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

is my full-time job to make health care easier for patients of refugee background. On a daily basis, I help approximately 20-60 former 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 patients of refugee background who were forced to flee their home countries. 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 these patients starts with better coordination between care teams, resettlement and migration agencies, community partners, and the refugee community. Better coordination helps not only our patients of refugee background, 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 care teams working with patients of refugee background by providing essential care information in a single location. The Refugee FYI identifies these patients, both newly arrived and previously resettled, so that appropriate care teams within the U of U system will be alerted and can offer culturally appropriate care. The FYI utilizes the dotphrase .refugeefyi that prompts the entering user to collect key information: the agency that is working with the patient, their date of arrival to the United States, their country of origin, their agency caseworker, and the date a two-way ROI is collected between patient and case management team. 

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 their patient’s country of origin so they know what priority health conditions as well as trauma to look out for based upon CDC recommendations. Third, the FYI provides information about possible resources and services available to the patient. A patient within a case working period (usually a set date of two years 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

Visiting a U of U Health facility can often be a patient’s first encounter with a Western medicine system. If your patient is having difficulty complying with their care plan, it may be due to health literacy. Even Utahns speaking English as their first language 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 patients of refugee background can make compliance even more difficult. You might consider the following practices: 

  • Don’t be afraid to ask questions for clarification. 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. Consider utilizing the teach back method. 

  • Don’t be afraid to use the iPad as the interpreter. We cannot improve health literacy without communicating to the patient in their language. In-person interpreters are not always available and many patients prefer the iPad to having an interpreter there in person. Interpreting Services has 3 applications contracted for medical use: Cyracom, AMN, and Martti. Interpretation is a service we must provide and we should not be using family members or minors. 

  • Utilize translated forms, visual, and audio aids. There are often forms that are more culturally appropriate for patients who are not native to the United States. Translation Services and Patient Education teams can help create forms to fulfill your patients’ needs if they don’t already exist. If a patient has a camera phone, they may want to record instructions you give them while the interpreter interprets. 

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

At the core of caring for patients of refugee background is a willingness to take a holistic view of the patient. Many patients don’t realize, their physical, mental, social, and spiritual wellbeing is all connected. They may not be able to focus on their diabetes until their housing concerns are taken care of. Utilizing all disciplines like social work, care management, pharmacy, and nutrition for the care team will be helpful.   

Patients of refugee background 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 some of these patients to be in clinic. 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.

Your patients aren’t alone—and neither are you

Clinicians often feel overwhelmed by complex patients because there are so many variables out of their control. Patients of refugee background experience cultural and economic barriers that can be hazardous to their health and well-being. There are a host of services available for refugees and tools available to busy providers. A lot is at stake for these patients and we make their lives better by using the available tools (Refugee FYI, Interpreting Services), resources (care teams, CDC, agencies), getting to know them as individuals, and treating them holistically. Take advantage of research, webinars, and opportunities to learn more about this population so you may incorporate that knowledge into your patient interactions.

Resources:

Understanding Resettlement and Refugee Health

Local Resources for Patients and Care Teams

Resources for Care Team Self-Care

Teach Back Method

National Level Resources

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

This article was originally published August 22, 2019. 

Contributor

Anna Gallegos

Refugee Services Program Coordinator, Redwood Health Center, University of Utah Health

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