Gardening is probably not the first thing you picture a primary care physician doing at their place of work, but Mango House is far more than an office to Parmar and those he serves.
In addition to medical services, Mango House includes tenant spaces for refugees and asylees to use, including dozens of shops, seven restaurants and about 15 spaces for meetings, events and religious gatherings.
Parmar is of Indian descent. He said his family was on the privileged side of immigration.
Parmar shared that on the flip side of that are the refugees, asylum-seekers and undocumented people — populations he was determined to help. But he didn’t want to limit his services to medicine -- partially, he said, due to an aversion to boredom.
“You’re going into family medicine because you like doing a little bit of everything. You don’t want to just do one body system or one gender or one age group,” he said.
With the help of others in the community, including a talented pharmacist from Ethiopia and a driven dental hygienist, Parmar was able to expand his medical services. And thanks to his purchase of a building that was once a JCPenney, he had plenty of space for other opportunities.
At Mango House, Parmar has a unique glimpse into the lives of refugees from many different countries, and in addition to medical practices, business ownership, conflict resolution and gardening, he has become an expert in cultural competence.
Cultural competence holds various definitions, but overall refers to a set of values that allows someone to operate in cross-cultural settings through education, understanding and respect.
People, for example, can exercise cultural competence through acts of service.
According to Parmar, many well-intentioned people are inspired by the mission of Mango House and want to give back, oftentimes with small financial contributions or by donating items.
Despite the fact that Mango House isn’t equipped to accept donations, Parmar uses these opportunities to encourage others to dream bigger when it comes to contributions by using their unique skills and talents instead of their checkbooks.
Cultural competence is a phrase commonly used in conversations around diversity, equity and inclusion. But what does it look like in practice?
Some might assume that, due to the ethos of Mango House, it is a nonprofit. But Parmar intentionally runs a for-profit medical office.
“That simply allows me to think and move much quicker,” he said. “Nonprofits have boards, you have to ask a lot of people and those checks and balances are put in there for a reason. But the opposite of that is innovation.”
Parmar said this autonomy Mango House function more smoothly. Business owners are motivated by their own decisions and mistakes and patients receive care catered to them. “We try to focus on the patients and the ways we know that work best,” he shared.
Parmar says an important element to cultural competence is the realization that “culture” is not limited to heritage.
“A lot of people don’t realize what I do is deal with the culture of poverty, which is not a refugee-specific thing,” he said. “We have plenty of it with people who are born in the United States ... and there’s plenty of it around the world.”
Understanding poverty comes with a thorough grasp on the way it affects people’s day-to-day lives.
“Some do not have a reliable cellphone, or a reliable car. Or maybe they come from backgrounds where they’re not taught some of the same manners in the same ways because they didn’t have as much hope when they were growing up,” he said.
In order to address poverty, Parmar first examined his business model, which helped make his clinic more accessible. This starts with his walk in-only model. “If you don’t have to call for an appointment, you don’t need a phone, you don’t have to worry about what time the No. 15 bus is going to get here on Colfax,” he explained.
“They come in with language barriers, cultural barriers or other. We call them social determinants of health,” he said. “They might have housing needs or food needs -- unpredictable reasons why they cannot follow your instructions as a doctor that makes them a more challenging patient, rather than in a richer neighborhood where you just say, ‘take this medicine, see you in two weeks.’”
Another barrier Mango House addresses is affordability. Parmar accepts Medicaid. He said the lack of Medicaid practitioners is partially because Medicaid and Medicare pay doctors about a third less than many insurance companies.
However, he said, sometimes the difference in pay is offset by the reliability of Medicaid payments compared to other forms of insurance, as navigating insurance can be complicated for both patients and doctors. “You never know whether you’re going to get paid that amount. With Medicaid, you actually do get paid. So it’s a misconception that a lot of doctors have.”
Having staff hailing from the various cultures the office serves also helps in providing care.
“We know the communities very well. We know their groceries, their pastors, their daycare leaders. We just know what makes them tick,” said Parmar.
A side effect of this in-depth knowledge of his patients’ communities, Parmar said, is joy.
“You really get to know them, where you sponsor their cricket team, where you shop at their grocery stores, where you attend their funerals,” he mused. “This all becomes part of family and that becomes your joy.”
Elle Naef is a multimedia producer at Rocky Mountain PBS.
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Credit: William Peterson, Rocky Mountain PBS
Credit: William Peterson, Rocky Mountain PBS