Fatima, mother
of eleven children, had watched as her town in northern Kurdistan was turned
from a small river community into a combat zone. With foreign armies marching
through her city and one son taken into captivity, her family fled to a refugee
camp in the bordering region. Years of economic sanctions and multiple home
displacements had already made life difficult. So when Fatima learned of an
opportunity to move to the United States, she knew it was a chance for a better
life. Departing her homeland was no easy decision, it was a last resort to save
her family.
For Fatima, family stability was the ultimate goal — to travel across the ocean to America was the only possibility of providing it, along with good health. Once in the U.S., her adult children traveled by bus to factory jobs and took English classes on the weekends. Her younger children thrived in the public-school system. Still, Fatima struggled to support her family because the culture, language and people were so unfamiliar. “Our lives have changed a lot and we are grateful,” she said, smiling uneasily. “But in a way we were forced to choose this life and say we are happy.”
* * * *
Refugees
like Fatima who face displacement from their ancestral homes are particularly
vulnerable to suffering from physical and mental illness. Their obtaining
treatment is often further complicated by a general distrust in western
healthcare systems and providers that are in many ways different from what they
are accustomed to.
With
issues of mental health or preventive care, refugees like Fatima are often less
inclined to pursue treatment than with more acute, immediate health issues.
Unless a health issue requires immediate, prompt care, trips to the doctor are
avoided. Underlying problems go unaddressed, with a focus on day-to-day
regimens of earning money or finding food. Ironically, refugees relocate
because of a desire to live better lives, so the simultaneous challenge of
incorporating good health should be a natural symbiosis.
In addition,
the majority of refugees like Fatima are uninsured, and even highly skilled
workers receive minimal wages. After eight months in America, those covered
through the Refugee Medical Assistance
Program must find another source of health coverage. According
to the Office of Refugee Resettlement, about 61 percent of refugees who find
jobs receive employee health coverage. But the safety net and temporary support
of a case worker doesn’t always shield refugees from problems caused by the
complexities of the U.S. health care system. Chief among those problems is the
language barrier and a lack of cultural competency.
For
example, Fatima, along with tens of thousands of Kurdish refugees, were
assigned the same birthdate (July 1) regardless of their real day of birth,
which naturally causes issues in determining a patient’s actual age. Also, just
because a refugee patient is now in a safer place, it doesn’t mean they are not
terribly frightened. Much can also be lost in translation due to a language
barrier. A simply inability to communicate can further compound cultural
barriers, cause stress, and lead to poorer health outcomes for refugees.
As
healthcare providers we can become prepared to understand the challenges our
refugee patients face. From my experience, patients may seek urgent care simply
because they want to share their trauma with another human and be heard, a form
of therapeutic treatment in itself. Whatever the case may be, it is possible
for refugees to receive proper treatment through “culturally competent” care.
This can
mean better translation services, cultural awareness, community support, and
medical providers who are able to understand unique needs after a past that
could include serious traumas and even torture. To help them further navigate a
seemingly-foreign health system, you can keep a list of specialists who offer
low-cost healthcare on regular basis. Or call multiple pharmacies to make
sure they have the generic version of the drug they need in the cheapest price
tag. The point is, to best prepare for refugee patients of the future, we must
begin planning for their care today.
