DEC. 12 2011 FIRST-TIME MEETING OF MONTAGNARD FORMER PHYSICIANS, US PHYSICIANS AND UNIVERSITY RESEARCHERS AT AHEC, MOSES CONE HOSPITAL. AT THE END OF THE MEETING, A CHALLENGE TO AMERICAN HEALTH PROVIDERS: HOW DOES YOUR KNOWLEDGE OF THE EXISTENCE OF MONTAGNARD DOCTORS READY AND WILLING TO HELP, CHANGE YOUR IDEAS ABOUT HOW TO IMPROVE MONTAGNARD COMMUNITY HEALTH?
Community activist Warren Williams organized harvest events and
coordinated with NCAT and Cooperative Extension office personnel.
J. Education Day
Touger Vang of UNCG speaks to Montagnard children and high schoolers about succeeding as a refugee during Education Day organized by Pastor Y Hin Nie. Many Montagnard high school and college students are enrolled in health and medical programs, but no formal programs exist to assist them or to connect them to existing health projects.
Future leaders. Local universities and colleges could make a bigger effort to encourage and recruit top students in the Montagnard community._______________________________________
YBhim Nie, proposed study of hypertension in the Montagnard-American community.
Lhiam Enoul, proposed 5-page health checklist translated into Rhade.
Translational research and community-based participatory research presentations
by NCTraCS attended by Montagnard doctors YBhim Nie and H Wier Siu.
DESPITE MANY EFFORTS to bridge the divide between American and Montagnard communities, language and culture remain significant barriers to better refugee health. The recent brutal triple slaying in Greensboro is a stark reminder these barriers cost both communities.
In 2010, the Montagnard Women’s Lay Community Health Team was created to test whether a community-based promotoras model could assist UNCG researchers to conduct interviews and deliver food, health and diet help to struggling families. The Health Team and Montagnard community leaders also identified former physicians, who were contacted and began attending NCTraCS workshops on translational research. Montagnard US-trained health professionals were also identified and contacted.
The successful demonstration of the Health Team and the “discovery” of existing medical expertise powerfully suggests the need for a formal program — in effect, a PERMANENT BRIDGE that unites American and Montagnard efforts towards better patient compliance and health outcomes.
In 2010, the Montagnard Women’s Lay Community Health Team was created to test whether a community-based promotoras model could assist UNCG researchers to conduct interviews and deliver food, health and diet help to struggling families. The Health Team and Montagnard community leaders also identified former physicians, who were contacted and began attending NCTraCS workshops on translational research. Montagnard US-trained health professionals were also identified and contacted.
The successful demonstration of the Health Team and the “discovery” of existing medical expertise powerfully suggests the need for a formal program — in effect, a PERMANENT BRIDGE that unites American and Montagnard efforts towards better patient compliance and health outcomes.
___________________________________
Stewart Rogers, Raleigh Bailey, Director of Center for New North Carolinians, and Kay Gable MD, Program Director, Dept of Pediatrics, Moses Cone.
Carolyn O' Brien is a Congregational Nurse at United Montagnard Christian Church.
Snow Rahlan Joyce, Lay Community Health Adviser, and Carolyn O' Brien.
Sitting behind them: Merle Green, Director of Guilford County Department of Public Health
Kwol Ksa, Montagnard Women's Lay Community Health Team, speaks with Wayne Hale.
Left: Lhiam Enoul
Researchers Jigna Dharod and Huaibo Xin, MD
I. VISUAL DOCUMENTATION
II. TAKE HOME: MONTAGNARD COMMUNITY
III. TAKE HOME: AMERICAN COMMUNITY
___________________________________
DEC. 12, 2011 Montagnard Health Meeting at AHEC, Moses Cone Hospital
Stewart Rogers MD, Dept. of Internal Medicine, Moses Cone, and meeting moderator, and Andrew Young, event organizer, welcome participants and observers.
Center: Y Siu Hlong, director of Montagnard Dega Association
Montagnard former physicians include (at far left) Lhiam Enoul and YBhim Nie. Y Khiem Nie studied medicine for 4 years. Y Yung Buon Ya practiced internal medicine, H Wier Siu practiced for 2 years. On far right, H Nu Ksor completed 7 years of medical study before coming to the US.
