The NRC-RIM team will hold sessions at the 2023 North American Refugee Health Conference (NARHC) in Calgary, AB, Canada from July 21-23 on health communications and public health preparedness for refugee, immigrant and migrant communities.
This year, Dr. William Stauffer, co-principal investigator of NRC-RIM, will join Dr. Drew Posey of the CDC's Immigrant, Refugee and Migrant Health Branch for a plenary presentation. They will cover topics pertaining to refugee and immigrant health. NRC-RIM and collaborators will also highlight tools & resources, and learnings that the project can carry into future public health responses.
Friday, July 21, 1:00 p.m. - 2:00 p.m.
Refugees, immigrants and migrants are often described by their trauma or the health inequities they face. While many have experienced hardships of immense proportions, that does not tell their whole story. Despite the challenges they face, refugees, immigrants, and migrants are an integral part of our social, cultural, and economic vitality. They have proven that they are strong, resilient and dedicated to the success of their communities. Focusing on only part of their story does a disservice to them as well as the health systems that serve them. If we take a strengths-based approach to talking about RIM communities, we can change how we think of them as co-equal partners in pursuit of health equity.
In this workshop, Syreeta Wilkins and Dr. Nasreen Quadri from the National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM) share how the language we use as individuals and as a society contributes to structural determinants of health, and offer solutions for how to change the narrative about RIM communities. With compelling examples from clinical settings and public health, Nasreen and Syreeta explore how the stories we tell can change the way we think about clients and patients, ultimately improving health outcomes.
By the end of this workshop, participants will: 1) Name two examples of ways language can impact structural determinants of health, 2) Describe the connection between language and health outcomes, and 3) Name two strategies for using language that honors RIM communities.
Syreeta Wilkins, MA | NRC-RIM
slw@umn.edu | LinkedIn
Syreeta is the communications strategist for the National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM), where she leads the communications efforts for the center as well as guides the creation and dissemination of health communications materials. She has more than a decade of experience in strategic communications, specializing in internal communications, digital media, and diverse and multilingual communities.
Dr. Nasreen Quadri | NRC-RIM Collaborator
quadr015@umn.edu
Dr. Nasreen Quadri is an Internal Medicine & Pediatrics Hospital Medicine Physician and Adjunct Assistant Professor in the Departments of Medicine and Pediatrics at the University of Minnesota. She completed her combined undergraduate and medical school degrees at the University of Missouri-Kansas City. During her residency training at the University of Minnesota Combined Internal Medicine & Pediatrics program, her primary clinic at the Center for International Health focused on providing primary care to newly arrived refugees and immigrants in Minnesota. She earned her Certificate in Tropical Medicine through the American Society for Tropical Medicine and Hygiene. After residency, she completed a chief year in Global Medicine. During her chief year, she partnered with the International Organization for Migration (IOM) to support international trainings of panel physicians and provide online content for programming. She worked alongside interns and registrars at Selian Lutheran Hospital and Arusha Lutheran Medical Center in Arusha, Tanzania during her chief year. Currently, she is Co-Chair for her Hospital Medicine department’s Diversity, Equity and Inclusion Committee, chapter representative for the Twin Cities chapter of Equal Health’s Campaign Against Racism, and a collaborator with the National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM). She is interested in forced migration as a social determinant of health and how the global is local in the US context.
- Addressing Bias and Stigma in the Language We Use With Persons With Opioid Use Disorder
- Are You What You Read? Predicting Implicit Attitudes to Immigration Based on Linguistic Distributional Cues From Newspaper Readership
- Expat identities: loaded words for movers abroad
- How We Label and React to People on the Move
- How Language Shapes Thought
- Lexicon of Global Migration
- 'Migrants’? ‘Refugees’? Terminology Is Contested, Powerful, and Evolving
- Negative Patient Descriptors: Documenting Racial Bias In The Electronic Health Record
- People around the world express more support for taking in refugees than immigrants
- Physician Use of Stigmatizing Language in Patient Medical Records
- Public Health in Minnesota
- Social Determinants of Health
- Tackling Implicit Bias in Healthcare
- Through the Veil of Language: Exploring the Hidden Curriculum for the Care of Patients With Limited English Proficiency
- Twelve Tips for Teaching Implicit Bias Recognition and Management
- Why are white people expats when the rest of us are immigrants?
- Why the language we use to talk about refugees matters so much
Friday, July 21, 2:15 p.m.
Background
Washington State Department of Health established the former Soviet Union (FSU) Vaccine Outreach Program in 2019 to address gaps in vaccination coverage seen in refugees from FSU countries. With COVID-19 vaccinations, Ukrainian refugees received vaccinations at the lowest rate among all refugee populations assessed.
