Special Episode: Refugee Health

Transcript

00:00 --> 00:02Yale podcast network.
00:05 --> 00:09Hi all welcome to a special episode of the Yale Journal Biology and medicine.
00:09 --> 00:11This episode is focused on Refugee Health.
00:11 --> 00:14The Yale Journal of Biology and Medicine is a pub.
00:14 --> 00:22Med indexed quarterly Journal edited by the Yale medical graduate and professional students and peer reviewed by experts in the field of biology and medicine.
00:22 --> 00:29I'm Wei, A third year graduate student in Microbiology and I'm your Cohost Kartiga second year graduate student Biomedical Engineering,
00:29 --> 00:33joining us today. Are 2 experts in the field of refugee health doctor,
00:33 --> 00:35Camille Brown and doctor Annamalai.
00:35 --> 00:39Doctor Camille Brown is the director of the Yale Pediatric refugee clinic.
00:39 --> 00:42In addition, she's an assistant clinical professor of Pediatrics,
00:42 --> 00:50at the Yale School of Medicine Dr Annamalai is the director of Yale Adult Refugee Clinic as well as an associate professor of psychiatry sort of start can you each
00:50 --> 00:59talk a bit about your career path and what your experiences are that informed your decision to work in your respective fields and with refugee populations.
00:59 --> 01:07So I Did not actually aspire to treat refugees that was not how I started my career path.
01:07 --> 01:10It was serendipitous and I sort of fell into it.
01:10 --> 01:23When I came here to work at Yale after finishing my training in primary care and psychiatry very enterprising resident in the residency program in internal medicine was just starting.
01:23 --> 01:28This clinic and then we've developed it and it has grown a lot over the years,
01:28 --> 01:32but when it first started I was just starting to work here.
01:32 --> 01:35And I was asked if I was interested in it,
01:35 --> 01:46and I jumped at the idea because I've always wanted to work with sort of underserved indigent populations and also being very interested in some of the cultural manifestations of
01:46 --> 01:51how people think about illnesses and how they present with illnesses.
01:51 --> 01:54And why you see some things more than others.
01:54 --> 02:02In some countries and in some cultures and that's always been one of my interests or this fit in neatly but why I mentioned that.
02:02 --> 02:06It was happens chances you know.
02:06 --> 02:14This can happen to anyone and you know you don't necessarily have to start out being an expert refugee provider.
02:14 --> 02:18I mean, you can do this sort of any stage in your career.
02:18 --> 02:19But since I started it.
02:19 --> 02:25I've been running this clinic for at this point 10 years.
02:25 --> 02:28So I guess I also fell into it.
02:28 --> 02:39I have always been a primary care doctor and similarly had always had an interest in underserved populations.
02:39 --> 02:47I was living with my family in California walking in primary care and then when we moved back from my husband's job here at Yale.
02:47 --> 02:58I was interested in coming back into the academic world in working within a pediatric residency program to be able to do some more teaching with pediatric residents.
02:58 --> 03:02So started working at the Yale Primary Care Center for Pediatrics,
03:02 --> 03:08and through the connection between IRS in the primary care center in a similar way,
03:08 --> 03:11the pediatric refugee clinic had developed.
03:11 --> 03:17To support the health care needs of the clients of IRS and the former director of the program doctor,
03:17 --> 03:22Schumacher was leaving and I said yes and stepped into the role.
03:22 --> 03:26So it was a learning process coming through that and so the same way.
03:26 --> 03:36I didn't expect it but it has been a fabulous opportunity and a lot of learning could you maybe for the audience who might not know tell us a little
03:36 --> 03:42bit about what who are refugees and how are they different from maybe asylum seeker?
03:42 --> 03:57Seekers and migrants. So very briefly refugees are different from asylum seekers in the sense that they have already fled their area of persecution and have been registered by the
03:57 --> 04:01United Nations health commissioner for Refugees,
04:01 --> 04:08which is the UNHCR and they have then been potentially resettled in 1/3 country,
04:08 --> 04:12which is how we see them.
04:12 --> 04:24Asylum seekers have usually come to the US or any other country as a student or for a job or as a tourist and then they're seeking asylum because there
04:24 --> 04:34afraid to go back, but the basic premise behind both groups is that they are fleeing some type of persecution and Becausr.
