Accessing care: A FEW WORDS WITH Atum Azzahir

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In this “A Few Words with,” SmartLink speaks with Atum Azzahir about the interplay of community, culture and health.  Atum is the executive director of  The Cultural Wellness Center.

The Cultural Wellness Center opened in Minneapolis, Minnesota, in October 1996 as an intense two-year community health and organizing initiative which emerged from listening to neighborhood residents share their experiences with current medical systems.  Over 40 ideas were implemented during those two years, including a farmer’s market,  a youth bike repair business, community forums on nutrition, a partnership between cultural elders and a local clinic to bring elder consultants to medical appointments, family exercise sessions, a walking club, and educational sessions on cultural health practices and ways of thinking.  This work led to the formation of the Cultural Wellness Center, where ideas from the community to improve health and well-being ontinue to be implemented.  Then, and today, the Cultural Wellness Center applies an understanding of culture and community to achieving healthier outcomes and economic development.

The Cultural Wellness Center seeks to unleash the power of citizens to heal themselves and to build community.  Core to the Center’s work is the idea that culture is a resource for people in their health and healing and that bridging between cultures contributes to healing  and strengthens community and personal health.   The Center believes community connections and cultural dignity are powerful medicines.

SmartLink:  At the core of the Cultural Wellness Center’s approach is the belief that those directly affected by a problem are ideally suited to develop solutions.  Can you describe a specific program or activity that represents this core belief?   
 
Atum Azzahir:  The Birthing Team was one of the first models we created to reduce infant mortality and pre-term birth.  It stems from the believe that women, family and community have the natural resources to produce the healthy birth outcomes. The Cultural Wellness Center’s role is to remind each participant of that and to help women negotiate with those in the medical profession who might see pregnancy only in terms of a medical application.

Our Birthing Team participated in 20 births in 2008.  We coordinated six home visits per month and had zero infant deaths. 

SmartLink:  Your organization very explicitly links the health of one’s overall community with the specific health outcomes of individual residents. 
 
What implications has this had for your day-to-day work? [i.e. how does this link change the way you might carry out a flu vaccination program or respond to a resident’s diagnosis with diabetes]?   

Atum Azzahir:  We try to see an individual and any symptoms he or she is experiencing as indicators that something is out of balance in the community. The person wants a quick fix. But, we try to unravel symptoms, working backwards to find an answer to the question, what is out of balance here?  A strictly medical fix or mental health diagnosis can exclude the person from having a role in the illness and recovery. The Cultural Wellness Center tried to argue for that the person’s role in a health issue is key.
 
Sometimes individuals want a doctor "just do it," to just fix them.  But, for example, when the diagnosis is diabetes, we emphasize the person's role to help support them in changing their eating practices.  We explore how eating practices might relate to there emotional or cultural needs.  In some cases, instead of food being a nutrient, it can become a medicine or a poison.  We share resources on the meaning of food within cultures to help folks understand this better.

The Cultural Wellness Center uses community dinners and family meals as an organizing activity and a path toward healthier families and communities. These group events help folks get a healthy meal, build friendships and restore family connections.  We focus on what goes into preparing for it. The meal is not an end in itself. It is a means to an end:  it opens doors for conversations, family gatherings, and relationship building.

SmartLink:  What implications do you think this approach might have for health care reform and how public health initiatives are performed in this country?

Atum Azzahir:  Health care reform must take into consideration population-based strategies. For example, the community-intensive way we are dealing with diabetes. The World Health Organization has looked at the resources available to groups of people who are healthy. Growing your own food, having green space, clean air -- all of this is critical and can be achieved through population or community-based approach. These strategies are not being talked about enough in the current healthcare reform debates.

SmartLink:  Have you been asked to measure or compare the impact of the Center’s approach to more traditional approaches to health and wellness?  What have you learned? 

Atum Azzahir:  Over the years, we have partnered with traditional health clinics, medical schools, medical residents and physicians because our work is about family and community and how each can become an essential complement to traditional medicine.  We are pleased that the social implications of health are becoming more popular to study and measure.  Some have even argued that community conditions can be the source of 85% of health conditions causing ill health. Community conditions can include what I described earlier, as well as individual behavior, lifestyle, personal decision making.

The Cultural Wellness Center has not tried to track traditional health outcomes, instead we try to partner with traditional providers and help them achieve healthier outcomes. I would refer you back to our Birthing Team work. We work with the provider to achieve better outcomes for women and infants. 

We are also focused on complementing, and changing, the approach health researchers have taken to study our communities.  You know, every approach to research is culturally-based, even if those cultural references are not recognized.  Cultural knowledge systems come into play significantly when people of different cultures are researching or being researched.  

So, to help take this into account, we work with researchers.  They  bring their studies to the Center's board for feedback on relevance, appropriateness, community involvement and how the research will be used. The committee is also explore broader questions about research, such as:

• How can we acknowledge and give space for other cultural knowledge systems?
• How can researchers recognize and utilize the knowledge and experience of community members in ways that give authority to and ownership?
• How can cultures come together -- without colliding -- to produce new knowledge ?

SmartLink:  When donors, especially smaller family foundations, consider issues like the health care system, it can be overwhelming.  Community-based health and wellness strategies seem to offer smaller donors a more accessible approach to strengthening health care for vulnerable communities. 

Having been so successful yourselves, how would you advise a local donor to assess community-based health organizations in their own communities?
 
Atum Azzahir:  My advice is to invest in the process of building relationships.  Look for organizations that value relationships and have built them. Look at the community organizations that continue to be relevant to people who may be experiencing a specific health issue [even if the organization is not focused on just that health issue]. 

Invest in things that retain the participation of people who live in the community.  And, where there is a holistic approach to health and there is no separation between the person and the community.

Related Reading

Other Ways to Take Action in Accessing care

• 2010 Health Care Reform: SmartLink Breaks It Down

  As a donor, you may be wondering how health care reform will affect individuals and families served by nonprofit health care providers, as well its impact on nonprofit organizations themselves. SmartLink has developed an overview of the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act. Consider this summary a starting point. Over time, we will learn much more about how donors and communities can influence the health care for low-income communities.

• Advocating for change

• Developing new programs

• Organizing for change

• Strengthening community groups

• Tackling immediate needs