Refugee Health Ed Conference - Jennifer Klem

April 14, 2021

ID6441

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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.