Health care provider – Marilyn R. Gardner

Yesterday was the busiest and best day of my entire work year. Every May we hold a conference for community health workers and patient navigators. The purpose of the conference is to bring this workforce together for learning, skills-building, and networking. It is a gift to work with these outstanding women and men who are serving their communities so well. Yesterday was that conference and I am once again overwhelmed by the privilege of working with these people, many of whom I have trained, others who have become personal friends.

Community health workers have been around for a while — their earliest mention was from Russia in the 1800’s. They were called “Feldshers” and were trained as layleaders to assist physicians and work in rural areas when physicians were not able to be present. The program that brought this idea to greater recognition and popularity was the successful Chinese Barefoot Doctor Program. This began around 1930 and is foundational to the idea of community members successfully working within their communities as lay health leaders.

In the 1980s, as health programs around the world faced budget problems, this workforce was unfortunately almost forgotten. We have only recently seen a resurgence and emphasis on community health worker and patient navigation programs.

A report published by the World Health Organization in 2007 highlights the work of these lay health leaders, not just as health care providers, but more importantly as advocates for their communities and agents of social change to “fight against inequities and advocate community rights and needs to government structures.”

This year our conference theme was “Telling Our Stories.” Anyone who has read this blog knows my love of stories. I wanted the theme to highlight the stories of these community health workers and patient navigators and how those stories intersect with the work they do. We had participants from across the country as well as Puerto Rico and Turkey. We had presentations from people on care of immigrants, maternal child health, caring for young adults who have cancer and more. It was a beautiful picture of the work that is done every single day with little recognition by a system focused on more and more education and less and less true patient care.

Each year we try to highlight the work that patient navigators and community health workers do through film. Film allows us to showcase their work in ways that others can better understand, without acronyms and medical speak, but with passion and heart. This year we focused on three navigators – Maria, Sabrina, and Mariuca. Not only are they navigators who do amazing work, I am also proud to call them my friends.

I have included the film so you can hear some of their stories and be inspired by the work that they do. Thanks for letting me brag on this group of people today. It is my privilege to work side by side with them.

Patient Navigators: Our Stories from Sean Clark on Vimeo.

Through my years of living, working, and communicating across cultural boundaries I’ve realized two things that sum it all up: one — this road is humbling and two – it’s a life-long learning process. Just when I think I have it all figured out, something, someone will come into my life and challenge my thinking and my well-worn tool box of ‘how to live and communicate across cultures’.

This is setting the stage for this post that is co-authored (though she doesn’t know it yet) by my cultural broker, colleague, and close friend Cathy. Cathy has taught me much about living and working across cultural boundaries. We have worked together to bring resources and workshops on culturally responsive, culturally competent care to health care providers in the Northeast for a number of years. Together we have come up with this list, compiled from a variety of sources. While we work primarily with health care providers, this list can be used in other situations.

So here’s our tool box for working and communicating across cultural boundaries:

Be aware of your cultural values and the beliefs you hold. This is a first and critical step to being able to effectively communicate across cultures. If you don’t understand the importance of culture — why you value what you do, how you make decisions, essentially how you live all of life, then it will be difficult for you to understand how culture affects others.

Become a student of the culture and the community. Even if you’re an expert in a certain area it’s important to rethink your role and be willing to learn as a student.

Recognize differences in narrative styles and practical behaviors across cultures. Be willing to research these differences and ask questions.

Understand that limited language proficiency (whether your’s or another’s) does not mean limited intellectual ability. People with limited language skills are usually capable of communicating clearly and effectively in their native language.

Have a high tolerance of ambiguity.

Seek help from bilingual/bicultural co-workers and individuals – find those who can help explain cultural nuances, the complexity of culture, dual causality and more.

Know the role of interpreters and learn to use interpreters effectively.

Allow the use of story-telling and props when speaking with others – we learn so much more in a story than in a list of facts. For healthcare providers, realize the symptoms are often in the story.

Include the patient and family as partners in determining both treatment plan and outcomes.

Recognize the primary person you are working with may not be the decision maker in the family.

Use empathy, curiosity, and respect as you work across cultural boundaries. Empathic listening, curious questioning, respectful observing.

Learn to be capable of complexity.

Be able to laugh at yourself and potential mistakes — if you don’t laugh you’ll find yourself crying way too much.

What would you add to this list? I would love to hear from you through the comments.

This week’s muffins are a delicious savoury mixture of chives and goat cheese. Stacy says this: “I used goats’ cheese with herbs and garlic to complement the chives. Delicious! This one will be a surprise to those who think muffins can only be sweet.”