Scattered thoughts

Tomorrow the Refugee Health Mediation Project proposal goes to the foundation. The field office director is still  trying to get some audit stuff that needs to be attached, and our DC people  seem to be in no hurry to provide it. We’ll see what they produce in the next few hours. It’s maddening to spend months working on something and have it held up for no good reason. DC had ample, ample time to prepare what we asked for.

Grrr…  inefficiency.


Last night, for work, I went to a dinner for visiting members of the Malawian Parliament. The conversation at my table  revolved more around the Afghanistan project than the Malawi one, though, because a table-mate just recently got back from Kabul and had stories to share. Oh, how all that Afghanistan talk tormented me!


One of the things I asked my recently returned colleague was how the international-national staff dynamic was playing out. His gritted teeth and guarded answer instantly made me think of this from Hamesha:

right now i am here sitting in a cafe a safe distance away from a vociferous expat who is grumbling and ranting loudly about lack of this and lack of that, from lack of capacity to lack of electricity and lack of security and lack of good food and lack of internet and lack of talent and lack of hygiene and lack of deodorants and lack of good weather and lack of good colleagues and lack of traffic rules and lack of obedience to traffic rules and lack of obedience to rules writ large and lack of knowledge of the english language and lack of appreciation for shakespeare and lack of…

how about lack of right attitude? for working in a an admittedly difficult postwar environment? and what the hell were you thinking when you landed that lucrative contract? how about lack of cultural sensitivity? and lack of humility? and how about an overabundance of presumption and self-righteousness and arrogance? and how about getting the hell out of here if it is all so difficult and unpleasant and insufferable?


I have been applying to every job I have a 1% or better chance of getting. Also, I despise Openhire.


It’s bitterly cold here, with a sharp wind that slices into any exposed flesh. I waited for a half hour at the bus stop this morning (because upstate NY somehow cannot provide public transport at the quality level of even, say, Pristina) and I was physically in pain and slurring my speech by the time the bus arrived.


I just found out that the refugee resettlement office was robbed. Two computers were stolen, including a laptop I donated when I left.  Fuck.  It was hard enough before.  Anyone have computers to donate?

Refugee resettlement and health mediation: part II

As I mentioned in my last post on this subject, I drafted a proposal for a health mediation program before I left the resettlement field office.  The proposal will be considered next week, and I have a meeting with the field office director at the coffee shop down the street in about an hour. We’re going to make some final edits and then have it approved by the HQ folks.

If all goes to plan and we get the requested funding:

-The resettlement office will FINALLY have a full-time refugee health coordinator on staff.

-Refugees who need it will have accompaniment to medical appointments during the first six months following resettlement.

-Newly resettled refugees will have “Health Care in the United States” orientations, and workshops on women’s health,  Medicaid, family planning, nutrition, and mental health will also be conducted.

-The health coordinator will put together a step-by-step guide to treating refugee patients for medical practitioners in the area.

-The office will finally have the time and money to conduct a survey of how local hospitals are implementing (or not implementing) the 2006 New York State law that requires them to provide non-English speaking patients with adequate interpretation.

-And so much more!

Here’s hoping.

Refugee resettlement and health mediation: part I

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…