Panelists: Linda Hill, MD, MPH; Chag Lowry, MEd; Janine Young, MD
Reported by: Natalie Sanfratello, MPH, CHCP, CE News Editorial Team
This session began with Dr. Linda Hill, MD, MPH introducing why we care about CPD without borders. Dr. Hill is a Distinguished Professor and Assistant Dean in the Herbert Wertheim School of Public Health at UC San Diego and the Executive Director of the Asylum Seeker Medical Screening and Stabilization Program. During this session she specifically spoke to her experience in the latter role. Dr. Hill emphasized that we care about CPD without borders because we need to address historical inequities, we exist within biased health systems, we serve diverse communities, and we serve diverse health professionals.
The success of her work has been realized by building trust with communities through the proliferation of personal relationships. Some key ways she has built trust have been to hire bilingual and bicultural interpreters and staff so clients or patients may feel more welcome, to speak with advocates; to conduct focus groups and to make sure to include members of the community in any planning efforts; to partner with ethnic organizations; to work with trusted members of the community (not just formal leaders); to hire directly from the community for both planning and implementation (which includes paying them fairly); and to never overpromise and underdeliver as quick flash in the pan interventions can erode trust. Dr. Hill provided examples from her work that went along with these suggestions including her experience working in transportation safety with railroad workers and working with refugees at a federally qualified health center after the fall of Saigon.
Next, Chag Lowry began his portion of this plenary. Chag Lowry is of Yurok, Maidu, and Achumawi Native ancestry, and his work focuses on research with Native populations throughout California as an Administrative Director in the UC San Diego Herbert Wertheim School of Public Health. Also, Chag is an accomplished comic book author with an award-winning World War I graphic novel, titled Soldiers Unknown which tells the lesser known real story of three Yurok men drafted into WWI.
Chag provided extensive context on the makeup and structure of native communities. He spoke to the fact that women guide native communities, and they guide with love and commitment. Native groups will often pool funds and form consortiums to better serve their communities. One example of this is the Indian Health Service (IHS), and he shared that native women were the architects of the clinic systems in California. Chag went on to give advice on who to speak to within the community to gain advice and direction when working with them. He pointed to the informal leaders and knowledge-keepers, specifically, traditional artists, storytellers, native language speakers, and elders. He further emphasized that the IHS clinics incorporate native architecture and imagery which draws the community in and helps to build trust. Symbolism and art matters in these spaces and can help to fight the tension existing between academic institutions and native peoples.
Mr. Lowry then went on to speak about native veterans and how the generational impact and trauma of military service has greatly affected the health outcomes in native communities. To improve health of the communities, their stories must be uplifted. He spoke about the why for his art telling the stories of native communities and inspiring the next generation to continue to be storytellers. He declared that “We are here as native peoples because we have to tell our stories and our stories are connected to our homelands.” Lastly, he encouraged the audience to complete our own comic strip using a blank piece of paper and colored pencils found in the middle of the tables.
Dr. Janine Young closed out the plenary speaking about health disparities in refugee, immigrant, and migrant communities. Dr. Young is a professor of pediatrics and an academic general pediatrician at UC San Diego, also serving as Division Chief of Academic General Pediatrics, Newborn Medicine, and Developmental-Behavioral Pediatrics. The main focus of her career has been the provision of health care to immigrants, migrants, and refugees, and she has presented nationally to healthcare providers and others on standards of care and considerations for this group. Dr. Young shared about the lack of required training at any point within the medical curriculum on caring for immigrants, refugees, and migrants even though they make up a large portion of the U.S. population – 13.6% or 45 million people. Furthermore, 67.8 million people in the U.S. speak a language other than English at home. Although likely all medical providers will see someone from this population at some point in their career, they are not trained on the specific needs they have. Some unique needs include language barriers, lack of community inclusion in planning, infectious disease exposure risks, trauma exposure, cultural beliefs around health and healthcare, access to healthcare, legal status, environmental exposure risks, nutritional risks, and health literacy. She went on to emphasize the incredible resilience of these patients she sees and how she incorporates an approach of humility to build trust.
Dr. Young continued with some considerations for quality improvement and systems-based changes to better serve this community. She encouraged the inclusion of those with lived experience on the care or advocacy team and to do some exercises to evaluate the accessibility of care. These exercises included calling the health system’s main line or local pharmacies to see if patients speaking a language other than English or Spanish could access any person to provide advice or make an appointment; secondly, she challenged providers to communicate lab results, appointment reminders, or patient education to a patient who speaks a language other than English or Spanish to see how communication could be improved.
Dr. Young provided resources for those interested in learning more about and teaching on refugee, immigrant, and migrant health which included the CDC Domestic Refugee Screening Guidelines, CareRef, NRC RIM, MN Center of Excellence in Newcomer Healthcare, EthnoMed, Society of Refugee Health Providers, North American Refugee Health Conference, and Society of Asylum Medicine. Further, she provided a framework to assess content for inclusion and appropriateness in which planners can ask nine questions: 1) who was left out?; 2) does it acknowledge historical inequities?; 3) does it include misinformation or debunked myths?; 4) does it address cultural considerations?; 5) does it include epidemiology and history of populations being discussed?; 6) does it include social context of populations being discussed?; 7) does it address barriers to care and services?; 8) does it discuss political issues affecting the population discussed?; and 9) does it embrace cultural humility?
The plenary ended with a question posed to the audience about what we can do in our own offices where groups provided detail on the resources they already have available, or what they could do to move the needle on these important topics.
