Monday, March 12, 2018

Lowry health navigators: A bridge between patients and providers

For years, the Lowry Family Health Center in East Denver was an infirmary for the U.S. Air Force. When the Air Force left, it was sold to Denver Health on the condition that it always be used to provide health care.

Nearly four years ago, Denver Health remodeled the facility into a modern health care center, where approximately 20 health care providers see around 150 patients a day, primarily refugees and immigrants. The center includes a WIC clinic for mothers and infants, dental services, a modern laboratory, Pharmacy, enrollment services for Medicaid and thousands of books lining the clinic walls - every child seen at the clinic receives a free book donated by R.O.A.R. (Reach Out and Read) as well as other community supporters.

As Denver Health Center for Refugees Services, Lowry is a global village of culture, languages and needs. Patients speak as many as 52 different languages and many come from places where health care services are unavailable or unknown, where health care practices as common as brushing teeth or getting vaccines are not part of their culture, where being healthy means not being sick and seeing a doctor can be a sign of weakness. Some need basic health care, while others have more serious conditions.

Connecting them to care is a cadre of five health navigators, some themselves refugees. While they carry a daily caseload of patients, they say there is no “typical” day. They spend much of their time interpreting languages and cultural needs between patients and providers, but they also remind patients of upcoming appointments, explain medical procedures and expand their health literacy to help them lead healthier lives and manage their own health care. Sometimes they arrange transportation or show them how to use mass transit, refer patients to food and housing assistance, help them find child care or simply stand by them as they face their health care fears.

“People get lost and confused” said Menilik Asfaw, a health navigator from Ethiopia, where he earned a medical. “I work as a bridge between patients and providers.”

The patients he works with have already been through a lot, he says, fleeing the threats of their homeland and facing new challenges in the land they now call home. The most important thing health navigators can do, he says, is establish trust. Once they’ve established that trust, they can more easily talk to patients about their needs, guide them through the clinic’s health care services and establish a connection with the clinic’s providers. 

Asfaw recalls a refugee from Southeast Asia who he had tried to reach for two months, left dozens of voice mail messages about upcoming appointments, only to wonder why he didn’t show up. He contacted the case manager at the voluntary organization, who went to the patient’s home to find out if anything was wrong and brought the patient back to care. At the clinic, Menilik asked the patient why he had not responded, only to find out why he didn’t know how to operate the voice mail command on his mobile phone. He showed him how to use the phone, to make calls and how to retrieve voice mail messages and he went on to catch up on all his health care needs.

“You have to be patient and understanding, because some patients start slow, others fail and many have to start again to access health care,” he says. “One thing I can do is help.”

A passion for helping people is what brought Adrien Matadi to the Lowry Family Health Center as a patient navigator. He also had to flee to Ethiopia, where he received his law degree and did his internship at the African Union in the Legal Department. In danger of being hunted down and killed, he immigrated to the United States where he had to start over “at the bottom.” Having experienced both sides of life gave him a unique perspective on the unmet needs of refugees, including a peaceful and secure life.

Once in Denver, he dove into community outreach and social work to make sure “immigrants’ voices would be heard.” After seeing the need for health care in his community, he joined the clinic and received patient navigator training supported by the Colorado Department of Public Health and Environment. Like Asfaw, he carries a daily caseload of patient and provider interactions, from easy to difficult.

One of the more difficult but rewarding experiences he had was with a young mother from the Horn of Africa whose child had so many health issues; she didn’t know where to start. Matadi helped her navigate an examination in one location, followed by two medical procedures in different locations and safely back home in a day’s time - a Herculean effort for refugees who had never before seen a doctor. To ensure the family stayed healthy, he connected them to food and housing support.

“All these little contacts become cultural exchanges,” Matadi said. “We are just there to guide them to a good decision and to live a health, decent and peaceful life.”

That guidance, that cultural bridge between patient and provider is what makes patient navigators critical to the success of the Lowry Family Health Center, says Nurse Manager Cynthia Vais. She sees lack of knowledge, fear of health care, stigma of poverty and confusion of clients visiting her clinic every day. Patient navigators, she says, are seen as community leaders and trusted by patients and providers alike. The clinic runs better because of them.

“Because of them and the passionate providers we have, our clinic helps hundreds of people each day that would otherwise have nowhere to go,” said Vais, a 25-year+ veteran of nursing, who says managing Lowry is one of the best job she’s ever had. “It’s making my heart sing.”

By David Brendsel
Colorado Department of Public Health and Environment

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