By Rebecca Rakoczy
CLARKSTON, Ga.—It’s Saturday morning, and the waiting room of Grace Village Medical Clinic is packed. Many of the patients are originally from Burundi, Pakistan and Burma, while others are natives of the United States. Some are elderly, others come with children in tow. All live below the poverty line.
The free clinic has served this community’s poor, predominantly refugee population for six years. Staffed by medical professionals who volunteer their time, and organized by members of Snellville’s Grace Fellowship Church, it is now one of the newest clinical sites for nursing students from Georgia State University’s Perimeter College.
It also is where a new health literacy program focusing on “teach back” is being piloted by the university. Funded through a grant from State Farm and the Georgia Alliance for Health Literacy, the “teach back” program is a way for patients to repeat to their health care providers what they understand they are hearing them say, making sure the directions are clear, said Valencia Freeman, a nursing instructor who oversees the students’ clinical rotations.
Designed in response to a community research study by Dr. Iris Feinberg, associate director of Georgia State’s Center for Adult Literacy Research, the health literacy program hopes to bridge longstanding health disparities in the community, where research shows language and literacy barriers as a key obstacle to improved health outcomes.
A recent Georgia State survey of more than 100 refugees and health care providers in the community found some 90 percent of the patients didn’t understand what their provider was trying to tell them, said Dr. Mary Helen O’Connor, director of Georgia State’s Center for Community Engagement at the Clarkston Campus. The data collected indicated a need for a more culturally and linguistically appropriate training for health caregivers who served the refugee communities, she said.
In response to the survey, Feinberg and O’Connor created a health care seminar for nursing and health science students, teaching culturally and linguistically appropriate health education using the “teach back” tool. As part of the program, Georgia State refugee students shared their experiences of displacement and migration with the health science students. helping them understand some of the obstacles refugees face when English is not their first language.
The students now are using their newfound knowledge of how to deliver more culturally appropriate care to patients.
“For example, directions such as “take one pill before a meal” need to be spelled out clearly and simply,” said Cecilia Barcelo, a Perimeter College nursing student who attended the seminar. She was in her second clinical rotation at Grace Clinic on a recent Saturday, and shared her experience using “teach back.”
“When you say, ‘take one pill every 12 hours, or take before breakfast, they (the patient) can be lost on that meaning. They need to know exactly what time to take that pill.”
Other students who participated shared how much they enjoyed working with the refugee community at the Clarkston clinic.
“It’s been a profound experience,” said Tiffany Harris, a second year Perimeter nursing student, who will graduate this month. “It’s very different from any other clinical experience we’ve had because you have to figure out how to communicate to people even if you don’t speak the language. I had to connect with the patients on a more intimate, emotional level, and I used a lot of hand gestures.”
Despite the communication gap, “every patient opened up intimately on what was going on in their life,” she said. “One patient, a mom, told me she was working, and didn’t have time to take care of herself. I was able to educate her about her medication and lifestyle choices. I feel like the point got across. “
Nursing student Patricia Roa also volunteered at the clinic.
“It was a great experience just to see all the volunteers working together to see clients that really needed the help,” she said. “They didn’t care what language they spoke — this was the medicine I wanted to see.”
“Working at this clinic has given me more patience,” said Perimeter College nursing student Jeremiah Johnson. “Knowing (the refugees’) background and what obstacles they are facing does help me see things differently.”
Not speaking English can be “very frustrating,” he added.
Harris noted that the "teach back" program will help in other clinical work when she graduates later this month.
“I hope that I would establish that emotional intimate connection first so my patient and I would have rapport before I start handing out medications or giving them any news,” she said. “That’s what I learned from Grace Clinic and what I hope to take with me going forward with my clinical experience.”
“When you’re in the medical system, it can be very scary,” Harris said. “You hope for someone there to say ‘let’s work on this,’ versus just give me this pill.”
The Georgia State Perimeter nursing students are important to patient continuity of care, said Michael Sorrels, clinic coordinator.
“We want to provide these patients with a health care home,” Sorrels said. “The students from Georgia State are really making a difference here. Georgia State is a wonderful partner.”
That partnership will expand this spring, when Georgia State’s nurse practitioner students will join Perimeter College nursing students for clinical rotations at Grace.