Christina Olson
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Interview Text and Audio
Abstract
Christina Olson is currently a first-year student at the University of North Carolina School of Medicine. She is originally from Greensboro, N.C. and studied at the University North Carolina at Chapel Hill for her undergraduate education. She has volunteered at the Student Health Action Coalition (SHAC) for four years, providing access to healthcare through interpretation services. Through her experiences working with Spanish-speaking patients, she provides insight into how various community clinics and university students can work together to help Spanish-speakers overcome barriers to accessing healthcare. Olson explains how the clinic operates, and describes challenges that are inherent to a student-run free clinic. In contrast, she shares many successes that the clinic has had in establishing itself in the community, starting new initiatives, and having numerous volunteers. Olson emphasizes that her role as an interpreter is not only to reduce linguistic barriers, but also to be an advocate for the patient. She shares several anecdotes that show how patients’ daily life experiences can have a profound impact on their health, particularly with immigrants. Olson refers to her time spent in Mexico and how it shaped her perspective of immigration and healthcare. Shifting the discussion towards her interest in primary care, she shares how these experiences have influenced her decision to enter the field of primary care for underserved patients.R0670_Audio.mp3
Transcript
Madhu Vulimiri: Interview with Student Health Action Coalition coordinator Christina Olson for Global Studies 390: Latin American Migration, on Monday, April 1, 2013, in the Health Sciences Library at UNC-Chapel Hill, on the topic of her experience working to improve Latino patients’ access to healthcare through SHAC; the interviewer is Madhu Vulimiri. So, just to start off, can you just tell me about your childhood and where you grew up?
Christina Olson: Okay, so, I grew up in Greensboro, North Carolina.
MV: Can I use your pen?
CO: I grew up in Greensboro, North Carolina. My family, I guess, is from the healthcare field. My dad is a physician and my mom's a pharmacist. I have a little brother and sister. I guess, related to working with Latino communities, I started working with Latino communities in high school through El Centro Latino in Greensboro--or, El Centro de Latino Acción in Greensboro, working with youth groups to promote well being and stuff. So, I met with different youth groups and we did tutoring activities and just fun and games, and that kind of thing. Also, worked with, also helping, like bringing the Mexican consulate and stuff like that. So that's when I really got involved working within Latino communities and it was a really cool way to connect with Greensboro in a different way than I was exposed to. I don't know, it was an exposure that opened my eyes to different people in my community. I went to public high school, public middle school, and then came to UNC-Chapel Hill for undergrad.
MV: What did you study at UNC?
CO: I studied Global Studies with a focus in global health and environment and a regional focus in Latin America, and minored in chemistry and biology.
MV: Wow, that's a lot on your plate. [laughter] So how did you--I guess, you talked a little bit about getting interested in access to healthcare--what made you interested in working with the Latino population in Greensboro?
CO: In Greensboro? Well, let me think. Honestly, I was really looking for a way to directly serve my community. I think in high school, there were so many ways--you could do fundraising and do one-time service events, and I was looking for a way to engage with the community on a long-term basis and also in a direct way. I was also hoping to utilize Spanish and get better at Spanish. So I just reached out to this non-profit organization and developed a really good relationship with the director. I just ended up being a weekly volunteer, and spent probably about a year and a half there. Just got to know a lot of the people. It became really easy because you form relationships with people.
MV: Your interest in healthcare, that's been something you've been interested in for a long time?
CO: I started out college, actually, thinking that was the last thing I was going to do.
MV: Really?
CO: Yeah, well, I was more interested in public health and not medicine, specifically. And so, the summer after my freshman year, I went to Mexico. I stayed in a small community in the region of Oaxaca called La Pe de Ejutla. It was called La Pe because it had two streets that were in the form of a backwards P. So it was a rural farming town and I was working with a small non-profit there called Puente a La Salud Comunitaria. It was a non-profit that promoted the use of a native superfood, amaranth, within the communities as a way of combating malnutrition. So, people could grow the amaranth close to their house, use some of the leaves in their tortillas or beans or whatever, and fortify their food a little bit more. Then we did a bunch of teaching with the kids and women. And, I just really enjoyed that. We also, there was a small clinic, and that's where we were doing the teaching, so I got to be in the clinic some too. And, I think, that was the turning point where I was really interested in medicine. Just because, I saw how you could really directly care for people in the clinic, and also engage in the community public health access kind of issues. You can kind of work on access issues and then be the person maybe people got access to.
MV: Cool. So, can you tell me a little bit about your experience working with SHAC? How did you get involved?
CO: SHAC, so, I had a friend tell me about it. And--.
MV: And what is it? Can you just explain?
CO: SHAC is a Student Action--Health Action Coalition. It's a student-run free clinic--that's the oldest free clinic in the United States--or, oldest, student-run free clinic in the United States. So it's run by students in a variety of the different graduate schools here, so the med school, pharmacy school, public health school, school of social work, nursing school and there's also undergraduates that can get involved. As an undergraduate, really the only ways that you can get involved is as an interpreter. So I started interpreting at SHAC my sophomore year of undergraduate. I started out doing more basic, like front/back and vitals until I was more comfortable, and started doing clinic interpreting later on. But, it's a really neat experience to be an interpreter there because the patients do go through public health--I mean, pharmacy questioning, public health questioning, social work questioning, possibly HIV counseling. Sometimes physical therapy and then medical questioning. So you do get to see the broad spectrum of the patient's life, as well as be an advocate for the patient between the different groups. You know, sometimes you would hear something in social work and you could tell the medical students, "Hey, this might be something of interest," and be a mediator between the groups. So that was something I really liked, that I got to see the whole picture of a person when I was there. And so, that kind of also was feeding my interests in both medicine, and also kind of the community context of where people come from and how those factors relate with their health.
MV: How long did you end up working there?
CO: So, I served as an interpreter for three years. Well--two years, and then, senior year, I was a coordinator. Which means in this year, my first of medical school, I'm also coordinator, which means we coordinate the interpreters. We assess new interpreters, deal with all the logistical side of being an interpreter, and also represent SALSA, which is the name of the interpreting group at the leadership meetings. So, I interpreted but also coordinated. That also meant that we were involved in little projects, like the pharmacy team wanted to translate all of the instructions for different medications into Spanish so that patients could have it in Spanish to bring home. We helped them with that. We partner with other groups who needed Spanish translation, if they didn't have members who could do that.
MV: So, how does SHAC do outreach to Latino folks in the area? Do they do outreach?
CO: I might not be the best person to ask. SALSA specifically doesn't, as an interpreting organization, but we do interpret for the Well Child clinics, which are four times a year. There's Well Child clinics for kids who need physicals to get into kindergarten or to play sports. So we do interpret for those, and we also interpret for two different health fairs. One at St. Thomas More and the other that I'm forgetting the name of. But we interpret for the HIV counselors at those health fairs. SHAC Beyond Clinic Walls but they're trying to expand an initiative to work with more Hispanic families so, that's a lot of times for elderly patients who can't necessarily get to the clinic, students will go out to their homes and help them with little things. Kind of help them coordinate their healthcare, and I know one of their initiatives is to try to include more Hispanic patients.
