Abbas is a physician who cannot convince his Indian mom to get regular medical screenings. And public health professional Mary Helen O'Connor shares strategies for effective health messaging and for nudging our parents to be proactive about their health.
Abbas is a physician by training and profession, and he's also the founder of Mipsterz, an arts and culture collective for emerging Muslim creatives.
Featured Expert:
Dr. Mary Helen O’Connor has courtesy faculty appointment in the School of Public Health. She oversees community engagement as a member of the Georgia State University Prevention Research Center team, which focuses on health and health disparities of refugees and migrants. She is the director for the Center for Community Engagement in Clarkson, which brings together Clarkston community members; governmental, nonprofit and faith-based agencies; Georgia State researchers, and local partners to work on issues important to the community, including health, education, legal rights and responsibilities, social integration and family sustainability. The center also works to coordinate research efforts on issues facing refugee and immigrant populations. Her teaching and research in the field of migration studies, education, and rhetoric and composition explores refugee education, agency, and identity. For more than a decade, she has been a volunteer and advocate for refugees and immigrants in Clarkston, GA, one of the largest resettlement communities in the U.S. She presents and lectures extensively on migrant students, refugee and immigrant issues, and community advocacy. Learn more about her work here.
Mary Helen recommends the following resources for speaking with parents about preventive health: GSU's Prevention Research Center has a lot of information about a variety of topics and in multiple languages, including COVID-19 resources, their Health Information Toolkit, and their Health Ambassador's Program. She also recommends this resource for providers, a quick guide to HIPAA, and information about the language line. Finally, for an example of powerful community work around health care and risk messaging, she points us to them.
If you loved this episode, be sure to listen to When Mamí Has a Drinking Problem and Parents’ Reason for Ignoring COVID-19 Restrictions: “We gotta live.”
We’d love to hear your stories of triumph and frustration so send us a detailed voice memo to virginia@lwcstudios.com. You might be on a future episode! Let’s connect on Twitter and Instagram at @TalkToMamiPapi and email us at hello@talktomamipapi.com. And follow us on Apple Podcasts, Spotify and anywhere you listen to your favorite podcasts.
Juleyka Lantigua:
Hi everybody. Today we welcome Abbas. Abbas has a hard time convincing his Indian mom to be proactive about her health now that she's an older adult. But get this, he's a physician, and feels particularly frustrated that his mom will not follow his advice. Let's get into it.
Abbas: My name is Abbas Rattani and I am an American, a Muslim, an obedient son, a process artist, filmmaker, ethicist, global health scholar, the director of an arts and culture organization, and I'm also a doctor. I didn't actually know what I wanted to be when I grew up. I think it was projected onto me by my parents. They both came to this country struggling. They were immigrants, my dad from Tanzania, my mom from India. I think it was very clear that they wanted me to have a better future. They wanted me to not struggle as hard as they struggled.
As an obedient son, I went off and became a doctor. It was a beautiful moment in the sense that I can advocate for my parents and I can guide them in terms of their own medical care. But the bittersweet component was as their care became more and more complex, or as care related to things like health screening or prevention, they were like, "Nah, we're good. I think doctors are just trying to make money. All these doctors, they're all the same. You're just trying to make me do tests to take advantage of me."
I was like, no. And it's hard, especially in the setting of this pandemic and getting them to get the first booster was a little bit of a challenge, but they got it. And now convincing them to get the second booster, I've already experienced this uphill battle, where I've now explained to them why it's important all over again, as if my first conversation about clinical trials didn't mean anything. My parents overwhelmingly are believers in science, but my mom is also very emotional. She's also a part of a lot of conspiracy WhatsApp groups. So she will do the thing that is scientifically correct, but then also forward me along these WhatsApp messages being like, "Hey, I got the vaccine, but I want you to know, they're just injecting water. And that if you take turmeric and ginger, that is in fact what's combating the virus. But I got it. I got the vaccine."
Abbas: Whenever they have specific medical questions, I'll explain the disease process and how a medication works as best as I possibly can. But then after that, it's just straight emotional appeal and then I get my sister on top of it. My mom will be like, "I love you, son, and I want you to be happy. And when you're happy, I'm happy." And I'm like, "Mom, you know what will make me happy? If you get a colonoscopy. That will make me happy." And then my mom immediately is like, "All right, this conversation's over. Bye now." My dad, on the other hand, I think he has seen what bad health has done to his siblings and his own parents. And I think because he's seen that and witnessed that, he listens to the doctor a lot more and I don't have to really convince him and push him.
I think the biggest challenge is that my mom doesn't follow my best advice because she doesn't have symptoms. And so she will say, "Well, I don't feel this. I don't have these symptoms. Why do I need to go pay a doctor, lose money?" Even though she's insured, to get something done or go through a procedure. Like a colonoscopy is invasive. I mean, you have to prepare for it. I'm not going to go into graphic detail here. You can look up how a colonoscopy is done. Especially in the setting of, I don't have any symptoms. That's a statement that I wrestle with even as a physician in my day to day practice, is how do you convince patients to do the thing that's better for them down the line?
