At BMC, our mission is to provide comprehensive and culturally sensitive women's health services along with integrated primary care services to immigrant and refugee populations, including those seeking asylum, and recent immigrant communities in the Greater Boston area. Listen in as Sheela Maru, MD & Courtney Massaro, CNM explains that our patients come from over 20 different countries and interpreter services, both in person and phone, are available to patients in over 30 languages, with an emphasis on promoting dignity, social justice, and human rights.
Sheela Maru, MD
Sheela Maru, MD is board certified in OB/GYN. She is the Director of the department’s section of Global Health and the Refugee Clinic. She supports women’s health access for all women and has worked in Nepal, India, and Nigeria.
Courtney Massaro, CNM
Courtney Massaro, CNM is a certified nurse-midwife (CNM). She has done women’s health and public health work in Burkina Faso, Nigeria, South Sudan, Burma, and Haiti.
Melanie Cole (Host): At BMC, the Refugee Women’s Health Clinic’s mission is to provide comprehensive and culturally sensitive women’s health services along with integrated primary care services to immigrant and refugee populations, including those seeking asylum and recent immigrant communities in the Greater Boston Area with an emphasis on promoting dignity, social justice and human rights. My guests today are Dr. Sheela Maru – she’s a board-certified OB/GYN and the director in the department section of global health and the refugee clinic and Boston Medical Center – and Courtney Massaro – she’s a certified nurse midwife that’s done women’s health and public health work in Burkina Faso, Niger, South Sudan, Burma, and Haiti. Welcome to the show, ladies. Dr. Maru, I’d like to start with you. Tell us a little bit about the Women’s Refugee Health Clinic at BMC and why did this come about.
Dr. Sheela Maru (Guest): Boston Medical Center has been the hospital of choice for a variety of immigrant populations in the Greater Boston Area for many years, and we have been able to provide comprehensive and specialized services so that we’re giving the best possible care to these populations with particular needs. We have seen that for women’s health, which can often be a sensitive and yet very important part of health care, that special services that are trauma-informed and are paying attention to trauma and experiences that people have come to up to the point of arriving at healthcare has been important for these particular populations.
Melanie: Courtney, where do some of these patients come from?
Courtney Massaro, CNM, FNP-C, MPH RN (Guest): We have patients from all over the world. I think that the majority of our patients right now come from Sub-Saharan Africa, but we have patients from Europe and Asia, Central America, South America, anyone who’s seeking asylum or has been granted refugee status, or those recent immigrants who need just a little bit of extra services and a little bit of extra support.
Melanie: Dr. Maru, for women as you said, this is such a sensitive area for women’s health services and certainly for people who are not as familiar with some of the healthcare opportunities in this country. Tell us about some of the unique services for immigrants and refugees that you offer.
Dr. Maru: That’s very true. We are really very focused on the concept of trauma-informed care. Many of our patients have experienced a variety of different traumas, including violence and sexual violence, and those things can play an important role when going through a pregnancy, for example, or even going through problems that are related to gynecologic health, such as pelvic pain or problems with bleeding or sexual functions. Trauma-informed care is one of the really important key principles of the care that we deliver in the clinic. Additionally, we also provide care for women who are seeking asylums in this country, and we have additional expertise female genital cutting, which is a practice that’s common among many of the countries from which our patients come from and can also be a reason that they are here in this country and that they're seeking asylum. Providing medical affidavits as well as consultants for that health issue is another one of our special services.
Another very important part of our clinic is our integration with other services that exist within Boston Medical Center and with the broader community. We have a social worker who sits in our clinic and meets with all of our patients during their clinic visit, and she is directly integrated with the Boston Center for Refugee Health and Human Rights. This center provides mental health services, legal services, case management and patient navigation. We are also very integrated with the internal medicine program for immigrant and refugee health, and that center provides medical and psychological affidavits and primary care for many of our patients.
Melanie: Courtney, I'm going to stick with you for just a minute because as a midwife, we in America can't comprehend the difficulties that women in other countries might endure when they're pregnant, and you mentioned medical affidavits and even female genital cutting. Tell us about how receptive and how difficult is it for you to work with some of these women and get them to feel comfortable with you and the intimacy of that type of service.
Courtney: It certainly takes time. Like any relationship, it develops over time. One of the really nice things about our clinic, not only for pregnant women, but for women who are seeking gynecological care, is we try and go very slowly. Pregnant women obviously have the whole pregnancy so it’s nine months of multiple visits where I slowly work into getting them to know me, me getting to know them, but also for gynecological patients. Most of the time, with the first visit, we just talk to them and we explain what our clinic is, we try and adjust whatever problem that they have – if it’s acute, it needs to be addressed immediately – but we want to build that relationship and then say for the next visit, you're going to come back and that’s when we’re going to do our exam.