MV: So, SHAC is run--I guess, it's run once a week, is that right?
CO: Once a week on Wednesday nights, yeah.
MV: And so, it's the free clinic on just Wednesday nights.
CO: Mm-hmm. And it's run at Piedmont Health Services, which is a clinic that also takes a lot of the patients that are referred. So SHAC acts kind of not as a long-term care clinic for patients, it's more of an acute-care based clinic and then one of the things that the people at SHAC try to do is connect the patients that come in with long term care. So a lot of patients who--if some patient come in with, let's say uncontrolled diabetes, and really needs to be with a primary care physician, it's not something that is--. You can help treat acute hyperglycemia, but we also try to work with those patients to get them connected to a long-term care provider, which is often physicians at PHS or UNC clinics.
MV: How important would you say facilities like SHAC, the acute care settings, are in a patient's life--like the ones you are typically seeing?
CO: I mean, my guess would be pretty important, because I know that there's other free clinics in the area, but it could prevent an emergency room visit. I know it's pretty--I think it's pretty well known in the Spanish-speaking community that SHAC is available, has interpreters, and is a place where you can go to get help and I would think that SHAC--and I know there's a free clinic in Durham, a couple of free clinics in Durham--and that might prevent people from going straight to the ER. It's a lot of--. I know that a lot of people refer patients to SHAC if they don't have health insurance. So I think it is important--and it's important, really in the first step of like, maybe getting to a place where you can even have long-term care if you are referred back to PHS.
MV: Okay. What do you think are the biggest challenges faced by the Latino patients you see in the clinic?
CO: Biggest challenges. In terms of getting access to care, a lot of the patients we see are undocumented, so that's probably the biggest barrier for obvious reasons.
MV: Because they can't get insurance.
CO: Yeah. And, other barriers--financial barriers to medication. You know, if they can't find a regular long-term care provider, it's hard to keep up with chronic diseases. We saw a patient that had a hernia that he had had for a really long time, which--if it became strangulated--could be a really big problem. So, you know, things like that, where patients present much later, when they're really sick, with a lot more problems that could have been prevented if they had long-term care. So, I would say, insurance, finances, and SHAC does help pay for some of the prescriptions. It often refers people to the four-dollar Wal-Mart prescriptions.
I would say also another thing is just not knowing where to go to get resources. One of the--I know the public health and social work students in particular have a lot of resources that they hand out to Spanish-speaking patients regarding a lot of--. One thing, something that we see a lot of is patients who are depressed and in need of some type of counseling. Particularly, you know, being displaced from your home, you're isolated, you don't know anyone. If it's difficult to get a job, it's just--you know, it's weighty. So, that's something that I think SHAC does a pretty good job of referring people to outside care, like El Pueblo. That's one of the places they refer to for counseling and stuff. Probably, like lack of knowledge, lack of resources, lack of insurance. That's kind of the things you would expect.
MV: Does SHAC have any way of following up with the patients that they see?
CO: Yeah, there's a whole team called Continuity of Care--the Continuity of Care team that does follow up with patients, to--. Also the Triage team, which I'll be a part of next year, calls--. There's a pretty high no-show rate at SHAC, so the Continuity of Care as well as the Triage team work together to call for appointment reminders, as well as call with results and that kind of thing.
MV: So SHAC goes by an appointment basis or first come, first serve?
CO: It's appointment basis and there's probably, say, four to five patients a night. The night is about twenty or so patients total. It changes--. The patient load changes according to who are the clinic co-directors. So, it was a little less this year because they were trying to streamline the visits a bit more. But, about four to five patients a night are walk-in patients, which are patients that are evaluated by the Triage team. So they're like evaluated on the basis of whether they really need help that night or whether they can wait for a week or if they just need to go to the ER right away. But otherwise it's an appointment basis.
MV: So do you ever end up seeing repeat patients?
CO: Yeah, every once in a while. As coordinators, we usually go every few weeks, so every once in a while, I have ended up interpreting for the same patient who's coming back for followup.
MV: How do you think their experience is different from the one-time patient's?
CO: There's a fair number of patients--there are a lot of one-time patients--. There are a fair number of patients who either come back for follow up or come back in a few--like, after a couple of years, if they have a new problem. And I don't know, I guess it's like you're a little bit more familiar with how SHAC runs--because it's different. You have all these different students coming in. People coming in from public health, social work, and so, it's different than you would expect at a regular clinic. So people who come for a second time may have their expectations set. It does take a long time because there's a lot of students, there's only two attending physicians, so it sets their expectations for how long it's going to take. That's probably what the biggest tangible thing I would say is. Oftentimes, people who come back--when you ask them about how their experience at SHAC. They're really thankful for SHAC and come back the second time. So usually I think for people it's a positive experience, though some--there's a fair number of people who get frustrated with how long they have to wait.
MV: And how long is that, on average?
CO: It can be a couple hours. It can be a long time.
MV: Do you have any sense of any specific perceptions they might have about SHAC? Any things they may have said in particular?
CO: You know, I don't know if I would hear it. Probably the most positive things I hear are, "Thank you so much." Just for the access to an appointment, the access to people who--. If you go and you talk with all the different groups, you do end up coming out with a lot of resources. Usually, if you do get a prescription, you'll get help paying for the prescription. You do get evaluated by a physician. So medical students come in first, but a physician will go in and oversee every patient. I think people are thankful to have the access. I would say the biggest complaint I hear is the time you have to wait, and it is a really long time. SHAC is constantly trying to make that time shorter. But, the nature of it being run by students is that it takes a long time.
MV: Have you, in your time there, heard any perceptions of patients and what they think of the healthcare system in general?
CO: The health care system in general. I think that, recently, it's been particularly hard to get an appointment at PHS, so--. I don't know if it is recently in particular, but that's my perception. It seems like it's been harder to get appointments at PHS because they're totally overloaded with patients--the patients that they see already. So that's a frustration that I've heard recently. "Okay, you gave me the number for PHS to call to get a follow-up appointment. I've called and they said they don't have room and now I don't know what to do," and so they'll come back to SHAC. And SHAC doesn't really have a way--it's hard, because they're one of the main people that we refer to. There's a couple of UNC-based clinics that we can refer to as well. I think probably the biggest frustration is that they're overloaded and there's not enough room oftentimes to take new patients. So they end up having to go through this haphazard way of going back to SHAC, waiting a really long time, maybe not getting the best long term care. Because that's not really what SHAC is built for. So that's probably the biggest frustration I hear from people.
