Provider Pulse Ep. 28: Bayle Conrad, MPH (Part 2) - Finding Agency in the Work

After her crisis of conscience in Kenya, Bayle Conrad made a decision: no more international work. But finding her place in global health wasn't that simple.

In this second part of our conversation, Bayle returns to Seattle with an MPH degree and more questions than answers. She turns down international jobs she's qualified for, takes a microfinance position that still involves those same power dynamics, and eventually stumbles into refugee resettlement work at the International Rescue Committee—a job she wasn't sure she could do.

What follows is six years of transformation. The anxious teenager who couldn't speak up becomes a caseworker handling crisis interventions. The student who questioned her right to help finds meaningful work here in Seattle. And the questions that nearly made her quit? They become her greatest asset.

This episode tackles the practical realities of refugee healthcare: Why "just pick up your prescription" isn't simple. How systemic barriers compound trauma. What happens when a care conference becomes an exercise in power dynamics. And most importantly, how providers can create space for agency rather than accidentally undermining it.

We end with Bayle's hard-won advice for students navigating uncertainty, anxiety, and the messy path toward meaningful work.

Topics covered:

• Transitioning from international to domestic work
• Refugee resettlement and casework at the IRC
• Navigating power dynamics in helping professions
• Barriers to healthcare for refugee populations
• Working with interpreters and cultural brokers
• Practical guidance for providers
• Advice for anxious, shy, or questioning students
• Finding your strengths in unexpected places

Perfect for: Healthcare providers working with refugees, public health professionals, students questioning their career path, anyone navigating the tension between helping and perpetuating harm, and those learning that their sensitivity might actually be their strength.

Visit EthnoMed.org for additional resources. Follow us on YouTube and Instagram @EthnoMedUW

Chapters

• 0:00 Bayle Conrad Opening Quote
• 0:27 Introduction: Recap of Part 1, Intro to Part 2 - Theme of agency
• 1:38 Microfinance and Remote Work: Returning to Seattle, turning down international jobs, microfinance work
• 3:50 The IRC and Casework: Starting at IRC, pivotal transformation, doing things she never thought possible
• 8:32 Navigating Power Dynamics: How working with refugees shifted the power dynamic questions from Kenya
• 12:00 Practical Lessons for Providers: specific guidance on pharmacies, appointments, health literacy
• 16:45 What Providers Need to Know: Systemic barriers to care, navigating broken systems, insurance/pharmacy challenges
• 19:26 Practical Lessons for Providers: specific guidance on pharmacies, appointments, health literacy
• 21:56 The Conference Room Story: Care conference with provider power dynamics in action
• 26:09 Working with Refugee Patients: Humility, confidentiality concerns, creating productive care environments
• 29:31 AI and Confidentiality Concerns: Ambient AI technology, immigration status fears, provider responsibility
• 32:01 Advice for Students: Guidance for anxious/shy students, career navigation, finding your strengths
• 37:58 Conclusion: End of Part 2 - Permission to stumble, trust your path, hang in there

Transcript

Bayle Conrad 25_10_23 

 [00:00:00] 

 EPISODE 2: "Finding Agency in the Work"

Opening Quote

Bayle: I did so many things at that job that I never would have thought I could do. But you just kind get put in the situation. Anyone who's a caseworker kind of knows, and I was actually kind of good at it, which was really surprising to me because if you had told me before, like, oh, you're gonna be with a patient or a client that has this crisis scenario and you're gonna have to talk to 'em about it and, and go through like a suicide, safety plan, I would've laughed.

I would've said, there's no way I, how would I possibly be able to do that?

INTRODUCTION

Bayle: Welcome back to the EthnoMed Podcast. [00:00:30] I'm your host, Dr. Duncan Reid, a primary care physician at harborview's International Medicine Clinic,  and medical director of EthnoMed. This is part two of our conversation with Bayle Conrad, program director with the equity, diversity and Inclusion team at Harborview Medical Center.

 In our last episode, we followed Bayle from Spokane to Nairobi through anxiety and academic success and into profound questions about power and privilege in global health work. We left her at a crossroads, newly graduated with an MPH degree, [00:01:00] turning down international jobs because she couldn't reconcile the ethical tensions.

 Today's episode is about what happened next, about discovering that meaningful work doesn't require flying halfway around the world about transformation that happens when you take a job you're not sure you're qualified for  and about learning, that the questions you carry can actually make you better at what you do.

But most of all, it's about agency. That word threads through Bayle's entire story,  the agency she felt she lacked as an anxious child,   the agency she worried about taking away from [00:01:30] communities in Kenya, the agency, she would spend six years learning to protect and nurture in her work with refugees. Let's continue.

