How pharmacists and public health workers build trust in Cambodia genocide survivors

Military injuries combined with starting work in a new country make obtaining medical care a particularly difficult task for immigrant refugees. Talking to a doctor or getting prescriptions filled out in an unfamiliar language is hard enough. But for refugees, the physical and psychological scars of fleeing war or genocide can complicate their health needs and meet them.

I am a clinical pharmacist trained in improvement drug safety and outpatient efficacy. Beginning in 2019, I was with a team of pharmacists who served Cambodian American patients in Connecticut and Rhode Island. I spent 15 months there studying the role of pharmacists and public health workers in helping disadvantaged immigrants get the medicine they need and learn take them consistently and safely.

Many of them fled Khmer Rougea tough political party and a military force operating under the regime Pol Pot in the 1970s Cambodia. They witnessed executions, starved to death or suffered hunger-related diseases.

As pharmacists, we have learned that the best way to care for these patients is to listen and learn from them. community members they trusted. This is a lesson for health care providers it may prove useful as the US welcomes new refugees from countries such as Afghanistan, Sudan, Myanmar and Ukraine.

Dangerous drugs

Cambodian refugees who have traumatized the population may be wary of strangers. They can avoid those who are considered government or other officials. Thus, they often rely on their own beliefs and assumptions, even about health.

Our research team has learned that some Cambodians expect to receive a cure for every disease. This assures these genocide survivors that something is being done about what is wrong.

If the doctor does not give them a prescription, they can look for someone to prescribe the medication. However, they can only take medication as long as they feel sick. When side effects happen, they may decide that the dose is too high, and reduce the amount they take. And medications are often shared among friends and family.

Limited knowledge of English may prevent immigrants from seeking medical attention. If they do, language barriers make it hard for health care providers to understand the patient’s symptoms and prescribe the right medication, especially since interpreters are not always available. So in immigrant communitiestranslation often falls on family members, sometimes children.

The presence of family members, especially children, can affect what patients and pharmacists say, especially with respect to sensitive subjects such as mental illness or reproductive health. And translation in a medical setting can be a huge burden for children. During our study, we learned about a 7-year-old daughter who was diagnosed with her mother’s cancer.

Established relationships

Local community health professionals dealt with these issues. With language translation skills and health informationthey help residents in their own communities manage their mental and physical health.

Our research team of four pharmacists worked with five health professionals from Khmer Defenders of Health, an organization in West Hartford, Connecticut, for Cambodian Americans who survived the Khmer Rouge genocide and their families. After four decades in the area, Khmer health advocates knew their community best. That’s why we followed the organization’s example when she directed the set for our study.

Health professionals introduced us and our research project to churches, temples and events such as the Cambodian New Year celebrations. They also went to medical clinics used by Cambodians and pasted leaflets at Cambodian enterprises.

Healthcare professionals also approached residents individually, contacting people on a personal level. As victims of genocide, trained in trauma-based care, they met patients in safe familiar places such as their homes. They ate together and discussed not only studies but also familiar issues such as financial difficulties related to the reset of life in the new country and the need to agree to low-paid services. In total, health workers helped recruit 63 patients to work with pharmacists.

Solving cross-cultural problems

Health professionals have taught us Cambodian culture, which is highly respected. The greeting “sampeah”, for example, consists of the palms clasped together in a prayerful gesture while bowing the head. The higher the hand and the lower the bow, the greater the reverence shown.

We also studied idioms to help us understand patient descriptions of their symptoms. For example, “spikes” are what they call neuropathy or nerve damage. This is a common symptom among those suffered beatings during the conflict. Another phrase is “kdov kbal”, which means “hot head”, to describe the feeling of warmth in the brain that interferes with thinking. A “phleu” means a loss of thought, as in cognitive impairment.

Healthcare professionals have also helped patients trust us pharmacists to help them manage medications.

When it came time to meet with pharmacists, health professionals had already interviewed patients to document medications, herbal products, traditional Khmer medicines, and the dietary supplements they were taking. The patient collected them all, preparing to talk to him pharmacist as a paramedic sat with them.

When I met with patients on video from my office, the health worker kept every medication up to the camera. I then talked to the patient about dosages, side effects and any issues. I explained ways to take medications to avoid side effects, and noted possible drug interactions for their recommendations to their doctors. Through it all the health worker has translated from English to Cambodian, from medical jargon to relevant cultural terminology and back.

We helped cure 63 patients more than 80% their drug-related problems are a good speed of solution for any community, whether English-speaking or not. Patients also better memorized taking medications, taking the right doses, and taking them more consistently. Our study found that community health professionals and pharmacists working together were critical to making these patients better manage their medications.

I saw up close how a cross-cultural team can effectively address drug-related issues in the immigrant community. Due to the war and conflicts of genocide that stimulate international migration, this model is being applied now when the health of the most vulnerable is increasingly at risk.

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