Speaking out: Lhiam Enoul on the difficulties former Montagnard physicians face trying to help their community.
Speaking out: Y Bhim Nie on tropical disease
Speaking out: Nai Tina Tou Prong Ho Le, US-trained pharmacist and CNNC Fellow, on the challenges faced by the Montagnard American community understanding the US health system.
Speaking out: H Wier Siu on the difficulties Montagnard Americans have in accessing health care.
On the far right, Y Wun Nie, who practiced for one year before coming to the US. Standing: Wayne Hale, MD, Dept of Family Medicine, Moses Cone. Also in the back, Kwol Ksa, community health worker. Plenty of expertise and talent in the room. Can they find solutions to Montagnard health problems?
Far left: Huaibo Xin, MD, Don Lucey, MD (retired), Clara Chu, PhD Department Chair of Library and Information Studies UNCG. Far right: Ward Robinson MD, Guilford County Department of Public Health.
Sitting behind them: Merle Green, Director of Guilford County Department of Public Health
Maura Nsonwu of NCAT speaks with Y Hin Nie, pastor of United Montagnard Christian Church.
Pastor Y Hin with Huaibo Xin, former medical student Khiem Nie and former physician Y Yung Buon Ya. In the background are H Mai Buonya and Lhiam Enoul, both former physicians.
Center: Amy deRodriguez oversees Reading Connections’ Project Shine health literacy program.
Former physician and (now QA technician with SRI) Jacob Siu with his daughter and Sharon Morrison of UNCG.
Meeting issues and strategies
Stills from the Montagnard Health Team presentation. Listen to the conditions they report on YouTube.
___________________________________ I. VISUAL DOCUMENTATION
II. TAKE HOME: MONTAGNARD COMMUNITY
III. TAKE HOME: AMERICAN COMMUNITY
___________________________________
I. VISUAL DOCUMENTATION
B. Community and Cultural Events
F. Disaster Preparedness Study
Presentation to Montagnard Dega Association ESOL class on disaster preparation
Ethnographic map of the Montagnard people (source: Gerald Hickey). Of the 50+ indigenous tribes, perhaps 5-7 tribes speaking different languages are present in the Triad — the largest Montagnard community outside of Southeast Asia. How large? 2010 US Census will eventually release numbers.
A. Blood Pressure and Diabetes Clinics
Reading Connections and partners
Reading Connections and partners
A blood pressure clinic with education follow-up with culturally appropriate materials held at Montagnard Central Highlands Church organized by Teresa Sullivan, Reading Connections volunteer. Similar sessions have been held at United Montagnard Christian Church.
___________________________________ 
Blood pressure follow up and results.
B. Community and Cultural Events
Montagnard veterans’ event
Y Suk performed with Rmah Dok at UNC School of the Arts' DMA-MDA project
Jarai and Rhade women in traditional dress
_______________________________________
C. Women’s Lay Community Health Team
Project Shine
UNCG
Montagnard Dega Association
Project Shine
UNCG
Montagnard Dega Association
Video still from Bill Moyers’ Santa Ana Health Crusade, a PBS program about the efficacy of the promotoras model in the Latino population. Could such a model work in the Montagnard population? For several months, I trained the community health workers (CHWs) of the health team and learned in detail about community attitudes about health, recurring illnesses and access problems, family and community beliefs, and attitudes about American doctors and Greensboro life.
Pero estamos montagnards, no mexicanos. Spanish appointment card given to a Montagnard client. Chronic barriers persist after 25 years.
My original proposal to train a two-woman health team, a cost effective way for university researchers to obtain important data about the Montagnard community. The first candidate had ten years of experience as a village health worker (VHW) and five years of school plus one year of technical training. The second candidate had no formal education but spoke many languages, had lived in the US almost 20 years, and was well connected to her community. Since Dec 12, we’ve added a new CHW and will add two more in late February, 2012.
Visualization of the lay health team role
Dialog between mothers and daughters.
A good age to date? When to marry?
Initial funding for the health team was provided by Project Shine (Temple University) and the Food Insecurity Study (UNCG). Funding remains an ongoing problem with all resources and contributions coming from out of the region or non-health organizations. Project Shine, a federally-funded health literacy initiative now under Reading Connection's supervision, helps fund part of the lay health team's stipend. My training and supervision of the women is voluntary. Both community health workers have contributed very large amounts of unpaid time and unreported hours because they believe in the mission and wish to alleviate the suffering in their communities.