CHAPTER 1: Microfinance and the IRC

Duncan: After graduation, Bayle came back to Seattle. She had made a decision, no international work, but that didn't mean she had a plan.

And then you graduated,

Bayle: Mm-hmm. 

Duncan: what was the job market looking like at that point?

Bayle: Um, it still wasn't great. and again, I think at this point in time I was at a low in terms of my identity in terms of the career I wanted to have [00:02:00] and the work I wanted to do, because of this tension that I held. And so I did, I actually applied for a number of jobs internationally, and I got a couple of them actually.

I was chosen as a candidate and I turned them down for a lot of reasons. But I think one of them was, I just really, I couldn't figure out how my presence internationally would be a value add as opposed to someone from that community. So I, I guess at that point I really made the decision [00:02:30] that international work wasn't for me. And I started applying to a lot of jobs, moved back to Seattle, and so I ended up working for a microfinance organization that did lending in a number of countries. Indonesia, Kenya, Ghana, a couple West African countries at the time, and I worked remotely from Seattle.

Duncan: Microfinance, it seemed like a way to address the need for economic opportunities she had witnessed in Nairobi. But there is an irony here. Although Bayle decided she didn't want to work internationally, she took a [00:03:00] job with an international microfinance organization.

She was still working across borders, still involved in the same kinds of power dynamics she'd questioned in Kenya. So now she was doing it from Seattle. 

Bayle: I would actually call people from Kenya or from wherever and talked to and ask them like, oh, I see you missed a payment on your loans. Um, like, can you let me know what's going on so I can give an update to your donors? 'cause the whole, it was a microfinance platform where people from, the western world, would give loans, small loans out to, people that [00:03:30] they never met from across the world.

And so I did that for a few years and then again found myself applying for jobs. I was really applying for jobs this whole time actually, and applied for like hundreds of jobs and never really had any interest from, the Seattle area and I think a big part of that is probably because you know, I went to grad school in Atlanta, so any networking connections I had were not here.

Duncan: The International Rescue Committee, or IRC, is one of the major refugee resettlement agencies in the United States. They support refugees navigating their first months and [00:04:00] years in America after resettlement: finding housing, enrolling children in school and accessing healthcare.

Bayle applied for a position as an AmeriCorps volunteer, She had no idea the experience would change her life. 

Bayle: And then I applied for a job at the International Rescue Committee as a AmeriCorps, which is like a stipend position. Kind of a half volunteer, half employee type of work. I'm not even sure if they still have the program. And it was doing casework for refugees with significant health [00:04:30] conditions.

I had never done any social work. I didn't really know what casework was. I knew about refugees generally, but I didn't know anything about the refugee resettlement program in the U.S. But started that work and then got hired on as a full-time employee and worked there for about six years. Yeah.

Duncan: How was the experience there?

Bayle: I feel like that was a pivotal experience for me throughout this whole time. I had been, working on the anxiety and the shyness and had gotten a little [00:05:00] less shy, managed my anxiety a little bit better, but the work I did at IRC really was kind of a major shift in how I saw myself and how I saw myself in my career.

Duncan: A major shift in how she saw herself, not just what she could do, but who she was. Bayle was overcoming the anxiety that had been interfering with her own agency.

Bayle: And by that I mean, I did so many things at that job that I never would have thought I could do. But you just kind get put in the situation. Anyone [00:05:30] who's a caseworker kind of knows, and I was actually kind of good at it, which was really surprising to me because if you had told me before, like, you're gonna be with a patient or a client that has this crisis scenario and you're gonna have to talk to 'em about it and, and go through like a suicide, safety plan, I would've laughed.

I would've said, there's no way I, how would I possibly be able to do that? Partially just 'cause of my personality, the shyness anxiety, but also 'cause I just, I think I just wasn't very confident in any, type of skill set I had. And so I went in to [00:06:00] that job and just sort of started being put in these situations that I never thought I'd be put into and actually kind of being okay at it, which was a really weird feeling.

And it was this weird feeling of, oh, I can actually do these things and stay calm and work with people who are very different than me and problem solve. I was actually a pretty good problem solver, which actually makes sense if you think about, just the anxiety component of my life that's been constantly it, fighting against that and really problem solving around [00:06:30] that while not having it solved.

Duncan: She realized that she had developed the skills of a problem solver. Her life had been spent managing anxiety, navigating panic attacks,

The anxiety that had felt like a weakness had actually been helping her to foster problem solving skills.  

