Laldin Liana, a recently-arrived refugee, sits in his doctor’s office in Columbia, Missouri, talking about his life – his favorite Jason Statham movies, life in Myanmar and his three children. He’s speaking with two nursing students from the University of Missouri, who are here to help him navigate his appointment.
The students, seniors Stone Chen and Emilie Winn, picked him up at his apartment, drove him to the doctor’s office, and stood back as he signed in, paid his co-pay and spoke with the receptionist.
Winn and Chen are working with Liana, and many other new refugees, as part of their Community Health class – where they are learning about public health by working in the field. The students partner with Refugee and Immigration Services, a part of Catholic Charities of Central and Northern Missouri.
Chen says prompting self-sufficiency among the refugees is a “big part of our program.”
He says the nursing students are there to watch and guide, but not take charge and do everything for the refugee. The idea is for refugees to learn how to use the available resources so that one day they will feel comfortable and confident going to appointments on their own.
“I think the best way to learn is you do it yourself,” Chen says.
According to the federal Office of Refugee Resettlement, being able to access health care is especially important for refugees. They face infectious diseases like tuberculosis; chronic diseases like diabetes and hypertension; and mental illnesses like post-traumatic stress disorder and depression.
Megan Gore, Refugee Health Coordinator for Refugee and Immigration Services in Columbia, says that refugees “are just a whole other level of need because they have so many more extra vulnerabilities."
Accompanying refugees to their appointments may sound more like social work than nursing. But Refugee and Immigration Services needs the help.
According to Gore, the case managers are “definitely exhausted.”
Columbia resettles an average of 150 new refugees each year, and Refugee and Immigration Services has a staff of only seven. So with each new refugee or family, case managers set up houses, arrange Social Security and food stamp benefits, and schedule initial primary care appointments.
“Most of the time they're just able to take them to the appointment and then pick them back up,” Gore says. That’s where the nursing students step in.
It was nursing students who created the Health Navigator program two years ago, as a part of their community health class. The students, each semester, are responsible for coordinating volunteers to assist with refugee health care appointments, taking the refugees to their health care appointments and assessing the level of self-sufficiency the refugee has reached.
Chen and Emilie Winn were the two navigators during the fall 2015 semester. They both say they learned about the barriers to care for refugees and worked to develop new ways to engage refugees and educate them about health.
Winn says she has already learned from her experiences with Refugee and Immigration Services, as it’s helped her become a better nurse by making her more conscious of other people’s challenges.
“It’s been a pretty good experience just to realize and change my care as a nurse. Just to realize that everyone comes from a different place and has their own barriers to deal with like language barriers and cultural barriers,” Winn said. “Just like seeing the person as a person, and not like a refugee or a race.”
Chen says the experience was different for him because he understands, from personal experience, what the refugees are going through.
“I'm an immigrant myself. I moved to America when I was 12. So I've been here 10 years. And so, for me, I understand some of the frustrations that a newcomer might have,” Chen says. “When I first came over here, I didn’t speak English at all. I didn’t understand very much of the culture.”
Gore said the program has been extremely helpful. In 2014 alone, nursing students, volunteers and case managers partnered to cover 130 health appointments.
In fact, she said it’s worked so well that she, along with others, are working to create a new, more sustainable, position – a refugee health advocate.
“A more advanced position,” Gore says. “Where students actually go into appointments, they keep track of case notes.”
This new position would work alongside the Health Navigator Program, helping refugees like Laldin Liana adjust to life in the US and the often complicated health care system – one appointment at a time.