Nonprofit Spotlight: Interview with Founder of Refugee Women's Health Clinic, Dr. Johnson-Agbakwu

Being a woman is no joke. Add a newborn to the mix, and you've got sleep deprivation, feeding obstacles and overwhelmingly emotional hormonal roller coasters. The best advice I received as a new mom was to find support, whether online, family, friends. Mine came in the form of the free weekly breastfeeding group at the midwifery practice where my son was born. Every Wednesday we sit together for two hours - babies and breasts welcome - and we talk, vent, share, and breathe.

And in it, I met Crista. I mean, Dr. Johnson-Agbakwu. 

Friendly and upbeat, Crista and her newborn daughter were a great addition to the group. Her and I chit-chatted on a particularly quiet day at the group, and our conversation took a very interesting turn. She mentioned she was an OB/GYN and that she worked at the Refugee Women's Health Clinic of Maricopa Integrated Health System, serving a large population of African, Middle Eastern and Southeast Asian refugee women, many who have undergone female genital cutting, endured traumatic rape, war and stigma. 

There were a few minor details she was shy to mention: 

1. She is none other than the founder and director of the clinic (RWHC). 

2. RWHC is the first of its kind in the U.S. 

3. The pioneer work that she does is being replicated all over the country.

Dr. Johnson-Agbakwu, who studied at Johns Hopkins, Cornell, George Washington University, University of Michigan and UCLA, is an incredibly multifaceted woman. Kind and highly intelligent, she is a leader and pioneer in her field, a role model, a wife and new mama.  She works locally and travels internationally, helping to empower women, to shed some stigma around their past trauma and to rebuild their lives through health education and cultural sensitivity training.

I was unbelievably intrigued and invited Dr. Johnson-Agbakwu and her little one to lunch with Baby and I so she could tell me more.

TTUP: Tell us a bit about yourself. Where did you grow up?

CJA: My parents are first-generation immigrants from Jamaica, and I grew up in Connecticut. There is a large Jamaican immigrant population in that area, and my parents have always been very socially conscious and entrenched in their community, helping Caribbean immigrants attain citizenship, ESL classes, etc. My dad founded a newspaper, the West-Indian American, and growing up I was very exposed to social consciousness and serving the community. That's where I developed my own sense of responsibility to give back.

TTUP: Your credentials are impressive to say the least. How did your studies impact your career?

CJA: The defining moment of my career was during the spring semester of my senior year at Hopkins. I took a course called Women in Pre-Colonial Africa (which I thought was just an easy A). I just so happened to have read Alice Walker's book, Possessing the Secret of Joy (sequel to The Color Purple) over the Christmas break before the class. The book follows the life of Tashi, who underwent female genital mutilation; up until then I had never heard of the practice, and the book was so riveting (...) that it opened my world to this entire cultural practice.

"I honestly think that was the defining moment for what has become my entire career."

The topic, including its historical and cultural underpinnings, became my thesis that semester. In medical school, that became my focus. Through an internship while at Cornell University, I did a lot of community activism and outreach to newly-arrived African immigrants who had undergone female circumcision. That helped solidify my public health interest in this issue. I already had a strong liking for caring for the mom and the unborn child, but I decided to pursue a career in Obstetrics & Gynecology because of this. I was sure this was my life calling, so I did my residency at the George Washington University Medical Center, and the three hospitals we covered served a large East and West African population, many Somali and Sudanese women.

TTUP: I teach Intercultural Communication classes to college students, and cultural sensitivity training is a big part of it. Tell me about the cultural issues you encounter in your field.

CJA: There are many challenges with cultural sensitivity. Most U.S. medical doctors do not have any prior training or knowledge of the practice, and the usual reaction to it is 'this is just barbaric' - which is the classic response of most people in the West. Unfortunately, it is not the best approach when trying to build a relationship with these communities. 

Female circumcision has deeply cultural underpinnings; it's done as a way of preserving chastity before marriage, ensuring a woman's honor and marriageability, and is often done on young girls from infancy up to 16 year-olds. Most are between 5-8 years old. Often there is no anesthesia and no sterile equipment, which can cause infections and long term complications such as recurring UTIs and menstruation and/or sexual problems.

I speak around the country in conferences on the subject and I generally get the same horrified reaction but I try to create a balance - not that I'm in support at all of cutting girls OR boys, I have issues with both. At the same time, in order to have a dialogue, you have to start from somewhere . A lot of times, these communities may not be aware of the health effects of the practice, so instead of just slamming them, let's talk about it. Let's ask, 'what does this mean to you? Tell me the significance this has to your grandmother, mom, family.' Not everyone views it the same way. I did a lot of research and worked in very large Somali communities and they view it with pride, honor and beauty. In fact, these women view us as the ugly ones: 'Americans are scandalous and promiscuous and I'm so glad I'm circumcised and pure.'

"We can't start attacking their practice by belittling the culture. Instead, we should be more sensitive, as they may not see it through the same lenses in which we see it. That's proven to be my experience, since I've built my entire career around this."

TTUP: Tell us more about the Refugee Women's Health Clinic. 

