Therese Lugano walks down a row of weathered brown apartments to a door she knows well. She knocks with the butt of her car key and then tries the door. As she does, a young woman unfastens the lock, peeks out and grins.
Lugano walks in and kicks off her shoes. An older woman, speaking Swahili, beckons her from the kitchen.
Lugano settles into a chair across from the older woman, Christina Ramadhan, and they exchange greetings in Swahili. Christina’s daughter Zawadi Matete, 19, carries out a plate heavy with fried fish and dense mounds of boiled cassava flour, called fufu.
Lugano, making her rounds as a community health worker at the Mid County Health Center, has already eaten. But she knows it would be impolite to refuse the food, so she pulls at sticky chunks of fufu and begins to chew. For an hour, Lugano and Christina talk about the pain of the past and hope for the future. And they laugh; for Christina, that’s something new.
Christina was severely depressed when she first arrived at Mid County last fall for a refugee screening. She was so withdrawn, her family says, they rarely saw her smile. She had once been a prominent woman in her village in the Democratic Republic of Congo. But then she lost her husband and suffered abuse and beatings that left her paralyzed from the waist down. She came to the United States without a wheelchair and took the first apartment available: a two-story duplex. Her children carried her upstairs to the bathroom when they could, and scrounged for money to buy adult diapers.
Lugano recalls the first time she visited Christina. The mother of five was sleeping on a mattress on the living room floor. Lugano helped Christina secure a wheelchair, find a single-level apartment and apply for disability benefits. She also made sure Zawadi was compensated for working as her mother’s caregiver.
Lugano is one of a team of community health workers who draw from their personal experience and pain to help the County’s eight primary clinics improve the health of immigrant and refugee patients and other clients who have culturally specific needs.
Lugano can see herself in Christina. She escaped from the Congo, too. Like Christina, Lugano had a husband who was murdered. Like Christina, she was prominent, serving as a federal politician. But that was before a political coup forced her to flee to the United States in 1999. Like Christina, Lugano was suddenly poor and desperately depressed in a country where she didn’t know the language or how to navigate our systems.
“When I experienced poverty, I found my way to cope with it by caring for people. I felt like I had to do something so I didn’t become crazy,” Lugano said. “All my life I was advocating; advocating for my people, my village, my town, my state. It had become a habit. So here I had to look where I could do the same thing.”
Vanetta Abdellatif, director of Integrated Clinical Services for the County, used a CareOregon grant two years ago to hire 16 Community Health Workers to extend the reach these nontraditional health workers in public health programs such as HIV prevention and maternal child health.
Community health workers work at the clinics to help patients who come through the doors. Some like Lugano, spend time in the field working in clients’ homes, escorting patients to specialty medical care, or helping them connect to community-based agencies.
“It gives these providers a level of authority,” Abdellatif said. “Providers love it.”
It’s also a proven model. Health systems that employ community health workers have documented drastic reductions in emergency room visits, inpatient treatment, and Medicaid reimbursements for clients who are paired with these nontraditional health workers. Those savings range from $2.28 to $4.80 for every dollar spent on Community Health Worker positions. Meanwhile primary care providers report these patients are better able to manage chronic disease and require fewer office visits.
“People call her ‘Mama Lugano,’” said Dr. Dean DeFontes, medical director at Mid County, where all refugees arriving in Oregon go for a health screening.. “She has this way of showing she cares and then being able to scramble together resources, often doing it herself. Lugano is one of those individuals who says, ‘If it can be done, I’m going to do it.’”
Lugano Nakito Therese was born into wealth. Her father, Lugano Mwenda Luc, struck it rich in a gold mining claim near his village in eastern Congo. He used the money to accrue a fleet of planes and launch a global trading company. His family settled in Bukavu, on the southern lip of Lake Kivu, in a mansion that once belonged to the Belgian royal family.
He won federal office, representing the eastern state of Sud Kivu. In a time when Congo, then called Zaire, was under the corrupt and economically inept rule of dictator Mobutu Sese Seko, a place in politics protected his business interests.
