For refugees who have fled their home countries, resettling in a completely new culture can be overwhelming. Not only are they often unable to speak the language, they face bewildering systems of health care, money, transportation and more. Some have never even used electricity.

“One of the common things is how a microwave works because microwaves are freaky,” said Bethany Hodge, M.D., M.P.H., assistant professor and director of the Global Education Office of the University of Louisville School of Medicine. “If you are coming from a place where you didn’t have electricity, let alone microwaves where you put something in a box and push a button and it’s flaming hot and you burn yourself because you don’t see it coming, it can be frightening.”

Students in the School of Medicine were introduced to the struggles of resettling refugees and the agencies that assist them in Kentucky at “Refugees and Our Competencies,” a Compassion Rounds presentation hosted by the UofL chapter of the Gold Humanism Honor Society (GHHS) on Nov. 30. Hodge and Rahel Bosson, M.D., assistant professor in the UofL School of Medicine and director of the Refugee Health Program, familiarized the students with some of the health concerns of these individuals and issues confounding their introduction to the U.S. health-care system.

Refugees may have health problems related to trauma or injury experienced in their home countries, as well as health conditions that have been neglected during their transition from a life in peril to resettlement in the United States. Hodge coached the students on how to navigate these issues sensitively in conducting a health history and physical. To complicate matters further, the patients may have different naming or date customs, and missing or fragmented medical records.

According to the United Nations High Commissioner for Refugees (UNHCR), the international body governing refugee status, refugees are individuals who have been forced to flee their home country because of persecution, war or violence. Typically, they leave their home countries for refugee camps in neighboring nations. Fewer than 1 percent of refugees who apply to UNHCR are resettled in a third country such as the United States, Canada or a European country. Most of the approximately 2,500 refugees arriving in Kentucky annually in recent years have come from Cuba, the Democratic Republic of the Congo, Somalia and Iraq. Refugee resettlement in Kentucky is coordinated by Catholic Charities’ Kentucky Office for Refugees.

Through the UofL Refugee Health Program, part of the UofL Global Health Initiative of the Department of Medicine, individuals are provided health assessments, immunizations, school physicals and other services. Bosson said the program addresses health and other needs to enable refugees to become self-sufficient as quickly as possible.

“Refugee health is complex, and health is really more than just the absence of disease. We address the varied components of a person’s health through partnerships in community health, education, social services and economic empowerment,” Bosson said. “The idea is to help these refugees move from a mode of survival to a platform where they can thrive and succeed.”

MeNore Lake, a fourth-year medical student and co-chair of the UofL GHHS chapter, also founded the Kentucky Refugee Outreach Program in which medical students are collaborating with the Refugee Health Program, UofL School of Nursing and Kentucky Office for Refugees to reach the newly arrived refugees in Louisville. The group is designing a standardized orientation plan for familiarizing newly arrived refugees with the U.S. health-care system.

“We are working on a process for telling them:  What can you expect the first time you go to see the doctor here in the U.S.? What are the levels of care that we have? What happens if you call 911? What are other options?” Lake said. “These are things we may take for granted because we have grown up in this country, but something that helps them transition to life here in Louisville and America.”

The refugees’ acclimation to life in Kentucky is supported by Kentucky Refugee Ministries, Inc.,Migration and Refugee Services of Catholic Charities and the International Center in Bowling Green. These organizations help with setting up apartments for the new residents, language instruction and help in finding employment and transportation. The agencies try to help the refugees become self-sufficient within eight months of their arrival.

The Gold Humanism Honor Society recognizes students, residents and faculty who are exemplars of compassionate patient care and who serve as role models, mentors and leaders in medicine. GHHS members are nominated by their peers. The society is a nationwide program of the Gold Foundation.

December 21, 2016