Trained as an anthropologist and a physician, J. Carey Jackson understands the challenges of providing health care to immigrant communities. Overcoming language barriers and recognizing cultural expressions of illness are only part of his continuing quest to care more effectively for these patients.
At Harborview Medical Center, where Jackson has served as Director of the International Medicine Clinic since 1992, providers treat patients from 70 language groups with the help of the medical center’s Interpreter Services. His team works with community leaders from numerous ethnic groups who help provide interpreters and advisers to work in the clinic. But understanding the language is just the beginning.
“Clinics need to engage meaningfully with the communities they try to serve,” he explains. “For us, this means a detailed understanding of the patient’s family structure, neighborhood, history of relocation and trauma, diets, and social lives before we can accurately address many health problems.
Many community clinics, migrant clinics and Indian Health Service Clinics do this well, but how does a large county hospital serving over 70 non-English speaking communities attempt this?”
In 1994, Jackson teamed up with pediatrician Ellie Graham and their Harborview colleagues to develop the Community House Calls Program.
The program builds bridges between ethnic communities and health institutions through a medical-anthropological approach that includes a well-integrated health care team and interpreter cultural mediators. These bilingual, bicultural mediators help non-English speakers navigate the health, social services and legal systems. This case management approach promotes dialogue and education to help medical systems become flexible and able to engage with social and cultural differences in varied ways.
Jackson’s remarkable community service and clinical care work are only part of the reason why he is the recipient of this year’s S. Sterling Munro Public Service Teaching Award. Not only has he reframed the concept of care to include cross-cultural medicine, but he has created a thriving teaching environment in which students and residents apprentice alongside physicians in caring for these vulnerable patient populations.
“Paul Farmer says it nicely,” Jackson says, referring to the subject of the inaugural UW Common Book Mountains Beyond Mountains who pioneered community-based treatment strategies for infectious diseases. “Too often, clinical systems use the ‘culture’ buzz word as a diversion, a smoke screen, to avoid engaging with patients in a meaningful manner that moves the system outside of its financial and administrative comfort zone. We need to continue to challenge our institutional practices through research and innovation by tracking cost and consequences with a goal to engage morefully with all communities to serve their unique needs.”
Residents rotating through the clinic are taught by attending physicians with additional training in international health, tropical medicine, social medicine or anthropology.
“They understand how critical it is to build community and institutional partnerships in order to provide clinical care outside of the narrow confines of a 15-minute office visit,” says Jackson, whose research has included hepatitis B screening and prevention, tuberculosis control, and methods to improve cervical cancer screening and prevention in immigrant populations.
Together with Community House Calls faculty and staff, he developed a Web site — http://www.ethnomed.org — that offers detailed clinical information on a variety of cultural and medical topics.
“We’re making progress because we sustain relationships with these communities over time,” Jackson says. “EthnoMed is not a library archive — as such, it is woefully incomplete — but it is a real work-in-progress that grows out of relationships. It’s like a family photo album, a journal of our living relationships in these communities.”
But Jackson refuses to take all the credit.
“This has been a collaborative effort on the part of many people, and Harborview deserves many accolades — it really stepped up to support and help develop the International Medicine Clinic, EthnoMed, Interpreter Services and the Community House Calls Program,” he says.
Dr. William J. Bremner, Robert G. Petersdorf Professor and Chair of the UW Department of Medicine, says Jackson “richly deserves” the recognition.
“Dr. Jackson has forged a nontraditional academic path that nevertheless has established a remarkable record of scholarship and community service and serves as a sparkling example to students and providers,” Bremner says.”And he has done this in a quiet, unassuming manner through meaningful partnerships and collaborations.”