CJA: After D.C., I moved to LA and then Michigan to receive further training in Health Policy and Public Health, so I could work on bringing awareness and cultural sensitivity to health providers who work with these populations. In 2008 I moved to Phoenix to start my own clinic, serving primarily the Somali women population. Over the past six years we have expanded to serve women from about 43 different countries across Africa, Southeast Asia, the Middle East.

We have a very low c-section rate, and we're building trust and helping women feel comfortable, so that they experience labor in a way that is natural and more similar to the way they would experience at home. We have two OB/GYNs and two CNMs (Certified Nurse Midwives) on staff and we've expanded our pediatrics program since we've delivered over 700 babies over the past 6 years. We also have a full-time staff of Cultural Health Navigators, trained medical interpreters who speak about 14 of our patients' languages. They are refugee women themselves, bicultural and multilingual, from the same communities they serve, who share their experience and help with the cultural aspect.

"This is the only clinic like it in the country, although there are other hospitals trying to replicate our model in Utah and Georgia. But so far we're the only ones of the kind."

Our largest populations are still Somali but we have Iraqi, Burmese, Bhutanese, Sudanese, Liberian, Congolese - who are our newest arrivals and some have suffered from traumatic rapes happening in Eastern areas of the Democratic Republic of Congo (DRC). I was able to travel to DRC last year, and over the years I've done a lot more international work in places like Kenya and Cameroon.

TTUP: What type of work do you do when traveling abroad? 

CJA: Our OB/GYN Department is working with the University of Arizona College of Medicine - Phoenix, in an effort to partner with the University of Buea in Cameroon to start an OB/GYN residency training program there. This is part of a larger national consortia of U.S. medical schools who are partnering with various countries across sub-saharan Africa to reduce maternal-child deaths and other complications in childbirth.

Last year I was in the DRC, working with colleagues from Johns Hopkins School of Nursing in the conflict regions with survivors of sexual and gender-based violence, looking at the role of contraception in helping families rebuild their lives and minimize the stigma of their rape. At the same time I still serve women and do a lot of community advocacy and outreach here in the U.S., so I've gained a lot of trust in the community. I'm applying for grants that will help with the empowerment of women, helping them rebuild their lives in the U.S., learning English, becoming self-sufficient and able to thrive financially, socially and spiritually too. We have a lot of programs enhancing their process of acculturation. 

TTUP: how can our readers help?

CJA: We are always looking for ways to enhance what we do, so we are always looking for volunteers and donations, whether monetary or material. Once a year we have a huge Christmas party, and we receive donations from all over the Valley (Phoenix metro). Churches, organizations, community groups and individuals donate items such as car seats, strollers, diapers, baby and adult clothes, detergent, sanitary napkins, bed sheets, etc. We start collecting all the supplies in September, and a few days before Christmas we give it all away to our patients, especially the ones who have delivered within the past year .

Also, for those who want to get involved wherever they might live, every state has a central refugee office, usually through the health department. Here in Arizona it's the Department of Economic Security that houses the refugee resettlement program. There are also voluntary agencies like the International Rescue Committee and Refugee Focus, which help with all aspects of resettling displaced refugees. 

"The United States is one of the leading host nations in the world, we resettle up to 80,000 refugees every year all over the country."

Thank you Crista and baby Johnson-Agbakwu for your time, company and insights! For more information visit the Refugee Women's Health Clinic website, or their profile with the Agency for Healthcare Research and Quality (AHRQ).

**FTC Disclosure statement: This post contains affiliate links, which means I might receive a small commission from Amazon if you decide to purchase the books mentioned using the links above. This doesn’t cost you anything additional. These commissions help support this blog, so thank you!

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Dr. Crista Johnson-Agbakwu is an Obstetrician/Gynecologist at Maricopa Integrated Health System, Phoenix, AZ, where she is Founder and Director of the Refugee Women’s Health Clinic (RWHC). She is also a Research Assistant Professor of the Southwest Interdisciplinary Research Center (SIRC), which is a National Institutes of Health funded National Center of Excellence in minority health and health disparities at Arizona State University.

She received her undergraduate degree from The Johns Hopkins University, medical degree from the Weill Medical College of Cornell University, and completed her residency in Obstetrics & Gynecology at the George Washington University Medical Center. She subsequently completed a fellowship in Female Sexual Medicine at the University of California, Los Angeles and then became a Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan where she obtained her Masters in Health and Health Care Research examining disparities in reproductive health care among refugees/immigrants through mixed-method Community-Based Participatory Research (CBPR). 

Dr. Jonhson-Agbakwu has presented nationally and internationally on refugee women’s health, and the challenges faced by health care providers in the care of women with Female Genital Cutting (FGC). She is a Fellow of the International Society for the Study of Women’s Sexual Health (ISSWSH) where she also serves as Chair of Online Services. Her current research incorporates CBPR to address health disparities among refugee women across many facets of health including women’s reproductive, preventive, sexual, and mental health. Through the RWHC, she has implemented a best practice model of care that is improving health care access and utilization, health literacy, community engagement, and health care provider cultural competency towards improved health outcomes for refugee women.

Her August 2011 article in The Female Patient, “Female Genital Cutting: Addressing the Issues of Culture and Ethics,” dealt with social issues, but also offered physicians clear instruction on how to treat circumcised patients. Her new research, to be published later in 2012, will look at the views of Somali men. More >