BEYOND BORDERS
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Photos of undergraduate student and high school student mentor-mentee pairs for Refuge Collaborative .
experienced such a loss of one or more children , in addition to the war and trauma they experienced before fleeing their homelands .
These differences necessitate providing orientation to patients to U . S . health care systems . I have the privilege of giving immigrants exciting news : that 911 and emergency health care is available to everyone regardless of the ability to pay , that medical interpreters are a right , and that locally we have enough doctors and dentists for routine visits to prevent problems . My patients are surprised to learn that the tap water does not have to be boiled before drinking , and that you can tell the fat content in milk by the color of the lid . In many countries , if medication is needed it is provided in full for the treatment duration and prescriptions are not necessary , so I explain that in the U . S . prescriptions are needed , and depending on insurance , they may need to go back to the pharmacy every month for a refill to avoid running out and having health problems . I offer to send prescriptions to a pharmacy with free monthly delivery to overcome lack of transportation .
Another point of culture shock can be the change in power dynamic . Overseas , doctors often give very clear recommendations , not necessarily weighing the risk versus benefits decision aloud with the patient . This can be confusing for immigrants to be suddenly forced into what can be an uncomfortable position of power to make their own decisions , where they are used to being given a clear direction . I often see patients shut down a conversation when they hear that a procedure or medication may have a serious risk , cutting off the possibility of weighing the benefits of the proposed option . By first establishing rapport , trust and mutual respect , I can more easily support my patients into that position of power in decision making . I ask more questions about aspects of their life that could affect this decision and elicit their personal values that could be impacted . After reviewing risks and benefits , I may offer a synopsis and what seems to be the best path forward in my opinion , and then my patient can make an informed choice that meets their values while still understanding risks involved .
In addition to bridging gaps in clinical care by orienting and explaining decisions in a culturally sensitive way , there are many more gaps yet to bridge locally . While many of my patients tell me they want to be a doctor or health care worker when they grow up , I still see a gap in representation in medicine . International medical graduates make up 1 in 5 physicians in the U . S ., filling important underserved areas in health care , 1 but the barriers for first generation immigrant children in low-income families attempting to achieve higher education in the U . S . remain significant . 2 We have seen increasingly diverse admissions to our medical student classes along with increasing interest in health equity . This gives me hope , as well as an eager volunteer pool , and an opportunity to meaningfully address the education gap . Last year , I started a local chapter of Refuge Collaborative , an organization of undergraduate mentors
18 LOUISVILLE MEDICINE