Improving refugees’ access to health care services is critical to managing diseases, promoting wellbeing, and increasing the quality of life in the country. Therefore, it is essential to conduct key informant interviews to collect relevant data and address ongoing challenges. This essay aims to identify the barriers to accessing health care in refugee communities in the United States based on the perspectives of Congolese and Afghan refugees and resettlement agencies, including case managers, ESL teachers, and job developers, in order to determine ways to address the problem.
Findings from the interviews with Congolese and Afghan refugees are presented in this section. It is worth noting that the marital status, household size, general background, religion, education level, and job industry of the interviewees differ, which allows for a more comprehensive perspective on the problem. In this regard, the Congolese refugee described the health services in his home country as poorer than those in the United States, where doctors’ expertise, quality of treatment, and access to medication are significantly better. The availability of a primary care provider (PCP) in Nevada was listed as an advantage. Nevertheless, the interviewee noted that seeing a specialist was more complicated in the US as they are unavailable in the refugee camp.
Overall, the Congolese refugee felt more “hopeful about getting better medical care” in Nevada. However, his experience accessing health services did not meet his expectations due to the long wait time and a complicated referral process. Furthermore, it can be concluded that Congolese refugees’ experiences with primary care providers are affected by insensitive and arrogant front desk receptionists, as well as a lack of professional interpreters. Inaccurately interpreted concerns and needs affect understanding between the client and doctor. These factors make refugees feel “very uncomfortable and frustrated,” discouraging them from further appointments. Language barrier and discrimination were identified as the main challenges for the Congolese refugee community when accessing healthcare. Therefore, one way to improve their experience is to ensure fair and considerate treatment from medical personnel and front desk representatives. Moreover, easier transportation and quality interpreting services must be available at all stages of healthcare provision.
The Afghan refugees describe doctors in their homeland as “very fast and helpful,” while medical knowledge, equipment, and resources are regarded as more advanced in the US. Interviewees emphasize the need to make appointments, get referrals, and wait longer as the main disadvantages of American medical care. Furthermore, health care services in Afghanistan are more flexible and accessible due to longer work hours. The US insurance system is another aspect that is new and unfamiliar to Afghan refugees.
Overall, Afghan interviewees described their experience accessing health services in Nevada as rather positive due to “very supportive” and patient staff and having “realistic expectations about the healthcare system.” One example where it did not meet the refugee’s needs includes difficulties scheduling appointments due to limited working hours that prevent clients from accessing medical care conveniently. Furthermore, Afghan refugees generally feel comfortable with their primary care providers, who are professional and show concern. Adaptability and knowledge of English can be identified as factors facilitating understanding and cooperation. At the same time, difficulty rescheduling an appointment and the need for continuous procedures were named as inconvenient aspects of American health care.
Challenges for Afghan interviewees regarding healthcare include the referral process, scheduling appointments, wait time and delays in access to medical care, filling out forms, understanding health insurance, and knowing one’s detailed health history. Faster medical care, easier referral process, reduced wait time, extended work hours, access to interpretation, and doctors’ availability on weekends would improve Afghan refugees’ experience in the US. Furthermore, the community’s needs include such health services as medical consultations at home, free over-the-counter medications, and education for refugees regarding medical insurance and making appointments.
Resettlement Agency Perspective
In this section, findings from the interviews with resettlement workers are presented. Case managers named different durations of working with refugees, ranging from several months to 22 years. Their main motivational factors to work in this position include supporting people in need and promoting cultural awareness by assisting refugees’ needs. The most common health and medical issues in their clients are “period pain” in women, “dental problems, high blood pressure,” as well as “vision issues.” At the same time, literacy and English language problems are widespread, which aggravates communication and the quality of health care. Refugees’ health impacts their overall progress toward self-sufficiency goals, particularly for students and workers. From case managers’ perspective, “providers should treat their refugee patients with respect” and have “cultural sensitivity” to make services more accessible. It is crucial to know that health needs vary in different refugee populations based on cultural and personal factors. Since Covid-19, online learning and social distancing have presented additional challenges for refugees.
ESL teachers that participated in interviews had years-long experience with refugees. They are mostly motivated by love for other people and the need to support vulnerable populations. ESL teachers describe the most common health and medical in clients as vision problems and a lack of knowledge of hygiene rules. Overall, the interviewees noted that health issues aggravated their students’ academic progress. In this regard, health service providers could ensure educational services for refugees, teaching them about health, wellbeing, hygiene, and safety to improve health outcomes in this social group and make medical care more accessible for them. It is essential for health care providers to know about cultural differences and show empathy and patients towards refugees. Social distancing rules and guidelines due to Covid-19 presented additional challenges for asylum seekers in the US.
The job developer interviewed had a 5-year of experience in the field. They reported developing motivation for this job in the process of working. The most common health and medical issues in their clients are “feeling depressed, having a difficult time adjusting to the US, feeling culture shock.” Refugees’ health impacts their overall progress towards self-sufficiency goals by affecting mental health and interfering with their work and studies. From job developers’ perspectives, the language barrier problem must be addressed to make services more accessible. Furthermore, it is essential to know that “doctors need to be more on hand with refugees” to provide quality care. The consequences of Covid-19 include “feelings of frustration, and difficulty with hospitals and ER’s being full.”
Overall, the problem of refugees’ access to health care services is complex since various factors affect individuals’ health outcomes in a new country. In particular, cultural differences, language barriers, availability and cost of services, as well as the financial status of refugees can prevent them from seeking medical help. It is essential to conduct key informant interviews to collect relevant data and address ongoing challenges, such as language barriers, culturally incompetent staff, and complicated procedures while making an appointment.