Cultural Awareness Learner Guide



Cultural Awareness Learner Guide

REFUGEE MODULE

In this module you will:

• Increase awareness of refugee populations in Wisconsin

• Understand the dynamics of resettlement and its impacts on health

• Increase knowledge and skills on how to work effectively with refugee populations

1. What is your definition of a refugee?

2. What is the difference between an immigrant and a refugee?

3. Which benefits are given to refugees upon arrival to the United States? How long do the benefits last?

4. Describe a refugee situation you are aware of in addition to the examples provided in the module. Some considerations include: experiences incurred due to plight; living conditions; financial constraints etc.

5. Which groups of refugees have you interacted and/or worked closely with? Reflect on situations where culture and/or the lived refugee experience (trauma, loss, etc) may have impacted your interactions. What did you notice? What did you learn?

6. What are the three options for refugees once they have left their country?

7. In addition to the myths listed in the module, can you think of other viewpoints and beliefs about refugees? Do you agree or disagree? Why?

8. After reviewing the module section on refugee resettlement challenges, which experiences have been most commonly identified by refugee communities in your service area? How have you and/or your organization addressed these challenges?

9. From your professional perspective, list other ways the experiences of refugees can impact their wellbeing.

10. Which agencies, organizations and other resources are readily available to assist refugees in your community?

11. In addition to the information presented within the capacity building section of this module, what other skills can you adopt and implement to improve communicating and working effectively with refugee communities? Are there skills that weren’t listed in which you or your organization have had positive experiences and outcomes?

Refugee Module Case Study

Who:

A family of five Somali refugees– Abdi Ali (husband), Rahma Ali (wife), and three children: Hassan (3-year-old son), Faheema (6 year old daughter) and Asiya (12 year old daughter)

Country background:

• 1970s - 80s: Somalia at war with Ethiopia, refugees left and entered both countries

• 1990s: Civil war in Somalia

• No stable government since 1991

• Large numbers of refugees fled the country

• In some areas of the U.S., large Somali communities have been in place for up to 20 years

• Most new arrivals have low English proficiency

• Most Somalis are Muslim

• Somalia has a patriarchal culture

• Men are the decision-makers for almost every aspect of society, including in the home

• Property is passed to sons

• Married women live with the husband’s family

All Somali refugees face health issues, but particularly women and girls:

• Malnutrition is very high in some groups from Somalia

• Female genital cutting (FGC) is very common, with estimated rates above 90%

Case Study Details:

Increasing conflict, violence, and food insecurity in the southern part of Somalia drove Abdi Ali’s family to flee to Kenya. Their escape was a harrowing experience; because Kenya’s border has been closed to refugees since 2007, the family had to sneak out, often seeking cover in the bushes and occasionally begging for rides. Abdi had been a small business owner, but he lost his business-the family’s sole source of support-due to rebel activity. When they arrived in Kenya, they were sent to a UN refugee camp that was overcrowded and unsanitary. The camp offered few resources and no job opportunities, nor did it allow its occupants to join Kenyan society. After waiting for nearly three years, the family was approved to resettle to Raleigh, North Carolina.

Since arriving to the United States, Abdi and his wife, Rahma, have had to shoulder many new responsibilities. They must find jobs to become self-sufficient, learn English, ensure their children get on the right track, and address health concerns. The family has delayed the federally mandated health checkup because they are worried about employment and afraid to leave home unnecessarily. They do not want to take the bus across town alone to see a nurse who does not speak their language. Furthermore, the children’s dental care has gone unacknowledged despite several signs of decay, but Medicaid doctors and dentists have closed enrollment for new patients due to the recession.

Although both parents enrolled in English classes upon arrival 2½ months ago, Abdi has stopped attending due to a new job and Rahma has stopped to care for her young son, Hassan (the two daughters are in school most of the day). While their limited English proficiency prevents them from being able to navigate everyday life, understand mail and procedures, and land non-entry level jobs, there is no opportunity for Abdi and Rahma to learn English and still take care of family obligations. There is no child care available for Hassan and no ESL classes available nearby during the hours Abdi is off work. Also, Abdi prefers that Rahma stay home rather than find a job, despite the fact that it long ago became clear that his wages alone will not be enough to pay for the entire family’s living expenses once government funding ends in four months.

Abdi and Rahma have distant relatives and some friends who live in Minnesota, but they did not know anyone in North Carolina prior to resettling here. They have made some friends (other Somali refugees) in their apartment complex and attend the nearby Islamic Center for religious services. The Islamic Center is always willing to reach out and help newly arrived Muslims with some meals and support after arrival. The Center also holds many social events for young people. The children are beginning to make friends there, but they still feel isolated at school.

The daughters’ school has recently become concerned because the girls are quite withdrawn and often panic when the school bell rings, fire drills occur, or children rush out to recess loudly. Furthermore, 12-year-old Asiya has been complaining of pain and the school nurse fears that she has a urinary tract infection. She recommended that the family take Asiya to the hospital for treatment, but Abdi and Rahma did not find it necessary because vaginal pain and infection was a typical side effect of female circumcision, or female genital cutting (FGC), as it is commonly referred to. The nurse further feared that 6-year-old Faheema may undergo the procedure when she gets older. Many Somali girls undergo FGC between the ages of six and twelve.

Abdi’s new job at a meat processing plant is menial and cold. This job is a big step down from owning a small business, and this demotion has put him in an increasingly bad mood. He is also stressed about how many bills there are in the U.S., the complexity of every institution, and the meddling of all the different agencies in their lives—although he is grateful for the assistance. Furthermore, he was called names in the supermarket when his Food Stamps card ran out of money, and last week he was accused of being a terrorist when he tried to cash a check at a bank where he did not have an account. Abdi takes out his frustrations on his wife and often yells at his eldest daughter as well. He has begun to drink more and harass Rahma, calling her “useless.”

Rahma has also discovered that she is about five weeks pregnant. She is not accustomed to receiving the extensive prenatal care that is the norm in the U.S. Despite the fact that she has Medicaid (as a newly arrived refugee and as a pregnant, legal resident), she has not been to the doctor because she has been too busy at home, does not have consistent transportation, does not feel comfortable meeting with the doctor without a family member, and relies on a third person to interpret.

 

Case Study: Discussion Questions

• What are some of the strengths of this family?

• What are some of the challenges they face that an American family at their income level may not face?

• What are some issues of cultural and religious norms regarding women’s roles that may shift as a result of resettlement to the U.S.?

• How can your agency work with the family, Asiya and Faheema’s school, Abdi’s employer, and community medical providers to coordinate services for the Ali family?

• How can public health professionals work to protect the rights and well-being of Rahma and her daughters in a culturally competent way?

• What are the challenges your organization faces in helping this family meet all their health needs?

• What are some of the ways you can help Rahma complete a healthy and successful pregnancy, considering her challenges?

• What resources might be useful to you in working with the family, and what external resources would you want to connect the family to?

• How could you intervene in the case of Asiya and Faheema in addressing the health risks of FGC? Some states identify FGC as an incidence that falls under mandated reporting of child abuse to Child Protective Services (CPS). What are some concerns or unique complications in reporting a refugee family to CPS?

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