By Jeremy Gerber
The Frist Global Health Leaders (FGHL) program affords young health professional students, residents, and fellows the opportunity to serve and train abroad in underserved communities for up to one semester. In doing so, they will bolster capacity in clinics in need of support as well as offer training to community health workers to promote sustainability upon their departure from these communities. As part of the program, they blog about their experiences here. For more information, visit our program page.
Eighty nations speaking seventy languages funnel into Nashville through the doors of Siloam Health, the non-profit clinic where I am currently undergoing primary care training. Many of these individuals have suffered greatly in their home countries and refugee camps and are coming to the U.S. in hopes of safety and a better future. Unfortunately, many soon realize that it is a long and difficult road to self-sustainability upon moving to the U.S. Refugees come with very little and must adapt to living in a new culture with an unfamiliar health care system. Insurance can be confusing even for fluent English speakers, let alone those facing language barriers. With limited funds, it is easier to avoid preventative care and simply seek help for acute illnesses, but in the process, many are left with large bills from emergency visits that could have been averted through education and primary care support. Being a part of the work at Siloam gives me the privilege of offering open arms to immigrants and refugees when they are most vulnerable in this unfamiliar country. It is a comfort for our patients to walk through the doors at Siloam to be greeted with warm smiles and reassurances of “you are welcome here.” In my first week at Siloam, I have been amazed at the innovate and compassionate ways that the staff here use the resources available to them to overcome cultural, spiritual, language, educational, and financial barriers and to enable patients to become self-sustaining.
Many of the preconceived ideas I had walking into Siloam on my first day were flat-out wrong. Each day here shows me the importance of not making assumptions or generalizations, but rather getting acquainted with each individual patient and his or her life story. It is often assumed that all refugees come from an impoverished background, but in fact many come from wealthy careers as engineers, doctors, etc., in their home countries and have been forced to flee due to various reasons. Therefore, it is quite devastating for these families to find themselves in a situation where they have nothing but the clothes on their backs, and they may not be comfortable with asking for help. Also, many refugees come with a large burden of post-traumatic stress that is unimaginable to the average American. Imagine suffering torture and seeing your family murdered in front of you! Although it may not initially be apparent, many physical symptoms of these patients are due to the mental, emotional, and physical trauma they have experienced. I am learning that taking time to listen to patients’ life stories gives me a deeper respect and a better insight into how to care for them.
When a patient walks into a primary care office for the first time and sits down in front of a provider who is a total stranger, there are many intimidating factors that can prevent the patient from sharing the details of his or her problems. The patient’s health concerns and understanding of his or her problem may be related to spiritual or cultural beliefs or life decisions that the patient is not comfortable sharing with a provider for fear of embarrassment. Nevertheless, it will be impossible to effectively deal with the patient’s problem unless these barriers to communication are addressed. The concept of making primary practice a “place of safety” can have tremendous benefits on patient care. There was one specific patient encounter this past week that demonstrated to me the importance of this issue. A young woman described to me how she had been struggling with suicidal ideations and drug abuse and was now scared because she was facing charges from the police. Her mother had recently died in an unfortunate accident, and her pregnant sister was coming to live with her. Partly out of a desire to be an example to her sister, she was surprisingly open to seeking help with her problems. My preceptor asked her, “Is Siloam a place where you feel safe?” She responded in the affirmative and then requested an opportunity to pray with the staff pastor. It dawned upon me the importance of creating a safe environment for our patients in family practice. This patient had been extremely vulnerable and was open to counseling and accountability from our staff because she knew they would respect and care for her. She was committed to taking legitimate steps to change her life because the providers at Siloam offered a helping hand. The staff had built a relationship of trust and confidentiality with this patient through her previous visits, so that she now had the freedom to share her struggles without fear of scorn or embarrassment.
The amazing thing to me about family practice at Siloam is that even though the providers hold strongly to an exclusively Christian foundation of values to govern their care, people of all beliefs, languages, and colors are welcomed and loved. This is an encouragement to me that I do not have to abandon my personal values as a provider to foster an environment of safety and openness for patients of all beliefs and backgrounds. Making primary care a “place of safety” where patients are not afraid to seek help for their problems is possible if we create a pattern of wise and compassionate provider-patient interactions with each visit. We must demonstrate to patients our commitment to confidentiality (as well as the limits of confidentiality) and providing the highest quality, whole-person care. We must take the extra minute to listen, to empathize, and to genuinely ask, “Do you feel safe here? Do you feel you can talk openly with me about the problems you are dealing with? If not, what can I do to help with that?” When our patients feel safe, they will be honest about their troubles, and clearer communication will facilitate more effective patient care.