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 the 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.
Barriers to Healthcare Access and Navigation for Afghan Newcomers
Afghan newcomers face considerable challenges in accessing healthcare services in the U.S. Upon arrival, many lack medical records as they flee emergencies, complicating providers' understanding of their health histories and needs. Navigating the intricate U.S. healthcare system presents practical hurdles such as arranging transportation, scheduling appointments, navigating clinic procedures, resolving medical bills, and obtaining prescriptions. These tasks can be especially daunting given language barriers, low health literacy levels, and cultural differences. Supporting Afghan newcomers by helping them understand their rights and communicate effectively with healthcare providers can help mitigate these barriers.
IRC Denver’s “Health and Wellness Workbook” Program
The IRC Denver office, founded in 2016, underwent significant expansion following the Afghanistan evacuation in 2021. Faced with a sudden influx of Afghan newcomers to the Denver area, the office swiftly implemented strategies to assess their health needs efficiently and effectively. This involved conducting health intake assessments within the first week of Afghan clients’ arrival to the U.S. to identify urgent health concerns, scheduling medical appointments, and providing health education through home visits tailored to individual healthcare needs.
However, staff quickly recognized that more was needed as numerous clients continued to rely on IRC staff to convey basic information to doctors, schedule appointments, and conduct other healthcare-related tasks. In response, the IRC Denver's health team created the “Health and Wellness Workbook,” a portable booklet designed as a centralized repository for the family's personalized medical information, U.S. healthcare details, and contact information and addresses of local health providers and clinics, all supplemented with helpful visuals. The booklet is customized for each individual or family and available in English, Dari, and Pashto, mitigating language barriers between providers and clients by providing the content in the client's preferred languages. The booklet also enables doctors’ offices to access clients’ records promptly while they await an interpreter, benefiting both parties by accessing crucial data and facilitating effective communication. In addition, the workbook helps Afghan newcomers gain knowledge about the available healthcare services in the Denver area and how to access them, ultimately enabling them to access the full range of high-quality healthcare services and support on their own and with limited assistance from IRC.
Collaborative Development and Content Validation Process
The IRC Denver’s health team crafted the "Health and Wellness Workbook" collaboratively with the Afghan community. The team incorporated input from IRC leadership, feedback from Afghan staff at the Denver office, and input from the Afghan community participating in the program. This inclusive approach ensured the workbook's content was culturally relevant and addressed the specific needs of Afghan newcomers.
The workbook is composed of various sections which are customized for each individual or family:
1. Family Health Information: Includes contact details for doctors, dentists, and other providers. The workbook includes fillable forms for clients to input their data. Information included in this section is:
- Family Health Information (fillable forms for names, addresses, phone numbers, and preferred language)
- Health Care Providers (fillable forms for primary care, urgent care, emergency care, pharmacy)
- Family Health Schedule (fillable forms)
2. Personal Health Information: Allows clients to record up-to-date medical details, health history, primary care clinic contacts, and individual care plans for each family member. These are also in fillable form format.
3. Healthcare Basics: An overview of the U.S. healthcare system, covering types of care, making appointments, patient rights and responsibilities, interpretation services, appointment procedures, medications, immunizations, and dental care.
4. Educational Materials:
- Health insurance details (insurance type, coverage, copays, member/policy numbers, plan type, and health insurance specifics like in/out of network provider requirements)
- Types of healthcare (primary, preventive, urgent, emergency, follow-up)
- Determining the appropriate type of care
- Healthcare providers
- Interpretation services
- Healthcare facilities
- Making, preparing for, going to, during, and after appointments
- Types of medicine, filling prescriptions, taking medicine
- Immunizations
- Well-child visits
- Dental care
- Patient rights and responsibilities
5. Specific Health Topics: Additional information on health issues, added over time.
6. Know Your Rights and Responsibilities: This section includes an NRC-RIM factsheet on the fundamental rights of patients receiving medical care in the United States, such as access to quality healthcare without discrimination, respectful and culturally competent treatment, clear communication, etc. It also likely covers your responsibilities to foster a productive relationship with healthcare providers.
7. How to Pay for Medical Care: This section includes an NRC-RIM factsheet on options for obtaining Medicaid eligibility and information on health insurance and affordable medical care in the U.S. like Refugee Medical Assistance, employer insurance, the Healthcare Marketplace, and free/low-cost clinics for those who don't qualify for Medicaid.
8. “I Speak” Cards: a wallet-sized card for clients to show their healthcare providers, indicating their preferred language to help medical provider staff ensure interpretation for clear communication during medical services.
9. Staff-facing section: This section is designed for IRC staff to document notes and information gathered during conversations with families. It serves as a space to record any needs expressed by the family. Additionally, it includes contact information for various IRC departments, facilitating client access and enabling easy communication if they need to reach out for support or services.
Ensuring Usability and Accessibility
After filling out the workbook with a specific client’s health details, health provider information, and localized health facility locations, the “Health and Wellness Workbook” for Afghan families or individuals and providing a hard copy to clients. IRC Denver staff conduct a home visit to review the workbooks with clients, ensuring comprehension of their use. Staff schedules home visits at times convenient for clients, allowing them to receive essential information in a comfortable, familiar environment without feeling overwhelmed and in the privacy of their home. During home visits, staff or clients (if able) handwrite any additional necessary information directly into the workbooks. The team incorporated visuals like photographs and icons to enhance user-friendliness and to ensure people with lower literacy levels can also engage with its content. Additionally, numerous parts of the workbook were designed so that users could take digital photos with their phones, ensuring easy access to the information. Throughout their time working with clients, staff update and further personalize the content as necessary, maintaining relevance and accuracy. Staff also emphasize the importance of safeguarding the workbook's sensitive information and not sharing it with anyone other than their medical providers.
Impact
From October 2022 to September 2023, the IRC Denver office provided 47 households with "Health and Wellness Workbooks" reaching a total of 170 individuals. The Denver team conducted 3-month follow-up calls to ten individuals who had received the "Health and Wellness Workbook." Results indicate that 80% of respondents reported "always" utilizing their workbooks or other health education materials when navigating the healthcare system. These outcomes demonstrate the effectiveness of the "Health and Wellness Workbooks" in allowing Afghan newcomer families to actively navigate the healthcare system as one client added, “'Oh, this was a lifesaver. I didn't have to spend so much time explaining to the front desk what I was here for.”
