New generation of Somali women is on the rise in Minnesota

When Sahra Noor first visited People's Center Health Services, she was a harried college freshman and the single mom of a toddler. She had arrived in the United States two years earlier after spending most of her teenage years in Kenyan refugee camps.

She returned to the center last summer as the chief executive of what is now a network of clinics headquartered in the Minneapolis' Cedar-Riverside neighborhood.

In the 15 intervening years, Noor earned a graduate degree and rose rapidly in health care leadership. But she says she will draw heavily on her back story as a patient — at a time when the pressure is on for safety-net clinics to better track patient results and cut costs. The proud Somali community of Cedar-Riverside has high expectations of Noor, as well.

"I see myself as a cultural broker, someone who understands the American health care system and the needs of low-income and immigrant communities," said Noor.

Over the past decade, a growing number of Somali-American women have launched successful professional careers. Now, some are aiming higher, eyeing new roles as decisionmakers.

On a recent morning at People's Center, Noor stepped out of her uncluttered corner office for a twice-daily ritual. She strode briskly through the clinic's ground floor, pausing to chat casually with patients in the waiting room and peeking into the new pediatric wing. A welcome sign in a dozen languages and a sign-up sheet for an immigration lawyer are posted on the pastel walls.

The ritual is an antidote to Noor's biggest fear — that marooned in her office upstairs, she might lose touch with the front lines of patient care.

"We are dealing with people's lives, and we need to think like a patient," said Noor, who started in August.

The center opened in 1970 as an all-volunteer operation with limited hours. By the time Noor became a patient in 1998, it was a full-fledged community clinic.

It was among a growing number of providers that rely largely on publicly subsidized coverage such as Medicaid as well as state and federal grants, but also aim to save taxpayer money by warding off costly emergency room visits and hospital stays.

Once Noor rushed in as her 2-year-old daughter cried in pain from an ear infection. The young mom had lapsed health insurance and no appointment. The nurse practitioner who treated her daughter gave the young family free medication and that ineffable "reassurance everything would be OK."

Noor had arrived in the United States at age 18 and squeezed a high school career into two years at a Virginia alternative high school. In Minnesota, Noor and her daughter moved into a Cedar-Riverside high-rise apartment so Noor could attend nursing school at St. Catherine University.

Noor had wanted to work in health care since she experienced firsthand the shortage of care at Kenyan refugee camps. Months after her extended family arrived there, relieved to have survived the fighting back home, tragedy struck: A pregnant aunt died of a treatable illness while Noor battled malaria.

Those early experiences fueled Noor's resolve when she arrived in Minneapolis. She juggled college, motherhood and a part-time job: in a nursing home, a call center and later as a medical assistant at Hennepin County Medical Center. All along, she says, "I felt I had

to be the best at everything I did. Being a single mom, I wanted to make sure I did not become a statistic."

She got up at 3 a.m. to study before dropping off her daughter at day care and heading to an 8 a.m. class. She was overwhelmed — and determined not to show it.

"She didn't want anyone to cut her any slack," said Noor's sister, Ilhan Omar, now a Minneapolis City Council senior policy aide. "Her daughter was never going to be an obstacle or an excuse."

After graduation, Noor worked as a nurse at Hennepin County Medical Center. Dr. Osman Harare, a Somali patient advocate at the time, remembers her explaining carefully how immunizations, insurance and appointments work to patients. Noor remembers working with people on dialysis and with pacemakers, and yearning to be a leader who championed prevention.

From there, Noor's career picked up speed. She got a job at the Community-University Health Care Center, a safety-net clinic in the Phillips neighborhood, as a health educator and later an assistant clinic manager. During that time, she also got a master's in nursing and health systems administration at the University of Minnesota.

Next, she landed a management position spanning eight states with insurer UnitedHealth Group. Friends joked she had crossed over to the "dark side," but as a supervisor of case managers for Medicaid beneficiaries, she saw herself as a patient advocate. Later, she took over the language services and community health department at Fairview Health Services, with a staff of interpreters who spoke 16 languages.

At the time, she launched the Health Commons in Cedar-Riverside, an innovative bid to bring health care to patients' home turf. There, walk-ins could take wellness classes and get free consultations with volunteer physicians and nurses.

Cawo Abdi, a University of Minnesota sociology professor, says for years now Somali-American women have launched businesses and pursued professional careers, defying more circumscribed gender roles mothers and grandmothers might have hewed to in East Africa. Now, Abdi predicts, more of them will rise to leadership positions, challenging an expectation — in the society at large and within the Somali community — that "women should not be too loud or too assertive.

"Young Somali women are becoming much more visible," Abdi said. "They are a part of the landscape now."

Stephen Blair Venable, a People's Center board member who led the search for a new leader, says Noor had it all: She is a seasoned health care leader, a former nurse with an intense focus on the patient experience, and a warm, personable presence. She also happens to be a trusted member of the Somali community, which accounts for 70 percent of the patients at the Cedar-Riverside location.

In the community, Noor's hire made a splash on social media. Somali leaders hosted dinners in her honor. Abdirahman Ahmed, the owner of Safari Restaurant in Minneapolis and a friend, held one of them. The dinner was emotional and celebratory, says Ahmed, but the guests also took the opportunity to give the new CEO a piece of their minds. Ahmed urged Noor to think big. He pitched a collaboration with the Mayo Clinic, with Mayo visiting hours at the center.

Noor has heard much more since. Omar, her sister, passed on feedback from several patients who thought the clinic could change its scheduling to make short-notice appointments easier and ensure that calls from patients did not go unreturned. "Oh my god, we pay consultants for that kind of feedback," Noor told her sister. "Give these patients my phone number."

Since, Noor has launched a call center that tracks call waiting and response times.

"In the Somali community, Sahra is family," said Omar. "People are comfortable giving her criticism and opinions. That also creates a lot of pressure, but she excels in pressure."

Noor already has a lengthy to-do list. She'll work to deepen a partnership with nine community clinics that banded together into an "accountable care organization" under the Affordable Care Act. Under the model, the state rewards clinics for patient results and Medicaid savings.

She's also gearing up to launch a new initiative to integrate the services the center offers, which include dental and mental health care. The idea is that if a busy mom comes in for a child's checkup, the center would also seamlessly fit in a dental exam and, if needed, face time with a social worker.

In returning to the center, Noor once again finds herself juggling a lot. Noor, who married six years ago, has a toddler and a new college student at home. The job is demanding: compliance deadlines, leadership meetings, new projects, all under the watchful eye of a patient community that sees Noor as one of its own. "It's OK to say no," Denise Ryan, Noor's assistant, told her recently.

But Noor feels a sense of purpose and, as her sister puts it, "a sense of homecoming."

"I am impressed," Venable said. "Sahra is rising to the challenge — as I expected she would."

Mila Koumpilova • 612-673-4781