Introduction
This project focused on identifying the major barriers to access to medical services for asylum seekers in the United States, considering the perspectives of refugees and people employed at resettlement agencies. Namely, the data for this study was obtained from three agencies: Catholic Charities of Southern Nevada (CCSN), African Community Center, and Southern Nevada Health District (SNHD). These organizations were selected due to their active and regular involvement in working with refugees, such as providing health care, education, and other services.
Several project goals were developed for this study, with the main objective to identify the main barriers to access to medical services for refugees in the US. Furthermore, it was crucial to consider the problem from several perspectives, including refugees, workers of resettlement agencies, and health care service providers. The key informant interview method was applied to achieve this objective. Finally, other important goals were to establish factors influencing the accessibility of medical services for refugees and gain in-depth insight into issues impacting the health of newcomers arriving in Nevada.
Key Informants
The study took place at three agencies involved in projects for asylum seekers. The key informants for this study included seven refugees, 15 resettlement workers, and one healthcare provider experienced in conducting post-arrival medical exams. Refugees were identified randomly based on their country of origin, attendance of medical appointments, and multiple interactions with the health team at CCSN. The resettlement agency workers were identified from CCSN and African Community Center due to having close interactions with refugees on a regular basis. The medical provider was chosen from the Southern Nevada Health District (SNHD) since this agency administers health screening exams for all refugees resettled in Southern Nevada.
Questions for the key informants are presented in the slide. As can be seen, refugees were asked about their experiences accessing healthcare services before coming to the United States and since coming to Nevada. Questions for resettlement agency workers aimed to explore common health issues and challenges and identify ways to improve accessibility to medical services.
Key Informants Description
A description of the informants can be found in the table presented in the slide. The interviewees’ marital status, household size, general background, religion, education level, and job industry differ, allowing for a more comprehensive perspective on the problem. A total of 23 key informant interviews were conducted over the course of six weeks with ass respondents resettling in Nevada. Refugees from the Congo, Afghanistan, and Iraq were interviewed. Informants arrived between 2018 and 2021 with an average of 1.5 years in the US.
Major Themes
Five major themes were identified in the interviews with key informants. The first one is language barriers and the lack of interpreters. Based on the data collected through the interviews, Congolese refugees had a more negative experience accessing healthcare than Afghan refugees. Factors that likely cause the difference include racial basis, language barriers, and the educational level of the asylum seekers, which often did not exceed 8th grade.
The second theme includes discrimination and cultural insensitivity, which are closely linked to the language barrier problem due to the poor treatment refugees face while attending their medical appointments. Most Congolese respondents emphasized that their negative experience with biased front desk receptionists and medical professionals discouraged them from returning to their providers. From case managers’ perspective, “providers should treat their refugee patients with respect” and have “cultural sensitivity” to make services more accessible.
The third major theme aggravating healthcare for refugees is navigating the complex US medical system. Specific challenges 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. Such processes are particularly challenging for individuals with multiple health conditions. Furthermore, refugees and resettlement agency workers noted that the US insurance system is a new and complex concept for asylum seekers.
The fourth major problem that requires improvement to make services more accessible for refugees is transportation. Reading a map and taking multiple buses to visit a healthcare facility is problematic for most newcomers to Nevada, particularly for individuals with low English and literacy levels. The need to use Uber services to attend appointments contributes to the overall treatment cost while going by bus is often complicated and confusing. Interpretation and transportation services are needed to help refugees navigate in the US.
Conclusion
Mental health is the fifth major theme that impacts refugees’ overall progress towards self-sufficiency goals and interferes with their work and studies. Many refugees struggle with adjusting to a new culture and the need to provide for their families. Furthermore, seeking therapy or counseling services is considered taboo in most countries where refugees come from. Multiple resettlement agency workers have noted that finding access to qualified mental health counselors to treat refugees has been extremely challenging.