Caring for the region's newest residents
Thursday, August 19th, 2010
The Philadelphia region is seeing a new influx of political refugees from the South Asian nation of Bhutan. Like other refugees, they are entitled to eight months of medical coverage. But providing that care is a challenge.
Jefferson Family Medicine dedicates Wednesday afternoons to refugees. Nearly three years ago, when the clinic opened, many of the refugees came from Myanmar, then a few Iraqis, some Eritreans. Now, it’s the ethnic Nepalis from Bhutan. Clinic director Dr. Marc Altshuler says one of the first steps is to make sure everyone has had their shots.Altshuler: The kids cannot go to school without vaccines, and if the kids don't go to school the parents can’t go out and get a job.
The Nationalities Service Center, a resettlement agency, helped launch the Jefferson clinic. Now, demand for the clinic’s services has the agency looking for other providers capable of the same type of one-stop care.
Wendell: Yes, my name is Gretchen Wendell. I'm calling on behalf of a client, the member ID number is 5, 0, 4.
While a case manager from the resettlement agency cuts through red tape with the insurance company, in the exam room, Dr. Amiee Packer gets a medical interpreter on the phone.
Packer: So, I'm going to ask you some questions about your arrival to the United States and go over some of the lab tests that you had about a week ago.
Newly arrived refugees should have an initial health screen within 30 days, but it took more than three months for Bagi Adhikari and her adult son Kamal to get in to see Dr. Packer.
Bagi: After we came to Nepal from Bhutan, I had a medication for that. Packer: So that was about 18 years ago when you first moved to Nepal?
The ailments differ with each refugee group but latent tuberculosis, malnutrition and malaria are common. When the Adhikaris arrived last winter, both were a little underweight.
Packer: Take a deep breath in again, and out.
Marc Altshuler says his doctors listen carefully to each refugee's story.Altshuler: We spend time asking 'Why did they become refugees?' cause that can help us figure out … Were they exposed? Were they beaten? But the bigger picture is, are they sometimes at risk for post-traumatic stress disorder because of what they went through?
About 100,000 people in the Nepalese ethnic minority fled Bhutan in the 1990s. The Adhikahirs were among them.
Bagi: They came to our villages, and they were everywhere. The army police took over our lands and placed themselves there, and that's why I couldn't stay there any longer.
Refugee experts say Bhutanese officials grew wary of the Nepali minority as its members moved beyond low-wage jobs as laborers and domestics and began to acquire land. Kamal was about 9-years-old, he says when his and the other Hindu families walked away in the middle of the night.
Kamal: There were five or seven families from the same village.
Accounts conflict, but human rights advocates say the Buddhist majority government began to systematically expel minorities who'd lived in Bhutan for generations.
Kamal: Our Nepali script, everything, our holy books, everything, were destroyed there and burned in the fire.
Bagi: They wanted us to do census, and then they asked for documentation. They started to classify us in terms of categories from 1, 2, 3, 4 til 7. Although we belonged to category 1, they still continued arresting, beating and taking us to the jail. And then, we got scared and so we left.
The Adhikaris and thousands of others ended up in refugee camps in Nepal. Bagi and Kamal spent 18 years in limbo there. It wasn't safe to return to Bhutan; Nepal did not accept them as true citizens.
The United States and several other countries offered permanent homes to some refugees, but Jefferson's Marc Altshuler says the refugee experience can leave damage.
Altshuler: We see significant mental illness and post-traumatic stress disorder. We’ve been trying to collect a lot of data on the refugees that we’ve been seeing, and I think our rates of PTSD are probably two to three times higher than the national rate.
All are adjusting to a new city and culture; Altschuler says some also have stubborn, decades-old hurts that resurface once they're safe.
Bagi: I couldn't bring anything. I couldn't bring anything from Bhutan. We just brought our bodies with ourselves.
The Nationalities Services Center recently hosted a training session for health providers on the medical and mental health needs of refugees and asylum seekers.
Yuki Poudyal translated and voiced the words of Bagi Adhikari.