Access to Care, Anastasia Coutinho, asking questions, Bhutanese refugees, Burlington, CHCB, Community Health Center of Burlington, culturally competent, Education, Empowerment, health as a human right, Insurance, medical orientation program, New Hampshire-Vermont Schweitzer Fellows Program, Peter Cooch, Refugee Health, Social Determinants of Health, University of Vermont College of Medicine, Vermont
Burlington, Vermont is home to over 2,000 refugees who often settle without an understanding of how the American healthcare system works, how to access care, or their rights and responsibilities as patients.
Schweitzer Fellows Anastasia Coutinho and Peter Cooch are doing something about it.
Building on the groundwork laid by previous Schweitzer Fellows Erica Pascuillo and Delia French, Coutinho and Cooch (who are students at the University of Vermont College of Medicine) partnered with the Community Health Center of Burlington (CHCB) to design a culturally competent medical orientation program that bridges the gulf between Bhutanese refugees’ healthcare needs and knowledge. Their program has been so successful that the CHCB hopes to expand it to all refugees entering the state.
Why did you decide to develop your particular Schweitzer project?
Coutinho:I am a firm believer that health is a human right, and that the health inequalities that arise in our society as a result of social determinants are avoidable. Refugees face enormous hardships in their transition to the United States, and despite established programs, they often do not take advantage of the healthcare system due to lack of knowledge. As soon as I heard about the work of two previous Schweitzer Fellows, Erica Pascuillo and Delia French, I saw that a medical orientation program focused on education and empowerment could benefit the health of this vulnerable subpopulation of our community.
In addition, throughout my undergraduate and graduate career, I spent much time working at a hospital in Karnataka, India and researching my thesis in Bandarban, Bangladesh. Combining my value system with the language and cultural barriers I encountered in South Asia made me that much more passionate about providing refugees here in the U.S. with the skills to navigate the healthcare system.
Cooch: Having grown up in a small town in Vermont, coming to Burlington (population 40,000) felt like moving to the big city. I knew it was a long shot from being an urban or international setting, but I also knew there was an influx of refugees from Bhutan, Somalia, the Congo and many other countries. These refugees are expected to be fully self-sufficient after eight months in the country—but the patchwork of social services they receive provides virtually no healthcare education. So Ana and I were eager to build on the wonderful work being done by Erica and Delia to improve refugees’ health literacy.
Hearing our participants’ stories of the daily struggles they endure has vividly exposed me to the socioeconomic determinants of health. At the same time, I’ve been exposed to an arsenal of resources to counter those forces. Vermont is fortunate to have great practitioners and social services, but they are useless to those who don’t know to ask and where to look. I love Vermont, and hope to practice here in a primary care setting for the rest of my life. The perspective I’ve gained into insurance snafus, interpretation services, and eligibility requirements as a result of this project will help me advocate for patients throughout my education and career. This project has completely overhauled my working knowledge of both obstacles and solutions to healthcare access in the state.
What do you hope will be the lasting impact of your project on the community it serves?
Coutinho: I would hope that each of the individuals attending our sessions emerge feeling empowered to navigate the healthcare system—and, more importantly, to ask questions! The more conversations Pete and I have had with our participants, the more stories we hear of new families having trouble understanding how often they are supposed to take a new medicine, not being able to ask their landlord to exterminate bedbugs, and not understanding the implications of their diagnoses.
So each lesson, we reinforce the value of asking questions—whether it be about a medical issue, a conflict with a landlord, a product at the grocery store, or a teacher at a child’s school. I hope that we can foster the skills for participants to ask questions and also instill in them the knowledge that they have a right to understand each of the changes that are happening in their lives.
We are seeing the impact of our program when we run into participants from previous sessions. I am excited at the prospect that Burlington’s Community Health Center, our community partner, has received a grant to expand this medical orientation program. As we continue to improve the lesson plans and the format of the sessions, the CHC hopes to scale-up the program so that all incoming refugees have access to the orientation.
Cooch: A major concept of the class is built around empowering the elderly members of refugee communities, who often go from being family leaders in home countries to being marginalized in the US. The curriculum emphasizes their role in passing on the material they learn to other members in their community. We hope they’re encouraged to not only better utilize the healthcare system, but also to advocate for their wellbeing through their lives.
As Ana mentioned, the CHC recently applied for and received a grant to continue the program. If the format remains successful, the CHC hopes to scale up the sessions to become part of the entrance process for all refugees entering the state. In the process, we hope to solidify a venue for medical students to get out of the library and become involved in one of Vermont’s most diverse and dynamic patient populations. Around a dozen first year medical students have already volunteered as group leaders. The medical students and the refugees are both bursting to share their experiences and learn about the others’. We’ve seen magic happen by putting the two groups in the same room.
What do you think is the most pressing health-related issue of our time, and how do you think it should be addressed?
Coutinho: Hands down, access to a healthy environment. Prior to entering medical school, I worked in Baltimore with African American youth and their caregivers, attempting to disseminate nutrition education. I can very clearly remember my experience with a single twelve year-old boy, who when weighed on the scale, broke it—it could not read anything above 399 pounds. His mother said, “Oh, I was hoping we could get a weight. His doctor said we need to find an industrial scale.” This mother presented the statement very calmly, as though it was a normal occurrence. I was shocked.
Access to a healthy environment includes more than just access to physicians and hospitals. We need to create a system in which equity is our priority—more healthy foods in low-income communities or programs to deliver food to the elderly, the creations of parks for exercising in safe areas, the education and resources to understand healthy behaviors and how to implement them. Underserved communities are just that: underserved. Not just in healthcare access, but in access to fresh fruits and vegetables, the security of knowing that your children are safe on the streets, or the feeling of belonging to a community.
