Community Health Workers (CHW), work under many different titles and in many different settings. They bring their training along with their shared language, culture, and/or life experience to effectively provide culturally-competent outreach, patient education, navigation, care coordination, and/or advocacy to underserved individuals, families, and communities. They advance health equity, help achieve the Triple Aim (improve population health, improve patient experiences, and reduce per capita costs), as well as expand and diversify the health care workforce.
Born in Burma to a Tai family, 12 year old Aung Win left home to escape the violence and civil war that imperiled his community. After spending several years in a Thai refugee camp, he joined his older brother in Minnesota. Win vividly remembers his arrival date—Feb. 26, 1999—and the many adjustments he faced such as cold, snowy winters; high school; and learning English. “This was all part of the excitement of coming to the United States,” said Win, although he admits that it was a big culture shock to adapt to a new country.
Using his multilingual skills in Tai, Shan, Karen, Burmese, Thai, and English, Win spent several years as a medical interpreter in the Twin Cities. Then a new door opened at HealthEast Care System in May 2012. HealthEast was recruiting community health workers to serve as care guides for its health care home model.
“When I heard the word ‘community,’ I knew that this new health role was for me.”
As one of 21 care guides currently employed by HealthEast, Win serves on the health care home team along with physicians, consulting nurses, and medical social workers to provide patient-centered care to a growing number of patients with chronic illnesses. He brings his language skills, cultural competence, life experience, and CHW training to his role at Roselawn Clinic, which serves many Karen refugees. In addition to on-the-job training offered by HealthEast, he completed the CHW certificate program at Minneapolis Community and Technical College.
Win starts his day at 7 a.m., checking his voicemail for messages from his patients or their caregivers. His growing patient panel, now at 120, ranges in age from a 1 to 86 years old, all with chronic illness and nearly all Karen.
Many of his patients also experience depression and other mental health problems related to post-traumatic stress disorder compounded by the situational stresses often associated with resettlement. He understands that Karen cultural beliefs about mental illness mean that many refugees, especially men, are reluctant to seek help for depression. Among his biggest challenges are finding culturally- and linguistically-appropriate mental health services for his Karen patients.
Every day Win meets with several patients who are new enrollees to Roselawn’s health care home program following their initial visit with their physician. He helps them set meaningful and achievable individual health goals in consultation with their doctor. He will then follow-up with them by phone to monitor progress, field or refer questions, and link patients to needed resources. Win contacts HealthEast’s consulting nurses and medical social workers when issues arise that require their expertise such as acute medical crises or child/adult protection matters.
Helping patients understand how to manage their chronic illness and how to use the U.S. health care system are ongoing, important care guide responsibilities. For example, patients may not understand the need or the process to refill their prescriptions, or they may use the emergency room or hospital instead of primary care. “I’m able to take the time that my patients need to understand how to navigate our complicated health care system.” Win also follows up with patients after they have visited with specialists.
Every other week, Win participates in a care guide meeting where he and his colleagues share success stories, discuss challenges, and identify improvements. They also discuss how to work most effectively on their teams. What’s it like to work on a health care home team? Win smiles and quickly answers, “Awesome! We have many success stories.” Monthly meetings bring together all team members for recognition, shared learning, occasional case discussions, and continuous improvement.
“The best part of my job is helping patients address barriers to health and to learn how to manage their care,” said Win.
For example, helping the parents of a 1-year-old born with kidney problems set up and make regular visits to the renal specialist and then follow through on daily medication means that their toddler is now doing well. Working with his diabetic patient on the importance of a healthy diet, regular exercise, and medication compliance translates to measurable improvements leading to better health, lower costs, and improved quality of life. And connecting a depressed parent with culturally-appropriate, affordable mental health services can impact the well-being of the entire family.
When he leaves the clinic at 4:30 p.m., Win knows that he and his health care home team are making a difference by helping patients with chronic illness succeed in living healthier lives.
Republished from Refugee Health Quarterly, Vol. 10, January 2014, with the permission of the Minnesota Department of Health.