You Don’t Have to Travel Far for Global Engagement to be Central to Service Learning: The World Comes to Lowell

March 9, 2009


You Don’t Have to Travel Far for Global Engagement to be Central to Service Learning: The World Comes to Lowell

Theme: Global Citizenship

Sheila Och
Director of Community Health Promotion
Lowell Community Health Center, MA
Constituent Group:
Community Partners

So much has been written about service learning and community engagement: the opportunities service learning creates, the enriching qualities it provides, and the impact on students and the communities they serve. This ground has been covered. Service learning has become an important part of the educational experience of many students and hopefully of many more in the future.

What I want to share is a bit about what service learning looks like from a dual perspective of someone who participated first as a student and now as a community leader who regularly supervises service learning students from the very same program in which I received my degree. This is a story about Lowell Community Health Center and University of Massachusetts Lowell and the partnership they have created. It is also a story about how institutions grab hold of the opportunity to adapt to changing demographics when the “world” comes to their door.

The world has come to Lowell’s door. Lowell, Massachusetts has always been an immigrant city, but this has become even truer in recent decades. Lowell is now home to families from Africa, Asia, Central and South America. All of the countries in Africa are represented by families living in Lowell. Lowell has mutual assistance associations of Cameroonians, Liberians, Sierra Leonians, and Kenyans, just to name a few of the many immigrant communities in Lowell. Perhaps most notably, Lowell is home to the second largest Cambodian community in the United States (the third largest in the world).

As a health center, Lowell Community Health Center — where I work and am Director of Community Health Promotion?is directly confronted with a diversity of health needs. Many of the immigrants and refugees now living in Lowell come from countries that are suffering through civil wars. People arrive with great health care and social needs. They come with very different experiences of health care and often differing beliefs about what constitutes responsive health care. How then can service learning students in health be brought on board to be a part of LCHC and through their experiences at LCHC learn to become the kind of providers that are responsive to and respective of diverse health needs that may be very different from their own experiences?

When I was a student I was very fortunate to discover UML’s Community Health program and my mentor Professor Nicole Champagne. All through high school, I thought I wanted to become a physician. That was my aim. I started taking the required premed courses such as organic chemistry. But at the same time, I volunteered to help with HIV/AIDS outreach and education programs helping some of the most vulnerable individuals I have met become self-sufficient. Here, I discovered that there was another way to have enormous impact and that was through health education. I fell in love with the feeling I had every time someone said “Thank you Misi,” Misi was a dear name clients called me which they used to demonstrate respect and appreciation. I changed my major to health education and discovered a program that has aspects of service learning built into nearly every course. Early courses started with small, limited components upon which students reflected. The program then culminates with an intensive service learning experience in the senior year in which students spend 32 hours per week for a full semester in the kind of setting in which they eventually hope to work. I carried out the service learning at Lowell Community Health Center doing HIV Counseling and Testing and HIV Case Management. In this capacity, I was able to see and experience many of the theories that we spoke about in our classes and was able to test my own assumptions about what would be effective or not. Creating lessons for HIV 101 Education classes, creating spreadsheets to collect process data, and seeing the holistic nature of helping someone were a few of the knowledge and skills I used during my service learning semester. Had I been thrown into the experience without all of the gradual steps that are the hallmark of the community health program’s approach to service learning I likely would not have understood the complexities in designing effective messages for LCHC’s patients and clients. But I was prepared for the experience by all of the earlier, smaller steps in the program. These included the designing of health education boards and the delivery of educational lessons on topics such as healthy relationships for teens, HIV/AIDS prevention for high risk individuals, proper nutrition and even tenant’s and landlord’s rights and responsibilities for new immigrants arriving to the area.

When I first came to my role at LCHC, I began to reflect a great deal on my service learning experiences as a student. What made these work? How could they have been even better? One of the conclusions I drew from my service learning experience as a student was that if students had a great experience, their interests were captured. They would want to continue the kind of work they did in service learning. But if students had bad experiences at an early stage they never seemed to recover. They seemed to be turned off from service learning for all time.

