By Gretchen Hammer
In 2012, Colorado welcomed roughly 1,800 refugees as new residents of our state. Mirroring national trends, in recent years the majority of refugees who settle in Colorado are Bhutanese, Burmese, from Iraq and Iran, and from African countries including Somalia, the Democratic Republic of Congo, Eritrea, Sudan and Ethiopia.
The path to Colorado is not smooth for many of these individuals and families. Many have spent years living in camps or moving from place to place to escape danger and suffering. By definition, refugees are persons who have fled their home country due to a well-founded fear of persecution because of race, religion, nationality, political opinion or membership in a social group. Each year the United States government determines how many refugees the country will accept for resettlement for 2013, 70,000 admissions were allocated. Globally, only about 1 percent of all refugees ultimately are resettled in another country, but of those that are, the United States welcomes more than all other countries combined.
Source: Colorado Coalition for the Medically Underserved. (Click on image to enlarge.)
Resettling to a country with an entirely new language, culture, food, weather, education and health care system can be daunting. To support individuals and families as they go through this transition, many local agencies are dedicated to supporting refugees as they adjust to their new lives. This includes everything from finding them housing to teaching them how to go grocery shopping. It means getting their children enrolled in school and helping them write a resume so they can seek employment.
Managing immediate and chronic health care needs of refugees and helping them learn to navigate our very complex delivery system is another important early issue. Each refugee admitted to the United States has an overseas medical examination and an initial public health screening once he arrives. In Colorado, the Colorado Department of Public Health and Environment manages the Colorado Refugee Health Program.
However, simply identifying health care needs is not enough for providers who aim to provide high quality care to refugee patients. Understanding the cultural traditions about health and health care is equally critical. Many refugees are used to relying on home remedies and traditional healers, and only seek health care as a response to a serious problem, as opposed to also seeking preventive care. There are also family structures and gender roles that can affect who and how refugees seek health care. To help providers better understand these customs and practices, the Refugee Health Program has a series of presentations designed for providers about the major refugee communities in Colorado. These presentations provide important insight into the cultural traditions about common health care issues for refugees including mental health, violence, childbirth, diet, chronic disease management and infections.
Another issue significantly affecting the health of refugees is the language barrier. Through a new collaboration between the Colorado Coalition for the Medically Underserved and Mercy Housing, I recently had the opportunity to sit down and listen to a number of refugees share about their health care experiences, and heard repeatedly about the importance of high quality language interpretation. Communicating about health can be hard even if the patient and provider speak the same language. For patients and providers who speak different languages, trusted and trained interpreters are an absolute must if both parties are to feel confident that critical health information is being shared accurately.
Beyond the issues of language and cultural competence, refugees mostly face challenges similar to those faced by other medically underserved Coloradans. These challenges include timely access to primary care services for children and adults, very limited access to oral health and vision services, difficulties with transportation to and from health care appointments, difficulties navigating complex and at times competing health care systems, and barriers related to cost. These issues are challenging enough on their own, so for refugees, differences in cultural norms and languages add an extra degree of difficulty.
Colorados recently resettled refugees have traveled a very long way to get here, and still have a long journey ahead of them to feel at home in our society. As we work to improve the health care system for all Coloradans, we must also account for the unique needs of our newest neighbors. This means that when we are working to improve patient and provider communications, we include translation services in our conversation. It means increasing access to primary health, oral health and vision care, and doing it in a way that is culturally sensitive. We must create smooth transitions of care that consider a patients unique situation and ability to navigate the system. It is the right thing to do for our communities, and it is the right thing to do for our state.
Access the full CCMU infographic on Colorados refugees at www.ccmu.org/refugees
Gretchen Hammer is executive director of the Colorado Coalition for the Medically Underserved.