If you’ve been to a hospital emergency room, it’s likely that some people you see will have been waiting there for hours. And much of the time, they are at the ER to be treated for common problems like ear aches, a bad cough or other ailments.

It would be better and faster if patients had gone to an urgent care or a doctor’s office for care. And that’s much less expensive than an ER. One study found that the median cost to treat an upper respiratory infection in the ER is $740. That’s about $580 more than the average cost of a visit to a doctor in Minnesota.

These scenarios are why HealthPartners hired Hawa Jama in 2015 to become our first community health worker. There are now two. Their roles are proving to be highly effective in advancing health equity in Minnesota.

What does a community health worker do?

When Hawa started her job as a community health worker with HealthPartners, she got a list of 145 people with our health insurance plans who had gone to the ER multiple times for minor medical problems. Many were Somali and Oromo people who had immigrated to the United States from East Africa. Hawa’s job was to connect with them and help them successfully get the resources they needed for their health. She started by asking questions to learn why some people were not using the clinic to get care.

“Some families who don’t live nearby might have one car that the breadwinner takes to work during the day. I explained that we can help with transportation,” she said. “Or they might have had a bad experience with a provider. I explained that they have a right to have their doctor listen to them and that they can choose another doctor. These are among the kinds of health care barriers that Somalis in Minnesota face often. And offering these kinds of supports is what’s central to reducing health inequalities.”

Hawa explained why they could get better care in a clinic or urgent care. “I told them that they don’t have to wait for hours, like they often do in the ER,” she said. “And I showed them that if a medication doesn’t work, they can call the clinic to get a different prescription.”

Why being a community health worker in Minnesota is the perfect job for Hawa

Hawa has always been drawn to helping people. That’s what gives her joy. She was born in Somalia and lived in Ohio for many years where she worked at a health center for low-income residents. She moved to Minnesota in 2013 after coming here on vacation.

“I grew up near the Indian Ocean. I love water and I love the lakes in Minnesota,” she said.

Fluent in English and Somali, Hawa worked as an interpreter after moving north. But it was sometimes frustrating because interpreters can only translate what is being said. Hawa often found that she wasn’t able to help people even if she knew how to help get them the resources they needed – like food, or help finding a house or job. So she pursued a Community Health Worker certificate at Minneapolis Community and Technical College. It would be a role where she could spend more time effectively advancing health equity in Minnesota.

The impact of HealthPartners' Community Health Workers, based on data collected from Aug. 2016 to Oct. 2018.

Understanding Somali culture and religion helps Hawa in her job as a community health worker. For instance, she knows in Somalia, people only go to see a doctor when they are sick. Seeing a doctor when you feel well in order to learn how to stay healthy is a new concept. So that’s something Hawa makes sure to explain when she visits someone in the Somali community. She knows many Somalis need more information about what preventive care is, what it means and why it’s important.

“I say, ‘Just like putting on a coat will keep you from getting cold outside, you can protect yourself from feeling sick by taking medication for things like asthma or getting immunized against illnesses like the flu,’” Hawa said. “That helps explain preventive care in a way that makes sense to them. Fortunately, our program allows me to spend extra time on this kind of education when I need to. That’s not usually the case for doctors. They tend to have to follow a tight schedule during their appointments with patients.”

With her in-depth cultural knowledge, Hawa is aware of things that others unfamiliar with the culture often don’t pick up on or consider. And she’s able to identify and use appropriate examples and references that resonate.

“There are many ways to educate. But culture affects what will work so that someone learns,” Hawa said. “Take explaining to a person what foods can keep them feeling healthy and energized. If they need more protein to achieve their best health, there are lots of protein sources I could talk with them about. But sometimes individuals can’t eat all of those options. There are, of course, medical reasons for not being able to eat something. But there’s also a whole host of cultural reasons. It could be because their religion tells them to not eat certain things. It could be because certain things cost too much for them to afford. Or it could just be that they didn’t have a certain thing in their home country, so they don’t really know anything about it or how to cook with it.”

“Oftentimes, though, there are protein options that the person is already accustomed to eating. So, I talk to them about these familiar options, rather than overwhelming them with all the others,” Hawa continued. “Trust comes easier when you can relate to someone and they show that they understand your culture. The people I visit with are more open to listening to the health advice I give them because this approach shows I respect their culture. They are also more willing to follow through. They understand what we talked about so they feel like they can actually do it with success.”

While it does take time to build trust, many people end up inviting Hawa into their homes. And getting to that kind of trusted relationship is what Hawa believes to be a crucial key to reducing health inequalities that Somalis in Minnesota face.

“When people are in their home, they are relaxed. They tell you things and you can see things they need,” she said. “For example, one family had no furniture. Imagine what it would be like to have meals without a dinner table. I gave them information about Bridging, an organization that provides donated furniture.”

While many of her clients are immigrants, about half of the people Hawa works with are people who were born here. No matter where they were born, affordable housing is a common problem. Food, winter clothing and school supplies are other common things that people need.

“Many of them have a lot of pride and don’t want to ask for help. A big part of my job is helping them feel comfortable to get the resources they need,” Hawa says.

The importance of community health workers

Three years after Hawa started, primary care visits had gone up and emergency room visits had gone down among the people she works with. That’s success for the program. Hawa knows that most of health is determined by what happens outside of the exam room. And for her, success is also being able to connect people to the resources they need.