Post 5: Self-Advocacy in Women’s Health

Themes from the women’s health workshop

On Wednesday, after a month and a half of planning, I walked into a room of thirteen women sipping tea and chatting around a large table waiting for a workshop on women’s health to begin. I’m interested in women’s health and health education because I believe it is so essential for women to understand how their bodies work and to be able to express any concerns to their doctor. So many times, women place the wellbeing of their children and families ahead of their own, and, with our clients who are trying to support their families in a life-altering transition, it can be even more apparent.

I’d noticed in the first few weeks at my internship that my clients did not volunteer information readily and that very pointed questions and relationship-building were needed to hear their concerns. Most providers start appointments by saying, “How are you doing today?” Clients reply, “Good,” and providers move on. When this happens, clients aren’t able to share their worries or problems. Since there is little access to women’s healthcare in Afghanistan, and speaking about reproductive health is culturally taboo, many of our clients did not know what was normal or abnormal, nor did they have the tools to self-advocate and ask their providers questions. So, I initiated and planned a women’s health workshop with a local OBGYN to provide some of our clients with the knowledge and tools to self-advocate at their appointments and understand the various tests and cancer screening procedures.

While the workshop was meant to be 30-45 minutes of presentation and 15 minutes of Q&A, it ended up being cut off after 2 hours! At first, the women were nervous, but as the doctor spoke, they began to smile, nod, and those that could write feverishly took notes. The doctor shared information about routine pregnancy care and labs; cervical, breast and colon cancer screenings; menstruation patterns; and controlling or augmenting fertility. She stressed the importance of women’s healthcare for reasons other than pregnancy as well, since so much focus is put on the health of women during pregnancy and for the sake of their children and not necessarily for their own benefit.

The doctor did an amazing job presenting the information in a straightforward way and encouraging the women to share their thoughts and ask questions. She used anatomical diagrams to help explain the female reproductive systems so that everyone could understand what their bodies looked like. The doctor stressed that because providers and patients don’t speak the same language or come from the same culture, doctors aren’t always able to communicate well with them. She shared that she doesn’t always ask the right questions of them and that sometimes she makes mistakes, so it’s crucial for them to tell her how they’re feeling and self-advocate. This openness allowed the women to feel comfortable sharing their worries and questions on everything from missed periods, to colonoscopies, to questioning why American women had such high breast cancer rates. The biggest revelation for the group was when they found out that men’s sperm is truly what causes the sex of babies, so having only girls was not the “fault” of the women. Jaws dropped, and several women yelled, “They lied to us!” through their interpreters.

The most rewarding part of the workshop for me was seeing the women’s faces as they processed the information and seeing their confidence grow as they asked and even answered questions for other women in the group. One workshop participant commented that while it was so important for the women to learn this information, that we should also hold a workshop for the husbands because they needed to know this information too! I know that this information will be handed down to daughters and other women in the community so others will also be able to understand their bodies and advocate for themselves at OBGYN visits. But, I also felt sad because as my internship comes to an end, I will have to say goodbye to the women and families with whom I have built relationships. There are still so many loose threads I wish I could help fix before I have to say goodbye.

I am so thankful to have witnessed the strength and determination of these women and their families adjusting to life in a new country. My advice for someone beginning a position like mine would be to listen and absorb as much information as possible. Being able to go with the flow and be all-hands-on-deck when a crisis arises is extremely important. Most importantly, being thankful for the relationships you build with people from around the world, as there is so much to learn from others.

-Maya

Disclaimer: The views expressed in this blog post are mine alone and not indicative of those of IRC.

Post 4: Warrior Princess, Cheerleader, Coach, Listener

Sometimes, my supervisor calls me a warrior princess after I get off a long phone call advocating on behalf of a client. Sometimes, I make exaggerated excited faces and silently cheer as my client successfully schedules their own appointment with a doctor for the first time. Sometimes, I spend the afternoon in the ER coaching a client through asking the doctor questions about how to re-insert their child’s feeding tube. Sometimes, I just sit and listen while a client tells me what they miss about their home country. Sometimes, I spend the day on the computer researching MediCal insurance policies, housing assistance programs, and childcare programs with language capacity to help connect my clients to resources they need.

Example of tasks to be completed during a “normal” day at the office

Every day, I walk into the office, and I’m not sure what the day will hold. Maybe I’ll spend the morning scheduling transportation and interpretation for medical appointments or submitting low-income housing paperwork. Then, in the afternoon, I might be helping a client apply for disability benefits. Maybe I’ll spend the morning calmly reviewing case files, but spend the afternoon completing urgent phone call requests on sticky notes handed to me by my supervisor as she talks on the phone to a client in crisis. The all-encompassing skill I’ve learned at my internship so far is the need to be flexible and willing to play different roles according to the needs of each individual client.

