Health-care professionals address diversity

Bhutanese refugee Ashok Gurung left government persecution behind when he came to Pittsburgh, but his trauma stayed with him.

At the Cultural Awareness in Health Systems workshop Wednesday, Gurung, a chairperson in his mid-30s on the board of directors of the Bhutanese Community Association of Pittsburgh, opened up to the audience about the severe anxiety he experienced when he first came to Pittsburgh in 2009. Gurang said his psychological symptoms manifested as a sensation of physical pain all over his body.

“Refugees are often in pain,” Gurung said. “The doctors don’t know what’s wrong with them, but the reality is they have mental health issues.”

Gurung was one of several speakers hosted through a partnership between Pittsburgh-based immigrant inclusion initiative All For All and the Pittsburgh branch of the Whitetulip Health Foundation, a nonprofit that connects health-care professionals who want to serve their community.

The doors to the Allegheny Health Network Center for Inclusion Health opened at 5:30 p.m. When the organizers called the meeting to order, about 40 community members sat in a semicircle of assembled chairs and waited for the speakers to begin.

After Gurung shared his experiences with health care in Pittsburgh, Stephanie Dewar, a pediatric hospitalist at UPMC Children’s Hospital, shared her insights on cultural awareness in medicine. Pittsburgh is one of the least diverse cities in the nation, according to a 2015 study by financial consulting company WalletHub — but Dewar said she has seen a significant increase over time in the diversity of her patients.

“The large number of immigrants and refugees that we support in this area is really quite impressive,” Dewar said. “It’s not something I remember about Pittsburgh from growing up. It makes me proud to be from here.”

Dewar said health-care providers and patients both have a lot of room to improve in their understanding of the cultural context others come from. Lack of cultural awareness is an issue, but Dewar said there are also instances of blatant bias.

“Pittsburgh is a very welcoming community overall,” Dewar said. “[But] some of our trainees have experienced some bigoted and hateful conversations with patients and families who are not as interested in making a real effort to coexist with people who look different than they look.”

In one such incident, a parent refused to allow a doctor to care for her child because the doctor was Muslim. The hospital’s administration responded to this incident and others like it by training residents on how to respond to xenophobic comments and sentiments.

After she spoke, Dewar moderated a panel discussion between three other health-care professionals. One of the panel members, Dr. Ermal Aliu of UPMC Children’s Hospital, emphasized the need for trust and bonding between providers and culturally diverse patients.

“[If a patient’s health-care provider] speaks their language, that’s better than just knowing someone has medical knowledge or a degree,” Aliu said. “Human interaction cannot be replaced with a piece of paper.”

This kind of provider-patient connection is important to Kiya Keili, All for All’s health and food access coordinator. Keili moved to the United States from Sierra Leone and joined All in All in part because she admired the work it does to make immigrants like her feel welcome in Pittsburgh.

“Even with female physicians, there are some things that in my culture I’m not comfortable talking about,” Keili said. “Instead of just delving right into the health issue, [I appreciate] getting to know me as a person first, so I feel more comfortable talking to the physician about issues I might have.”

Stephanie Miller, a second-year resident at Forbes Family Medicine and a woman of color, has personally experienced racial insensitivity in a medical context — for instance, people have assumed she is a member of the cleaning crew instead of a professional health-care provider. Miller said attending the workshop made her realize how much of the medical community is interested in becoming more culturally aware and providing better care to diverse patients.

“People already say our health-care systems don’t work, but refugees and immigrants have to deal with extra barriers on top of that,” Miller said. “Providers owe it to their patients to make change.”