04:34 --> 04:39They have a well founded fear of this persecution,
04:39 --> 04:42turning into serious harm for them.
04:42 --> 04:52They are qualified to be registered as refugees or asylum seekers.
04:52 --> 04:55So, just for a little bit of background for audience,
04:55 --> 04:57according to the World Health Organization.
04:57 --> 05:03There are currently about 68,000,000 people who have been forcibly displaced from their homes.
05:03 --> 05:10Historically, the US government selection invites about 70,000 to resettle and this has decreased significantly in recent years.
05:10 --> 05:12And so currently in 2019.
05:12 --> 05:16This is capped at 30,000 and it decreased again in 2020 and is now capped at 18,000,
05:16 --> 05:26So what are some of your thoughts on this and has it had any effects on your perspective as a health care provider and as an advocate of refugees.
05:26 --> 05:33Sure, um as you just said the cap has been steadily decreasing in the last 2 or 3 years,
05:33 --> 05:46but it was actually increasing prior to that where we had gone up to a total of 110,000 every year but that was before the central administration changed.
05:46 --> 05:57So we have to see how the future year goes but this is the lowest it has ever been since the US formally started a refugee resettlement program in 1980
05:57 --> 06:01as healthcare providers living in the US we of course,
06:01 --> 06:05see the people who already come here as refugees.
06:05 --> 06:16But we do know both anecdotally an from reports from other places that there are many refugees in Limbo who are waiting at camps or in other places that they
06:16 --> 06:21have fled to. Seeking medical care so from a health point of view,
06:21 --> 06:27definitely that's a barrier to them seeking health if they're not able to be resettled keep in mind,
06:27 --> 06:31though, that even when we were at our highest point of resettlement.
06:31 --> 06:36That's still a fraction like a set of the 70 million refugees in the world.
06:36 --> 06:40That's always something we should keep in the back of our mind,
06:40 --> 06:49but I think what has happened in recent years from an advocacy perspective is the USI think has lost its place as the world's leader.
06:49 --> 06:53In refugee resettlement because of the rapid decline in numbers.
06:53 --> 06:57In the past, we had the.
06:57 --> 07:08We we could probably say that we were resettling more refugees than all other countries combined and we no longer can say that.
07:08 --> 07:10So you touched a little bit about this,
07:10 --> 07:13but regardless of this decline.
07:13 --> 07:16What is providing as a health care provider?
07:16 --> 07:21What does resettlement look like from that standpoint for a refugee?
07:21 --> 07:28So resettlement is essentially offered to those refugees as a method of last resort,
07:28 --> 07:33so of all the people who have fled their countries borders,
07:33 --> 07:47which is technically necessary for a legal definition of a refugee after fleeing the first objective of the United Nations is to repatriate them to their home country.
07:47 --> 07:52If the conflict is over and if it is safe to do so.
07:52 --> 07:57If not the second option is to then integrate them into their local community.
07:57 --> 07:59For example, in recent years,
07:59 --> 08:01many Syrians have come to Jordan and Lebanon,
08:01 --> 08:07an the goal is if they cannot go back then to integrate them into the local community.
08:07 --> 08:11So resentment is really offered to people for whom neither is an option.
08:11 --> 08:21So it really applies to people who are the most persecuted or at least for whom there is most fear in staying or going back and what resettlement means is
08:21 --> 08:24then they're basically invited by this third country an?
08:24 --> 08:28Over 60 countries participate in the resettlement program,
08:28 --> 08:31though some countries take in very few refugees.
08:31 --> 08:40But what it means for the refugees than they are moved to this new host country and they are accepted as eventually permanent residents of that country and so of
08:40 --> 08:44course, along with health. There are a lot of other things that go into it.
08:44 --> 08:47Like finding them housing, helping them find jobs,
08:47 --> 08:55education, etc. So there's a lot of social things that go into a country deciding to do this and each country is different in terms of how many.
08:55 --> 08:59If it is it takes and what types of supported offers.
08:59 --> 09:11From the health standpoint what are some kind of post resettlement stresses or what is the impact on the mental health of refugee populations so I'll speak to the adults
09:11 --> 09:16on doctor Brown can then speak about the kids so there are multiple levels of migration.
09:16 --> 09:21So we traditionally have divided them into the pre migration.
