Pennsylvania Dutch: WellSpan tries to close cultural gap in health care

Maria Yohn
York Dispatch

As the U.S. health care system continues to move at warp speed into a brave new world of digitization and ever-expanding bureaucracy, one local program is striving to ensure that a large but often forgotten portion of the York County population isn't left behind.

Via its plain community relationships program, York County-based WellSpan Health is hoping to provide its Amish and Old Order Mennonite patients with 21st century medical knowledge and procedures, tempered with a 19th and 20th century focus on doctor-patient relationships.

According to Joanne Eshelman, director of plain community relationships for WellSpan Health, the program was first offered at the Ephrata Community Hospital more than 10 years ago in response to growing requests from the plain community for assistance in navigating the increasingly complex world of health care.

Eshelman added that the plain community was especially at a disadvantage because they don’t believe in accepting government assistance and do not carry health insurance.

Therefore, the newly created program began catering to their population through two avenues — easing the affordability of health care through bundled programs and discounts, and improving the accessibility of health care by providing liaisons who are familiar with important aspects of Amish and Mennonite culture. 

The program developed slowly over the years as the staff learned more about the needs of the plain community, and when the Ephrata Community Hospital was acquired by WellSpan in 2013, they brought their unique program with them.

“This is something we brought to the relationship. It was new and different for WellSpan,” Eshelman said.

A young amish teenager, who chose not to be identified, measures out a truss edge Thursday, March 3, 2016, in Codorus Township. The Amish are expanding west of Lancaster because of the lack of farmland there. Amanda J. Cain photo

The director said the first focus of the plan, providing affordable options, consists of bundling health services around a specific procedure, such as an appendectomy, and providing them at a price that is consistent at all WellSpan locations. 

Services that aren’t bundled often are offered at discounted rates, Eshelman explained.

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The second focus of the plan involves improving patient navigation of the health care system, and for that purpose, three liaisons were hired to communicate with the plain community and educate staff workers about their special needs.

Eshelman emphasized that although navigating the health care system can be challenging for anyone, it is especially so for members of the plain community who prefer social communication and face-to-face interaction to the remoteness of the modern, bureaucratic system.

In this manner, the liaisons have been invaluable for providing personal assistance, including meeting patients where they live, if necessary. 

Eshelman explained that they advertise their services to the plain community through a variety of Amish publications, including “Die Botscraft,” which reaches readers as far away as Ohio.

However, “word of mouth” is the most important advertising, so liaisons have made it a point to meet with deacons and leaders in the plain community on a regular basis to ascertain their needs and promote the service.

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According to Eshelman, one liaison, Lydia Nolt, is an Old Order Mennonite and can speak Pennsylvania Dutch. After attending a 40-hour course, Nolt recently became the first certified Pennsylvania Dutch interpreter in the state, Eshelman said. 

Eshelman related that although most Amish people are fluent in English, Pennsylvania Dutch is the language they first learn to speak and the one they use at home with their families. Therefore, she said, it is sometimes more helpful to communicate in that language, especially before serious medical procedures and crisis situations.

"It can help ease stress," Eshelman said.

The two other liaisons also have extensive backgrounds in the Amish community — one taught at an Amish school and the other assisted midwives in the Amish community.

Understanding the culture is vitally important, Eshelman said, and that's why she and her liaisons also educate WellSpan employees about the important aspects of Amish culture they might be unfamiliar with and to dispel any preconceived notions they might have.

Eshelman said her liaisons frequently educate medical staff about the differences between the Amish and the general population, such as stricter modesty standards and the need for more accommodations for Amish families, which are often larger and usually stay with relatives while the relatives are hospitalized.

Although some hospitals have similar plain community programs in different parts of the country, WellSpan's program in Pennsylvania is the most extensive that Eshelman knows of.

“If we can be a good resource for them, we want to do that,” she said.