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 brushing their teeth every day. And 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 in a sugar-laden western diet.
“In our country brushing teeth is nothing,” said Marie Claire, 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.”
Linda Shepard, RN, helps coordinate the PLN training for the collaborative, which is possible in part by community benefit funds from Providence Health & Services Alaska; $20,000 in for the Peer Leader Navigator Program and $15,000 for health literacy and health education. 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, community resources and 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,” Shepard said. 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 said. “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 added.
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, Marie Claire 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 already look acclimated, silently scrolling through their smartphones as Marie Claire speaks. But they are also simultaneously listening. After Marie Claire explains that sugar also contributes to obesity, high blood pressure and diabetes, Jean wants to know if he can still drink soda if he works out every day, to offset the damage. Daniel perks up when Marie Claire 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 PLNs 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 said. “They are becoming leaders in their community. We planted the original seeds of the PLN program, but they have created the branches."
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