Vulnerable Population: Maine Refugee

Hello,

my name is Effie and I'm going to be doing a

presentation on refugees as a vulnerable population and health care.

Um I just want to start this presentation by explaining why I chose refugees as my

my population to talk about.

Um, the first being that my grandmother was actually a refugee from Syria.

Her and her six siblings and parents came over from Syria um

fleeing from the war and she was born on Ellis Island, which is pretty cool.

Um Another reason is because I spent my first semester

at UN E working at the Boys and Girls Club

in

Riverton and Riverton is a neighborhood that primarily

houses refugees from Somalia and West Sudan.

I really love my time there

and I really think there's a lot to be said about how

we as nurses can

work to look as a patient

as a whole person. Um,

and figure out ways to

give them more culturally competent care.

So with that being said,

let's get started.

Ok, so who are refugees?

Refugees are people that are forced to flee their own country and seek safety.

They're unable to return to their country because of feared persecution.

This can be because of who they are or what they believe

in or it can be because of armed conflict and violence.

Why do refugees matter to us here in Maine?

There's a lot of reasons. While in 2022 only 3.8% of Maine's population

was foreign born.

37% of that foreign born population

lived in Cumberland County, which is where we are today

and this number is only increasing.

So Maine state officials expect that 840 refugees will arrive in Maine in 2024.

And the main place that they come is Portland.

This is

really illustrated quite well in this diagram

um which you can see that Portland houses a good amount of people um

in the Cumberland area.

So they're very relevant to our care here.

OK.

Why are refugees defined as oppressed or

marginalized from a health care perspective,

refugee enters the United States and they

immediately face many barriers to health care.

These barriers

um include challenges navigating the US health care system,

limited English proficiency proficiency

barriers, defining culturally and linguistically appropriate health care,

um availability of social and community support systems

and the overall cost of health care.

Now, how do these barriers affect their care and their overall well being

for this, I'm going to look at social determinants of health.

Um I spent a semester in South Africa studying public health

and this was the first time I had learned about social determinants of health.

And I think it's a really great way

that we can look at patients

from a holistic perspective and really see them not

only for maybe what their clinical manifestations are,

but see how their lifestyle

and struggles that they're experiencing can affect their health.

So,

social determinants of health are the conditions

in the environments where people are born,

live, learn work, play worship and age that affect a wide range of health,

functioning and quality of life outcomes and risks.

And social determinants of health can be broken down into many categories.

These five categories, I'm going to be talking about a little more in depth.

Um

Next.

So starting with economic stability,

refugees often don't have great economic stability.

This is in part um due to the fact that they're placed

receiving entry level or low income jobs when they first come to the United States,

a lot of this has to do with their language proficiency, proficiency um

or their

educational status

um without really being able to speak English. Well, this really prohibits

many people from getting higher up or higher paying jobs. Um because

unfortunately, in America, if you can't speak English, it's really challenging.

We should also look at economic stability

from

an environmental standpoint. If you

don't bring in

um

an adequate income,

you are likely not able to buy healthy nutritious food or live in an

adequate

an adequate house um

which brings us to our next point, neighborhood and environment.

So many of these refugees are placed in subsid,

subsidized housing or low income neighborhoods when

they first come to the United States.

And it's generally seen that

in these neighborhoods, there are higher crime areas.

I know when I was working at the boys and girls club, um

little kids came,

came in every day crying because a bike was stolen

um which was really heartbreaking,

but it's really just the environment

that unfortunately um some of these families are

are living in.

Um

And with higher crime comes higher stress

which can have negative health impacts which I will get into. And a little bit later.

Um in the presentation,

it's also important to note that in Portland, we're really running out of places for

refugees to be housed. Um

It was noted that in May 1200 asylum seekers were currently being housed

in Portland and there's not really many places to

to continue to house them as our refugee population continues to grow.

There are two interesting articles that I found about this.

Um One from N PR which kind of focuses on um Portland but

also the surrounding rural areas as refugees aren't able to fit in Portland,

how um

they're starting to

um

come to the

surrounding areas in Portland and how cities are adapting to that.

And then this one was actually four days ago.

Um In late March,

there were 64

asylum seekers that had to be relocated because

of a cockroach infestation about from where,

where they were currently living.

Um, I think this is a,

a really good way to point out if

you have a cockroach infestation where you're living,

what other conditions are you probably living in?

Um, one that really, I think of is mold.

Uh I'm sure there's mold in this place and that really has negative outcomes.

Um, cockroaches surely aren't great for your health. Um

aren't great for your health either.

So it's important, I think this is important. Um

an example of really the environment that these

people live in and how that can impact

um overall health outcomes.

A few other ways we can look at this as from an educational standpoint,

71% of Maine's refugees don't

have a bachelor's degree which limits their jobs.

