Refugee Health Ed Conference - Jennifer Klem
April 14, 2021ID6441
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- 00:00My name is Jenny Clem.
- 00:02I work at Iris as the reception
- 00:05and placement manager.
- 00:06I oversee case management for
- 00:08the first three months that a
- 00:11refugee arise into the country,
- 00:12so thank you so much Maya for
- 00:15setting the stage for the current
- 00:17state of refugee resettlement.
- 00:19I've been asked to speak to
- 00:22the effects that Covid has had.
- 00:24On a local level,
- 00:26as relates to refugee resettlement,
- 00:28both generally and then more
- 00:30specifically as relates to health
- 00:32related challenges observed by
- 00:34both Iris staff and our partners
- 00:36at Yale Refugee Health Clinic.
- 00:38As well as how we've sought
- 00:40to address these challenges.
- 00:41So I'll jump right in with talking
- 00:43about the variety of factors that
- 00:45have been at play with the effects
- 00:48Covid has had on the populations that
- 00:50we serve and the work that we do.
- 00:53Anne,
- 00:53there's definitely been a
- 00:55cultural aspect to covid there's,
- 00:57you know,
- 00:58there's certainly been caution and
- 01:00fear expressed by a lot of our clients.
- 01:03And yet at the same time,
- 01:06there seems to be a noticeable
- 01:08amount of clients who have continued
- 01:10to interact between households,
- 01:12putting themselves at a higher risk
- 01:15for covid some cultural anecdotes of
- 01:18dynamics at play that I find helpful
- 01:21or have found helpful in in this time.
- 01:24And things that have been observed
- 01:26by some of our case managers.
- 01:29Will hopefully give give us a
- 01:30little bit of a sense of the
- 01:32perspectives that are at play.
- 01:34For example,
- 01:35one one of our Afghan clients said to one
- 01:37of our case managers when she was explaining.
- 01:40You know, I'm not going to go into your home.
- 01:42We're going to talk about this
- 01:44on the sidewalk.
- 01:45His response was were Afghans.
- 01:47We can't get Covid covid just
- 01:49happens to other people.
- 01:51Another another anecdote was
- 01:52you know a client saying well,
- 01:54as long as you have a clean heart,
- 01:57you won't get sick and this
- 01:59was in reference to, you know,
- 02:01having like a clean conscience.
- 02:03And I think there's also just a general
- 02:06pressure to provide hospitality,
- 02:08and that this may be cultural
- 02:11pressure can often outweigh the
- 02:13health risks involved in doing so.
- 02:16We've also definitely seen an
- 02:18economic impact on our clients.
- 02:19They've struggled financially because
- 02:21many of the sectors that they work in
- 02:24have been affected by economic closures,
- 02:26which makes sense,
- 02:27right?
- 02:27A lot of the jobs that our clients
- 02:30are eligible to work for when
- 02:33they first arrived to the US.
- 02:35Not the types of jobs that can
- 02:37easily shift their employees
- 02:38to to working remotely.
- 02:40Oftentimes their frontline workers,
- 02:41essential workers who have to be
- 02:44onsite to do to do the work that they do.
- 02:47Ann,
- 02:47and so we've definitely seen as well
- 02:51as social and emotional impact that
- 02:54our clients have had as as result
- 02:58of covid And there's definitely
- 03:00been an increased isolation.
- 03:01A lot of our clients have expressed
- 03:03just a sense of loss of community that
- 03:06they used to be able to receive by
- 03:08being physically present at our office.
- 03:11And we, you know, have had to close our
- 03:13office to the public during this time,
- 03:16and that just results in a general loss
- 03:19of connectedness between staff and clients
- 03:22when we're not physically present in
- 03:24the same space on a day to day basis.
- 03:27And we've been able to adapt our
- 03:29sense of community in some some ways.
- 03:31I definitely credit our ESL
- 03:33instructors and their creativity.
- 03:34So while we've had to cancel
- 03:36things like our in person,
- 03:38women sewing group for the time being,
- 03:40our staff have come up with creative
- 03:43alternatives like our virtual tea
- 03:45and talk time that happens over
- 03:47zoom for women on a weekly basis.
- 03:49As well as weekly health literacy
- 03:51classes that happen during the
- 03:53evenings on a weekly basis and cover
- 03:55a range of topics including cobett,
- 03:57of course.
