining 80% is impacted by social and economic factors, health behaviors, and your physical environment. The fewer resources and social support an individual has, the greater the barriers to optimal health outcomes.

Across the board nationally, statewide, and locally, healthcare organizations are embracing opportunities to address SDOH. Locally, Alliance serves on the Steering Committee of the Wake County Medical Society Community Health Foundation (WCMSCHF), which seeks to create a formalized approach to addressing SDOH by linking clinical and social services organizations.

  Hasana Wooding, MPH Candidate, and Meaghan Henry, LCSW candidate, have worked this summer to draft the social screening questionnaire and help implement roll-out.

Hasana Wooding, MPH Candidate, and Meaghan Henry, LCSW candidate, have worked this summer to draft the social screening questionnaire and help implement roll-out.

A priority of the WCMSCHF is to roll-out a social needs questionnaire in the medical setting, and implement a purposeful referral process to link clinical and social services.

A report prepared for John Rex Endowment by the North Carolina Institute for Public Health echoes this need: "[Key informants] would like to contribute data into centralized, well-coordinated systems that could benefit others outside their organizations. . . . High quality, coordinated referral systems that would allow them to track the people they serve as they access other services."

Likewise, the John Rex Endowment report concluded that "key informants need access to up-to-date, relevant and reliable data that could better inform their work."  The Wake Network of Care is a hub for social resources, and Alliance has expanded social resource information on our website for easy review by patients.

This summer, Alliance will roll out a social screening to new patients through our Patient Services Team. At enrollment, questions around transportation, food access, housing, employment, and childcare will be posed to new patients, with resources identified for them immediately, referrals made, a plan built, and a note made in their medical record. 

How Alliance first defined "comprehensive care" may have evolved over 15 years, but the way we intentionally embrace addressing the needs of each individual patient has remained the same. 

We remain committed to leaning in to opportunities that can positively impact our patients’ health, and to being a leader in innovative initiates and working with other organizations to find ways to address barriers to improved health. 

Patient Spotlight: Manuel

After moving to the United States from El Salvador, Manuel Ramos-Sifontes, like many others, struggled with finding stable medical care. At the time, his mother-in-law was struggling with managing her diabetes, and soon found care at Alliance Medical Ministry. Once Manuel saw how Alliance was able to help his family, he felt encouraged to seek medical care of his own.


As a father to four, husband, and employee, Manuel recognized the need and importance of preventative healthcare. 

When he first came for care at Alliance seven years ago, Manuel was suffering from psoriasis, a chronic skin disease. “It was all over, my skin was cracking, it was very painful.”  Alliance's Referral Coordinator referred him with Blue Ridge Dermatology, and later Duke Dermatology through Project Access, for medication and treatment. The doctors at Blue Ridge Dermatology and Duke Dermatology were able to provide Manuel with a specific medicine that helped reduce his symptoms. With their support, Manuel has been able to control the disease.

"Coming here made me feel much better about [my psoriasis]. It helped reduce a lot of stress, and build my confidence."


After receiving care, Manuel decided to get involved with some of the wellness programs. “I was nervous about going to yoga, but it helps support my mental state. It is an amazing program!” Manuel has been attending yoga weekly for over one year.  "For your life, you need to keep focused on what you’re doing. Yoga has helped me a lot with deep breathing and focus."

Seed to Supper

Manuel was first introduced to Garden & Wellness Coordinator Jesse Crouch during a yoga class. Jesse introduced Manuel to Seed to Supper, the garden education program offered twice a year in the Alliance Community Garden in partnership with Inter-Faith Food Shuttle.

  Manuel Ramos-Sifontes  (L) with  Jesse Crouch ,  Flor Lopez , and other students of the Seed to Supper spring class.

Manuel Ramos-Sifontes (L) with Jesse Crouch, Flor Lopez, and other students of the Seed to Supper spring class.

