When pediatric patients follow a member of the medical staff at the B Street Health Center down the hallway to step on the scale and take a look at the eye chart, they often stop to ponder the bulletin board filled with clippings about the high school soccer team.
"Devil's story has perfect ending" reads one headline, right across from a sign reminding patients to take off their jackets and shoes before stepping on the scale.
Those newspaper clippings are part of a strategy in helping kids understand how important it is for them to take responsibility for their health and well being in order to reach their goals.
"Want to be on the soccer team when you grow up?" the medical assistants ask children before requesting they read the third line of the eye chart. "Make healthy choices."
The clippings provide a window for the medical staff at B Street to talk about the key components of growing up healthy: eat well, don't do drugs, listen to your parents, exercise and study hard in school. In 2015, as detailed in ONE GOAL: A Coach, A Team, and the Game That Brought A Divided Town Together, Lewiston's Blue Devils soccer team brought the high school its first state championship in soccer, with members of its immigrant community leading the way and acting as role models to future generations of athletes.
Since 2001, Lewiston, Maine – a former textile mill town that sits on the banks of the Androscoggin River – has seen a steady flow of thousands of African immigrants settle in its many vacant downtown apartments. Some 25 percent of the high school's population is from this community, the majority of whom are Somali families who moved to Lewiston after being relocated to the United States from refugee camps in Africa.
The B Street Health Center's full-service medical practice sits in the heart of downtown, its red brick and glass entrance welcoming patients from the surrounding neighborhoods, some of which are the poorest in the state. Open weekdays from 7 to 7, B Street offers comprehensive primary medical care to Lewiston's downtown community. The clinic's cultural brokers help families navigate health care needs, providing translation services and explanations for things that might not be clear.
Just upstairs in the same building sits Maine Immigrant and Refugee Services. In 2008, when MEIRS was the Somali-Bantu Youth Association and held its meetings in the basement of a subsidized housing apartment complex, it asked Somali youth what they wanted, what they needed. Homework help, many said. And soccer.
"We paired school with soccer," remembers Abdikadir Negeye, one of the organization's founders, in ONE GOAL. "Do the homework, work on academics, and then go to the field and practice." MEIRS has now grown to offer culturally and linguistically competent counseling and mental health services for all ages, working closely with B-Street providers.
While soccer isn't health care, per se, it provides a useful place to focus when talking to kids about good health and good decisions. It is a buffer to the daily acute dangers and longer-term chronic disease risks that spike for children living in poverty. While many varsity athletes get their annual sports physicals at B Street, nurse practitioner Carolyn McNamara states that the work starts in early childhood, encouraging kids and families to maintain cultural traditions, including limiting junk food, keeping connections to elders, and staying physically active playing soccer. While soccer is cultural and not religious, kids who play soccer are more likely to follow religious guidelines, such as avoiding alcohol and delaying sexual activity. They are more likely to have mentors in older coaches and athletes from their community rather than other influences, including classmates engaged in high-risk behaviors.
In many ways, the Somali adults that found their way to Lewiston have been public health experts their whole lives, protecting their families and finding them a safe place to grow up, get an education, and raise their own children free from civil war, drought, famine, and infectious diseases such as cholera and tuberculosis. But once settled, there is more work to be done.
"Leaving a refugee camp is just the beginning," says McNamara. "The safety of kids and family unity requires constant vigilance and work, because there are so many threats to all kids' health in the United States." These threats include obesity due to poor diet and a sedentary lifestyle, causing hypertension and diabetes in adolescents; early pregnancy; alcohol, tobacco and substance abuse; depression and suicidal ideation; and a breakdown of communication within families due to language and cultural barriers between generations.
But the power of community cannot be underestimated. When a series of fires ravaged some of Lewiston's downtown apartment buildings a few years ago, leaving hundreds homeless, the community made sure everyone was safe.
"All the Somali Bantu families found housing with friends and relatives while their non-Somali neighbors had to move into public facilities or short-term hotel rooms provided by the city until they could find somewhere to go," writes Catherine Bestemen in her important book Making Refuge: Somali Bantu Refugees and Lewiston, Maine. Indeed, she continues, the creation of this kind of safety net is exactly why the Somalis migrated to Lewiston in the first place: to be able to build a community that could withstand catastrophic moments.
Still, the grind of health and safety that kids face on a daily basis is a tough one. With certain health risks in the rearview mirror, the racial and socioeconomic health disparities we are so familiar with in the United States remain headlines for the medical staff at B Street to battle.
But at B Street, a few headlines about a championship soccer team can help counter them. "Soccer," says Warsame Ali, who scored the game-winning goal in last fall's state championship game, Lewiston's second title in three years, "is life."