anna gallegos
Marcie Hopkins, U of U Health
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Don’t Get Lost in Translation: Expert Advice for Caring for Refugees
As Redwood Health Center’s refugee coordinator, Anna Gallegos has learned valuable lessons that can help all of us better care for refugees and vulnerable populations. Here are three suggestions to help make caring for refugees easier.
It

is my full-time job to make health care easier for refugees. On a daily basis, I help approximately 20-60 refugee patients who come into Redwood Health Center solve problems with their case workers and interpreters, coordinate with resettlement and migration agencies, support our clinicians, and teach staff to create an easier and more patient-centered experience for patients.

Over the last five years, I’ve learned a lot about our refugee patients. They are in new surroundings, often do not speak English, and are vulnerable in ways that other patients are not. They also have tremendous care coordination challenges. The path to better care for refugees starts with better coordination between care teams, community partners, and refugees. Better coordination helps not only refugees, but all of our patients.

Here are three suggestions to help make caring for refugees easier.

Tip #1: Use the Refugee FYI

I helped to create a tool in Epic that helps teams and refugees by providing essential care information in a single location. The Refugee FYI identifies refugees, or former refugees, so that the registration staff collects pertinent information about the patient. That information includes the agency that is working with the refugee, the year they resettled, their country of origin, and their caseworker. Traumas unique to refugee populations—like war or famine—can also be listed in the FYI.

Screen grab of Refugee FYI in Epic:

refugee fyi desktop screengrab

The Refugee FYI is important for three reasons. First, it standardizes information in a single place so the care team can easily access the information when they need it. Second, the FYI provides an important cultural cue to the care team, letting them know they need to modify their care based on the background of the patient. For example, a provider might need to be aware of traumatic conditions in the patient’s past. Third, the FYI provides information about the resources available to the patient. A patient within a case working period (usually a set date since they have resettled) has access to more resources than a patient who is out of case management.

Thanks to Truly Ashby in revenue cycle who helped me set up the FYI!

Tip #2: Plan to spend more time on education and health literacy

Patients often don’t comply because they just don’t understand. Even English-speaking Utahns have a hard time digesting and complying with advice given by a health care provider. The language and cultural barriers between American care providers and refugees can make compliance even more difficult. You might consider the following practices:

  • Don’t be afraid to ask questions. Asking questions is a good way to connect and teach health literacy. It allows you to assess comprehension and provide additional context or education where necessary.
  • Don’t be afraid to use the iPad as the interpreter. Many patients prefer the iPad to having an interpreter there in person. 
  • Use the right forms. There are often forms that are more culturally appropriate for refugee patients. The Refugee FYI can help guide you.

Tip #3: Take a more holistic view of the patient

At the core of caring for refugees is a willingness to take a holistic view of the patient. Even that they had the courage to tell their boss they had to leave for a medical appointment is a fact worth celebrating.

Refugees face unique challenges that may seem incomprehensible to many of us. Demonstrating empathy is an important way of connecting with patients and, as research demonstrates, can improve outcomes. Demonstrate empathy by asking about their language lessons, work, and school—not just their physical health.

Think about what it takes for these patients to be there. Maybe they had to take two busses. Maybe they struggled to get time off. They’ve gone through so much already—refugee camps, political violence, war. Give them time and take the time to build a connection with them.

Refugees aren’t alone—and neither are you

Clinicians often feel overwhelmed by complex patients because there are so many variables out of their control. Refugees experience cultural and economic barriers that can be hazardous to their health and wellbeing. But tools and processes exist to make care better for refugees and providing care better for busy clinicians. There are a host of services available for refugees, and tools available to providers. A lot is at stake for these patients and we make their lives better by using the available tools (Refugee FYI), getting to know them as individuals, and treating them holistically.

Rave Reviews for Anna's Work

"Anna has been instrumental in helping new refugee arrivals better understand and access health care within the United States. She goes over and beyond to help not only support clients, but also does so much to help  support the refugee resettlement organizations. Working on projects such as preventative health care and pregnancy classes for refugees has helped our clients to not only have a more holistic approach to healthcare, but also to feel valued."

— Jenny Hart, Maternal & Child Health Program Coordinator, International Rescue Committee

Anna facilitates a class taught by Dr. Keri Gibson for pregnant refugee women at Redwood on the second Tuesday of every month. "One of the challenges and unique opportunities of this class is the combination of different cultures. The languages range from three to seven per class. Currently, they have three iPads and 3-4 interpreters attending to translate for our patients in this session...They reorganize the conference room for each class to create a more inviting atmosphere, have all female staff, interpreters, and volunteers, which is more adaptable to their learning and comfortable for them to interact. Anna has been working closely with the agencies and the OB team to get things coordinated and a process in place. This is such a great example of overcoming barriers, adapting, and really going that extra step to provide the care and education that these patients need, in a safe environment."

— Nickole Canfield, Administrative Office Specialist at Redwood Health Center

Contributor

Anna Gallegos

Refugee Coordinator, Redwood Health Center, University of Utah Health