09:21 --> 09:30Phase the phase of actual migration and travel which for some refugees can be 10 or 15 years in a camp but for some rich refugees it might just be
09:30 --> 09:34a year or 2. And then there's The Post Migration Phase,
09:34 --> 09:44which is when they're trying to adjust to the new country so the stressors start accumulating from the beginning of the conflict through all these faces and traditionally,
09:44 --> 09:46though we talk a lot about the trauma,
09:46 --> 09:49the experience. That's only a part of the whole stress.
09:49 --> 09:51I mean, Doctor Brown and I both see many,
09:51 --> 09:54many, many stressors related to resettlement,
09:54 --> 10:01which is be cause. You're adjusting to a host country that may be completely new that may not necessarily be the country,
10:01 --> 10:09you chose. You may be completely unfamiliar with the system in the country and with the language used in that country.
10:09 --> 10:16So I would broadly categorize the sources of stress for refugees as the prior trauma,
10:16 --> 10:21which if present can definitely exacerbate the post migration stresses,
10:21 --> 10:26but then also a huge part is the post migration stress,
10:26 --> 10:32so traditionally. We talk a lot about post traumatic stress disorder in adults,
10:32 --> 10:34but there are I think not.
10:34 --> 10:39Majority of the refugees actually don't necessarily have that as a diagnosis,
10:39 --> 10:44but they have a lot of other stressors related to these social problems,
10:44 --> 10:54including for many people starting completely from scratch with no money and completely not being able to use their prior educational level.
10:54 --> 10:59To work in this country and they have to work at basically much lower skill levels.
10:59 --> 11:05I mean, these are just a couple examples of the stresses but how it manifests is not just Pete ESD,
11:05 --> 11:11but various types of depressive anxiety disorders and sometimes it might not be a full blown disorder,
11:11 --> 11:16but just several symptoms of distress that we routinely say.
11:16 --> 11:23And I think you are unique to children can be the added stresses of learning,
11:23 --> 11:27a new culture and integrating a new culture and.
11:27 --> 11:31Being stuck a little bit between the culture of that family,
11:31 --> 11:38where they came from and their expectations of integrating and becoming a part of a new culture.
11:38 --> 11:44Some of this we see is with language acquisition that children will learn to speak.
11:44 --> 11:57The language before their parents and can get the put in the role is becoming the translator for the families in taking care of adult business interactions or interpreting interactions.
11:57 --> 12:02And putting them in a stressful relationship with their parents of still being the child,
12:02 --> 12:05but then actually having to play.
12:05 --> 12:15Some adult roles, it can also be a struggle for children as they adjust trying to assimilate into the new American culture and then also having the expectations at home
12:15 --> 12:27of continuing the roles of the culture from kind of the cultural and their family norms from their country of origin and especially as our children go through adolescence there
12:27 --> 12:31can be. Simple and difficulties with that and then for children.
12:31 --> 12:39It's assimilation into a new school getting the support that they need for English as a second language.
12:39 --> 12:52Uh a lot of our children have come with interruptions with their schooling and so also some of the pre resettlement stresses may have affected that developmental levels.
12:52 --> 13:02And so needing to have extra supports at school and then some of the underlying discrimination or bias or bullying at the school can also be.
13:02 --> 13:05The potential source of added stresses.
13:05 --> 13:16I also point out that there's a lot of these families will be very isolated here and that can be a stress an also they will have many times.
13:16 --> 13:28Family members that they're worried about who may still be in the country in origin or their country of Displacement and so there can be a lot of worries for
13:28 --> 13:34these families about their family members who are still in areas of danger.
13:34 --> 13:42Or have been resettled in different countries around the world and kind of some of the support systems for these children aren't actually hear directly with them,
13:42 --> 13:46but there are scattered around around the globe.
13:46 --> 13:56So I can imagine that with all these stressors from a mental health standpoint of physical health standpoint and a social standpoint refugees face unique stressors.
13:56 --> 14:06Once they migrate? What sort of resources are in place in order to help mitigate some of these challenges in terms of organizations and community organizations.
14:06 --> 14:15Government organizations translators, even what are some of the most commonly utilized resources for mitigating these challenges?
14:15 --> 14:20I think community resources can really kind of show some of the differences.
14:20 --> 14:31When we were talking about the definition of refugee and how we apply that for our patients who come through the refugee clinic have been designated in given refugee status.
