Munira Maalimlsaq, family nurse practitioner at HealthPartners Clinic Maplewood, and Greg Fedio, senior project manager at Park Nicollet, are both heavily involved in making health care more equitable. Their combined work is crucial in helping reduce disparities in local communities, and the Twin Cities Somali community in particular. But the work isn’t done in a vacuum – it’s encouraged by a love of using their talents to help others.

Driven by the HealthPartners culture of “Head + Heart, Together,” Greg comes from a patient-facing clinic background that has evolved into his current behind-the-scenes role. And while the “head” part of being a project manager and self-proclaimed “data geek” is fully engaged, he sometimes misses the “heart” side of seeing how his work directly impacts patients. His work with different outreach initiatives in local communities helps him regain that balance.

Munira’s motivation thrives on collaborating efforts and breaking down barriers, leading with community voices and making sure they have input. She’s careful that she and her colleagues aren’t just going into the community and dictating change. Instead, they are asking about the issues that the community is facing and how she and her team can work with them to come up with the answers that fit their needs. In addition, it’s important that her questions are followed by listening to their responses and then clarifying what’s being said. Creating community ownership in what’s being built together – in something that everyone is proud of and can be used by everyone – is what inspires Munira to do more.

Recently, Munira and Greg worked together with the local Somali community using the Equity Action Lab model developed by the Institute for Healthcare Improvement (IHI). In today’s Off the Charts, they both chat with Dr. Haley and Dr. Jackson about how their effort transformed into Open Faces, finding better ways to connect with the Somali community and why positive and lasting solutions created from the effort are important, now and in the future. Listen to the episode or read the transcript.

From the Equity Action Lab to Open Faces

As Greg defines it during the podcast, the Equity Action Lab “is a model of working with a community and community stakeholders to really identify what their needs are.” Working with IHI to bring the lab to a real-world test, “there was a reason we were very specific (in working) with the Somali community. (Doing our due diligence), we looked at the data and we said, ‘which community really does need our help when we’re looking at (health care) metrics?’”

“It was clear that it wasn’t necessarily the Somali community as a whole, but it was, in particular, the Somali-speaking community. When we look at that data … we really did see a lot of disparity gaps (there). So, we started putting feelers out and try to find community members that wanted to work with us. Luckily, Munira … had a lot of resources.”

But, as Munira says, the project is not about coming in with only answers. Rather, the lab is about working with the community to find ways to improve health that resonate. Granted, there were some initial targets leading into the project, like colorectal cancer screenings, breast cancer screenings, diabetes management and immunizations. However, it was crucial to make the first interaction an ask of “What does being healthy mean?” “Just to understand their perspective and where they were at and try to meet them there. Yes, we did have an agenda, but at the same time, we made sure that they understood where we were and met them there.”

An excellent example is how the name of the project evolved, as applied to Munira’s friends and neighbors. As Greg recalls, “We found out early on when we were talking to Munira and other community members that the word ‘lab’ really didn’t resonate well with the community. I mean, you can think of a lab as coming in and doing tests, so we wanted to make sure that we weren’t using that terminology.” During the four days of initial project work, “there was an activity around (a new name) and it came out that there was a (Somali) phrase – Open Faces.”
Munira followed, “Yes, because in Somalia, there’s a saying that you do not go to an open door, you go to an open face. So your door can be open to me and you could tell me, ‘My business is open to you.’ But, if your face shows something else or you’re not welcoming to me, I’m not coming back or I’m not sitting there. So one of the females that was part of the group said that’s how she felt in this project, so let’s call it ‘Faces’ or ‘Open Faces.’”

The renaming of the project to something more familiar and personalized to the community is just one of many examples of how Munira, Greg and community members worked together, bonded, listened to each other and created priorities and solutions to deliver together.

Finding better ways to connect

Collaborating with community members to create specific and effective approaches to health care, especially education around prevention and maintenance, is especially important for the Somalian community in the Twin Cities. As Munira describes it, “For Somalians in particular, the life expectancy is around 47. So, there’s not a lot of prevention that is being done back home and a lot of the people that we are seeing that need the most help are people that have lived here for the last five, 10 years.

“How do we tell them what prevention is and to actually take your medications if they do not understand where taking a medication every day is needed? Because if you’re used to getting only acute care, now ‘Oh, do I have to take this medication (for the rest) of my life?’ (All the time or every day?) That is a turnoff.

“So, how do I meet them where they’re at? Or how do I educate them? Because a lot of the times they do not understand doctors, so how do we give them information in languages that they understand, (in) ways that they understand? And that’s one of the things that they’ve (witnessed). ‘Don’t give me paperwork because I can’t read, so I need somebody to read it to me or have it recorded so that I can understand it,’ or different ways of learning. And that was eye-opening for me.”

“Me, too,” says Greg. “And I think we think so much about translating materials being the answer, and that came out very loud and clear in our conversations … that’s not going to be enough. We’re going to need recorded options. So we have started taking some steps around projects, but it became very clear that this is our first step with this group. This is really where we’re starting. So even the beginning things that we have put in place since the project, we have so much more to learn and so much more to do.”

Why building solutions with communities is important now and in the future

Moving forward from the initial work coming from Open Faces, it’s clear that the project’s success in creating solutions is crucial to the well-being of the community. From Munira, “Recently, I read somewhere that 10% of Minnesotans have been diagnosed with diabetes or were told by their providers that they are diabetic. And if I didn’t know that 76% have type 2 diabetes, which is related to foods that we eat … then how do I take care of myself? And if the person doesn’t get the concept of food, diabetes, hypertension – all of them are related – then I’m not sure I can impact them the most.

“So for us, it’s making sure that we understand our audience and how much they know. And with this project, what was different was, in the beginning, we didn’t just say, ‘okay, this is what we’re going to get done.’ We went in, we listened, we waited and just got to know each other. And I think, in most places when things like this are being done, the same concept could definitely work for any community that we work with.”

During the podcast, Greg also says, “We talk a lot about that in our projects around closing disparity gaps, learning the patient’s story. You have to really go upstream and keep finding out what’s going on with their life. And I think, unfortunately … we don’t have the time to learn the patient’s story (a lot of times). So that’s one of the unique things and great things about this project was we actually had several activities where we talked to people and learned their story and really helped to identify not only the differences in the community, but the similarities between all of us, too.”

When it comes to next steps in outreach, community-specific health fairs in St. Paul’s Midway neighborhood and Minneapolis are in the works, as well as a children’s health fair to help encourage immunizations. Work is also continuing on including more recordings in patient materials and doing more social activities within the community. But for the health care community at large, building on the work of Open Faces can be as simple as volunteering or even just showing up at community events as a health care professional.

As Munira says, “I would say, during Somali events, come show up and get to know (us). Eat food together. And I feel like that would make a big difference in how we connect with our patients, and we can bring that back to the clinics. It’s not as scary if you’re part of the team.”

To hear more from Munira and Greg, including more about Open Faces, how health care professionals can use the seeds of trust planted in the community to help with their own day-to-day jobs, and how the two keep their mental tanks full to be there for others, listen to this episode of Off the Charts.