How to help families struggling to find their way in a foreign culture [PODCAST]

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“We are blessed to work in a clinic that has a very large immigrant population. Over the years, we have cared for those who speak over 80+ languages with an even higher number of unique countries and regions represented. Arabic and Spanish are our two most commonly spoken non-English languages. We also have patients who speak unique languages such as Kurdish, Zomi, and Uyghur who do not have a corresponding recognized country affiliated with them. Several of our staff and residents are foreign-born. Many of them are first-generation or come from ethnic homes, and nearly all have a deep appreciation for world cultures. Despite this, there is no way we can know about every unique culture and every corresponding custom. Yet studies have shown that immigrant families are strongly impacted by clinic members’ demeanor towards them and their perceived acceptance of them. Maybe it is the language struggles that make our unspoken actions so important, but it is a factor that needs to be accounted for, especially in COVID times, where even basic facial gestures of greeting are not seen. Families may decide if they want to come back to our clinic based on something that we did or didn’t do, such as simply making them feel welcomed.”

Gabriella Gonzales is a pediatric resident.

She shares her story and discusses her KevinMD article, “A simple act to help families struggling to find their way in a foreign culture.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Gabby Gonzales. She’s a pediatrics resident. She co-wrote many KevinMD articles, the last of which is “A simple act to help families struggling to find their way in a foreign culture.” Gabby, welcome to the show.

Gabriella Gonzales: Well, thank you so much for having me. I’m happy to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Gabriella Gonzales: Yeah, for sure. So I grew up in Northern Kentucky, Florence, Kentucky, if you’ve heard of it. A lot of people know it from the water tower by our mall. I grew up there, then went to undergrad at the University of Notre Dame in Indiana, and came to medical school at Ohio State, actually, and that’s where I’ve been, in Columbus, for the past five years now.

But yeah, I really came to medicine in a roundabout way. I knew I always liked math and science growing up. My mom was a very strong proponent of having my sister and me both go to a lot of STEM meetings, and of being females in medicine and math and science specifically. It was great to have all these strong women in the sciences coming to speak with us, in our schools and in programs through our libraries and things like that.

So I initially thought that I wanted to do engineering. That was what I liked in high school. But I had a really great opportunity my senior year of high school, actually working at our local children’s hospital, shadowing and just navigating the world of pediatrics, and I really fell in love with medicine. Since then, through work at clinics, through my work in undergrad especially, just working at volunteer clinics and things like that, my passion just grew, and now I’m here as a pediatrics resident.

Kevin Pho: So you’re just entering your second year. How is the pandemic affecting your training, as well as affecting the incoming intern class?

Gabriella Gonzales: So it’s definitely been a difficult past few months. I’m very thankful that we haven’t had too many cases at our children’s hospital, and it seems like this COVID is affecting more adult patients. So thankfully, we haven’t had too many sick children here. Particularly where I live, in Columbus, our governor was very quick to shut things down and enforce the social distancing rules and things, so we didn’t see too much of that here, too much of COVID.

But yeah, I feel like each day I go to the hospital, there’s a new practice, that we’re wearing another mask or goggles or things like that. But I’m very appreciative that within our residency, and higher up within the children’s hospital where I work, they were very, very great about weekly communications and things, and taking a lot of feedback from even just residents, second-year residents, first-year residents.

So I think that this is something new for everyone, and that was definitely a surprise for me at the beginning of all this as a trainee, also seeing some of my preceptors, these people who have been in the field for long periods of time, who are also learning how to navigate this unknown. But medicine is a team sport, and I feel like we’ve all been working, and we’re working as a team, to help navigate through all this craziness right now.

Kevin Pho: One of the earlier KevinMD articles that you co-wrote was tips that you could share with incoming interns. Now, especially during the pandemic, do you have any advice to share with that incoming class?

Gabriella Gonzales: Yeah, for sure. So I have always been really interested in mentoring, from high school to college to medicine to my career as a resident, mainly because I’ve latched on to mentors through my life as well, and I’m so appreciative of their guidance. I think that was one of our big points within that article: asking for help and looking to those not just older than you, but who are more skilled and more trained in things that you’re unfamiliar with.

I think that as physicians, we try to think that we have all the answers, and we try to figure out things on our own without asking for help right away. It’s almost like a sign of defeat or weakness. But I definitely asked for a lot of help my intern year, and I still do, and that’s why I try to make myself both approachable to our interns, and also encourage them to ask for help from me, from their attendings, from their fellows, and things like that, because I think we’re all learners every step of the way.

So I think that that’s important to do, as well as just to be flexible, as we all are even outside of medicine. Nobody else in my family is a physician, but they’re all navigating this new normal, how it affects their jobs as well. So I think flexibility is really important right now, too.

Kevin Pho: Great, well said. I think that advice can apply to me as well. I’ve been practicing for 18 years, and asking for help is something that I do on a frequent basis as well.

So your last KevinMD article that you co-wrote, I found of great interest, and it was titled “A simple act to help families struggling to find their way in a foreign culture.” Now, for those who didn’t read that article, can you walk my audience through it and share the story of why you decided to co-write it?

Gabriella Gonzales: Yeah. So this idea: We have, within our residency, throughout our three years here, continuity clinics, where we go usually weekly, and then we have a dedicated block month over there for an entire month. In my particular continuity clinic, we see a lot of immigrant families, frequent use of the interpreters, frequent learning of countries I’ve never even heard of before and different languages and things like that.