Methods
Interviews, focus groups and surveys were conducted in Ukrainian and Russian on COVID-19, vaccines, and health needs. A Community Coordinator model was established to respond to vaccine-related issues and an FSU outreach workgroup was created to convene community groups and leaders together to advocate for their community and disseminate information.
Results
With the establishment of the FSU Outreach Workgroup, the attendance at these meetings began with 12 members in 2020 growing to 94 members in 2022. Community Coordinators hosted 17 total events August-December 2022, with approximately 2,300 refugees in attendance. The first community health board for Ukrainian and Russian speaking communities, Nashi Immigrants Health Board, was established as a result of these partnerships; it is an independent non-profit community health board addressing and advocating for broader community health issues.
Conclusion
This program model is an example of effective community engagement, demonstrating what centering authentic “trust-building” between health jurisdictions and communities can look like within public health. Beyond vaccinations, this approach to community engagement can be applied to other community health needs. Recently, Washington state has welcomed 15,000+ people from Ukraine through “Uniting for Ukraine” and the existing workgroups from this program have resulted in more effective responses to arising needs.
Vadim Kogan | Washington State Department of Health
vadim.kogan@doh.wa.gov
Ekaterina Teterina | Washington State Department of Health
ekaterina.teterina@doh.wa.gov
Danielle Koenig | Washington Department of Health
danielle.koenig@doh.wa.gov
Kimberly Yu | UMN
yu000623@umn.edu
Saturday, July 22, 1:00 p.m.
Background
Health departments and health systems across North America face challenges in understanding how to meet the needs of refugee, immigrant, and migrant communities. Qualitative interviews are one effective method for gathering in-depth data about community attitudes, practices, and actionable health-related gaps. Qualitative interviews present opportunities as well as challenges and should be developed mindfully, in partnership with stakeholders, to maximize their usefulness for health research and program improvement.
Content
- Discuss when qualitative interviews are appropriate for health research and program improvement.
- Review well-established tips for conducting interviews and introduce perspectives on the unique challenges and opportunities of conducting interviews with refugee, immigrant, and migrant communities.
- Share perspectives and insights for supporting cross-cultural and cross-linguistic qualitative interviews in your own setting.
Instructional Methods
1) Opening Panel: The workshop facilitators present key considerations for conducting qualitative interviews with refugees, immigrants, and migrants, including: deciding when qualitative interviews are
appropriate, partnering with communities throughout the research process, cultural and power dimensions of interviews, navigating cross-linguistic interviews, and communicating with funders about the complexities of qualitative research in multiple languages. Duration: 20-25 minutes.
2) Breakout: Participants divide into small facilitated groups, organized by program type (e.g., health system, community-based research) to review scenarios in their own settings that highlight aspects of the content described above. Duration: 20-25 minutes.
3) Closing Panel: Facilitators summarize successful strategies, including examples from their own collaborations, and review a take-home worksheet for participants. Duration: 10-15 minutes.
Julieta Altamirano-Crosby | City of Lynnwood, WA
julieta.crosby@yahoo.com
Elizabeth Dawson-Hahn, MD, MPH | University of Washington
eedh@uw.edu
Diego de Acosta | UMN
deaco011@umn.edu
Gabriel Fabreau | University of Calgary
gefabrea@ucalgary.ca
Nadège Mudenge | CHOP / PolicyLab
mudengen@chop.edu
Kimberly Yu | UMN
yu000623@umn.edu
Katherine Yun | Refugee Health Program at Children's Hospital of Philadelphia
yunk@chop.edu
Saturday, July 22, 2:15 p.m.
Background:
This study examined the association of self-identified preferred language with COVID-19 vaccine uptake timing and disease outcomes (hospitalizations and deaths) to add granularity to previously reported racial and ethnic disparities.
Methods:
A cohort study of 851,410 adult subjects (>18 years) in a large health system in Minnesota and western Wisconsin between December 15, 2020 and March 31, 2022 was conducted. The exposure studied was self-identified preferred language and limited English proficiency (LEP) as measured by interpreter need. Subgroups were created using US Census categories and attention to capture languages known to represent refugee groups. Overall age-adjusted Hazard Ratios (HR) for time to first vaccine, and Rate Ratios (RR) for COVID-19 vaccine uptake and disease outcomes were estimated to compare across language preference other than English (LPOE), LEP, race/ethnicity, and selected languages.
