Archives for February 2017

Simple, but Powerful Medicines: Patience, Listening and Trust

By the end of my time at Davidson, I had become so accustomed to immediate results. After a long evening session in the library, elegant graphs, lengthy Spanish sentences, and even chapters of my thesis would appear before my eyes. It was so satisfying to see my ideas and efforts rapidly crystallize into a tangible product (a metaphor for my organic chemistry professor, Dr. Stevens).

Thus, when I first began my fellowship at Mountain Area Health Education Center (MAHEC), I myopically assumed that I would instantly see “results” in all of my projects. I thought to myself, “I am going to make a radical impact, immediately”. How idealistic of me! My sense of time was completely skewed. It can be very difficult to change an individual, a community, a culture or a system. Difficult, but still possible. Through both my research and clinical roles at MAHEC, I have learned to embrace my work with a new sense of patience.

As a research fellow, I am involved in two projects. One project is a community education program for long-acting birth control, which aims to reduce unintended pregnancies in two surrounding rural counties in western North Carolina. Since the topic of birth control can be controversial, we recruited 15 local community members to help us design a culturally-sensitive birth control message and figure out appropriate ways to spread it. Although designing our own campaign is much more time-intensive than distributing existing posters from an established birth control campaign, our thoughtful approach will hopefully have a long-term impact because we are developing a culturally-specific message that will actually resonate with the people in our target communities. This project has shown me the vital importance of patience. My other main research project is a study on childhood trauma and the social determinants of health. I appreciate this research project because it has enhanced my understanding of the psychosocial factors and human behaviors that affect health.

As a community health worker, I get to apply what I’ve learned in my research and address some of these psychosocial factors and behaviors with actual patients. In essence, I help patients follow their treatment plans and engage in behaviors that positively impact their health. Helping patients adopt a healthy behavior, such as eating a more nutritious diet or quitting smoking, usually entails changing a deeply ingrained unhealthy habit. This aspect of my work has tested my patience in a new way. It may be one of the most challenging things I’ve ever done, given that humans are creatures of habit. During the first few months of my fellowship, I felt frustrated. I kept asking myself: “Why am I not seeing results? How do I motivate my patients to change their behaviors? Where does motivation even come from?”  I contemplated this last question for a while. When I asked Cathy, my wonderful boss and mentor, for advice, she encouraged me to take time to learn more about my patients’ interests, activities, goals and dreams. So, I started listening.

I learned about my patients’ lives. I listened to their stories. I learned what brings them joy and meaning. Although listening seems like a simple task, I have found it to be one of the most crucial clinical skills. After learning what things are important to to my patients, I am more effective in helping them adopt healthier behaviors because I can encourage and motivate them in a personalized way. This approach requires more time and patience, but it’s worth it. Additionally, I have observed a powerful side effect of listening — it builds trust; it demonstrates to patients that I am invested in their stories, instead of merely being interested in their medical progress.

I am especially grateful for my impact fellowship because it has enabled me to understand these lessons before I enter medical school and begin my career as a physician. In my medical school personal statement, I wrote the following sentence: “I grasped the power of listening and the importance of making patients feel heard.” From my work at MAHEC, I have learned that it is so crucial to not only listen, but also to make patients feel heard, recognized and validated; to bring compassion and to be really present with patients in the midst of their vulnerability, pain and illness. That is how a lot of the healing happens. Listening, trust and compassion are some of the most powerful medicines I’ve seen.

Pictionary in Tanzania: Bridging Cultural Gaps at the Touch Foundation

I am a Program Analyst at Touch Foundation in Mwanza, Tanzania. Over my time at Touch the program team has consisted of 2 Australians, 1 Bulgarian, 2 South Africans, 1 American, 1 French person, 4 Tanzanians and 2 Italians. Not only is there a variety of nationalities but religious backgrounds, professional backgrounds, and socio-economic statuses vary greatly throughout the team. Needless to say there are a lot of cultures working under the same roof towards the same goal: strengthening the health care system in the Lake Zone of Tanzania and more broadly the country. This diversity manifests itself in a variety of different ways throughout our open-plan office. On the main whiteboard there is a section for Dutch words, Southern phrases and Kiswahili numbers.  There are three languages spoken at any one time in the office, and it is commonplace to hear intelligent conversation about world events showcasing opposing perspectives. At first I was overwhelmed by this culture driven by diversity because I could only understand one of three languages. However, after spending 7 months immersed in this unique environment I am able to understand Kiswahili and I have become accustomed to our team dynamic. Especially now, given the current global political climate, and after my initial time here at Touch I am energized by the vast perspectives and challenged by how to positively influence the team dynamic.

A true test of adapting and facilitating team dynamics in a diverse group appeared when I was charged with planning the office holiday party. Naturally, I wanted to have a game for all of us to participate in to facilitate conversations and team cohesiveness (the Davidson Outdoors group facilitation skills course (GFSC) taught me well). The situation was made all the more complex because it wasn’t just my colleagues (that are already a diverse group) but their families as well. The game needed to be equally accessible and entertaining to people who cannot speak English, people who do not work for Touch, people who are very skeptical of games, people who cannot read, people from various religious backgrounds, and people aged 4-60. After a brief time on the internet I only found appropriate behavior for an office holiday party (pretty entertaining but irrelevant) and games that were specific to the white American Christian holiday experience. While some of the games were appealing and familiar to me (as a white American woman raised in a Christian household) there were no games that met all of the criteria. To involve everyone I needed to step outside of my familiar cultural context and be intentional about inclusivity and tap strongly into my sense of creativity.

After laboring over it, I finally developed a unique activity. The result was a Pictionary type game which required everyone draw a depiction of what they spend most of their time doing: personal or professional. Then, we passed the pictures around and individually had to guess who drew each picture.  While the game was not flawless (communication barriers still existed between English and Kiswahili) it was successfully completed and everyone seemed to enjoy it. For all of the Touch employees, it allowed us to communicate about the work we do in a different form other than spread sheets and power points (a sometimes cold and inaccessible form of communication) to our colleagues and families.

I could have easily picked a game like “name your favorite Christmas memory”, but the majority of the party guests would have felt isolated making for an uncomfortable evening. Instead, the team and our families connected across all of the cultural lines, allowing everyone to contribute and feel included. While this was just for a holiday office party I have seen this situation manifest itself in different ways while working here. I have come to know that being a part of a diverse team is challenging and it is easy to fall back on familiar culture norms. However, when the diversity is embraced and everyone’s perspectives are equally valued, the team works more efficiently and thinks more deeply.

I am lucky to be in an environment that pushes me to think beyond the white, Christian context I was raised in. It is not always easy and comfortable but exposing oneself to “foreign” perspectives and experiences is necessary in today’s world. Working in this diverse environment with atheists, Muslims, Christians, men, women, etc., I am able to empathize with people who are continuously discriminated against and targeted. This empathy is missing in our world today and is something that should be prioritized throughout the United States and the world.