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Features: January/February 2017

Recently there has been a spike in racist threats and remarks to people of color, particularly those in our Muslim communities. The following is excerpted from Healthcare Provider Resources for Refugees, Immigrants, and Asylum Seekers written by a coalition of health care and service providers in Washington State who have prepared some tips and resources to help providers think about how to support their patients and community members.

Tips for Providers

Immigration Reform
Immigration Reform by Susan Melkisethian is licensed under CC BY-NC-ND 2.0

Stress and anxiety from being targeted by others through hate messages and harassment directly impacts patients’ health. Please make yourself aware of how this new climate of fear impacts your patients. People who are most vulnerable to the stressors related to these fears include LGBTQ individuals, people of color, and those who are refugees and immigrants. Those with baseline mental health vulnerabilities such as anxiety and depression may also be at risk for exacerbation of symptoms during these times of increased stress and uncertainties regarding the future. For refugees and asylum seekers, the increase in prejudice and fear of deportation may also reactivate traumatic memories from having been oppressed by government and threatened by military in their home countries that led to being uprooted from their homes in fear of persecution.

The immigrant and refugee families that you serve, as well as your clinic and hospital staff, may encounter direct threats to their safety and well-being as public expressions of racism and bigotry continue to increase. In addition, patients and staff may live in fear of becoming victims of racism and prejudice. It is helpful to create a safe space for people to share their concerns, stories and questions. 

The first step in providing support to clients that face racism and prejudice is to ensure that your workspace welcomes diversity in color, religion, and ethnic background, and does not tolerate acts of hatred. Clearly demonstrating that your workspace is open and supportive will facilitate patients and staff to express their fears and anxiety. Allowing families to voice their fears can provide support and reassurance that they are being heard and cared for. While it may not be possible or helpful to state that “it’s going to be ok”, being able to have their concerns and fears heard and validated in a supportive environment by people who they respect, can have important impact on reducing stress and anxiety. In addition, providers should be aware of legal resources so that they may seek legal support appropriately.

Additional Healthcare Provider Resources:

American Academy of Pediatrics Statement on Protecting Immigrant Children

Northwest Immigrant and Refugee Health Coalition
A coalition of health and service providers in Washington State have joined together to promote health equity for refugees, asylees and immigrants. This group was previously called the New Arrivals Working Group (NAWG), and was cited in the American Journal of Public Health as an example of innovative collaboration on behalf of refugees.  They have collaborated on several resources:

Tips for Providers and Resources for Refugees, Immigrants, and Asylum Seekers
Provides suggestions about how to address the fears in our vulnerable populations, particularly children.

Resources for Individuals
Highlights 3 particular subgroups of the refugee & immigrant populations that are particularly vulnerable:  Muslim women, refugee & immigrant children, and undocumented immigrants.

Anti-Immigrant Sentiment
Additional resources for providers to to help address anti-immigrant behaviors their patients may be experiencing.

Migrant Child Health
Some of the hyped claims and concerns over health risks from migrant children stem from ignorance, if not racial prejudice. The answer to responding to disease challenges is not scaremongering, but ensuring that appropriate treatment is in place for them, regardless of where geographic borders lie.

Interpreting Pearls: Cultural Brokering & Advocacy - Interpreting for Patients with Emotional Trauma

Patients presenting with physical health complaints may often have emotional trauma as a cause of their symptoms. In these vignettes, a patient’s complaint of sleeplessness is triggered by worry about her friends and family in her home country. Iraq is the example here, but over the last decades patients have come to the US from wars in Vietnam, Guatemala, Cambodia, Bosnia, Congo, Honduras, Ethiopia, and Syria, just to name a few. Emotional trauma doesn’t emerge solely from war, however. It is important to remember that patients may have trauma due to domestic violence, homelessness, neglect, chronic physical illness, joblessness, childhood events, and innumerable other sources. The goal of these vignettes is to show examples of well-intentioned help that goes wrong and juxtapose it with balanced medical care and interpreting that communicates compassion for the trauma while focusing on the present complaint.

Scenario 1 

In the first vignette below, the patient presents with difficulty sleeping and attributes it to worries about war in her home country. As she describes her worries, the interpreter, who is from the same country, starts to share with her news of additional bombings and mentions specific people who have been affected by them. 

Scenario 1  Discussion of Scenario 1

Sometimes, it is helpful for interpreters to provide additional information during an encounter. In medical interpreting, we call this ‘cultural brokering’ – providing additional cultural information to the patient or provider so that both parties understand one another better. However, it is necessary for interpreters to use discernment when adding this information: Does the supplementary information aid in providing better care or does it distract from the focus of the encounter? As the patient states in the discussion above, the interpreter’s additional information is not helpful to her; rather, it piles on more concern. The physician also states that when the interpreter is from the same region as the patient it is possible that the interpreter has lived through the same trauma. However, it is never appropriate for the interpreter to work out his/her personal concerns while working with a patient. 

See more scenarios and discussions on this topic:  Interpreting Pearls: Cultural Brokering & Advocacy - Interpreting for Patients with Emotional Trauma

See also additional topics in our Interpreting Pearls series of video vignettes produced to illustrate some best practices in working with medical interpreters:

  • Interpreting Pearls: Sight Translation Role-play scenarios and subsequent discussions illustrating examples of when it is appropriate for interpreters to sight translate documents and when it is not. 
  • Interpreting Pearls: Pre-Sessions Role-play scenarios and discussion focused on the importance of providing contextual information to the medical interpreter.

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Refugee Health Weekly Roundup

This summary is compiled by the Washington State Department of Health Refugee Health Program. The Weekly Roundup highlights upcoming events and opportunities, resources and news relevant to refugee health. Some information is local to WA, but also what's on the national agenda. Read the latest edition of the Refugee Health Weekly Roundup.

Migrant Children and Health

The Migrant Children and Health Campaign has created a video featuring leaders in immigrant and refugee health advocacy introducing the facts about migrant children health and the continued history of racial and ethnic disease scaremongering in the U.S. For more information about this Campaign and to view the video "Migrant Children and Health: Borders, Boundaries, and Bigotry" click here.

Torture Resources

Resources for clinicians and advocates around issues of torture, often related to warfare and political repression.  Includes information about Northwest Health and Human Rights (NWHHR) coalition serving refugees, asylum seekers, and immigrants in Washington State.  Visit Caring for Survivors of Torture page for additional information.