Health care systems can be challenging to navigate for everyone. But that difficulty only increases for people with language barriers or mistrust of health care systems.
Generations of people have gone through life without someone to walk them through the ropes. Tatiana Jara Pacheco feels passionate about the work of cultural brokers because of the gap that has historically existed.
Jara Pacheco and her family immigrated to the United States from Ecuador and faced hardships navigating the things she’s helping people with today as a cultural broker with Comunidades Latinas Unidas En Servicio (CLUES).
“Something that made me want to go into this job is having that support that I didn’t really see growing up that I wish my parents would’ve had,” she said.
The concept of “cultural brokerage,” which in Spanish translates roughly to “cultural agent,” has a big role in the community.
“The idea of like a cultural broker, the translation of it is really weird. So, I say I’m a promoter of health and wellness,” Jara Pacheco said.
She works with Spanish-speaking clients, with a typical caseload of 30 people. They come to her with various needs, like applying for SNAP benefits, rental assistance, making doctor’s appointments, making sure families have proper winter gear and referring people to different food shelves depending on their home addresses.
Sometimes, Jara Pacheco will go to client appointments, like for glasses, because some places don’t offer Spanish-speaking services. Even though that’s not technically a part of her role, she still goes because there’s not someone who can always translate and interpret for them, she said.
The Fairview Foundation has funded positions for six brokers for five different communities: Hmong, Karen, Latin, Native American and Black people in Minnesota. The intention is to create a link between the health care system and communities to increase health outcomes, said Keith Allen, the manager of the program.
“Eighty percent of health is happening outside of our clinical wall,” Allen said. “If you talk to our doctors and nurses, medical professionals, a lot of times that other 20% is getting in the patients’ and community’s lives at a late stage. If we really want to be impactful, we have to be in the community.”
It is the program’s fifth year running, and Allen says they’ve helped around 15,000 people so far. Each year, the program sees 300-400 clients. Allen said that the clients also average four visits a year, making the program fairly well-used.
Powwows and more
Monique Nelson is a Native American and Hispanic woman who has been well acquainted with the American Indian Health Family Center since she was a kid. Now, she works there as a cultural broker through Fairview.
While she’s fairly new to the role of cultural broker, it’s something she said she’s been doing well before the term was coined.
Earlier this month, Nelson was at a powwow at Humboldt High School in St. Paul, put on by Indian Education. The event brought Native American communities together and served as a vaccination clinic where attendees could get flu shots and COVID boosters.
In speaking with her, her connection to her community became clear. Sitting at a table to talk for this report, within three minutes, a handful of people had walked by and said hi, given her a hug, or shared a warm glance.
“We’re tight; we’re small; everybody knows everybody, as you can see,” Nelson said.
One way Nelson cares for her community is by emphasizing healing from historical traumas. A couple of weeks ago, she organized a screening of “Dakota 38,” a documentary that describes the impact of a mass hanging of 38 Native Americans in Minnesota during Abraham Lincoln’s presidency.
“It (the documentary) was a way of demonstrating what historical trauma is, and then you’re starting to get a better understanding of what we are dealing with,” she said. “This one of many. We hang onto it, and it affects our mental health.”
Community members come to her with a range of things. Among them, too often, she says, is housing insecurity.
“A lot of our relatives are suffering cause there’s just not enough programs and there’s not enough money, or they don’t fit in a certain guideline to be able to qualify for placement, or there’s no available spots, no beds,” she said.
Housing options exist, but not in a feasible way. For example, a woman from the Twin Cities recently went to Nelson to get help in looking for housing, but the closest option was past Detroit Lakes, with no guarantee she would have the spot, Nelson said.
She sometimes spends her weekends calling around trying to find better solutions for her clients, she explained.
“I’m the type of person that if someone’s needing help, I’m gonna help. Even if I’m not clocked in,” she said. “If you’re doing it with your heart, you’re gonna do it.”
She aims to use culture as healing and connect people with ceremonies and relatives who can give guidance.
“Sometimes, if a person has been disconnected from that, they don’t feel worthy and we’re battling depression every day. Maybe they don’t even know they’re depressed. Going to ceremony is helping them to get strong, to find that in them again,” she said.
The program’s roots
The Eastside Health and Wellbeing Collaborative was an initiative that addressed things like food access and mental health and stress resiliency. In 2016, the people who were part of it noticed that a cultural component was missing, Allen said.
“They wanted to have a free resource in the community, and they wanted to have it to be low barrier. And they wanted folks to be able to be engaged and welcome in the community, and no stigmas attached to it, like making sure folks didn’t have to have a certain kind of diagnosis, but if they identified with this culture, they could be served,” he said. “They also wanted to make sure the people that were in these roles, was not necessarily driven by high degrees and expertise, but more so that cultural expertise and resource to the community.”
When asked if other health systems and organizations have shown interest in the program, he said he hopes they will.
“I don’t know if folks will reach out, but I welcome them because the community is benefiting from it,” he said. “I would love for other folks to want to learn how to increase that reach as well.
Fairview is considering adding a Somali cultural broker and also thinking about making broker positions for other communities like the unhoused peoples in Minnesota.
Why be a broker?
Despite the job’s hardships, Jara Pacheco says the feeling she gets from helping people is unmatched.
“I think I’ve stuck with this job because it makes me feel, it may sound a little selfish, but it makes me feel that I’m helping my community in a way that, like, I would’ve loved my family to be helped,” she said. “And it makes me really happy to hear my clients call me whenever they need help and be like, ‘you’re the only person that I can think of right now.’”
Because of her background, being Ecuadorian herself, and understanding the difficulties many immigrants, she has a different relationship with them than someone else might have.
“I think of them as an extension to my family because I try to help them as much as I can in a way that, like, I’m not helping a client. It’s like if I were helping my grandma or my mom or my little brother,” Jara Pacheco said.