This story additionally ran on Mic. This story might be republished without cost (details).
EL CAJON, Calif. — In his native Syria, Mahmoud spent months in captivity in a crowded room three flooring underground, by no means seeing the solar. Disease unfold rapidly among the many prisoners, he stated. Food was scarce, usually spoiled.
Mahmoud stated his captors, foot troopers of Syrian President Bashar Assad, tortured him and shot him within the leg.
“I was in jail for seven months. They let me go, but I was physically sick, and tired,” the 29-year-old refugee stated, talking inside a cheerful, trendy medical clinic right here with indicators posted in English and Arabic. “I had infections, inflammation. I’m still trying to get treated for it all.”
Mahmoud, tall and pleasant, agreed to be interviewed on the situation that solely his first identify be used for concern of retaliation towards household again house. He settled in one of many largest Syrian refugee communities within the United States — a midsize California city close to San Diego.
And by advantage of this inflow of refugees, it has turn out to be a well being care hub for a traumatized and bodily ailing inhabitants.
On an old style Main Street, amongst Western-themed murals, thrift retailers and halal markets, sits the bustling El Cajon Family Health Center, serving Mahmoud and different victims of the devastating civil warfare in Syria.
Halal markets in El Cajon cater to the Iraqi immigrants who’ve been coming to the realm for greater than 30 years. Today, the markets are additionally frequented by the rising Syrian refugee group.(Heidi de Marco/KHN)
The El Cajon Family Health Center is a group clinic that treats many Syrian refugees.(Heidi de Marco/KHN)
Syrian refugees wrestle disproportionately with post-traumatic stress dysfunction, nervousness and melancholy due to their publicity to excessive violence and nervousness about kin nonetheless in Syria, clinic employees and group volunteers say. Most who’ve fled spent years holed up in camps or flats, with little entry to routine medical look after warfare wounds or continual situations equivalent to diabetes or coronary heart illness.
Virtually all the individuals who enter this nation as a part of the federal authorities’s refugee resettlement program qualify by revenue for Medicaid, the government-run medical insurance program for low-income individuals (often known as Medi-Cal in California).
Physicians and others who work with Syrian sufferers say that the refugees expertise lengthy waits and should usually journey lengthy distances to see specialists — challenges shared by many different low-income teams.
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But entry to medical interpreters is woefully inadequate, and refugees are sometimes stymied by the paperwork and forms so in contrast to what that they had again house. There, they had been accustomed to strolling in and seeing a physician with out having to attend, stated Suzanne Akhras Sahloul, founding father of the Syrian Community Network, a Chicago-based nonprofit that aids refugees.
Patients are sometimes confused by Medicaid and the managed-care plans that present it. They typically change well being plans inadvertently, which might result in delays in care, El Cajon Family Health Center physicians and caseworkers stated.
Of the 5.6 million individuals who have fled Syria since its civil battle broke out in 2011, solely a tiny fraction — around 21,000 — resettled within the U.S.
More Syrian refugees got here to San Diego County than some other U.S. metro space — over 1,000 as of the primary quarter of 2017, in accordance with the State Department. And greater than 80 p.c of them stay in El Cajon, the place county service suppliers and resettlement company workplaces abound, stated Chris Williams, government director of the Syrian Community Network-San Diego, a neighborhood department of the help group.
Medical assistant Lagham Katola speaks Arabic throughout a checkup with a Syrian affected person. Health care services are required to offer medical interpretation providers, however they usually achieve this over the cellphone.(Heidi de Marco/KHN)
Resettlement companies, which work with the State Department to easy entry into the U.S., typically assist refugees join Medicaid and get the care they want for his or her first three months on this nation. After that, they’re largely on their very own to keep up protection and get care.
“They will say, ‘Why do I need to visit the family doctor? Why can’t I go to the specialist?’” stated Aileen Dehnel, a case supervisor on the El Cajon Family Health Center.
“Everywhere we go, people are helpful,” stated Mahmoud, who now lives in Anaheim, Calif. “But the No. 1 challenge is the language.”
Relatively few skilled interpreters within the space converse Arabic, and they’re in excessive demand. In a communication vacuum, Mahmoud stated, info will get handed from neighbor to neighbor, altering barely with every telling, as in a recreation of phone.
“We don’t know what’s going on,” he stated.
Translators don’t at all times assist, Mahmoud stated. One time, he needed to rush to the emergency room after a gallbladder assault, and an interpreter on the cellphone saved asking everybody to repeat themselves, blaming the problem on dangerous audio tools. Mahmoud and his spouse, Noura, turned so pissed off that she used Google Translate to determine what the nurses and docs had been saying. (Noura additionally spoke on the situation her final identify not be used.)
Aileen Dehnel, a case supervisor on the El Cajon Family Health Center, helps a Syrian mom and daughter examine in. Dehnel says refugees turn out to be confused by the paperwork and typically change their well being plans with out realizing it. Dehnel writes detailed directions in Arabic for the sufferers she works with, however a lot of them cannot learn in any language, she says.(Heidi de Marco/KHN)
The indicators within the El Cajon Family Health Center foyer are written in English, Spanish and Arabic.(Heidi de Marco/KHN)
Another refugee, 34-year-old Nisreen Tlaas, recalled having fainting spells after her arrival from Homs, Syria, in 2016. Two emergency rooms misdiagnosed her sickness earlier than the employees at a 3rd hospital carried out an MRI and noticed an aneurysm in her mind.
She lastly acquired lifesaving surgical procedure — however solely after a caseworker from the Syrian Community Network smoothed communications between a surgeon and a medical interpreter.
Dehnel, of the El Cajon Family Health Center, writes detailed directions in Arabic for the sufferers she works with, and lots of pharmacies in El Cajon now print prescription labels in Arabic as effectively. But that’s not sufficient to verify a diabetic affected person will get his insulin or a pregnant girl takes her prenatal nutritional vitamins accurately, as a result of lots of the sufferers can’t learn in any language, she stated.
Language frustrations apart, the principle problem dealing with many Syrian refugees is psychological misery.
PTSD amongst Syrian refugees contributes to bodily signs equivalent to continual ache, stated Dr. Mai Duong, a household physician on the El Cajon Family Health Center.
Some sufferers have seen kin harm or killed in combating. Others don’t know if their family and friends are secure. Syria is among the many international locations affected by the Trump administration’s “travel ban,” and the administration additionally just lately cracked down on refugee admissions on the whole.
Adjusting to life within the U.S. can also trigger huge nervousness. But many Syrian refugees resist asking for assist for concern that authorities will swoop in.
“People always downplay their distress,” Duong stated. “They worry that their kids will be taken from them.”
Mahmoud has tried speaking to psychologists. But they haven’t been in a position to assist him escape his darkish ideas.
“Our families are in a war zone right now,” he stated. “I’m always in fear that my family will be killed.”
This story additionally ran on Mic. This story might be republished without cost (details).
This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.
Heidi de Marco: heidid@kff.org”>heidid@kff.org, @Heidi_deMarco
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