Vanderbilt 4th year medical student Andrew Wu shares about his training experience at Siloam. Click the video to watch.
We often blog about medicine being a calling…one, to which practitioners are motivated by God’s tug on their life to pursue. Unfortunately, “a not-so-funny thing happens on the way to the forum.” Their motivation to practice medicine shifts. As one of my colleagues often states, “many go into medicine to do good, yet come out of medicine to do well.” Here is an opportunity to do good…and, possibly get back to that original “calling.”
Doctors Without Borders/Médecins Sans Frontières (MSF) helps people worldwide where the need is greatest, delivering emergency medical aid to people affected by conflict, epidemics, disasters or exclusion from health care. On November 6, 2014, medical and non-medical professionals are invited to a late afternoon presentation from 5-6:30 in Vanderbilt University Medical School’s, Light Hall, Room 208, to learn more about how they can join Doctors Without Borders’ pool of dedicated aid workers. For readers outside the Nashville, Tennessee area or otherwise unable to make the meeting, more information about opportunities can be found at this link: http://www.doctorswithoutborders.org/work-with-us
The Siloam Institute offers clinical rotations to nearly 40 health professional trainees annually. Their rotation at Siloam helps them to deepen their understanding of how to engage persons living in poverty, work cross-culturally, and learn how to integrate behavioral health and spiritual care into their practice of medicine.
Click the video below to watch Samaiya Mushtaq reflect on a particular patient encounter stating, “I did not offer them a magic solution to their health problems, but I think they felt a little more healed after that visit.” Samaiya is a fourth-year Vanderbilt medical student who plans to pursue a residency in psychiatry.
Siloam’s Community Health Immersion students worked to train refugee lay health workers for a more effective outreach to the refugee families in Nashville. This work drew much of its inspiration from successful community health worker programs found in impoverished nations.
In a guest blog at Huffington Post, comments made by James Nardella (Lwala Community Alliance) resonate with our experience here in Nashville.
James writes: “Scale and efficiency are important to moving health care goods and services…. But, when it comes to addressing the root causes for poor health in many places, scale can be a distraction. Delivering goods and services alone will not motivate people toward health seeking behavior.” James goes on to point out that, “…health-seeking decisions are made at the family level.”
“I‘m too much glad to see you because you are Nepali.” Greetings like this one from a Nepali man bring joy to 19-year old Anita Nepal who loves helping people in the Nepalese community of Nashville. Anita, born in a refugee camp in Nepal to Bhutanese parents, was recently trained as a lay health worker by pre-medical students participating in Siloam’s Community Health Immersion program. Nashville’s Nepali community – mostly made up of refugees from Nepal and Bhutan – appreciate the cross-cultural understanding that Anita brings as she teaches within her community on the health topics she recently learned.
“Many of the Nepali people do not understand the health care system in America,” says Anita who works full-time in housekeeping at a local hospital. They struggle to know how to make appointments to see a doctor or how to get medicine from a pharmacy because as Anita says, “… in Nepal there were no appointments or prescriptions…you just show up and ask for what you need.”
“I learned many things – I can help many…”
For Siloam’s six-week Community Health Immersion program, pre-medical students were recruited from around the country to live in a refugee apartment complex in southeast Nashville where they trained nine lay health workers like Anita from the neighborhood. Training topics included preventative care like oral health, nutrition, and exercise, along with health navigation topics like how insurance works and the difference between an emergency room and a primary care clinic. Beyond learning how to teach lay health workers, the pre-medical students also explored how to see the vocation of medicine as a calling and to see how to care for patients as whole persons as Jesus did.
The pre-medical students’ work with the lay health workers is making a lasting impact. The oral health topic alone made an immediate impact on Anita’s family of five who were resettled a year ago in Nashville after spending 21 years in a refugee camp in Nepal. “We did not know about dental floss or how many times each day to brush our teeth or for how long,” Anita says. “Now we do. I learned many things – I can help many Nepali and Bhutanese people.”
It has been quiet this week since our nine CHI participants (7 pre-meds and 2 directors) left town after spending an exciting six-weeks with us on a Community Health Immersion. As we celebrate our nation’s independence this weekend, let’s also celebrate the ministry of presence that our freedoms allow us to carry out. Check out this video that the students put together as a celebration of how God is moving in their lives as they prepare to be future physicians:
Guest blogger Chelsea Travis, one of seven students in this summer’s Community Health Immersion, writes…
Living here in the Highlands Apartments, surrounded by a community of refugees and low-income neighbors, and being a part of an immersion-promoting program – I wonder are we truly immersed? Most would say yes, and I believe that would probably only be 60% right. In some ways, we are immersed. We are living in the same environment as the residents here which include: loud honking car noises at night, a “coins only” laundry mat, new and sometimes reckless drivers riding through the neighborhood, an always occupied soccer field, beautiful rose bushes, roaches, and very active ethnically diverse neighbors and children.
Although we live here, many of us have things that most of these refugees do not. These aren’t simply tangible material items like cars, laptops, smartphones, an installed washer and dryer, or nice business clothes – of which we so often take for granted – but it’s even more than that. It is intangibles like nearby family, education, the ability to speak English with an American accent, our western clothes, and an established, if not assumed, reputation.