MV: Are there any particular stories that come to mind when you think about your experience at SHAC that are particularly symbolic of the health care system today? Anything that has really struck you while you were there?
CO: Let me just think for a second. Um, sorry, I'm just trying to think. I was trying to think of this before I came to the interview. [pause] Sorry. Gosh, there have been so many people. [pause] I think something--I don't know. There's been a lot of really--. I think something that strikes me is how many people come in and seem to be really isolated and depressed. I think that comes out a lot more when, kind of like in tandem with the medical questioning, having that public health and social work questioning, where people ask about you know, how are your relationships? Do you feel safe at home? and that kind of thing. Different things have come out. Like, a number of women I've interpreted for had been abused. A number of people were concerned about their partner cheating on them or someone, you know, a family member, a few weeks ago, I interpreted for a lady where her husband had recently been deported.
MV: Wow.
CO: So there's just a lot of--lot of things going on in people's lives. I think those stories of--"My husband just being deported and now I'm here with three kids. I don't speak English. And I'm having trouble finding a job"--is like, sadly, very common. Kind of the breakdown of family because of the distance of, "I'm here and I'm working, my wife and kids are in Mexico"--or, that kind of thing. That always strikes me. I don't--I've never heard feedback on how the counseling is at El Pueblo, but usually people get referred to El Pueblo for counseling. So that always really strikes me.
Like I mentioned before, there's a lot of people who come in who have conditions that have just gone awry, like the guy with the hernia. He had had it for so long. It doesn't acutely--. It's not bad unless it gets strangulated and then you could get an infection. He had had it for so long that it--he was at risk of having that. And just, people with diabetes. It's hard to control because they don't have the long-term care. I'm trying to think of a specific story. [pause].
MV: That's okay, I can ask some more questions and you'll see if anything comes up. So, I guess, can you describe your role a little more as an interpreter? What are you specifically doing?
CO: So, we simply interpret. That sounds kind of dumb--like a dumb answer to your question, but. So we get paired--we try to pair all the interpreters there with a patient. And so they stay with that patient throughout the whole night. Some patients are med team only, if they're coming for follow-up. Some patients come in just for HIV counseling, but a lot of patients come in--like I said--for all those different groups. And so, you essentially just are paired with this patient and whenever a new team goes to do questioning, you're in the room. What we instruct our interpreters to do is to literally only say what the other people are saying, and to not really add anything. You're just a mediator between the two people. And also, I think, also helpful when talking, debriefing with teams afterward, it's helpful to have the interpreter there, because you're remembering, "Well, they said it like this and the meaning of this word is maybe a little different in Spanish than it comes out in English." A lot of times, I'll talk with the teams afterwards and that kind of thing. So you can be a support for the teams themselves and like I said before, you can inform incoming teams of what you've learned on past--like going in with social work, you can inform the medical team, "There's this thing going on." There's been a couple of times when someone will express, "I really want birth control" or "I'm really worried about"--. This one lady was really worried about birth control or having a possible STI and didn't bring it up to the medical team, but since I had heard about it in social work, I brought it up to the medical team, and they asked her directly about it. So you can be an advocate in that way and make sure that everything they brought up is brought to the table.
MV: That's cool. What do you think makes SHAC unique from other free clinics?
CO: You know, I haven't worked at other free clinics, so I'm not really sure. I guess, Baylor would be the closest experience I've had to working in other free clinics. So, I think the main difference is that it's run by students. It takes a little longer, it's a little bit kind of heavier. It takes a lot longer, it's less efficient, and that kind of thing. I also think there's an advantage to being run by students sometimes because students will take a lot longer asking questions and stuff. Sometimes you'll get patients to talk about things that they might have not mentioned in a quicker fifteen-minute interview. Then, I also think having the multi, or inter-disciplinary approach is really helpful. On the leadership team you have groups, people from every, all these different departments who are putting their heads together there to try to make SHAC better. I also think it's really important from the student side of things, to have students engaging with these kind of activities, so that, as they become physicians, they have a better idea of the needs that are out there, and have a better idea of the population. Even particularly for interpreters, for the Spanish-speaking population that's going to be a big part of our population.
MV: What challenges--so we talked a little bit about challenges that the patients might have--but what challenges do you think you and the other students who run SHAC face in trying to run it effectively?
CO: I think one of the biggest challenges in general with SHAC is that there's a lot of volunteers but not very many really dedicated--there's a lot of volunteers, and a small cohort of really dedicated volunteers, who tend to be the coordinators who are there on a more consistent basis. Otherwise, volunteers will come in one month and then they won't come in for three more months, which is fine, because we want people to have--. A lot of times, the reason for that is because it gets filled up, because people want to volunteer. But it does make it hard in terms of training everyone and having everyone be on the same page. So that's always a difficulty and the leadership turns over every year, just naturally, because it's medical and other graduate students who are running it. So, a lot of times there's not as much continuity between the leadership teams and I think that makes it--every year it's different, every night it's different. And so, I think that's a challenge.
Specifically, as an interpreter, I think most of us are students. I'm not a native speaker. We do have a number of native speakers that are interpreters, but it's always just keeping up with Spanish enough to make sure that you're doing a good job. I think for us as coordinators, it's difficult to--one of the difficulties we have is assessing volunteers so that we have enough volunteers to help, you know. So that we have enough volunteers to help and that we can get people involved and excited about working with Spanish-speaking patients but also making sure they're good enough to be accurate and not cause mistakes of care, mishaps in communication. So that's always a difficulty, particularly when it comes to more specific interpreting, like HIV counseling.
MV: Yeah, that makes sense. Are there any institutional challenges that might exist? Particularly, with undocumented patients?
CO: Within SHAC specifically?
MV: Mm-hmm.
CO: Well, SHAC takes everyone, regardless of insurance status. So I don't think there's any difficulty in access for undocumented immigrants, but it's probably more difficult to establish follow-up care. Like I said, PHS is, as of my knowledge, one of the only places that will take undocumented people along with UNC-based clinics. So that poses a challenge in that there's just not as many places to refer to get long-term care. In general, patients without insurance, that's a difficulty but it's just a compounded difficulty. Otherwise, for SHAC specifically, I don't think there is. I don't think it's more difficult to take patients who are undocumented versus those who aren't, specifically for SHAC. Just maybe harder to establish long-term care.
MV: Right. I guess, what successes do you feel like you or SHAC as an organization have had that have been really great for the patients?
