Friends of Refugees

A U.S. Refugee Resettlement Program Watchdog Group

“Mental illness? Sorry, we don’t cover that. Need an interpreter? Oh well.”

Posted by Christopher Coen on January 31, 2011

According to an employee who manages health and wellness programs at Integrated Refugee and Immigrant Services (IRIS) in Connecticut it’s almost next to impossible to get mental health care if you have Medicaid. Waiting lists are often longer then the eight months of Medicaid coverage for refugees. Need a translator? Sorry, many therapists don’t work with them. Plus, physicians aren’t trained to work with interpreters. The New Haven Independent tells more: 

The soldiers dragged out a pregnant woman and slit open her belly. A witness who was personally tortured for his political activism in Congo is more haunted by that image than his own pain.

Safe in Connecticut now, he has daily flashbacks and wants to see a therapist in order to cope with this memory as well as the stress of leaving his home, friends and family to start a new life in America.

But it will likely take months before he gets help. And if he does his therapist must speak French to communicate with him or be willing to work through an interpreter. To make matters worse, those months of waiting work against him – since he’ll qualify for health coverage for a limited time…

…About 28,000 refugees currently live in Connecticut, according to Integrated Refugee and Immigrant Services (IRIS) in New Haven. Many refugees come to the U.S. after suffering through traumatic experiences in their home countries, but financial and language barriers often keep them from getting mental health care.

This is one of many shortcomings in the services offered to refugees, according to a report issued this month by the Congressional Research Service, which was critical of federal resettlement programs that provide short term aid and often do not address the unique problems that refugees face, including trauma histories.

The long-term consequences of not providing refugees with good mental health care are devastating, according to Mary Scully, director of programs for Khmer Health Advocates in West Hartford. She connects untreated mental illness in her clients who came to the United States in the 1970s and 1980s with a wave a physical illness in the Cambodian-American community today. “Now we see the whole gamut of trauma-induced chronic disease,” she said.

The witness and other refugees need to go to providers who accept Medicaid, which covers refugees for their first eight months in the U.S. “It’s almost next to impossible to get mental health care if you have Medicaid,” said Kelly Hebrank, who manages health and wellness programs at IRIS. The providers who do accept Medicaid have long waiting lists, she said.

That waiting list means the duration of therapy is shorter, explained Zurowski.  She has advocated nationally for extending the period of Medicaid coverage so that refugees have longer to establish themselves in jobs that offer health benefits. The Congressional Research Service also identified the short duration of Medicaid for refugees as a problem…

A greater barrier is the refusal of some therapists to work through interpreters. Health care providers may resist using interpreters because it takes time during the appointment, time already limited by insurance regulations, said Dr. Hendry Ton, director of the University of California Davis Transcultural Wellness Center. “It’s almost an incentive not to use an interpreter,” said Ton, who is a psychiatrist. Most physicians, he added, are not trained to work through interpreters. Nor is there any standard of training for medical interpreters…Read more here

I guess I’m not understanding why a physician would need training to treat a patient who communicates through an interpreter. And why would any therapist worth their weight in salt not be willing to work through interpreters?

The interpretation for refugees at medical appointments reminds of a time in 2005 when a Sudanese refugee arrived with a giant mass protruding from his back (approximately 6’”x 5” and sticking out 2-3”) . Firstly, no one from his resettlement agency came to pick him up for his medical specialist appointment for this apparent tumor, so he had to wait another month for a new appointment. This time I took him to his appointment at which there was no scheduled interpreter even though he spoke Sudanese Arabic but almost no English. As a result of the lack of interpretation services medical personnel were not able to inject him for the CT scan as they were not willing to risk being unable to communicate with him in the event he had an adverse reaction to the injection. He then had another appointment at which there was only a Somali interpreter who spoke very little Arabic. Luckily, the CT scan done without the injection was sufficient that the doctor was then able to determine the need for a biopsy.

Once again I took him to the next appointment for the biopsy and, once again, there was no interpreter. The medical personnel then suddenly got the idea to call the Language Line (an over-the-phone interpretation service), although the refugee later complained that the interpreter on the Language Line spoke a Kurdish Arabic that he could not fully understand. As a result of this insufficient interpretation he endured a biopsy into muscle tissue in his back, including cauterization, while not being able to communicate to medical personnel that he had insufficient local anesthesia. He later said that the pain was excruciating. They then scheduled him for an X-ray. Once again, no interpreter arrived.

He was later diagnosed as having a hemangioma (most of the time a benign tumor of the capillaries or blood vessels – although rare for being of this large a size and at this location in the muscle of the back) and scheduled for an injection by an interventional radiologist in order to shrink the tumor. Unfortunately, he was so traumatized by this time by the earlier biopsy without sufficient local anesthesia that he then refused to go back to the doctor. All during this time his resettlement agency seemed oblivious to his case. At no time during my interaction with this refugee did anyone from his resettlement agency ever try to help him navigate the health care system, provide him with rides to the doctor or even a bus pass when he ran out of passes, or anything else that would have been helpful. They seem to have no awareness or interest in his plight. He later moved out of town having never returned to the doctor for treatment, and I sometimes wonder what his fate was.

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