Changing the system: Leaders share ideas for improving refugee health care

This story was produced as a larger project by Tim O'Shei for the 2020 National Fellowship, which focuses on explaining the myriad mental health challenges refugees face and taking readers up close to those realities through the experience of families.

His other stories include:

WNY could see increase in asylum-seekers crossing to Canada

Finding true safety and refuge to build a life in Buffalo

Three ways to help refugees – and each other – create a healthy path

Refugees come here for a better life. That’s an essential truth – but is it actually true? Are refugees being given the chance to have a safer, happier, healthier life?

There’s no simple answer, but here’s a hint at the reality: Research by Harvard Professor David A. Williams shows that immigrants of all racial and ethnic backgrounds tend to come to the United States in better health than their American-born counterparts. But over the course of their lives and subsequent generations, he told a group of reporters in July, “their health worsens.”

Williams, who was speaking to a group of journalists convened by the University of Southern California’s Annenberg Center for Health Journalism, shared a slide titled “Lifetime Prevalence of Psychiatric Disorder.” For Caribbean Blacks, Latinos and Asians, it showed the instance of mental illness falling below the U.S. average for the first generation of people to come here. The second-generation numbers for all three groups came close to the U.S. average of 30% to 35%. The third generation, however, shot above 50% for Carribean Black, and north of 40% for Latinos.

Summarizing the data, Williams said, “You see worsening health – mental health status, in this case – by increasing length of stay in the United States.”

It’s important to note that Williams was speaking of immigrants, and not specifically refugees, who by definition are fleeing an unsafe place and typically arrive with health conditions rooted in that trauma. But his larger point still applies: The race-driven health and socioeconomic inequities in the United States are harming people’s health, especially people of color.

With that in mind, a variety of health-care practitioners and executives from Western New York refugee resettlement agencies talked about identifying policy and systemic changes they would like to see made. Here’s a sampling of suggestions, gleaned from several interviews:


Ensure the availability of interpretation services. Health-care providers who accept Medicare and Medicaid payments are generally required to provide interpreters for non-English-speaking patients. But many don’t.


“We've had providers say, ‘Well, you know, we don't usually work with people who don't speak English,’ ” said William Sukaly, director of immigration and refugee assistance at Catholic Charities of Buffalo. “The big issue is cost,” he added, noting that interpreters – who are available both in Buffalo and via telephone and online services – often bill at $50 an hour.

“Nobody gets reimbursed for interpretation services,” Sukaly said. “That’s why they have a tendency not to want to provide it, especially if they're a smaller practice.”

Sometimes a family member ends up providing interpretation – “a major no-no” for privacy, Sukaly points out. Other times, an interpreter may be booked but speak a different dialect of a certain language, rendering the conversation halting or worse. When an interpreter is successfully secured, a 60-minute appointment can stretch to two hours to allow time for the translation.

“We put in twice the amount of time, but we don’t get paid for the additional piece that we do,” said Dr. Molly Short Carr, president and CEO of Jewish Family Services, a resettlement agency that also provides mental health-care services. “I still have to pay my clinician for those two hours.” From a policy perspective, Carr said, being able to adjust billing time and reimbursement for interpretation services “would make a significant impact on everybody’s ability to provide services.”

Put more equity into the citizenship exam. Dr. Myron Glick, the founder and CEO of Jericho Road Community Health Center, points out that refugees – like immigrants – are put on a pathway to citizenship. They receive a green card and ultimately are expected to pass a citizenship test – in English.

Immigrants choose to come here, Glick points out, and “have the wherewithal to pass that exam. But refugees – especially elderly refugees – really, really struggle sometimes to pass that exam.” If they don’t pass it, they can ask doctors to fill out a waiver. But that waiver is narrow and not everyone qualifies. “They’re left in limbo,” Glick said. “They’re not citizens. They’re not deported.” They keep Medicaid insurance but lose Supplemental Security Income benefits that support people with limited resources. They don’t have a passport so they can’t travel, which means visiting their home country to see family members is out.

“They’re just stuck,” Glick says. “I don’t see the point. Why make elderly refugees have to pass an exam in English?” 

Stabilize the Victims of Crime Act fund. Domestic abuse through violence, manipulation and isolation is a key focus area for Amy Fleischauer, director of survivor support services at the International Institute of Buffalo. She is hoping the VOCA fund, which supports programs for people who are the target of domestic violence, will be stabilized. VOCA’s financing comes from the penalties paid for white-collar crime prosecution, which was down 26% to 30% during the first three years of the Trump administration, and ground to a near-halt during the pandemic.

It’s likely that the Department of Justice under a Biden administration will more aggressively prosecute white-collar crime.

“I imagine that will be a pretty big change,” Fleischauer said. “The money that will be going into that victims fund will also be significant, and allows us to do our work and do it better.”

Dial down the rhetoric. Several people interviewed by The News acknowledged the challenges of working in the refugee field during the Trump years, which they said stoked an anti-immigration, xenophobia-fueled rhetoric that prompted some agencies to preemptively take protective measures. “I never thought going into this role that I would have to think about active shooters and what sort of glass should we have in the office,” said Journey’s End Refugee Services CEO Karen Andolina Scott, noting that she and her staff looked to their colleagues who came to the United States as refugees and “really relied on their resiliency to teach us how to get through difficult times and still look forward to the future.”

This article was produced as a project for the Dennis A. Hunt Fund for Health Journalism, a program of the USC Annenberg Center for Health Journalism’s 2020 National Fellowship.

[This story was originally published by The Buffalo News.]

Did you like this story? Your support means a lot! Your tax-deductible donation will advance our mission of supporting journalism as a catalyst for change.