Munira MaalimIsaq remembers how difficult navigating the health care system was for her family after they moved to the U.S. from Somalia when she was 9 years old. Since then, she has wanted to help others in a similar position and give back to her community. Asking people what they need and providing education have been her keys to connection. MaalimIsaq, a nurse practitioner at HealthPartners Clinic Maplewood and former telemetry nurse at Park Nicollet Methodist Hospital, shares how she was able to help and serve members of the Somali community by dispelling COVID-19 myths, providing vaccines, and establishing a support group at mosques for those struggling with alcohol addiction.
Munira MaalimIsaq remembers how difficult navigating the health care system was for her family after they moved to the U.S. from Somalia when she was 9 years old. Since then, she has wanted to help others in a similar position and give back to her community. Asking people what they need and providing education have been her keys to connection.
MaalimIsaq, a nurse practitioner at HealthPartners Clinic Maplewood and former telemetry nurse at Park Nicollet Methodist Hospital, shares how she was able to help and serve members of the Somali community by dispelling COVID-19 myths, providing vaccines, and establishing a support group at mosques for those struggling with alcohol addiction.
Hosts: Kari Haley, MD, and Steven Jackson, MD
Guest: Munira MaalimIsaq, FNP (family nurse practitioner)
HealthPartners website: Off the Charts podcast
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Kari Haley:
He's a rehab doctor from Chicago.
Steven Jackson:
She's an emergency medicine doctor from the Twin Cities.
Kari Haley:
Together, we're examining the health equity emergency.
Steven Jackson:
Inviting voices for change without the cue cards.
Kari Haley:
I'm Dr. Kari Haley.
Steven Jackson:
I'm Dr. Steven Jackson.
Both, together:
And this is Off the Charts.
Steven Jackson:
Welcome to our show. We are so excited to be joined today by Munira MaalimIsaq, who happens to be a nurse practitioner at HealthPartners Clinic Maplewood. Welcome.
Munira MaalimIsaq:
Thank you so much for having me. Appreciate it. I recently graduated with family nurse practitioner beforehand. I was a nurse at Methodist Hospital and that was one of the best jobs I've ever had. So now I get to see patients on different a side, in a different way.
Steven Jackson:
Awesome.
Munira MaalimIsaq:
I'm really excited about that.
Kari Haley:
Well, welcome to the show.
Munira MaalimIsaq:
Thank you.
Steven Jackson:
So tell us about your passion for connecting with communities and making an impact. Where does that come from and why should we even do that in the first place?
Munira MaalimIsaq:
Honestly, I immigrated to the United States when I was nine from Somalia to Fargo, North Dakota. And, I love, love, love being part of this country and I think I keep wanting to give back, right? And I remember when we didn't speak much English and we had to navigate through the health care system how hard that was not just for me but for my parents. And, since I've gotten older, I realized most of the times people are just doing things for us instead of asking us how we want it to be taken care of and what our opinion was, just because you do not speak the language or you do not understand different medical terminology, it doesn't mean you just do it. And, I really wanted to get involved in providing education to the community. And in order for me to do that, I wanted to connect with the community. I wanted to be where they were. And develop that relationship with them. So I started doing food cares in the community and blood drives, little stuff, but being present, and that made it useful in establishing that trust with them.
Kari Haley:
There's that word trust.
Steven Jackson:
That's a buzzword on this show.
Kari Haley:
A buzzword, yes.
Steven Jackson:
You get a gold star every time you say trust. So, keep it coming.
Munira MaalimIsaq:
For sure. For sure.
Steven Jackson:
So, it's interesting, you talk about being amongst the people, and you also mentioned that because maybe there was a language barrier or maybe even not being familiar with customs that are here versus where you come from, it was a sense of people doing something to you, as opposed to doing something for you or with you in terms of health care. How difficult is that and was that?
Munira MaalimIsaq:
That is pretty hard. I feel like you do not understand what's going on. So let's just say that I had diabetes for instance. If I didn't make that plan with you, or we didn't make that goal together, I am not able to work on my diet, I am not able to do different things that I really need to do to take care of myself. And then, what happens, right?
