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Care.” Demographically-speaking, there are 1.3 million residents in Maine; 3.9 % are foreign born; and 6.5% speak another language other than English. Of the refugee population arriving in Maine, 61.8% are from African countries; of those, 61.1% are Somali natives. In 2016, African immigrants made up 1% population of Maine. From the statistics alone, CCCG emphasizes the growing need in Maine, and across the US, for people to be culturally literate. “[As cultural brokers] we can kind of figure out how we can best get patients what they need,” Regina says. Cultural brokers, as opposed to just interpreters, are leaders in the community with lived experience and education about their culture. Deqa references a time when she was a cultural broker for a Somalian woman. During her exam, the physician asked the woman if she has sex with men, women or both. In the US, it is a standard question made to be inclusive of the LGBTQI community by not making assumptions of patients’ sexual preference or behavior. “The woman became angry,” Deqa recalls, “and wanted to know why she would be asked such a question.” The Somalian woman didn’t understand that this was a question the physician asks of all his patients. “When it was explained to her in this way, she understood it better and was able to answer the question,” Deqa says. “If you ask in this way, be mindful what questions you ask, especially if they don’t speak the language.”
Regina Phillips, MSW, Abeir Ibrahim, Deqa Dhulac, MSW, MDP, Fides Elamparo, COM '22, Hwyda Arafat, MD, PhD, MSc MEdL, and Karissa Rajagopal, COM '22
The More You Know
During the presentation, students were faced with different scenarios to determine solutions on how to approach particular situations. “Students may not stay in Maine,” Regina says. “Working with refugee populations and people of color is going to come up.” During the scenarios, Regina, Deqa, and Abeir discussed best practices in their field. Regina gave an example of the difference between medicines in the US versus other countries. When physicians dispense medications to patients and expect them to be compliant, if their patient is Muslim, they need to take into account whether the pill has pork in it, or to help the patient understand how a little white pill is supposed to make them feel better. “There is a huge disconnect between physicians and their patients,” says Regina. Abeir reiterated with a story about a 15-year old boy from Iraq who was at home having a mental health crisis. When the police arrived on scene, they neutralized the situation by placing the boy in handcuffs. To the family present, the cuffs translated that their son was a criminal, not that he was sick. “Remember the person in front of you does not believe in your system," Abeir says. "Healthcare does affect how we've been treated or what we request out of our providers. And I believe at this point, it's a must learn for any medical provider.”
Taking a patient’s culture into consideration is vital in establishing trust, and while first impressions are important for all physician-patient relationships, they are especially important for communities of color. “First impressions are so important,” says Regna. “You want to make a good impression because otherwise they won’t come back… this is about having a conversation… try to gain their trust right at the beginning.”