Four years ago, a family physician at the University of Iowa Hospitals & Clinics discovered a pattern of adverse outcomes among the Congolese patients.

In an effort to understand and serve the changing demographics of the community, she reached out to UI public-health Assistant Professor Will Story. Together, the pair laid the foundation for community-based participatory research that focuses on understanding prenatal and pregnancy health in the Congolese community by partnering with the latter to learn about people’s needs and concerns.

First, Story said, the Congolese were trained in methods of community-based research, taught how to facilitate focus group discussions, and determined what their needs were.

“We did more than 50 interviews of men and women in our Congolese community in their native languages: French, Lingala, and Swahili,” Story said. “From that, we identified some of the major barriers and concerns in the community.”

What they found, Story said, was a concern for navigating health insurance, understanding the importance and process of natal care in the U.S., different options for childbirth in Iowa, and steps the community can take to access health care.

As a result, Story said health-care providers in the partnership continually work to clarify cultural differences in the health-insurance process in the U.S. versus the Democratic Republic of the Congo.

“It’s not just about informing our community,” Story said. “It’s informing our providers the expectations of health care from our community.”

Story and his associates held a session for around 30 health-care providers in February to teach them about cultural implications in Congolese patients.

One idea to satisfy the need for better care, Story said, is a Doula cultural interpreter who could assist and advocate for Congolese women during pregnancy, coach them in their native language, and provide social support.

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Another idea would be providing group prenatal care for pregnant Congolese women, so they can be empowered as a community while also receiving ultrasounds and similar services.

“I’ve been really impressed with both the commitment from our providers here at the UI and the commitment, dedication, and leadership from the community,” Story said. “It’s just been a really impressive partnership, so I do see a really bright future for this going forward.”

Congolese community President Peter Nkumu said an influx of immigrants and refugees from his home country is primarily the result of war in the Congo. Many people who win the U.S. State Department’s green-card lottery choose to come to Iowa for job opportunities.

Such a large population coming at the same time, unprepared to live in the U.S., can cause a cascade of health-care problems, he said.

“The partnership started because of a need to learn how to better serve that group of immigrants,” Nkumu said. “I’ve been involved since the beginning, and everything’s been very helpful in a learning process.”

The Congolese community may be the largest immigrant group now in Iowa City, he said. The partnership accommodates them by providing two-way learning to enable U.S. health care to engage patients from the Congo.

“When it first started, we were a small group, and not many people were involved,” Nkumu said. “Over time, a lot of health-care providers have been invited and involved.”

UI OB/GYN Clinical Assistant Professor Mary Rysavy said a major issue is a lack of Iowa Medicaid for legal residents who have lived in the country for fewer than five years.

“I think that’s one of the big challenges of the immigrant community is discerning who qualifies for Medicaid and who doesn’t,” she said. “It is a really difficult situation when you have pregnant women who really need care.”