African refugees to United States lack access to adequate health care

African refugees need high-quality health care

[A special thanks to Kelly Corr, M.D., who contributed to this blog]

With the continuous influx of refugees into the U.S. health system, they represent a unique minority population that challenges clinicians. As noted previously in this blog, racial health inequities run rampant in this country.  However, one group not well understood nor frequently cited in the health disparities literature is refugees and, more specifically, African refugees.  The United States currently has 275,461 refugees from all over the world and 69,003 of them are from fifty-one African countries.

Refugees endure overt and subtle degrees of discrimination due to their minority status and “otherness” in U.S. society. Moreover, numerous cultural, religious, educational, economic, language, social and political barriers impede their ability to lead a successful, healthy lives in the United States. While they may gain economically by living in the United States, they lose significantly in terms of social status and their ability to negotiate the societal waters.

Upon their resettlement to local communities in the United States, refugees undergo health assessments through local health departments. They are re-screened for tuberculosis and other communicable diseases. Cases unearthed in this fashion are treated within the health department. Depending on the health department, other health problems brought to light in this assessment are either treated there or referred to a primary-care provider.

This hand-off of care to the primary-care sector does not always go smoothly, and refugees often find that follow up on medical problems after their initial health assessment is lacking. Lack of access to primary-care clinical services is one of the major health problems plaguing the refugee population.

Local voluntary refugee agencies focus a lot of their attention on helping the newly resettled refugees find employment, hoping that their jobs will provide them with health care insurance or enough money to pay for health care services. The reality of getting entry-level jobs, with their concomitant poor pay and poor health insurance, means that refugees have unequal access to care.

Refugees present with unique conditions — many of which are preventable via vaccination and proper nutrition.  Refugees to the United States come with a wide range of problems, presenting a complex array of health concerns. Their diverse ethnic, geographic, socioeconomic, and other backgrounds adds further challenges to providing them with high-quality clinical care. Diagnosing illness is more challenging for providers due to language and social barriers, and the conflicts between the biomedical disease model and the disease perspective in refugees are significant. Another challenge confronting U.S. health care providers who treat African refugees is that these patients arrive from areas where illnesses such as malaria, schistosomiasis, and other “tropical diseases” may be endemic. These diseases are not seen by many U.S. clinicians.

In addition to trying to treat illnesses with which we may be unfamiliar, clinicians caring for African and other refugees also must care for patients who have undergone a great deal of physical and psychological hardships – both in their countries of origin and in their long trek to the United States. Emotional and psychiatric problems such as post-traumatic stress disorder, depression, and anxiety are prevalent and usually linked to exposures to violence.  Refugee patients often relate the causes of these psychological ailments to social disconnectedness and community alienation.  Their psychological discomfort often expresses itself as somatic complaints — a presentation that both makes it more difficult for biomedically trained clinicians to diagnose and to treat.

Sunday, August 15th, 2010 at 19:37