Small-town hospitals brings big-time case to immigrants
By Matthew Malamud, as appeared in the September 3, 2007 issue of AHA News
Siler City, NC, is probably best known as the home town of Frances Bavier – the actress who played Aunt Bee on “The Andy Griffith Show.” Located about 50 miles west of the state capitol in Raleigh, the tiny town once upon a time resembled the fictional town of Mayberry, where the Andy Griffith Show was set; however, in the 1990s an onslaught of migrant workers primarily seeking jobs in the local poultry plants altered its population composition and the demand on health care services.
Today, though Hispanics represent more than 50% of the Siler City population, “they are significantly underserved from a health care perspective,” said Pamela Frasier, Ph.D. and associate professor at the University of North Carolina Department of Family Medicine. She is director of the Hispanic Health Initiative – a program that promotes wellness among the community’s Hispanic population in Siler City and greater Chatham County.
Frasier, with support from Chatham Hospital – a small, rural critical access facility – and an initial grant from the Duke Endowment, in 1998 developed the initiative, which today includes lay health advisors; workplace health roundtables; a breast cancer screening program; diabetes self-management programs; bilingual child-safety experts; free dental clinics; free health-risk assessments; a community garden; an interfaith health ministry designed to help those with long-term illnesses or disabilities lead independent lives; and a doula (birth coach) program where trained and certified women assist expectant mothers before, during and after childbirth.
“After researching what others across the country were doing and what had worked in other countries in South and Latin America, we decided that a ‘freirian model’ would be our best approach, where [we] use lay health advisors,” said Frasier. The freirian education model involves teaching or relaying information in a less formal manner than the more traditional teacher-student approach; learning is based on dialogue.
With the support of local leaders from Hispanic churches and businesses, Frasier trained bilingual individuals with an interest in health to relay information in Spanish to others about such things as understanding insurance benefits available to poultry plant employees and how to learn about certain illnesses. Queries range from the basic, like how to treat poison oak and ivy, to how to eat healthy once diagnosed with diabetes.
The program has grown from its start with four lay health advisors to today’s many services. While the initiative operates out of a central office, most of the programs function within the community. The goal, as Frasier sees it, is for the Hispanic community to have equal access to health care. “The more people know about what their health care needs are, the likelier they will utilize the resources available to them,” she said.
The impact of the program has been very positive, according to Frasier. The initiative keeps clinical data that have demonstrated improvement in individuals’ health outcomes, and outside observers have documented similar findings. For example, one student from the UNC School of Public Health, for a master’s thesis, studied the Chatham Comadre (co-mother) project, or doula program, and reported several benefits expectant mothers received from the program. In a review of the diabetes self-management program, another student observed marked improvement in participants’ knowledge of the illness and ability to manage their diabetes.
For their work, the initiative has received several awards. Most recently, DONA International – an organization that promotes the use of doulas – honored initiative volunteers with the Annie Kennedy Award for excellence in a doula group for the initiative’s vision in meeting the needs of the community.
According to Carol Straight, Chatham Hospital CEO, the program owes its success to Frasier. “Pam was successful because she worked in the community and with the community and mobilized people in the community… In some ways she has worked herself out of a job because she has organized them to become self-sustaining,” said Straight.
Still, Frasier sees herself as just a member of a greater community of like-minded people who value family and community above all else.
“Last year,” recalled Frasier, “we had a major dental event because it is a major need in the Hispanic community. The former CEO of Chatham Hospital and the police chief and other community leaders got up at 4:30 in the morning to cook a ham and eggs breakfast for 70 or 80 volunteers in a local church. That really hit home with me that there was such a sense of community and such an outpouring of leadership in the community. Where do you see a hospital CEO or police chief getting up so early to cook breakfast for a big group of people?”