Even as a patient, I don't do that, because I feel fine. I don't have any symptoms. I exercise. I eat well. I'm a doctor. I think I would know if I need to go see a doctor. But that's not how it works, right? The way it works is from the data, right? We know from looking at the entire population that a certain percentage of the population will get this disease, for sure. And because we know that, we want to prevent that thing from happening.
I think the way I make peace with my mom's hesitance or resistance, with my father as well, is recognizing that they know I'm their son. I have their best interest in mind, despite emotional blackmail about who's going to take care of the grandchildren if you don't. Despite all of those earnest attempts, at the end of the day, they're in charge of their own domain. My sister gets the most frustrated and I say, "Look, at the end of the day, mom and dad are decades older than us. They're wiser than us. They're constantly watching the news so they know that these things are real."
Abbas: And at a certain point, you just have to step back and not ruin your relationship with your parents. Because I think there was a point where my mom said, "Every time we talk, inevitably, the conversation goes to, you need to have a colonoscopy. I'm not going to have a colonoscopy. I don't want one. That's it. Okay? You got to stop." So as an obedience son, I was like, "Okay, fine. As long as you know." And I think that's the approach that I take oftentimes with my patients. And there's no benefit for me to force them to do something that they themselves have no intrinsic motivation, because it's not sustainable. It's not going to last. They may get a colonoscopy once, but they're not going to keep up with those healthy behaviors.
Lantigua: So obviously I'm not a medical professional, but I so identify with his frustration. I mean, the fact that he has a medical degree and his parents still don't listen to his advice, I can't even imagine. I know that the situation is familiar to many of us. I've been through it. So what can first gens do to help our parents access and follow sound medical advice? How can we effectively nudge them to take the necessary medical steps to avoid preventable health risks? To help us figure it out, I called in an expert.
Mary Helen O'Connor.:
My name is Mary Helen O'Connor. I am by trade an English Professor at Georgia State University's Clarkston campus, which is located in the most diverse square mile in America. I've been teaching refugee and immigrant students for 16 years, but that kind of has morphed into my personal life and all of my advocacy work, and I'm sort of a big advocate and community collaborator. I actually moved to Clarkston during the pandemic. I'm the Deputy Director of what is called a Prevention Research Center. So that's a CDC funded project that is, we are working to develop culturally and linguistically responsive health interventions in the community. So that's what I do.
Lantigua: Welcome to the show. Thank you for being here. I asked the same question to get us going, which is, as you listened to Abba's story, what did you hear?
O'Connor: I have a running joke with someone who's just like him, who's now a grown up cardiologist, but he's my partner in all good trouble in the community. His name is Heval Kelli. And I tease him because he tries to make every immigrant or refugee student decide that they need to be a doctor. And I'm like, you don't... No, there are other things you can do. And then there are all these other parts of his story that connect with the work that I do, especially around preventive care. I've had those conversations with community members, with my students whose parents don't want to go get a colonoscopy or get any kind of preventive care, and I've actually started preventive programs for community members. We have a very high uninsured population in our community, so we started a specific program for women. It was shocking. That started last year. Our data just supports what his narrative said, and 75% of the women that we saw last year had not seen a doctor in the last five years.
Lantigua: Wow.
O'Connor: So that's astounding.
Lantigua: So first of all, congrats on getting that program off the ground. What an incredible resource to add to a community. But I want you to unpack a little bit what the dynamics are at play that contribute to this sort of indifference to medical healthcare.
O'Connor: One of the things that we run into, and this may not seem obvious, is that in most non-Western countries, you don't have to make an appointment to go to the doctor. So making an appointment and holding yourself accountable to show up to that appointment is a huge barrier to care in our community. Then there's the language barrier, which our kind of research says that language is the primary barrier to health disparities. If you don't understand how to communicate with the person to navigate getting an appointment, if you don't have the language skills to speak with your doctor or your nurse or your health educator or provider, there's so many layers to unpack there. And then we're not even talking about insurance. And so if you look at it from the perspective of a very well educated person of privilege, it's still difficult to navigate healthcare. The whole complicated system in the United States of insurance and healthcare is just hard.
Lantigua: Abbas's case is really interesting to me because he is an actual doctor and he's still being ignored by his family. And so I feel like even when you become a doctor, there are still cultural factors that make it easy for our immigrant parents to ignore the best advice.
O'Connor: I think generationally, all of my refugee students, whether they're doctors or not, have issues dealing with their parents and their acquisition or accessing healthcare and being healthy. I think another thing that is unique about children of immigrants is that they are often put in a position where they have to be the broker of knowledge when it comes to healthcare and education and many other things. I think it's unfair and I also think that it crosses over some cultural norms about what children and parents talk about. If you have to take your child to the doctor with you to translate, and you're a woman and your child is talking to your provider about a pap smear, that is just not a normal situation for any kind of culture. And so I think there are some complicated dynamics there.