In a prior blog post, I wrote about how IRC offers holistic programming to cater to the needs of each client as an individual. My clients have varying needs because the ethnic, language, cultural and educational backgrounds they come from dictate their transition to a new country.

I have one client who speaks English, has experience in security for the U.S. military in Afghanistan and is working on enrolling in community college classes. This client and I are working on helping him apply for jobs and become more confident in advocating for his daughter with special needs to receive services and quality medical care. For this client, I am a cheerleader and coach.

I have another client who does not speak English, is living in an area without other Afghans, and has no transportation and little awareness of or connection to local resources. This client is focused on getting a job to feed his large family and making sure his wife receives mental health treatment. For this client, I am a warrior princess making sure his wife receives timely care by calling insurance, medical providers, and mental health providers to get her authorizations, referrals, and appointments. I am a coach for phone calls to insurance and doctors as well as a cheerleader when those calls go well (see my last post!). I am also a listener when this client describes feelings of worry around his wife’s mental health and difficulty providing for his family.

As I get to know and work with different clients, I have learned to play a variety of roles to ensure that their needs are met, their thoughts are heard, and their progress and victories are celebrated. To be able to transition between these roles I have learned the importance of being flexible, multi-tasking, and becoming familiar with local resources and policy.

Unfortunately, social justice work can slip into the realm of grouping individuals into a singular “oppressed” category with disregard for their individual characteristics and try to “fix” all of their problems. The recognition of the various identities, strengths, and weaknesses of my clients allow me to think of them as individuals and serve in a variety of roles as a warrior princess, cheerleader, teacher and listener to assist them in achieving their goals.

-Maya

Post 3: How can we measure success?

Programs are measured on the records of their achievements, and the IRC and Intensive Case Management programs are no different. During the intake process, our clients create a list of goals they have for their time enrolled in our program. These goals vary from learning English, to getting a job, to making connections with other people in their community, to navigating the healthcare system.  While this goal-setting process could be seen as “What do I want to be done for me?” it’s really more of a “What skills do I need to (re)learn to survive in this new place and culture?”

Prevalent themes in client goals                                (created with wordcloud)

How do we measure success and completion of these goals? After intake, our program completes a three month, six month and close-out assessment with the client to measure their progress. A numerical scale is used which ranges from safe to very vulnerable. It is common for a client to start at a one or two and move up one value during their twelve-month enrollment period. Does that seem like progress to you?

Yesterday, I spent almost two hours with a client coaching them on using the phone interpreter through their health insurance to schedule a medical appointment. This client does not speak English so the first step is navigating the automated menu in English because the only other language option is in Spanish. Once the client got connected to an operator they had to repeat “No English, Dari!” while the operator asked them in English to repeat themselves and spell the language. After connecting to an interpreter, the insurance refused to schedule the appointment until I intervened and said that insurance is required to provide language services to their members so that they can readily access healthcare services.

We then tried to schedule an appointment with the provider information that the insurance had on file, which ended up having an incorrect phone number, which we discovered after calling the clinic twice. Eventually, the client was able to schedule an appointment for himself! We smiled, applauded, and let out deep sighs and laughs. We laughed even though we had spent two stressful hours on the phone, even though we didn’t speak the same language, and even though we both knew that this was only the first hurdle for this client to receive the appropriate physical and mental healthcare services. That phone call will not move the client up a number on our assessment form, and we will probably have another coaching system in the next few weeks to solidify the skill, but those two hours on the phone were progress.

Will our clients ever fully reach their goals? I hope so. Will all the goals be achieved fully during the course of our program? Probably not. Progress is slow because change is slow and building up people’s confidence is slow. Additionally, some of these goals will not be achieved because of systemic constraints within the healthcare system such as language and cultural barriers causing health disparities, the education system, lack of access to quality mental health services to address trauma and the current political climate with its prejudice, and the lack of welcome towards refugees.

I would be proud to have a fraction of the resilience I see from our clients, many of whom have experienced great trauma. For example, some share stories of a wife patrolling the house while the husband slept to protect him from Taliban bombings as well as the loss of family members left behind in Afghanistan. One of the goals a client shared for their child was that they hoped that their child would “grow up in a safe, secure and peaceful place with access to healthcare and education so that they could pursue their own goals.” So, I will continue to define progress as making difficult phone calls to insurance and building self-confidence to complete other tasks. These are the first steps to helping our clients make their goals for themselves and their children a reality.

– Maya

Disclaimer: The views expressed in this blog post are mine alone and are not affiliated with the views of the IRC or ICM program.

Post 2: Thoughtful Social Justice Work and Providing Tools for Self-Sufficiency

 

A wide variety of programs offered at the San Diego IRC office (source)

What I love about the Health: Science, Society and Policy program at Brandeis and the compliment it provides to the Biology program is that it allows me to think about both biomedicine and the sociological perspective of health. In the class Sociology of Health and Illness, I learned about the distinction of illness and disease, where a disease is the biological mechanism within the body causing symptoms while an illness is the symptoms and how the person experiencing them feels. A disease is seen and measured in a doctor’s office, while an illness is the lived experience and how a person manages the condition in their day-to-day life.

