The United Nations Refugee Agency (2022) estimated there to be 27.1 million refugees and 4.6 million asylum seekers worldwide by the end of 2021. With refugees in need of fundamental human rights such as security, shelter, and food, many refugees have been able to obtain safety in the state of Arizona. The Arizona Refugee Resettlement Program (2022) has tallied the number of refugees resettled in Arizona in the past 7 months as 4,331, an extraordinary jump from 2021, with a yearly total of 647 refugees. When categorizing by nationality, 2,087 of the 4,331 refugees resettled this year in Arizona are Afghan nationals, while 1,350 are Cuban (Arizona Refugee Resettlement Program, 2022). Comparably, 135 Ukrainian refugees have resettled in Arizona so far this year, but this number is expected to increase as the Biden Administration has promised to soon resettle 10,000 Ukrainian nationals in various parts of the United States (Arizona Refugee Resettlement Program, 2022).
Through government sponsored health care programs like Medicaid, Children’s Health Insurance Program (CHIP), the Health Insurance Marketplace, and Refugee Medical Assistance (RMA), refugees have access to health insurance; eligibility for each health coverage program depends on the state of residence and the eligibility criteria (Centers for Medicare & Medicaid Services, 2021). These programs, under the Centers for Medicare and Medicaid Services (2021), are fulfilling a commitment to improve health equity by making sure refugees who would otherwise not have access to health insurance are covered.
Although host countries require wealth to provide refugees with human rights’ necessities such as housing, food, education, and health care, refugees can in return provide benefits to the society. Adult refugees can contribute to the host country’s workforce and end up paying the sum of all federal benefits received back and more through taxes (Miliband, 2017). Refugee children need education for a similar reason to help them become future productive members of society. Moreover, refugees want to contribute to the host country by earning their own living and being valued members of society (Miliband, 2017). Refugees can also add to society by helping to create a diverse population. Pope Francis (2022) stated that thanks to the presence of migrants, “we can grow in our common humanity and build together an ever greater sense of togetherness. Openness to one another creates spaces of fruitful exchange between different visions and traditions, and opens minds to new horizons. It also leads to a discovery of the richness present in other religions and forms of spirituality unfamiliar to us, and this helps us to deepen our own convictions.”
The individuals who make up the health care community have within them the values and character of human rights’ advocates. As part of the social contract between medicine and society, the medical community should pay close attention to the health care needs of the more vulnerable as part of their social responsibility (Dharamsi et al., 2011). Social responsibility encompasses having a conscience about systems of inequality and working towards justice and the common good (Dharamsi et al., 2011). Physicians can play a crucial role in the refugee crisis as their commitment to beneficence has already been established when swearing their allegiance to the Hippocratic Oath.
The health care community should provide culturally competent care because a person’s culture can influence their perspective on risk, danger, disease, treatment, health, and wellness (Feinberg et al., 2021). Culturally competent health care incorporates cultural considerations such as race, ethnicity, primary language, English proficiency, age, gender identity, economic status, spiritual beliefs and practices, geographic location, and family roles (Arizona Complete Health, 2018). The Office of Minority Health (2013) highlighted the importance of providing culturally appropriate health care services to minority populations as a way to achieve health equity and work towards eliminating the social determinants of health. In addition to responding to demographic changes in the population and helping to eliminate health disparities amongst diverse populations, practical reasons also exist for providing culturally competent services in the health care field: to decrease the likelihood of malpractice claims; to meet regulatory health mandates; to improve quality of care; and to gain a competitive edge in the marketplace (Office of Minority Health, 2013).
Having undergone and fled oppression from their own governments, refugee populations tend to be suspicious of government health information; so, a lack of cultural competence when communicating public health content can leave refugee populations at a high risk of not being able to find, understand, or use health information (Feinberg et al., 2021). To be more responsive to the needs of a diverse population, health organizations need to integrate the culturally competent model, which begins with an awareness of one’s own biases towards culturally diverse populations (Lopez et al., 2017). This then progresses to the development of a communication skill, which will promote trust with patients from diverse backgrounds and lead to the implementation of policies at an organizational level that respect cultural differences (Lopez et al., 2017). The Office of Minority Health offers free, accredited, online cultural awareness and competency training available for Arizona-based health care professionals though their program Think Cultural Health.
Other than culturally competent care, another policy physicians should incorporate when treating diverse populations, like refugees, is trauma-informed care. Practicing trauma-informed care will change the philosophy of medicine from “What is wrong with this person?” to “What has happened to this person?” (Buffalo Center for Social Research, 2022). Refugee populations, compared to the general population, have a higher rate of anxiety, depression, posttraumatic stress disorder, psychosis, and dissociation due to being exposed to or having witnessed murder, torture, sexual violence, extortion, and degrading treatment (Uschan, 2017; Feinberg et al., 2021). Traumatic events that involve violation of a person’s bodily integrity often have adverse effects on a person’s physical and mental health and attitudes toward medical care and, ultimately, cause poorer outcomes throughout their lifetime (Raja et al., 2015). Patients of lower socioeconomic and minority status will benefit from trauma-informed care as it is an attempt to ease the distrust and the perceived power imbalance between provider and patient (Raja et al., 2015).