Having family nearby, even if they are 600 miles away, is such a great asset especially when compared to family members of refugees who could be thousands of miles away. Since starting this program I have received 2 packages from close family and friends back home that have been so beneficial to me. I cannot imagine not being able to draw from that life line of support because my family is either still in my war-torn country or they are scattered in various places around the world.
We often take for granted our educational experience as well. In this country the expectation is that people, especially young adults, attend college and even some schooling beyond that. The refugees whom we come in contact with actually have an array of educational backgrounds. Some have learned in educational institutions, some were apprentices of their parents or grandparents, and some have simply learned from the school of life.
Overall, it is interesting how education affects a person’s ability to adapt to new situations. It seems that individuals who have been challenged academically or have been conditioned to exercise their intellectual skills (even if only up to the high school level) are more able to adapt and learn new languages and systems. We don’t realize how valuable our education is. If we understood that not everyone in the world is afforded the opportunity to obtain even a high school education, we would not complain and be lazy about classwork, reading assignments, papers, or skill-granting liberal arts classes because we think we “don’t need” that coursework. Foolishness.
Also the fact that we speak English fluently and with clear American accents and wear Western (American) clothing makes us less immersed when compared to the realities of our neighbors. Just the very fact that we possess these attributes causes us to obtain more respect, trust, or even assumed positive reputations. Without anyone really knowing us we probably could receive a loan, purchase a car, or get better job opportunities than our immigrant and refugee neighbors of comparable abilities. This is in part because when people do not adequately speak the dominant language of a society that person’s intellectual abilities are often assumed to be low. These judgments are too often made without even knowing the past professions and careers many of these refugees held in their former home countries – I’ve met former doctors, professors, and innovators.
One thing many of these refugees do have that I wish I could be further immersed in is their drive to survive and to thrive. They are so strong, enduring, humble, and passionate people. They want a better life for themselves, for their families, and for their home countries. I attended an English class being taught by and for Burmese people who wanted to take their U.S. citizenship exam. There were several young women present at this class – one had a baby tied on her back, another nursing a baby in her lap, and two with babies on the couch, and one child playing outside – and they were still so engaged in the class, flipping through their notes and answering questions. I was so inspired! They wanted this English lesson so badly they were not going to let anything distract them. Glory to God what a poignant lesson for my own life!
With everything that a refugee has endured throughout their lives including: wars, persecution, discrimination, and genocide, we will never be truly immersed enough to understand life in their shoes.
Guest blogger Will Davies, one of seven students in this summer’s Community Health Immersion, writes…
I thought it was another normal day at Siloam. The health care providers were supplely moving about the clinic, tending to each of their patients (including any unscheduled walk in patients). Interpreters were turning the confusing syllables of patients who spoke no English into relatable language for the health care providers. And as if the administrative staff had personally learned from God, himself, when he formed the world, they too brought all sorts of chaos into order.
It’s here that our team has seen how Siloam isn’t just restoring the health of those who live in financial poverty, but they are bringing down the Kingdom of God to their patients, helping restore different types of poverty as well. For we live in a world stricken with poverty. Relationships with loved ones, our self-image and worth, the creation around us, and our relationship with God can all exist in poverty.
And our CHI team has been lucky enough to join with Siloam and fight against these different types of poverty.
“…a refugee…sat hunched over from pain…”
Two weeks ago I found myself in a clinic room with two people: a refugee, and one of Siloam’s health providers whom I was shadowing. What could have been a simple check up was made trying, for our patient, a refugee who had no insurance, has no family in the States, and to make matters worse. . . spoke no English, sat hunched over from pain caused by constipation.
Yes, medicine could help this patient, and I’m sure it did. But he needed more. In fact, the physician’s prescribed treatment was instructed to his case worker: “Find some people to stop by his apartment, spend some time with him, and help cook him a healthy meal!”
You see, it wasn’t a problem of financial poverty. This patient suffered from poverty of all sorts of other relationships! Having been in the states less than two weeks with no family, no friends, and no one to be with, there was plenty of room for restoration.
My having grown up in a financially blessed family, society, and Church, it is easy to view poverty in one way: the lack of material possessions. As a church, it can be easy to give materials away to the poor, pray blessings over them, and call it a day. This method of help is easily measured and has a nice ring to it: “We went to this poor area of town, gave away certain material gifts that can help improve the resident’s lives, built a certain amount of homes for them to live better lives in, and oh ya- we also provided them food because they were hungry.”
“…he called his disciples to a life of greater financial poverty…”
Those are good and needed things. . .but only sometimes because this type of aid only helps with financial poverty.
What about the relational poverty that our neighbors are living in? As Christians, we are called to love people relationally as well as financially. It’s not glorious to forsake your own life, fight for other people’s lives spiritually, and equip others to do the same. But that’s what Christ did.
When Christ called his disciples, he didn’t walk up to them, seeing that they were poor, hand them some extra change, or even build them a better house! In fact, he called his disciples to a life of greater financial poverty! What!? Wow. And asking them to live life with him, he revealed to them who God was. He fought for their lives spiritually, and because of it, the poor became rich, and followed him.
