“You can’t say, ‘he’s going to die’ to the family,” explains Anab Abdullahi. “If you’re a Muslim, you can’t say that. Because you’re not God, and you don’t know. Only God knows.”
In this case, though, the medical team did know. The 36-year-old Somali man, brain dead after a heart attack, would never wake up. Abdullahi coached his doctors through decision-making with his family members, thousands of miles away. She called the funeral home, the young man’s employer, his friends.
“As caseworkers-cultural mediators, we are the family,” says Abdullahi, who works for the Community House Calls program at Harborview Medical Center. “We hold their hands. We cry, deep down; we don’t show them our emotions. But we’re human beings. We can’t just be numb. This is the way I’d want to be helped if I were in their shoes.”
“While they interpret, they’re more than interpreters,” says Lea Ann Miyagawa, M.N., R.N. She’s talking about Abdullahi and her colleagues, the eight-person team that staffs the Community House Calls program at Harborview. Started with a two-year grant, the program aligned so well with the hospital’s mission — exceptional care for everyone, including refugees, immigrants and homeless people and their families — that it was absorbed into the hospital’s work.
Abdullahi starts her day by reviewing a list of Harborview trauma patients, ones who’ve identified Somali as the language they wish to use. She accompanies her patients as they go to medical appointments, including visits at Seattle Cancer Care Alliance. Sometimes, she’ll follow her patients to court appointments or school, easing their way through the system. Abdullahi also runs a weekly support group that doubles as social time for Somali women. She’s a consistent, reliable presence for her community.
It’s a lively but demanding job. “By the time you get home, you might feel very exhausted, and you don’t want to talk to anybody,” says Abdullahi. Rose Cano, sitting next to Abdullahi, laughs sympathetically. “But the reward for my day of work is immense,” says Abdullahi. “I know I made someone’s life a little better.”
The House Call
Cano, a Spanish-speaking diabetes navigator at Harborview, also makes house calls. Like the time she went to South King County to figure out why a patient was missing appointments and neglecting her medication.
When Cano visited the woman at home, everything became clear. It took the patient three bus rides to pick up medication. Her young daughter was autistic and had a very specific, school-related bus schedule; her mother had to work around it. And she was facing deportation. “I don’t have time for diabetes,” she told Cano.
“All these things are happening in our patients’ lives,” says Cano. “A lot of our patients are really unstable or the safety net is very thin, so one thing happens, and a person loses a job. Healthcare comes sixth on the priority list.”
Cano set to work to remove some of the hurdles. First, she told the patient about light rail, riding with her to the Tukwila stop. Now it would take less time to get to medical appointments and to the pharmacy. Then, a bit later, the two met up for lunch in Chinatown, talking about vegetables, diet and carbs. “It was a nutrition lesson, on the way to her bus stop, that didn’t feel like a lesson or appointment,” says Cano.
Still, there are some things even Cano can’t fix. The patient’s son, who was killed; the older daughter who was left behind in Central America. Ultimately, Cano hopes she gives her patients tools to help them live their lives, even with diabetes.
“You want someone to feel like they have control over their chronic disease, not that the disease has control over them,” she says.
Although some of Harborview’s patients face one or more barriers to care — a different language, poverty, transportation, homelessness, the threat of deportation — Cano, Abdullahi and their colleagues are there to help. They do so by being nimble and selfless. By listening. And by advocating for patients and their communities and providing culturally sensitive care.
“We can go beyond the boundaries of the consult room,” says Cano. “I think we make a difference.”