Bayle: And so yeah, I just, I learned a lot about myself. I became a lot more confident in the skills I had and I just really, really enjoyed the work. I really enjoyed working with, the clients and the staff. I learned so much about not [00:07:00] just myself and my own skill sets and the things I was good at, but also about different communities and different cultures and, constantly having to check myself and my privilege and my again, the power dynamic between me as a white American woman, working with these refugee populations.

And one thing I really appreciated about the program I worked in is that there was a pretty big focus on self-sufficiency and agency, and I really appreciated that because the stereotype of refugees are people who are, poor [00:07:30] and have no agency and need to be helped.

And while some of those things could be true, I feel like the program that I ran, which was an intensive case management program focused on people who had significant vulnerabilities, was really more about providing the clients information about how things work in the US and their options. And then working with them to meet whatever goal they wanted to.

 Bayle again notes the importance of agency. The IRC program focused on self-sufficiency and agency, [00:08:00] not we know what's best for you, but rather here is how things work.  Here are your options. What would you like to do?

One approach says, you're helpless. Let me save you.  The other says, you're capable.  Let me provide you with the information and tools so that you can make your own decisions.

For Bayle, This made sense. This felt ethical.

 Sometimes the goal wouldn't work out. Sometimes the option they chose would not be the option I would choose, but it was always really important to me to focus on that agency and giving that power back to [00:08:30] people who had that power taken away from them.

CHAPTER 3: Navigating Power Dynamics

Bayle: Bayle had a crisis of conscience in Kenya. The question that nearly made her quit her MPH program was, what right do I have to be here? What's the difference between me and the donors on slum tours?

Working with refugees in Seattle didn't eliminate those questions. But it shifted them. It made them more navigable.

Duncan: So you identified when you were in Kenya that the big problem was this gulf in power and that dynamic and being an outsider. Do you feel like that shifted or that [00:09:00] changed in this job at all, where you saw yourself less as an outsider?

Bayle: I think it shifted a little bit just because of the nature of the work. So while I was in Kenya or, you know, even, imagining any sort of job overseas, there's no way to get out of the fact that I am entering a different community geographically, culturally, often language wise.

And I think a little bit of that tension was resolved because I was still in an American context.

And really my job as a caseworker was kind [00:09:30] of, the way I saw it was to be an information broker. It was to learn all of these things about American systems, which to be honest, I didn't know anything about before.

But things like, food stamps, social security income, all of the kind of benefit systems, welfare systems we have in the country. And to know and understand those systems really well so that I could provide that information to a client coming in from a totally different, world basically. And so I think the fact that really [00:10:00] my job was to be an expert on America, kind of in a lot of ways did shift that tension a little bit.

However, there is still always that power dynamic, right, between myself and a client. Even if it's a male client who's older than me, there is going to be a dynamic there that can never be changed or can't be changed for a long time. I think. Part of that is, I speak English and a lot of the clients I worked with didn't, [00:10:30] so they're going to be dependent on me for that. Part of it is, I'm a caseworker who can provide them a service that holds power no matter what I look like or who I am, And clients might acquiesce to certain things because they think if they don't say or do something the right way, I might stop the services I'm providing.

Duncan: Even if it's a male client who's older than me, there is going to be a dynamic there. In many cultures, older men have authority, respect, power. But in this context [00:11:00] in a caseworker's office in Seattle, Bayle has the power.

She speaks the language.  She knows the systems,  she controls access to services. The usual social hierarchies get inverted and clients might defer to her,  might agree with her,  not because they actually agree,  but because they're worried about losing services

if they don't. That's the power dynamic that can never fully go away, no matter how kind you are, how respectful, how culturally sensitive. When you control access to resources someone desperately needs, there's an inherent [00:11:30] imbalance.  Bayle knows this. And knowing it, staying aware of it is what allows her to do good work in spite of it.

Bayle: So that power dynamic is never going to go away. But I think having some humility around the work And not thinking I know everything, right? Because a lot of the people we work with had whole careers overseas. even if they hadn't been educated, like everyone you meet knows something you don't know, right? Like even if they're a farmer in the Congo, I don't know anything about farming.

Everyone you meet knows something you don't [00:12:00] know. They have skills, knowledge, experiences that are valuable, that are worth respecting. When you internalize that, it changes how you show up.

You become curious, instead of condescending. You become collaborative, instead of prescriptive. You become someone who facilitates, rather than someone who rescues.

Bayle: So there's just trying to reduce that power dynamic as much as possible and being really aware of it, I think just became really important to me to be an effective [00:12:30] caseworker.

Duncan: And would you say it's a part of your role is to empower these people and to lessen not only on an interpersonal level, but even on a institutional level, to lessen those disparities in power?