His youngest daughter, Lugano Nakito Therese, meanwhile, went off to college in the Ivory Coast, where life remained comfortable.
“Since I was born, I never cleaned. I never used my hands,” she said. “I always had a driver, everywhere you go in Congo. That was my life. Even in the university, my father used to land his plane there just to see me.”
Shortly after she graduated with her business degree, in 1982, her father grew sick. The family flew him to a hospital in Belgium, where he died of arsenic poisoning. Lugano was left to run the family business, and within two years, local politicians were encouraging her to run for office. She was elected to represent Bukavu in state government.
“People advised me, ‘It will be good for business,’” she said. “But once inside, I thought, ‘Oh! I can help people with this. My village doesn’t have this or that, and I can advocate for them.”
And so, in addition to her work trips to Antwerp and Paris, Lugano launched a nonprofit to arm women with artisan skills and train them in small business management. She won grants through USAID and she would visit the wives of government officials and accept donations from them as well.
After four years in state office, Lugano won election in 1990 to a federal post previously held by her father. At that time she was married to an executive from a state-owned engineering firm. But two years later her husband died, also poisoned with arsenic. By then, she had three young children.
During her term in parliament, the First Congo War erupted. The Hutu majority in neighboring Rwanda had killed 800,000 Tutsis over 100 days in 1994. When the Tutsis launched a revolt and took power, 2 million Hutu fled for neighboring countries, including Congo. In the fall of 1996 a rebel leader in Congo named Laurent-Désiré Kabila lead ethnic Tutsi fighters into Congo to hunt ethnic Hutu.
But they didn’t stop with Hutus.
“Our village was 100 miles from Bukavu. They killed everyone in a single day. The chief, they slit his neck,” Lugano said.
Lugano was in Kinshasa on business. But her children survived. They were in nearby Bukavu and fled the city, disappearing into the jungle. Two months later a Red Cross team found them, and took them to Lugano in Kinshasa. By then the rebel leader Kabila had taken power.
Lugano left her children in the seeming safety of the capital when she flew to the United States in 1999 to stay at a Christian seminary. While she was gone, Kabila began arresting politicians who had served under Mobutu. She wouldn’t go home again for more than two decades.
Lugano applied for asylum in 1999, a process that took two years and during which she wasn’t legally allowed to work. She had heard there were Congolese people living in Portland, and hoped to connect with people from her country. But she found herself isolated.
“I experienced poverty for the first time,” Lugano said. “I had to learn how to clean. I remember I became sick because I didn’t know how to use the bleach.”
She cleaned houses for people she met through a local church, and stayed with parishioners for periods of time. But she spoke no English. She had no legal documentation. And she was Black and African in a very White American city.
“That was crazy,” she said. “I became so depressed I started to fall, to pass out. I didn’t have any insurance but I went to the emergency room. They said it was a high level of trauma.”
Lugano was alone, and she was scared. When she received a bill for the ER visit, she was terrified she would be deported because she couldn’t pay. That’s when she walked into the offices at Lutheran Community Services NW.
It was a Thursday afternoon and the office was quiet. Debbie Fisher, a volunteer coordinator at the time, remembers when Lugano walked in, wearing a long white dress with big red flowers.
“This woman comes walking down the aisle, she’s in tears,” Fisher said. She was accompanied by a staff member who happened to speak Swahili, and who interpreted for Lugano, who handed Fisher the bill from Oregon Health and Science University. Fisher called the hospital and reassured Lugano she wouldn’t be deported for nonpayment.
“I put my arm around her and asked, ‘Is there anything else I can help you with today?” Fisher said. “She just collapsed, and that keening….” Fisher learned then that Lugano had no stable housing.
“I had just divorced and I had a house with an extra bedroom,” Fisher said. Still mourning her marriage, Fisher preferred to be alone. But she offered Lugano a room for a few weeks, just until something more stable came along.
