By Kaitlin Ugolik Phillips
When immigration is in the headlines, the context is often politics, legislative reform, and harrowing stories of survival. For the latest issue of the North Carolina Medical Journal, we took a closer look at what happens when immigrants and refugees settle in a new place and, like all other residents, require medical care.
North Carolina has long been a hub for immigrants and refugees from around the world. As of 2017, 7.8% of our population was foreign-born, according to the U.S. Census Bureau. The state ranks 10th in the nation for number of refugees settled; in 2015, more than 3,000 refugees settled here, with 2,200 more following in 2016.
The state and our many local, regional, and practice-specific programs strive to meet the medical and mental health needs of all our residents, but unique challenges and barriers to care remain. Interpretation services can be difficult to obtain, even where legally required; toxic stress is prevalent among patients and burnout can be a problem for the clinicians who treat them; varying explanatory models of disease and cultural customs can create discomfort and confusion in the exam room; and the harsh realities of migrant farm work and human trafficking take a toll.
“Health care clinicians can provide a level of security and trust for immigrant and refugee patients that is otherwise lacking in today’s political climate, and have the opportunity, if not obligation, to engage in immigration policy,” write guest editors Jeffrey Walden, director of the Cone Health Family Medicine Refugee Clinic in Greensboro, and Holly Sienkiewicz, director of the UNCG Center for New North Carolinians.
Toward that end, clinicians and other experts from around the state have provided commentaries on the following topics. Click the titles below to read their work, and feel free to reach out to our managing editor, Kaitlin Ugolik Phillips, with any questions at kaitlin_phillips@nciom.org.
Immigrant and Refugee Health in North Carolina by Jeffrey Walden and Holly Sienkiewicz
“Despite myriad backgrounds, practice recommendations do exist when working with refugees and immigrants, and clinicians and other health care providers should adhere to these standards when working with these underserved individuals.”
Connecting Newly Arrived Refugees to Health Care in North Carolina by Jennifer Reed Morillo
“Beyond initial refugee screening, accessing general medical, dental, and mental health services can be significantly challenging.”
My Life Journey: One Man’s Path from Ethiopia to North Carolina by Taye Gonfa
“A few days prior to my departure from Kenya, I was in departure orientation class when the facilitator told our class something I would never forget: ‘You are going to the land of opportunity.’ From that day on, I had only one question – how could I get back to medical school?”
Community Engagement and Equitable Policy: Promoting Resilience and Stability for Children in Immigrant Families in North Carolina by Mariya Mohammed, Shruti Simha, Kathleen Clarke-Pearson, Lourdes Pereda, Ricky Hurtado, Emily Esmaili, David T. Tayloe, Jr., and Julie M. Linton
“We are in the process of building a task force to bring together those who work closely with the North Carolina immigrant population to promote resilience and stability through legislative and policy advocacy.”
The Impact of Family Separation on Immigrant and Refugee Families by Shruti Simha
“The resilience of immigrant families can buffer the effects of adverse childhood experiences (ACEs). Family separation removes this buffering effect, subjecting children to lifelong negative effects on health and contributing to health disparities.”
Human Trafficking of Immigrants and Refugees in North Carolina by Maura Nsonwu
“Falsely assuming that human trafficking only occurs in developing countries prevents us from recognizing that such human bondage occurs in our country and in our own neighborhoods.”
The Echo in the Room: Barriers to Health Care for Immigrants and Refugees in North Carolina and Interpreter Solutions by Cynthia Mejia
“Medical providers need to be able to provide interpretation and translations services so that limited English proficiency patients can experience the same level of care as their English-speaking counterparts.”
The Health and Well-being of North Carolina’s Farmworkers: The Importance of Inclusion, Accessible Services, and Personal Connection by Elizabeth Freeman Lambar and Gayle Thomas
“Farmworkers contribute significantly to North Carolina’s communities and economy; however, they incur significant occupational risks with limited workplace protections.”
Immigrant and Refugee Explanatory Models of Chronic Disease: Provider “Learning Up” for Culturally Responsive Care by Sharon D. Morrison
“Immigrant and refugee populations in North Carolina bring with them traditionally based explanatory models of disease that influence health care interactions… Participation in “learning up” opportunities increases provider awareness and capacity for cultural responsiveness when dealing with immigrant and refugee clients.”
Maternal Health Care Challenges Confronting Arab Muslim Refugee Women in Triad North Carolina by Shahla Y. Namak and Julienne K. Kirk
“Without support, fear and isolation may impede [these women] from becoming active in society. Highlighting these issues can bring awareness to the needs.”
Spotlight on the Safety Net: El Futuro by Kaitlin Ugolik Phillips
“El Futuro is like any other mental health clinic, with he addition of a focus on cultural competency… All of El Futuro’s clinicians don’t have to e Latino, but they do have to speak Spanish.”