Bayle: Yeah, I think so. I mean, I hate the word empowerment because at least using it in terms of me, because it applies that for you to have power, I have to do something, which I guess is true to an extent, but again, if it hasn't become clear, agency is really important to me. So it kind of takes away that agency a little bit.

But I do [00:13:00] think, yes, advocating for the clients that I worked with. With hospitals, with medical teams, with social security administration with all of these agencies was a way to both kind of broker that power dynamic, but also to, provide some education to the client. I don't mean that in a, oh, they need to be educated because they don't know anything way, but things like, these are the types of questions you can ask a doctor and it's okay to ask this question, you know, really basic things that you take for [00:13:30] granted here, but if you're coming from another context, might've not been okay at all.

So really just providing that additional context, to try to give the clients I worked with the tools so that when I was no longer their caseworker, hopefully they could, over time, slowly build the confidence to use those same strategies when they were talking to their doctor.

It's not that easy. I say it like it's super simple, because they're going to always have the power dynamic as a foreigner in this country or as an immigrant to this country, there's always going to be that [00:14:00] dynamic. The minute you open your mouth and you have an accent, if you are, you know, a woman who has a head covering, the minute someone sees you, if your skin is a little bit darker, that is never going to be completely resolved.

But I think trying to give the context of what things are like in an American setting, was the least I could do.

Duncan: After six years at IRC, Bayle moved to Harborview Medical Center, where she now works on the Refugee Health Promotion project, a federally funded grant program that sits at the intersection of healthcare and refugee [00:14:30] services. In many ways, it's a perfect fit. She gets to use everything she learned as a caseworker, but now instead of working directly with clients, she's supporting the caseworkers themselves. She's become, in her words, a caseworker for caseworkers.

Duncan: And what is your role now? So now you've moved to Harborview Medical Center. 

Bayle: Yeah. Yeah. So I work with the International Medicine Clinic, which is a clinic that serves refugees and immigrants. And I work on a specific grant that is federally funded, but passed through the [00:15:00] Department of Health of the state that's, called the Refugee Health Promotion Project.

So my job here is to sort of facilitate between caseworkers at resettlement agencies and other outside agencies that are working with the refugees and immigrant patients that we see in clinic and doing a couple different things. So part of it is, doing care coordination. Like, oh, we know that this person qualifies for a, b, C services.

Can you as their caseworker, get them connected to these [00:15:30] services or just sort of trying to delineate tasks so that, nothing's duplicative. But also because I had the experience of being a caseworker for six years and not knowing how any of these systems work, especially at the beginning and being really confused and frustrated by trying to fit, you know, your client into a system that is really bureaucratic and hard to navigate, is really kind of being a caseworker for the caseworkers in a way.

So, doing a lot of trainings 

So trying to be that supportive role. Because [00:16:00] if, you're a caseworker or social worker, it can be really overwhelming, especially at first to try to understand the ins and outs of everything that you're trying to connect your client to.

And then also working internally with the clinic staff to, consult on patients and think through, some of the possible resolutions to really major and immediate issues that, our patients face.

Duncan: Major and immediate issues. This goes beyond routine healthcare. We're talking about families with multiple members who have complex medical conditions. We're talking about people who've experienced trauma, [00:16:30] who have limited English proficiency, who don't understand how insurance works or how to make appointments or what to do when they receive a bill. And Bayle's job is to bridge that gap to be the interpreter, not just of language, but of culture, of systems, of expectations. 

CHAPTER 5: What Providers Need to Know

Duncan: When we asked Bayle what providers in the general public should know about barriers to care for refugees, she started not with cultural differences or language barriers, but with something more fundamental. The systems themselves.

Duncan: What should some providers or just the general public know [00:17:00] about some of the barriers to care that resettled refugees face?

Bayle: Yeah, one thing that has become clear to me over time and, there's a lot of different immigration categories and there's a lot of rhetoric right now about immigration in this country, but refugees traditionally have had a really protected status and they've been a very specific group that's come in.

But really with almost every refugee that comes in, probably a lot of immigrants, you're basically trying to fit them into, these services and benefits that help poor people. And [00:17:30] to be completely frank, this is within a context of a country who does not care about poor people.

Duncan: Refugees arrive in the United States often fleeing violence, persecution, impossible circumstances. They're granted protected status. They're supposed to be helped, but the help available Medicaid, food stamps, tANF, housing are difficult to access, difficult to maintain, difficult to navigate, and when refugees arrive they face all the same obstacles that poor Americans face, plus additional barriers of language, [00:18:00] culture, and unfamiliarity with how anything works.

