Health care report 2008: Clinics are beacons of health and hope

Miracles happen every weekday in the basement of Christ Lutheran Church in Harrisburg.

In that basement, a group of nurses heals the bodies and the souls of the sick who live in the city's Allison Hill neighborhood. They do so in English, in Spanish, in Arabic, in Hausa.

The nurses are part of Holy Spirit Hospital's Medical Outreach Clinic. Each year, the clinic serves thousands of patients, many of whom do not speak English.

"It's a warm, welcoming, loving place for (the patients)," said Jody Silliker, director of medical outreach services. She also is Christ Lutheran's senior pastor.

It's an environment many of the patients don't experience elsewhere. An Institute of Medicine study published in 2002 reported that racial and ethnic minorities are less likely to receive routine medical procedures and experience a lower quality of health services.

In this challenging environment, clinics such as Holy Spirit's are beacons to patients who cannot navigate the U.S. health care system because of language and cultural barriers. The clinics also provide refuge for patients dealing with a hostile world marred by poverty and prejudice.

At the Medical Outreach Clinic, the focus on diversity starts in the waiting room. A couple of large white sheets of paper ask patients to write down complaints and compliments. The sheets are covered in writing, in English, Spanish and Arabic. A map of the world hangs on the wall. Stars mark countries from where patients have traveled. The stars sit on places as diverse as Russia, Ecuador and South Africa.

Walking through the room, Silliker remembers an immigrant and her child who came to the clinic shortly after arriving in America. As she watched them, Silliker had a revelation about a poster hung behind them, which read "It's easy to get five servings of fruits and

vegetables a day."

"I saw the poster in a whole new light," she said. "It's not easy to get five servings of fruits and vegetables if you have no money to buy them."

Silliker's soft voice exudes tranquility. Her short gray hair frames her face, which is punctuated by her deep brown eyes. Her eyes grow intense as she talks about the clinic's commitment to its patients. She is warm and friendly, easily interacting with her staff. But she becomes more guarded as she talks about her patients. She is hesitant to tell personal stories about them, often stopping her conversation before revealing too much information.

Yet, stories emerge as Silliker continues through the clinic. She points out medicine bottles labeled in English and Spanish. She flips through a picture dictionary that the staff uses to communicate with patients when words do not suffice. She shows rooms stocked with personal-hygiene items, towels, blankets and other items patients can take home.

In this difficult environment, Silliker and her staff have come up with ingenious ways to communicate with patients. They show paint swatches to patients so the patients can point out the color of their sputum or stool. Illiterate patients are given thermometers that use colors, and not numbers, to display temperatures. All staff members can say basic greetings in five languages: English, Spanish, French, Arabic and Hausa.

"Every day, we have our work cut out for us," Silliker said.

Jim Kelly faces the same challenge. He is executive director of SouthEast Lancaster Health Services, a clinic where more than 60 percent of the patients are Hispanic. A substantial portion of these patients do not speak English, Kelly said.

Many of the center's staff are bilingual and are trained to provide culturally competent care. For example, many Hispanic patients want family members to accompany them to appointments. The staff knows not to intercede when several people follow a patient into an exam room, Kelly said.

Although it is hard to work with a diverse clientele, the effort comes with rewards. The number of people using the center's prenatal program has shot up during the past five years. One reason for this growth is the center's reputation as a place that welcomes diversity, Kelly said.

"(The patients) are much more comfortable here than they might be in another practice," he said. "We don't take a cookie-cutter approach."

Silliker and Kelly expect that health care providers will face increasing challenges to meet the demands of a diverse patient population. Some barriers might not ever be overcome, Kelly said.

"Diversity is always going to be a barrier," he said. "We might not be able to eliminate the barriers, but we can at least address them."