Results:
Of the 851,410 subjects, 7.5% were foreign born, 4% LPOE, and 3% LEP. Marked temporal clusters were observed for COVID-19 vaccination uptake, hospitalizations, and deaths associated with primary series vaccine eligibility, booster availability, and COVID-19 variants. Delayed first dose vaccine was observed with LPOE [HR 0.83, CI 0.82-0.84] and LEP [HR 0.81, CI 0.80-0.82] compared to those with English language preference and proficiency.
Conclusion:
Data collection of language preference and interpreter need provides actionable health intervention information. Standardized system-level data collection, including at a national level, would improve efficient identification of social groups that suffer disproportionate health disparities and provide key information on improving health equity.
Dr. Nasreen Quadri | NRC-RIM Collaborator
quadr015@umn.edu
Dr. Nasreen Quadri is an Internal Medicine & Pediatrics Hospital Medicine Physician and Adjunct Assistant Professor in the Departments of Medicine and Pediatrics at the University of Minnesota. She completed her combined undergraduate and medical school degrees at the University of Missouri-Kansas City. During her residency training at the University of Minnesota Combined Internal Medicine & Pediatrics program, her primary clinic at the Center for International Health focused on providing primary care to newly arrived refugees and immigrants in Minnesota. She earned her Certificate in Tropical Medicine through the American Society for Tropical Medicine and Hygiene. After residency, she completed a chief year in Global Medicine. During her chief year, she partnered with the International Organization for Migration (IOM) to support international trainings of panel physicians and provide online content for programming. She worked alongside interns and registrars at Selian Lutheran Hospital and Arusha Lutheran Medical Center in Arusha, Tanzania during her chief year. Currently, she is Co-Chair for her Hospital Medicine department’s Diversity, Equity and Inclusion Committee, chapter representative for the Twin Cities chapter of Equal Health’s Campaign Against Racism, and a collaborator with the National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM). She is interested in forced migration as a social determinant of health and how the global is local in the US context.
Sunday, July 23, 2 p.m.
Background:
The Minnesota Department of Health (MDH) and the University of Minnesota Mobile Health Initiative (MHI) coordinated a robust interdisciplinary response to support the medical needs of Afghan nationals resettling in Minnesota following their rapid evacuation from Afghanistan. A temporary housing site was created for newcomers to ease the transition until permanent housing was secured. At the site, two rooms were transformed into small clinics where initial medical screenings were conducted. For time and space efficiency, family members were screened together. However, this model was suboptimal to elicit personal health concerns from individuals, especially adult women, who were uncomfortable voicing private concerns in front of their husbands, children, and male providers and interpreters.
Methods:
Thus, a Women’s Clinic model was created, staffed by female medical providers and interpreters, with a goal of providing care in a safe and private environment. It provided the foundation for focused programming to address health concerns such as somatic manifestations of acute stress and trauma, as well as offered an opportunity for domestic violence screening. In this one-on-one environment, women were more likely to report physical concerns like genitourinary symptoms, reveal mental health challenges, and discuss family planning preferences.
Results:
A total of 14 weekly 3-hour clinics were held as part of the Women’s Clinic initiative. Of the 206 adult women eligible for participation, 103 (50%) chose to attend the clinic.
Conclusion:
Adapting the clinic according to the unique cultural needs of this population was key in providing thorough and inclusive care to all evacuees.
Dr. Nasreen Quadri | NRC-RIM
quadr015@umn.edu
Dr. Nasreen Quadri is an Internal Medicine & Pediatrics Hospital Medicine Physician and Adjunct Assistant Professor in the Departments of Medicine and Pediatrics at the University of Minnesota. She completed her combined undergraduate and medical school degrees at the University of Missouri-Kansas City. During her residency training at the University of Minnesota Combined Internal Medicine & Pediatrics program, her primary clinic at the Center for International Health focused on providing primary care to newly arrived refugees and immigrants in Minnesota. She earned her Certificate in Tropical Medicine through the American Society for Tropical Medicine and Hygiene. After residency, she completed a chief year in Global Medicine. During her chief year, she partnered with the International Organization for Migration (IOM) to support international trainings of panel physicians and provide online content for programming. She worked alongside interns and registrars at Selian Lutheran Hospital and Arusha Lutheran Medical Center in Arusha, Tanzania during her chief year. Currently, she is Co-Chair for her Hospital Medicine department’s Diversity, Equity and Inclusion Committee, chapter representative for the Twin Cities chapter of Equal Health’s Campaign Against Racism, and a collaborator with the National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM). She is interested in forced migration as a social determinant of health and how the global is local in the US context.