CO: I think the fact that SHAC has been around so long is a success in itself. I think that it's an establishment in the community that often, we don't--I don't think SHAC does a ton of advertising for itself, in the sense that, people in the community know about SHAC and know that it's a resource. I think that's a success in itself. I also think some of the new--and I'm not as familiar with these programs since I haven't worked with them specifically, but--some of the newer programs like SHAC Beyond Clinic Walls has been a really cool program, going into people's homes and who may not be able to get to the clinic, I think that's a really cool thing. Specifically with SALSA, we haven't done any major revamps, but we've really worked on recruiting. A few years back, we had a small number of interpreters and we're always looking for more volunteers, and now we have more volunteers that can sign up. So I think that's been good, specifically working with undergraduate coordinators, like I was to try to recruit more undergraduates. Which I think is cool, because we get people who--for me, it was a really helpful experience to solidify that I wanted to go into medicine. I think, for a number of our interpreters, it has been a similar experience. So that's cool, in people's lives like that. I think, specifically for the clinic, that outreach with the SHAC Beyond Clinic Walls has been really successful, as well as just the fact that it's been around so long and it remains an establishment that we have a number of attendings who are really dedicated to making sure that--a lot of attendings there often. Residents who come in and are really excited about helping. I don't know, I think there's--I just think it's cool that it's been going on so strongly for so many years.
MV: Is there a particular moment you can remember being at SHAC where you really made a difference?
CO: [pause] Not a particular moment, but it always means a lot when patients--after interpreting for them--thank you a lot. In the sense that, I don't know, I feel like that's a success. When you feel like you've really been able to be a voice for the patient. I don't know, I think that's the coolest part of being an interpreter. Being a voice for the patient and making them feel comfortable. So it's not really like one success, but those nights when you're working with someone who's maybe a little more complicated or has a lot going on, and you're able to just be a calm mediator and make a situation that's kind of stressful a little more calm. I think that that's a success.
MV: Yeah definitely. That makes sense. How have you felt yourself change since starting at SHAC?
CO: One thing that--gosh. So, what I want to do, I think, in general, in medicine is... I think I want to go into primary care and work with underserved populations. So SHAC in a lot of ways has been solidifying of that idea. So. I think--I don't know. Sorry, I'm trying to articulate. I think that, more than anything, I grow from hearing people's stories, and you have this repertoire of stories in your head of what people's lives are like so that you have a better idea of how to serve them and the difficulties and challenges a particular community faces. I think that repertoire of stories and getting to know people from those backgrounds and just becoming a better communicator in general, I think, will--. I don't know, it's just been cool--sorry, I'm going to try to rephrase this. Yeah, I think getting to know stories, getting to know a community that I might possibly work with in the future has been really inspiring and it's been really rewarding to be able to be a voice for people and to be a mediator. I think, yeah, it's just solidified my desire to want to work in these kind of settings in the future. The importance, particularly as a physician, of being a communicator and making patients feel comfortable, making patients feel heard. Even though I'm not the one coming up with the sentences and that kind of thing, I think just learning how to communicate, in general, in that way is something that I've grown in. Yeah. Also, just a desire to engage with the Spanish-speaking community, which is going to be such a large community of people in our future and so, it's cool to just build up an image of who those people are and that kind of thing.
I think also my work in Mexico was really helpful to see--. It was a sending community, so a lot of people went to, actually South Carolina, to work in Christmas trees. That was where a lot of people went. It was really--it's been neat. I did a couple farmworker trips also in undergraduate, so between the farmworker trips and working at SHAC and my work in high school and then being in Mexico, it's been interesting to see where people come from and what they have to deal with once they get here. So that's been neat too.
MV: Yeah. So, it's really great to hear that you are interested in going into primary care because that's a field that has such a shortage. I guess, what is it that anchors you, or you hope will anchor you, in going into primary care, knowing a lot of the challenges that are associated with that field in particular? Long hours, overwhelming number of patients, less pay. What grounds you in wanting to do that?
CO: Well. I would say the pay isn't a huge factor for me, because I think any field of medicine you go into, you'll be able to support yourself. I think a big part of it is that I want to develop long-term relationships with patients. I also really am interested in being part of the community and understanding that community, so as to be able to be better able to help patients. I feel like if you know a community, you're better able to put people's medical conditions into context of what's going on with their daily lives. I'm also--I'm really interested in--. I think primary care's a neat field right now because there's a lot of quality improvement research and that kind of thing going on. I'd love to be in a setting where I can be creative about, "How can we get access?" or "How can we make care accessible to these patients? How can we be doing better?" I'm doing work this summer on a quality improvement project in a PHS clinic, actually, on access to contraception for post-partum women. Then I'm also going to be in Honduras this summer, working on a women's health project where we're going to be screening for--it's been a project for ten years, it's called the Honduran Health Lines--and we're screening for cervical cancer, STIs, that kind of thing. So, I don't know where I was going with this--.
MV: Knowing the community?
CO: Oh yeah, primary care. So, I think those kinds of things are really cool. Being able to be creative with your colleagues about how to best deliver care to people. So that's exciting to me. The idea of learning how to best do that. Knowing people long term. In terms of long hours and that kind of thing--anything you go into medicine is going to have long hours. I think, something that I will be--I'll prioritize as I go into medicine is hopefully finding a situation where I can have some work-life balance and that usually just depends on what particular context you're in.
MV: So you talked a little about having a better understanding of the communities that you're working with. Have your perceptions about immigration changed as a result of working at SHAC, or even your experience in Mexico?
CO: Yeah, I mean... I wouldn't say politically my views have changed very much. They've kind of been strengthened if anything. I think probably the most striking thing to me about immigration was that the host family--or the striking story in the context of immigration was--the host family I stayed with in Mexico. The mother was talking about crossing the desert with her young nine-year-old daughter right after we left. After living with them for two months and kind of building a relationship with that family because her husband told her that if she didn't come over to America he was going to end the relationship and stop sending money over. And so there's four kids in the house and the wife. She, I think, was really severely depressed when we were there. And really struggling with whether she was going to cross the desert or not. Whether she was going to cross with her young daughter but leave her two sons--three sons behind. It was just really--I don't know. It was just heart breaking. And the desert is so dangerous. Everyone in the community was just like, "Bernadita's going to cross the desert," and talking about how dangerous it was. That was one of the more striking examples of just how immigration reform is really important in the coming future.
Also, working in farmworker communities and seeing what the conditions are when you have to live in the shadows, was striking as well. And like I said, the number of people who come in and have these--you know, they have these medical conditions, but they have insurmountable barriers in their life. Of, how to get a job, how to take care of their kids, you know not having money for medication, not knowing where to get access. There's just so many different factors that play into health. Particularly when mental health can affect so much of your physical health. I think immigration is tied into that for sure, with the breakdown of families and being displaced.
MV: My last question is, what are some lessons that you will take from SHAC into your training into becoming a doctor, knowing what you do from SHAC and from spending time in Mexico, and with the farmworkers?
