The Power of Listening: Communicating Across Cultures

As a Patient Navigator on Squirrel Hill Health Center’s mobile medical unit, I travel to areas of Pittsburgh that are home to some of our city’s most underserved populations. In any given two-week period, we visit two neighborhoods of predominantly Nepali-speaking Bhutanese refugees, two predominantly Spanish-speaking neighborhoods, a behavioral health center, an opioid addiction recovery center, and an old Pittsburgh steel community. Each of these sites is located in an area of the county where access to primary care services is severely limited.

I was originally drawn to the position at Squirrel Hill because of the incredible diversity of the health center’s patient population. Despite my enthusiasm for this, however, getting to know the culture and environment at each different mobile unit site seemed slightly daunting at first. Each neighborhood population faces its own unique challenges, and I wanted to make sure that I became as informed about each of them as possible.

Surprisingly, I have been able to gain this knowledge much more naturally than I expected. In addition to my more formal roles, I unofficially serve as the “gatekeeper” for the mobile unit, chatting with patients while they are waiting to be seen by the provider and doing my best to put them at ease. In these interim moments, many of our patients will tell me pieces of their stories. I have had patients tell me about challenges from their constant struggle to stay clean to their flight from their home country to their frustration at the lack of fresh food in their area. In each case, I offer support and empathy as best I know how. While these one-on-one interactions are small individually, they have allowed me to piece together a picture of each site in a way that I never could have done otherwise.

My interactions on the mobile unit have also taught me how to work most effectively with people from diverse backgrounds. For example, I have learned that in the Bhutanese refugee community, family members tend to be far more heavily involved in one another’s healthcare than is typical in most Western societies. Often, several family members will come to one person’s appointment, and many members of the extended family are kept informed about the patient’s care. I am no longer remotely surprised when five people show up for one appointment, and I do my best to comfortably accommodate them all and make them feel welcome.

Talking with my patients while helping them find referral services has also highlighted for me some of the major flaws in our healthcare system. Our uninsured patients are often hugely burdened by something as simple as a diagnostic test order. Our non-English-speaking patients often express anxiety about going to see a specialist physician, because navigating an already complex system is particularly difficult for them. Our patients in outlying areas tell me that they haven’t seen a dentist in years, because there are no offices anywhere nearby that accept Medicaid plans. I am always grateful for these opportunities to learn firsthand about how our systems can be improved upon, especially as someone who wants to pursue a medical career. My conversations with our patients have been some of the most rewarding parts of my experience thus far, and I am looking forward to continuing to learn from them in the months to come.

This post was written by NPHC member Sarah Crowe.

Sarah serves at Squirrel Hill Health Center as a Patient Navigator.