Empowerment Through One's Own Culture

It is a quiet Sunday afternoon in Wenatchee, Washington, a scenic town perched on the eastern slopes of the snow-peaked Cascade Mountains. Carolyn Serre Johnson, F.N.P., M.A., sits and talks with friends and colleagues at a café where she works on weekends. The topic of discussion is of particular interest in Wenatchee—the convergence of western medicine and ceremonies of the Hispanic folk healers called curanderos that enhance the quality of life and health for migrant workers and recent immigrants from remote Mexican villages.

On Monday, her cafe patrons return to their jobs with a new respect for people they see usually in the context of menial labor, and Johnson returns to Columbia Valley Community Health Services, where she shifts her attention to providing quality health care for her predominantly Hispanic patient population. In fact, she characterizes her weekend work in the cafe as "creating a balance in my life that keeps me going all through the week."

For more than 25 years, Johnson, an alumna of the NHSC Loan Repayment Program, has served the needs of America's most vulnerable population in a way that defines compassion and cultural sensitivity. Fluent in the rural dialects, or what she calls "bush Spanish," and graced with a first-hand knowledge of the cultural and healing intricacies of the remote villages of Mexico and Guatemala, Johnson eases her patients into blending the best of their homeland cultures with the best of what their adopted country has to offer.

Over the years, newcomers settling into the Wenatchee Hispanic community have learned that Columbia Valley's clinics and mobile units are places of safety and understanding—and if they bring their families to Johnson, she will provide health care that they will understand and trust.

"Many times, my patients have not seen a doctor in years, and their children have never been to a doctor in their lives," says Johnson. Along with the many medical issues she treats and preventive services she offers, Johnson sees a lot of depression and anxiety resulting from severe culture shock and isolation. From her extensive knowledge of folk modalities that would be familiar to a newly arrived patient, she might characterize a specific and culturally based anxiety as susto—a fright or trauma that causes the soul to become separated from the body. The treatment she offers might be a combination of anti-depressants or anxiety medication coupled with Sieta Azares—a calming herbal tea, prepared by a well known and respected local curandero.

Hispanic women and children are vulnerable to domestic violence, especially when families face drastic cultural changes coupled with severe economic stress. "Domestic abuse occurs frequently among newly arrived immigrant families and is probably the most difficult health care issue I have to deal with," Johnson says. She vigilantly looks for telltale signs of domestic abuse and violence—such as mental distress and low self-esteem—in her female patients. "It is not enough to just remove women and children from abusive environments. You have to actively help them take control of their lives and make their own way without their abuser."

After each healthy child exam, Johnson presents her little patients with a Spanish-language picture book—a donation from a literacy program that she helped spearhead, and encourages the family to read together. If the mother cannot read, she spends a little extra time showing her how to "fake it," in the hope that the book will be a catalyst for her as well as the child.

"The result has been empowering," Johnson says. "Many women who come to America from remote Central and South American villages do not speak any English, cannot read, have no marketable skills, and are completely dependent on the men in their families."

As such, according to Johnson, they are effectively shut out from health care and social services for themselves and their children unless they can find a special place that accommodates their unique cultural needs. Fortunately for them, the Columbia Valley Clinic is one of those special places.