“…he happens to live in our neighborhood!”
So last week, as our group was rewinding after a day at the clinic, the same patient from the clinic happened to run into us because he happens to live in our neighborhood! Wow, it’s amazing how the Lord sets things up. As we invited him into our house, he looked much better than previously, but still spoke no English. And it’s here where our CHI team was able to start to love him, know him, and bless him. We are not great at it, but it’s a beginning. And as we will get to know him more over our next few weeks, I pray that the spirit of God will move through him and us, and our poverty of relationships will be restored.
Guest blogger Will Tucker, one of seven students in this summer’s Community Health Immersion, writes…
Last week I had the marvelous privilege of shadowing Lauren Smith, a Family Nurse Practitioner with Siloam Family Health Center. The experience was an enormous blessing to me and I have rarely seen a more refreshing sight during a home visit. Most of my experience with patient interaction has always been in an office setting and this was actually my first interaction in a patient’s home.
“…I have rarely seen a more refreshing sight…”
Amazement was my initial reaction as we were welcomed into their homes and I could tell that these appointments were full of purpose and provided insight to a fundamental aspect of Siloam, whole-person care. Chelsea and I were the students able to travel to the home visit that day and we both recorded notes as the patient/practitioner dialogue transpired, some of which was in Spanish.
Walls I anticipated to be up were non-existent in the visits as conversation flowed freely in two languages. I clearly witnessed the value of language that is so applicable in everyday life and is often the form of communication we take for granted the most. Language is a cultural component that conveys along with it meanings for objects or action that cannot be accurately translated, but we were blessed to learn from Lauren its importance in action.
“…not everything can be simplified down to chemical reactions…”
We also learned to focus on other cues a patient may unintentionally give through their environment or behaviors. Through careful observation of many factors in the home a much more thorough understanding of what affects patients on a daily basis is acquired. I have heard it said many times that personal daily decisions will always factor into a person’s overall well being more so than any other factor that a medical professional can assist with and if it were not clear already, I saw with much clarity the truth in that statement.
During each visit I listened intently to the interaction occurring and made various observations about the home and various family relationships that patients had established. I was even fortunate enough to get to read a few jokes in an almanac with the husband of a patient and somewhat dip my toe into the waters of fine trust that exist between patient and practitioner as an observer.
“…I was surprised to find that hope overflowed…”
While I expected home visits to be solemn occasions, filled with despair and hardship, I was surprised to find that hope overflowed and peace persisted despite all opposing circumstances. Emotional & spiritual support was provided by family and friends, physical guidance, emotional, and spiritual support was also supplied by Lauren as she reviewed medicines and plans of action with each patient. But the most important and intriguing facet is that all of those good things were firmly rooted in Christ.
At the conclusion of each visit Lauren sought to pray with her patients and in doing so acknowledged that not everything can be simplified down to chemical reactions, treatments, careful planning, medications to solve this and that problem, but that there are somethings we do not understand yet and may not at all. While I hope that we continue to make great strides in knowledge acquisition, always acknowledging God as its source, I also pray that we never forget the anchor that we have in the love of Christ and its compelling power to peace, understanding, wisdom, and its call to be whole in Him.
Guest blogger Frances Cobb, one of seven students in this summer’s Community Health Immersion, writes…
“How many servings of fruits and vegetables do you and your family eat a day?
What are the biggest problems for you and your family?
For your community?
Do you exercise?
Has anyone in your family been sick in the last year?
Do you know where to go for healthcare?
Do you and your family have health insurance? ….”
These are some of the questions we asked refugee families in our Community Health Surveys (CHS). This summer as part of Siloam’s Community Health Immersion, nine of us went door-to-door completing the CHS among refugee families in the Highlands and surrounding apartment communities. Through the CHS we sought to assess basic wellness and identify community-wide issues encountered by the refugees in understanding the American healthcare system and in transitioning to life here in the United States.
When I first heard we would be going door to door interviewing refugees, I think my blood pressure and anxiety shot up. It sounded like an awesome opportunity to interact with the refugees and assess their health across different nationalities within our new community here at the Highlands, however I was mildly terrified of knocking on the doors of strangers and inviting myself into their homes.
When we first set out, I wasn’t quite sure what to expect, but what I encountered behind each door we knocked on was a generous, resilient family working against language barriers, childcare issues, financial burdens, and general confusion in their transition to a new culture.
In that week and half, it was like we were traveling the globe. I spoke with Bhutanese, Burmese, Rwandan, and Ethiopian families within our community. No one refused to answer our questions and many people went so far as to thank us for taking time to listen to them and trying to understand the difficulties they have encountered in transitioning to life away from their home country.
I was so encouraged as a volunteer and future healthcare provider by the generous and helpful attitude of the refugee families I had the pleasure of meeting. By interacting with them in their homes and taking time to sit with them, we were able to gain a better understanding of the health environment experienced by both newly arrived and established refugee families.
Additionally we had the opportunity to observe the aspects of the American healthcare system that cause confusion among these families and ultimately act as barriers to staying healthy.