Bayle: And so when you're trying to get someone signed up for Medicaid or for TANF welfare benefits or for food stamps, the bureaucracy of getting people connected to these systems that are set up to fail people is incredibly difficult and frustrating. and so I think that's kind of the first thing to be aware of and to know is that once someone enters this country, they kind of become part of that [00:18:30] bigger group of people who are under the poverty line. And that's a group of people that we traditionally don't care about. 

Duncan: Before we get into the practical details of working with refugee populations,  Bayle wanted to share something more fundamental, something that cuts through all the differences of language  culture and background.

Bayle: One big lesson I learned, is that  people across different cultures and countries will sacrifice almost anything for their children. And I think that's really important to keep in mind because I can't tell you how many coworkers [00:19:00] I've had, or clients I've had who have basically told me my life is over because maybe they had a career overseas or, were successful in whatever they were doing. But I'm here for my children.

And I think thinking about some of the political rhetoric that has come up, that's something that everyone can agree upon for the most part. in general the love that parents have for their children is such a, continuous theme throughout any population I've worked with. Any language, any culture.

CHAPTER 6: Practical Lessons for Providers

Duncan: Now let's get practical. What are the specific things providers need to [00:19:30] understand when working with refugee and immigrant populations? Bayle has learned these lessons through trial and error, through watching what works and what doesn't. Through paying attention to the details that seem small but matter enormously.

Bayle: I think other things for providers to know specifically,things that I'd really take for granted growing up in a US context as an English speaker that might need to be explained to somebody. And it's really hard to catch those things. But as you serve this population more and more, you'll realize what those points of [00:20:00] confusion might be.

So for example, the idea of going to a pharmacy, telling a patient like, oh, just pick up your prescription. And because of that power dynamic that's inherent in any sort of interaction, a patient might be like, okay, yeah.

Mm-hmm. Yep. And then have no idea what, to do. Things like making a follow-up appointment. Again, I get confused by that sometimes as a patient. Like, who's making it? Am I making it? Are you gonna call me? So just trying to really think through kind of all those hiccups that could happen.

Duncan: Just pick up your prescription. It sounds so simple, [00:20:30] but think about what that actually requires. You need to know what a pharmacy is. You need to know that you can't just go to any pharmacy. You need to go to this specific one where your prescription was sent.

You might need to know how to call and ask if it's ready. You need to know that you might need to show your insurance card. You need to know that there might be a copay.

You need to know what to do if they tell you your insurance isn't covering it, or if they say they need prior authorization or if the medication isn't in stock.

Bayle: I also think, the idea of patient confidentiality in the US is very different than it is in [00:21:00] other places and trying to explain to the, patients you're working with.

Like, I can't share anything you tell me with another family member without your written express consent. Because in a lot of other places in the world and even in the US there's a lot of stigma around certain illnesses, certain questions that you might ask your doctor and there aren't necessarily these legal structures in place to stop someone from sharing that. And so really making that [00:21:30] clear I think could be one of the major things you can do as a provider, meeting a family for the first time to really make it clear like, this stays between us. Unless you're about to hurt yourself or someone else, you know, giving the context of what might be the limitations to that, but really making that clear early on.

Because if you just say like, oh, everything we talk about is confidential, you're not explaining what that actually means. And I think I did that a lot as a case worker without realizing like, oh no, I need to actually sit here and explain to you all these things.

CHAPTER 7: The Conference Room Story

Bayle shared a story about a care conference, a meeting between medical providers and [00:22:00] a refugee family with two very sick children. It is a story about good intentions and unintended consequences about how even excellent life-saving medical care can be delivered in ways that reinforce power dynamics and make it harder for families to advocate for themselves.

It's also a story that's deeply personal for Bayle because it connects to her own childhood experience of feeling small and powerless in medical settings.

And it shows how lived experience can make you a better advocate.

Bayle: I remember being in an in-person conference with this patient [00:22:30] who, had two very sick kids and there were maybe 12 providers in the room and with a mom and dad and me.

And the first question one of the providers asked in this care conference was, dad, can you tell me your understanding of your child's illness? And I felt like that was such an inappropriate thing to do because again, looking back at that power dynamic that dad is sitting there with 12 mostly white people who are in the medical field [00:23:00] and having to explain in another language what his understanding of his child's illness is.

12 providers in a room, all well intentioned, highly trained in the middle of them, a mother and father who don't speak English fluently, who come from a refugee camp. And the first question asked is, dad, can you tell me your understanding of your child's illness? It's meant to be patient-centered.