As far as the pregnant women, like I said, it takes time, but I think most of these women see how much Dr. Maru and I care about them and we’re the only providers within the refugee clinic because we want that continuity of care. We want them to always know the providers that they're seeing and to feel comfortable with them and not like they have to continually retell their story or re-discuss or rethink about any trauma. Again, I think our social workers are very important and the whole team that we’re involved in, as Dr. Maru just mentioned because the women that need pregnancy or gynecological related care, we can take care of, but it also wonderful to be able to say “I know Dr. Crosby or Dr. Kimball, the doctor that you're going to see for your PCP appointment,” or “I know Dr. Lynn or Dana, the doctor you're going to see for your therapy.” We know these people very well, and so we have a really good relationship with them, and we can make sure that the patients get that extra support, which I think is very important given often their trauma and their situations before coming to the states.
Dr. Maru: One other thing I’d like to add is that during pregnancy care, Courtney and I have the wonderful opportunity to also be able to focus on and take the time to prepare for that very intensive moment of birth, which can often be the hardest time for someone who is new to the country and who may have very little social support and perhaps have also gone through trauma, which may resurface at the time of something intense like birth. One of the things that we tend to focus on during pregnancy care is preparing for that time and for the very important time afterwards for both mom and baby in a new place with a lot more responsibility.
Melanie: Dr. Maru, what about basic gynecologic care and awareness – things like mammograms and pap smears and things that they might not have gotten before and that weren’t available in the countries that they lived in previously? How do you get them aware? How do you get them to understand the importance of these kinds of screening exams?
Dr. Maru: Courtney and I also do have the advantage of having a practice or having practiced in various different resource-limited settings, and it’s nice to be able to really familiar with some of the places that many of our patients come from and understand generally what is available and what things may be quite unfamiliar. Like Courtney said earlier, we really do start with the basics and with thinking about what are the most important things that are available and we would want to offer to our patients, and then taking is slow step by step and making sure we get it all of the important screenings, but also take care of whatever acute problem may be bothering them in the moment.
Melanie: Courtney, what about interpreter services? From so many different countries, there's so many different languages. Do you and Dr. Maru use an interpreter? Do you both speak some of these languages? Explain a little bit about that.
Dr. Maru: One of the great things about Boston Medical Center is because we have patients from all over the world, we have a very extensive interpreter network. We have some interpreters who are able to come in person and be with us during the visit, but then we also have a language line, two telephones, that have 300 languages. That is certainly something that we use frequently.
Melanie: That’s amazing and these women are so lucky to have you ladies. Courtney, give us a little bit of a wrap up of why it’s different than just a regular OB/GYN office for these women to go visit for their gynecologic and trauma care and pregnancy needs. Give us a little rundown on why it’s so different.
Dr. Maru: This is what I explain to the patients. Whenever a new patient comes in, I say “hi, I'm Courtney, this is the Woman’s Health Refugee Clinic, I work with Dr. Maru,” and I feel like we’re not any more special than other physicians or other midwives or nurse practitioners who work in the clinic, but we know a little bit more. We know a little bit more about trauma-informed care and we also know about the steps that they may or may not have gone through yet in order to become a refugee, in order to see asylum, and often times in order to seek asylum, you have to fill out an affidavit – that involved finding a lawyer. We have resources in order to help our patients find lawyers, and as Dr. Maru mentioned previously, we know how to fill out affidavits, which are very specific legal documents that help the patient move forward and narrow their asylum seeking process. We are cognitive in many things that our patients have been through and try to go slowly with their visits and explain in a way that makes the patient the most comfortable, and provides them not only with obstetric and gynecologic care that they need, but also that overreaching, that lawyer, that making sure they have housing, trying to make sure they have enough food – all of those services that can be very important and very stressful for someone who’s recently arrived in the country and has minimal to no support.
Melanie: Dr. Maru, we would like to finish with you. Wrap it up for us on why listeners should come to this clinic raising awareness for the Women’s Health and Refugee Clinic at Boston Medical Center.
Dr. Maru: There are really challenging times in terms of national politics for our specific patient population for immigrants, refugees and asylum speakers. I think that having a clinic that especially for them sends a really strong message that we care, that they're welcome and that they're safe. We are really happy and privileged to be able to provide services that can really address a variety of different needs that they may have. I think that being able to provide pregnancy care, postmortem care, conception services, consultations around female genital cutting and connect people to those other resources like legal services, social services and community services that are specific to some of these communities is what our clinic is all about.
Melanie: I’m just going to finish here with what a wonderful program with an emphasis on promoting dignity, social justice and human rights that’s the Refugee Women’s Health Clinic at Boston Medical Center. For more information, you can go to bmc.org. That’s bmc.org. This is Boston MedTalks. I'm Melanie Cole. Thanks so much for listening.