 Teacher and Master Gardener  Rich Woynicz  taught Seed to Supper students about soil quality, rotation, and natural pesticides.

Teacher and Master Gardener Rich Woynicz taught Seed to Supper students about soil quality, rotation, and natural pesticides.

Manuel participated in the spring Seed to Supper program, and at the class conclusion built his own backyard garden!  "Jesse gave me some compost to help me start the garden. The garden is a help to me because I’m exercising, moving around and eating differently!”


Cooking Matters & Diabetes Prevention Program


This summer, Manuel enrolled in the one-year Diabetes Prevention Program, offered in partnership with the Wake County Department of Health & Human Services. As part of that program, he has the goal of exercising 150 minutes a week and losing 7% of his body fat.

To continue his nutrition education and support his health goals, Manuel is taking Cooking Matters this summer, learning how to better incorporate the foods from his garden into his everyday meals. 

“I am going to start eating differently, and make sure I get exercise by working in the garden!” Manuel continues to work hard to create a healthier lifestyle for his family and himself, and enjoys every part of it!

“I’m very happy with AMM, it’s incredible how it changes your life if you need help.”

May: Mental Health Awareness Month, Dr. Toby Bonar, Director of Pastoral Care & Counseling


May is Mental Health Awareness month, an opportunity to highlight our society’s progress toward a more accepting attitude about mental health and mental illness, as well as the continued need for increased awareness. 

The mind, body, and spirit collaborate interdependently within us like notes in a musical chord; when a person is disintegrated, dissonance results in the form of illness from the fragmentation of interdependent parts.

Just as musical dissonance is obvious to those who hear it, illness presents itself disharmoniously to those who are living in tune with the community. It remains quite a challenge to destigmatize mental illness from the shame our culture has placed on those who experience it, and yet we are hopeful for the day when receiving treatment for mental health is as understood and accepted as receiving treatment for physical ailments. 

An Integrated Approach

Mental healthcare is part and parcel of patient care at Alliance Medical Ministry.

Since our inception, Alliance has offered care to address the mind, body, spirit interconnections of our patients via pastoral care services through chaplain interns from Duke Divinity School.  In 2010, we created our Pastoral Care and Counseling services with a chaplain on staff.  Since 2013, we have cultivated a more comprehensive staff and volunteer team of psychotherapists including pastoral counselors, psychologists, social workers, marriage and family therapists, and a psychiatrist.  With an uninsured patient population, Alliance has developed a collaborative approach to patient care by integrating mental healthcare directly into a primary care setting.  

Psychotherapy was born from the theories and clinical practices of Sigmund Freud.  The Greek term “psyche,” from which Freud coined his psycho-analysis, however, represents the complexity of an “embodied soul,” a much more unified understanding than our modern connotations of an exclusively mental emphasis. “Psyche” does not separate a person into parts, as do the words “pneuma” (spirit) and “soma” (body).[1] Thus, treating the “psyche” involves treating an embodied soul, not simply one’s mental state.

At Alliance, we strive to treat our patients as embodied souls created in the image of God with whom we can collaborate to address the interconnections of their physiological, psychological, environmental/social, and spiritual lives. 

The Challenge & Our Approach

Within the historical primary care framework, physicians solely treat a patient’s physiological makeup, often without having communication or collaboration with the patient’s mental health practitioner(s).  In a traditional primary care setting, a physician may grow concerned about a patient's mental health and make recommendations for area mental healthcare providers. However, the burden ultimately falls on the patient to navigate issues of cost, health insurance coverage, convenience, mental health expertise, as well as generally overcoming the stigma of seeking mental health care.

For uninsured patients, the ‘follow-through’ is even more complex with far fewer affordable mental health options. Patients must take time from work to research available providers, determine co-pay, make an appointment, find transportation to the provider, complete the appointment, and determine financial resources to pay for any prescribed medication.

