Before landing an international development fellowship, I spent eight months working at a regional refugee resettlement office. Initially, I was attached to the human trafficking victim services program, but I was later moved (or moved myself) to outreach and program development. Additionally, I, like the rest of the staff, spent a great deal of time just running the office, especially after the director moved on to a better position elsewhere and left us leaderless during the high season of resettlement.
The office I worked at was typical of refugee resettlement offices in the United States: underfunded, understaffed, overworked, and underpaid. Case managers scrambled just to provide minimum services to their long lists of clients. Often, colleagues and I would work from before opening well into the night, go home, and do it all over the next day. And yet, there were still tasks that never saw completion, and programs that fell through because they were staffed entirely by people who were already splitting time between two or more full-time programs. “Cloning is our only hope,” I once joked with my supervisor. Joking aside, during my time at the resettlement office, I became aware of a serious gap in the services provided to clients (refugees). That gap was health mediation.
The largest refugee populations resettled by the field office were Burmese, Iraqis, Afghans, Congolese, and ethnic Nepalis from Bhutan, but we also resettled Somalis, Meskhetian Turks, and Kunama, as well as asylees fom Sudan and Iran. Each population suffered prior to resettlement and had its set of common health problems. For the Burmese, coming mostly from overcrowded camps along the Thai-Burma border, the list of ailments was almost endless: rotted teeth, skin infections, malnutrition, lead poisoning (from contaminated water in camps), post traumatic stress and depression, eye problems, amputations (often from some time ago) that had not been performed properly, respiratory disorders, complications from pregnancy, and lots more. For the Afghans and Iraqis: lots of stress and trauma, as well as dental problems. The other groups had combinations of all of these. The Kunama and Somali women added the issue of FGM. And several clients were torture survivors.
Just housing and feeding a rapidly swelling list of beneficiaries pushed the small staff to its limit. Unpaid interns were brought in to perform full-time work in education, ESL, and housing services –work so technical and time-consuming that it should have been done by a full-time staffers. Health fell by the wayside. It was everyone’s problem and no one’s responsibility. If a client came in and showed a prescription, obviously confused, someone would rush out of an office, give it a glance, and send the client on his or her way, usually just as confused as before. Occasionally, someone would draw the short straw and have to take time out (invariably from another task nearing deadline) to drive a client to the doctor’s office or hospital. If a client required accompaniment to the low-cost health clinic, a member of the staff or an intern would lose her or his entire day, because the clinic was a nightmare of hurry up and wait and endless paperwork.
Most of the time, however, clients were on their own. This usually resulted in poor care and lapses in treatment for serious conditions. Medical providers, especially those that catered to the poor, had neither the time nor the know-how to properly provide medical care to refugees. Clients who spoke no English were often treated without explanation or real consent (telling someone to sign next to the X when she or he has no idea what that will authorize is not consent.) One client, a young and frightened woman resettled just weeks before, gave birth without interpretation services because no one was there to tell her doctors that they needed to get a Karen interpreter on the language line. When it came to mental health care, well, the story was even bleaker. Depressed Afghan? Traumatised Iraqi? Sorry, you’re SOL, I’m afraid. I could go on and on with anecdotes, each more distressing than the last, and, in fact, I spent many late nights at home doing just that over sad beers with my roommate-coworker.
Complaining can be useful –it brings problems to light and can spur others to voice similar concerns– but it needs to be followed with action to be productive. Before I left the refugee resettlement office, I fiendishly researched health mediation programs for refugees. I found programs in the United States and elsewhere and looked into how they were funded and implemented and what the results were. Then, I drafted a proposal for a refugee health mediation program for my field office.
to be continued…