Lantigua: So this women run, women led service that you set up, what were some of the things that you all put in place to encourage people, to encourage women, patients, to come in and be screened and to just have the comfort and the trust to come in and have their preventative care needs met?
O'Connor: It is about trust and we're constantly learning. So some of the things that we've put in place, we knew from the beginning that female providers were going to be a better match for female patients. So we prioritized that in our marketing and outreach. We said all of your care is going to be provided by women. In addition, we're going to provide language support. So there will be people who are not part of your family who can provide interpretation services for you. But also the trust factor is the most important thing. We also do a lot of work in the community around vaccination right now. We've hired a team of community health ambassadors from each cultural and ethnic community to work within those communities and we partner with some organizations in the community who have health promoters.
O'Connor: I absolutely believe that community health workers and health promoters are the answer to all of these questions. They bring the trust component and they can help. Often my mother is more willing to listen to a nurse at her doctor's office than she is me about anything. So that has been the most helpful connector for us, people who are trusted leaders in the community. They don't have to be doctors. We also know and have learned that a lot of community members will listen to schools and to religious leaders, so we often rely on principles and teachers and our religious leaders in the community to talk about health problems.
Lantigua: So Mary Helen, the stuff that you've just described and the success has to do with sort of a community level outreach, where there are many stakeholders and many people who are committed to the success. How can individual folks have, I don't know about success, but maybe just make inroads into having these conversations with their family members?
O'Connor: Well, I was thinking about what I would say to Abbas. I think what we tend to forget is that he's always going to be their child to them. He's not going to be their doctor. So if you can help facilitate having your parents get connected to health providers, it doesn't have to be a physician. But I think we forget that they don't really... A lot of times older people are not going to ask questions. I think doctors spend what, maybe five or ten minutes talking to people. Sometimes another thing you can do is give your mom or dad or your aunt or uncle a list of questions to ask their provider. And then finally, we always forget about the HIPAA form. And unless you have that paperwork signed and you have an agreement, the doctors are not legally allowed to share information with you.
So those are a lot of things that you can do to help facilitate communication in situations that are difficult with parents and with older adults and people who need a little bit of an extra push. The other thing is don't forget, nurses know more than doctors oftentimes. Sometimes that nurse can be the best connection to communicating with your parents. And they often know more about what's going on and actually have more time to share and to communicate. The other thing I always, always want people to remember, the LanguageLine is a civil right. It is actually a law that health providers are required to use the LanguageLine. LanguageLine interpretation is not the best, but it's better than nothing. And there is also another option, which is video interpretation.
Lantigua: My last question is if there are resources online or places that you would recommend people go visit to get familiar with some of these practices or to get more resources about these kinds of issues?
O'Connor: There's a website called EthnoMed. They sort of collect information, but most of these are from the perspective of healthcare providers. Our website is prc.gsu.edu, and we have a lot of information. Our health information toolkit is actually there, as well as a number of other projects. For example, we were asked by a clinic to provide instructions translated into I think about 13 languages on how to take your medication, because the pharmacy's not going to give it to you. I'm sure that they probably do in Spanish in the United States in some communities. But largely in this community where we have a half foreign born population, and I've been working in this space for almost 20 years and refugees have been resettling here for 40 years, and the pharmacies still don't do it.
Lantigua: Mary Helen, what a treasure you are. Thank you so much for coming on the show.
O'Connor: Oh, it was a real honor to speak with you today.
Lantigua: All right. So here's what we learned today from Mary Helen.
Be a connector. Your parents may feel comfortable receiving advice from other people they trust who are not their children. Connect them to a doctor, a health promoter, a religious leader, a community educator, anyone who's not you. And then let them deliver their information your parents need.
Encourage questions. Help your parents prepare in advance for a doctor's visit by creating a list of questions about things they don't know. Keep in mind, the best person to answer these questions might be the nurse and not the doctor.
And remember: mind the paperwork. Just because you're their child does not automatically give you access to their protected health information. Talk to your parents and their healthcare providers about filling out HIPAA forms and other necessary documents to give you access to their legally protected medical information.
Lantigua: Thank you for listening and thank you for sharing us. How to talk to Mami and Papi About Anything is an original production of LWC Studios. Virginia Lora is the show's producer. Kojin Tashiro is our mixer. Manuela Bedoya is our marketing lead. I'm the creator and host, Juleyka Lantigua. On Twitter and Instagram, we're @talktomamipapi. Bye everybody. Same place next week.
CITATION:
Lantigua, Juleyka, host. “Doctor's Mom Won’t Listen to His Medical Advice”
How to Talk to [Mamí & Papí] about Anything,
LWC Studios., April 18, 2022. TalkToMamiPapi.com.