By Kate Callaghan, Frist Global Health Leader
“Namaste,” the young Bhutanese woman said opening the door of her and her family’s apartment for the medical assistant (MA) and me. As she and her in-laws warmly welcomed us into their living room/dining room space, another young woman and a little girl emerged from the bedroom. “How many of you are living here?” the MA asked the only gentleman in the room through the interpreter we had on the phone. “There are five of us,” he answered.
For the next two and a half hours, we talked at length with the three family members who had been diagnosed with diabetes. They had arrived to the US from Bhutan only one month ago, and the diagnosis came through the routine blood tests done as part of their refugee intake physicals. All three of them sat next to one another on their couch, and the MA and I went from one end to the other, talking with each patient and taking their vitals. Whenever we got to medications and what each person had or had not been taking, the youngest of the three, the young woman who had opened the door for us when we arrived, would get up from the couch, go to the dresser in the corner, and pull out a bag of medications from one of the dresser drawers. It appeared that each person’s medications were in a different drawer. The biggest piece of furniture in the room had become their medicine cabinet.
As the conversation evolved, I asked the family how they were feeling about being in America. They smiled and communicated gratitude for being in the US. Then I asked if there was anything that was hard about being here. The gentleman said that he was worried about their diabetes, “We didn’t have diabetes in the camp in Nepal. I’m worried about our health.”
It was clear from the preceding individual conversations that only one of the three had been taking her medications appropriately, and the fasting blood sugars for all of them were consistently over 200, much higher than we would like. So we used Mr. A’s voiced concern about their health as an opportunity to reiterate the importance of taking their medications as prescribed, a difficult task given that they couldn’t read the English instructions written on their bottles of pills. We then moved on to talking about diet and exercise.
“What do you all eat for meals?” I asked. “Flat bread and vegetables.” “What do you mean by flat bread?” I responded. “Can you show me?” The young woman went to the kitchen and brought back what looked like a tortilla. “Okay if I eat four of those?” the gentleman asked. I shook my head, “Mr. A, it’s not good for your sugar to eat lots of flat bread. A little is okay, but a lot makes your sugar high.”
“What am I supposed to eat then?” he replied, a look of both sadness and frustration on his face. The MA and I pulled out a book with some pictures with proper proportions of vegetables, protein, and carbohydrates for diabetics, explaining what foods fit in each category. Mr. A nodded that he understood, but still seemed frustrated.
“Making big changes all at once is often really hard,” I said. “But if you can do a little bit at a time, it’s a little more manageable.” Again, he nodded. “Do you have any other questions for us?” we asked. The gentleman shook his head and the young woman answered, “No.” The visit concluded with the family sharing some tea with us, a recipe from their home country, and warmly thanking us for coming to see them.
When we got in the car, I turned to the MA and noted how hard I thought it must be to come to a new country, know no one, have to learn a new language and acclimate to a new culture, and on top of that be diagnosed with a new disease they never knew they had.
“And then we tell them that one of the only familiar things they still have, food from their country, has to be changed, too. That’s got to be so challenging.” The MA nodded in agreement, himself an immigrant.
Before this rotation, even in the first week or so before I’d heard patients’ stories, I was so unaware of the difficulties intrinsic to refugee resettlement. Thanks to people like the A family, who have so generously shared their home and their stories with me, I now have some small insight into the breadth of challenges refugees face. I hope that as I leave from here, a new curiosity to seek to understand the complexity of suffering of those I get to care for enlivens my encounters with patients.
Kate Callaghan is a Frist Global Health Leader working at the Siloam Family Health Center with refugee, immigrant, and other underserved individuals.