The Underground Railroad may no longer operate, but the strategies slaves developed more than 150 years ago to reach freedom help today's African-American community distinguish between institutions that claim concern and those that deliver.
Katrina Walker is outreach coordinator to the African-American community for Humility of Mary Health Partners' Hospice of the Valley in Youngstown, Ohio. Her charge is to interact with community members and familiarize them with hospice so they will be comfortable with the service.
She calls her outreach work the "new Underground Railroad," and she has learned the hard way how to travel it.
"When I first went out into the community, it was hard to open the door," said Walker, a licensed social worker. "There were those on the inside who knew who people were, they knew how to maneuver through the system, but I had to learn the process on my own."
Walker said the key is to gain the trust of gatekeepers, people of influence who determine which outsiders deserve the community's trust. Gatekeepers have inherited their forefathers' wary and protective natures.
She said the gatekeepers are not always obvious to outsiders. For instance, she was surprised to find that invitations she sent to area pastors got stopped by gatekeepers, who can be any number of people in a position to determine what's important enough to merit the pastor's attention. Too, gatekeepers can be protective of their congregations by limiting access. "I see the same with health fairs — a lot of churches host their own because they want to pick who is there because they want to make sure what's there is beneficial and not exploitative. "
It takes real time to find out who the gatekeepers are, Walker said.
Walker gained the attention of the community the traditional way — speaking at community outreach events, block parties, churches and health fairs. She put her face on billboards and bus ads that read, "Trust Us with Your Loved One." She also participates in other community functions such as NAACP dinners and Black History Month events.
Walker preaches patience in building trust within the African-American community. "Agencies often feel like if they aren't successful within a certain period, it's time to move on. But what's actually happening is the gatekeepers want to make sure you are committed," said Walker. "And Hospice of the Valley is. I made sure of that before I put my face out there. I didn't want to be just another person making promises."
Mary Foster, executive director of Hospice of the Valley, created Walker's position after Humility of Mary Health Partners studied ways to better reach the African-American community.
"She understands the community and is very well-versed in its concerns," said Foster. "Her approach has been so comprehensive — reaching out to funeral directors, the media, everyone," said Foster. "She's also helped us to learn more about ourselves, that we all have our biases and they can influence us on a daily basis."
When Walker first arrived, African Americans made up only 4 percent of the patients at Hospice of the Valley, though they represent 13 percent of the region's population. Walker has more than doubled African-American participation in the hospice program.
Walker said people in the community mistakenly may think "hospice is just a way for doctors to hurry up and get rid of the person," she said.
She introduces the doubters to the range of outpatient and inpatient services offered through hospice and reassures them about the central role the family plays in decision making.
Walker also educates professional caregivers, who may have their own biases or a basic lack of cultural understanding.
"There is a perception that we don't want hospice because we are a people of family," said Walker. Or, she said, "if an African American asks questions, they can be seen as resistant or aggressive when actually they're just trying to understand all of their options."
She urges caregivers to follow what she calls the new Golden Rule — treat others as they wish to be treated and put the spiritual ahead of the clinical in conversations about death.
"This is one of the most crucial areas to be addressed because typically African-American individuals and families are faith-based," said Walker. "We don't typically distinguish ourselves as separate from our faith. So what happens if someone approaches me, and they begin immediately talking about the medical, and they haven't acknowledged the spiritual first, they've lost me.
"The whole concept of death and dying and it being in God's hands needs to be acknowledged. It means a lot to families when that is recognized," Walker said.
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