Steven Jackson:
Right.
Munira MaalimIsaq:
So, that was something that I noticed, and not even as a caregiver, but as a person who received care and not understood what was really happening in the moment. So, that's something that I'm most mindful of.
Kari Haley:
Yeah, I mean we had a episode in our first season talking about cultural humility, versus cultural competence. So, we do have a large Somali population here in Minnesota, but it's not necessarily every city. Can you talk to us a little bit about, I mean, what I'm hearing is that really cultural humility piece can be missing sometimes. And how we understand other people who might not have the same cultural background or background in general from us and how you integrate that into medicine and providing good care and connection.
Munira MaalimIsaq:
That was evident back when COVID was starting to take place, we had a lot of people that were dying. And, all of a sudden, how we take care of end of life and Methodist in particular came into culture-wise we didn't understand. So, being part of the health equity, we went out into the community, we asked 75 individuals on how they wanted to be taken care of, and made a plan, showed them the documents that we had or the advanced directive forms that we have currently. And we found out that it didn't make sense to them. And there was a reason why we didn't have a lot of planning done and there was so many misinformation there, and that mistrust, and they were frustrated when they came into the hospital, and the doctors were frustrated because they would make plans and say, "We want to go on comfort care." And all of a sudden, not understand what comfort care actually meant. And wanted everyone to do everything, right?
So, having that spread out and understanding what that meant for them or where that miscommunication was coming from, we were able to fix it and go back into the community and see if that's actually what they wanted us to do, rather than having this savior mentality where we just changed forms.
Steven Jackson:
Yes.
Munira MaalimIsaq:
Because we thought this is what made sense. So, I think I've been lucky in working at a new organization that actually wanted to hear what their patients actually wanted and leading with their voice.
Steven Jackson:
Mm-hmm.
Munira MaalimIsaq:
That has been really helpful and I am really excited about our new end of life forms, and planning, and how that will help the community, and the providers, and everyone else.
Steven Jackson:
Yeah. When you're attempting to build trust with people, or a group of people, et cetera, what I'm hearing is it's important that you listen.
Munira MaalimIsaq:
Mm-hmm.
Steven Jackson:
Wow, how fundamental is that? Have we ever heard that, boys and girls out there? And, I would imagine that it'd be very... You can call a lot of things angering, saddening, off putting, et cetera, that someone would present a plan of care without talking to you about it or without your input. And, I'm sure that can lead to, again, mistrust or maybe even not going to the doctor in the first place, because, "They're not going to listen anyway, or consider my values, or my culture, or my faith, tradition, et cetera." What have you seen on the frontline in terms of people just turning their backs on health care because of something like that?
Munira MaalimIsaq:
I have seen where people are coming into the hospital for things that could have been prevented by going to the clinic, or by seeing their providers ahead of time and making them yearly visits. All of a sudden, they're uncomfortable with going in for that, or they're just coming straight to the emergency room because things are out of control. So, we're not listening to their point of view in most places. But, one thing I am really excited of is we're paying attention to that now, and we've got data on CHF (congestive heart failure) readmissions in the hospital, right, for people of color, and how do we close that gap is something that we are paying attention to. And that makes me really excited, just because we are knowledgeable and we are doing something about it. But, I think it's something that could have been done a long time ago in a way.
Steven Jackson:
Mm-hmm.
Munira MaalimIsaq:
Yeah.
Steven Jackson:
Yeah. And I just want to say really quick, CHF is congestive heart failure for our non-medical listeners we might have a few out there.
Kari Haley:
Can you talk a little bit about, you mentioned, when COVID started and the work that you did within the community. Could you elaborate a little bit more on what you were able to do? Because, I think it's a great story. I was reading about it and stuff, but I would love for our listeners to hear more too.