- 03:59Some of our clients have also
- 04:01struggled with family separation as a
- 04:03result of covid travel restrictions,
- 04:05and that certainly takes a toll
- 04:08on their emotional health.
- 04:09One client that I can think of off
- 04:12the top of my head has had his family
- 04:15join him in this past November,
- 04:18though he was expecting them to come
- 04:21right before Covid shutdowns last
- 04:23March and you know all the delays.
- 04:26Resulted in them coming about
- 04:28nine months later than planned.
- 04:30Our supportive therapist on staff
- 04:32also has seen a drastic increase in
- 04:35the number of new referrals that
- 04:38that have come through throughout
- 04:40the the you know,
- 04:41the period of covid and not only has
- 04:46you know covid affected our clients,
- 04:48but it's affected the way that we
- 04:50carry out our work. As staff at iris.
- 04:54So we learn definitely to provide
- 04:56our services remotely through,
- 04:58you know,
- 04:59through a lot of practical
- 05:01difficulties were always seeking
- 05:03to improve and re-evaluate the way
- 05:06that we deliver our services as the
- 05:10public health situation involves.
- 05:12For example,
- 05:12we've had to shift to doing
- 05:14remote case management,
- 05:16so this is anything from explaining
- 05:18to clients how to obtain a money
- 05:21order and and address an envelope.
- 05:23In order to pay their rent to
- 05:26meeting clients out on the sidewalk
- 05:28to review their Mail together to
- 05:30determining whether we thought it
- 05:32was safe to go into a client's home,
- 05:34to show them how to turn on their
- 05:37gas stove for the first time as we
- 05:40Orient them to their new apartment.
- 05:43So it's definitely been a learning curve,
- 05:45and it has required a lot of
- 05:48adjustments of expectations.
- 05:49Both of our staff and of our clients.
- 05:53We thankfully have been able to
- 05:55incorporate a lot of volunteers
- 05:57who can help get our basic get
- 06:00basic needs out to our clients,
- 06:03so some examples being weekly food
- 06:05deliveries from our food Pantry,
- 06:07monthly diaper deliveries for clients
- 06:10to qualify for our diaper bank.
- 06:13As well as the delivery of
- 06:15kobic care packages.
- 06:17For color care packages we you
- 06:19know we receive some funding
- 06:21from our national organization
- 06:22few months into the pandemic,
- 06:25be able to provide hygiene products,
- 06:27cleaning supplies, masks,
- 06:28PPE to all of our clients
- 06:30from who arrived between 2018
- 06:33through on to the present,
- 06:34and we continue to be able
- 06:37to provide those items to
- 06:39our newest arrivals as well.
- 06:43We've had to focus on working as
- 06:45well with clients through the loss
- 06:48of jobs and decreased work hours.
- 06:50You know, there's been a shift from
- 06:52helping clients to apply for employment
- 06:55in general to applying for unemployment
- 06:57insurance or unemployment benefits,
- 06:59as well as reapplying for public
- 07:02benefits after they've lost their jobs.
- 07:05And we've also seen a huge
- 07:07increase in the Re liant Suppan.
- 07:09Our weekly food pantry distribution.
- 07:11Pre covid we averaged about 80
- 07:14households a week that we served
- 07:17through our food pantry and now during
- 07:20covid it's probably around 300 three,
- 07:2325 households per week,
- 07:25both through a combination
- 07:27of walking and delivery.
- 07:29Distribution options.
- 07:33Anile moving now into more specific
- 07:36challenges related to health care access.
- 07:40At the start of the pandemic,
- 07:42we all know that there was a suspension
- 07:45of non essential health care visits.
- 07:48The messaging was to stay away
- 07:50from clinics to reduce the risk of
- 07:53contracting covid and to prevent
- 07:55overwhelming health care facilities.
- 07:57So this meant that the initial refugee
- 08:00health screening that all of our newly
- 08:03arrived clients typically get within
- 08:06their first month were postponed.
- 08:08This appointment is also their entry
- 08:11point into establishing primary care,
- 08:13so there was also a delay in
- 08:16their establishing routine care.
- 08:18And this meant that clients,
- 08:20not knowing where else to turn,
- 08:22would often end up in the
- 08:24emergency Department.
