Catholic Charities Southwestern Ohio

Ayesha Hasan, Summer 2010

As someone that grew up surrounded by immigrants, I felt that I was uniquely situated to understand the obstacles and difficulties encountered by newly-arrived refugees to the United States. I came to discover this was far from the truth. As the Urban Health Project intern working with Catholic Charities of Southwest Ohio's Refugee Resettlement program, I gained a greater understanding of the obstacles faced by displaced individuals in obtaining quality healthcare. I was designated the role of assisting refugees wade through the quagmire of the American healthcare system.

From a physicians point of view, delivering healthcare to refugees is a challenge - a number of barriers existed that impeded the development of healthy doctor-patient relationships. The majority of refugees that I worked with had never been formally examined by a physician other than their intake interview conducted by a UN official. Furthermore, a few of the refugees that had lived under repressive regimes had been mistreated and even tortured at the hands of doctors. Thus, the unease of a few of the refugees during medical interviews was palpable. Their bright and smiling eyes would all of a sudden narrow with suspicion as physicians began the examination.

Even when trust was established between the refugees and their physician, communication remained lacking and imperfect. The two main refugee populations that Cincinnati hosts are Burundian and Nepali, and while every healthcare facility is required to provide a translator for the interview, it was often difficult for physicians to phrase questions in a manner that made sense for the refugees. For example, because few knew how to count, it was difficult for them to relate the level of pain they were in on a simple one to ten scale. Additionally, because different cultures view the concept of 'family' differently from Western culture, patients would often relate the medical history of their neighbors when asked about their 'family medical history' and at one point, three women had separately claimed that they were the mother of one boy. While the language barrier had been surmounted, significant roadblocks to communication continued to exist.

Even though it was impossible for me to talk with the refugees I worked with without a translator present, we devised ways of communicating with each other nonverbally. I carried around pictures of the different clinics that the refugees visited, so I could show them where I was taking them on the day of an appointment. One of the highlights of my summer was during a two hour wait in an ophthalmologist's office when I handed an elderly Burundian woman an H&M magazine. She proceeded to flip through it, pointed to articles of clothing and taught me their names in Kigali, while I taught her the names in English. The resilience of spirit and willingness to learn exhibited by the refugees I worked with was immensely inspiring.

On a personal level, it was often difficult to watch the families that I worked with struggle to explain themselves to physicians, only to be misunderstood When I could, I tried to assuage confusion but oftentimes the only thing I could do was just stand back and make a mental note about the importance of taking one's time when conducting a medical interview and asking the same question in multiple ways.

This internship was an extremely challenging but undeniably rewarding experience. The exceptional individuals that work at Catholic Charities Refugee Resettlement Program adore their professions and strive to provide as much support and assistance to a population of people that could not be more deserving. I am grateful to have had the opportunity to work alongside them.