Khamael Khaleel uprooted the life she had built in Iraq and moved to the United States 10 years ago.
Her home in Iraq did not feel safe for her kids or her family, Khaleel said. Coming to the United States, she did not have any help with things such as accessing health care or registering her kids for school.
“This decision was the hardest one in my life because I will start from the beginning,” said Khaleel, who now works for Salem For Refugees, a local organization that provides transitional services to individuals and families moving to the U.S., who they call “new neighbors.”
Salem For Refugees (SFR), a 6-year-old organization, is aimed at reducing barriers to adjusting to life in a new environment. The resettlement agency in 2021 became an affiliate site of the U.S. State Department, which helps with funding. The relationship also allows Salem For Refugees to receive cases directly through World Relief and bring long-term refugee resettlement directly to Salem.
Accessing health care and understanding how to do things like apply for health insurance and make appointments is a primary focus for the first 90 days after a refugee arrives.
SFR has case managers, like Khaleel, who provide individualized services to newly-arrived refugees. All case managers are former refugees with shared cultural experiences. New neighbors are mostly paired with someone who speaks the same language.
Resource teams help new neighbors figure out how to access health care and education and aim to set them up for success early on.
“Good neighbor” volunteer teams welcome refugees with hospitality, friendship, and connections to the community by checking in on them, organizing group events, and helping them find community resources such as churches.
“Our job is to help them be able to help themselves in the system,” said Lauren McNaughton, health care navigator and health resource team co-chair.
Adjusting to new health care
Penner said Salem For Refugees views its work through the lens of social determinants of health. Those are conditions that impact both individual and group differences in health status, like economic stability, education and health care access and quality, neighborhood and social environment.
By meeting the needs for stability in each of these conditions, they hope to alleviate some of the stress of adjusting to a new life.
Refugees are met at the airport by a welcome team.
The first two to three weeks focus around making and attending initial appointments at primary care clinics, registering for Oregon Health Plan, reviewing medical records, and getting started with immunizations.
Initial appointments are scheduled at clinics that partner with Salem for Refugees: Northwest Human Services West Salem Clinic and Lancaster Family Health. After care is established, health care navigators work to help families find care for individualized medical needs, like mental health care.
Adjusting to new health care can be challenging, especially when facing language and cultural barriers.
“Ours is just another system, but it’s a fairly complicated system,” said McNaughton, health care navigator.
Khaleel said that some parts of the American health care system, such as waiting months for appointments or having to wait for a doctor to interpret results when a nurse has already provided care, can be an adjustment. In Iraq, there is just one place to go to and receive care when sick. There was no preventative care like check-ups with a physician, she said. Other systems, like online portals and automated phone messages, can be difficult to navigate.
Clinics make interpreters available, but they cannot always find one that speaks the same language as clients, McNaughton said.
Khaleel said she finds joy in being able to do anything she can for families, making them feel welcomed and letting them know they always have help. “I’m so happy to do everything, even the small details.”
While the health care resources team helps meet medical needs, case managers work on meeting other needs such as:
- Registering with the Social Security Administration
- Finding schools for children
- Moving into a home, host home, or hotel
- Signing up for English classes
- Finding a job
- Getting an identification card at the Department of Motor Vehicles
- Establishing a bank account
- Connecting them with religious services if they want
- Acquiring computers for them
- Registering for services through Women, Infants, and Children (WIC) like nutritional programs or the Department of Homeland Security (DHS) if needed
The basics are covered first, then they work to meet other needs. The first 90 days in Oregon are considered as the “intensive case management period,” said Elijah Penner, Direct Services manager.
New neighbors also take cultural orientation classes, which consist of 12 one-hour modules.
Understanding complex needs of refugees
Salem For Refugees began as a volunteer only organization, now they have full-time staff and volunteers. As their work continued, they began to better understand the complex needs of those immigrating to the United States.
“It became very clear that it would be a better system if there were people [at SFR] who had cultural and linguistic similarities,” said McNaughton.
These early years helped determine the need for case managers who spoke the languages of new neighbors and had shared experiences with them.
McNaughton and Greta Horn, health care navigator and health resource team co-chair, have been with Salem For Refugees since it began in 2016.
Stepping into the job, Horn, who previously worked as a labor and delivery nurse, had to learn new skills to know how to best support people and make them feel safe moving into the community. She said she has learned so much meeting people from other countries and other cultures.
“You go into this saying ‘I want to do this for other people,’ and you don’t realize how much it will do for yourself,” said Horn.
Sydney Wyatt covers health care inequities in the Mid-Willamette Valley for the Statesman Journal. Send comments, questions, and tips to her atSWyatt@gannett.com, (503) 399-6613, or on Twitter@sydney_elise44
The Statesman Journal’s coverage of health care inequities is funded in part by the M.J. Murdock Charitable Trust, which seeks to strengthen the cultural, social, educational, and spiritual base of the Pacific Northwest through capacity-building investments in the nonprofit sector.