- 08:25Both for, you know,
- 08:26serious health issues,
- 08:27as well as relatively minor health issues.
- 08:30Just because I didn't really understand
- 08:33their options or access points.
- 08:35So are rare are yell refugee
- 08:38health clinic partners really had
- 08:40to advocate with their clinic
- 08:42leadership to allow for new intakes
- 08:45of refugee clients in a virtual way?
- 08:48Because at that time,
- 08:49no new patients were being
- 08:51scheduled in any clinic,
- 08:53so we're really grateful for their
- 08:56advocacy in that way that allowed
- 08:58us to continue serving clients and
- 09:01meeting their health care needs.
- 09:04We've also, you know,
- 09:05switched to a lot of Tele health visits,
- 09:08and we're super glad that those
- 09:10are an option during this time.
- 09:12But it also should be noted that
- 09:14those you know come with increasing
- 09:16complications whenever you have
- 09:17to involve an interpreter,
- 09:19and also whenever you're dealing
- 09:21with clients who maybe have a
- 09:24lack of digital literacy.
- 09:26So oftentimes,
- 09:26clients who you know didn't have a
- 09:29lot of prior experience or knowledge
- 09:32with navigating technology would
- 09:34end up having phone virtual phone,
- 09:37you know appointments.
- 09:38This is less than ideal,
- 09:40you know both for establishing repor
- 09:43and trust between the patient and
- 09:45provider as well as the providers
- 09:48ability to even physically observe
- 09:50a patient visually.
- 09:54Another challenge we faced with
- 09:56transportation to in person appointments
- 09:58when when there were in person appointments,
- 10:00you know most of our refugees
- 10:03do not have vehicles.
- 10:04Sometimes they have friends or family
- 10:06members who can take them to appointments,
- 10:09but oftentimes they are relying upon public
- 10:12transportation and for awhile you know,
- 10:14as we assessed the risks we were,
- 10:17you know, advocating or advising that
- 10:19clients not not necessarily subject
- 10:22themselves to public transportation.
- 10:24And so this you know creates
- 10:26creates difficulties,
- 10:27but we eventually were able to use
- 10:29some grant funding to help cover
- 10:31Uber rides health appointments.
- 10:33We also had developed a great network
- 10:36of volunteer drivers who would be
- 10:38willing to step in at a moment's notice.
- 10:41So we're very thankful for that.
- 10:44I'm turning to health education
- 10:49surrounding Covid.
- 10:51Especially like in the initial
- 10:53stages of the pandemic,
- 10:54Iris as well as the refugee
- 10:56health clinic at Yale.
- 10:58We were kind of scrambling to ensure
- 11:00that our refugee clients were
- 11:02understanding all the public health
- 11:05messages that were circulating.
- 11:07So the Yellow Clinic had some of
- 11:09their medical students called
- 11:11patients and explain things.
- 11:12And Iris staff also was making an
- 11:15effort to communicate with clients
- 11:17are health team at Iris accumulated
- 11:19an translated resources into the
- 11:21languages that our client speak?
- 11:23So we dispersed information
- 11:25in whatever means we could.
- 11:27So that was WhatsApp mass texts,
- 11:29mass emails, paper Flyers,
- 11:31and many many phone calls.
- 11:33We did hours and hours of outreach
- 11:36to all of our clients who arrived
- 11:38within the last two years,
- 11:41as well as trying to to target
- 11:43our clients who arrived within
- 11:45the last five years,
- 11:47especially if they were over the age of 65
- 11:51or had any underlying health conditions.
- 11:55And we also did our best to assist
- 11:57clients in getting covid tests,
- 11:59which at first you know we're limited
- 12:01and you know understanding of how to
- 12:04access these tests and transportation
- 12:05to the test sites was a challenge,
- 12:08but thankfully there have been,
- 12:09you know,
- 12:10a number of resources that have
- 12:12been developed to allow for
- 12:15transportation to these test sites.
- 12:17Anne.
- 12:17And our focus at the current moment is,
- 12:22not surprisingly and very excitingly,
- 12:24that we are able to help clients
- 12:26gain access to the COVID-19 vaccine.
- 12:29So Doctor Legarde from Fairhaven
- 12:32Community Health Center reached out
- 12:34originally to Iris to partner with us
- 12:37and a few other local organizations
- 12:40to prioritize vaccine access.
