No one ever refused when nurse Bria Chakofsky-Lewy offered to give a shoulder massage during the home visits she and a cultural mediator/interpreter regularly made to Somali women in Seattle. I could see a womans face change when I spent five minutes rubbing her back, she observed.
That observation clicked into place as Chakofsky-Lewy, RN, MN, contemplated why physician-prescribed physical therapy failed to relieve her Somali clients pain. The answer, not surprisingly, had little to do with Western-style medicine. Instead, it germinated an innovative means of meeting healthcare needs in the community.
Chakofsky-Lewys spontaneous back rubs have morphed into Daryel, a thoughtful treatment modality that fits this group of African immigrants and refugees. Daryel is the Somali word for wellness. Each Sunday, women of varying ages gather to work on their health issues and replenish their spirits with social interaction.
Diagnosing inner pain
The community nursing outreach is part of Harborview Medical Centers Community House Calls program in Seattle, where Chakofsky-Lewy is a supervising nurse. The program also reaches into Cambodian, Amharic, Vietnamese, Spanish and Tigrignan-speaking communities.
Id heard about complaints from Somali women that they described as half body pain, only on their right or left side, Chakofsky-Lewy said.
Some of the women, who had been traumatized by experiencing or witnessing violence in their homeland, were seen by Harborview physicians who diagnosed conditions such as arthritis. Chakofsky-Lewy said that to her, the womens pain seemed somewhat metaphorical for having a very big and very [emotional] pain.
She said that sometimes the trauma that many refugees experience manifests as PTSD or depression, other times as musculo-skeletal pain. In the Somali community, Chakofsky-Lewy said, there is a great deal of stigma about mental health.
Chakofsky-Lewy began to interpret the pain women verbalized as expressions of both their physical and emotional hurts. She noticed the Somali women didnt like the physical therapy prescribed to treat their pain; some women said the treatment felt more hurtful than helpful.Bria Chakofsky-Lewy, RN
Once the back and shoulder rubs sparked Chakofsky-Lewys epiphany that massage was more culturally acceptable than physical therapy, cultural mediator Salma Mussa, who worked with Chakofsky-Lewy, found a massage institute whose methods were culturally acceptable and respectful toward the Somali women.
Eventually the massage was coupled with yoga, then health talks by Harborview providers were added to help the women gain control over their health concerns and make beneficial choices.
Outcomes of wellness and hope
The women say they find each aspect of the weekly four-hour Daryel program enriching.
I have learned many important health topics, one participant acknowledged. Others have told Chakofsky-Lewy that Daryel is a new starting of great health for their future.
Its beyond clinic based healthcare, Chakofsky-Lewy said. So much about health doesnt have to do with medicine. Its nice to be on the end of the spectrum that has do with health and well being.
Chakofsky-Lewys interest in the cultural and community concerns of the delivery of healthcare moved her to study for her masters in nursing, which she completed in August. Her work includes supervising caseworkers and cultural mediators who work directly in the community and as patient navigators with patients at Harborview.
She said Daryel participants are deeply thirsty for social interaction with other women who speak their language; living in a large urban setting is so unlike their lives in Somalia.
To be able to both provide a few hours of very nurturing social environment and be teaching self care through yoga plus the health talks has a ripple effect into the community. For the women and their families, Daryel allows for more wellness and thus the capacity to live more fully, be more effective in their lives.
The group is constantly refining itself; a student nurse recently developed a Facebook page for the group to extend its social network. Two University of Washington postgraduate students will participate in Daryel this year to complete their nursing practicums. And Chakofsky-Lewy hopes additional culturally sensitive massage therapists will step forward to volunteer their services to the women.
Chakofsky-Lewy sees Daryel as an example of what nurses can bring to the community. The womens feedback reminds her how vital the program is. As one Somali woman told her, Its a place of hope and health.