Trauma-informed care is broken into 2 domains: Universal Trauma Precautions, which consist of small changes providers can make without a patient having to disclose a trauma history; and Trauma-Specific Services through which providers draw from strategies after knowing the patient has experienced a traumatic event (Raja et al., 2015). The Arizona Trauma Institute provides both in-person and online training for health care providers and organizations to obtain trauma specialist certifications. Within 12 months of completing trauma training, applicants will need to apply for certification through Trauma Institute International.
Within the domain of Universal Trauma Precautions, providers should move away from reassuring patients to helping patients feel more in control (Raja et al., 2015). This can be done by sharing an overview of what will happen during the visit, offering the patient choices of how the examination can be conducted, and encouraging the patient to speak up if they are uncomfortable during the interaction (Raja et al., 2015). According to Raja et al. (2015) “When health care providers are empathic and sensitive, survivors of sexual violence report that they are more likely to follow up on medical appointments and engage in preventive care” (p.220). Also, within the domain of Universal Trauma Precautions, providers are aware of the possible relationship between trauma and maladaptive coping mechanisms, such as smoking, alcohol use, drug use, binge eating, or engaging in unprotected sex. (Raja et al., 2015).
As part of the Trauma-Specific Services domain, providers should keep a list of referral sources for patients who disclose a history of trauma unless the providers have had specific training in providing trauma-informed care (Raja et al., 2015). Grossman & Grossman LTD, Sierra Tucson, and Valleywise Health are a few Arizona-based health care professionals who are certified in providing trauma-informed care. Also, within the domain of Trauma-Specific Services, providers should understand their own trauma history, because “when health care providers are themselves survivors of traumatic events, they may feel uncomfortable talking about these issues for fear of retriggering their own feelings” (Raja et al., 2015, p. 222). Providers should also be aware of when they are experiencing professional burnout because empathic communication can be hard to achieve when the physician feels overwhelmed (Raja et al., 2015).
Being in a position to help people in need demonstrates strength. Just as the United States took the responsibility to help displaced people after World War II, we again need to express empathy to our fellow human beings. How else will we meet the needs of millions of refugees displaced in today’s political climate?
About the Author:
Helai Alizada is currently a 3rd year Master of Public Health with Dental Emphasis student at A.T. Still University. She earned her Bachelor of Science degree from the University of California, San Diego in Biology, Ecology, Behavior, and Evolution in La Jolla, CA.
Citations:
Arizona Complete Health. (2018). Cultural competency program. https://www.azcompletehealth.com/content/dam/centene/az-complete-health/pdf/508_AZ%20Cultural%20Competency%20Program%2018%20Eval%20and%2019%20Description%20-%20FINAL.pdf
Arizona Refugee Resettlement Program. (2022). Refugee arrivals by nationality and FFY of resettlement. https://des.az.gov/sites/default/files/Refugee_Arrivals_Report.pdf?time=1661902125357
Buffalo Center for Social Research. (2022). What is trauma-informed care? University at Buffalo. https://socialwork.buffalo.edu/social-research/institutes-centers/institute-on-trauma-and-trauma-informed-care/what-is-trauma-informed-care.html
Centers for Medicare & Medicaid Services. (2021). Health coverage options for Afghan evacuees. Department of Health and Human Services. https://www.medicaid.gov/medicaid/eligibility/downloads/hlth-cov-option-afghan-evac-fact-sheet.pdf
Dharamsi, S., Ho, A., Spadafora, S. M., & Woollard, R. (2011). The physician as health advocate: Translating the quest for social responsibility into medical education and practice. Academic Medicine, 86(9), 1108–1113. https://doi.org/10.1097/acm.0b013e318226b43b
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Lopez, M., Hofer, K., Bumgarner, E., & Taylor, D. (2017). Developing culturally responsive approaches to serving diverse populations: A resource guide for community-based organizations. National Research Center on Hispanic Children & Families. https://www.nsvrc.org/sites/default/files/2017-06/cultural-competence-guide.pdf
Miliband, D. (2017). Rescue: Refugees and the political crisis of our time. Simon & Schuster.
Office of Minority Health. (2013). National standards for culturally and linguistically appropriate services in health and health care: A blueprint for advancing and sustaining CLAS policy and practice. U.S. Department of Health and Human Services. https://thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedCLASStandardsBlueprint.pdf
Pope Francis. (2022). Pope Francis’ message for the 108th World Day of Migrants and Refugees. SLmedia. https://slmedia.org/blog/pope-francis-message-for-the-108th-world-day-of-migrants-and-refugees
Raja, S., Hasnain, M., Hoersch, M., Gove-Yin, S., & Rajagopalan, C. (2015). Trauma informed care in medicine. Family & Community Health, 38(3), 216–226. https://doi.org/10.1097/fch.0000000000000071
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