January First and Refugees

By Alli Straubhar

For many individuals residing in the United States, January 1st represents a day to dust off the forgotten resolution list, to celebrate new beginnings with friends and family, or to nurse hangovers. For many of the resettled refugees residing here, this day represents their pseudo birthday, an arbitrary day given to them when they came to this country.

Some 70,000 individuals seek sanctuary annually in the United States. This is not a quota but more of a ceiling that is not exceeded. This birthday that they share symbolizes a mechanism utilized by our government to standardize and categorize them within our infrastructures. This also perpetuates the fact that these individuals are continually in limbo as they are shuttled throughout the world devoid of nationality or identity.  They fled their homelands leaving behind friends, family, community and identity.

When refugees come to this country, they are faced with a unique set of problems as they try to navigate our systems and assimilate within our culture. As many of these refugees have been residing in the developing world prior to resettlement in the United States, many of them face health concerns such as infectious diseases, chronic diseases that are undiagnosed or untreated (hypertension and diabetes), and limited or no prior preventative healthcare. In looking at the women refugee populations, it is apparent that many women have never had cervical cancer or breast cancer screening.

In giving women these birthdays with inaccurate years, this creates a unique set of problems for healthcare professionals in trying to provide accurate care. A woman’s birthday in her electronic medical record (EMR) may be significantly younger than her actual age. When she came through the resettling process, an official gave her that birthday with that specific year.

Sometimes men want to improve their social standing within their community by having a younger wife on paper. Without any official documentation like a driver’s license, passport or birth certificate, (or even times when there is such documentation), or when the actual year of birth is unknown because the individual was born during five floods ago, US officials have to use an estimate. They can go by the appearance of the woman, and by what they are told by the husband.

Later, when the woman presents to clinic for problems suggesting infertility, it may not be that she has premature ovarian failure but she is actually in menopause. This inaccuracy in the EMR can present challenges for the physician that are difficult to sift through and unless they are aware of this issue within the refugee population, unnecessary and inaccurate health care can be administered to patients.

This represents one of the innumerable challenges healthcare professionals face as they try to provide holistic, accurate, culturally sensitive, and cost-effective healthcare to the refugee population. Refugees need assistance in learning to pilot through our systems and strive to develop their own identity within the constructs of our society. Refugee communities are flourishing within the Salt Lake valley. On New Year’s Day, these individuals join together forging new identities, building new communities, and signifying that despite the horrors and hardships they faced, they will persevere and life continues.

Alli Straubhar is a medical student at the University of Utah School of Medicine

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