CO: I think, working with SHAC--working within SHAC and working within this specific community. I think more than anything, you learn that everyone has a story. And that if you get to know that person's story, the better you are able to care for them, both by pointing them to resources in the community and caring for them with their physical needs. Also just being an empathetic ear. The importance of that, just listening and being a voice for patients, and being an advocate for them. Whether that's providing resources of coordinating care. I don't know, just--I think that support role. That has been really emphasized to me. And how complex these patients are. Also in general, working with different teams of providers--public health students, social work students, everything. I think that has emphasized to me the importance of team-based care. Having different people with different strengths all helping someone in all of the many facets they need help with. That's really been emphasized through SHAC, through different experiences I've had. Also engaging with those disciplines and not being afraid to, and not separating the medical from all the other social factors that are present in someone's life. I think that's really been emphasized within SHAC and these other experiences I've had.
MV: Is there anything else that I haven't asked you about, particularly your experience at SHAC that would be important to know about?
CO: I don't think so.
MV: Well, thank you so much for sharing with me about how SHAC works and what your experiences have been working with Latino patients in the Triangle Area.
Christina Olson: Okay, so, I grew up in Greensboro, North Carolina.
MV: Can I use your pen?
CO: I grew up in Greensboro, North Carolina. My family, I guess, is from the healthcare field. My dad is a physician and my mom's a pharmacist. I have a little brother and sister. I guess, related to working with Latino communities, I started working with Latino communities in high school through El Centro Latino in Greensboro--or, El Centro de Latino Acción in Greensboro, working with youth groups to promote well being and stuff. So, I met with different youth groups and we did tutoring activities and just fun and games, and that kind of thing. Also, worked with, also helping, like bringing the Mexican consulate and stuff like that. So that's when I really got involved working within Latino communities and it was a really cool way to connect with Greensboro in a different way than I was exposed to. I don't know, it was an exposure that opened my eyes to different people in my community. I went to public high school, public middle school, and then came to UNC-Chapel Hill for undergrad.
MV: What did you study at UNC?
CO: I studied Global Studies with a focus in global health and environment and a regional focus in Latin America, and minored in chemistry and biology.
MV: Wow, that's a lot on your plate. [laughter] So how did you--I guess, you talked a little bit about getting interested in access to healthcare--what made you interested in working with the Latino population in Greensboro?
CO: In Greensboro? Well, let me think. Honestly, I was really looking for a way to directly serve my community. I think in high school, there were so many ways--you could do fundraising and do one-time service events, and I was looking for a way to engage with the community on a long-term basis and also in a direct way. I was also hoping to utilize Spanish and get better at Spanish. So I just reached out to this non-profit organization and developed a really good relationship with the director. I just ended up being a weekly volunteer, and spent probably about a year and a half there. Just got to know a lot of the people. It became really easy because you form relationships with people.
MV: Your interest in healthcare, that's been something you've been interested in for a long time?
CO: I started out college, actually, thinking that was the last thing I was going to do.
MV: Really?
CO: Yeah, well, I was more interested in public health and not medicine, specifically. And so, the summer after my freshman year, I went to Mexico. I stayed in a small community in the region of Oaxaca called La Pe de Ejutla. It was called La Pe because it had two streets that were in the form of a backwards P. So it was a rural farming town and I was working with a small non-profit there called Puente a La Salud Comunitaria. It was a non-profit that promoted the use of a native superfood, amaranth, within the communities as a way of combating malnutrition. So, people could grow the amaranth close to their house, use some of the leaves in their tortillas or beans or whatever, and fortify their food a little bit more. Then we did a bunch of teaching with the kids and women. And, I just really enjoyed that. We also, there was a small clinic, and that's where we were doing the teaching, so I got to be in the clinic some too. And, I think, that was the turning point where I was really interested in medicine. Just because, I saw how you could really directly care for people in the clinic, and also engage in the community public health access kind of issues. You can kind of work on access issues and then be the person maybe people got access to.
MV: Cool. So, can you tell me a little bit about your experience working with SHAC? How did you get involved?
CO: SHAC, so, I had a friend tell me about it. And--.
MV: And what is it? Can you just explain?
CO: SHAC is a Student Action--Health Action Coalition. It's a student-run free clinic--that's the oldest free clinic in the United States--or, oldest, student-run free clinic in the United States. So it's run by students in a variety of the different graduate schools here, so the med school, pharmacy school, public health school, school of social work, nursing school and there's also undergraduates that can get involved. As an undergraduate, really the only ways that you can get involved is as an interpreter. So I started interpreting at SHAC my sophomore year of undergraduate. I started out doing more basic, like front/back and vitals until I was more comfortable, and started doing clinic interpreting later on. But, it's a really neat experience to be an interpreter there because the patients do go through public health--I mean, pharmacy questioning, public health questioning, social work questioning, possibly HIV counseling. Sometimes physical therapy and then medical questioning. So you do get to see the broad spectrum of the patient's life, as well as be an advocate for the patient between the different groups. You know, sometimes you would hear something in social work and you could tell the medical students, "Hey, this might be something of interest," and be a mediator between the groups. So that was something I really liked, that I got to see the whole picture of a person when I was there. And so, that kind of also was feeding my interests in both medicine, and also kind of the community context of where people come from and how those factors relate with their health.
MV: How long did you end up working there?
CO: So, I served as an interpreter for three years. Well--two years, and then, senior year, I was a coordinator. Which means in this year, my first of medical school, I'm also coordinator, which means we coordinate the interpreters. We assess new interpreters, deal with all the logistical side of being an interpreter, and also represent SALSA, which is the name of the interpreting group at the leadership meetings. So, I interpreted but also coordinated. That also meant that we were involved in little projects, like the pharmacy team wanted to translate all of the instructions for different medications into Spanish so that patients could have it in Spanish to bring home. We helped them with that. We partner with other groups who needed Spanish translation, if they didn't have members who could do that.
MV: So, how does SHAC do outreach to Latino folks in the area? Do they do outreach?
CO: I might not be the best person to ask. SALSA specifically doesn't, as an interpreting organization, but we do interpret for the Well Child clinics, which are four times a year. There's Well Child clinics for kids who need physicals to get into kindergarten or to play sports. So we do interpret for those, and we also interpret for two different health fairs. One at St. Thomas More and the other that I'm forgetting the name of. But we interpret for the HIV counselors at those health fairs. SHAC Beyond Clinic Walls but they're trying to expand an initiative to work with more Hispanic families so, that's a lot of times for elderly patients who can't necessarily get to the clinic, students will go out to their homes and help them with little things. Kind of help them coordinate their healthcare, and I know one of their initiatives is to try to include more Hispanic patients.
MV: So, SHAC is run--I guess, it's run once a week, is that right?
CO: Once a week on Wednesday nights, yeah.
MV: And so, it's the free clinic on just Wednesday nights.
CO: Mm-hmm. And it's run at Piedmont Health Services, which is a clinic that also takes a lot of the patients that are referred. So SHAC acts kind of not as a long-term care clinic for patients, it's more of an acute-care based clinic and then one of the things that the people at SHAC try to do is connect the patients that come in with long term care. So a lot of patients who--if some patient come in with, let's say uncontrolled diabetes, and really needs to be with a primary care physician, it's not something that is--. You can help treat acute hyperglycemia, but we also try to work with those patients to get them connected to a long-term care provider, which is often physicians at PHS or UNC clinics.
