Hospital Cultural Liaison Helps Breakdown Barriers So Healing Can Take Place

Jan 28, 2018

Kassie Runsabove, the health disparities coordinator at St. Vincent Healthcare, poses with her daughters before the start of the 2018 Women's March through downtown Billings.
Credit Jackie Yamanaka

Saint Vincent Healthcare in Billings joins Benefis Healthcare in Great Falls in employing a health disparities coordinator.

Kassie Runsabove, in conversation with Jackie Yamanaka, talks about her work as a cultural liaison for Montana’s largest minority population – Native Americans.

Kassie Runsabove: And a lot of times discussions don’t come out until I do a cultural sensitivity presentation or a cultural humility presentation and people will either ask in front of everybody or afterwards and they’ve expressed that I’ve never heard it in that way and I’m glad that you expressed it in the way that you have because it will make me a better person and help me understand where my patient is coming from.

YPR: Can you give us a specific? Help us understand.

I get the question quite a bit: Why has drugs and alcohol affected the population? ...And my answer is: I haven't seen drugs or alcohol positively impact any population.

Runsabove:  Sure, I get the question quite a bit, ‘Why has drugs and alcohol affected the population so well.’ And my answer is, ‘I haven’t seen drugs or alcohol positively impact any population. And when we only see the worst of the worst at a hospital, that’s all we know.’

So, unless you have friends or family that are Native, you understand that there is diversity, there is the healthy, there is the ones living in poverty, there’s those that suffer from drugs and alcohol, and we also have very healthy families as well that end up in the hospital because of illness.

And so, I try to encourage them to meet the patient where they are and what needs that they have and not to put a bias or stereotype, but I also educate in a way to try to meet our clinicians and our providers where they are. 

Some of them are well versed in our population and some haven’t really been around our population or any other disparities or any other diversity populations so it’s very unique to them to find out what their needs are and what they want to know about our population.

YPR: Are they pretty open in talking about their own biases or assumptions or misunderstandings about Native cultures? Is it hard for you to listen to or is that something that individually, one-on-one, that you want to draw from an individual?

Runsabove: Absolutely, I love the ones that are very open and honest and also share their experiences because I always remind our physicians at my presentations that I can guarantee that you’ve probably had a negative encounter or a very uncomfortable encounter with our population, as well as they’ve probably had an uncomfortable and negative encounter with other populations. But when you’ve had it with one, you’re very gun-shy because we’re people. We’re human beings. Our mind functions as a safety net. 

I try to break down those barriers and really get to the root of where those biases are coming from.

So, if you’ve had a negative or uncomfortable encounter with somebody and they’ve had brown hair and brown eyes, your body is going to react in that way of, as a little bit defensive. So, I try to break down those barriers and really get to the root of where those biases are coming from.  So, I appreciate when people are open, honest.

As to date I have never been offended by any question anybody has ever asked. I actually appreciate those ones because either they’ve developed that own bias because of an experience and/or is third-hand and has really nothing to do with anything other than somebody said and they have no evidence for it.

So, I love it that people can be open and honest with me and I’m open and honest with them as well, as generally as I possibly can because I’ve had my own experiences as a person that is Native and also being a minority, somebody of color, a woman, and I’ve also worked within these populations within our very own populations.

I’ve encountered different experiences as well. So, I like to validate where their feelings are coming from so they can move on from that experience in a healthy way and then move on to the next experience. Because that next experience that patient is waiting for that provider or that nurse for help. If we can break down language barriers, health literacy barriers, environment barriers that that patient can overcome all of those, as well as the provider then healing can take place.

If we can break down language barriers, health literacy barriers, environment barriers that that patient can overcome all of those, as well as the provider then healing can take place.

YPR:  We were talking earlier that you know of only one other individual that has a similar position that you do at St. Vincent Hospital. Do you ever talk?

Runsabove: We talk quite a bit, actually. Her name is Lisa Whitford. She’s out of Benefis Healthcare System out of Great Falls.

YPR: what do you talk about?

