Healthcare of African Refugees

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Healthcare of African Refugees Immigrants
Challenges and Solutions

• Ralph Holcomb, MSW, PhD Abdisalan Mouse, MS

Al Kharaz Somali refugee camp, Yemen.
Oregon Chapter NASW Conference March 7, 2008
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What Were Going to Cover Today

• The felt experience of immigrants and refugees
• Background immigrants and refugees in the
  Portland area, mixed in with some
  
• Models for understanding the experience of
  transition
  
• Recommendations for intervention
• But first, some definitions
• Legal Refugee/Asylum/immigrant versus
  undocumented immigrants

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Refugees The Felt Experience

• Keep ancient lands, your storied pomp!" cries
  she With silent lips. "Give me your tired, your
  poor, Your huddled masses yearning to breathe
  free, The wretched refuse of your teeming shore.
  Send these, the homeless, tempest-tost to me, I
  lift my lamp beside the golden door!"
• Emma Lazarus

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The Felt Experience Opening Exercise

• The 10-minute refugee experience exercise
• On a sheet of paper, write down everything you
  value (your children, partner, possessions,
  degrees, knowledge, etc.)
  
• Wait for instructions

Al Kharaz Somali refugee camp, Yemen
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Refugee Stories
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Why Come to the USA?

• Conditions in various parts of Africa
• Conflicts
• Civil Wars
• Refugee camps

Block numbers in the Al Kharaz refugee camp each
number corresponds to age of child in photo.
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Four Possible Outcomes for Refugees and Immigrants
CONFUSED Cultural confusion (Individualism vs. C
ollectivism)
WITHDRAWN Cultural Isolation
ASSIMILATED Rejects old culture and embraces new
culture
INTEGRATED Bridges two cultures Makes most of t
he two cultures
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Understanding Refugee Health Transition to
Self-sufficiency A Two-Factor Model

• Similar Cultural Background
• Dissimilar Cultural Background

Unhealthy
Healthy
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Why Come to Portland-Metro?

• Already-established African immigrant and refugee
  communities critical mass
  
• Family members,
• friends

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Prior to Arrival in US

• Grueling selection process
• Background checking
• FBI Fingerprinting
• Health Screening

Somali mother and child waiting for rations at
Dabaab refugee camp in northern Kenya
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Portlands Refugee and Immigrant
Population-Statistics

• First African Immigrant Refugee came to Oregon
  1972 (probably).
  
• Current Population (IRCO estimate)
• 24,000 African Immigrants and Refugees in the
  Portland-Metro Area
  
• The 2000 Census
• Foreign born population nationally grew 57
• Oregons foreign born population grew by 108,
  16th fastest growing state.

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Portlands Refugee and Immigrant Population
(cont.)

• 11 of Portland population foreign-born, (9 in
  Oregon as a whole)
  
• Foreign-born is 13 of city population
• 53 arrived since 1990 Almost one-third arrived
  after 1995
  

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USA Refugee Admissions in FY 2005 and FY 2006
Source Bureau of Population, Refugees and
Migration Proposed Refugee Admissions for
Fiscal Year 2007 Report to the Congress
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Refugee Arrivals in Portland-Metro Area by
Country of Origin, 2004-2005
22 of Total
Source Oregon State Refugee Office
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Refugee Arrival in Portland Metro by Continent
Source Oregon State Refugee Office
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Portland Refugees Year over Year Change
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Overview Continuum of Care
ACUTE PHASE Arrival to 8 months Oregon Refugee
Resettlement Program
Somali Refugee Camp, Yeman
CHRONIC PHASE Beyond 5 years Self-sufficiency
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Continuum of Care - Acute Phase

• 0 - 8 months
• Poor health background
• Refugee trauma
• Communicable diseases-TB Hepatitis B
• Malaria, Typhoid Fever, Malnutrition, Parasites
  and Trauma
  
• Insurance coverage (Medicaid) during this phase
  only
  
• Mandated attendance to acquire life skills
  (English, jobs)

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Illustration of Acute Phase

• 50 year old widow and her two sons aged between
  14-19
  
• The 19 works graveyard full time
• The 14 years old full time student
• The 50 year has trauma diabetics hypertension
• Later diagnosed with TB
• Navigating the health care and its complex
  appointment system

Woman carrying water, Somali refugee camp
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Continuum of Care- Transitional Phase

• 8 months - 5 years
• Begin to develop diabetes, hypertension, asthma
  and arthritis
  
• Are underinsured or uninsured
• 61 have income

Former professional footballer, now the camp
butcher.
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Illustration of Transitional Phase

• Adam and his wife Merriam with their 5 children
  (aged between 10 -19) come here in Oregon in
  2003.
  
• Father began working as a security guard while
  his wife started a part-time job as a
  housekeeper. Neither job provides health
  insurance.
• Father had hypertension and uses traditional
  medicine (garlic).
  
• 19 years son broken his arm went to ER and was
  billed 500 for emergency room visit.

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Continuum of Care - Chronic Phase

• Beyond 5 years
• Develop chronic conditions that never existed
  prior to arriving in the USA
  
• Remain underinsured or uninsured

Somali refugee camp in Kharaz, Yemen
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Refugee Dilemma

• Unlike any other established minority
  communities, the refugee and immigrant
  communities have had no specific program directed
  at them beyond the initial refugee screening.

Al Kharaz camp for Somali refugees in Yemen
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Policy Recommendations
TRANSITIONAL PHASE 8 months to 5 yrs

• Provide primary care services at MCHD to
  immigrants/refugees during transitional phase
  when OHP coverage expires if income
• Case manager for high need cases and programs.
• Health educator to provide Stanford Chronic
  disease self management classes and provide
  information/education on individual basis and to
  community.

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Practice Recommendations

• Increased Sophistication
• Africa is a continent, not a country
• Learn simple greetings Saying hello
• Understand traditional healers and tropical
  medicine.
  
• Establish trust and relationship
• Flexibility and humility
• Generosity
• Patience

Al Kharaz camp for Somali refugees in Yemen
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Questions? Comments?