MV: How important would you say facilities like SHAC, the acute care settings, are in a patient's life--like the ones you are typically seeing?
CO: I mean, my guess would be pretty important, because I know that there's other free clinics in the area, but it could prevent an emergency room visit. I know it's pretty--I think it's pretty well known in the Spanish-speaking community that SHAC is available, has interpreters, and is a place where you can go to get help and I would think that SHAC--and I know there's a free clinic in Durham, a couple of free clinics in Durham--and that might prevent people from going straight to the ER. It's a lot of--. I know that a lot of people refer patients to SHAC if they don't have health insurance. So I think it is important--and it's important, really in the first step of like, maybe getting to a place where you can even have long-term care if you are referred back to PHS.
MV: Okay. What do you think are the biggest challenges faced by the Latino patients you see in the clinic?
CO: Biggest challenges. In terms of getting access to care, a lot of the patients we see are undocumented, so that's probably the biggest barrier for obvious reasons.
MV: Because they can't get insurance.
CO: Yeah. And, other barriers--financial barriers to medication. You know, if they can't find a regular long-term care provider, it's hard to keep up with chronic diseases. We saw a patient that had a hernia that he had had for a really long time, which--if it became strangulated--could be a really big problem. So, you know, things like that, where patients present much later, when they're really sick, with a lot more problems that could have been prevented if they had long-term care. So, I would say, insurance, finances, and SHAC does help pay for some of the prescriptions. It often refers people to the four-dollar Wal-Mart prescriptions.
I would say also another thing is just not knowing where to go to get resources. One of the--I know the public health and social work students in particular have a lot of resources that they hand out to Spanish-speaking patients regarding a lot of--. One thing, something that we see a lot of is patients who are depressed and in need of some type of counseling. Particularly, you know, being displaced from your home, you're isolated, you don't know anyone. If it's difficult to get a job, it's just--you know, it's weighty. So, that's something that I think SHAC does a pretty good job of referring people to outside care, like El Pueblo. That's one of the places they refer to for counseling and stuff. Probably, like lack of knowledge, lack of resources, lack of insurance. That's kind of the things you would expect.
MV: Does SHAC have any way of following up with the patients that they see?
CO: Yeah, there's a whole team called Continuity of Care--the Continuity of Care team that does follow up with patients, to--. Also the Triage team, which I'll be a part of next year, calls--. There's a pretty high no-show rate at SHAC, so the Continuity of Care as well as the Triage team work together to call for appointment reminders, as well as call with results and that kind of thing.
MV: So SHAC goes by an appointment basis or first come, first serve?
CO: It's appointment basis and there's probably, say, four to five patients a night. The night is about twenty or so patients total. It changes--. The patient load changes according to who are the clinic co-directors. So, it was a little less this year because they were trying to streamline the visits a bit more. But, about four to five patients a night are walk-in patients, which are patients that are evaluated by the Triage team. So they're like evaluated on the basis of whether they really need help that night or whether they can wait for a week or if they just need to go to the ER right away. But otherwise it's an appointment basis.
MV: So do you ever end up seeing repeat patients?
CO: Yeah, every once in a while. As coordinators, we usually go every few weeks, so every once in a while, I have ended up interpreting for the same patient who's coming back for followup.
MV: How do you think their experience is different from the one-time patient's?
CO: There's a fair number of patients--there are a lot of one-time patients--. There are a fair number of patients who either come back for follow up or come back in a few--like, after a couple of years, if they have a new problem. And I don't know, I guess it's like you're a little bit more familiar with how SHAC runs--because it's different. You have all these different students coming in. People coming in from public health, social work, and so, it's different than you would expect at a regular clinic. So people who come for a second time may have their expectations set. It does take a long time because there's a lot of students, there's only two attending physicians, so it sets their expectations for how long it's going to take. That's probably what the biggest tangible thing I would say is. Oftentimes, people who come back--when you ask them about how their experience at SHAC. They're really thankful for SHAC and come back the second time. So usually I think for people it's a positive experience, though some--there's a fair number of people who get frustrated with how long they have to wait.
MV: And how long is that, on average?
CO: It can be a couple hours. It can be a long time.
MV: Do you have any sense of any specific perceptions they might have about SHAC? Any things they may have said in particular?
CO: You know, I don't know if I would hear it. Probably the most positive things I hear are, "Thank you so much." Just for the access to an appointment, the access to people who--. If you go and you talk with all the different groups, you do end up coming out with a lot of resources. Usually, if you do get a prescription, you'll get help paying for the prescription. You do get evaluated by a physician. So medical students come in first, but a physician will go in and oversee every patient. I think people are thankful to have the access. I would say the biggest complaint I hear is the time you have to wait, and it is a really long time. SHAC is constantly trying to make that time shorter. But, the nature of it being run by students is that it takes a long time.
MV: Have you, in your time there, heard any perceptions of patients and what they think of the healthcare system in general?
CO: The health care system in general. I think that, recently, it's been particularly hard to get an appointment at PHS, so--. I don't know if it is recently in particular, but that's my perception. It seems like it's been harder to get appointments at PHS because they're totally overloaded with patients--the patients that they see already. So that's a frustration that I've heard recently. "Okay, you gave me the number for PHS to call to get a follow-up appointment. I've called and they said they don't have room and now I don't know what to do," and so they'll come back to SHAC. And SHAC doesn't really have a way--it's hard, because they're one of the main people that we refer to. There's a couple of UNC-based clinics that we can refer to as well. I think probably the biggest frustration is that they're overloaded and there's not enough room oftentimes to take new patients. So they end up having to go through this haphazard way of going back to SHAC, waiting a really long time, maybe not getting the best long term care. Because that's not really what SHAC is built for. So that's probably the biggest frustration I hear from people.
MV: Are there any particular stories that come to mind when you think about your experience at SHAC that are particularly symbolic of the health care system today? Anything that has really struck you while you were there?
CO: Let me just think for a second. Um, sorry, I'm just trying to think. I was trying to think of this before I came to the interview. [pause] Sorry. Gosh, there have been so many people. [pause] I think something--I don't know. There's been a lot of really--. I think something that strikes me is how many people come in and seem to be really isolated and depressed. I think that comes out a lot more when, kind of like in tandem with the medical questioning, having that public health and social work questioning, where people ask about you know, how are your relationships? Do you feel safe at home? and that kind of thing. Different things have come out. Like, a number of women I've interpreted for had been abused. A number of people were concerned about their partner cheating on them or someone, you know, a family member, a few weeks ago, I interpreted for a lady where her husband had recently been deported.