This distinction has guided my work with Intensive Case Management at IRC because I am focused on the day-to-day life of my clients and their lived experiences. While a client may have diabetes, I am not focusing on their blood sugar level or their insulin dosage; instead, I am focusing on making sure they have access to food, transportation to doctors appointments, and an interpreter to allow them to share concerns with their doctors. As someone focused on medicine at Brandeis, this has been slightly difficult for me because I am interested in the blood sugar numbers as a mechanism to allow me to understand what is going on in the client’s body to then dictate their treatment. What I would miss there would be that I am not thinking about the client’s lived experience and how they are managing their symptoms along with other trials of adjusting to a new country and way of life.

Refugee resettlement at IRC takes on a holistic approach by considering clients’ physical, emotional, and psychological needs during the resettlement process. The services during the first ninety days include multiple trips to the refugee health clinic for health screenings, signing up for health insurance, cash aid, food stamps, enrolling children in school, a cultural orientation, and finding and furnishing an apartment. While these services are required by the federal government, IRC goes beyond this by offering my program as well as an anti-trafficking program, and various employment programs to aid refugees in their transition to the U.S.

These extended programs and the IRC philosophy of “building programs that rebuild lives” works to do just that — help to build a better life for the whole person, not just medically. With their variety of programming, IRC is helping refugees and recognizing their many identities as parents, farmers, children, teachers, providers, and, most importantly, as human beings. It might be easier to sign people up for services and not teach them how to utilize those services and advocate for themselves, but IRC, like the sociological perspective of health and illness, recognizes that it is essential to focus on the lived experience and how to make the day-to-day events possible.

The proverb, “You can feed a man for a day by giving him a fish or feed him for a lifetime by teaching him to fish,” sums up the importance of helping people towards self-sufficiency. People, no matter what circumstances they have overcome, are still individuals and should be treated as such. In social justice work, it is important to refrain from grouping people into the category of “oppressed” and taking the stance of a “fixer” to fix all of the problems of the “oppressed group.” Providing resettled refugees with the tools and support to become self-sufficient and recognizing and celebrating their identities allows IRC to do social justice work in a thoughtful and holistic manner. IRC prioritizes these ideas while making a real difference in the lives of the individuals with whom they work.

– Maya

Post 1: WELCOME! خوش آمدی

IRC Logo www.rescue.org

Hello everyone! My name is Maya London and I’m a rising senior studying HSSP and Biology with interests in public health, healthcare access in vulnerable populations, shared family health behaviors, and the patient-provider relationship. To learn more about the needs of medically complex and vulnerable populations, I chose to intern with IRC Sacramento in the Intensive Case Management program.

IRC is an international humanitarian organization that responds to humanitarian crises worldwide and serves as a refugee resettlement organization within the United States. Their motto is “From harm to home.” The domestic branch provides holistic resettlement services to assist refugees in their transition to American life by picking them up from the airport and then helping them register for healthcare and English language classes, find a home and become oriented to American culture.

While the initial resettlement period required by the government is only 90 days, IRC has recognized that there are some clients with disabilities, complex medical issues, or other vulnerabilities who need more assistance navigating social systems to become self-sufficient. My program in the Sacramento office exists in addition to the initial resettlement program and enrolls clients for up to 12 additional months. Our services include coordinating medical and mental health appointments and social services, accompanying clients to appointments and, most importantly, assisting our clients in achieving their goals and becoming self-sufficient.

So far, I have learned to schedule client’s medical appointments, interpreters, and transportation services, as well as advocate for clients during medical encounters. Additionally, I have helped clients read through social services paperwork, as well as coaching them in their communications with doctors and other medical staff.

Some takeaways from my first few weeks have been the need for change in U.S. medical, insurance, and social services systems to make them more accessible for non-English speaking clients. Most of the refugees in Sacramento are SIV (Special Immigration Visa) holders from Afghanistan and speak limited if any English, in addition to some combination of Dari (the language in this blog post’s title), Pashto, Farsi or Urdu, so navigating mechanized phone menus with the only additional language option being Spanish is next to impossible. Yesterday, it took me three tries to get through to an operator using the automated menu, and when I told them my client was non-English speaking and that going through the menu system would be difficult for them, they told me to simply write down the series of numbers the client would need to click to enter into the system.

My clients are also clients of socials services, insurance companies, and schools in this area and their needs must be met in the same way as any other client. This summer, I am excited to learn more about the barriers faced by my clients and advocate for change in these systems. I hope to be able to bring the experiences and knowledge from the “patient” side to my career as a family physician and have a better understanding of the barriers faced by my patients, and how I can best support them in their health journey.

Disclaimer: The views expressed in this post are my personal views and not those of IRC or the Sacramento office.