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Changing Perspectives

"As a health intern, I learned that the American medical system is not well-equipped to deal with refugee health because of the rigidness of our social structure."

Elena Diller '17 New American Pathways Atlanta, GA

I sit in the passenger seat of a 15-person van, listening to 90's rap music on a hot July Wednesday. Perhaps it's just my imagination, but the van squeaks up onto its two right wheels as we round the corner, my case manager rapping to an old-school Usher song. The van lets out a sigh of relief as we straighten onto the road. We had just dropped off a client at a doctor's appointment. The young man is from Uganda, yet due to his sexual orientation, he is not safe in his home country. Up on the main road, I see a banner waving above a red food truck in an otherwise empty parking lot, partially surrounded by abandoned buildings. The words "Refuge Coffee" fly in a white print and I can't help but wonder if the banner is connected to the thousands of refugees which are resettled in the neighborhood.

* * * *

Clarkston, GA is one of the most diverse cities in the United States. Over 2500 refugees every year find themselves relocated in the small town just miles outside of metro-Atlanta. From the outside, Clarkston seems to be filled with run-down strip malls, apartment complexes teetering on top of each other as they compete for space among the overgrown grass and cracked sidewalks. Yet, from an insider's view, a status I have earned by working as Shepherd intern this summer, Clarkston is the world condensed into square feet. Congolese mothers walk with their children to Thriftown, the local discount grocery where a Bhutanese woman stocks the shelves. Twenty feet away from the store, Ethiopian and Nepali restaurants serve hungry customers during the throes of lunch hour. It was not, however, until I visited Somali plaza, a strip mall of Somalian-owned stores, that I understood the vitality and resistance of refugees. How little countries may form anywhere in the world so long as there is culture and community.

I called my visits to Clarkston "field trips" from my daily health internship at New American Pathways (NAP), a refugee resettlement service in Atlanta. To be honest, most of my days at NAP consisted of paperwork and logging case notes in paper format and online. Though NAP is funded primarily on donations and grants, the Georgia Department of Human Services is also a source of funding. Such paperwork is therefore integral to the success of the organization, as funding from the government requires documentation of services provided. By the time case managers at NAP provide comprehensive services, which range from picking up a refugee family at the Hartsfield-Jackson Atlanta airport to renewing their Medicaid and Food Stamps, they have little time to case note. Often, I would serve the agency by doing the deskwork of the case managers, scheduling doctor's appointments (read: being put on hold for 10-90 minutes at a time), prepping case files and making copies.

These seemingly mundane tasks proved to be exceedingly difficult at times. As a health intern, I learned that the American medical system is not well-equipped to deal with refugee health because of the rigidness of our social structure. Our medical system, and to a larger extent, American social welfare, lacks the flexibility to understand personal circumstances. Government welfare requires that refugees follow the same rules as American citizens, yet refugees have extenuating circumstances that prevent them from receiving the same benefits as native-born Americans. For example, all Americans must apply for Medicaid using state paperwork, a process that takes up to a month. Because refugees lack health insurance when they first arrive, they use the Emergency department for the most basic of healthcare needs. They frequently utilize ambulances because they lack the knowledge and ability to transport themselves. The result is thousands of taxpayer dollars wasted, as the refugees cannot pay the medical bills. If the state government was to amend certain welfare assistance programs to accommodate for these unique circumstances, refugees would receive better health care upon arrival to the United States, and the healthcare would be cheaper for the state.

Even with laws in place to specifically help refugees, refugee resettlement services are left to align healthcare disparities. For example, although medical providers are required by law to provide interpreters if they accept Medicaid, a majority of providers do not provide this needed interpreter. Thus, I found myself calling Medicaid to schedule interpreters on behalf of my clients. Other times, I would run around the office and persuade one of our multi-lingual staff members to attend the appointment with the client. Sometimes, these attempts would be in vain as refugees would arrive late or completely miss their appointments. Public or even Medicaid-provided transportation would delay my clients' arrival to appointments, as would different cultural understandings of promptness. Therefore, the duty of our organization, and arguably the moral duty of all of those who engage with refugees, is to provide that needed flexibility.

For example, case managers often take it upon themselves to drive clients to appointments to ensure a timely arrival. That July Wednesday, after my case manager and I dropped off the client at his appointment, I found myself looking up at the "Refuge Coffee" banner. My case manager pulled into the parking lot and parked behind the red food truck. As we walked up to the truck, the creative branding initially impressed me. But listening to my case manager talk with the truck owner put meaning behind the shiny logo. Refuge Coffee not only trained and employed refugees in making caffeinated drinks, but was also dedicated to combatting the social isolation this disadvantaged group faces.

Despite closely-knit ethnic communities, there is little integration between different ethnicities. Somalian families are resettled with other Somalian families, while the Bhutanese families are resettled with each other. This technique is often helpful for newly arrived refugees, as they like to be surrounded by similar cultures and people, yet it creates ethnic isolation over time. Clarkston lacks a community center, so whether by choice or social structure, refugees often feel stuck within their small social circles. Refuge Coffee provides a meeting place that is not only accessible to most of these various ethnic communities, but also allows integration with native-born Americans. My case manager and I departed the establishment, a coffee in my hand for me and for the Ugandan man we were going to pick up. Through my Shepherd internship, my understanding of community has grown because of the problems I've observed in Clarkston, but also the community I was welcomed into while interning.

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