Refugees in Fort Worth overcome barriers to healthcare

Radhika Subedi leads a discussion about mammograms in her native language to refugee women from Bhutan who live in an apartment complex in southeast Fort Worth.

The women, who meet in a clubhouse that serves as a classroom, smile and exchange pleasantries before Subedi begins an informative speech that turns somber when students learn about the warning signs of breast cancer.

The women haven’t been in the United States very long, said Subedi, 35. Many don’t speak English and are unfamiliar with the American healthcare system. Talking about their bodies is not easy and Subedi wants to make them comfortable.

“They don’t talk about their health,” Subedi, said, explaining that in their culture it is important for people to show they are healthy.

Subedi tells them why checkups are important. She tells them what to expect when they are tested for breast or cervical cancer. It’s part of her work as a lay health educator for Building Bridges, a program offered through the University of North Texas Health Science Center.

The Building Bridges program is a grassroots project funded through a $1.3 million three-year grant from the Cancer Prevention and Research Institute of Texas. The project was created by Amy Raines-Milenkov, an assistant professor at the health science center who focuses much of her efforts on helping refugee women. She said the women, who have escaped persecution in their homelands, find themselves lost in their new American surroundings.

The idea of going to a doctor is daunting, Raines-Milenkov said.

“You may or may not have healthcare insurance,” she said. “Some don’t understand what the exams are about. … They don’t have any experience with it.”

Raines-Milenkov’s solution is to let refugees help one another at a grassroots level. The work empowers both the teacher and the student, she said.

“We learn many things,” Dawa Tamang, 44, said through an interpreter. “I like this class, that’s why I don’t like to miss this class.”

‘Find themselves lost’

Texas received more than 7,000 refugees last fiscal year — the most among all the states. Tarrant County is typically among the top three counties to resettle refugees.

The Kingdom of Bhutan is in South Asia, bordered by China and India. Refugees from Bhutan are ethnic Nepalese who migrated to southern Bhutan decades ago but were forced out in the 1980s. Many lived for years in refugee camps in Nepal before resettling in the United States, according to experts who help refugees.

Refugees leave their homelands because of fear of political, ethnic or religious persecution. Between Oct. 2014 and July 2015, Tarrant County resettled 59 people from Bhutan.

The plight of refugees has received recent international attention because of Syrian refugee crisis. This year, the State Department announced plans to increase the numbers of refugees admitted from about 70,000 to 85,000 this fiscal year. The U.S. also plans to admit about 100,000 next fiscal year.

When refugees arrive in the United States, the federal government provides short-term cash and medical assistance, according to Office of Refugee Resettlement. Refugee programs aim to help newly arriving people and families to become self-sufficient, experts said.

Many times, refugee women are in “the fog of being in a new place” while trying to find work, learn English and figure out how long they can qualify for government aid, Raines-Milenkov said. They also need help understanding how to access healthcare — especially when Medicaid and other supports end, she said.

“They kind of find themselves lost,” Raines-Milenkov said.

Trusting their teachers

Building Bridges fills the gaps, she said.

The program, which is in its third year, helps refugee women who are medically undeserved, Raines-Milenkov said.

Studies show that refugee women don’t get cervical screenings or mammograms, according to the Building Bridges program. One study of Bosnian, Cuban and Vietnamese refugees in Texas found that 86 percent of women had never had a mammogram, according to the program’s website. These routine exams are perceived as invasive and can be shocking when refugee women aren’t educated about them, Raines-Milenkov said.

Additionally, there is a need in refugee communities for hepatitis B education and vaccines, Raines-Milenkov said, adding that she would like to expand the program to include maternal care, mental health and diabetes education, and screenings.

Subedi is one of four lay health educators linking refugee women to health screenings. The three others focus on helping Somali, Central African and Burmese Karen.

Raines-Milenkov said the program relies on the community leaders who emerge among refugees. Often these leaders volunteer myriad hours to interpret, teach and help their community, she said. Building Bridges lets the educators make a living while helping, she said.

The educators are bilingual and bicultural and rely on their refugee experience to help bridge cultural divides. They can speak about doctor visits and health issues in their own languages while also being aware of cultural differences.

The students trust their teachers.

“I learned we cannot stay at home and be sick,” said Deo Bhujel, 43, a refugee from Bhutan.

‘A great opportunity’

Subedi said she was a child when her family decided to leave Bhutan because their Nepalese ethnicity became cause for persecution.

“There were two kinds of people living in Bhutan,” Subedi said. “People are Dukpa and the other people are Nepali like me.”

Subedi said the Nepalese weren’t accepted by the Dukpa people who controlled the Bhutan government.

“We try to follow our religion,” she said. “We try to follow our kind of dresses while going to the market or celebrating religiously, but they didn’t like it.”

The Nepalese in Bhutan couldn’t speak their language or practice their Hindu religion. In schools, Nepalese wanted to read their books in their language, but those weren’t allowed, she said.

“The police or armies used to come to the village, where our people lived, and they were trying to take our parents to jail,” Subedi said.

When Subedi turned 9, her family hid her in a storeroom so she wouldn’t be sent to an army barracks where little girls were sent, she said.

“The girls had to stay with them and do whatever they like,” she said, adding that after about six months in hiding the family fled Bhutan.

“At night, we left the house and walked toward India,” Subedi said. She said her family eventually made it to a refugee camp in Nepal where she lived for 20 years.

While in the refugee camp, she received a scholarship that allowed her to become a professional midwife. She offered prenatal care to women at a refugee camps in Nepal through a program with the U.N. High Commissioner for Refugees.

But when Subedi arrived in the United States in 2012, she couldn’t work in her field. Instead, she worked in a hotel and at an Amazon fulfillment center before becoming a lay health educator.

For about 16 months, she has been using her expertise to help fellow refugee women. She said she loves her job.

“I’m really happy to teach these women because they already knew me when I was back in Nepal and they can believe me,” Subedi said. “I have great opportunity to make my people aware about the processes that they are going to do at hospitals.”

This story was originally published November 7, 2015 at 5:52 AM with the headline "Refugees in Fort Worth overcome barriers to healthcare."