Munira MaalimIsaq:
No, for sure. Actually, when it first came out, there were so many misinformation, misconception out there, and I am part of three different communities. I would say, the Somali community, the Muslim community, Asian and Hispanic altogether, right? And I knew I had their listening ear. And Jen Myster, who's our president at Methodist, actually reached out and said, "What can we do?" Because our data did not show that a lot of people from these communities were not getting vaccinated or were not interested in getting vaccinated. So we were able to reach out to them. And going into the community centers churches, we went to, I think, nine different mosques, and we spoke about how the virus actually spread, what were the signs and symptoms that they needed to look for. And, especially in the Muslim community, they were afraid that there was either gelatin, pork, fetal cells, and that was one of the most commonly asked question that we got.
Another thing where it causes infertility or miscarriages and that was totally a myth and we were able to show in information on that. And, the other big factor was language barrier. And, in Minnesota right now we've got 78,000 Somalis that live here and only 20% of them speak English well or have that health literacy. So it's just having documentations that they could understand or in their language was very important, or having someone that looked like them explain it to them made it a lot easier. Looking back now, I can say that personally I gave over 1,500 shots by going to communities and having their trust in that. But, I had a lot of people from the organization that would sign up and make appointments with me or either give the shots with me on the weekends and reach out, which was really exciting.
Steven Jackson:
Wow, that's awesome. And, I don't know if we've said that the term specifically about trust transference, but sometimes if you're trusted by a person or a group of people, then it's almost like it makes it easier for them to maybe connect with a particular entity like Methodist as an example, simply because you went out into the community. Have you seen people be more favorable in terms of coming into the organization, instead of waiting to, they need to get to the ER and see Dr. Haley?
Munira MaalimIsaq:
Dr. Haley's amazing, I'm pretty sure. But, yes, we have seen that. Or they'll actually email me and say, "Hey, I'm coming in." Or, "Who do I go see in the clinic?" Right? "Is that a person that you recommend?" I get that a lot. Like, "What doctor should I see?" Because we talked about preventative cares that they can do in the community. And, they're like, "Oh, OK. I want to go do this. But what doctor would you recommend?" Or, "I want to go and see if I actually have diabetes. These are the symptoms that you talked about. I feel like I have it. Which doctor would you recommend?" So, helping them navigate that through has helped a lot from what I can see.
Kari Haley:
Well, I think hearing those stories and hearing the feedback from the community itself has to be so inspiring. Have you heard any really breakthrough stories or people who've come to you and they had that moment where they're like, "I went to the doctor..." They got on their health care journey because of you being out there in the community?
Munira MaalimIsaq:
I actually just got an email the day before yesterday. I had a young lady who just had a baby, did not want to breastfeed, but she heard a Zoom conversation that we had with the community on breastfeeding. And she tells me, she's like, "Where do I find a lactation consultant, because I actually want to breastfeed now." And, that was one of the most fulfill... Because to me, breastfeeding is really important. And, one of the most fulfilling that someone reached out to me with, for sure.
Steven Jackson:
Wow. So, you're seeing a lot of success stories. Tell me about maybe some of the ongoing challenges as we talk about things like trust and misinformation. Tell me about some more difficult situations that you're still navigating through.
Munira MaalimIsaq:
I think there is a fear of the unknown. One thing that I've noticed, or I've gotten information on was on how we deal with certain people, right? OK, so there's this thing called labeling someone as an aggressive. Or, let's just say that you have a parent who's passing away, and you are passionate, and you are explaining yourself in a way that seems aggressive to someone, or may have their own bias that they have not touched with, or they're not aware of just yet, and are making decisions based on that. And, that is something that is continuously happening, or that we're continuously working on and are aware of.
But, I see often, more than I ever, it's just... Or we'll call security on someone just because they said, "I want this." Or, "This doesn't touch me." Or in a way that you're speaking with your hand and you're passionately speaking, but all of a sudden, I am not comfortable with you speaking this way. I feel like I'm going to get hurt and I am calling security on you. And nowadays, being called security up on, in people of color, it's not something that's seen as fun, right?
Steven Jackson:
That's one way to put it. Yeah.
Munira MaalimIsaq:
We are fearful of it. And, I think in a way that is causing some mistrust in the community and we're working on that. And, it's just interesting, I would say.
