Providing Culturally Humble Care: global health comes to Milwaukee
“The family is roasting coffee on their carpeted floor; we need to address food safety,” a volunteer told me. She visits refugee families in their homes, troubleshooting problems and creating community.
I am one of the Nurse Practitioners at Aurora Walker’s Point Community Clinic (AWPCC) in Milwaukee. We provide primary care to people from around the world, refugees from Asia and Africa and immigrants from Latin America. For 25 years, AWPCC has mostly served Spanish speaking clients, but refugees now add to the diversity at AWPCC.
Nearly 300 refugees are currently patients at the AWPCC. We try to provide culturally competent care, or “culturally humble” care, as we listen and learn different perceptions of health, time, beauty, faith and medicine. We use conferences, online materials and interpreters to help bridge some of the cultural gaps. But most importantly, we support one another, checking CDC recommendations and other resources that guide our practice.
Because each refugee completes a very long immigration process before entering the United States, many have been waiting more than 10 years in refugee camps. Children are born in the camps and grow into school age kids as their families wait. Once in Milwaukee, local resettlement agencies help refugees connect with services. Health screenings at AWPCC (including tuberculosis, parasite and mental health screenings, records review, and care for both chronic and urgent health needs) usually happen within days of arrival from Myanmar, Syria, Iraq, Somalia and other countries. In 2017 we completed 180 health screening exams for newly arrived refugees. Latent tuberculosis is not uncommon in refugees and AWPCC provides directly observed therapy for latent tuberculosis, including home visits for families who would have difficulty navigating weekly visits to the clinic.
Each refugee brings their own unique health history and stories of migration and loss. AWPCC has on site counseling and trauma counseling available. We also collaborate with volunteers and other agencies to create events that bring refugees together. AWPCC hosted several “Welcome Baby” events for Syrian, Rohingya and Somali women due to give birth to their first American-born babies. At the last event, 18 pregnant women celebrated together and received loads of baby items.
In addition to traditional primary care, WPCC experiments with innovative ways to bring health and wholeness to the community. Each year, 450 women receive free cardiovascular screening, and breast and cervical cancer screening through the Well Woman/Wise Woman programs at our clinic. In collaboration with the CDC and the State of Wisconsin, the programs help women understand and reduce their cardiovascular risk, following the women year to year, supporting positive change and documenting their progress.
“Reto Dulce” is a new program developed at AWPCC for diabetics. It is a social media program to help people with diabetes maintain or improve diabetes self-care over the winter months. Reto Dulce is now recognized by the Wisconsin Wise Woman program as reimbursable. Individual health coaching is also available to help people identify their health goals and motivations.
Spanish speaking patients can participate in free nutrition classes, brought to the clinic by the UW Cooperative Extension. Healthy foods are prepared on site. Spanish speaking women can attend ¡Venga y Relájese! (Come and Relax) stress reduction classes. Participants achieve short-term reductions in stress, enhanced self-perceptions of wellness, and significantly improved perceived control of their stress. Further, it creates constructive social spaces for Latina women to reduce isolation and share their stories while learning healthy coping strategies.
AWPCC completes approximately 12,000 individual patient visits a year. We strive to help those who help make Milwaukee a vibrant and vital place to live.
Carolyn McCarthy is a nurse practitioner at Aurora Walker's Point Community Clinic in Milwaukee.