Runsabove: We talk about what our issues are being in the positions we are. Also, movements we have also accomplished in the hospital. We talk about who are the key people in the organizations that have helped us and understand. I know that our leadership has been phenomenal. I wouldn’t have been able to do the work that I do without their support and Lisa, as well.

We talk about different scenarios and talking about how we work with certain patients when they are in really intense ICU situations and helping the families that come from very far away. I ask what resources do they provide for their families over there. They (Benefis) have a Native American Welcoming Center there and their staff is growing. So I learn a lot from Lisa, in that regard.

And we also share and talk about the Center for Minority Health is doing. We both sit on the regional Health Equity Council at a national level and we cover our region which is the MT, ID, and WY region.

So, we talk about that and we talk about efforts we are doing. November is our month, it’s Native American Heritage Month. It wasn’t until 1992 when George Bush passed that and so it’s very recent when you think about it. So, we share ideas of what can we do to celebrate that month because we see patients that come from very far away. We see patients that are urban. We see patients that were flown down here and they have no family here. We see patients that are end of life. We see patients that are brand new to this world. So, we try to accommodate some of those understandings and the teachings we can share with the public and also with our patients.

What we’ve done for this past November we put up our teepee in the lobby, and it is our own St. Vincent Healthcare teepee, and it went up in the lobby this November and we had it up from October 31 all the way until December 1 to honor the entire month of November. We had native prayer that went out overhead. At around 8:20 every morning at St. Vincent Healthcare we share scripture with our patients and every Wednesday in the month of November we shared Native language prayer overhead.  And so we also had teepee talks. So any of our associates who wanted to ask us questions with our Native American Steering Committee we were able to talk about different topics with our associates.

YPR:  So, as far as you know, you and Lisa are the only ones that have this type of position designated for you. Do you know if other health care providers have at least one person to deal with cultural issues?

Runsabove: I don’t know of anybody else across Montana in the healthcare system and I’m just speaking of hospitals and not clinics because I’m not sure.

The cultural liaison role or health disparities coordinator role it does seem like it’s a new position. But we’ve been striving for this for such a long time. So it’s really exciting to have St. Vincent Healthcare be a part of this. The Office of Minority Health has been really influential in my understanding of health disparities and how to incorporate your role in an organization. The number one piece of the puzzle is administration. Leadership has to acknowledge and validate the work that the cultural liaison or health disparities coordinator is doing.

And our leadership has recognized that the most abundant minority population that we have is the American Indian population. It’s not that other populations aren’t being honored or celebrated it’s just that right now we are working specifically on our American Indian population. But our eyes and ears are open to all the other issues of gender issues, migrant workers and our Amish families our Hutterite families, Spanish-speaking families.We are aware and we do discuss those families as well.

YPR: How long have you been in your position?

Runsabove: I’ve been in my position now for about a year-and-a-half, but I’ve been here at St. Vincent Healthcare for 5 years. I was the Child Ready Program Coordinator and the cultural liaison. It was a grant out of the state. But I served in that role and went across Montana doing cultural sensitivity training to other hospitals across Montana.

YPR asked Billings Clinic if it had a health disparities coordinator or a cultural liaison. Here is the written response from a spokeswoman:

“Hi Jackie, we do not have a cultural liaison specifically at Billings Clinic. A little background, Billings Clinic was a pioneer in the area of Native Patient advocacy when we established a Native Patient Advocate Program (NAPA). Through this program, Billings Clinic adapted protocols (such as procedures for smudging)and trained clinical staff in the unique cultural needs of our American Indian patients.

We have maintained robust outreach and collaborations with Tribal governments, American Indian-serving organizations and individuals. We expect all Billings Clinic employees to understand and be sensitive to the cultural needs of the many diverse patients we serve. 

Thanks for checking in with us.”

Neither the federal Office of Minority Health or the Montana Department of Public Health and Human Services had any data on whether any other Montana hospital employed someone to act as either a health disparities coordinator or a cultural liaison.