Steven Jackson:
Yeah. I want to go back to something Dr. Haley brought up, and that's really along the lines of cultural competency versus cultural humility. Because in my mind, cultural competency, it's fact-based, so to speak. And I'll put "facts" in quotes because if it's a curriculum then sometimes those facts are based on maybe what we observed as an outsider looking into another culture. So we go into a situation knowing facts, and then we make decisions, and possibly make generalizations based on some facts that we "know." Whereas, culture humility, I think about curiosity. And with curiosity, there's likely less judgment, and it's almost like curiosity puts that bias in check, because now you're in a position of, "I don't know and I want to know." And so, I just think you're making a case for just the ongoing need for culture humility.
Munira MaalimIsaq:
Definitely.
Steven Jackson:
Because I talk with my hands. And, you might have to help me with a couple of terms here, but is it code switching where you change a little bit?
Munira MaalimIsaq:
Yeah. Yeah. Code-switching.
Steven Jackson:
I find myself code-switching more often than I like to realize. If I get loud and passionate, something in me says, "Calm down, because you're going to be viewed differently. So, lower your voice." And so, I do things like that.
Munira MaalimIsaq:
Yes.
Steven Jackson:
Because, some people don't get it, and they might feel a certain way about that.
Munira MaalimIsaq:
Right. Right. And that is important, right? Because when you're going through something that... When you're in the hospital and you're very vulnerable or when you're at the clinic and you have no idea what's going on with your body. And, all of a sudden, you need everyone else, and you may not be yourself. So how do you remind yourself that? Or how are you always in touch with yourself to know, "OK, I need to come down. I am being aggressive." Or, "I'm being viewed as aggressive." Even though you're not.
Steven Jackson:
Yeah. Do you feel any pressure? I feel like I just asked this question to someone else, but do you feel any pressure? Now that you've put in the work obviously, you have the passion, you've put in the time and the effort to build trust with your community and other communities and you've introduced them to health care in a way that now, "I don't mind going to see a doctor. I don't mind getting checkups, those things." Do you ever feel a pressure to always be that go-to person and wanting to uphold a certain standard now that you've developed this trust?
Munira MaalimIsaq:
Honestly, when I think of our organization alone, we've got 26,000 people, right? We've got amazing... I think, was it Dr. Zeke McKinney?
Steven Jackson:
Yeah, McKinney.
Munira MaalimIsaq:
Or, we have-
Steven Jackson:
Season one, everybody. Episode one.
Munira MaalimIsaq:
... Who's great with the community. So, we've got a lot of people that we can tap on, and messengers of the community that we can use, and help, and grow this health literacy that we desperately needed. And, I think of, for instance, Dr. Yang, which does, especially, she spoke about COVID, there was a video that I watched recently where she spoke about COVID-19 and vaccines and everything else. And I'm like, "Huh." So hearing it from her, and if I looked like her, even though I still love who she is, it helps. So, there's a lot of me out there. And, I'm glad to do what little part that I'm doing, I would say.
Kari Haley:
What advice would you have for people who want to learn more about how they can be culturally “humiliate”? What am I looking for?
Steven Jackson:
Humble. Humble.
Kari Haley:
Humble. Humble In how they interact with the other cultures. What advice would you have for them? Especially, as someone who might not look like the culture or the patients that they're treating, but they want to be that. They want to be able to have that connection and they want to be able to build that trust.
Munira MaalimIsaq:
Oh, I think talking to each other, I think we forget the simple human connections. Asking, saying, "Hey, this is what... Can I learn a little bit more, right? I am curious about this. What food do you guys eat?" Food is always one thing that we can all connect on.
Steven Jackson:
Oh, yeah. I like to eat. Go ahead.
Munira MaalimIsaq:
So, find something that is non-viewed as in, "Oh this, it's a topic I shouldn't even touch right away." But something that we can both connect on and talking to each other and asking, it's really simple to say, but it's not done as much as we should. And sometimes we don't want to offend someone by asking them about their culture, right?
Steven Jackson:
Yeah.
Munira MaalimIsaq:
But, I'd rather you asked and you learned something then you kept it inside. We're not growing. And, I don't know, it just does not make sense to me not to ask.
