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Kimberly Woo, RN, BSN, QI coordinator and interim head nurse at Asian Health Center, Oakland, Calif., comforts her pediatric patient with a colorful sticker after administering an immunization.

As a new mother, 27-year-old Xue Jin Yee* feels depressed and overwhelmed. Her family, the main support she counted on during the delivery of her first baby, is far away in Hong Kong. Her husband works long hours for little pay and is unable to help out. It’s been two months since the birth of her baby and Yee is sleep deprived and feeling further isolated because of her inability to speak English. She turns to Asian Health Services (AHS), a Community Health Center (CHC) in Oakland, Calif., for help.

Across the country

In rural and urban areas, more than 3,500 CHCs form the cross wires of the primary health care safety net. CHCs grew out of the civil rights movement in the 1960s and the desire to provide accessible and affordable health care to low-income and community residents unable to access other care. The centers are non-profit and congressionally mandated to provide this care.

“We absorb patients that the city and county cannot absorb,” says AHS clinical services manager Susan Park, RN. CHCs provide care for the growing numbers of uninsured and underinsured and homeless families at higher risk for serious illnesses than the general population, in addition to migrant farm workers, undocumented immigrants, persons with chronic illnesses, and people with substance abuse problems. Like AHS, many centers were formed to serve diverse populations and provide culturally sensitive primary care services.

Estimates are that CHCs care for more than 15 million patients across the country, as more than 45 million people remain uninsured and even more are without a regular source of care, according to the National Association of Community Health Centers. The Institute of Medicine (IOM) report, America’s Health Care Safety Net: Intact but Endangered, underscored the critical importance of the safety net to the health and well being of the nation’s most vulnerable. Park says that in 2003, AHS provided 66,000 medical and dental visits, 95% of them to patients with limited English skills. The proof of success lies not with just with the numbers, but also with the improved quality of care.

All in a day’s work

AHS interim head nurse Kimberly Woo describes the course of a typical clinic day. First there’s telephone triage and troubleshooting. Patients call for advice, need to schedule an appointment, or have questions about their test results. Then the walk-ins arrive. By day’s end, treating symptoms of a cold or chronic illness, dressing a wound, providing immunizations and birth control injections, referring people to the local ED, charting, and returning patients’ calls have all become routine. What makes the work unique is the accommodation of culture into patient care and communicating with patients in their native language, be it a Chinese dialect, Vietnamese, Mien, Cambodian, Korean, or Tagalog.

When Xue Jin Yee complained about her depressive symptoms, Woo empathized with her in Cantonese. Woo explained that she recently gave birth and knows firsthand what Yee is going through. “Hang in there a little longer,” Woo encouraged her patient. “In a month, when the baby’s sleep improves, you’ll be more rested and better able to cope.” Woo, aware of how much the patient values her family, felt it was important to intervene as a substitute support system. Yee returned later to thank Woo for her advice. And Yee is happier since her parents have moved to the States and are helping out with their second grandchild.

Culture is key

Native Americans for Community Action (NACA), an urban Native American resource and cultural center, provides advocacy, education, and support for wellness to the community. Last year, NACA’s Flagstaff, Ariz.-based Family Health Center (FHC) treated more than 10,000 patients of all ages, mostly Native Americans from the Navajo and Hopi tribes, according to Carol Barth, RN, nurse manager at the FHC. The FHC is a primary health care facility for those who may easily fall through the cracks — mainly Native Americans living “off reservation” who don’t have health care insurance or who don’t qualify for the Arizona Health Care Cost Containment System (AHCCCS), Arizona’s form of Medicaid.

Many of the Native American FHC patients work in town and are bilingual and acculturated, but others maintain their cultural ties, going home to the reservation on weekends. They attend Christian churches but also participate in Native American rituals and ceremonies conducted by medicine men. Because NACA’s vision includes preserving Native American traditions, staff and programs accommodate culture and may include traditional healing practices and other culturally appropriate activities. “Culture-based care depends on and is tailored to each client,” says Barth.