14:31 --> 14:43They come to the United States with a connection to a local resettlement agency they come with the support of getting medical medical insurance for adults 8 months for children
14:43 --> 14:45in Connecticut, they get to have.
14:45 --> 14:50Husky insurance and so they have some support systems.
14:50 --> 15:02This can be very different for children who are in families were coming in as immigrants or asylum seekers who have not been given the?
15:02 --> 15:12I guess the have not got their support of being an asylum seeker yet and they will not have the same type of support systems as our families that are
15:12 --> 15:16coming through the refugee resettlement program.
15:16 --> 15:20If you are coming through the refugee resettlement program.
15:20 --> 15:27The families are connected with the refugee resettlement agency and coming into our refugee clinic.
15:27 --> 15:32It tends to be multidisciplinary clinic and So what that means is through.
15:32 --> 15:37Iris which is integrated refugee and Immigration Services are local.
15:37 --> 15:43New Haven resettlement agency they will come with a connection through a health care coordinator,
15:43 --> 15:50who will help them with setting up their first appointments in some of the health literacy.
15:50 --> 15:54Education learning than you healthcare system within our clinic.
15:54 --> 16:05We have designated pediatric providers who will see the patients designated nurses who will help with our families and also really help with the health literacy.
16:05 --> 16:18We have connection with the Yale Child Study Center to have a pediatric psychiatrist see the patients and we also have connection with a neuropsychologist who can help do some
16:18 --> 16:23evaluations with children that we worried about so it really is.
16:23 --> 16:29As I said a multidisciplinary team to be able to help support these families.
16:29 --> 16:34If for families that we see in clinic who.
16:34 --> 16:37Similar fleeing from a refugee situation,
16:37 --> 16:41but do not come into our clinic with refugee status.
16:41 --> 16:47It is harder to find some of the community supports but within within the New Haven area.
16:47 --> 16:54There's different different community supports into different programs and also within our clinic.
16:54 --> 17:02We have support from amazing social worker in case managers to help support these families.
17:02 --> 17:04So I just want to add 2.
17:04 --> 17:07Watt, doctor, Brown summarize very well.
17:07 --> 17:10The healthcare part of the payment.
17:10 --> 17:16Excuse me for the health care comes from a federally funded source like doctor,
17:16 --> 17:20Brown said. When they come as part of the resettlement program.
17:20 --> 17:29They do get some sort of medical assistance for the first eight months of their stay in this country and in most states.
17:29 --> 17:33It takes the form of the local Medicaid.
17:33 --> 17:38So that is at least one source of care which asylum seekers do not have as doctor.
17:38 --> 17:49Brown mentioned and I also wanna say that even though the refugee resettlement program is federally funded the money for refugees actually very small.
17:49 --> 17:52The idea is in the spirit of what this country,
17:52 --> 17:57usually stands for that. The refugees would become independent very quickly.
17:57 --> 18:05Unfortunately, that's not reality and that's why sometimes the success of resettlement depends heavily on the.
18:05 --> 18:08Local agency and our local agency that doctor,
18:08 --> 18:22Brown mentioned iris has been quite successful and entrepreneurial in finding different agencies and funding sources an so they're able to support the refugees much more than many other result
18:22 --> 18:24meant agencies across the country.
18:24 --> 18:30But the point also sort of I wanted to emphasize from what both of us are saying is.
18:30 --> 18:36You know a lot of it is really like social services,
18:36 --> 18:41even for health that we really need an some of it.
18:41 --> 18:45You know, we can do with the federal assistance.
18:45 --> 18:46But a lot of it.
18:46 --> 18:50We need outside support. So just going off of that?
18:50 --> 19:00How are you able to ensure that these social services or even the health care that is provided is culturally appropriate and also.
19:00 --> 19:11Is there a good reception towards the health care that is being provided in the states for people that are coming from other cultures and other countries.
19:11 --> 19:16So I think uh it depends again heavily on where the result meant occurs.
19:16 --> 19:21I think we're fairly lucky to be living in Connecticut and New Haven,
19:21 --> 19:33which in many ways, is quite receptive to immigrants and refugees compared to many other parts of the country in terms of providing culturally appropriate care again from a health
19:33 --> 19:38perspective. I mean that often need some additional training.
19:38 --> 19:47Which is why doctor Brown and Ivy train residents and students in the clinic to learn this as their training and you know,
19:47 --> 19:53we could do more development of Physicians and other faculty attendings to make this happen,
19:53 --> 20:01but cultural appropriateness is something that is becoming a bigger part of Madison even outside of refugee care.
