Lay health workers trained by Siloam students

“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.”

Lay Health Workers and CHI Students pose outside their apartment - 2014 - cropped

Pre-medical students and lay health workers pose outside following a training session. Lay health workers include (L-R) Samson Sarki from Bhutan (in turquoise), Paulos Ezekiel from Eritrea (in purple), and Anita Nepal from Nepal (in blue and red). Pre-medical students (L-R back row) include Will Davies, Stewart Goodwin, Kenny Namkoong, Frances Cobb, Caleb Huber, Will Tucker, along with Reinie Thomas (kneeling), and Lauren Roddy (in blue on right). Pre-medical student Chelsea Travis is behind the lens!

Off with a bang!

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:

How Deeply Can You Be Immersed?

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.

Neighbor children know that fun and attention await them just on the other side of the CHI students' back door.

Neighbor children know that fun and attention await them just on the other side of the CHI students’ back door.

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.

Highlands Kids 2 (Chelsea Travis blog)

Chelsea Travis, a recent graduate from the University of North Carolina’s pre-medical program, poses with refugee children in the neighborhood.

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.

 

 

Home visits bring heart

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…”

Home visits open doors to greater understanding about barriers patients face. Photo credit: medicalhometeam.com

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.

Will Tucker is a rising senior at Union University.

Will Tucker is a rising senior at Union University.

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.

From Strangers to Neighbors

Guest blogger Reinie Thomas, one of seven students in this summer’s Community Health Immersion, writes…

Low-income neighborhood they told me. I thought we would rarely be outside in our neighborhood. How I was wrong. Within the first few days of arriving at the Highlands, I have interacted with some of the most generous, good-hearted people I have ever met.

Watching out for suspicious people that hang around our apartment was implied, but once again that was not the case. Every single time I walk back to my room, an old Nepali couple is sitting outside the entrance to our flat.

“…we meet our hands together and bow in return with a ‘Namaste,’…” 

We all know the male Nepali around here for wearing an orange t-shirt and hat. What it signifies, I’ll probably never know. He greets us first the American way with a handshake, then we meet our hands together and bow in return with a ‘Namaste,’ which is the appropriate greeting for those from Nepali. Even from two completely different cultures, we both try to relate with one another which is honestly such an amazing experience.

Reinie with two young friends

Reinie Thomas, a rising sophomore at Hope College, enjoys building relationships with two young neighbor friends.

We have found that many of our neighbors have children as well, and those children now know exactly where we live. Many Nepali, Burmese, Hispanic among other local children visit us daily so we can come play soccer with them, give them a glass of water, have them play with our hair, play on the playground or simply to talk.

Within a few days we built a genuine relationship through these activities. Soon, the children’s demand for us to play with them occurred during our (the CHI students) work, meal and nap times. In extreme cases, we began having to slowly close the glass door to our house with children grasping on to it, with their faces pressed against the glass and locking it so we could have a meal (we all felt so awful for doing this!).

One time, this led to a mini child-march outside the glass window by our table during dinner so that we would re-open the door and play with them. There were kids from ages 2 to 11, arms crossed, and one-by-one walking by the glass door with pouty faces. Once the children had gone back to their apartments and we had finished our meal, we found written on the sidewalk outside our door an “I love you Laurin” from one of the girls as a final plea for us to finish our meal and play.

This living environment originally had me worried, thinking that we would have to keep to ourselves most of the time, but as I have described, it’s the complete opposite. Very few things have made me feel unsafe in this community, rather, I feel comfortable and am eager to meet more people. It’s a great feeling when every time I walk through our neighborhood I know someone, child or adult, and am able to share a common greeting with them!

As a CHI team we each bring something different to the table when it comes to meeting new people, which I could not be more thankful for. As mentioned in Romans 12:6-8 We have different gifts, according to the grace given to each of us. If your gift is prophesying, then prophesy in accordance with your faith; if it is serving, then serve; if it is teaching, then teach; if it is to encourage, then give encouragement; if it is giving, then give generously; if it is to lead, do it diligently; if it is to show mercy, do it cheerfully.”

This has allowed me to meet many people that I would have never interacted with before solely due to the gifts of my team members. Through these first few weeks, it is evident that we are growing as individuals, a team and a community.

I am sure the best is yet to come.

Globe trotting by knocking next door

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. Door Knocking at the HighlandsThrough 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.

CHI participants Will Davies and Stewart Goodwin with shoes courteously removed interview Burmese neighbors about their health status.

CHI participants Will Davies and Stewart Goodwin with shoes courteously removed interview Burmese neighbors about their health status.

 

“This is fun!” … a Selfie on day one

Today marks the first day seven pre-medical students stepped into another world – the world of Siloam.

Caleb captures morning devotionals with several of the CHI students.

Caleb captures morning devotionals with several of the CHI students.

These seven are participating in a six-week community health immersion.  The morning started early with breakfast and devotionals for Chelsea, Davies, Frances, Kenny, Lauren, Reinie, and Tucker.  Co-directors Caleb and Stewart round at the team.  They arrived at Siloam by 8:00 a.m. to be quickly dispersed among various roles helping with “Refugee Mondays.” One student called out, “This is Fun!”

While living in a predominantly refugee apartment complex in south Nashville, they will train refugee lay health workers to work in the community, they will shadow clinicians at Siloam, and explore a Biblical theology of health care.  Pay attention to the “fun” they will have as they come and see* what God has in store for them this summer.

*John 1:39, Holy Bible