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This module considers the experiences, health disparities and health needs of immigrants, refugees and asylees.

Introduction | 6 minutes

Activities
Videos
Podcasts
Readings
Additional Resources

Activities

Learning Objectives

Learners will better understand the complex and difficult journeys many refugees experience.
Learners will reflect on barriers to healthcare that many refugees experience.
Learners will recognize how to use interpreter services for clinical encounters for interpretation but also as cultural brokers.

Part 1

Read A Trajectory Model for Understanding and Assessing Health Disparities in Immigrant/Refugee Communities (2010) and answer the following:

List some factors contributing to health disparities among immigrant and refugee populations.
Write a paragraph about an example of how a cultural difference in health knowledge and practice impacted the ability to access care and treatment recommendations.

Part 2

Choose 1 video or podcast from the collection provided and answer the following:

Which video or podcast did you select?
After reviewing, what struck you about what you viewed and how will this impact your future practice as a physician?

Part 3

Group discussion:

Watch Health is an International Language below. Then use the guides provided to review and discuss.

Videos

Our immigration conversation is broken- here's how to have a better one | 16 minutes
Paul Kramer | TED

How did the US immigration debate get to be so divisive? In this informative talk, historian and writer Paul A. Kramer shows how an "insider vs. outsider" framing has come to dominate the way people in the US talk about immigration -- and suggests a set of new questions that could reshape the conversation around whose life, rights and thriving matters.

What does my headscarf mean to you? | 14 minutes

Yassmin Abdel-Magied | TED

What do you think when you look at this speaker? Well, think again. (And then again.) In this funny, honest, empathetic talk, Yassmin Abdel-Magied challenges us to look beyond our initial perceptions, and to open doors to new ways of supporting others.

Cultural Competency - for Providers | 11 minutes

Healthy Androscoggin, New Mainers

A training video created by the REACH grant to help providers educate their staff on the importance of culturally competent care.

The psychological impact of child separation at the US-Mexico border | 15 minutes
Luis H. Zayas | TED

How does psychological trauma affect children's developing brains? In this powerful talk, social worker Luis H. Zayas discusses his work with refugees and asylum-seeking families at the US-Mexico border. What emerges is a stunning analysis of the long-term impact of the US's controversial detention and child separation policies -- and practical steps for how the country can do better.

Lost Boys of Sudan | 83 minutes
Documentary | PBS

The genocide in the Darfur region of Sudan is the most recent violent episode in a country where a 20-year civil war has killed an estimated two million people and displaced more than four million. The Dinka tribe has been hardest hit. Lost Boys of Sudan follows two young Dinka refugees, Peter and Santino, through their first year in America. As small boys, Peter and Santino lost their families to the war and were forced to flee their homes. Along with 20,000 other boys, they wandered hundreds of miles across the desert seeking safety. After a decade in a Kenyan refugee camp, nearly 4,000 “Lost Boys” have come to the U.S. as part of a refugee resettlement effort. Peter and Santino set out to make new lives for themselves in Houston and in Kansas City. Their struggle asks us to rethink what it means to be an American. An Independent Television Service (ITVS) co-presentation.

Podcasts

Somalis in Maine | 30 minutes
Catherine Bestemen | Safe Space Radio

This episode of Safe Space Radio features Catherine Bestemen, Francis F. and Ruth K. Bartlett Professor of Anthropology at Colby College. She is the author of Unraveling Somalia: Race, Class, and the Legacy of Slavery and has worked closely with the Somali community in Portland, Maine. She discusses the extraordinary resilience of this community, the impact of historical xenophobia, and how she responds to claims that refugees are a financial burden on the state.

Navigating the asylum process | 30 minutes
Phil Mantis | Safe Space Radio

Lawyer Phil Mantis works for the Immigrant Legal Assistance Program, or ILAP, in Portland, Maine. ILAP provides free legal help to people seeking asylum in the United States. Phil explains the difference between a refugee and an asylee, describes the most common reasons asylum cases are denied, and explains how ILAP helps asylees apply successfully.

The Experience of Refugees and Asylum-Seekers | 60 minutes
Multiple experts interviewed | Safe Space Radio

This show explores the unique challenges that refugees and asylum seekers face. We focus on the experiences of women who have re-settled in Maine as a case study of the resettlement process throughout the U.S. We explain the technical aspects of being a refugee or asylee and the difficult process that these individuals have to go through in order to be granted a new home. Expert accounts frame two deeply personal and inspiring stories of persecution, trauma, courage, resilience, and hope.

Let me count the ways | 1 hour 18 minutes
This American Life, NPR | September 14, 2018

Yes, youʼve heard about the family separations. Youʼve heard about the travel ban. But there are dozens of ways the Trump administration is cracking down on immigration across many agencies, sometimes in ways so small and technical it doesnʼt make headlines. This week, the quiet bureaucratic war that’s even targeting legal immigrants.

Readings

A Trajectory Model for Understanding and Assessing Health Disparities in Immigrant/Refugee Communities (2010)

In this article by Edberg and Vyas in The Journal of Immigrant and Minority Health, the authors discuss the interaction of factors contributing to health disparities among immigrant and refugee populations and discuss a framework for planning, implementing and evaluation interventions aimed at reducing disparities.

The Violence of Undertainty - Undermining Immigrant and Refugee Health (2018)

Grace et al. discuss the violence of uncertainty in this NEJM Perspective article. Immigrants and refugees in the US have long faced structural violence due to unequal access to health care. Policies around family separation and immigration create 'fear of the uncertainty' which deters many from seeking care.

Additional Resources

MITE Educational Innovations Video Project Discussion Guide

MITE Educational Innovations Video Project Discussion Guide - Questions only

Use this discussion guide with questions and suggested points of discussion to review and discuss the video we created "Health is an international language"

Malvina Gregory, Interpreter Services Manager, Use of Interpreter Services - PowerPoint

This PowerPoint presentation by Malvina Gregory, LCSW, manager of Interpreter Services, provides a nice overview of how to most effectively use Interpreter Services at MMC.