20:01 --> 20:06So I think people are a little bit more sensitive to that.
20:06 --> 20:15Uh the Biggest practical barrier that we find is just finding interpreter resources because to be truly culturally appropriate.
20:15 --> 20:24You have to be able to communicate effectively with the person sitting across from you and interpreter services are not.
20:24 --> 20:29Unfortunately something that's particularly well funded legally in this country.
20:29 --> 20:33If you receive any federal assistance in your programs.
20:33 --> 20:36You are required to provide language services,
20:36 --> 20:39but when that's translated into practical.
20:39 --> 20:45Utilitarian terms, it means that the clinics cannot turn somebody away because of language reasons,
20:45 --> 20:53but they're not necessarily giving the providers and extra time with the interpreter or even providing necessary.
20:53 --> 21:05A good qualified interpreter. It may just be some minimal interpreting service to fulfill requirements and in general in my experience I've found that nobody is says they don't want
21:05 --> 21:09to care for Refugees. But I think most people mean well and want to do it.
21:09 --> 21:14But again, it's hard for them to pay out of pocket for an interpreter service.
21:14 --> 21:18If there are private agency or even if there are public agency you know,
21:18 --> 21:28finding that extra time to accommodate people when there is already so much scarcity and need for health in the population of New Haven outside of the refugees.
21:28 --> 21:30Could you guys give some examples of?
21:30 --> 21:34What culturally appropriate care looks like maybe from your own experience?
21:34 --> 21:41What do you try to emphasize when you train residents and and like future physicians in working with refugee populations.
21:43 --> 21:50One of the practical things of which I alluded to earlier is how to use interpreters effectively.
21:50 --> 21:55I mean that in itself is a skill if you've never done that before.
21:55 --> 22:06Sort of knowing very practical things like you're still talking to the patient and not the interpreter and you're talking directly to the patient use using first person terms and
22:06 --> 22:08not for example, telling the interpreter.
22:08 --> 22:17Can you tell the patient there's no you're telling the patient XYZ and the interpreter is just interpreting that so very simple things like that,
22:17 --> 22:18if you haven't done it.
22:18 --> 22:21You may not know so we train them to do that.
22:21 --> 22:25And there are other parts of interpreting that's part of the training.
22:25 --> 22:27And then also you know,
22:27 --> 22:36we teach trainees that communication styles are very different in different countries and ethnic backgrounds.
22:36 --> 22:46And you cannot be culturally quote Unquote competent in everything because we see people from so many different parts of the world.
22:46 --> 22:55It's more being culturally sensitive and be open and attuned to responding to their needs for example.
22:55 --> 23:04You know, we see many people from Afghanistan recently we've been seeing a lot of them and there is again you can never generalize but frequently we find that the
23:04 --> 23:09female at least the adult females frequently prefer you know female providers.
23:09 --> 23:19We can't always accommodate that but we try to and their way of greeting often we don't necessarily handshake with them because that's also an alien concept to them and
23:19 --> 23:21sometimes depending on the person again.
23:21 --> 23:25It's very variable even within a country and within a background but.
23:25 --> 23:35Sometimes they don't even make eye contact so you just have to be aware that those things might happen and because they don't make eye contact doesn't mean that the
23:35 --> 23:40depressed or hostile but that's just how they communicate with the world.
23:40 --> 23:44Those are just a couple examples an one other thing that comes up.
23:44 --> 23:50With adults is preventive care in terms of a lot of immunizations and cancers doctor.
23:50 --> 23:52Brown can speak to the kids better,
23:52 --> 23:55but I think for in some ways,
23:55 --> 24:00the kids many things are mandated an it may be easier to convince parents.
24:00 --> 24:07But for the adults. They often don't necessarily there very new to the idea of getting health care.
24:07 --> 24:14When they're not actually sick so that's something also we try to tell trainees to effectively communicate.
24:14 --> 24:17That doesn't mean we're going to refuse care.
24:17 --> 24:20BIH cause they don't want certain things,
24:20 --> 24:25but just remembering that they view healthcare very differently.
24:25 --> 24:30I absolutely agree with doctor Anna Molly I.
24:30 --> 24:36I look at it up with the with the trainees a little bit about kind of learning learning.