And then also with education comes health literacy. I think

the healthcare system and understanding the body is something that

many, many people struggle with. But if you don't speak the language and

um

you don't maybe have a very high educational

level,

it it can be more challenging to understand your health care

and really what it means to live a healthy lifestyle,

which brings us to our next point of health care access and quality.

So while

refugees should be given Medicaid,

it can take up to eight months after

their arrival to the United States before this Medicaid

um

is fully active.

So what are these patients doing in the

eight months that they don't have health services?

What if it takes longer?

Do they even know that Medicaid is something they can provide?

They can, they can get for themselves? And

health insurance isn't an easy thing to go through. Are they equipped to um

to be able to enroll in these services? And do they know about them?

Another thing that

I bring up is limited in person interpreters.

During some of my clinicals, I worked with a refugee who spoke no English and um

use an Ipad interpreter for the majority of his stay.

And one thing I really noted was

the lack of humanity that can often be found in Ipads.

Um ipad translators while of course,

um

a translator, regardless of who and how we get it is better than no translator.

But he seemed very frustrated with,

with the use of the ipad and having to get it set up and often

kind of shook his head when we started to set up the ipad and the nurses

and other health care staff that I witnessed kind of just let this happen.

And I don't really think this is

um acceptable patients have a right to receive health care in their own language.

And we should be looking for ways to improve this and um

finding

health care that really looks at humanity

um

and provides,

you know, translators that everyone can,

can kind of agree with and be on the same page with.

And then finally,

um we can look at refugees from a social and community standpoint.

So

there's a lot of

politics out there that refugees are taking American jobs

on this negative viewpoint can really be quite discriminate,

discriminatory to refugees.

We can also look at this from a racial discrimination perspective

and when you have discrimination, you generally have poor

mental health um

and overall higher stress levels.

And

um I found this

pretty interesting study that looked at discrimination

and its impacts on physiological health.

And they found that when you have discrimination,

it can often cause acute and chronic stressors which can raise

your blood pressure and your heart rate and cortisol secretion,

which o which um leads to mental and physical decline.

And I think this is really important when we think about, you know,

the stress system with cortisol and

epinephrine and your sympathetic nervous system,

this impacts you greatly.

If you have cortisol, always pumping through your system,

you're gonna have an increased glucose level.

So it makes sense that they might

have higher morbidities like diabetes and hypertension.

Um

with those stress hormones elevated all the time.

One study I found that I thought was pretty interesting. Looked at um

Somalia

Somalian refugees. Oops, let's see right here.

And Somalian refugees are one of the larger groups that we

have in Portland and they found that Somali Somalian as compared to

other American descent are more likely to have obesity, hypertension,

diabetes and

um hyperlipidemia.

So I think it's important to look at these

stressors as a way that can impact physiological health.

But also when we're seeing clients day to day,

we need to keep these um morbidities in mind

to provide the best care that we can.

So what can we do to help this population?

There are actually quite a bit of resources.

It's just a matter of making sure that refugees know about these

resources.

Um Some of some that I've listed are the Office of Refugee

Resettlement

Program, the Catholic Charities of Maine,

which does really a ton of work in all areas for refugees.

They help house them, um

They help them find employment, they also

help on the other end, help businesses who want to hire refugees

kind of sort through that process and look at what a refugee may need.

Um They also offer mentoring services and legal services

for our current health care resources.

We have Medicaid, of course, but I've mentioned some of the barriers to, to Medicaid

and um

in hospital translators, ipads are a source for now.

But I think we often should take a step back

and make sure that we're really connecting with the patient

um

on a compassionate level while we're using,

while we're using ipads.

Ok.

So how can nurses be an advocate for refugees?

I think we can look at this through an ethical standpoint, a legal standpoint

and then a political standpoint.

So

for ethical considerations as nurses,

it's super important that we look at patient rights.

For instance, patients have a right to

receive health care in their first language. So it should be really important that

we aren't just slacking and taking blood pressure and saying good no.

But actually using the translator whenever we can

to make sure that they're fully understanding their care and

that they can ask questions whenever they need to.

We also need to ensure that they have culturally competent care.

One example, I think of is these patients often have completely different diets

than um the standard Americanized

diet. So how are we adapting so that they can have the food that they want?

Um or that they're used to while they're in the hospitals?

And also are we offering dieticians that understand

their perspective of food and how we can,

how can we adapt um services so that they can receive that,

that culturally competent care

for legal considerations?

Of course,

patient rights are really important um from a legal standpoint.

But also we need to ensure that patients

understand that they have a right to Medicaid.

My bad.

Um

And that main care can be provided for pregnant women and for Children.

So do they know about these services and have they signed up for them?

And then finally, political considerations. So there is a ton

of organizations that nurses can join.

Um these that I've listed all have community health workers,

which you can join to help improve health literacy and refugees.

And they also offer family assistance, mentoring youth programs.

Um And overall are just great resources if nurses want

to be advocates for this group and get involved.

So

that is all I have for you.

Um And there's a lot more we could.

Vulnerable Population: Maine Refugee

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