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Providing Culturally Sensitive Health Screening and Education to Local Scranton Refugee Communities

Briana Abrams, SPT

Alesia Heimes, SPT

Hailey Kenyon, SPT

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The Leahy PT Clinic

Student-run pro bono clinic providing PT services to those that are uninsured or underinsured in the Scranton community
Focus on evidence-based practice and quality of care
Collaboration between first, second, and third-year students
Guidance/recommendations from faculty supervisors as needed

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Scranton Refugee History¹

Over 7,000 resettled refugees in the local Lackawanna and surrounding counties with the highest prevalence from the countries of Bhutan and the Democratic Republic of Congo.
In 1900, Scranton was 38th largest city in US.
Scranton was a popular destination for immigrants and refugees due to industrial jobs, especially mining.

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Refugee Health

Non-white populations have higher rates of poverty which is associated with a higher risk of experiencing mental health disorders, chronic conditions, and decreased cognitive functioning.²
Refugees, especially women, may experience severe trauma from forced displacement, violence, and the resettlement process.³

Trauma has been associated with:

Poor maternal and fetal health outcomes
Chronic pain
Chronic conditions such as cardiovascular and pulmonary diseases
Poor cognitive and executive functions

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Accessing Healthcare Resources¹

The resettlement process poses challenges for refugees and may limit their ability to access quality healthcare due to the following reasons:

Lack of available time
Unstable employment-insurance/monetary concerns
Cultural and socioeconomic disparities
Inadequate community support
Limited transportation
Limited or inadequate translation services

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Community Outreach for Screening �and Education

The Leahy PT Clinic community outreach project provided services to refugee communities outside of the on-campus location.
To increase access, volunteers traveled to Bhutanese and Congolese refugee community centers.
Student volunteers provided screening and education about various health-related topics based on community needs.
Funding from AllOne Charities grant covered costs for giveaway items, supplies, and translation services.

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Cultural Sensitivity

Trained Volunteers¹

Provided education on working with a translator
Guided appreciation of differences, while recognizing commonalities
Advised to be personable, while not being invasive about trauma
Raised awareness of challenges refugees are forced to face
Emphasized how much these individuals have to offer!

Addressed Communication Barriers

Translators at event
Pamphlets in English and native language

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Spring 2022 Health Fair

Assessed vitals, fall risk, activity levels, and stress at several stations
Provided education through pamphlet handouts
All age groups and genders welcomed
Collaborated with OT to provide education on sleep, hand hygiene, and recreational activities
All done by student volunteers with faculty present if questions/concerns arose that students could not answer
Helped guide approach for future health fairs

In April of last year, we had our first health fair at the Bhutanese community center. Our professors communicated with community leaders to spread awareness about the event which resulted in many participants. Ages of attendees ranged all the way from young kids to older adults who are wheelchair bound. We communicated through translators when available, but also relied on short English phrases and nonverbal communication when necessary. At this fair, we set up various stations that each had a specific educational handout and students and faculty to explain the handouts and answer questions. The DPT students assessed vitals and fall risk assessments and then provided health education regarding blood pressure, activity levels, stress management, and how to prevent falls . We got an incredible response from students, professors, community members and leaders about the impact of the event and constructive feedback about how to improve these outreach events in the fall semester.

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Community Needs Assessment

Reached out to find what each community needs

Discussions with community leaders

Chose topics based off health-related questions from participants at fair in Spring 2022
Altered approach to provide health fairs more frequently so we could expand on a single topic for each health fair in Fall 2022

Between the health fair in spring of 2022 and the beginning of the fall 2022 semester, our professors had discussions with the community leaders about what each community needed, the days and times we could reach the most people, and any health supplies that each community could benefit from. We also got many health questions from participants at the Spring event and we wanted to make sure we addressed those, one of the most common being back pain. By the end of this reflection process we decided that it would be more beneficial to provide several different health fairs that each expanded on a single topic as opposed to trying to address all needs at once. This allowed us to develop more detailed educational pamphlets and provide more services that related to each topic. Now Briana will tell you more about the Fall 2022 health fairs.

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Monthly Health Fairs

Individualized health fairs for Bhutanese and Congolese communities
1-2 DPT faculty and 6-8 DPT students at each location
Screening, education, and giveaways

Bhutanese: stations

Older population: education to older adult(s) and caregiver

Congolese: stations/large group discussion

Children: provided age-specific education and giveaways

Collaboration with nursing

Free onsite blood glucose monitoring

Another aspect that is important to note is we provided different health fairs to each community so that each could be in a space where the individuals felt most at home, we could tailor the approach to the population, and to keep the size of each fair smaller so that students could still educate to small groups. We were fortunate to have many DPT students volunteer for the event and generally had 6-8 DPT students at each location, along with 1-2 DPT faculty. The set up of the monthly health fairs was similar to the spring in that we provided screening, health education, as well as giveaways. Some differences to note between the 2 populations is that the Bhutanese is primarily an older population and many of them were accompanied by their middle aged children whereas the Congolese community was primarily made up of middle aged individuals and younger children. After learning how many children would be attending the events we modified the health education to be age-appropriate and provided the families with many toys that would help the children stay active. Another important service we were able to provide was free onsite blood glucose monitoring. Hailey worked with the University's nursing faculty in facilitating nursing students in performing blood glucose checks on all participants.