It's meant to be good practice make sure the family understands, start where they are. but in this context, in this power dynamic, it becomes [00:23:30] something else. It becomes a test. Can you perform your understanding for us? Can you prove you're paying attention?

Can you speak our language well enough to explain complex medical concepts back to us?

Bayle: And this is a family who didn't have a lot of education from where they came from. And also they were specifically not told what their children's illness was in the country they came from because refugees were really looked down upon. And so when they had to go out of the camp to get specialist care, they were just really brushed off.

[00:24:00] And so, again, I know I've said this so many times, but just being really aware of that dynamic and how awkward you would feel in that situation.

Bayle: And I think part of the reason why that is something that is so personal to me is because when I was a kid, I actually had a condition that required me to go to Seattle Children's, which is about a four and a half hour drive from my home. And it was a scary situation for my parents and I was like 11 or 12.

So we would have to drive over to Seattle [00:24:30] every three to six months for these appointments. And I remember even at that age, just knowing that my parents felt very overwhelmed and they felt really stupid at times because they didn't understand all of the jargon that was being used or how the medical system worked.

'cause this was like kind of the first time they were really, had to deal with this type of care. And that is, you know, those are two educated white Americans, native English speakers who didn't speak up and ask [00:25:00] questions. And who felt kind of like the hicks from the boonies who were coming to this, medical center for care for their daughter and who were really scared because I didn't really know what was gonna happen.

And so I reflect on that a lot. Not that I'm trying to compare my experience to this families or to other families, but just that feeling that we've all had when we're in a situation of someone who has more prestige than we do. And it could be a lawyer, it could be a doctor, it it could be any situation and just feeling so stupid.

 That feeling [00:25:30] we've all had. When you're facing someone with more education, more expertise, more authority, when you feel like you should understand, but you don't when you're too embarrassed to ask questions because you don't want to look dumb. when you just nod and agree because it's easier than admitting you're lost.

We've all felt it. Maybe in a doctor's office, maybe talking to a mechanic about your car. Maybe in a meeting with lawyers or accountants or any expert who speaks in jargon you don't fully understand. Now multiply that feeling by sitting in a foreign country in a language you're still learning, surrounded by 12 [00:26:00] people who hold your child's life in their hands, carrying trauma from previous medical experiences where you were dismissed and disrespected.

That's what these patients were facing.

Bayle: And so I think, entering any sort of interaction you have with a patient with some humility, and I, keep in mind that saying like, everyone I meet knows something I don't. To me, that's really important to realize that maybe I know things that in my culture are considered useful, right? But I don't know anything about the crops that you should [00:26:30] plant in x, y, z country. You know, I mean, just really thinking through that people have different experiences and different backgrounds, and just because they're refugees doesn't mean they didn't live a different life or weren't successful.

But also recognizing that coming into a situation like the one I just described can be really overwhelming and actually really non-productive because then the family just sits there and parrots what they think the doctor wants to hear. They're really nervous, they're really ashamed. And that same family I was, asked a couple, months after that meeting, like one of the [00:27:00] providers came to me and said, you know, they don't ask any questions.

And we're really concerned 'cause they're not asking questions and it's like, well no kidding, they're not asking questions. Look at that conference you just had. that's not something that was okay from where they came from.

Asking a doctor questions is, was like questioning their authority. So that's another lesson that I learned and that I would try to instill into the clients I serve. Like it's okay to ask questions. That's not gonna solve the problem. They're not gonna go to their next appointment and say, Hey, I have 25 questions for you.

But trying to just [00:27:30] change that, understanding and that experience little by little hopefully, you know, will eventually lead to the confidence that you can ask questions and it's okay.

Duncan: And going back to that scenario with the providers, my guess is that they were trying to be patient-centered and having a teachback,

Bayle: they were.

Duncan: but then the way the Teachback could have been interpreted by the patient is being put on the spot, being tested about what they actually know.

Bayle: Yeah, and I think that's actually, totally appropriate to do. I think a change that I would've preferred in [00:28:00] that setting was maybe not having that many people there, trying to have as few as possible. I get there are times you're gonna need a lot of specialists in the room with the parents, but building up to that or having, one person come in and be kind of the lead on all of these things would've really helped.

And I, everyone in that room had really good intentions. And like I said, they literally saved the lives of these kids. These kids, especially one of them would have died, without the intervention of the specialist there. But, and it's not even anyone's fault because it's, again, you don't [00:28:30] think about it.

You're just used to how things happen in an American context. So you might not really be aware, especially if you're a busy doctor and you're doing surgeries or whatever, you're not gonna sit and take a step back and think, okay, how do these parents feel? Where do they come from? You don't have time to look at their chart to see, you're just trying to literally save the life of their kid.

