Catholic Charities Southwestern Ohio

Jeff Harmon, Summer 2011

I thought I had turned off the radio on my way to the Hamilton County Tuberculosis Clinic. A Bhutanese man and his niece I was transporting had just arrived in the United States, and both had tested positive for tuberculosis. I assumed neither would like the music on the radio, and I did not want them to suffer listening to talk radio in a language they did not understand. As a result, the ride home was silent. I drove fast. I felt anxious driving a TB positive man and his niece at all. I could think only about how much longer I would be in charge of them.

Ten minutes into the ride I heard a soft, unintelligible voice. I assumed I had accidentally turned the radio down (as I usually do when refugee clients are in my car). However, in reality it was the small two year old girl, singing in Nepali and staring out the window. She said nothing at the clinic. She had only opened her mouth for the physician to check the back of her throat. I spent the entire day worried about having two refugees with TB in my car — despite the fact that it is non-transmissible in its latent form. This young girl's voice was a relief. Her voice refocused my attention on the fact that I was transporting a sweet little girl and her adoring uncle who arrived from refugee camps in Nepal in search of health and happiness in the United States. This experience summarizes my experience at Catholic Charities. I learned that these refugees' identities transcend their medical and socioeconomic status. More broadly, my experience at Catholic Charities mirrors the experience of all the medical students who have participated in the Urban Health Project; the patients we will serve as physicians have a depth of personality that we will need to understand in order to properly address their health needs.

The U.S. State Department accepts the refugees Catholic Charities resettles from the UN High Commission for Refugees. Catholic Charities serves these refugees for between three and five years. Most are largely independent after three years. Reception and Placement (R&P) lasts only 3 months. They are provided with housing and cash assistance during this time. They are also enrolled in English as a Second Language (ESL) courses and in Medicaid for either 8 months or 3 years for mothers and their children. Furthermore, the refugees receive a range of employment services, including work assessment for the disabled and coaching for employment interviews.

I primarily managed the refugees' healthcare. I can proudly say the healthcare coordinator at Catholic Charities, another intern and I served 193 refugees out of a population of approximately 400 during the month of July, 2011. We communicated with their healthcare providers, scheduled physicals, immunizations, neonatal care, and specialist visits. We also transported them to their appointments and coached them in taking their prescription medications. Our goal has been to reduce the burden health problems place on them so they may focus on building a life in the United States. The young girl and her uncle I spoke of are Bhutanese refugees who arrived from Nepal. Both tested positive for tuberculosis, a disease that survives on the margins of society in the United States, mostly in the homeless populations and immigrant poor. The burdens they face in coming to the United States are already prohibitive to gaining employment and attending school. The medical care we assist in providing them truly changes their lives.

From my experience I have learned not only what it is like to live on the margins, but also what it is like to feel the isolation of being a refugee. Their lack of English skills and basic misunderstanding of American society — and that of the developed world — are a hindrance. However, the aspirations of these people should not necessarily be underestimated.

One client, a young man from Eritrea named Merkeb makes frequent use of the medical care available to him. He once laughed at me for using hand sanitizer in a hospital and exclaimed confusion over all the paperwork he has been required to fill out for each medical visit. I asked him what he likes to do at home when he is not at medical appointments or in school. I had assumed he enjoyed playing soccer. He told me he enjoyed doing math problems and reading. He wants to attend college in the United States and eventually reunite with his father and sister who were resettled in Toronto, Canada.

The refugees' experiences illustrate a population adrift, often unaware of how to be proactive with their health and finances. All grew up in camps where everything was given to them. Some are settled into passivity. However, many others actively learn English, seek employment, and try to provide what little they can for their families. They are slowly adjusting to living in the American suburbs and learning what being a good neighbor entails. They are doing their best to survive as they always have. And my role is to make sure their health is not one thing that prevents them from doing so.