Caring for Regugee and Immigrant Populations
by Kelly Kreisler, MD, FAAP
I nearly had an accident this morning. Someone pulled out in front of me, and I slammed on my brakes, cursing under my breath. I missed them by inches. “Pay attention!” I shouted to the inattentive driver that couldn’t hear me, as I nearly dropped my cell phone into my breakfast. Feeling lucky that nobody got hurt, I put down my phone and kept both hands on the wheel during the rest of my commute. The feeling of nearly getting into an accident reminded me of the day that working with refugees and immigrants become my passion and not just a casual interest. A miscommunication with a refugee patient nearly caused a serious error. It wasn’t intentional. Unlike a car wreck, where the damage is immediately visible, I might have never known that this accident had occurred. The language listed for the patient was a language spoken in their home country, and the patient could communicate a few words with the interpreter. Something just didn’t seem right. Knowing that I would be hopelessly behind for the rest of the day’s schedule, I “put down my cell phone,” and I asked the interpreter why my patient’s answers didn’t make sense. At the time I didn’t know the difference between a refugee and immigrant let alone the different languages and dialects spoken in Burma.
Definitions are very important for examination of demographic statistics, patients’ legal rights, access to services, etc. A refugee is someone who has a “well-founded fear of persecution for reasons of race, religion, nationality, membership of a particular social group or political opinion.” (United Nations High Commission on Refugees 1951) A secondary migrant is a refugee that relocates during their first eight months in the country. An immigrant is a person who comes to live permanently in a foreign country. Although Kansas may be viewed as a homogenous state, jobs for limited English speakers in farming and meat packing attract a large population of refugees and migrant workers to the area.
Refugees and immigrants are often disenfranchised populations that face significant barriers to accessing a variety of essential services. The Special Population Health section of the Kansas Department of Health and Environment oversees the Kansas Refugee Preventive Health Program and the Kansas Statewide Farmworker Health Program. Providing support to health providers who serve people with diverse cultures and languages is also an important function of this Section.
Migrant farmworkers in Kansas are typically foreign born and children of immigrants with 96% limited English proficient with about 68% Spanish speaking , 25% Low German speaking and a smaller group of Chuuckese speaking. The Kansas Statewide Farmworker Health Program assists approximately 5000 low income, uninsured migrant and seasonal farmworkers and their children to access primary health care services. This is achieved through a statewide voucher program that contracts with over 500 physicians, mid level providers, dentists, laboratories, radiologist, specialists, and pharmacists among others. A staff of bilingual (English/Spanish, English/Low German and English/Chuuckese) case managers and health promoters provide outreach, screening, referral, interpreting, health education and follow up to farmworkers to facilitate care and promote healthy lifestyles.
Approximately 500 to 800 refugees will be resettled in Kansas over the next year, but this number is double when secondary migrants are considered. Refugee populations being settled in Kansas include Burmese, Bhutanese, and in smaller numbers, refugees from various nations in Africa. While refugees must pass an oversees health exam before arriving in the United States, a domestic health screening during the first few months of arrival provides protection to the current U.S. population and helps to identified health issues that may impact on a refugees ability to work or attend school. Screenings include tests for tuberculosis, hepatitis B, lead, HIV and sexually transmitted diseases, parasitic infections, immunizations, mental health and a general physical exam. More specific information about the screening is found at http://www.kdheks.gov/olrh/refugee.htm . Referrals for follow up of identified health issues needing further care and referrals to a medical home are made through resettlement agency case management. Challenges in serving refugees include finding adequate interpreters of numerous refugee languages and providing services to refugee populations that are culturally sensitive and appropriate. The new Kansas AAP Task Force for Global and Immigrant Health was created to assist with connecting Kansas pediatricians with available resources to better serve a global population. The task force consists of resettlement agencies, community agencies, government agencies, and pediatric primary care providers in Kansas. For more information and resources, check out our new webpage at: http://kaaptest.com/?page_id=2814.
The Burmese patient I mentioned at the start is now a patient I follow in our refugee clinic. She is Karen, one of the many ethnic groups from Burma, and speaks a distinct language for which we obtain an appropriate translator. The story of her journey is heroic and inspiring, and if you put down your phone long enough, she will share it with you.