Phoenix health clinic volunteers guide, connect with refugee women

"I'm from Somalia, Somali-Bantu," Abdalla told the patient, introducing herself. "So, you're pregnant?"

The woman, timid and soft-spoken at first, quickly opened up to Abdalla. Within minutes, they found they had mutual Somali-Bantu friends in the refugee community.

Volunteers like Abdalla are the lifeblood of the Phoenix clinic, working hands-on to guide refugees through every step of their appointments. Many of them, including Abdalla, are refugees themselves. They understand the fears and frustrations these women feel about navigating something totally alien: the American health-care system.

The clinic has served more than 400 patients since it was opened in October 2008 by the Maricopa Integrated Health System as part of its larger women's clinic. The clinics are funded through the county health system.

Crista Johnson, the clinic's medical director, said she recognized the need for more hands-on involvement when patients began wandering around MIHS for hours at a time, not knowing where to pick up prescriptions or get blood work done.

The clinic, which now has five volunteers and five translators, is an important resource for Arizona's refugees, whose population is growing as its demographics shift. There are 3,260 refugees in the state, according to the Arizona Refugee Resettlement Program. Somalis, Cubans and Sudanese historically have dominated Arizona's refugee population, but since 2008, there has been a surge from Bhutan, Myanmar, Burundi, Iraq and Iran.

To accommodate the changing population, clinic organizers developed a community advisory coalition, partnering with ethnic-community leaders, health-insurance providers, housing and social-service agencies, and refugee-resettlement organizations.

Through that coalition, clinic organizers hope to create a network of "culturally competent" providers who are sensitive to the needs of various populations, said Jeanne Nizigiyimana, the clinic's program manager and a refugee from Burundi.

Jennifer Kao, district manager of a Phoenix apartment complex with a growing number of refugee residents, said she is adapting to cultural differences. For instance, she would find that a refugee family moved out without notifying the leasing office. Kao now signs monthly leases with refugee residents, in case they need to vacate their apartments on short notice.

When cultures collide

For most refugees, scheduling an appointment is a foreign process - like everything else about their new lives here.

The ultimate goal is to empower patients to navigate the health-care process by themselves, Johnson said.

Until then, patients are guided every step, starting with a knock on the front door.

Employees at apartment complexes remind every patient of her appointment the day before and call for a taxi to pick her up on the day of the appointment.

Once the cab drops a patient off, hospital volunteers accompany her as she waits in the reception area. They help her fill out insurance paperwork and start friendly conversation.

A volunteer or an interpreter stays with every patient throughout the appointment, taking care of her other children while her temperature is taken or translating from behind a curtain in the exam room as she gets a pap smear.

Then, volunteers take every patient to pick up her prescriptions or get X-rays. Before patients leave the clinic, Nizigiyimana schedules follow-up appointments and calls for taxis to take them home.

Georgia Sepic owns and manages a Phoenix apartment complex in which 97 percent of residents are refugees. Sepic said she emphasizes the importance of routine health checkups to her residents.

But attitudes toward doctors vary among cultures, and there are taboos and nuances associated with each ethnic group, said Sepic, 45, who fled the former Yugoslavia in 1985 as prewar ethnic tensions arose.

Somali women, for example, often distrust doctors and prefer the system that has worked for them for centuries: consulting female family members, friends and midwives about their pregnancies and gynecological issues, Sepic said.

Other refugees, like Ethiopians, are used to money being the only prerequisite for seeing a doctor, said Misrach Lulseged, an Ethiopian volunteer at the clinic.

Personal connections

Clinic volunteers and many members of the community advisory coalition are refugees or immigrants themselves, increasing the pool of languages that can be translated at the clinic.

Of the 14 languages spoken among patients at the clinic, 12 are provided on site by hired translators and staff.

Halima Abdirazak, 27, a Pakistani medical assistant at the clinic who came to America a decade ago, said the language barrier between her and patients helps her realize just how far the women are from their home countries.

"The language barrier motivates me to support them and become a voice for them," Abdirazak said.

Refugee women are skeptical and fearful of authority, Nizigiyimana said, because many of them have experienced rape, torture or trauma. Volunteers like Abdalla try to minimize the patient-provider mentality by approaching the women as friends.

"There's no specific job description, but you can do whatever to help them out, to make them feel comfortable," Lulseged, 36, said.

In some cases, that means helping decrease the frustration between doctors and patients, Nizigiyimana said. Volunteers bridge cultural gaps by relaying patients' issues in the context of their cultural backgrounds - such as issues related to female circumcision, which is common among Somali patients.

After patients leave the clinic, Nizigiyimana follows up by contacting apartment-complex managers about the non-medical needs their residents have brought up during medical appointments.

Sepic and Kao, the complex managers, meanwhile, work with other agencies and organizations to provide some of what the women may need: English classes, dental care, domestic-violence-prevention workshops and classes on managing their finances.

Sepic's Iraqi residents recently approached her with concerns about Senate Bill 1070, Arizona's immigration law. She coordinated a workshop with the Phoenix Police Department, at which the law was explained to help quell their fears.

Women have started referring others to the clinic, helping each other find proper health care, Nizigiyimana said. She greets each returning patient with a hug, in hopes of making her feel welcome and comfortable about seeking help.

The women begin recognizing familiar faces around the clinic and making friends with the volunteers, Nizigiyimana said.

Lulseged said the satisfaction she feels from helping women become independent motivates her to volunteer every week.

"I miss them when they deliver and go home. It's easy for you to attach yourself to them," Lulseged said.

Source: The Arizona Republic