- 12:42This was specifically to communities
- 12:44of color,
- 12:45undocumented communities and those who
- 12:47would otherwise be disadvantaged in
- 12:50their access to these vaccine resources.
- 12:52So our health and Wellness Manager,
- 12:55Pamela and her health team at
- 12:57Iris are leading the way on this.
- 13:00We've been given access to a live
- 13:03schedule that we can update to
- 13:05schedule client appointments so
- 13:07that clients don't have the the
- 13:10barrier of trying to schedule
- 13:12vaccination appointments online in.
- 13:14In addition,
- 13:14Iris has expanded services in
- 13:16recent years to undocumented
- 13:18immigrants in Connecticut,
- 13:20and this is through our Son program.
- 13:22Our services to undocumented neighbors.
- 13:25So through their partnership
- 13:27with the Fair Haven Clinic,
- 13:29we're reaching out to undocumented clients,
- 13:32assuring them that they have access
- 13:35to the vaccine and helping to overcome
- 13:38hesitations that they may face related
- 13:41to a lack of medical insurance.
- 13:43You know, having beers
- 13:45regarding disclosing it,
- 13:46immigration status and related concerns.
- 13:50And I want to end with just some
- 13:54general lessons learned and
- 13:56generally positive outcomes from
- 13:58this particularly difficult time.
- 14:01One exciting trend that we have
- 14:04noticed at Iris is that a lot of our
- 14:08male clients who were previously
- 14:10less engaged in medical services
- 14:12have seen we've seen an increase
- 14:15in their willingness to engage with
- 14:18with both telehealth and virtual
- 14:20mental health services,
- 14:22and clients have specifically voiced
- 14:25that they are more willing to engage
- 14:28in these services given the amount.
- 14:31Or the level of anonymity that a
- 14:33virtual or Tele health appointment
- 14:35allows them?
- 14:36You know,
- 14:37so they don't have to be in the
- 14:39waiting room and fear potentially
- 14:41seeing others from their community,
- 14:43which you know.
- 14:45You know they they attribute to
- 14:48the social stigma around accessing
- 14:52these services.
- 14:53There's also been a greater
- 14:55ability to serve clients remotely,
- 14:57and this is led to some practices
- 14:59that were not necessary pre covid,
- 15:01but we think will continue even
- 15:04after we don't have to.
- 15:05After things you know,
- 15:07return to whatever the new
- 15:10normal looks like with covid.
- 15:12A few examples of that would just
- 15:14be applying for public benefits
- 15:16online rather than in person
- 15:19and and using my chart,
- 15:21making sure that all of our clients
- 15:23are set up with my chart from
- 15:26the start so that they are able
- 15:28to navigate their Tele health,
- 15:31appointments, medical records,
- 15:32scheduling appointments,
- 15:33and communicating with their
- 15:35health care providers.
- 15:37And I think most importantly,
- 15:39in within the Iris community we
- 15:41have not had any deaths or major
- 15:44hospitalizations due to covid
- 15:46amongst our client populations.
- 15:48And this we really credit to
- 15:51the education outreach efforts,
- 15:53an ability to provide deliveries to
- 15:56vulnerable clients to meet their
- 15:58basic needs without them having
- 16:01to risk exposure.
- 16:02And this is definitely been through the
- 16:05help of many partnerships and volunteers,
- 16:08and so we're really thankful for that.
- 16:12And to end I would say that we've
- 16:15seen a lot of resilience amidst the
- 16:17challenges of the time of kobid,
- 16:19both from our clients and from
- 16:22the Community support networks
- 16:23that surround them.
- 16:24You know,
- 16:25we've all learned to adapt and
- 16:27considerable waste and continue to
- 16:29addressing needs where incredibly
- 16:31grateful for the partnerships that we
- 16:33have with the Yale Refugee Health clinic,
- 16:36heal,
- 16:36patient navigators,
- 16:37Fairhaven Community Health Clinic,
- 16:39and other medical and social
- 16:41service providers in the community.
- 16:44One thing I often say is that it takes a
- 16:46community approach to resettle refugees,
- 16:48and I also think it takes the Community
- 16:51approach to overcome COVID-19.
- 16:52So I just want to thank you
- 16:54all for your support in in.
- 16:57In both of those endeavors.
- 16:59Thank you so much.