For as long as he can remember, Dr. John Birky has been interested in serving the cross-cultural community. After graduating from residency at the University of Kansas, he sought out a position that would give him 8 weeks off per year to do short-term medical cross-cultural service trips, internationally.
He found a home in Lakin, Kansas. After serving the diverse community in Lakin for four years and taking time off each year to serve internationally, he and his wife realized that Garden City, Kansas – a town of 27,000 people just 20 minutes away from Lakin, was a town of rich diversity where 27 different languages were spoken on a daily basis in its schools.
“In addition to having a large cross-cultural population, Garden City is historically underserved for primary care,” explained, Dr. Birky. “The average American has a hard time finding a doctor – much less immigrants who don’t understand our healthcare system. Many of them were using the ER for everything.”
Dr. Birky wanted to find a better way to serve the diverse population of immigrants and refugees in southwest Kansas, so he and his family moved to Garden City in 2015 with the intention of exploring the best way to meet the healthcare needs of the refugee community.
After meeting with several members of the refugee community, Birky realized that language was one of the primary barriers that stops them from seeking and accessing healthcare services.
“We decided to start a nonprofit organization, New Hope Together, to bridge the gap between refugees in Garden City and healthcare. The organization has 2 components. One is meeting healthcare needs through the New Hope Together clinic and the other is a focus on teaching English,” he said.
To make accessing healthcare as easy as possible for the refugee community, Dr. Birky and his team of volunteer providers opened New Hope Together in a remodeled two-bedroom apartment in an apartment complex where many refugees live.
“We made the living room our waiting room, and created treatment rooms out of the two bedrooms,” he explained. “Right now we offer a walk-in clinic on Saturdays and are open one day a week for follow up appointments. This helps to ensure that refugees are able to keep their immunizations current and provides access to preventative care.”
Dr. Birky has been purposeful about making connections with prospective physicians who have a service mindset. Through networking regionally and building relationships with other like-minded physicians, he has formed a team of providers who share his vision for meeting the needs of the refugee community. The clinic is staffed by a team of 6-8 physicians who donate a few hours each month.
Rather than offering the services free of charge, they charge a small fee on a sliding scale to keep it affordable. “We decided to charge a fee because we’ve found that when the services are free, people don’t value them or see them as reputable. They even feel indebted, somehow,” Birky said. “When we charge a fee, they value it and trust it more. They don’t want a free handout. They are working and earning money, and they want to show appreciation for the medical help they receive. In fact, in our experience, those in the refugee community are quick to pay the bills for the services they receive.”
In addition to offering an access point for culturally sensitive care, New Hope has a literacy component with one-on-one English tutoring. Volunteers meet in a coffee shop or local restaurant, and if they both feel comforable enough, in each other’s homes to teach English.
Dr. Birky is especially excited about this service because it’s not duplicating any services that are already being provided for refugees in Garden City. With language being one of the primary barriers that stops refugees from accessing medical services, New Hope is building cross-cultural bridges and breaking down some of the cultural barriers that are often difficult to see.
Birky wants to encourage medical providers to look beyond the short term service opportunities and seek out ways that we can serve those in need all around us.
“The make-up of the U.S. is different than it was 20 years ago. There has been a big influx of refugees. It’s amazing that there are now 27 different languages spoken in a school system in Garden City, Kansas. We’re in the middle of nowhere! If you’re interested in serving cross culturally, you no longer have to cross a border to do that.”
It may be a cliché that people pursue a career in medicine because they want to help people. But it’s a cliché for a good reason. Most of us have done exactly that.
For most of us that desire extends beyond the confines of our professional endeavors. Wanting to help people and be of service doesn’t stop with our patients.
When I began working with Docs Who Care in 2005 I knew that my medical career was one of my top priorities, but I also knew that it wasn’t my only priority. Early in my tenure with Docs Who Care I realized one of the great benefits was that I could more easily devote time and energy to multiple areas of my life that I wanted to prioritize.
One of those areas for me is my family. I could still be a good husband and father if I was in a traditional practice setting. But I’ve found the ability to maintain flexibility through my Docs Who Care schedule has allowed me to be even more present on a regular basis in service to the people I love most.
I’ve also felt a strong pull to be of service outside my family and practice settings. Working with Docs Who Care, and having the flexibility it offers, has allowed me to pursue many other service opportunities. For the past decade I’ve been fortunate enough to be a part of Camp Hope, a summer camp for children who have or have had cancer.
