An influx of Haitian immigrants to Springfield has sparked a dramatic increase in the number of patients using Rocking Horse Community Health Center and forced the center to adapt how its serves its patients.
Chief Medical Officer Dr. Yamini Teegala said the center has worked to get immigrants to schedule appointments instead of walking in, added three translators who speak Haitian Creole and improved the way its providers ask questions to ensure they are giving patients the best care.
Rocking Horse does not turn away anyone who is seeking help.
“I take it as a compliment that (Haitian immigrants) want to come to Rocking Horse. It is kind of a telling statement that they believe in our nonjudgmental care,” Teegala said. “But I do worry that if we don’t have a good overarching strategy on how (Rocking Horse) is going to streamline this, I do believe that all of us will continue to struggle, and so will they, because we haven’t understood what to do.”
Teegala said she believes all Haitian immigrants in Springfield who seek primary care go to Rocking Horse.
No one knows for certain, but groups working with the immigrants estimate the Haitian population in Springfield and Clark County between 4,000 and 7,000 people now, almost all within the last five years.
Sharp rise in patients
Rocking Horse experienced a 257% increase in Haitian immigrant patients from 2021 to 2022, seeing 115 Haitian patients in 2021 and 410 in 2022, Teegala said.
In January of this year, the numbers skyrocketed again, with about 220 visits with Haitian patients just that month.
Teegala said most patients initially were seeking pediatric and prenatal care, but many more are now visiting for primary care.
Another change: the center’s staff, Teegala said, now asks more direct questions to ensure patients are following medical providers’ treatment plans and getting the best care possible.
“If I give a medication, I quickly run through the questions,” Teegala said. “They are very, very fast: ‘Which (pharmacy) is it you go to? Do you have a ride there? OK, good. Do you have a co-pay? You’re OK with that?’ Because if you don’t, it’s a moot point; the medication didn’t even get picked up.”
Teegala said at first the patients were coming without appointments because that is how they received care in Haiti. Now, when they call, they can reach a person who speaks Haitian Creole who can help them set up an appointment.
Teegala said providers quickly realized that any appointment where translation and interpretation services were required took twice as long as those without, so they couldn’t have enough visits for everyone. She said this led to a lot of provider burnout in 2022.
The phone translation line the medical center uses wasn’t going to be enough to successfully serve the volume of Haitian patients, Teegala said, so Rocking Horse hired on-site patient advocates who also speak Haitian Creole.
Johnson Salomon, a patient advocate who speaks Haitian Creole, French and Spanish, said he uses all three languages and his own background to help patients receive the best care possible. Salomon is a Haitian immigrant who came to Springfield after his mother told him she liked the city and it was a good place to live.
Salomon said he left Haiti in response to pervasive gang violence in the country.
“If I could stay, I’d stay in my country because I feel better, everybody feel better in their own home,” Salomon said. “But it’s come to a point where you cannot stay; you have no more option. You have no more option than leave, even if you don’t know where you’re going.”
Johnson said he encouraged Sony Auguste, another patient advocate who he had worked with in Haiti, to leave the country and come work with him in Springfield.
Teegala said Salomon helps break down cultural barriers. She said in one case a pediatric patient had irritation on his scalp that could have been due to his braids being too tight. She said she asked the mother who braided his hair, but the woman didn’t understand until Salomon asked who plaited it. Once Salomon cleared the confusion by using a word the mother uses in her culture, Teegala said she was able to provide proper care.
More than medicine
But Rocking Horse does not just provide medical services to the immigrants.
Salomon said, on a daily basis, about 40% of people who he helps require translation for their medical appointments. He said he mostly helps people with translating and understanding important documents pertaining to immigration, the Department of Job & Family Services, school registration and similar issues.
Teegala said staff members are working to provide care to both established patients and newer immigrant patients, but it has been difficult with longer visit times and cultural differences. She said people doing their required clinicals for medical degrees have helped ease some of the burden caused by an increase in patients.
These students don’t just go straight into patient visits, though, Teegala said. She said they first work with the patient advocacy team to learn some of the most important skills they will need in medicine, particularly with so many patients being Haitian immigrants who struggle with housing and getting the resources they need.
“When students come here, I always tell them, ‘How to treat strep throat? Medical school will teach you. But when you go into a room and somebody tells you that (they) don’t have a home, medical school doesn’t teach you what to do,’” Teegala said.