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Friday, June 24, 2022

Scientists at work: how pharmacists and community health workers build trust with Cambodian genocide survivors

The wartime trauma paired with starting in a new country makes health care especially challenging for migrant refugees. It’s hard enough talking to a doctor or filling a prescription in an unfamiliar language. But for refugees, the physical and psychological scars of surviving war or genocide can complicate finding and meeting their health needs.

I am a clinical pharmacist trained to improve drug safety and effectiveness in the outpatient setting. From 2019, I was with a team of pharmacists serving Cambodian American patients in Connecticut and Rhode Island. I spent 15 months there studying the role of pharmacists and community health workers in helping disadvantaged migrants get the medicines they need and get them consistently and safely.

Many of them fled the Khmer Rouge, a brutal political party and military force operating under Pol Pot’s regime in Cambodia in the 1970s. They saw executions, survived starvation or suffered famine-related diseases.

As pharmacists, we learned that the best way to care for these patients was to listen and learn from the community members they trusted. This is a lesson for health care providers that could prove useful as the US welcomes new refugees from countries such as Afghanistan, Sudan, Myanmar and Ukraine.

unsafe drug

As a traumatized population, Cambodian refugees can be wary of strangers. They can avoid any person deemed to be government or other officials. As a result, they often rely on their own beliefs and beliefs, even about health.

Our research team learned that some Cambodians hope to receive medicines for every disease. It reassures these massacre survivors that something is being done about what is wrong.

If a doctor doesn’t give them a prescription, they can look for someone who will prescribe medication. Even then, they can only take medicine for as long as they are feeling sick. If side effects occur, they may decide the dose is too large and reduce how much they take. And medications are often shared among friends and family.

Limited English proficiency may prevent immigrants from receiving medical care. When they do, language barriers make it difficult for health care providers to understand a patient’s symptoms and prescribe the correct medication, especially since interpreters are not always available. Therefore, in immigrant communities, translation often falls on family members, sometimes children.

The presence of family members, especially children, can affect what patients and pharmacists say, especially those with sensitive topics such as mental illness or reproductive health. And translating to a medical setting can be a heavy burden on children. In the course of our research, we came across a 7-year-old daughter who had her mother’s cancer diagnosis translated.

established relationships

Local community health workers have been addressing these problems. With language interpretation skills and health information, they help residents of their communities manage their mental and physical health.

Our research team of four pharmacists worked with five community health workers from Khmer Health Advocates, a Connecticut-based organization for Cambodian American survivors of the Khmer Rouge genocide and their families. After four decades in the field, Khmer Health Advocates knew their community best. So we followed the organization’s lead as it directed recruitment for our study.

Health workers introduced us and our research project to churches, temples and events such as Cambodian New Year celebrations. They also went to health clinics that Cambodians use and flew Cambodian businesses.

Health workers reached out to residents personally, connecting with people at a personal level. When narcissists themselves survived with training in trauma-informed care, they met patients in safe, familiar places such as their homes. They dined together and discussed not only studying, but familiar concerns like the financial difficulty of resuming life in a new country and accepting low-paying service jobs. In all, community health workers worked with pharmacists to help recruit 63 patients.

With training in trauma-informed care, community health workers work directly with residents to help them improve their mental and physical health.
Photo courtesy of Khmer Health Associates

cross-cultural problem solving

Health workers taught us in Cambodian culture, which attaches great importance to showing respect. For example, the “samphih” salutation involves pressing the palms together in a prayer posture while bowing the head. The higher the hand and the lower the bow, the higher the degree of respect is visible.

We also learned idioms to help us understand the details of patients’ symptoms. For example, “spuck” is what they call neuropathy or nerve damage. This is a common symptom in people who have suffered beatings during conflict. Another phrase is “kdov kbal”, meaning “hot head”, to describe the feeling of heat in the brain interfering with thinking. And “Fleu” means losing the train of thought, with cognitive impairment.

Community health workers also help patients manage their medications by helping pharmacists who trust us.

When it came time to meet with pharmacists, healthcare workers had already interviewed patients to document the medicines, herbal products, traditional Khmer medicines and supplements they were taking. As the health worker sat down with them, the patient would collect them all in preparation to speak to the pharmacist.

When I met patients on video from my office, the health worker held each drug in front of the camera. Then I talked to the patient about the dosage, side effects, and any questions they had. I explained how to take the drug to avoid side effects, and I referred potential drug interactions to their doctors for my recommendations. Through it all, the health worker translated from English to Cambodian, from medical jargon into culturally appropriate terminology and back again.

We helped 63 patients solve over 80% of their medication-related issues, a good resolution rate for any community, English speaking or not. Patients also got better at remembering to take medicines, getting the correct dosage, and taking them consistently. Our study found that community health workers and pharmacists working together were important for these patients to be better at managing their medications.

I took a closer look at how a cross-cultural team could effectively solve drug-related problems in an immigrant community. With international migration due to war and genocidal conflicts, this model now applies when the health of the most vulnerable is at risk.

World Nation News Desk
World Nation News Deskhttps://worldnationnews.com/
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