Months passed. They sat together at night watching English movies with French subtitles. “No violence, no love, no sex,” Fisher said. “She couldn’t have the trauma of violence. I couldn’t handle the trauma of love scenes. So we watched Whoopi Goldberg and James Bond.”
That’s how Lugano began to pick up English. Fisher later helped her enroll in English classes at Portland Community College.
Once settled in with Fisher, Lugano began to truly mourn. “All this time I was surviving, I couldn’t think of the past. And then it hit me,” Lugano said. “What the heck am I doing here?” Each morning she would wake up and sob to discover she was still in the United States.
Her only constant was Fisher. “She took care of me,” Lugano said. “That’s my dear mom.”
“Lugano saved my life,” Fisher said. “She saved my life by coming into it.”
Lugano finally won asylum in 2001 and brought her children to Oregon. She worked as a certified nursing assistant for more than a decade, then returned to school to earn a bachelor’s in Community Development from Portland State University along with a certificate as a Community Health Worker. She helped found the African Women’s Coalition, joined the board of the Oregon Community Health Workers Association, and went to work for the Immigrant and Refugee Community Organization.
“We call her Mama Therese. Even though she’s no longer a politician, we still give her that respect,” said Djimet Dogo, director at Africa House. “She was very respected back home. So that helped her bring people together.”
She helped new refugee families adjust to life in the United States and held workshops on health and social welfare. She worked with communities from Central Africa that harbored deep animosities toward one another for atrocities their ethnic groups committed against one another.
“She tried to ask people to put aside the back-home politics and move forward for the good of the community,” Dogo said.
Susan Palmer, supervisor for the County clinics’ community health worker program, said the partnership between culturally-specific health workers and traditional western medical teams allows each provider to focus on his or her expertise.
“So instead of having a behavioral health provider looking for food resources, they can pull in a community health worker who can address food resources and look at the bigger picture,” she said. When a community health worker calls a family, they’ll ask, “How are your kids? Is there anything else I can help you with?”
It’s that “something else” that a primary care doctor can’t prescribe. Lugano Lugano, for example, organized a community gardening program for Swahili speaking women, during which the women met weekly during the summer to grow vegetables, sing, pray, dance and talk. It wasn’t a program directly focused on improving physical health. But it had that effect.
“She’s been able to address their needs and provide pro-social activities that build their social networks,” Palmer said. “And that supports their health over time. If we can carea a little more support in the community, then they’re not coming into the clinic in crisis.”
Lugano has never just one job, never played just one role. And seemingly she never rests.
“She plays a big role as a woman and as an immigrant,” said Edna Nyamu, a program director for the Oregon Community Health Workers Association. “She can’t say, ‘I’m done with work and my phone is off. So she goes beyond the profession. They call her for everything.”
Lugano is also not shy asking for something that could help a client.
“She can call me and say, ‘Edna, I’m looking for a mattress. This person needs a place to sleep.’ It’s not easy to find people like that.”
Parked in a corner of Christina Ramadhan’s apartment is a flashy lime green electric wheelchair. “We fought like crazy for that,” Lugano says on a recent Friday in October, as she sits at Ramadhan’s dining table and picks at the head of a fried fish. Zawadi sits quietly and grins as her mother and Lugano talk about the future. “She’s changed a lot,” Zawadi said of her mom. “Since we started working with Lugano, she has started to work. She’s more open. She laughs.”
Zawadi agrees to model some of the dresses her mother sews: elegant ball gowns, tailored business jackets, funky short/vest combinations, all made of bright patterned fabrics imported from Africa. Christina says she can finish three dresses in a day now that she has electricity that allows her to work after the sun goes down.
She wants to start a business. Maybe she’ll work as a seamstress. Maybe she’ll launch a food cart that features Congolese fare. Or maybe she’ll employ her skills tressing women with tiny ornate braids. But she has also considered following Lugano’s lead, and working with refugee women.
Community Health Workers often build a bridge from desperation and good health.
“The doctor can give medicine,” she said, “but if you don’t help me with resources, it’s like throwing that away.”