In the early 2000s, “Plain” families – Christian groups including the Amish and Old Order Mennonites – in Holmes County, Ohio, tended to avoid the local Pomerene Hospital, seeking medical care elsewhere. But when a new CEO joined in 2005 he met with Amish elders to discuss ways the hospital could better serve the needs of its local community. Now around 35–40 per cent of Pomerene’s patients are Amish, and it treats more Amish patients than any other hospital in the world.
1. Bisli Deitsh gayt en langa vayk (A little Dutch goes a long way)
Pennsylvania Dutch is an outgrowth of German, which was spoken by many of the central Europeans who migrated to Pennsylvania in the 1700s. Today, most Amish speak Pennsylvania Dutch among themselves and English with everyone else (hence why they refer to non-Plain people as “English”).
Last summer, Pomerene Hospital invited an Amish schoolteacher to lead a ten-week language course, open to all staff. A little Dutch can go a long way: once, an elderly man who had had a stroke wasn’t responding to his nurse’s prompts. When another nurse tried in Pennsylvania Dutch – the language of his earliest years – he responded.
2. Hire a patient advocate
Born and raised in an Amish family but now working at Pomerene, Laura Schlabach is uniquely suited to serve as a bridge between the Amish and healthcare professionals. Schlabach coordinates the hospital’s self-pay programme, initiated in 2006 at the request of the Amish community. She also visits Amish patients daily, answering questions and even sitting with families whose loved ones are dying. Her first language is Pennsylvania Dutch, so she can communicate with Amish children who haven’t yet learned English in school.
3. Know your patients
Some Amish women come to the emergency room wearing a starched white prayer covering on their head, which isn’t suitable for lying in bed. So an Amish woman sews two kinds of head covering specially for Pomerene: a white one with a tie in the back for older women, and a black one with hair clips for younger women. “We actually go through quite a few,” says Schlabach, who tries to keep them available on every unit. “You think it’s such a little thing, but if you walk into somebody’s room and you offer one of these, their face lights up.”
4. Connections matter
Though big research centres often outstrip community hospitals in resources, Schlabach and Monica Bear, a nurse supervisor at Pomerene, suggest there are advantages to conducting research in a smaller setting. “We are in touch with the community whereas a larger facility might not have that connection,” says Schlabach.
Bear was the lead nurse for the hospital’s study into an Amish burns treatment called B&W. She says that although the study didn’t get the number of participants they had hoped for, it did get the ball rolling. Plain burn dressers are now allowed to treat their patients inside Pomerene. The study also attracted outside attention. For example, a hospital in Colorado contacted Pomerene to see how it devised its B&W protocol. “Even though our numbers were small,” Bear says, “they still spoke pretty loudly.”
5. Be flexible
Schlabach still recalls one doctor’s reaction to the Plain B&W regimen, which includes using burdock leaves to cover the burn. When the burn dressers showed him the leaves, “He was like, ‘Woah! You want to bring this in here?’” she says. Even after Pomerene decided to run a B&W trial, Bear says, it was a challenge to get everyone in the hospital on board.
But it’s not just the staff – Bear suggests that Plain people need to be flexible too. Like most health professionals, she believes some injuries do require skin grafts, but Plain patients and families prefer to avoid the practice. “When you go in there with a mindset of ‘grafting is bad, it’s never a good thing,’ then you’re not open to suggestions about what’s best for the patient.”
6. Don’t assume
Gender roles are stricter in Amish culture, explains Schlabach, pointing out that some Amish women won’t make eye contact when you talk to them, or that a man might answer on behalf of a woman. She says that her own mother would have expected her father to enter a room first and would have been uncomfortable otherwise.
Still, behind closed doors, husbands and wives may discuss matters on an equal footing. But, says Schlabach, “From the outside looking in, it might look different.” She tells the story of two families who came in with kids who needed surgery. Before one of the husbands left to run an errand he told his friend in Pennsylvanian Dutch, “I have to check first with the boss” – his wife.