Steven Jackson:
Well, when you get involved with the community and you're not just an arms length away, but you're again, as I said earlier, amongst the people, and you're getting to know what the community needs, again, you develop trust and we've talked about that, but I'm sure you've come across touchy subjects and things like substance abuse, things like that.
Munira MaalimIsaq:
Yeah.
Steven Jackson:
How have you navigated that? And maybe tell us a little bit the work that you've done with Metro Youth, in that regard.
Munira MaalimIsaq:
Yeah, definitely, substance use disorder and mental health is a very sensitive topic in the Somali community. But it's something that we see a lot.
Steven Jackson:
Sure.
Munira MaalimIsaq:
And I think before 2018, we did not have any AA-NA meetings at all, or any support group in the community. So people would go and seek care and treatment, and then not have something else that just helps them on the daily. And, I found that out and I'm like, "That does not make sense to me. We need to have something in place." And because I have that trust again, I was able to go out into the mosque and talk to the leaders and say, "Hey, this is not working."
Steven Jackson:
Wow. That's powerful.
Munira MaalimIsaq:
And, currently I think, every Wednesday we get about 168 people that are either coming in-person or through Zoom and we're just able to support each other and not feel like no one cares about you.
Steven Jackson:
Mm-hmm.
Munira MaalimIsaq:
There's support there, there is help there. And, you feel like you can be yourself. And, I love seeing it. And we've been doing it for four years now, and it's amazing.
Steven Jackson:
Wow. Were there any challenges with that?
Munira MaalimIsaq:
Oh, yeah. It was hard to get in. It took about nine months or so to even have those conversations and to get people to accept it. And then, there was a lot of fear of shame and stigma. So, what people wanted to do were... Let's just say that I would come in for my brother and say, "Hey, my brother is having this problem, can you do one at a time?" I'm like, "There's no way." So, hide in it. Almost being ashamed of your person. And, I guess when we labeled it and we spoke about it, now I see people are more open to getting help.
But beforehand, it was almost like I was promoting alcoholism in the community because I made it OK. And, I remember my dad got a voicemail saying that he needed to talk to me, that this was not acceptable. And I saved this voicemail because this was a person that is well trusted and loved in the community. I value his opinion, or I did value his opinion beforehand. But to say that it was just like, "Huh." But, it told me, though, we were doing something right.
Steven Jackson:
Yeah.
Munira MaalimIsaq:
Because we had so many people against the idea of helping each other.
Steven Jackson:
Wow.
Kari Haley:
Yeah, I mean that piece of identifying that, "Hey, maybe we're on the right track, because we're having conflict." Is something I don't think that I personally haven't really thought about necessarily in my own life. But I think that's a really good point. And, do you think that because of how you are so passionate about it that you were able to move through that conflict? Or, what tools did you have to be able to help yourself and your vision be able to continue forward? Because I think that could have been a really hard stop.
Munira MaalimIsaq:
Yeah. No, for sure. Because I think, and I want to think about this a little bit, just because for me there were a lot of information out there saying... Everyone would ask me, "Do you drink? Is this something that you had a problem with?" And, saying that it's not about me, and it's about the community, and wanting to go, "Am I hurting people? Or am I helping?" And then anytime that I saw someone feeling comfortable in asking for help, it just reassured me that I was doing the right thing. And I think having weekly meetings with the people that we were helping helped. But yes, definitely there were times that I'm like, "OK, maybe I need to take a step back and reevaluate this." Because I did not want to break that trust that I had with the community. And I also did not want to give up on the people that we're helping.
Steven Jackson:
Yes.
Munira MaalimIsaq:
Because we had weekly where we would have either a police officer come, or someone from MADD, Mothers Against Drunk Driving, come in and speak on their experience, and just to connect with the community, right? I didn't want to miss out on that education piece either. So, I don't know.
Kari Haley:
Yeah. It's a fine balancing act.
Munira MaalimIsaq:
Yeah. Yeah.
Kari Haley:
But it sounds like you've really found success with at least walking that line and stuff. And I think there's a lot of good lessons that we can take from some of the things that you've been doing and put them into practice in real life. Because, it is tricky.
