These KU Medical Center professors refuse to let language be a barrier to care

February 14, 2012

By David Martin

Joseph LeMaster, MD, MPH, helps Sarita and Khadka Gajmes improve their ability to speak English at Mission Adelante in Kansas City, Kan.

Joseph LeMaster, MD, MPH, spends a portion of each week seeing Bhutanese refugees in the KU Family Medicine Clinic. His fluency in Nepali, their mother tongue, surprises his patients. "People just can't believe that I speak the language," says LeMaster, a professor in the Department of Family Medicine.

Bhutan is a tiny kingdom nestled in the Himalayas. In the early 1990s, the ruling elite expelled tens of thousands of ethnic Nepalis who had lived there for more than 200 years. They were driven into camps in eastern Nepal, unable to return to Bhutan and denied citizenship in Nepal. In 2007, the United States and other countries agreed on a massive resettlement program.

Today, approximately 500 Nepali Bhutanese live in the Kansas City area. The enclave is mostly clustered around 18th Street and Central Avenue in Kansas City, Kan. Most of the adults work in food processing and other low-skill jobs. The older refugees tend not to speak English or are struggling to learn. Some cope with the physical and psychological effects of torture.

Working with refugees is a challenge that many KU Medical Center faculty members embrace. LeMaster is unique in that he can communicate with one group without an interpreter.

LeMaster owes his ability to speak Nepali to the years he spent living and working in rural Nepal. He made his first trip when he was a fourth-year KU medical student. At the time, LeMaster says, it was fairly common for med students to spend time overseas. "The quality of experience was not as carefully monitored as it is nowadays," he says.

His experience was excellent. LeMaster was able to apply his basic skills in a place where the need was great. "It was an exotic location, it was a beautiful place," he says. "I was in the mountains of Nepal." LeMaster worked on an international team in the district of Okhaldhunga, just south of the Mt. Everest region of eastern Nepal. The team included his future wife, Judy, who trained as a nurse midwife in her native England before going to work in Nepal as a community nurse.

LeMaster returned to the United States to train as a resident in family medicine. He and Judy married in 1986 and were living in Fort Worth, Texas, when they made the decision to go back to Nepal once he completed his residency. "As we talked about it and as I thought about it, it became more and more obvious that I didn't have any really good excuses not to do it, at least for some period of time," he says.

The couple worked side-by-side in a 32-bed hospital in the Okhaldhunga. LeMaster treated gangrenous limbs injured during falls from trees and women with obstructed labor. His care-giving stopped just short of open-chest surgery. "Everything that you could imagine might happen did happen," he says.

While living in Okhaldhunga, LeMaster and his wife adopted a boy whose mother had died. The boy, now 23 and a senior at the University of Missouri, was about the same age as their daughter, who had been born while the couple was living in Texas.

LeMaster and his family spent a total of nine years in Nepal. After the family left Okhaldhunga in 1996, he was working in Kathmandu for an organization that did research with patients with Hansen's disease, also known as leprosy, when Nepal's political instability made it impossible for the work to continue. In 2000, the government asked LeMaster and his colleagues to leave.

The family landed in Seattle. After obtaining a master's in public health at the University of Washington in 2002, LeMaster joined the faculty of the Department of Family and Community Medicine at the University of Missouri School of Medicine.

Bhutanese refugees began arriving in the United States in 2008. Through a mission colleague, LeMaster came into contact with an enclave in Albany, New York. The refugees, he discovered, were like the hill people he had come to know while serving in Okhaldhunga.

LeMaster was eager to work with the Bhutanese refugees, but they were not being resettled in Columbia. He began to investigate the possibility of joining the faculty at KUMC, which would allow him and his wife to establish ties with the Buthanese community in Kansas City.

"I had a reached a place of stability and success at Columbia," he says. "I was a tenured associate professor. But we felt that old tug of the connection that we've had to Nepal. Plus, no one helping the refugees here spoke Nepali."

Research indicates that language barriers reduce access to and lower the quality of health care. LeMaster says it's easy to underestimate the challenge that patients and providers face when they don't speak the same language. "It puts you in a different zone when you can communicate with people directly without having to go through an interpreter," he says.

Doctors and nurses at KUMC who also work with refugees can attest to the strains of indirect communication. Kelly Kreisler, MD, MPH, an assistant professor in the Department of Pediatrics, treats ethnically Karen and Karenni refugees from Burma. She's had visits in which an interpreter has translated her words into Burmese, and a family member has translated the Burmese into Karenni for the child.

Mindful of the difficulties, Kreisler worked last fall to establish an alternate language clinic within the Department of Pediatrics. The goal, she says, is to provide a patient-centered medical home for refugees in the community. "It can be really challenging," Kreisler says. "It's very rewarding, too, if you can help that patient."

Kreisler obtained a grant to identify the barriers between Karen refugees and access to health care. LeMaster, too, has been busy writing grant proposals. Working with the Wyandot Center, Wyandotte County's designated mental health provider, for instance, he applied for a grant from the Sunflower Foundation to increase mental health access for refugees. The two-year project starts this month.

LeMaster is unusually qualified to work with refugee populations. But he's also mindful of his limitations. "If we start doing outreach to Burmese refugees, I'll be in the same boat as everybody else," he says. "I won't have the language."

Last modified: Mar 05, 2012