Breaching Barriers of Culture and Understanding

"It popped into my head one day, after hearing stories of doctors working as nurses' aides, in housekeeping, hotels and restaurants," Friar said. "If I could get more, I'd bring them on in a second."

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Belyayeva's seminars were taught by Lev Nora, a former internist who fled Ukraine in 2000. Now in Rockville, he is one of three medical graduates who have worked with Friar as health educators. The other two, both Latinos, have since relocated.

Nora, 49, had been the chief of the department of internal disease at the Municipal Hospital of Odessa. His salary was low, and because the government was in turmoil, he worried that his position was not stable. "I could lose my job at any time," he said.

Soon after he and his family arrived in Maryland, Nora studied for the U.S. Medical Licensing Exam. The part-written, part-clinical exam was the first step toward practicing medicine in the United States. He also had to complete residency training, a multi-year ordeal.

"It was like finishing medical school again," he said.

When Nora's wife had a complicated pregnancy, he had to abandon the residency before getting his license. After a chance meeting with Friar, Nora became involved in the health educator program, which is funded through state and local grants. Nora sets up shop in community centers, apartment complexes and sometimes coffeehouses, sharing his new cultural competence with members of the burgeoning Russian community.

He teaches mostly heart-health and tobacco-cessation programs but discusses anything with his participants, he said. If they need aid, he helps them with the paperwork. If they ask, he'll volunteer to go with them to their doctor.

In Russia, Nora explained, it is common to give the family more information about the patient's status than the patient receives, he said; it protects the patient's will to live. For immigrants, the American process is confusing, and misunderstandings occur even in the presence of translators, he said. Some of his clients have been here for years and have never seen a doctor.

Nora's comments are borne out by Belyayeva's experience. Not only was the new system a challenge for her, but the hospital was intimidating, with a big emergency room and an intensive care unit where everything was new and high-tech, and the doctors asked a barrage of questions. Her daughter was there to help, but meeting Nora, she said, was a stroke of good fortune -- and a relief.

Nora estimates that half his participants act on what they've learned in the seminars, whether it's through lifestyle changes, getting screened for cancer or forming a doctor-patient relationship.

After a short stint in the intensive care unit, Belyayeva went home. She controls her blood pressure and cholesterol with medicine, and aside from a painful dental filling, she said, she feels good.