Munira MaalimIsaq:
Change is hard.
Kari Haley:
Change is really hard.
Steven Jackson:
It is. I think what's great about what you've done and what you're doing, number one, you're obviously passionate. It's coming out of your pores.
Kari Haley:
It's radiating.
Steven Jackson:
It's radiating and it's contagious. And, I think, your passion has enabled you to endure some of the backlash and some of the, "Well, what are you doing? And, we're offended by this." But your passion wasn't misplaced, because along with the passion was that humility in that, "I'm not here to tell you necessarily what's best, but let's partner, so that perhaps we can get past this issue together." And I think that's why you've been successful. And I think that's why so many people have benefited from you.
Munira MaalimIsaq:
And I think I had to even check my own bias, because I grew up in a household that drinking was not an option, right?
Steven Jackson:
Right.
Munira MaalimIsaq:
So, I had to make sure that I didn't place that on anyone, saying that, "This abstinence is everything that you have to do." That was not what I was going for. It was more of, "You're here, and I accept you for who you are." Kind of thing.
Steven Jackson:
Yeah.
Munira MaalimIsaq:
And that helped a lot.
Steven Jackson:
I love that. And I think that these are really some key principles in building trust and in building connection. As an organization, one of the things that we say in our vision is, relationships built on trust and service to all. But I don't think you can get there if you go there without humility.
Munira MaalimIsaq:
Oh, yes.
Steven Jackson:
And if you go there without a passion to really help others.
Munira MaalimIsaq:
Yes.
Steven Jackson:
I think service is really about the other person.
Munira MaalimIsaq:
Yes.
Steven Jackson:
And, you've really lived that and we really appreciate you just taking the time with us today and sharing about the great things you're doing.
Kari Haley:
Yes, definitely. It's been great to hear and learn more about all of your successes, because I think, like I said earlier, I think we can all learn from what you're doing. And, you are living it. You are living, breathing it, and embodying all of those principles and things that we've talked about on this podcast, which, it's just great to pair that with success, it's just even better.
Steven Jackson:
Before you go, can you speak to our listeners, particularly in the community that have given up hope. They've had bad experiences, maybe with health care, maybe it could be cultural, it can be relational language, but it could be a lot of things. But, they're thinking that health care is not for them, and they'll go to the ER if they have to. Other than that they're not going. Can you speak to that person that needs you right now?
Munira MaalimIsaq:
Yeah, definitely. There is a lot of mistrust and it's deep-seated, and rightfully so. But, as someone who's worked in this amazing... And you said something about drinking the Kool-Aid of HealthPartners.
Steven Jackson:
I have said that, probably a few episodes.
Munira MaalimIsaq:
Honestly, I feel that. Because we look at the data, we care, and, I think, we want to change that. We want to connect with our community and we want to give back. And I've seen so many doctors that want to help. So, what I would say, if I was a community member is, give it a chance, speak to your provider, let them know what your fears are, and build a connection from there. Because, it is hard to not come in and see your provider for three, five years, and then all of a sudden you've got something that's big, and how do you even navigate that, right? Because you are not seeing me on a regular basis. So, I think, I've seen a lot of changes. I have seen so many things that we're trying to do to help the community. And in connecting with that. And, we have acknowledged, I think, there were some things that we needed to change. And I love that we're changing it and we're working on that and that we're aware.
Steven Jackson:
Yeah. Well, again, thank you so much for what you're doing. Look forward to hearing some big news articles or news stories about what you're doing.
Munira MaalimIsaq:
Well, thank you so much for having me.
Kari Haley:
Yeah, thank you so much for joining us and good luck in Maplewood. I'm sure you'll be taking care of people incredibly well in that community.
Munira MaalimIsaq:
I am excited. I'm excited.
Steven Jackson:
Take care. "Off the Charts" is a production of HealthPartners and Park Nicollet.
Kari Haley:
It is recorded by Jimmy Bellamy, with creative by Peggy Arnson, Tina Long, Tim Myers and Jeff Jondahl.
Steven Jackson:
Production service is provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.