24:36 --> 24:38The culture, the whole time,
24:38 --> 24:42so we never as she said were never experts as doctor,
24:42 --> 24:45Emily I said, and really cultural humility,
24:45 --> 24:49so part of it is that we are learning the whole time,
24:49 --> 24:53we do see families and populations from across the Globe in.
24:53 --> 24:58I think you can as you see more and more families from a different culture,
24:58 --> 25:01you will learn more about their culture.
25:01 --> 25:10But I also think it's really important to understand that every individual every family is unique every families traditions and norms are different,
25:10 --> 25:14and their kind of their interpretation of their cultural values can be different,
25:14 --> 25:24too, so never going in my training is never going in thinking that you know what they're thinking and what the expectations are is really trying to listen to the
25:24 --> 25:26family and finding out from the family.
25:26 --> 25:30Having worked with amazing interpreters,
25:30 --> 25:40some of our in person interpreters through through Yale Hospital has really given me and my trainees and understanding of Watt,
25:40 --> 25:52a good interpreter is like and I think that then gives us the ability to excuse me understand when we have poor interpreting going on and helping us actually either
25:52 --> 25:57kind of change to a different interpreter or being able to.
25:57 --> 26:03Help lead an interpreter to help us interpret better.
26:03 --> 26:15I think things we can run into in different different cultures is the words that were using as doctors is some of the lingo we use cannot be translated.
26:15 --> 26:26Correctly, or interpreted correctly. I think it teaches us to really learn what we're saying on what we're trying to say to be able to use less words.
26:26 --> 26:36An more basic words and so we become more descriptive and what we're trying to say rather than just throwing out a diagnosis.
26:36 --> 26:43So it actually makes us become better communicators learning how to work with with an interpreter.
26:43 --> 26:46Uh depending on on the cultural norms.
26:46 --> 26:57I once again agree a lot with kind of gender roles and understanding that and we also try if we can have similar genders between providers and patients,
26:57 --> 27:00but that often is is very difficult.
27:00 --> 27:07It's we can't we can't change around schedules to always be able to comply with that.
27:07 --> 27:14But I think his understanding that and being able to work with the patient to make them feel as.
27:14 --> 27:17The most comfortable and I also think is you know,
27:17 --> 27:24we should be curious is finding out a little bit about the expectations that the families have?
27:24 --> 27:28What that understanding is a lot of it is a lot of.
27:28 --> 27:30To be education for ourselves as providers,
27:30 --> 27:32but also we do a lot of Health,
27:32 --> 27:42Education, for our families. It's a brand new healthcare system that they are navigating an it is really our role to continue to educate and repeat things and help them
27:42 --> 27:47with their learning so they can be actually successful within the healthcare system.
27:47 --> 27:52And so we definitely become educators as well as providers.
27:52 --> 27:56Doctor anomaly you talked about how in adult populations.
27:56 --> 27:58You see that there's in some cultures.
27:58 --> 28:09You don't go to the doctor unless you're sick or you see something that's evident in terms of mental health and we covered some of the mental health challenges that
28:09 --> 28:15are evident and this is very common in many communities not just refugee populations.
28:15 --> 28:23It's not really considered a disease or something you seek help for specifically for refugee adults do you see this?
28:23 --> 28:32A similar situation how do you kind of educate them that this is or maybe a serious problem and how they can find help and get services for that.
28:32 --> 28:37So I get asked that question and different people call it different things.
28:37 --> 28:40And it's often couched under stigma and whether you know,
28:40 --> 28:44people from other countries have more stigma than what we see here.
28:44 --> 28:48And in my experience I mean that's definitely true.
28:48 --> 28:55I think they're more reluctant to call something like a mental health thing or a mental health disorder.
28:55 --> 28:57But on the other hand,
28:57 --> 29:06I think some of it is actually sort of a matter of Semantics and really what you call it so when I talk to people and that applies sometimes to
29:06 --> 29:11people here, too, depending on their background and their general approach to health.
29:11 --> 29:21I will say something like you know it seems like you're really struggling to cope with some of the things that you've gone through or it seems like after we
29:21 --> 29:29moved here sleep has been a big issue for you and then I would sort of plan the treatment around that I would not necessarily say,
29:29 --> 29:38Oh, by the way. Do you have PT SD or you have depression I might say something like we see a lot of people in your similar situation who go
29:38 --> 29:43through similar things but I wouldn't necessarily give it a name in that way.