And what were some of these bad experiences? Some (but not all) seemed to reflect the preparation/receptiveness of the community partner. Was the setting such that the students had few enriching things to do? Was there little in the way of a reflective piece built into the experience? Were the tasks appropriate to the student level?not too hard, not too easy, not too big, not too small? Most important?if we are thinking about global issues?how did the setting set these cross-culturally experiences up? How as a site supervisor could I develop creative and effective involvement of students so that they would better prepared to contribute to the future?

I found that if I was to be effective at my job and there effective as a supervisor of service learning, I needed to learn much more about the communities we serve, cultural health beliefs and how these interact with the health care system. One extended experience at LCHC was key to my learning: the Cambodian Community Health 2010 partnership. This is a CDC-funded program that happens to include much in the ways of activities and initiatives that could provide opportunities for students to engage in service learning. CCH2010 is a multiyear program. It is a partnership program. My role in the project was as staff development coordinator. I am not Cambodian. To assist the staff in their growth I needed to listen closely and learn, while using and adapting my skills learned. The staff and partners in CCH2010 taught me so much about the Cambodian community, the coalition building process and the importance of obtaining community feedback in program design and evaluation.

So, I wanted UML community health students to be a part of and learn from CCH2010. But how? Let me describe one experience. Two students from the Community Health Education program asked to do their service learning semester with me working on the CCH2010 project. After thinking through the possibilities, I gave them the task of creating a heart disease newsletter that would be produced first in English and then in Khmer, the Cambodian language. The first impression the students had was that this task was much too easy and would not take much time. At CCH2010, we needed this task done. We did not have the time or staffing. The students at first assumed that they could simply find the relevant information in the literature and then write the text themselves, place a few pictures and send the newsletter to print. Wrong. They found that they needed to facilitate a process. They needed to listen to CCH2010 staff and participants to identify what should be included and how the information should be presented. Only then would the science, audience, and prevention come together. The students needed writing skills, but they also needed to find the people who would suggest ideas and approaches to be included that would effectively reach out to the Cambodian community, particularly to elders. To do so, the students had to build trust; they had to go to meetings and listen. They did all of this. And they ended with a wonderful newsletter and template that CCH2010 continues to use and an incredibly rich cross-cultural experience that will be with them forever.

There were many points in this process of involving students in CCH2010 that things could have derailed. However, since I was fortunate enough to have experience with service learning as a student, I was able to have some say in the approach we took. I found that I could frame the student tasks at the appropriate level and could anticipate the inevitable problems that emerge. Many of these challenges had to do with cultural competence. How do students begin to approach learning about cultural competence? Learning about cultural competence is important in this new world in which we live but this kind of learning is subtle.

How do we prepare students and shape the request for their involvement at the right level? Often this is very challenging. Perhaps I can illustrate this with a “midsemester” example. Dr. Champagne called me to see if two of her students could be moved to LCHC; they were in placements that were not working out. In their current placements the students were learning little and they were not being challenged to apply their knowledge or reflect on what they learned. I agreed to have them come to LCHC to work on a pressing issue for us. We were in need of a detailed literature review of African immigration and its impact on host community.

This topic was important for LCHC because we were undertaking a much-requested new program that would focus on torture survivors and their needs that could be met through health programs. The students had little previous experience in carrying out a literature review where the focus was not strictly academic. They asked about the parameters of the review. They asked many questions about how to do. If I had not had my own service learning experience I would have been unprepared for the degree to which the students needed initial coaching to succeed at a task that looked relatively straightforward. The students underestimated difficulties, for example; they underestimated how hard and how time consuming this task would be. Yet, once they completed the review, they were very appreciative of having been given this opportunity. They said that they, prior to the service learning experience, had no ideas of how serious and widespread torture is an issue worldwide.

Was their literature review of the highest quality? Perhaps not. But it provided LCHC with useful information and, perhaps more importantly, it changed the way these students viewed health care and health education. The students are eager to find post-graduation positions that would bring them into the world of diverse health needs.

One of the things that we are learning at LCHC is how much we have to offer. Lowell Community Health Center was chosen as one of the top five culturally competent health centers in the nation in a report commissioned by the Office of Minority Health. We are realizing the degree to which we can be a resource. In the past we have not thought of ourselves in this way. I now go into UML classrooms to lecture about what we do, how we do it and why we do it, particularly utilizing real scenarios based on our experiences. This is one way to close the gap and create a feedback loop. As a result of these service learning experiences, we end up with better employees and better health care is offered.

