On a snowy winter evening, Marie Claire Mukambuguje knocks on the door of a Congolese family, who arrived to Alaska five months earlier. The Nyirabashali family – grandmother, mother and daughter – are wearing bright colorful clothing typical of their country, but sport winter knit hats and snow boots to protect them from the cold to which they are so unfamiliar.
Also unfamiliar to them: The idea of protecting their teeth against the ravages of a sugar-laden diet. In the Congo, where sugar is a rare treat, cavities are a rarity. But in the United States, dental hygiene is extremely important. That’s why Marie Claire is visiting. Her title is peer leader navigator, and her job is to help refugees acclimate to life in their new country. Her passion is dental hygiene and she is showing the family how to prevent cavities as they adjust to a western diet.
“In our country, brushing teeth is nothing,” says Mukambuguje, one of the newest PLNs in the Anchorage Health Literacy Collaborative Peer Leader Navigator program. “When people arrive here and start drinking a lot of soda, they can get cavities in every tooth. They don’t know what tooth decay is because in the Congo, we have grains and a lot of protein, but no sugar.” Access to foods to which they are familiar is difficult.
Linda Shepard, RN, helps coordinate the peer leader navigator training for the collaborative, which is possible in part by community benefit funds from Providence Health & Services Alaska. In 2018, the Peer Leader Navigator program received nearly $20,000 in community benefit funds. An additional $15,000 went to health literacy and health education. This support was in direct response to a regional community health needs assessment (CNHA), which identified access to services, especially to the poor and vulnerable, as one of the greatest unmet needs in the region.
The program began as a small effort more than six years ago to help those with language barriers navigate the American health system. A group of women were trained in how to access health information and community resources, and how to share it with their respective language’s communities. Countries such as Rwanda, Sudan, Mexico, Nepal and Venezuela, among others, are represented.
“We used to call them peer language navigators because it was about the language barrier,” says Shepard. But that, it turned out, was not the real problem.
“In 2016, we realized that this really didn't have that much to do with the language,” she says. “It has much more to do with the experience of migrating to the United States. So we changed the name to peer leader navigator instead of peer language navigator.
“That lived experience of coming into a country is what really connects them,” she adds.
In the Congo, dental hygiene consists of a small wooden pick that is used sporadically to remove seeds or other pieces of food stuck between one’s teeth. If a toothache occurs, sufferers simply pack the sore spot with a particular type of leaf thought to help the pain.
But at the Nyirabashali home, Mukambuguje explains that the western diet affects teeth quite differently, and that leaves will not solve their pains. Sugar contains acid that eats away at teeth, and if it is not removed regularly, she explained, tooth decay will occur.
“You have to remember that you have teeth and gums and a tongue, and you have to brush everything,” she explains in their language, and then interprets in English.
Jean D’Amour and Daniel Faustin also are in attendance at the meeting. The two young men arrived in Alaska just a month prior and on this evening they silently scroll through their smartphones as Mukambuguje speaks. But they are also simultaneously listening. After Mukambuguje explains that sugar also contributes to obesity, high blood pressure and diabetes, D’Amour wants to know if he can still drink soda if he works out every day, to offset the damage. Faustin perks up when Mukambuguje talks about cleaning the “whole tooth, all five sides,” and asks for clarification on the process. To them, this information is groundbreaking, not something that would ever have entered their minds in the Congo.
Today, the peer leader navigator program is thriving, in part via the support of Providence. Shepard coordinated training for the sixth cohort of peer leader navigators this past year, who are spreading health education across their respective communities.
“When they come to the U.S., they have to start over,” Shepard says. “They are becoming leaders in their community. We planted the original seeds of the program, but they have created the branches.”