Culturally-based language lessons. Team members also used Apple Shuffles to study health terms, disease names, and practice pronunciation.
Team members assisted at a health fair at Avalon Trace
_______________________________________
_______________________________________
D. Montagnard Family Health Screening
Stephen Sills PhD
UNCG
Screening form
This form also asks difficult questions.
Basic information collected
Stephen Sills PhD
UNCG
Basic information collected
Selection of participants and interpretation assistance for UNCG research
assistant Juan Miranda, who is working with Dr Stephen Sills.
_______________________________________
E. Health and Disease Prevention Perspectives...
assistant Juan Miranda, who is working with Dr Stephen Sills.
_______________________________________
E. Health and Disease Prevention Perspectives...
Sharon D. Morrison, PhD, MSPH
UNCG
UNCG
Culture and language are key components to good health outcomes. Excerpts from a presentation by Dr Morrison in which she uses the Montagnard population to illustrate how the PEN-3 model could improve community health.
Lay heath workers and other families participate in interviews conducted by
UNCG graduate students in Dr Sharon Morrison's Public Health Education class.
_______________________________________F. Disaster Preparedness Study
Huaibo Xin, DrPH, MD, MPH,
Southern Illinois University at Edwardsville
Disaster Preparedness Study
Southern Illinois University at Edwardsville
and interview interpretation for Dr Huaibo Xin.
_______________________________________
_______________________________________
G. Food Insecurity Study
Jigna Dharod, PhD
UNCG
A Latino food pyramid, based on actual eating habits and food preferences. Creating
a comparable Montagnard food pyramid would require closer study of the diet.
Assisting Dr Jigna Dharod to research food habits and interview 50 families.
Identification of foods in the Montagnard diet through shopping trips to community stores.
Simple method for interviewing participants about amounts consumed.
Recipe demonstration by the health team
A Montagnard food pyramid
BMI chart used by health team
Concept map explaining the relationship of weight and BMI to diet. Community members asked why they had high blood pressure or other health problems if they were not overweight.
Simple education sheet explaining how work and exercise, once one and the same in Vietnam, are now specialized activities in America.
Culturally sensitive questions had to be reframed by the health team. Community members had to believe sensitive information would not be shared.
A Montagnard mom during an interview session.
Mothers have been the focus of the lay health team’s assistance.
Early participants also received cloth samples donated by a textile salesman
_______________________________________
_______________________________________
H. Interpretation - Translation - Transcription Method
Andrew Young
Side-by-side method adopted for US Census
Andrew Young
Original proposal for interpretation to translation method. The lay health team would
learn how to record and the transcribe audio to digital text assisted by technology.
A multi-language, cross-reference data base for medical terminology still in progress.
Training version of the survey used by the health team. The reading difficulty had been reduced from the original 3.5 grade level to 2.2 for easier learning. The survey was redesigned to a fill-in format with a heavy emphasis on bridging cultural gaps.
On the right, another training version of the survey with English and a crude Vietnamese translation side by side. This method allowed the learner better understand the survey questions and adjust her translation to the participant’s education and primary language while she practiced interviewing community members.
_______________________________________ I. Urban agriculture and NCAT food harvests
In 2010, Greensboro was ranked #4 in food hardship in the US.
Past efforts in community gardens
Practicing what she preaches. Health team member exercises by jogging around her new garden beds. It was important for health team members to learn by doing and to give feedback about culturally appropriate ways to communicate good health behavior to their friends and neighbors.
Large garden plot created by one of the lay health workers in her backyard. She used donated seeds from Big Lots, seeds from friends and family, and saved seeds from the previous year.
The lay health team escorted community members to NCAT’s
demonstration farm to harvest vegetables and deliver them to
needy families. They picked over two thousand pounds of produce.
Community activist Warren Williams organized harvest events and
coordinated with NCAT and Cooperative Extension office personnel.
Or, we can offer fresh produce to refugees through well-intentioned but otherwise time-consuming and meaningless programs like this one meant to support local farmers. The total coupons available for each family had a value of $12.00.
