Morocco was the last place that Asma Bulale expected to spend her summer vacation when she started medical school. But several years ago, the 31-year-old former Somali medical student at the University of Washington decided to switch from cardiology to public health and become an AmeriCorps volunteer.
Last summer, Bulale began working with rural community-based health organizations in Morocco. A native of Mogadishu in northern Somalia, she visited health clinics in villages in dire need of basic health education. Eventually Bulale and her fellow volunteers set up clinics to do screenings for general health. That experience proved to be life changing.
Now Bulale is a community health promoter in another marginalized, low-income community where access to affordable health care is problematic: south King County. At first glance, applying the lessons learned from developing nations in North Africa, Asia, or Central America to residents in Tukwila and SeaTac might seem a stretch. But Bulale has learned otherwise.
South King County is home to a growing melting pot of newly-arrived refugees and immigrants who speak well over a hundred different languages, from Somali, Eritrean, Ethiopian [Amharic], and Bhutanese to Spanish, Arabic and Turkish. According to the 2010 Census, Tukwila now has the most diverse school district in the nation.
Besides the language barrier, immigrants in Tukwila and SeaTac face other formidable hurdles navigating the American health care system. Foremost among them is a basic distrust of western medicine. “They’re very set in their ways because of their culture and religious beliefs,” said Bulale, who is fluent in Somali and Arabic herself.
The nation’s center for global health, Seattle seems the logical place for the development of new approaches to providing health care in under-resourced communities. Besides the Bill and Melinda Gates Foundation, organizations such as PATH, the Fred Hutchinson Cancer Research Institute, Seattle BioMed, Seattle Children’s, Infectious Disease Research Institute, the University of Washington, and Washington State University are engaged in groundbreaking research in the kinds of medical intervention that Bulale and other community health promoters are delivering.
Three years ago, Dan Dixon and Dr. Rod Hochman set about looking for new solutions to the health-care needs of low-income residents in Washington State. Dixon, vice president for external affairs at Swedish Health Services, and Hochman, CEO at Swedish, hosted a gathering of 20 global health leaders in the region. That meeting eventually spawned the Global to Local Healthcare Initiative [G2L].
A collaborative partnership of the Washington Global Health Alliance, Seattle and King County Public Health, HealthPoint, Swedish, and the cities of SeaTac and Tukwila, the G2L project seeks to improve health outcomes and reduce health disparities in the target, underserved South King County communities of Tukwila and SeaTac through the use of proven global health strategies.
In November 2010, the project commissioned PATH, a Seattle-based global health organization, to do a landscape analysis, which confirmed many of the suspicions of local health experts. Along with its significant racial, linguistic, and sociocultural diversity, high rates of poverty, and poor health are the area’s defining characteristics.
“We discovered in our assessment that SeaTac and Tukwila have large pockets of poverty with a health index nearly identical to Nairobi, Kenya,” said Dixon. “We were shocked, and sobered. It seems patently unacceptable.” The survey also revealed longstanding economic disparities between haves and have-nots.
Those findings are borne out by recent demographic surveys of south King County and Tukwila-SeaTac. Compared with King County, the health indicators in those two communities are among the nation’s worst: higher incidences of chronic disease, increased infant mortality, cardiovascular disease, diabetes, asthma, and tuberculosis. A large proportion of the non-English-speaking residents are uninsured, and lack money and access to affordable health care. Local stores are inaccessible to transit and even lack fresh produce.
“While some places in King County are the healthiest in the nation, some of the least healthy are just a bike ride away,” said Dr. David Fleming, director and health officer at Seattle King County Public Health. The former director of the Gates Foundation’s Global Health Strategies Program is optimistic however.
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