猫咪社区

Soledad Estrada-Castrejon felt self-conscious about her rosary. It wasn鈥檛 that anyone had said anything negative. Still, she wasn鈥檛 entirely comfortable clutching her beads and praying around people she didn鈥檛 know. Maria Alejandra Combs understood and offered Estrada-Castrejon reassurance. 

Estrada-Castrejon was born in Mexico; Combs in Venezuela鈥攄ifferent cultures in many respects, quite similar in others. Both countries are predominantly Catholic. 

Combs is the Hispanic patient navigator at  in Winston-Salem, North Carolina. Estrada-Castrejon, 26, has stage 4 ovarian cancer and says Combs makes her journey less arduous. 

鈥淚 feel comfortable telling her things,鈥� Estrada-Castrejon says. 

In big and small-but-significant ways, Combs serves as a guide for her Hispanic patients. She explains next steps, assists with forms, helps connect them with resources within the hospital system and beyond. She provides emotional support.

Estrada-Castrejon was initially being treated in Hickory, a little more than an hour away. She came to Wake Forest Baptist for surgery and was soon introduced to Combs. 

鈥淪he鈥檚 really awesome,鈥� Estrada-Castrejon says. Cancer and its treatment is a bewildering experience for anyone. Estrada-Castrejon is grappling with financial issues, concerns for her family, depression. With Combs on her side, 鈥淚 feel better. Yeah, much better.鈥�

Dismantling Barriers

Patient navigation was introduced in 1990 by Harold P. Freeman, a surgeon in Harlem, with a program  screening, diagnosis, treatment, and support.

Karen Winkfield, director of Wake Forest Baptist Health Comprehensive Cancer Center鈥檚 Office of Cancer Health Equity, says that Freeman was troubled by the number of African American women he was seeing with locally advanced breast cancer. He recognized the need for education on prevention and detection and available resources.

鈥淪o he recruited people from the community, lay individuals, and he gave them some basic understanding of what sorts of things are needed around breast care,鈥� Winkfield says. 鈥淗e educated them and then sent them out into the community to provide information.鈥� 

The result was a dramatic reduction in the number of women arriving in his offices with a locally advanced cancer. 

Wake Forest Baptist Health adopted Freeman鈥檚 model six years ago with services for the Hispanic population and now also provides patient navigators for the African American and rural communities in its region. Combs and her population-focused navigator colleagues work in concert with nurse navigators.

鈥淥ur navigators in the population health program are really focused on the reduction of social barriers,鈥� Winkfield explains, including transportation, food insecurity, and housing. 鈥淭he nurse navigators then focus on helping patients understand their clinical care.鈥�

The cancer center鈥檚 data indicates that the . Patients report 97% satisfaction with the navigation services they receive. Encouraging results are also found in prevention and early detection through outreach efforts. Nearly 90% of patients receive a definitive diagnosis within 45 days of an abnormal mammogram, reducing their risk of a late-stage diagnosis.

Winkfield鈥檚 team has designed a  that measures and identifies the level of need of each individual and then leads them on a path to care accordingly. Each of the three patient navigators is providing assistance to 25 to 30 patients a month.

Culturally Appropriate Care

鈥淔irst of all, you have to be passionate, passionate about your community,鈥� Winkfield says of the qualities she looks for in a patient navigator. 鈥淭hat鈥檚 critical. Then it really depends on the community you鈥檙e serving.鈥�

Population health navigators must understand their constituent community, she says, to provide culturally appropriate assistance. Cancer and cancer treatment are received and perceived differently by different cultures.

In Hispanic culture, Winkfield says, the decision-making process is often a familial one, and health care providers must recognize the importance of talking with patients in the presence of family members. 鈥淭here鈥檚 a family discussion that needs to happen around how care is provided,鈥� she says.

It鈥檚 not uncommon, Combs says, for there to be the patient and three or more family members in the room during a consultation with a doctor, with more waiting in the lobby. Providers have grown accustomed, she says, to speaking to large audiences.

Combs also notes a strong tendency among her patients to perceive cancer as a death sentence. 

鈥淭hey鈥檙e speaking with their provider, who鈥檚 explaining their diagnosis, and when they hear the word 鈥榗ancer,鈥� they may stop listening.鈥�

鈥淪o the information needs to be reinforced,鈥� she says, 鈥渟o that patients can have a good understanding of their diagnosis and treatment plan in order to make informed decisions about their care.鈥�

Many of her patients nurture a strong faith; they believe that God will care for them. Combs says that while emphasizing the need for comprehensive care, providers are respectful of each patient鈥檚 religion.  

Combs agrees with Winkfield on the criticality of compassion. Equally important, she says, is the courage to advocate for your patients.

Estrada-Castrejon relies on that advocacy. When asked to introduce herself, she begins, 鈥淚鈥檓 a mom.鈥� She鈥檚 arrived this day for her visit with Combs with her husband and 3-year-old son, Jason. She鈥檚 no longer able to work; her husband picks up day jobs when he can. She鈥檚 understandably concerned about her family鈥檚 immediate and long-term needs.

Combs helps her wade through paperwork and bureaucracies and identifies assistance opportunities鈥� reduced prices for medications, for example. 

The navigator鈥檚 first step may be helping an uninsured patient in getting financial assistance to access care. To apply for charity care, patients must provide an ID, income verification and proof of address. Because some Hispanic patients have no form of ID, an organization called  assists with getting a community ID that the hospital accepts. 

Some undocumented patients may work under another name for fear of deportation and have a challenging time showing proof of income. Or they may need assistance paying their utility bills. Combs scours the community for available resources. 

The population health navigators can provide lunch and gas vouchers as needed. It鈥檚 difficult for Estrada-Castrejon to ask for such things. 鈥淚 get shy,鈥� she admits. Combs reassures her and helps bolster her confidence.

Raising Voices

鈥淢y best tool,鈥� Combs says, 鈥渋s empowering my patients. Empowerment in navigation is crucial. It鈥檚, 鈥業鈥檓 here for you, but I鈥檓 going to guide you in how to do things on your own.鈥� Hopefully, they鈥檙e empowered after their cancer treatment, and they can feel they can speak up鈥攊f they don鈥檛 have the information they need, they can raise their voice.鈥� That鈥檚 often a challenge, particularly with newly diagnosed patients. 

鈥淚 tell them, 鈥榊ou have the right to ask questions if you don鈥檛 understand. It鈥檚 a lot of information at one time, and if it鈥檚 not clear, you can ask. It鈥檚 not disrespectful.鈥� I want to help give them that tool鈥攖hat 鈥業 can speak up and advocate for myself.鈥欌�� 

Combs asserts to her patients: 鈥淵ou鈥檙e a whole. You鈥檙e a body and mind and spirit. What are the tools that you need to feel healthy, to feel empowered, to feel that you have overall quality of life?鈥�

Winkfield says her hope is that those who鈥檝e been assisted by a navigator will have had a much easier time going through what is undeniably a difficult experience鈥斺�渢hat they know that they have somebody who they can call on should they experience a barrier to their care, someone who will respond in a way that really can help ease that journey.鈥�

Had Estrada-Castrejon not been introduced to Maria and her nurse navigator she says, 鈥淚鈥檇 be very stressed out. I think I鈥檇 probably be crying all day, like, 鈥榃hat am I supposed to do?鈥欌�� 

Now, 鈥淚 get to see Maria, and I get to just tell her, 鈥榊ou know, I鈥檓 having issues.鈥欌��I鈥檓 so thankful.鈥�

This story originally was published by . It has been published here with permission.