AND HOW COMMUNITY MEMBERS’ CONTACTS CREATED THE MONTAGNARD HEALTH TEAM
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1 Community Access
We gained access into the community through many channels over a period of about three years. The most important and sustained contacts were made possible through Montagnard Dega Association (MDA) and art and folklife grants to investigate backstrap weaving. At MDA, we taught ESOL and conducted lengthy interviews to ascertain employment and life skills. 2 Pool of Candidates and Selection Process
When it came time to seek candidates who could be trained to become both researchers and community health workers, we eliminated the handful of known nursing students and nurses because they were young and unlikely to gain the confidence of families we would visit. And with studies or a new career, they would not have the time. As we reviewed the research topics and personal questions (STDs, food insecurity, income) the CHWs would be asking, it became clear that older women who were underemployed would be likelier candidates, despite the misgivings of some religious, military, and political leaders we consulted.3 Qualifications
No candidate existed who could speak, read, write and translate all 5 major Montagnard languages, plus Vietnamese and English. Our work with elders to translate the 2010 Census informed us of the significant technical and cultural problems languages posed. Production of good written translations from field recordings, the gold standard of research, had been a lengthy and expensive endeavor — enough to break any research budget. Between two candidates, however, we found older women who could speak all the languages. One was literate in Vietnamese and a fast learner. She had ten years of clinical experience as a village health worker (VHW), a history that only came out after many employment interviews with her. The other had a long history of playing the role of a CHW, helping community members to get to doctors’ appointments and interpreting at employment offices. Both were mothers and grandmothers who were respected by their peers.4 Social Network of the Community Health Workers
The connections of Kwol were extensive and reflected her almost 20 years of living in the US. She seemed to know every family and their kids and be familiar with every employer where Montagards worked. She knew the wages and working conditions. She knew the court system, lawyers, schools, social services, and places where people shopped. Her life experiences reflected those of a refugee forced to flee her village when she was very young and who faced hardships and loss. She knew people from all tribes, and was even connected to the Amerasian and Khmer communities. By nature, she fit the CHW profile: sympathetic to others, inclined to help, and willing to persist against custom in order to achieve good outcomes for the families she had helped. Khin, a more recent arrival, came from a more settled life. Her village was close to a city and she could read and write her first language and Vietnamese. She was methodical and familiar with record-keeping and bureaucracy through her past career. She understood good health practices, nutrition, and exercise. Through her, we made important connections to former physicians, which set into motion a first-time meeting with American doctors to discuss ways of improving community health. Because she moved to a Greensboro neighborhood that is blossoming into a large Jarai-Bahnar enclave, she has been able to mobilize her neighbors into forming a women’s learning group.Top Down or Bottom Up
While most past efforts to connect to the Montagnard community had been through its religious, military and political leaders or through occasional friendships and sponsorships of individuals, we needed to identify those most likely to know and understand family life, meal preparation and home economy and who kept up with neighborhood news. We found most men were too busy, young women were not experienced enough, and children and teens with fluent English lacked intellectual capacity. This left mature mothers and grandmothers.
False Funding Arguments
Arguing for two hires instead of one, even with an explanation of the historic language problems associated with communicating with the Montagnard community, is a reflection of bureaucratic biases and administrators’ anxieties and not a true financial factor. The cost of two culturally competent, highly skilled and well connected grandmothers is less than the going rate for one specialist with strong skills in one or two languages. The pool of specialists is tiny, the fact of which has probably influenced the kinds of work and quality of work that have been attempted in the past.
For our work, we were lucky that Project Shine was seeking community participation to supplement their pool of mostly college and university applicants. Through two AmeriCorps programs, we were able to eventually deploy 5 CHWs.