Alliance removes many of these barriers by providing our patients with access to free, on-site mental health options. Having mental healthcare providers onsite in a primary care setting normalizes mental health care as synonymous with patient care. As our primary care physicians address patients' physiological needs, they can collaborate with our mental health providers and patients in addressing mental health, directly referring (often immediately) patients for on-site counseling, and creating an integrated care plan toward wholeness.

When primary care moves toward addressing patients as integrated beings, it incorporates more of its patients’ unexplored stories and understands better how relationships, conflicts, and communities impact health and healing.  

At Alliance Medical Ministry, we strive to create relationships in which our patients are empowered toward self-care and healing.  Relational approaches to mental healthcare have moved toward creating a collaborative environment in which providers and patients journey together to empower patients to participate in their return to wholeness rather remaining in a condescending hierarchical relationship of superiority and inferiority. Patients become teachers of their tremendous stories of pain and resilience, and we providers listen with curiosity to understand so we work together with our patients toward their wellbeing. 

An Opportunity for Healing

Having time with a counselor at AMM is an opportunity for our patients to journey with someone into the depths of oneself to discover brokenness, stifling patterns, and unhealthy tendencies, as well as virtues of courage, perseverance, character, and resilience that they did not see in themselves. Encountering someone willing to sit and listen attentively without judgment is a gift that not many of us have in our lives, and our patients routinely reveal to us very intimate hurts and sacred moments that they have never shared with anyone. At Alliance we offer relationships of time, presence, and care to empower our patients and encourage their collaboration and self-participation in their healing.

As we explore deeper into our patients’ lives, we discover stories of disintegration that have led our patients’ dis-eases.  Many of our patients have experienced overwhelming trauma that have greatly disrupted their health to the point of fragmenting their minds, bodies, and spirits.  Painful events that disrupt wholeness render us scattered, afraid, unable to process, and at times unable to articulate the deep, dark, suffering moments and places within, where we can remain stuck. In a safe, caring environment of a nurturing relationship, we can find connection and begin the process of reconnection. 

We often treat patients who lack access to basic human needs, and face particular barriers that make them more susceptible to illness and disease. Maslow’s hierarchy of needs highlights how far from self-actualization patients without access to their basic needs, including rest, food, safety, etc.) remain.

Through social workers and community partnerships we can assist our patients with addressing these basic needs, such as prescription medication, food, transportation, improved employment, childcare assistance, and immigration issues.

Our Vision

A community that is disintegrated is dis-eased and ill.  When individuals find safe environments of care in which they can reveal themselves and become reintegrated with themselves, they can heal and become reintegrated into the community. The Christian gospel accounts document that Jesus’ healings returned his care recipients to wholeness in mind, body, and spirit, and consequently restored them into community, no longer defined by illness or outcast from society as unclean. Similarly, the practice of Shiva in the Jewish faith ends with a return of the bereaved to community.

Peter Drucker famously shared a story that has become a parable about the kind of vision necessary to be an effective leader:

“A man came across three stonecutters and asked them what they were doing.

The first replied, ‘I am making a living.’

The second kept on hammering while he said, “I am doing the best job of stonecutting in the entire county.”

The third looked up with a visionary gleam in his eye and said, ‘I am building a cathedral.’”[2]

When we approach community collaboratively, we recognize that until all are healthy, we remain a sick community.  It takes more time and effort than the culture offers in most primary care settings, but at Alliance we are not simply doing the best job of managing patient symptoms, we are striving toward a healthy community. 


Toby Bonar, Psy.D, M.Div., CFBPPC
Director of Pastoral Care & Counseling

1 Cooper-White, Pamela.  Many Voices: Pastoral Psychotherapy in Relational and Theological Perspective (2007). 

2 Drucker, Peter.  The Practice of Management (1954). 

May 2018 Volunteer Spotlight: Dr. Fred Horton, Psychiatry

 L to R: Dr. Toby Bonar, Director of Pastoral Care & Counseling; Dr. Fred Horton, volunteer psychiatrist

L to R: Dr. Toby Bonar, Director of Pastoral Care & Counseling; Dr. Fred Horton, volunteer psychiatrist

After 44 years away, Dr. Fred Horton -- Raleigh born and bred and N.C. State University graduate -- came back "home" in 2010 to begin his retirement after a 40 year career in psychiatry.

