Knyaw Ler took a deep, ragged breath and closed her eyes.
The 45-year-old diabetic was experiencing extreme dizziness. When she ran out of insulin three days before her appointment at Summa’s Family Medicine Center of Akron, she had to stop taking the twice-a-day medication.
A native of Myanmar, formerly Burma, Ler came to Akron after spending a decade in a refugee camp in Thailand.
What Dr. Emily Godlewski couldn’t say directly to Ler with words, she conveyed with a comforting rub on the back.
“We’re going to make you feel better, OK?” Godlewski said through medical interpreter Kprue Moo.
Ler is one of about 1,250 refugees from war-torn countries who get medical care each year at Summa Health System’s Family Medicine Center. The center on the Akron City Hospital campus serves as a training site for residents.
The center has responded to the health needs of the region’s growing refugee population by scheduling special days for refugee patients and assigning specific residents to the patients, said Dr. Sharon Van Nostran, chair of Summa’s committee to serve limited English proficiency patients.
Summa also has initiated staff training to increase cultural understanding and community-based programs to educate refugees about common health issues, she said. In addition, the health system has hired a doctor who speaks Nepali, one of the most common languages spoken among the region’s refugee population.
“It’s been rewarding to serve this population,” Van Nostran said. “It’s been very rewarding, but it’s also been very challenging.”
Each year, about 350 refugees from Myanmar, Nepal, Iraq and other countries arrive in the Akron area with the help of the International Institute of Akron, according to Kate Sass, the institute’s director of refugee resettlement. Another 350 refugees who have been living in other cities throughout the United States also relocate to the region in a typical year.
Last year, the staff at the Family Medicine Center recognized the trend. About 5 percent of their patients are refugees from Myanmar, Bhutan or Nepal.
Summa works with the International Institute to schedule medical interpreters for appointments, as required by the federal government, Van Nostran said. The hospital pays for the interpreter service, which typically costs $50 per hour, plus transportation fees.
Cultural differences
Along with the obvious language barrier, things such as transportation issues and cultural differences create challenges, Van Nostran said. Some patients also struggle with post-traumatic stress disorder from their past experiences.
The staff has learned, for example, that it is considered rude in some cultures to only use one hand instead of two to give patients their prescriptions or other paperwork.
In another case, Van Nostran said, hospital staff were concerned that a refugee couple were ignoring their newborn shortly after birth. The staff later learned this was the custom in the family’s native culture, which believes doting on a newborn will draw the attention of “evil spirits.”
“It has challenged us not to make assumptions but to ask specifically about cultures,” she said.
A refugee health task force with representatives from Akron’s three hospital systems, social service agencies and the Summit County health department is meeting regularly to discuss health-care needs for refugees living in the Akron area.
The goal of the group is “to look at some of the common issues we’re experiencing with delivering quality and appropriate health care to the refugee population,” said Dr. Marguerite Erme, Summit County Public Health’s medical director.
Summit County Public Health has a contract with Ohio Jobs and Family Services to provide the initial exams when refugees arrive in the area, Erme said. When refugees arrive, they must have an initial health exam within 30 days for parasites, hepatitis, tuberculosis, dental problems and other health issues.
Some refugees have latent tuberculosis, which isn’t active or contagious but still must be treated with a nine-month course of antibiotics to avoid an active infection in the future, she said.
“You learn a lot,” Erme said. “Health-care providers who take care of refugee patients need to be open to learning and realize that what we were taught in our medical professional education may not always apply to this population.”
Adult refugees have health coverage through the state-run Medicaid program for the first eight months after they arrive, Sass said. Children typically can maintain Medicaid coverage longer because eligibility for them is broader.
The vast majority of refugees who need ongoing medical services seek care at Summa’s Family Medicine Center for adults or Akron Children’s Hospital Locust Pediatric Group, Erme said.
Caring for children
At Akron Children’s Locust Pediatric practice, Medical Director Dr. Cooper White said “not a day goes by that we do not have refugee patients in the clinic.” The primary-care practice has about 800 patients who are from refugee families.
Although the majority of children are in good health when they arrive, he said, refugees have some medical concerns that typically aren’t seen in American-born children — things such as oral health problems, latent tuberculosis, parasites, anemia, failure to thrive, chronic ear infections and hepatitis.
“The language barrier is easily the largest challenge,” he said. “Transportation and being able to navigate the current health-care system remain significant challenges for many of the refugee community.”
A nurse in the clinic coordinates care for refugee patients, White said. The practice also provides immunization information and other patient education items in other languages and uses interpreters and pictorial strategies to communicate.
At Summa’s Family Medicine Center, Godlewski is one of the two doctors-in-training who primarily see the refugee patients.
During a recent visit, Godlewski carefully maintained eye contact with her patient, Padmi Subba, 27, while talking to her through a medical interpreter. Subba spent 18 years in a refugee camp in Nepal after fleeing Bhutan because of religious persecution.
Through the interpreter, Subba said she is pleased with the care she gets at the center.
“They ask everything about medical history,” she said. “They are so polite.”
Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com. Follow Powell on Twitter at twitter.com/abjcherylpowell.
