"That was one of the hardest things, leaving my dad behind. ... I still have that picture of walking through the gate. ... I was thinking, 'This is the last time I'm going to see him, ever,' " said Ahmed, a 24-year-old Somali woman.
She got off the plane in Iowa in December.
"That was the first time in my life I've ever seen snow. I saw it on TV. I didn't realize how cold it was," she said. "I'm wearing a small sweater. ... And the cold, it just hits me. 'Whoa. What is this? Am I in a freezer?' "
Her family made a home in St. Cloud. Several years later, Ahmed reunited with her father in Africa.
"For a good minute I did not recognize my father. He was standing there smiling at me, and I'm over here like, 'Where's my father? Where's my dad?' ... It took a minute for it to just kind of register. ... My dad is not the person that cries because he's been through way more than I've been through. And we just cried," she said.
Eventually, her father was able to join the family in St. Cloud. Ahmed graduated from Apollo High School and later St. Cloud State University, with a degree in community health. She is completing a certification as a community health worker.
The experiences of separation, resettlement and reunion fuel her passion for her unique job as a community health worker at CentraCare Health, where she helps Somali patients in the obstetrics and pediatric and adolescent medicine clinic. Many of the families she guides are navigating the complicated U.S. health care system as brand-new residents..
Ahmed knows, from personal experience, that for Somali refugees and immigrants coming to Minnesota, the first year is the hardest.
"Everybody goes through that," she said. "It really is the hardest. But it gets better.
"I get it. When they come and they sit in front of me, and they tell me all this stuff they went through. They're like, 'Oh I've been here for three months and life is hard, and I don't know a way to get around.' And they just talk about all the struggles and how they don't understand the culture and how they don't speak the language. That is a big, big barrier, the language, the transportation. Back home, we could walk. ... And they were familiar with this life."
The medical system refugees are used to is very different from what they encounter in the U.S.
"My whole job description is to help them navigate the health care system," she said, though she is not to be confused with a medical interpreter.
Ahmed has plenty to do. CentraCare can roughly track the number of Somali families that use an interpreter. Among obstetrics, women's health and pediatric patients where Ahmed works, 1,790 in-person interpreters for Somali were used in a six-month period.
Amina Ahmed, community health worker at the CenraCare Health Plaza talks with her supervisor Sarah Schindler, director of pediatrics and allergy, on Dec. 19.(Photo: Jason Wachter)
The clinic where Ahmed works has had a community health worker for about two and a half years, said Sarah Schindler, director of CentraCare Pediatric and Allergy. Ahmed joined the clinic this summer, replacing a health worker who came to CentraCare on a short-term basis via a grant. Now CentraCare budgets for the position.
"(Community health workers) are such a trusted voice for the families," Schindler said. "It's a point of contact that is comfortable."
Her commitment comes from her own experiences.
"I remember how I felt. I felt lost," she said.
It can be as simple as getting to the appointment.
"I make sure they will have a ride that day. Because it's a big chunk of time for us. If they don't show up, we lose a lot of time where we could be seeing other people," she said.
"Most of the time, 90 percent of the time — this is just my calculation — they don't have rides set up," she said.
Ahmed will coordinate with programs that provide services to refugees, including Lutheran Social Services. She'll call patients a week ahead of an appointment, a day ahead, the day of — as well as talking to other agencies.
"My job is to make sure I get my patients here," she said. "Because of that contact from the beginning ... we make this connection."
She'll coordinate with nurses, suggest urgent care or a walk-in clinic, if an issue arises.
"Just like any other mom, if their kid is not feeling well, they want their kids to be seen," she said.
They'll ask about county benefits, insurance or nutritional assistance, and she'll do what she can to help.
"Every day for me is an adventure," she said. "And I love it. ... I have learned so much. People think I have the answers. No, I'm learning from everybody."
Some appointments are required as a condition of resettlement in the U.S. She helps the refugee and immigrant families get tested for diseases prevalent where they came from: tuberculosis, malaria, hepatitis, lead levels and parasites.
She makes sure they understand to know how important it is to show up to an appointment, and to come ahead of time.
She helps families establish primary doctors. She knows that Somali patients can press 4 on an insurance hotline to get the instructions in Somali.
She'll hold their hands. She'll laugh through the sometimes uncomfortable process. She will joke with the families.
"It makes them feel comfortable," she said. "It builds trust." She also tries to empower the families, so they can navigate more independently.
"A big part of it is, where do you go, where do you shop? And if you go to the store, what do you buy?"
She told of one man who was given a list of supplies to get to prepare for a colonoscopy. He didn't know where to go to find them.
"He came to me," she said.
She said many of the Somali people are more comfortable asking her than another professional.
Ahmed also provides a bridge to Somali culture for providers.
"I've got providers calling me all the time," she said.
Schindler said she's seen the impact learning even a few short Somali phrases can have on patients. It shows that the doctors and nurses care.
"They light up," she said.
Ahmed, too, does her best to help people feel comfortable.
"For me, I'm like a natural. I can meet you today and speak like I've known you my whole life," she said. "That's kind of one of my things."
Schindler agrees.
"She is very open, very transparent. Her focus is on the family and really providing them with the best possible care and experience," she said.
Ahmed is the only one of her kind at CentraCare. She stresses the need for more community health workers, for everyone, not just Somali families.
"I see the difference, when they show up for appointments here, and they feel welcome ... and respected," she said.
She has tried to talk to her Somali friends about going into the community health worker field, as well as recruiting Somali nurses and doctors.
"Because I see the difference when I help these families. ... I notice they show up to their appointments more. They actually feel welcomed here and they feel like CentraCare cares about them," she said.
"I get people from other clinics calling me asking for my help," she said.
"We need more in St. Cloud. We need more for everybody," she said. "We all need guidance, because it's complicated."
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