Before we are able to address larger health concerns, such as universal health insurance, obesity, antibiotic resistance, or the increasing rates of cancers, we need to confront issues of poverty and education in the hopes of creating an equitable and increasingly equal society. If this occurs, I truly believe that many of our other pressing health issues, will resolve themselves without medical intervention.
Cooch: Over several generations, aging and lifestyle-related diseases have replaced infectious disease as plagues of health in our society. However, only a tenuous line-up of therapies prevents microbes from once again surging to the forefront of illness. Although infectious disease has never exited the stage in much of the developing world, efforts to curb its reach have faltered in the face of threats such as multidrug-resistant tuberculosis. It is absolutely paramount that we curb antibiotic use in livestock, which accounts for tens of thousands of tons of antibiotics used each year in the US alone, and physicians have an imperative to take great care with their own prescriptions. Finally, vaccines represent one of the few fronts where we can make permanent gains against pathogens. A renewed focus on vaccine development, access, and education may provide enormous benefits.
What has been the most surprising element of your experience as a Schweitzer Fellow?
Coutinho: The gratitude we have received from the community. The transition to settling in Vermont is by no means easy, and the social and economic environment of the day doesn’t make it any easier. Yet, each week I am privileged to talk to participants about how their previous week has been: what new foods did they find at the grocery store, how was their holiday, has their son or daughter received word about immigration? I can answer any simple questions they have and let them know the people in the community of Burlington care about them, their families, and their community.
Walking through the hospital, I have run into a number of participants walking around and am able to add a smile to a confusing process. Although Pete and I started this project wanting to instill medical knowledge, I think we have both quickly come to realize that being a friendly resource in a new community is just as important.
Cooch: How much of a difference small gestures can make! So many of the world’s injustices seem overwhelming in scope and complexity. Yet there are still many ways just a little effort can make a huge difference. We started this project intensely focused on what sorts of knowledge we hoped to convey. Since then, I’ve come to believe the most important element of our project lies in simply providing a welcome to folks that may feel forgotten.
Details from the class may be forgotten. But what I believe will change their lives in Vermont is the realization that they have neighbors who care about their wellbeing. As this becomes clear, it’s not uncommon to see participants reciprocate with incredibly positive energy. We host a potluck as part of our final meeting. Sharing the incredible feast that the participants invariably bring has always been the most meaningful part of the experience for me. I hope a newfound confidence will allow our friends to feel comfortable and be proactive and engaged within this country.
What does being a Schweitzer Fellow (and, ultimately, Fellow for Life) mean to you?
Coutinho: The Schweitzer Fellowship has allowed me the opportunity to continue my commitment to public health while gaining the knowledge I will need for clinical medicine. My priority as a future provider will be serving vulnerable and underserved communities, both domestically and internationally, and I would like my career to incorporate both clinical medicine and the development of community health education and prevention programs. I am able to have amazing interactions with our participants each week that inform me about their concepts of health and healthcare. With a firm knowledge about the obstacles of understanding and accessing healthcare in Burlington, I will be better equipped to maintain the wellbeing of my future patients.
In addition, I have the knowledge that our program was able to empower participants and help them take ownership of their own health, which will in turn filter on to children, families, and future generations. I am also continually inspired by our participants’ stories and courage.
The network of Fellows for Life is a community of individuals who serve as a vast resource of constant motivation and inspiration from other like-minded individuals, further ensuring I will continue a lifetime of community service, both nationally and internationally. I am also excited to provide the same stimulation and mentorship to others. I want to move education outside of the classroom—I have learned so much more from the community than I could ever learn from a PowerPoint.
Cooch: Five years ago, I had a very influential conversation with one of my favorite professors at Dartmouth. I had just begun to consider a career in medicine and was hoping for guidance. Professor Rassias, a member of the French department, asked if I’d heard of Albert Schweitzer. At the time, I hadn’t. He took his copy of Schweitzer’s Out of my Life and Thought off his shelf and gave it to me, telling me that I might find some guidance within. Then he offered the advice that, “The key to sustaining yourself throughout life’s journey is keeping company with optimists.”
Since then, I’ve found great inspiration in the words of Schweitzer’s autobiography. And I’ve always associated Schweitzer’s ideals with Rassias’s credo of seeking support among individuals that inspire you.
With decades of challenges to overcome in our futures, it will be vital to sustain a wonder for life and commitment to the wellbeing of others. Few things safeguard this better than being able to reach out to cohorts with a similar perspective. Belonging to a lifelong network of Schweitzer Fellows will insure that wherever I am, I’ll never need to reach far to reconnect with that optimism. I can think of no other group that exemplifies such positive energy and a can-do spirit. It will be a privilege to remain inspired by such individuals throughout my lifetime.
Anastasia Coutinho and Peter Cooch are Schweitzer Fellows in Vermont. Click here to read more about The Albert Schweitzer Fellowship (ASF)’s New Hampshire-Vermont Schweitzer Fellows Program and the Fellows like Coutinho and Cooch it supports in creating and carrying out yearlong direct service projects that improve the health and well-being of vulnerable people and communities. To make a gift to support the New Hampshire-Vermont Schweitzer Fellows Program, click here.
Each week, Beyond Boulders delivers a new installment of “Five Questions for a Fellow” – an interview series with Schweitzer Fellows across the country and in Gabon, Africa who are leading the movement to eliminate health disparities. For an archive of previous “Five Questions for a Fellow” interviews, click here.