One hundred and eighty-five million people worldwide live outside their country of birth. Forty-two million people of them are displaced refugees. As these immigrants assimilate into foreign cultures, many struggle to overcome traumatic experiences that have left them with psychological disorders or other health concerns. On Wednesday evening, Marga Kempner ’12, Public Service Scholar, presented her research on the challenges of health care in an increasingly global world.
Her presentation, titled “Health and Illness Across Cultures: Refugees in Americas,” featured Ron O’Connor, the founder of Management Services for Health (MSH) and an expert in global health care. While Kempner’s presentation examined the need for improved medical care in the United States, O’Connor’s remarks addressed the need for community-based care on a global level.
Kempner’s presentation was the culmination of two years of work and research in refugee communities in Burlington, VT.
Refugees comprise nearly 10 percent of the total state population. Seventy-three percent of the refugee population are immigrants from Africa, who moved to the United States to escape armed conflict in central Africa.
Kempner said, “Refugees have escaped violent environments, hopped across borders and sometimes walked for months to reach refugee camps.”
The most common illness refugees face are intestinal parasites, malnutrition, low immunization rates and malaria. The long-term effects of trauma, rape and torture accompany many of the refugees when they immigrate.
These immigrants require urgent medical care that they may not be able to access.
To illustrate this need for more accessible health care in the United States, Kempner shared the story of a young refugee girl whom she taught at a community summer school. While the girl was bright and energetic, she could not speak English well and suffered from an intestinal parasite. Her parents, unaware of health insurance policies, were unsure how to act.
“Some days, she would rarely speak and ask to go to the bathroom frequently. When I asked her what was wrong, she told me she was having stomach aches. I urged her to talk to her parents about going to the doctor. But her parents disagreed about whether they should continue to use traditional medicine or take her to the hospital. Her parents, neither of whom spoke English, worried about whether going to the doctor would cost even more,” Kempner said.
“They were entering into a system that is not used to serving people from other cultures,” she said.
According to Kempner, refugees often face four distinct challenges regarding differences in language, culture, religion and gender roles. Language is often the most difficult barrier to overcome. While medical translators are available at nearly every hospital, medical terms often have no accurate equivalent in other languages.
Even after physical symptoms of illness are treated, these cross-cultural barriers can keep psychological disorders from being diagnosed, according to Kempner.
She said that beyond the first phase of initial immigration, undetected psychological symptoms can develop into Post-Traumatic Stress Disorder (PTSD), depression or paranoia, and can induce “chronic” phases of unrest in refugees.
Because they are unaware of the health and social services available, many recent immigrants keep to themselves. However, rifts within immigrant families can form as immigrant children generally assimilate into foreign cultures more quickly than their parents.
According to Kempner, these cross-cultural issues with health care can be resolved only with trust. Doctors must be open to understanding their patients’ situations and cultures. Communication is crucial between doctors and patients and can be facilitated by medical translators.
“Health care is not inherently problematic, but too often, health care is thought of in black-and-white terms. Either we give [care], or we don’t. Health care is far more complex than this,” said Kempner.
Following Kempner’s presentation, O’Connor displayed his study of the work of international health organizations. There are few medical professionals in many Asian and Central African countries, with the lowest nurse-to-household ratios in Liberia, Bangladesh and Honduras. Due to a lack of pharmacies, nearly a third of ill patients in Africa cannot obtain necessary drugs, according to O’Connor.
O’Connor said that in Tanzania, licensing local women to run pharmacies gave communities a monetary incentive to improve health care standards. This not only reduced the occurrence of death due to preventable diseases, but also employed locals.
Condemning organizations such as Doctors Without Borders, which leave few sustainable, long-term health care systems, O’Connor said that community-supported changes are key to improving local living conditions.
He said, “[Doctors Without Borders] does not really [establish] a health system. It’s essentially large-scale missionary work with no sustainability.”
O’Connor encouraged students interested in global health care to consider futures as trained medical personnel rather than engaging in short-term community service projects.
He said, “Going for a week is medical tourism. That’s not helpful.”
Emily Adler ’12 said, “I thought what he said about Doctors Without Borders was very interesting… [O’Connor is] thinking about the broader picture and not just [addressing] the problem but the root of the problem.”