And so it wasn't like anyone's fault, but it was just one of those moments to me where I, again, probably mirrored my own self of thinking, oh my gosh, how many times have I done something like [00:29:00] this?

How do we provide excellent medical care while also being attentive to power dynamics, cultural context, emotional experience? How do we do both? There's no easy answer, but awareness is the first step. And having people like Bayle, people who bridge worlds, who understand both the medical system and the refugee experience, who can advocate for families and educate providers, that makes a difference.

That's why roles like Bayles matter, not just for individual patients, but for the system as [00:29:30] a whole.

Before we move to Bayle's advice for students, there's one more contemporary issue we need to address: technology and political reality. How do providers maintain trust and confidentiality when the tools are changing and the political landscape is uncertain? 

Duncan: And then going back to that idea of confidentiality, I'm wondering now in the era of AI, ambient AI technology works by using your own cell phone where it records on there. I'm wondering if you think there might be some [00:30:00] misunderstanding in terms of the confidentiality, especially for these refugee patients.

Bayle: I think probably, and I think it's probably more important than ever to be really straightforward and clear about confidentiality because of the political rhetoric around immigration right now. And patients are scared. Even if they have come into the US with a protected status that they're legally here, they're scared.

And so even though, you know, you might not think someone's [00:30:30] health appointment has a direct tieback to their immigration status, that might not be the impression of your patient, first of all. And, I think it devalues the ability of anyone to speak to an authority figure.

And so I do think especially in this world where AI is becoming involved in healthcare or, other recordings or things that are happening, just being very, very clear about how it's gonna be used, why it's being used.

And if you start realizing you don't know the answers to those questions as a [00:31:00] provider kind of trying to look into it. Because the last thing you wanna do, and I've seen this happen not in an AI setting, is telling patients, you know, this is a confidential, and the, thing that comes to mind is, the Medicaid expansion in our state last year to undocumented folks.

And then here we are a year later and have found out that, some of that information was provided to the federal government. But at the time, it was unthinkable that private health information would be provided to the government. And so I've had a, couple of doctors say to me the moral injury of [00:31:30] that, of knowing that you told somebody, Hey, sign up for this benefit. I know you're undocumented, but you qualify and this is very confidential information. This will never be used in any way other than for insurance purposes. And then that's not the case ,

Bayle: I mean, that's probably an outlier because it's hard to know.

But I think if you are using some sort of AI system or recording system and you don't actually know the answers to that, it's better to err on the side of caution and to say that than to promise. this is gonna be confidential. It'll never come out of this, [00:32:00] room.

CHAPTER 9: Advice for Students

We wanted to end where we began with young people who might be struggling with similar questions, similar doubts, similar feelings of not quite fitting in, people who might be anxious, shy, questioning uncertain about their path.

Bayle has traveled the long road from the anxious teenager in Spokane to the confident professional she is today. So what would she say to someone who's where she was?

Duncan: So we're working with a lot of undergrads at the University of Washington where you were, what advice would you give to a [00:32:30] younger version of yourself? there's some undergraduate that has a lot of the same attributes Bayle Conrad has, right?

Like. Insatiable reader, very curious, but might not be that comfortable putting themself out

there and maybe doesn't benefit from mentorship and all of these other personal relationships. Having gone through all of this and having developed as a person and professionally, what kind of advice if you were talking to a young person in a similar situation as you.

Bayle: I would [00:33:00] first probably say, give yourself some grace. Because the amount of time I spent beating myself up or thinking like, oh, I, I should be different, I should be more confident, I should be more outspoken, I should be more outgoing. You know, I look back and just wanna give that version of myself a big hug to think like, there's nothing wrong with you know, there are things that can help you but that you don't know about, but there's nothing wrong with you. So I think you still have a lot of strengths as a person, even if you do have, if you are shyer or you find it harder to [00:33:30] network. I think it took me a long time to find out what those were for me personally,

 give yourself some grace. That's where Bayle starts, not with strategies or techniques or networking tips, but with compassion, with the recognition that there's nothing wrong with being shy, with having anxiety, With not fitting the mold of what you think a successful person should be.

Bayle: I would also say, one thing that I was so caught up in when I was in school was making the right [00:34:00] decision. For like the next thing, right? Like, oh, if I choose this internship but not this one, is this gonna make it so that I have to follow this path. Nothing is set in stone. You know, there's nothing that says you can't change your trajectory, your career, what your interests are. Yeah, it could be more challenging if you're going into anthropology and then you decide you wanna be a marine biologist. But in general, I wish I had known not to put as much pressure on each decision and part of that is because I have found that [00:34:30] taking opportunities that I didn't 100% want, you know, maybe they were like 85% aligned with my interests or whatever actually were some of the best decisions I made.