MV: Wow.
CO: So there's just a lot of--lot of things going on in people's lives. I think those stories of--"My husband just being deported and now I'm here with three kids. I don't speak English. And I'm having trouble finding a job"--is like, sadly, very common. Kind of the breakdown of family because of the distance of, "I'm here and I'm working, my wife and kids are in Mexico"--or, that kind of thing. That always strikes me. I don't--I've never heard feedback on how the counseling is at El Pueblo, but usually people get referred to El Pueblo for counseling. So that always really strikes me.
Like I mentioned before, there's a lot of people who come in who have conditions that have just gone awry, like the guy with the hernia. He had had it for so long. It doesn't acutely--. It's not bad unless it gets strangulated and then you could get an infection. He had had it for so long that it--he was at risk of having that. And just, people with diabetes. It's hard to control because they don't have the long-term care. I'm trying to think of a specific story. [pause].
MV: That's okay, I can ask some more questions and you'll see if anything comes up. So, I guess, can you describe your role a little more as an interpreter? What are you specifically doing?
CO: So, we simply interpret. That sounds kind of dumb--like a dumb answer to your question, but. So we get paired--we try to pair all the interpreters there with a patient. And so they stay with that patient throughout the whole night. Some patients are med team only, if they're coming for follow-up. Some patients come in just for HIV counseling, but a lot of patients come in--like I said--for all those different groups. And so, you essentially just are paired with this patient and whenever a new team goes to do questioning, you're in the room. What we instruct our interpreters to do is to literally only say what the other people are saying, and to not really add anything. You're just a mediator between the two people. And also, I think, also helpful when talking, debriefing with teams afterward, it's helpful to have the interpreter there, because you're remembering, "Well, they said it like this and the meaning of this word is maybe a little different in Spanish than it comes out in English." A lot of times, I'll talk with the teams afterwards and that kind of thing. So you can be a support for the teams themselves and like I said before, you can inform incoming teams of what you've learned on past--like going in with social work, you can inform the medical team, "There's this thing going on." There's been a couple of times when someone will express, "I really want birth control" or "I'm really worried about"--. This one lady was really worried about birth control or having a possible STI and didn't bring it up to the medical team, but since I had heard about it in social work, I brought it up to the medical team, and they asked her directly about it. So you can be an advocate in that way and make sure that everything they brought up is brought to the table.
MV: That's cool. What do you think makes SHAC unique from other free clinics?
CO: You know, I haven't worked at other free clinics, so I'm not really sure. I guess, Baylor would be the closest experience I've had to working in other free clinics. So, I think the main difference is that it's run by students. It takes a little longer, it's a little bit kind of heavier. It takes a lot longer, it's less efficient, and that kind of thing. I also think there's an advantage to being run by students sometimes because students will take a lot longer asking questions and stuff. Sometimes you'll get patients to talk about things that they might have not mentioned in a quicker fifteen-minute interview. Then, I also think having the multi, or inter-disciplinary approach is really helpful. On the leadership team you have groups, people from every, all these different departments who are putting their heads together there to try to make SHAC better. I also think it's really important from the student side of things, to have students engaging with these kind of activities, so that, as they become physicians, they have a better idea of the needs that are out there, and have a better idea of the population. Even particularly for interpreters, for the Spanish-speaking population that's going to be a big part of our population.
MV: What challenges--so we talked a little bit about challenges that the patients might have--but what challenges do you think you and the other students who run SHAC face in trying to run it effectively?
CO: I think one of the biggest challenges in general with SHAC is that there's a lot of volunteers but not very many really dedicated--there's a lot of volunteers, and a small cohort of really dedicated volunteers, who tend to be the coordinators who are there on a more consistent basis. Otherwise, volunteers will come in one month and then they won't come in for three more months, which is fine, because we want people to have--. A lot of times, the reason for that is because it gets filled up, because people want to volunteer. But it does make it hard in terms of training everyone and having everyone be on the same page. So that's always a difficulty and the leadership turns over every year, just naturally, because it's medical and other graduate students who are running it. So, a lot of times there's not as much continuity between the leadership teams and I think that makes it--every year it's different, every night it's different. And so, I think that's a challenge.
Specifically, as an interpreter, I think most of us are students. I'm not a native speaker. We do have a number of native speakers that are interpreters, but it's always just keeping up with Spanish enough to make sure that you're doing a good job. I think for us as coordinators, it's difficult to--one of the difficulties we have is assessing volunteers so that we have enough volunteers to help, you know. So that we have enough volunteers to help and that we can get people involved and excited about working with Spanish-speaking patients but also making sure they're good enough to be accurate and not cause mistakes of care, mishaps in communication. So that's always a difficulty, particularly when it comes to more specific interpreting, like HIV counseling.
MV: Yeah, that makes sense. Are there any institutional challenges that might exist? Particularly, with undocumented patients?
CO: Within SHAC specifically?
MV: Mm-hmm.
CO: Well, SHAC takes everyone, regardless of insurance status. So I don't think there's any difficulty in access for undocumented immigrants, but it's probably more difficult to establish follow-up care. Like I said, PHS is, as of my knowledge, one of the only places that will take undocumented people along with UNC-based clinics. So that poses a challenge in that there's just not as many places to refer to get long-term care. In general, patients without insurance, that's a difficulty but it's just a compounded difficulty. Otherwise, for SHAC specifically, I don't think there is. I don't think it's more difficult to take patients who are undocumented versus those who aren't, specifically for SHAC. Just maybe harder to establish long-term care.
MV: Right. I guess, what successes do you feel like you or SHAC as an organization have had that have been really great for the patients?
CO: I think the fact that SHAC has been around so long is a success in itself. I think that it's an establishment in the community that often, we don't--I don't think SHAC does a ton of advertising for itself, in the sense that, people in the community know about SHAC and know that it's a resource. I think that's a success in itself. I also think some of the new--and I'm not as familiar with these programs since I haven't worked with them specifically, but--some of the newer programs like SHAC Beyond Clinic Walls has been a really cool program, going into people's homes and who may not be able to get to the clinic, I think that's a really cool thing. Specifically with SALSA, we haven't done any major revamps, but we've really worked on recruiting. A few years back, we had a small number of interpreters and we're always looking for more volunteers, and now we have more volunteers that can sign up. So I think that's been good, specifically working with undergraduate coordinators, like I was to try to recruit more undergraduates. Which I think is cool, because we get people who--for me, it was a really helpful experience to solidify that I wanted to go into medicine. I think, for a number of our interpreters, it has been a similar experience. So that's cool, in people's lives like that. I think, specifically for the clinic, that outreach with the SHAC Beyond Clinic Walls has been really successful, as well as just the fact that it's been around so long and it remains an establishment that we have a number of attendings who are really dedicated to making sure that--a lot of attendings there often. Residents who come in and are really excited about helping. I don't know, I think there's--I just think it's cool that it's been going on so strongly for so many years.
