Addressing Cultural Competency: Healthcare for Refugees & Minority Populations

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.”

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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.