This article mainly came from just thoughts and brainstorming on ways that we can make these families feel welcome within our culture here in Columbus, Ohio, which is very different from where a lot of them came from. I think as providers, we sometimes get lost in the shuffle of our day-to-day, getting patients in, getting patients out, and things like that, and especially with those who need interpreters, visits that take extra time. I think that we more so think how we can be most efficient during those encounters, and not necessarily think, “How can we actually get to know the patient on the other end of the exam table?”

So yeah, we had this idea to just simply ask these families where they’re from, and a little something about their culture, also for our learning too. We have maps within each exam room in our clinic, where we’ve encouraged patients to show us on the map where they’re from and say a little bit about their culture, again, just to help us get to know them better and have them warm up to us as well.

I couldn’t imagine being a new immigrant in a new place and seeking medical care, some of them for the first time. It can be overwhelming and stressful, especially when you don’t speak the language. So I think just opening the conversation, being an inviting face, and encouraging them to share their stories, I think that helps one to improve the patient-physician relationship, but also to learn a little bit about ways to particularly tailor your medical care to their needs. So yeah, it’s mainly just tips on how to start that conversation, how to get your patients a little bit more engaged, and also learn about their cultures as well.

Kevin Pho: In your clinic, where you see a primarily immigrant population, what are some of the obstacles that you see in your clinic that prevent someone from getting the best health care that they should have?

Gabriella Gonzales: Well, obviously, I guess the most obvious is the language barrier, for sure. The use of interpreters, as I already touched on, is a little bit more time-consuming. So I think at the end of a very long day on a Friday, when it’s five o’clock and we can be focused on getting to the weekend or getting through the long week, it can be challenging at times to be very thorough, especially with the use of interpreters. So that’s obviously an obstacle.

Even just, I could think of examples off the top of my head this week, caring for patients and having nutritional counseling where, in their particular culture, a particular food is a staple, and to us it can be seen as unhealthy, and it’s something that we would want to cut out if we’re interested in improving BMI or weight loss or things like that in our patients. So we have tried to adopt their approach of, how can we incorporate this very important food or this very important practice into our advice to give them going home? So that can be difficult to navigate, again, as we learn more about their cultures and things that are important to them.

I think also just access to care. I think that that is very apparent in not just our immigrant populations, but some of our different clinic populations associated with lower socioeconomic backgrounds and things like that. Just getting to and from doctor’s appointments, as we know, can be difficult, and I think that that’s something we don’t always see, because we see them for 15 minutes or so, but we don’t really know what the journey was like getting there and going home, especially when there are multiple children in the family. A lot of these immigrant families do have several other children, and have even other families that they’re living with as well. So just access to care is definitely something that we’ve seen is difficult for a majority of our patients.

Kevin Pho: We are speaking in mid-August, and of course school is coming up in the fall, and I know the possibility of school openings or not, they are disproportionately impacting the immigrant population. So what are some of the issues that you are seeing specifically within your immigrant patients as it relates to schools potentially opening?

Gabriella Gonzales: It’s difficult. I know it’s definitely on every parent’s mind when they come to the doctor: “Would you recommend going back to school?” or, “How does that look for them?” Right now, I’ve heard mixed things. I’ve heard that it’s going to be partially online, partially in the classroom. It can be difficult, not just for the immigrant populations, where maybe English is not their first language, so obviously English as a second language courses and classes are important, and I don’t know how well those are going to fit into this virtual curriculum, or if they’ll always still have those providers available within the schools. So that is a difficulty.

As well, even outside of the immigrant population, some of our patients have various therapies that they get within school, whether it be occupational therapy, speech, or physical therapy. Those kinds of things are difficult to incorporate, I think, in a limited way, with our limited time that they’re allowing within the classroom, and scheduling those things virtually can be difficult, especially if families don’t even have access to the internet or to computers and things like that. So that has been difficult as well.

I’m very appreciative that we have a social worker within our clinic, who we bring in on almost every patient encounter, especially the new ones, to help with those resources within our community that are new and that we’re not always familiar with.

Kevin Pho: We’re talking to Gabby Gonzales. She’s a pediatrics resident, and she co-wrote the KevinMD article “A simple act to help families struggling to find their way in a foreign culture.” Now, if you were to recommend one thing that can help reduce the disparities between the immigrant populations and non-immigrant populations, what would that one thing be that will have the biggest impact?

Gabriella Gonzales: I honestly just think opening the conversation and asking the simple question of “Where are you from?” With that, I’ve seen my patients light up, and they have stories. They have their own struggles, as we all do. But just asking, and also asking them to share something special about their culture that they find most special, I think just that invites you into a look into their own lives, and also makes you more approachable as a provider. Because as an immigrant, it can be hard coming into a new place where you don’t know anybody, let alone this person who’s asking you all these very detailed questions, and it can be nerve-racking. So I think just showing that you’re an approachable person who wants to get them the best health care they can is my advice.

Kevin Pho: And my final question: Do you have a take-home message that you want to share with the KevinMD audience?

Gabriella Gonzales: I think especially now, it can be hard when our days are long and things are stressful, with COVID, with the new interns here, new second years, and new fellows starting and everything. But I always try to at least step back at the end of the day and reflect on how special it is to be invited into the lives of our patients, even if it’s only 15 minutes, even if it’s three days in the hospital. I think that we play a very special role in not only getting the health care that they need and the medications that they need, but also showing them that they are important and their health is important to us. I think that it’s a privilege to be in that role and to have that relationship that not very many people get to have.

Kevin Pho: Fantastic. Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Gabriella Gonzales: Yeah, thank you so much for having me.

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