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Refugees Get Off to a New Start with Health Care Services

The United States has a longstanding history of accepting refugees in search of a new life, all of whom have fled war-torn countries or cannot safely return to their home country. After a lengthy vetting process, refugees approved to enter the United States are resettled where other relatives are already living or placed in areas based on the best match between a community's resources and a refugee's needs. Approximately 3,000–5,000 refugees per year have resettled in New York State, the majority in the upstate region.

Although refugees come from different parts of the world, many experience similar challenges as they seek adequate medical care in their new communities. These challenges are often exacerbated by their exposure to torture, terrorism, poverty, and lengthy stays in refugee camps, as well as cultural shock and language barriers. In the last decade, upstate New York has been home to health care clinics that have either shut their doors to new refugee patients or have closed down altogether because of the financial burden of treating these patients.

However, two NYSHealth grantees have found a way to overcome these challenges: Rochester General Hospital (RGH), which devised a financially sustainable refugee health care model, and the Jewish Family Service of Buffalo & Erie County, which launched the Western New York Center for Survivors of Torture, the first of its kind in upstate New York.

Below are the stories of resettled refugees and their families who received quality health care services from these organizations, helping them rebuild their lives.

Som Gurung* resettled in Rochester in 2015. He was a victim of ethnic cleansing in Bhutan in the early 1990s and fled to Nepal, where he lived in a refugee camp for 21 years. Som entered the camp alone at the age of 13 and has spent the majority of his life behind its barbwire confines. At the camp, he suffered from severe weight loss, but the camp doctor treated him only with vitamins.

After resettlement in Rochester, Som met with staff members from RGH’s refugee health care program, and it was quickly discovered that he had juvenile diabetes that was never treated. Som entered into immediate treatment and was introduced to his new doctor. Over a period of several weeks, his diabetes was controlled and he returned to a normal weight.

Initially, Som’s care was delivered in Nepali and all his prescriptions and patient information were written in Nepali so he could understand. Since his arrival, he has learned English and is now in a local community college learning to be a nurse. Without the intervention of the program, Som would have continued to suffer from his untreated diabetes and would eventually have ended up in the hospital with serious complications and expensive care as a result.

To date, the Rochester refugee health care program has entered more than 6,000 newly arrived refugees into primary care services—each one with a similar story. Through the efforts of the program, thousands of refugees have been able to access appropriate health care while the community has benefited from decreased health care costs through the elimination of unnecessary emergency department visits and hospitalizations.

Mohammed Hussan* is an Arabic-speaking refugee from Iraq; because of his Christian faith, he was jailed and beaten in his home country. He fled the Gulf War with his wife and two children and was housed in a temporary refugee camp in Jordan. Mohammed could never return to Iraq, and Jordanian authorities wouldn’t allow him to gain citizenship there. An intelligent, hardworking man who had worked as a carpenter in Iraq, Mohammed and his family arrived in Rochester in 2014.

Upon arrival, they spoke no English and knew no one here. Mohammed also suffered from post-traumatic stress disorder (PTSD). Despite their best efforts to survive in their new city, Mohammed and his family were isolated and had no understanding of how to access resources for help.

Through RGH’s regional refugee health care program, Mohammed and his family received immediate access to care with a culturally sensitive doctor. The site where he received care had appropriate interpreters and support personnel who could help Mohammed beyond the delivery of medical care. His family was assigned an Iraqi peer counselor through the clinic, and they were taught how to increase their independence in accessing health care and how to use the bus route to the clinic. The family’s medical issues were appropriately addressed, and Mohammed gained access to mental health services.

The peer counselor connected the family with an Arabic support group, English classes, and job training at a local nonprofit educational center. Mohammed’s wife was connected with a person in the children’s school system who spoke Arabic and helped the children enroll in school. A few months after arrival, Mohammed was able to find a job as a carpenter—enabling the family to get off public assistance. Mohammed’s therapy sessions helped him overcome some of the symptoms of PTSD, and the family is getting regular preventive care check-ups and has developed a trusting relationship with their new doctor.

Without the interventions of RGH’s refugee health care program, Mohammed and his family would have been at high risk for multiple emergency department and urgent care visits, as well as not getting connected with the right resources to successfully resettle in Rochester. Thanks to the program’s interventions, the family is living independently as productive citizens in Rochester.

Mr. Pha* knew no one in the United States when he arrived in Rochester in 2009 as a refugee from Burma. But within his first week here, he was able to find a place to stay, receive a health screening, and get school placement assistance with help from RGH and the hospital’s local refugee resettlement partners.

Just one year earlier, the only health care option for refugees like Mr. Pha was through costly trips to the emergency department; the last two clinics that had been serving refugees in Rochester had closed their doors. Instead, Mr. Pha was able to access primary care services through RGH’s refugee health care program.

Through this program, when Mr. Pha arrived in Rochester, he underwent an initial health assessment, was assigned a primary care provider, received health-related materials in Burmese, and had access to a translator when meeting with doctors. In addition to receiving health care services, Mr. Pha took a course through RGH designed to help refugees develop their interpreting skills. Mr. Pha now is in sound health and has full-time job, and he remains committed to giving back by staying connected with the Rochester refugee community. He helps fellow refugees navigate some of the American systems that may be unfamiliar or confusing, such as bus and other transportation schedules and public school enrollment for their children.

“I now have opportunity and hope here. It’s a better life,” said Mr. Pha

Ms. E*, a 38-year-old refugee referred to the Center by one of its local partners. Attacked by a militant group in her home country of the Congo because of her beliefs, she was kidnapped, raped, brutally tortured, and mutilated. As a result, Ms. E suffers severe symptoms of post-traumatic stress disorder, has hearing problems, and experiences difficulties in walking and with her circulation.

Referred to the Center by one of its local partners, Ms. E began working with a care coordination team in October 2014. She was involved in creating her own case plan, which included stabilizing housing, accessing health care, and seeking rehabilitative activities. The Center’s staff has assisted her in finding appropriate health care providers; conducted medical and psychological forensic evaluations; coordinated with her immigration lawyers; and provided emergency assistance as needed, such as food cards and transportation.

After extensive counseling and assistance from the Center, Ms. E has begun feeling better medically. She has placed her trust in the Center and its staff, and also has begun to smile and laugh again. She now volunteers by tending to the Center’s garden, which has helped her break down fear and allowed her to express feelings about her new life in the United States.

Mr. B*, now 36 years old, had been a successful professional in Nigeria, but because of his ethnicity, he was extorted by a criminal group. When he would not pay the extortion, he was kidnapped, placed in a government-run prison, and beaten by prison guards. As a result, he suffers from anxiety and is afraid to be in contact with anyone from his community.

Referred to the Center, Mr. B was involved in creating his case plan, determining the direction and order in which services are provided to him. Since he started at the Center, he has received many services to help him rebuild his life, including medical and psychological forensic evaluations; health services; assistance with employment authorization and employment services; psycho-education on the effects of torture and trauma; training on relaxation techniques and coping skill mechanisms; rental assistance; referrals for prenatal care and WIC for his wife; and linkage with a religious organization so he can practice his faith.

As a result, Mr. B has developed an increased interest in giving back and has begun looking for ways to help survivors. He is able to function in a wide range of activities to support his family and have a relatively safe and stable life.

Read more about the development, implementation, and replication of RGH's innovative health care model for newly arrived refugees in the NYSHealth report, "Opening Doors: A Sustainable Refugee Health Care Model." Watch a video about the model’s impact on newly resettled refugees, along with the community and health benefits it has generated.

*Name changed or hidden to protect privacy

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