patient navigator – 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.

I don’t often talk about what I do – like my paycheck job, the job that pays for food, rent, and children’s college tuition. But today, because it is my biggest and busiest day of the year, I want to talk about what I do. Because I have found my niche — as a nurse in public health working with patient navigators and community health workers.

I have always loved that I am a nurse. I have always worn the title RN or Registered Nurse with deep pride. First because I couldn’t believe I actually made it through school;second because I love the profession. It challenges my weaknesses and gives voice to my strengths.

But though I have always loved being a nurse, I’ve not always been a good nurse. There was the fear factor that I would do something wrong in my early days, there was an insecurity in my skill set, a sense that I still didn’t really know where I fit as a nurse.

While living overseas in Pakistan and Egypt I worked sporadically – private duty cases, teaching childbirth education, and accompanying women during labor and childbirth.

When we moved to the United States I began working as a visiting nurse, going into homes and caring for patients who had just been released from the hospital. I was restless. I knew that clinical nursing was only half the picture of what I wanted to be doing.

It was during that time I made a job change and discovered public health. Public health allowed me to use my clinical skills as well as my creativity in developing programs and presentations to use in communities. I learned more about the big picture of health and why it matters. It allowed me to focus on underserved communities, communities that don’t have as many resources like immigrant and refugee communities, like poor minority communities. I began to understand more about working with people who have the greatest need and where, with the least amount of money, you can make the biggest impact. I ended up specifically working in preventative health screening – breast, cervical, colorectal, and prostate screening. Connecting patients to doctors and clinics so that instead of waiting until a cancer lump grew and the cancer spread, the patient would be screened early; so that instead of coping with chemotherapy and drastic life changes, they would have a minor procedure.

I found my niche in a space where I began educating community health workers and patient navigators, helping them see their natural abilities as valuable and adding clinical knowledge and other skills so they could work in their own communities and effect change. These men and women were bilingual and multicultural, but often without opportunities for higher education they struggled to find a place where those skills mattered. They are from all over the world and had made their way by various paths to the United States. They hail from Spain and Brazil, Portugal and Dominican Republic; Puerto Rico and China; Bangladesh and Somalia; the Sudan and Haiti. And they are finding their own niche in a country that is far different from the countries and places where most of them grew up.

So today we hold a conference that allows these patient navigators and community health workers to come together and learn, to come together and present what they are doing, to come together and be celebrated, to realize that they are a valuable part of our health care system.

But back to the niche – an amazing thing has happened through this process. I realize that the skills of communicating and negotiating across cultures are used regularly in this job. Those skills I felt would lie dormant and not be used again now allow me to build relationships and connections, encourage and voice understanding of the experiences of both patients and community health workers. Because all of us are outsiders that have gone through the process of adjusting to an unfamiliar world, working to carve out a niche where we can use who we are to make a small difference in the lives of some of the most vulnerable in our communities.

If you are interested in hearing from some of the people I work with about the amazing work they do take a look at this video that we are showing today at the conference. It’s about 8 minutes long and includes both animation and stories from the community health workers. It was created by my son, Micah.