So really thinking less about this obsession with I have to follow this specific pathway or I'm not gonna make it. And taking different opportunities as they come and realizing like there's a lot of opportunities I took that I didn't love, but I learned so much about myself and the things I was [00:35:00] good at and the things that I wasn't good at, and the things that I liked to do and the things I didn't like to do.

And I think that's just as important in some ways.

I think the last thing I would say, and I wish I had known more of this at the time, is

Bayle: when you're an undergrad or in college, even in grad school. I didn't have a great idea of what type of positions were out there. I had no idea. Right. Like I said, I knew that you could be like a professor. I knew like the basic careers you could choose, but I had no idea that you could be a caseworker [00:35:30] for refugees with medical needs.

Not to say that if I had known that I would've been, you know, sign me up. That's what I wanna do. But I think, you know, looking through, job postings, not because you're trying to apply for a job, but just to get a sense of what type of careers are out there and paying specific attention to the requirements because there are things in the requirements that might not be black and white in terms of, oh, you need to like this degree, but could be skills that you could strengthen over time.

Or you could decide, [00:36:00] oh wow, that's a skill set that I am not great at. Or I really don't like doing those things, so maybe this isn't the pathway for me. But, you know, trying to just sort of learn about the different options, that are out there. That could be looking through job postings. It could be trying to find a mentor in the field that you're working with.

I mean, I wish I had known that. I wish I had known that that's a great opening to say, Hey, I'm interested in this field, but I don't know the types of jobs that exist. Could you tell me more about some of the career paths that are offered, through [00:36:30] X, Y, and ZI? That would've been a great opening to start talking to a mentor.

And I think I struggled really hard with even that piece, like who am I to talk to this person?

Bayle: But yeah, just trying to familiarize yourself with the different types of, of work. 

But it just, takes exposing yourself to different things, trying different things, figuring out like what you really thrive in and what you don't like. For example, I learned through my work at IRC that I really like problem solving.

That's not a career that's, you know, that's just one trait that you [00:37:00] might have. But, you know, using that to your advantage, thinking through those things that you are really strong at, that you really like doing, that will not only make your resume or cover letter better, but also it helps you just think through the types of work that could or couldn't be a good fit for you.

Duncan: Well, thank you so much for your time today.

Bayle: Thanks, Duncan.

Duncan: that was, for me, incredibly illuminating. And I think it offers a lot of practical advice

Bayle: Hopefully.

Duncan: to undergraduates because I think they're dealing with the same, right? There's a lot of [00:37:30] uncertainty right now, especially with technology changes, political changes.

So I think the more information you have about potential jobs, and I think mentorship too can be quite helpful in navigating what is really uncertain for a lot of people.

Bayle: Yeah. And I think hang in there because even if you end up at a really crappy job that you don't like, you will learn something about yourself through that experience, and it won't be forever. Yeah.

CONCLUSION

Bayle: Bayle Conrad's journey from [00:38:00] paralyzing anxiety to confident Advocacy isn't a straight line. It's a story of stumbling forward taking jobs she wasn't sure she was qualified for, making decisions that seemed contradictory. Carrying questions that were never fully resolved. Through it all, there's been one constant. Her commitment to agency, to recognizing power dynamics, to constantly checking herself and treating every person with dignity. For students listening, especially those who feel like they don't fit. Who struggle with anxiety or shyness, who carry [00:38:30] uncomfortable questions about power and privilege.

Bayle's story offers permission. Permission to not have all the answers, permission to stumble permission to take jobs that are not 100% aligned with your interests. Permission to turn down opportunities that don't feel right, and it offers reassurance. The things that feel like weaknesses might actually be strengths.

 The questions that won't go away might be what makes you good at what you do. Give yourself grace. Nothing is set in stone. Explore what's out there, learn what you're good at. Ask for [00:39:00] help even when it feels scary, and hang in there because even the worst jobs teach you something and nothing lasts forever.

Most importantly, trust that your path doesn't have to look like anyone else's. Trust that the questions you're asking matter. Trust that you'll find your way even if you can't see it yet.

Thank you for joining us for this two-part conversation with Bayle Conrad. For more information about EthnoMed and our work in Cross-Cultural Healthcare, please visit our website at ethnomed.org.

This is the EthnoMed [00:39:30] podcast. I'm Dr. Duncan Reid. If you enjoyed today's episode, please share it with a friend or colleague. Thank you. until next time.