Dr. Horton's background includes an undergraduate degree in Zoology from N.C. State University, and an M.D. from Medical College of Virginia.  Dr. Horton completed his internship, residency, and fellowship at Vanderbilt University Hospital in Nashville, Tennessee, and stayed in the area in private practice for over 30 years. He continued to work part-time in in academia, serving as assistant professors within the Psychiatry Department at Vanderbilt University School of Medicine up until his retirement.

Why is mental health important?  It makes you more adaptive and more resilient. Life is wonderful, but it is a struggle birth to death. It doesn’t mean you struggle every day, but there will be some bad days. Do you plummet and not respond in a constructive way? Mental health allows you to identify the problem, come up with a constructive plan, and implement the plan.  You have to be willing to review your plan, and modify pieces of it as necessary.  Mental health allows you to have resilience in dealing with your world.
— Dr. Fred Horton

Fortunately for Alliance Medical Ministry, Dr. Horton's retirement includes continuing to practice medicine in a volunteer capacity! 

Dr. Horton heard about Alliance through long-time volunteer Dr. Robert Bilbro, and officially joined our Pastoral Care & Counseling team in January, now seeing patients weekly for psychoanalysis.

Dr. Toby Bonar, Director of Pastoral Care & Counseling, says, "Dr. Horton is a gift to Alliance.  He epitomizes the benefit of having collaborative relationships within a primary care context.  His presence and care empower our patients to equip themselves with treatment in support of their efforts to manage obstacles to well-being.  Dr. Horton's work with our patients has encouraged them to take steps forward so they can take advantage of opportunities toward growth."

Thank you, Dr. Horton, for generously volunteering your time and expertise to our clinic and patients!




We need YOU! Help us raise $30,000 by June 30.

Meet Maryse.


When Maryse Joseph moved to Wake County, she, like many, did not have health insurance.

In 2008, WakeMed Hospital referred her to Alliance Medical Ministry after a brief hospitalization. She has been a patient of Dr. Sheryl Joyner since that time -- 10 years!

A few years ago, Maryse became critically ill and was hospitalized again. "Dr. Joyner told me that every day while I was in the hospital, she checked up on me. She encouraged me. 'Maryse, if you can leave the hospital, you need to keep fighting. You can make it!' That changed my  life."

"Dr. Joyner takes time to listen to me.  It's personal."


In 2017, Dr. Joyner told Maryse she was pre-diabetic, and prescribed Cooking Matters @ Alliance and the Million Step Challenge.

Maryse is from Haiti, and said it is very normal in her culture to cook home-prepared meals. She enjoyed taking the Cooking Matters class, offered in partnership with the Inter-Faith Food Shuttle, picking up favorite recipes like quiche."Everyone can participate. Families come with their kids! I take recipes home to my own family."

"We learned we don’t need a lot of money to eat healthy."

Through the 2017 Million Step Challenge initiative, Maryse received a FitBit, and walked 1,785,204 in 112 days, taking second place in the Million Step Challenge. Over the past year, Maryse has changed her exercise and eating habits as a result of these programs. Every morning, she wakes up between 4:30 and 5:00 am daily to walk. This Spring, she joined fellow patients Teresa. Michelle, and Flor in leading other women in a Million Step Challenge. Maryse remains the top walker in the competition!

  In the 2017 Million Step Challenge, Maryse was one of the top walkers!

In the 2017 Million Step Challenge, Maryse was one of the top walkers!

  In 2018, Maryse joins fellow Million Step Challege alumni Teresa and Michelle in leading a team in this Spring's challenge.