_______________________________________J. Education Day
United Montagnard Christian Church
K. Distribution of school backpacks and supplies
Goat Lady Dairy CSA, Spears Family YMCA
Goat Lady Dairy CSA, Spears Family YMCA
Backpacks and school supplies donated by members of the
School supplies donated by Spears Family YMCA, Greensboro. The lay
Goat Lady Dairy CSA and organized by volunteers. The lay
health team selected recipients and helped deliver items.
School supplies donated by Spears Family YMCA, Greensboro. The lay
health team selected recipients and helped in transportation.
_______________________________________
_______________________________________
L. Distribution of emergency food
Girl Scouts
Girl Scouts
The lay health team visited Girl Scout Troop 41738 (Greensboro), spoke about their lives and their community, accepted their food donations and divided and delivered them to the neediest families.
Food packages ready for deliver.
_______________________________________
_______________________________________
M. Orange Card sign-up drive
Project Shine (Reading Connections)
in coordination with
Food Insecurity Study - 2
Jigna Dharod, PhD
UNCG
Project Shine (Reading Connections)
in coordination with
Food Insecurity Study - 2
Jigna Dharod, PhD
UNCG
The Orange Card entitles qualified, low-income recipients to receive health care at reduced cost.
The 12-page Orange Card application form
Visual instruction sheet the health team uses to explain
essential documents to preliterate community members.
The reverse side of the information sheet targets mothers to obtain indigent health care.
A sliding scale fee to see a doctor is comparable to buying fast food or cigarettes.
essential documents to preliterate community members.
A sliding scale fee to see a doctor is comparable to buying fast food or cigarettes.
The health team tracks community members who are keeping food receipts or need
the Orange Card. They also assist women to get food stamps and other needs.
the Orange Card. They also assist women to get food stamps and other needs.
Happy to have gotten it. The mother was laid off from work three months ago. The father works and brings home less than $1500 each month. They have two young children. Recently they moved from their apartment complex to even cheaper, run-down quarters. As the economy worsened, Montagnard workers who held steady jobs for more than ten years were permanently laid off.
The health team also assists families to organize bills, important papers and documents while helping them find Orange Card requirements. This is highly appreciated by preliterate parents. Some families also keep food receipts as part of the Food Insecurity Study - 2.
_______________________________________ 
Moms as change agents in community health
Staggering bills such as these cannot be paid by poor families. Preventive care
is the start of cost controls and reduction of health costs to Montagnard families.
is the start of cost controls and reduction of health costs to Montagnard families.
N. Montagnard Health Meeting
Center for New North Carolinian
Center for New North Carolinian
Inquiries about Montagnard doctors and other health professionals
in the community came up during conversations with the lay health team.
Lhiam Enoul, proposed 5-page health checklist translated into Rhade.
by NCTraCS attended by Montagnard doctors YBhim Nie and H Wier Siu.
Proposal to bring former Montagnard physicians together to talk with American counterparts and to discuss university researchers’ findings.
–––––––––––––––––––––––––––––––––––––––
II. TAKE HOME: MONTAGNARD COMMUNITY
A. NCTraCS Pilot Program $2,000 health grantA grant to investigate a community health problem.
B. NCTraCS Community-Based Participatory Research charretteAn expertly facilitated meeting to generate a fundable, community-based health research project.
C. Montagnard Health Professional Study, Huaibo Xin, DrPH, MD, MPHA study to investigate the problems faced by Montagnard health professionals.
D. Montagnard Food Insecurity Study, Jigna Dharod, PhDAn expanded study of the food, diet, and health problems experienced by the Montagnard community.
–––––––––––––––––––––––––––––––––––––––
III. TAKE HOME: AMERICAN COMMUNITY
A. The lay health team interprets and communicates effectively to a preliterate, multilingual population at 40% of the standard rate ($20 per hour compared to $50 per hour).
B. It frees scarce, highly qualified translators and interpreters to do more important work.
C. As a regular community presence, it reduces costs by making sure patients understand and follow basic instructions, arrive on time, bring essential documents, etc.
E. Montagnard former physicians and US-trained professionals are the final pieces to a permanent bridge to good health, patient compliance and reducing health costs.
F. Both require modest, stable funding.