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Monthly Health Fairs cont.

*Provided at every fair: multivitamins, feminine hygiene materials, and other miscellaneous items upon request from community*

	September	October	November	December
Topic	Stress	LBP & Pelvic Pain	Diabetes, HTN, Nutrition	Cancer
Giveaway	-Stress balls -Yoga Mats	-Lumbar rolls -Hot/cold packs -Heel inserts	-Mirrors for feet checks -Automatic BP cuffs -Pulse oximeters	-Lip Balm -Sunscreen -Aromatherapy oils

Thanks to the grant from AllONE charities, we were able to provide these communities with many health necessities. We related the giveaways to the topic for each month and educated the participants on how to use any equipment. As Hailey mentioned prior we gave away stress balls and yoga mats to help individuals manage their stress. In October, participants were educated on when to use heat vs cold as well as the importance of proper sitting posture and how a lumbar roll can help. We gave away heel inserts because after talking with members of the community we learned that many of the jobs that these individuals have require prolonged standing, and not much sitting. For November it was incredible that we were able to give away a significant amount of automatic blood pressure cuffs, pulse oximeters, and mirrors with long handles. For this fair, we had participants cycle through each station, during which they had their blood pressure, heart rate, oxygen saturation, and blood glucose checked. If any of the values were of concern they were marked on a handout given upon entry. Once the participants arrived to the final table with the giveaways their handout was assessed and they were given the appropriate equipment to be able to take home. For example, if they had a history of high blood pressure and got a high reading that day, they were given an automatic BP cuff or if they had a history of diabetes, they were given a mirror to be able to check their feet for wounds. DPT students educated each participant on how to use all of the equipment so each person was confident before they left the fair.

In addition to the giveaways related to each topic, we were also able to provide multivitamins and feminine hygiene supplies upon request from the leaders of each community

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Testimonials from DPT Students

"I feel very grateful to have had this opportunity to be involved in such worthwhile community events. I was able to participate in all the Bhutanese health fairs and getting to know the people in this community was the most memorable aspect for me. Translators and participants alike recognized and thanked me for spending my time with them and caring about their health needs throughout this semester. Working with the Bhutanese community allowed the opportunity for both personal and professional growth, cultural competency, and the ability to help meet some of the needs for the patients in this population. I firmly believe that the better represented and understood the patient (or community) is, the better they can be treated, and the health fairs in collaboration with these communities is one step in the right direction."

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Testimonials from DPT Students

"One interaction that will stick with me, was speaking with a young woman in the Congolese community. She not only expressed gratitude for the opportunity of these health fairs, but she reported that hearing the health information we shared inspired her to want to pursue nursing. I talked with her for some time about potential ways to get connected into a nursing program. Beyond that, she shared more about her culture, family and experience in the United States. I learned so much from her and felt that I had made a truly meaning connection while learning so much!!!"

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Testimonials from Community

"We are so grateful for you all taking the time to come to us and share this information. Thank you for caring about us."

"No one has ever done this for us, no one has ever asked what we needed and came to us to help."

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Continuing in Future

Fall 2022 as building and learning period

Obtained supplies (tablets, treatment tables, privacy screens, etc.)
Trialed best way to provide education and structure health fairs
Demonstrated the importance of enough translators for events
Trained volunteers

Continuing health fairs going forward based on requests/needs of each community

Spring 2023 topics: respiratory health/tobacco use, pediatric health, prenatal/postpartum health, sexual assault and domestic violence

Hope to reach more communities in need in the future!

The health fairs we executed in the fall have become a foundation for the Leahy Clinic Community Outreach for years to come. We were able to purchase many supplies that can be continually used (tablets, treatment tables, privacy screens), we learned the best way to structure the events, we recognized the importance of doing all we can to ensure there are enough translators at each event, and we trained volunteers that can help assist the younger students so that these fairs can continue. We purchased many of the giveaways that will be distributed at the health fairs this spring. The new Leahy Clinic team just had their first fair of the spring semester about prenatal postpartum health and it was a success! They are preparing for future fairs related to respiratory health and smoking, pediatrics, and sexual assault and domestic violence. We were honored to be able to establish relationships with these communities and I am looking forward to the new partnerships that develop years to come.

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References

Schumacher Cohen J. Refugees in Scranton: Historic Legacy of Migration & Current Refugee Communities. Scranton, PA: University of Scranton; 2022.
The University of Scranton. 2022 Living Wage Report. Issuu.com. https://issuu.com/theuniversityofscranton/docs/living_wage_report_2022. Published November 17, 2022. Accessed February 25, 2023.
Walton L. Trauma in Vulnerable Populations: National and Global Health Inequities. lecture presented at the: University of Scranton.