In 2018, Maryse joins fellow Million Step Challege alumni Teresa and Michelle in leading a team in this Spring's challenge.

Maryse works as a CNA at a nursing home, and her daughter wants to be a doctor. Maryse translates Dr. Joyner's compassion into her own work, and encourages her daughter to do the same. 

"Dr. Joyner taught me to do everything with my heart. I try to show the same compassion to my patients, and hope my daughter will do the same."

To our Alliance family:

15-Years (2).jpg

Over 15 years, a strong common thread weaves through the comprehensive primary medical care Alliance has provided: each day, we walk alongside our patients on their journey to improved health, building strong relationships with them to help them reach their goals and overcome barriers.

Every new medical service and program added, new staff member hired, and new row planted in the garden has been to meet our patients’ needs and support them in achieving better health outcomes.

The statistics speak for themselves.

Over 15 years, Alliance has cared for -- and saved the lives of -- tens of thousands of our neighbors, providing over 100,000 patient visits, millions of dollars in medication, thousands of counseling sessions and referrals for specialty care, and a comprehensive variety of wellness offerings to help change patient behaviors.


And over 15 years, here’s what we have learned:

Providing medical care and medication is often not enough to manage and overcome poor health issues. We must help patients identify and address the economic and social barriers they face. By tackling both through Alliance and the support of our community partners, patients are better providers for their families, stronger employees and community members, are more productive, and are able to navigate the path toward economic sustainability.

Alliance must raise $30,000 by June 30. We need your support more than ever.

Please make a gift today.

Megg short signature.jpg

Megg Rader, Executive Director

May: Skin Cancer Awareness Month

Thank you to our friends at Blue Ridge Dermatology for providing this information!

Just in time for sunshine, southern summer temps, and sunscreen...May is skin cancer awareness month!

The incidence of both non melanoma (basal cell carcinoma and squamous cell carcinoma) and melanoma skin cancer rates continue to rise each year in the United States.

Now is the time to invest in a baseline skin examination by a dermatologist, and be educated on how to do an efficient and thorough monthly skin self-examination!  Skin cancers that are detected early, even melanomas, can often be cured by a simple excision or other less invasive treatment(s). 

Here are some tips:

 Whether you're in the garden or at the beach this summer...wear a hat!

Whether you're in the garden or at the beach this summer...wear a hat!

  • April through September: Avoid unprotected sun exposure, particularly between 11 AM and 4 PM to reduce the risk of getting a sun-induced skin cancer.   You don't have to stay indoors...but protect your skin!

  • Wear hats and protective clothing, apply broad spectrum, SPF 30+ sunscreen, and reapply sunscreen every 80 minutes when swimming or perspiring, or sooner if toweling off sun exposed skin.

  • Preventative care is critical!  Melanoma skin cancer can be independent of sun exposure and can, therefore, occur on any part of the body, not only where the sun shines.  Each month, take a few minutes to look at your own skin, head to toe.

  • Here's what you should be on the lookout for:
    • Moles, whether flat or raised, that are darker, larger, asymmetric, more irregular in border or color or pinker than the other moles on our bodies or than how they looked on the previous month.
    • Moles that are irritated, itching or bleeding should also be evaluated closely by a dermatologist.  Even moles present from birth can evolve into melanoma and should be watched for any visible changes.
    • Pimples that do not heal after a month, places that stay scaly or bleed easily should also be brought to the attention of a dermatologist. 
  • Ask your hair stylist to notice the skin of your scalp when your hair is wet
  • Visit the dentist and eye doctor regularly.
  • Ask a close friend or family member to check areas that are difficult to directly monitor ourselves.

Healthy skin habits take only a few minutes each day and screening yourself for skin cancer signs takes only a few minutes each month. Establishing these routines can literally save your life by preventing a skin cancer or detecting one in its earliest stages.

This May, please make a commitment to both protecting and monitoring your skin so that you can enjoy the great outdoors in great health for many years to come!