Wednesday, 5 March 2008

A world of caring

Richard Tsong-Taatarii, Star Tribune
At the Center for International Health, Dr. Patricia Walker, left, and Yanakry Chhit said goodbye in the traditional Cambodian way. Chhit lost her husband, siblings and parents to the murderous Khmer Rouge regime in Cambodia. The St. Paul center’s roots go back to a small medical team on the Thai-Cambodian border in 1979.

The Center for International Health in St. Paul offers medical care for immigrants, many of whom are confounded by the American system.

By KEVIN GILES, Star Tribune
March 4, 2008

Yanakry Chhit lost her husband, siblings and parents in the Khmer Rouge killing fields of Cambodia. Adel Ganopolskiy emerged a survivor from the cancer-drenched region around Chernobyl, the leaking nuclear plant in Ukraine. Jacob Matadi escaped Liberia's civil war, in which at least 150,000 of his countrymen died.

"It's a mixture of fascination, relief and fear," Dr. Patricia Walker said of these patients and hundreds of other immigrants who come to the Center for International Health in St. Paul for medical care.

A new book, "My Heart it Is Delicious," details the history and growing prominence of the Center for International Health, which has its roots with a small medical team dispatched to the war-torn Thai-Cambodian border in 1979 to tend to sick and starving refugees. One of the volunteer doctors was Neal Holtan, who later founded the Minnesota clinic. Another was Walker, then a third-year student at Mayo Medical School in Rochester.

"The book feels, to me, so much a Minnesota story," said Walker, 52, who was born in Taiwan and lived in Thailand until she was 11. "It reminds me that we really are a global village."

Walker is featured prominently in the book, written by Biloine Young, a St. Paul historian and author who lived for seven years in Guatemala and Colombia.

The Medtronic Foundation paid printing costs for "My Heart it Is Delicious," published by Afton Press, but also has given the Center for International Health grants totaling about $1 million over the past 10 years. David Etzwiler, the foundation's executive director, said the clinic is a "jewel in the crown" of Minnesota health care because of the staff's understanding of language and cultural needs. Etzwiler speaks highly of Walker, one of many people the book features.

"You can't spend a whole lot of time around Pat without understanding she's a pretty amazing individual," he said. "Her purpose in life is truly caring for people, understanding them..

"The Center for International Health, a pioneer in immigrant health in the Twin Cities, is seeing nearly eight times more medical patients than when it opened in 1987. As wave after wave of immigrants arrived -- more than half of the clinic's patients came from Somalia, Vietnam, Laos and Cambodia -- the need to overcome challenges, from tropical illnesses to language barriers, becomes more urgent. Misunderstandings can lead to misdiagnoses, self-medication and distrust.

"The reality is, demographics are changing Minnesota, and we have to be on the front end of that," said Walker, the clinic's medical director, who also manages a caseload of 1,000 patients, teaches at the University of Minnesota and recently co-edited "Immigrant Medicine," a textbook about immigrant health care.

On any given day, immigrants line the clinic's hallways. Many are recent arrivals unaccustomed to modern medicine. Most doctors and nurses are immigrants themselves, and those who aren't speak at least one foreign language. Walker, for example, speaks Thai, Lao and Cambodian fluently. In addition, the clinic employs several interpreters.

"It's a pretty special clinic, this place is," said Angela Kuria, a registered nurse from Kenya who speaks English and Swahili.

Minnesota has had its share of "really heartwarming and really tragic stories" involving immigrant patients, Walker said.

For example, a Somali patient who once visited another clinic told an interpreter he'd been bitten by a hyena, which turned out to be a euphemism for syphilis. The interpreter, however, misunderstood the patient because of regional differences in language -- one being from north Somalia, the other from the south -- and the patient was treated for rabies.

Immigrant health care, Walker said, once was "just fraught with misinterpretation and errors and unnecessary tests because doctors really didn't understand what's going on." Knowing immigrant health care means understanding why patients think they're sick because of evil spirits or the loss of a loved one, or why they value a tribal treatment over what a doctor recommends, Walker said.

Kuria said she identifies with the confusion. "I was really scared," she said, when she came to the United States in 1996 to attend the University of Wisconsin-Eau Claire. At the clinic she spends much of her time helping patients navigate newfound bewilderments such as pharmacies.

One of those patients who had to learn what pharmacies do was Matadi, from Liberia, who said there was "no medicine at all" in his native country. When he arrived in the United States he suffered from malaria, pneumonia, diarrhea and other maladies and went into a coma for two weeks.

Now, as Walker's patient, he marvels at the treatment he's getting. "For them to heal me, it's a miracle," said the St. Paul man.

The patient census at the clinic dipped in 2007, a year after the clinic relocated from the Regions Hospital campus to 451 N. Dunlap St., just off University Avenue in St. Paul. That change could have contributed to the decline, said clinic spokeswoman Conni Conner, as could a recent slowing of new immigrant arrivals, more immigrants moving to the suburbs, or the opening of more clinics for specific immigrant groups.

But some CIH patients don't want to change clinics. Ganopolskiy, from Ukraine, has been Walker's patient since 1992. "She's wonderful, as a human being and as a doctor," she said of Walker. "She's very understanding. She listens to the complaints and she's very good with diagnosis."

Kevin Giles • 651-298-1554

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