DISCONNECTED: SOMALI REFUGEES AND U.S. HEALTHCARE PROVIDERS
Background: Language challenges, differences in health beliefs, and cultural misunderstandings between Somali refugee patients and staff at a university community clinic have often lead to confusion, frustration, wasted resources, and, ultimately, poor health outcomes. Refugees from Somalia are the largest refugee group to be resettled in Utah. Most of these refugees seek healthcare at a specific university community clinic, due to close proximity of residence and transportation routes. Providing care at this site for refugees has been identified as a challenge by both the clinic’s healthcare providers and Somali refugees.
Methods: After IRB approval, clinic healthcare providers (nurses, medical assistants, nurse practitioners, and physicians) who met inclusion criteria were recruited for voluntary participation from the community clinic and assured of lack of impact on their employment, if they participated. Two focus groups of these providers were conducted, recorded, transcribed, and analyzed with ATLAS.ti ®. Somali community contacts assisted in the recruitment of Somali refugees receiving care at the university community clinic site. Three focus groups of Somali refugees (males and females in separate groups), who met recruitment criteria, were held, either in apartments or at a trusted community site. Certified translators were hired and provided translation for three languages. At the request of the Somali groups, no recordings were made. Both the researcher and research assistants took notes in all focus groups and met after each group to review and agree on content heard. Results were analyzed, categories were identified, and opportunities for improvement emerged.
Results: Both providers of care and refugees appreciated the efforts of the other group in the healthcare interaction. Culturally knowledgeable and Somali-language-proficient medical assistants and nurses were seen by the refugees as more important than culturally knowledgeable and Somali-language-proficient physicians or nurse practitioners. All groups cited lack of sensitive and gender-appropriate translators, too-short appointment times, and lack of knowledge about the others’ culture as disconnects in the healthcare interaction. Transportation issues were also identified by both groups as contributing to care difficulties. Refugees did not share complementary or alternative therapies with providers, lacked understanding of preventive care, and equated receiving a medication with good care. This information was shared with the Somali community through the Somali community organizations, healthcare providers at the university community clinic, and with administrators at that same clinic site.
Implications / Significance: Education for clinic healthcare providers is needed to increase their understanding of the Somali culture, common Somali health beliefs, and Somali health practices to assure their abilities to provide accessible and appropriate care. Increasing orientations to U.S. healthcare by refugee resettlement organizations and Somali community organizations will assist refugees to access and understand care. Clinic administrators must address sensitive, gender-appropriate translator availability and creatively address transportation availability.