BEYOND BORDERS
Bridging the Gap from Global Health to Local Health
by NICOLE BICHIR , MD
Photos of undergraduate student and high school student mentor-mentee pairs for Refuge Collaborative .
If you have never migrated , it is difficult to imagine the emotions and challenges of finding oneself suddenly in a foreign country – with foreign people , language , foods , customs , health practices and health systems . It is also difficult to imagine the fear and trauma that a person must have experienced to be forced to flee , leaving everything behind . Yet these are challenges that we all must face to be good neighbors and to provide effective and sensitive health care to newcomers . We must imagine what might improve our experience if we were in those shoes – whether it is a warm greeting in our native language , an expression of welcoming , an open and curious mind , acknowledgement of our difficulties , or connection to helpful organizations and resources .
Being from rural Kentucky , I was lucky to be raised in a culture steeped in hospitality and generosity . Like many of our talented and warm-hearted trainees , I wanted to find an altruistic purpose in medicine , serving the neediest among us . Already a lover of foreign languages and travel , when I came across refugee medicine and global health , I was hooked . After working abroad in India and Ghana , I came to realize that “ majority world health care ,” including systems and available resources in low- and middle-income countries , is an important background to understand how to best serve immigrant patients locally .
Enormous health gaps exist in the U . S . for refugees and immigrants : they are much more likely to be uninsured , may not be eligible for benefits like Medicaid , and are less likely to seek health care due to barriers such as language and immigration fears . With competing priorities for a newcomer family , like finding and maintaining housing , jobs and learning the lie of a new land , children ’ s health care may seem less pressing . Educating families , recognizing the stressors , assisting through community partnerships , and reducing barriers to health care are imperative to reduce this disparity .
In pediatrics , common challenges we see among immigrant patients relate to lack of understanding of the importance of wellness visits , lack of understanding of medication directions and refills , and difficulty understanding the options presented as part of a risks versus benefits discussion . This is much more than just a language barrier , but more of a cultural one . If you consider the patients ’ perspective , many of the refugees I see are coming from a country where there are not enough doctors for wellness visits , and children often die at home from preventable causes due to lack of emergency services and the fact that fees must be paid before care is provided . Most of my patients from sub-Saharan Africa have tragically
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