Not only have I been able to attend the camp for one week each summer without using limited vacation time, but I’ve also been able to become involved in a leadership role in which I can devote time weekly to this cause.
That involves planning camp, but it has also evolved in recent years to helping start and subsequently operate a non-profit. That organization not only sponsors camp, but also provides extended services to families affected by childhood cancer.
Beyond the day-to-day life with my family and my time with Camp Hope, my Docs Who Care schedule has allowed me to be able to provide service as worthy needs have arisen. Whether that’s volunteering at school functions, going on a medical mission trip, or coaching my children’s sports teams, I have the flexibility to be able to serve in a multitude of ways.
Providing service was a key principle in the founding of Docs Who Care. And it continues to be at the heart of what we do and who we are. Not only are we in service to the communities and facilities with whom we partner, but also the structure of our work provides great opportunities to continue our service beyond the professional setting.
For those of us who first pursued medicine because we wanted to help people, it’s comforting to know that Docs Who Care models and fosters that cliché, or rather that ideal, to its core.
We had a chance to sit down with Dr. Daniel LaPerriere near his clinic in Boulder, CO to hear about his experience with Docs Who Care…
Dr. LaPerriere: After I finished my residency I spent a year volunteering as medical director for a health center in a remote area of Ethiopia. When I came back to Colorado I wanted to continue working in a rural area but desired to live in a more urban environment. Some of my colleagues had done work with Docs Who Care, and after hearing about it from them, I thought it would be a good match allowing me to work and live in the areas I wanted.
After working for 9 months with DWC at various sites, Yuma District Hospital in Yuma, CO, negotiated to buy out my DWC contract. I was able to continue living on the Front Range and work in Yuma 3-4 days a week. I worked in Yuma for about 7 years.
About 2 years ago, I took a position at a concierge medical practice in Boulder. While this work is fulfilling, I missed working with patients from the rural community and providing ER care. I reached out to Docs Who Care and once again began covering some shifts.
Supplementing my regular salary with occasional locum tenens has enabled my family and I to pay down loans, open a new hair salon and spa business (My wife is a hair stylist and now salon owner), and build up a down payment for a home in Boulder.
I recall recently sitting with an elderly couple at a rural site; the wife was hospitalized with CHF. She’d had this diagnosis for some time, but they did not understand what was causing it and what the treatments being prescribed were doing. They appreciated their local providers, but these providers are so overwhelmed that they often lack time.
I was able to sit with them and explain what was going on, draw pictures, and answer their questions. They were so appreciative to have a provider who traveled to their community to provide extra help and who could spend extra time with them.
These skills are also valuable in managing my regular clinic patients as I feel better able to make clinical decisions and to evaluate how a patient was treated in the hospital or ER.
Our government continues to make attempts to tell us how and when to practice medicine, so we must be very diligent in following the guidelines that have been established in each state with regards to pain management and the use of narcotics.
Docs Who Care has maintained a strong stance in encouraging us to be careful about the use of narcotics and to be especially careful in the amount we prescribe. However, at the same time, we have the obligation to take care of individual patients in a manner best suited for their needs.
Make certain you are aware of any new regulations or policies that have been developed in the state or states where you work. It may be helpful to understand how the local hospital and pharmacies are looking at the situation.
If you are working in clinics where patients are receiving regular doses of narcotics, make certain they have a contract that clearly spells out the parameters of usage. If a patient is on a contract, provide clear documentation in the chart of a visit with a pain management professional and/or clear documentation of the exact continuing reasons the patient needs the narcotic. It would seem prudent to update the patient’s chart every six to twelve months in this regard.
Carefully document the exact reason you are choosing to use narcotics, even on a short-term basis, in an ER or clinic setting. Don’t assume it is clear from the situation you have documented, and only give refills of narcotics in the ER setting in rare circumstances.
In sites where you work regularly, you will inherit patients who may be on inappropriate doses of narcotics. Without creating real animosity with patients, I would encourage you to show evidence in the charts regarding the pros and cons of their individual situations and encourage them to consider other regimens if appropriate.
Remember, we can be compassionate and caring while still being firm about what should change. Hospital administrators appreciate it when we can do this with tact and finesse.
Paul Wardlaw, MD – Medical Director (CO, NE, KS)