Understanding Barriers to Healthcare Among Resettled Refugees

Midwifery, Midwifery students, Reflections on racism and oppression in midwifery

Written by Olivia Kimble, Student Midwife at Bastyr University for the first class in the Midwifery Care series

The life of a refugee is inarguably more difficult than most healthcare workers probably imagine. It is easy to forget about the challenges refugees face because many of our own communities are made up of homogeneous, native-born citizens. Citizens are more likely to understand and exercise their access to healthcare through private or community clinics, or, as a last resort, the emergency department. In contrast, a refugee has to overcome additional obstacles before accessing healthcare, and then might only have access to racist and xenophobic providers.  

The people displaced because of civil war, political oppression, and economic instability face many challenges and traumas in their attempt to seek liberty and safety. Once these people have made it to a new location, usually illegally, they face hurdle after hurdle trying to establish a life. Refugees are subject to sweeping employment discrimination because they cannot speak the native language (or are easily recognized because of an accent), are undocumented and therefore cannot demand better working conditions or livable salaries, and cannot setup informal businesses without attracting law enforcement (Langa, 2011).

Langa (2011) reports that “by and large refugee women live in fear, and feel dislocated, and displaced” (p. 2). As a provider it’s important to recognize how a refugee’s health status is tied directly to their plight as a refugee. Understandably, refugees are probably not the most reliable patients because they have to spend such an inordinate amount of time finding or creating livable income to support themselves and their families.

What some health care providers might describe as uncooperative or difficult patient behavior was clearly visible in The Spirit Catches You and You Fall Down (Fadiman, 1997). Lia’s parents are continually seen as disagreeable because their Hmong customs and ideas conflict with American ideals of personal responsibility and hierarchical submission to their doctors’ orders. The Lee family relied on state assistance and thus did not have the freedom of movement, time, and resources that the doctors expected from their patients. Foua’s culturally-motivated rapt attention to Lia and her determination to carry her, clothe her, feed her, and love her regardless of her physical health status created a strange tension between her doctors who were also trying to care for Lia in their own American, individual way (Fadiman, 1997). Unfortunately the doctors who treated Lia were somehow immune to the family’s plight as refugees and saw their battle for economic security as a hindrance to their care instead of informing how to best care for the Lee family.

Refugees are often among the hardest working people in any country because they have to be. Finding a new home, creating economic stability, and rebuilding a community are monumental tasks to undertake even with good health. Unfortunately, needing and seeking healthcare as a refugee might be as costly and dangerous as remaining ill.

References:

Fadiman, Anne. (1997). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. New York, NY: The Noonday Press.

Langa, M. (2011). Women empowerment: A case study of a refugee women’s group at the Centre for the Study of Violence and Reconciliation. Retrieved from http://www.csvr.org.za/images/docs/Other/women_empowerment_a%20case_study_of_a_refugee_women_s_group_appendix_e.pdf

Written by Olivia Kimble, Student Midwife at Bastyr University for the first class in the Midwifery Care series