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Behavioral Healthcare in Immokalee, FL: The discovery of a beautiful culture and their strength in the midst of hardship

Posted By Molly Coates, Wednesday, December 5, 2012
Updated: Tuesday, December 4, 2012
New Faculty Forum

Molly Coates's blog is the first post in a month-long series from recent graduates in their first semester of a faculty or junior faculty position.

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each week.


I left the mountains of Colorado to move my family to Southwest Florida, a place I knew little about other than my fellow Coloradans’ dire warnings of the potential and looming disasters-- hurricanes, snakes in the toilet, flying roaches as large as palm fronds, alligators waiting for a misstep, and the exotic Nile monitors that run loose in the city with carnivorous desires. However, all that being said, I was ready for an adventure and the spirit of Florida State University College of Medicine was calling. 

FSU College of Medicine has a particular mission statement, one that speaks to me deeply. The college’s mission emphasizes providing primary care to Florida’s elderly, rural and other medically underserved populations and places value on the doctor-patient relationship, generalist medical care and working as part of the health care delivery team, including behavioral health. I was first attracted to and excited about the job position as providing entry into what I believe is the future of healthcare delivery, an integrated and holistic model of care.

"...exotic Nile monitors
run loose in the city with
carnivorous desires."

However, when I arrived onsite at the Immokalee Health Education Site, I became immersed in a challenge greater (and more exciting) than just starting a new job. I was mostly aware of the cultural differences I would encounter, in a theoretical and academic sense. Speaking with my colleagues on the first day of work, I received some wise advice that gave me valuable perspective and a glimpse into the reality of the population--If you ask one of your pediatric patient’s where he/she would chose to go on his/her "ideal vacation,” you just might get the "Walmart” in the next town over as a response. In context, the closest Walmart is 30 miles away and not a typical experience for our patients—imagine what you might buy! This anecdote begins to accurately depict a population whose struggles are very unique.

The medically underserved in this area consist of migrant farm workers following the Eastern route. This population has been referred to as the Nation’s Invisible Population with an estimated 1-3 million taking the annual trek. Resources are scarce to non-existent, life stressors beyond compare, and fear of deportation thriving. The cultural differences are immense and more so when considering this is a population displaced from their home country for various reasons. In Immokalee, families are hesitant to leave the township other than to travel to other migrant farm villages.

The predominant languages are Creole and Spanish, and they must learn to speak two or more languages while navigating systems (e.g., school, healthcare) delivered in their second, sometimes third, language. They have limited access to healthcare and other resources, while their healthcare needs are immense. Their children face changing schools several times a year as the family follows the harvests. Many are victims of chronic and complex trauma. Their life is hard-- listening to the multitude of complex stressors they experience and barriers to accessing resources, it is easy to feel overwhelmed.

How do I best serve my patients in Immokalee? I feel honored to bear witness to all of my patients' narratives, and I am continually reminded of the remarkable resiliencies of this group. They not only survive their hardships, but display an amazing resilience that they do not always recognize. Empathically relating to their narratives, reflecting on their strengths and suffering, and respecting the shared human experience allows me to help foster a self-image of resiliency and pride in my patients. I hope that with this knowledge, perhaps another change is being effected—one of self-efficacy, confidence, and hope as they navigate their life realities.

Molly Coates

Molly Coates, PsyD is a Postdoctoral Psychology Resident at the Florida State University College of Medicine, serving at the Immokalee Health Education Site, Isabel Collier Read Medical Campus. She works in pediatrics and women’s health. Her research interests include chronic pain management, obesity prevention, psychological assessment, and ADHD, Autism and Behavioral Disorders in children.


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Comments on this post...

Randall Reitz says...
Posted Tuesday, December 4, 2012
Thanks for posting your experience Molly. I'm sure that Florida will love you as much as Colorado did. You're bound for great things!
Permalink to this Comment }

Matthew P. Martin says...
Posted Tuesday, December 4, 2012
It can be quite humbling to work with a population that survives and thrives in the face of mounting challenges. Your terrific post reminded me of a quote by Sebastian Moore:

"The rejection of our common fate
Makes us strangers to each other,
The election of that fate,
In love, reveals us as one body."

There is so much that binds us all together as human beings. Thank you for a great reminder about the "shared human experience".
Permalink to this Comment }

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