Literacy, Health Literacy & Family Culture: One Woman Refugee’s Story of Seeking Health Care In DenverPosted by Mary Ann Whiteside in Blog, Special Topics
If your American family story is like mine…
your ancestors were probably voluntary immigrants to this country, not refugees. My maternal grandfather came over from Poland at the turn of the last century, knowing eight languages, but not one of them English. He was thirteen, alone, with just a note hung around his neck with a destination written on it. In honor of his memory, I wanted to help another newcomer to the United States, and that is why I volunteer to teach English as a Second Language (ESL) in the Colorado Refugee English as a Second Language Program (CRESL) at Emily Griffith (http://www.refugee-esl.org).
A person doesn’t choose to be a refugee. It happens to you.
Refugees have been forced to flee their homeland, and through the United States refugee resettlement program, have found refuge in our country. By official definition, a refugee is any person who is outside his/her country of nationality, and is unable or unwilling to return to that country because of persecution or a well-founded fear of persecution on account of race, religion, nationality, and membership in a particular social group, or political opinion.
Women refugees are often isolated at home.
The refugees in the CRESL in-home tutoring program are overwhelmingly women who are to unable to attend the regular ESL classes for various reasons – perhaps health issues or small children at home or cultural and religious issues that forbid women from appearing in public without being chaperoned by a male family member. The in-home tutoring program was established to aid these women in learning English and becoming acculturated so that they are not isolated. They learn the English language and American cultural ways so that they can ride the bus and do their own grocery shopping, go to their children’s school appointments, rent an apartment, and basically live day to day in an American city. Also, as I discovered firsthand, learning English is crucial in helping these women refugees access much-needed health care.
Literate in three languages, zero health literacy.
I was first assigned to tutor a woman in her mid forties named *Fatima. In some ways Fatima shares similarities with my grandfather, as she is literate in three languages but speaks no English. She and her family also share his courage and desperate longing, maybe you could say a determined optimism, for something better.
I was considered very lucky as a tutor; my student knew how to read and write in several languages, one of them Russian, a rather complex language. And, she was used to living in large cities. Often refugees are illiterate and from rural areas. Literacy made it much easier to teach a second language and familiarity with urban, modern living meant many of the tasks of teaching daily skills could be skipped. Thankfully, I wouldn’t have to pantomime why one should put chicken in a freezer or refrigerator to keep it fresh.
Fatima lives with her husband and two teenage sons. She also has a married daughter in Ohio. Fatima and her family are Muslims and would be considered rather liberal. For example, Fatima wears a head covering, but it looks more like a large headband that does not cover her head like a traditional Islamic head covering.
The doctor suspects cancer.
One day Fatima asked for my help arranging a follow-up visit to a health clinic. Her teeth and gums were in terrible condition, due in large part to her time in a refugee camp. She was unable to eat solid food and continued to lose weight. It turned out her gums were so inflamed and full of sores that she had previously gone to the clinic on an emergency basis where the doctor, suspecting cancer, had done a biopsy.
I was able to assist her with scheduling the second appointment. Upon her request, I also went with her and her son to that appointment. She wanted me to stay with her during the actual visit, and I did. Thankfully she didn’t have cancer, but she was in a great deal of pain and had been for months. The clinic sees and serves many people. They are overwhelmed. What I had to explain to Fatima was that although she was in terrible pain, and although her mouth looked so bad that they had initially thought it might be cancer, they could not see her for dental care for at least 6 months. Further, they would not give her help with pain management while she waited for dental treatment. After a brief statement from the doctor and the interpreter I was left trying to explain this. My pantomime skills – never any good to start with, and any dexterity I had paging through the English- Russian dictionary, were inadequate to explain the situation. But with her experience as a refugee Fatima grasped the totality of the situation more completely and more quickly than I did. “No money, too many people, has to wait.”
Family culture can be a health care barrier.
Our overburdened public health care services weren’t the only challenge I would have to navigate to find Fatima the care she needed immediately. I was in for a real “cross-cultural awakening.” After searching the internet for a few hours I found that the University of Colorado School of Dental Medicine runs an emergency dental clinic (open Mondays – Fridays sessions at 10 a.m. and 2 p.m.) that was open and available to Fatima. Yes, they assured me, if I got there early I could get Fatima into one of the slots that next day. But I had to convince Fatima’s two young sons, since her husband was out of town, to let their mother receive the emergency dental care she needed. One of the sons would need to get up early enough to accompany us to the clinic because Fatima was not allowed to go anywhere without a male member of the family. We finally negotiated to have one of the sons would go with us, but only to an afternoon session; we would have to hope that one of the afternoon slots might be open. Also, I assumed I would drive, but oh no! Her son had to drive us because no woman could be allowed to drive. I am thankful that we made it without being stopped for his myriad traffic infractions.
Eventually, Fatima had all her teeth pulled, got dentures, and is much happier and pain free. Not long after, her family moved to Ohio to find work and to be closer to her daughter’s own growing family. I miss Fatima – her laugh and good spirits and her attempts to teach me a bit of Russian. But I am pleased for her that her loneliness is eased with having her daughter close by.
I learned more than I ever imagined working with Fatima, maybe more than she did. I learned that for a refugee trying to get health care there are both obvious and invisible barriers. Language differences and the financial limitations of both the refugee and the care providers themselves are easy to see. It was the cross-cultural barriers that caught me by surprise. This woman’s culture, her values, beliefs, and attitudes from a remote area of Turkey, determined whether or not a she could leave her house to visit an emergency clinic or choose a safe convenient method of transportation to get herself there.
Perhaps your American family’s story is more like Fatima’s than mine. At the very start, I imagined the refugee I would be tutoring would have much in common with my maternal grandfather. Well, Fatima shares some traits with him, indeed. As I noted earlier, she and her family share his courage and determination to build better life in a new country. But Fatima, being a woman and being Muslim, has a much harder road to travel here with a unique set of barriers she must struggle to overcome.