Many of the Afghans displaced by the Taliban takeover of Kabul in 2021 found refuge in the United States through Operation Allies Welcome (OAW) and the ongoing Operation Enduring Welcome (OEW) Response. OAW was an interagency initiative that coordinated efforts across the federal government, military, state and local governments, NGOs, and private partners to manage the resettlement of nearly 90,000 Afghans. As Afghan newcomers began arriving in the U.S. in 2021 amidst the COVID-19 pandemic, resettlement agencies worked alongside federal offices, healthcare systems, public health departments, social service providers, and community-based organizations to provide much-needed assistance.
Resettled Afghans are acclimating to life in the United States, enriching their new communities, securing public benefits, and seeking opportunities for their families. At the same time, they are experiencing ongoing challenges related to the trauma of sudden displacement and navigating complex systems like health care as English-language learners.
Challenges in Healthcare Access for Afghan Women Resettling in the U.S.
Afghan newcomers frequently experience challenges in navigating the U.S. healthcare system due to complexity, lack of English skills, transportation barriers, lack of insurance, and unfamiliarity with preventative care. Female Afghans may have even more barriers due to higher levels of pre-literacy, childcare obligations, a lack of access to technology with which to schedule appointments, and cultural considerations in wanting female providers. Focused support is needed to support Afghan women in understanding and accessing needed healthcare in the U.S. so they can make informed decisions about their and their families’ well-being.
The "Dialogue with Doctors" Series in San Diego
The International Rescue Committee (IRC) in San Diego developed a comprehensive approach to support the health and wellness of Afghan women through its innovative "Dialogue with Doctors" series. This series is one component of IRC San Diego’s Women's Resilience Center (WRC), established in 2020, and provides a safe and collaborative space for women and girl refugees worldwide. The WRC offers programs to enhance health, safety, well-being, and community connectedness during the transition to life in the U.S.
The "Dialogue with Doctors" series focuses explicitly on Afghan women, facilitating direct engagement with healthcare providers who share their linguistic and cultural backgrounds. This program remotely connects clients with U.S.-based Afghan doctors or individuals who practiced medicine in Afghanistan and have since resettled in the U.S. This linguistic and cultural alignment addresses language barriers and fosters a deeper understanding of health concerns. As a result, an increased sense of comfort and understanding can be nurtured between the women and the doctors during the dialogues held in Dari and Pashto. The series, consisting of six interactive sessions, covers various topics determined before the series begins, ranging from maternal health to mental well-being, tailored to the needs and interests of Afghan women. Participants have the flexibility to engage in one or all sessions.
Program development (initial and ongoing): Initially, an Afghan Advisory Group was formed, which includes a doctor, Afghan IRC staff, and female clients from the community to develop and refine the program. This advisory group plays a crucial role in determining the topics of interest and providing feedback on the program's delivery, such as the best times for sessions and whether they should be cohort-based or drop-in sessions. IRC San Diego also conducts surveys at the beginning and end of each six-week program to collect feedback from clients on what topics they would like to cover and how the program could be adjusted to serve them better. Examples of topics discussed in the program include mental health to combat stigma and bias, nutrition, breast cancer, and sexual and reproductive health topics, including contraception options and other topics identified by Afghan female clients.
Program logistics: The Dialogue with the Doctor series is held weekly online or in-person for one hour and is structured as presentations followed by Q&A sessions. Recruiting volunteer presenters involves a multifaceted approach, leveraging the advisory group's connections and conducting open searches on the internet for individual volunteers and organizations with relevant expertise, such as Cornerstone and the Afghan Health Initiative. Since all participants are female, only female presenters are invited to the sessions. This ensures cultural humility and respect for the client's privacy and considers the participants’ comfort. To accommodate varying levels of digital literacy and access to hardware among participants, Nazi, the IRC’s Women's Resilience Center facilitator, provides individual assistance to those who need it before the session. This ensures that all women have the necessary means and skills to access and navigate Zoom, allowing full participation in the sessions regardless of their digital literacy levels. Recruiting participants for "Dialogue with Doctors" leverages existing relationships with clients through the WRC and community staff members with refugee experiences. Outreach efforts include using WhatsApp to share flyers and updates, and internal referrals within IRC programs.
Program evaluation: The September to October 2023 "Dialogue with Doctors" series engaged 41 unique participants throughout six sessions, improving health knowledge, confidence in utilizing the health system, and overall understanding of women’s healthcare topics among the attendees. According to the post-survey results, 100% of participants expressed satisfaction with the services provided, confirmed they were likely to use the information they learned, and believed it was relevant to their needs. This achievement underscores the effectiveness of culturally and linguistically congruent health education.
The “Dialogue with Doctors” community-informed approach emphasizes client input from the initial planning stages to post-program surveys. The series has enhanced the health knowledge and confidence of attendees. Staff members, including Katie and Nazi, have observed the program's impact on increasing clients' understanding of their health and have showcased the success of the program, which effectively improves health literacy and fosters a supportive community among Afghan women in San Diego. Nazi, WRC’s Facilitator, highlighted the positive feedback from clients, "each month and each topic, there were clients who expressed how glad they are that they are in the group, how happy they are that we covered that topic.” The program's success is largely attributed to the adaptations made by program staff in response to the continuous feedback from participant input that ensures alignment with the evolving needs of Afghan women.
Keys to Success
The keys to success for "Dialogue with Doctors" include several strategic adaptations:
Culturally Aligned and Community-Driven Leadership: The IRC Women's Resilience Center maintains a community-centered approach through hiring and working with facilitators from Afghanistan. For example, the lead facilitator, Nazi, is from Afghanistan and plays a critical role in connecting with community presenters and building trust among staff and participants. A community-centered approach also considers the language preferences of the participants. Katie Medlin, Women's Resilience Center and Social Work Field Placement Coordinator at IRC San Diego, reflects, “A lot of the success is owed to the fact that, 80% to 90% of the time, discussions are presented in language by our Afghan staff.” Additionally, inviting only female presenters ensures a gender-sensitive approach and respects clients' privacy, particularly as all clients are females.
Flexible Session Formats: The program offers flexibility in session formats, providing both virtual and in-person options to accommodate the diverse needs and preferences of the participants.
Use of Familiar Technology and Training: The inclusion of familiar technology platforms, like WhatsApp for communication and Zoom for virtual sessions, along with digital literacy training ensures clients can overcome technological barriers and enhance participation.
Client-Centered Approach: Clients continue to be actively involved in the program design and were invited to collaboratively design the program from the inception by suggesting topics aligned with their needs. Their voices are included in all stages of the program, emphasizing a client-centered approach that prioritizes their input and ensures the program aligns with their evolving needs.
Promoting Digital Literacy for Preliterate Clients: To ensure all clients are reached tailored outreach initiatives audio clips, and visuals in WhatsApp messaging, and conducting surveys verbally to enhance participation.
