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Global Health at Home

December 09, 2018

DGHI team brings big-picture approach to address barriers to health for refugee families

By Michael Penn

When Emily Esmaili began working as a pediatrician at Lincoln Community Health Center, a Durham clinic that serves many resettled refugee families, she quickly realized her patients’ most pressing needs often weren’t things medicine could help. 

“Most of these kids are healthy physically,” she says.  “The issues have more to do with cultural acclimation.” Most families who come to her clinic don’t speak English, for example, and are struggling to adapt to new ways of life. Even visiting a pharmacy could be an insurmountable barrier. 

“The support they need goes well beyond what medical professionals are trained to provide,” says Esmaili, who is completing a research fellowship with the Duke Global Health Institute (DGHI). 

In 2016, Esmaili began organizing an effort to provide that support. She started knocking on doors at Duke, where she was pursuing a master’s degree in bioethics and science policy. That led her to Kathryn Whetten, a professor of public policy and global health and director of DGHI’s Center for Health Policy and Inequalities Research (CHPIR), which focuses much of its research on health disparities in the United States. 

Whetten looped in two global health colleagues—physician Nathan Thielman and Deborah Reisinger, a French professor who has worked with resettlement agencies to provide language services to refugees. Together, the team designed a year-long student project to assess the barriers families like those in Esmaili’s clinic face. Launched in fall 2017, the project enrolled nine Duke students, representing fields from public policy to chemistry. 

“It was a very diverse group, and that allowed us to address issues from a variety of perspectives,” says Melissa McGovern, a research coordinator with CHPIR who facilitated the project. 

Through interviews with resettlement agencies and focus groups with refugee families, the students identified areas of significant need, including access to mental health care for refugee children and parents facing the stress of resettlement.  They also noted how simple logistics—such as calling to make a medical appointment or even riding a bus—can become obstacles for families unfamiliar with American systems. Esmaili is working with the students to publish their findings. 

The team also has created materials to help newcomers navigate situations they may find culturally or linguistically challenging, including a brochure and a series of videos that convey information in several languages. The videos, produced this fall by students in Reisinger’s “Issues in Global Displacement” course, depict scenarios such as shopping for groceries or visiting a pharmacy, working in details many newcomers may not know—such as the fact that pharmacies must offer a translator if customers request one. 

Reisinger says the brochure and the videos will provide case workers and volunteers with more tools they to aid families’ adjustment. They also underscore the importance of considering language as a factor in health outcomes for vulnerable populations, especially in the United States. 

“Too often, we design interventions without considering how language might impede access to resources or how cultural practices might affect an individual’s choices,” she says.

Esmaili, meanwhile, is embracing the opportunity to bring a global health perspective to her clinical work in Durham. Having spent five years treating patients in Laos and Rwanda, she says working with refugee families feels like a natural progression.

“Global health for me is caring for and considering the problems of people from an entirely different background. It has very little to do with geographic location,” she says. “Certainly, it’s easier to imagine a group of people living across the globe having a set of very different problems to address. But in fact, a lot of the same problems exist in our own communities.”

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Project team member Rayan Kaakati, a medical student, talks with refugees living in Durham.
Project team member Rayan Kaakati, a medical student (far left), talks with refugees living in Durham.

Too often, we design interventions without considering how language might impede access to resources or how cultural practices might affect an individual’s choices.

Deborah Reisinger, French professor and DGHI affiliate

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