Reaching Out To the Margins

Yesterday, I received a call from a young college student with an interest in Public Health who wants to volunteer at our health department. After a telephone conversation and a string of emails, I gleaned that she is from Cape Verde, speaks Cape Verdean Creole (Portuguese married with African dialects) as her first language, and also speaks and understands some Spanish. Thinking quickly, I realized that this is a golden opportunity to utilize this individual's language and cultural knowledge to reach out to the Cape Verdean community in our town. While not as sizeable as our Chinese, Tibetan, Cambodian, and Latino communities, I know for a fact that a pocket of Cape Verdeans are scattered amongst the population, and this young woman may be the key to doing some important outreach to a marginalized segment of our municipality.

The director of our health department is dedicated to issues of racial justice and social equality, and a significant multi-year social justice grant has given our department just the push it needed to bring to life her much appreciated vision. With a part-time worker devoted to fulfilling the social justice grant and a Cambodian outreach worker dedicated to the Khmer community in our area, we are well aware that there are ethnic and racial groups that also deserve our attention.

While public health does indeed involve immunizations and infectious disease surveillance, the 21st century has brought the very enlightened awareness that the control of chronic disease is where we should be focusing in the wake of the 20th century's successes vis-a-vis the virtual eradication of vaccine-preventable diseases such as polio and measles. However, to control chronic diseases and improve quality of life and lifespan, we must also ascertain why and how health disparities occur amongst various ethnic, racial and socioeconomic groups, subsequently taking concerted action to assuage those disparities. From infant mortality to rates of diabetes, people of color are more burdened than their caucasian counterparts. While some genetic differences may account for a small portion of these differences, it has been demonstrated time and again that socioeconomics and the very stress of living in a racist society can indeed have a significant impact on health outcomes. Of this we are now certain, although some are still not convinced.

So, enter my new, young and earnest Cape Verdean volunteer, who is excited that I even know anything at all about her language and culture. When health care professionals and agencies take pains to make contact with marginalized and vulnerable segments of the population, everyone benefits. Gathering data on sub-populations and ethnic groups is a useful and intelligent undertaking which, as a bridge-building exercise, encourages dialogue, communication, and the building of trust. Vulnerable citizens with poor English-language skills and discomfort with American culture are more likely to reach out for assistance and utilize existing services if they feel seen and understood. While a well-meaning white outreach worker without appropriate language skills can make some inroads, a worker who is a native of the target population's country and who speaks the language fluently can make significantly more progress within a community that may feel collectively invisible.

My town may still be white by a vast majority, but our segments of Latino, Caribbean, and Asian citizens is apparently growing by the month. Cambodians, Tibetans, Cape Verdeans, Central Americans---these communities are all growing, and even as their children learn English and quickly become Americanized translators of culture and language for their elders, reaching out to those elders who are less comfortable with the transition to American life is key. I will use this new volunteer energy to my benefit, and to the benefit of our town, our department, and the people who we serve.

Reaching out to the margins is crucial, and as bridges are built, those living on the edges become significantly less marginalized. The margins make us see that we are all more similar than we are disparate, and taking culturally sensitive action in order to serve those who are most vulnerable improves the quality of life for all concerned. The reach of the human heart and its compassion is without measure, and I have seen for myself how magic can happen when our arms are opened wide enough to embrace those who lack our cultural, economic, and social privilege. Our community's diversity is an enormous strength, and our ability to welcome all into the heart of the community speaks volumes about our singular and collective humanity.

(c) 2009 NurseKeith