Story and photos by MICHAEL OLSON
A translator enters Amelia Self’s office at the International Rescue Committee. She greets him while handing him a piece of paper. It is a form for the doctor to fill out during a refugee’s medical appointment.
“Will you ask the doctor if he needs to make a follow-up appointment for when he finishes the prescription?” Self tells the translator. “Let me know and I’ll make the appointment, OK?”
Self, 28, is one of the health programs coordinators at the IRC in Salt Lake City. She is responsible for the health care of more than 400 refugees, coordinating their appointments with primary care physicians, specialists and dentists. Self must also make sure their appointments are scheduled with doctors who accept Medicaid, the insurance refugees are given for their first eight months here.
Trying to schedule their medical appointments during this eight-month time frame can be tricky. It can take as long as five months to get in to see a specialist, should a refugee need it. Then Self only has a three-month window to schedule any follow-up appointments.
Self also has to make sure an interpreter is present for the appointments. These translators usually provide transportation for refugees to the doctor’s office as well.
“It’s pretty intense but it keeps us busy,” Self said.
The medical needs of refugees coming to the US vary greatly. Some have received medical care before their arrival; others may not have received proper medical care since birth.
Dr. Margaret Solomon, 37, specializes in internal medicine and pediatrics at the University of Utah Redwood Health Center. She sees refugees after their medical screenings and makes sure their children are in good health.
The Burmese and the Bhutanese have been in refugee camps for 10 to 20 years. Their health has not been monitored the way it should have been, Solomon said. People coming out of these camps usually need to be treated for things like malnutrition and skin rashes.
Self said refugees from Iraq are often treated for high blood pressure and trauma-inflicted injuries because a lot of them are torture survivors. These individuals are referred to the Utah Health and Human Rights Project, a nonprofit mental health agency.
Self sends her clients only to doctors who have worked with refugees in the past, or who have expressed interest in working with them so she can be sure they are getting the best care possible.
It also helps that these physicians want to be involved with refugees because appointments can be time consuming. Self said working through an interpreter and trying to get through all of the refugee’s concerns can turn a 15-minute appointment into 45 minutes.
Within 30 days of their arrival in America refugees need to have a medical screening, which is a basic physical examination. Doctors also check for any communicable diseases, the most common among refugees being tuberculosis, Hepatitis B and Guardia.
Translators are vital to the information gathering process. Through them the IRC coordinates with refugees and other care providers.
“We rely heavily on on-call medical interpreters,” Self said. “Most of them are former refugees themselves.” They must have a proficiency in English and their native language.
“We’ll assign them appointments and they will contact the family to make sure they know about it,” she said. Then interpreters report back to her any follow-up appointments.
Many refugees are sent to the Redwood clinic to see specialists such as gastroenterologists and cardiologists. Any specialists not on staff are just a phone call away and refugees are referred to them if necessary.
Many refugees speak very little English and the doctor’s office is full of medical terminology that can be difficult to understand. Solomon is grateful that translators are present during appointments.
“They’ll clue us in on some of the cultural things and other things refugees are worried about that we don’t think about,” Solomon said.
It can be difficult to find translators for some languages, Solomon said, but they make due with the help they can get.
She remembers an appointment with a patient from Sudan who spoke only her native tribal dialect. Solomon had to speak through an Arabic translator, who relayed the information to the patient’s son, who translated for his mother.
Solomon said it can be difficult to rely on translators to explain complex medicine instructions.
“It’s hard for me to know what is being translated to the patient,” she said.
Han Win, one of the IRC’s Burmese interpreters, has worked as an English translator for more than 14 years. He finds it challenging to accompany refugees to the doctor’s office.
Like most translators, Win must find words to explain what the doctor is trying to convey while gauging the refugee’s reaction and expounding upon anything they have difficulty understanding.
“If I said it directly the same words to them they don’t understand what it means. I have to explain that term in detail more than what the doctor said,” Win said.
Providing for refugees’ health needs can be a frustrating task, but also a rewarding one, Solomon believes.
“I really enjoy providing health care for refugees,” Solomon said. “I’ve been here [at the Redwood Health Center] three years and I’ve been seeing some of these families that whole time.”