MV: Is there a particular moment you can remember being at SHAC where you really made a difference?
CO: [pause] Not a particular moment, but it always means a lot when patients--after interpreting for them--thank you a lot. In the sense that, I don't know, I feel like that's a success. When you feel like you've really been able to be a voice for the patient. I don't know, I think that's the coolest part of being an interpreter. Being a voice for the patient and making them feel comfortable. So it's not really like one success, but those nights when you're working with someone who's maybe a little more complicated or has a lot going on, and you're able to just be a calm mediator and make a situation that's kind of stressful a little more calm. I think that that's a success.
MV: Yeah definitely. That makes sense. How have you felt yourself change since starting at SHAC?
CO: One thing that--gosh. So, what I want to do, I think, in general, in medicine is... I think I want to go into primary care and work with underserved populations. So SHAC in a lot of ways has been solidifying of that idea. So. I think--I don't know. Sorry, I'm trying to articulate. I think that, more than anything, I grow from hearing people's stories, and you have this repertoire of stories in your head of what people's lives are like so that you have a better idea of how to serve them and the difficulties and challenges a particular community faces. I think that repertoire of stories and getting to know people from those backgrounds and just becoming a better communicator in general, I think, will--. I don't know, it's just been cool--sorry, I'm going to try to rephrase this. Yeah, I think getting to know stories, getting to know a community that I might possibly work with in the future has been really inspiring and it's been really rewarding to be able to be a voice for people and to be a mediator. I think, yeah, it's just solidified my desire to want to work in these kind of settings in the future. The importance, particularly as a physician, of being a communicator and making patients feel comfortable, making patients feel heard. Even though I'm not the one coming up with the sentences and that kind of thing, I think just learning how to communicate, in general, in that way is something that I've grown in. Yeah. Also, just a desire to engage with the Spanish-speaking community, which is going to be such a large community of people in our future and so, it's cool to just build up an image of who those people are and that kind of thing.
I think also my work in Mexico was really helpful to see--. It was a sending community, so a lot of people went to, actually South Carolina, to work in Christmas trees. That was where a lot of people went. It was really--it's been neat. I did a couple farmworker trips also in undergraduate, so between the farmworker trips and working at SHAC and my work in high school and then being in Mexico, it's been interesting to see where people come from and what they have to deal with once they get here. So that's been neat too.
MV: Yeah. So, it's really great to hear that you are interested in going into primary care because that's a field that has such a shortage. I guess, what is it that anchors you, or you hope will anchor you, in going into primary care, knowing a lot of the challenges that are associated with that field in particular? Long hours, overwhelming number of patients, less pay. What grounds you in wanting to do that?
CO: Well. I would say the pay isn't a huge factor for me, because I think any field of medicine you go into, you'll be able to support yourself. I think a big part of it is that I want to develop long-term relationships with patients. I also really am interested in being part of the community and understanding that community, so as to be able to be better able to help patients. I feel like if you know a community, you're better able to put people's medical conditions into context of what's going on with their daily lives. I'm also--I'm really interested in--. I think primary care's a neat field right now because there's a lot of quality improvement research and that kind of thing going on. I'd love to be in a setting where I can be creative about, "How can we get access?" or "How can we make care accessible to these patients? How can we be doing better?" I'm doing work this summer on a quality improvement project in a PHS clinic, actually, on access to contraception for post-partum women. Then I'm also going to be in Honduras this summer, working on a women's health project where we're going to be screening for--it's been a project for ten years, it's called the Honduran Health Lines--and we're screening for cervical cancer, STIs, that kind of thing. So, I don't know where I was going with this--.
MV: Knowing the community?
CO: Oh yeah, primary care. So, I think those kinds of things are really cool. Being able to be creative with your colleagues about how to best deliver care to people. So that's exciting to me. The idea of learning how to best do that. Knowing people long term. In terms of long hours and that kind of thing--anything you go into medicine is going to have long hours. I think, something that I will be--I'll prioritize as I go into medicine is hopefully finding a situation where I can have some work-life balance and that usually just depends on what particular context you're in.
MV: So you talked a little about having a better understanding of the communities that you're working with. Have your perceptions about immigration changed as a result of working at SHAC, or even your experience in Mexico?
CO: Yeah, I mean... I wouldn't say politically my views have changed very much. They've kind of been strengthened if anything. I think probably the most striking thing to me about immigration was that the host family--or the striking story in the context of immigration was--the host family I stayed with in Mexico. The mother was talking about crossing the desert with her young nine-year-old daughter right after we left. After living with them for two months and kind of building a relationship with that family because her husband told her that if she didn't come over to America he was going to end the relationship and stop sending money over. And so there's four kids in the house and the wife. She, I think, was really severely depressed when we were there. And really struggling with whether she was going to cross the desert or not. Whether she was going to cross with her young daughter but leave her two sons--three sons behind. It was just really--I don't know. It was just heart breaking. And the desert is so dangerous. Everyone in the community was just like, "Bernadita's going to cross the desert," and talking about how dangerous it was. That was one of the more striking examples of just how immigration reform is really important in the coming future.
Also, working in farmworker communities and seeing what the conditions are when you have to live in the shadows, was striking as well. And like I said, the number of people who come in and have these--you know, they have these medical conditions, but they have insurmountable barriers in their life. Of, how to get a job, how to take care of their kids, you know not having money for medication, not knowing where to get access. There's just so many different factors that play into health. Particularly when mental health can affect so much of your physical health. I think immigration is tied into that for sure, with the breakdown of families and being displaced.
MV: My last question is, what are some lessons that you will take from SHAC into your training into becoming a doctor, knowing what you do from SHAC and from spending time in Mexico, and with the farmworkers?
CO: I think, working with SHAC--working within SHAC and working within this specific community. I think more than anything, you learn that everyone has a story. And that if you get to know that person's story, the better you are able to care for them, both by pointing them to resources in the community and caring for them with their physical needs. Also just being an empathetic ear. The importance of that, just listening and being a voice for patients, and being an advocate for them. Whether that's providing resources of coordinating care. I don't know, just--I think that support role. That has been really emphasized to me. And how complex these patients are. Also in general, working with different teams of providers--public health students, social work students, everything. I think that has emphasized to me the importance of team-based care. Having different people with different strengths all helping someone in all of the many facets they need help with. That's really been emphasized through SHAC, through different experiences I've had. Also engaging with those disciplines and not being afraid to, and not separating the medical from all the other social factors that are present in someone's life. I think that's really been emphasized within SHAC and these other experiences I've had.
MV: Is there anything else that I haven't asked you about, particularly your experience at SHAC that would be important to know about?
CO: I don't think so.
MV: Well, thank you so much for sharing with me about how SHAC works and what your experiences have been working with Latino patients in the Triangle Area.