LCHC is good site for service learning because we provide preventive and corrective perspective. We are both a community based organization and a health center. Students are able to see a continuum of activities. They see diversity and see how much their skills are needed and they are able to see people through a continuum of care and on the road to becoming healthy individuals. Students see all the pieces coming together at LCHC from social case management, to health education, to treatment of chronic disease and treatment for mental health.

At LCHC, we see ourselves as continually learning from our patients, our clients and community. Becoming culturally competent is, as one of our LCHC colleagues has stated, a journey and not a destination. As our communities evolve, so do our practices and our approach. This makes service learning in this type of setting even more important and valuable. We are aware that realities are different for each individual and we do whatever it takes to meet them where they are. Because of this, many see LCHC and its leadership as teachers and mentors. Our executive director stills sees herself as a learner, yet, someone like me, who is much newer in the field, sees her as a teacher. Her passion for greater good for everyone is contagious ? this is vital in any service learning experience. This is the experience I have had at LCHC and continue to pass on to many of the students that have walked through our doors. Now I am ‘passion’ contagious.

This ability to share our experiences with students also has a positive effect on our staff at LCHC. Aside from learning from our students, our staff morale raises knowing that they can now teach others about what they have learned. As an example, two of our community health education service learning students shadowed one of our Community Health Workers for a week. The students wanted to learn what “outreach” was all about. Did it work? Do people really listen? What is outreach? So they went out to conduct street outreach. Street outreach basically consists of going to the street and speaking with random individuals as they walk by. After a few attempts, the students quickly learned that engaging people takes skill and practice. The students were shocked to see how well our Community Health Worker stopped people and asked them about their primary care and whether or not they had health insurance. In many instances, the health worker would use her own cell phone to make a supported referral to the health center to assure that people got connected with a primary care provider. One student said, “it’s as if she knows the people,” the reality is, she did not. Through this activity, the students realized the level of skill needed to conduct outreach and developed an appreciation for the work. So much, that both students were hoping to be employed at LCHC to do the same.

The previous example demonstrates how service learning is so important to a student’s vision of her or his future. What happens in service learning can make or break student interest. If early service learning does not work well, student interest can be soured. Yet at the same time, what they learn, what they take away from the experience can’t always be predicted. As I mentioned earlier, some of the learning is subtle. This is particularly true when testing our own biases and assumptions we make. One time a student who was at our site observed a case management session between a gentleman, a health worker and a financial counselor at the health center. The student was attentively listening to the man who was seeking assistance and listening to his story of how he was thrown in jail, and what he was trying to accomplish now that he was out of jail. The student later approached me and said “Sheila, I never knew that people who went to jail looked like that [normal]. I thought people were dirty and on the street.” Such experiences, such as simple observation, have the wonderful side benefit of making it hard for students to stereotype others. Additionally, it helps students realize that their realities are not necessarily the realities of their ‘target audiences’ ? as we called them in school.

As should be apparent, much of this is a partnership between LCHC and UML. LCHC gives feedback. LCHC gets feedback. We are asked about and are thinking about what needs to be changed in or added to the UML curriculum. For example, many students I have supervised do not seem to understand that the production of materials and development of programs takes money. For this reason, I feel since it is important for the curriculum to include classes that speak about grant writing, the importance of obtaining funding and even how to write the grants or grants basics. At times, this lack of understanding has become an area of frustration for them in the beginning of the internship. In the end though, the students realize how things work and how things come together in the ‘real world’ and know that things do not just happen, but instead, things are skillfully created through a detailed process that includes time, a lot of effort and creative thinking.

I’ve been changed by fulfilling these dual roles?student and supervisor?and having them take place in the LCHC-UML partnership in the very diverse immigrant city of Lowell, Massachusetts. I no longer think that things like service learning are one-sided with only the student undergoing learning. I no longer assume that you can put things in place at the outset and they will simply run themselves. Increasingly I think of service learning opportunities as a bit like “gardens” that take tending by experienced “gardeners” who initiate the involvement of people who are new to gardening. These are master gardeners in the sense that they have lots of knowledge that they are ready to test out under the various weather and soil conditions that can unpredictably but regularly occur. The community of Lowell continues to provide all of us opportunities to learn and change as we try to meet the needs of all of the people who find their way to Lowell.

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