29:43 --> 29:52But. In spite of that some refugees are extremely sensitive to this and because I practice both a primary care and psychiatry.
29:52 --> 29:54I definitely I had one patient.
29:54 --> 29:59I remember who was seeing me as a primary care provider in the clinic,
29:59 --> 30:03which is why he was even willing to come in the 1st place.
30:03 --> 30:09But he was extremely resistant to answering anything I was asking about his emotional state.
30:09 --> 30:17And he would not have even come to see me if I had seen him as part of a psychiatry visit so we do have extremes like that,
30:17 --> 30:25but we also have people who may have had significant mental health problems before they came even low levels of psychosis are low mode,
30:25 --> 30:33which was significant enough that they were in treatment before and they are actually quite open because I've already experienced it.
30:33 --> 30:41They've already gotten some sort of treatment and they're OK with that and then there's sort of a large group of people in between who.
30:41 --> 30:43Are OK about talking about their stress?
30:43 --> 30:47I mean stress? Is a very loosely commonly used word?
30:47 --> 30:55Which works well in a lot of situations and they may be very acknowledging of the fact that they do have stress and that they need help.
30:55 --> 31:04They don't necessarily want to call it mental health or want to take psychotropic medications but they're willing to talk to you and receive some sort of help.
31:04 --> 31:09So you negotiate with them as to what might work and what they're willing for but.
31:09 --> 31:16In my Personal opinion stigma as we see it as less of a problem than really access to Resources,
31:16 --> 31:21which is more of a problem when it comes to treating them.
31:21 --> 31:33And do you see something similar in working with children especially kind of communicating that there might be some underlying mental health disorders in the children with the parents of
31:33 --> 31:35the children as well doctor.
31:35 --> 31:38Brown absolutely and I think children.
31:38 --> 31:42We also then have to see see them in the context of the whole family.
31:42 --> 31:49So parental mental health is also very important to children's mental health well being and development.
31:49 --> 32:04We know that there's a high prevalence of mental health developmental issues with children who come to us as refugees and it can be complicated with children because.
32:04 --> 32:16It's hard to tease out whether this is just an acute adjustments situation whether it's more of a chronic disorder whether it's a developmental or in English as a second
32:16 --> 32:27language issue with with kind of their behaviors whether this is due to a delay in development or whether it is a behavioral issue because of maybe some mental health
32:27 --> 32:29or some well being so.
32:29 --> 32:40We often have to try to tease out a little bit about what is causing these behaviors but very similarly.
32:40 --> 32:43Kind of talking about stress and adjustment,
32:43 --> 32:50sometimes will use anxiety, but how the body responds to the stress in children.
32:50 --> 32:58We can see some summarisation where will have children coming in with chronic abdominal pain or headaches,
32:58 --> 33:11or sleep problems tend to be common and trying to workout medical versus this is more of a behavioral manifestation of behavioral or mental health disorder.
33:11 --> 33:17And so we talk a lot about stress and stress affect on the bodies.
33:17 --> 33:23I also think it depends a little bit on what type of timing in the resettlement process.
33:23 --> 33:32The beginning is a huge time of adjustments and that can cause a lot of disruption to to kind of behavior and well being of children.
33:32 --> 33:41So we spend a lot of time at the beginning really trying to support the families within the resettlement so safe housing financial security,
33:41 --> 33:47helping them making sure that they feel comfortable that they're sleeping they eating well,
33:47 --> 33:53getting kids. Into into school trying to get the family connected within the community.
33:53 --> 34:06The kids connected and so we may not be initially jumping down the road to what we would think of about as treatment for a mental health or behavioral health
34:06 --> 34:18disorder as therapy. Instead, it's really trying to work on successful resettlement because a lot of times as the resettlement continues the families.
34:18 --> 34:24Become more financially stable and the stress goes down within the whole family.
34:24 --> 34:31Some sometimes we can see that all the behavior mental health concerns improve.
34:31 --> 34:36So you mentioned previously that mental health stressors could manifest us physical symptoms.
34:36 --> 34:43Are there ways that mental and physical health treatment are integrated at the clinic and what does that sort of look like?
34:43 --> 34:47Um so I'm being a little facetious when I say this.
34:47 --> 34:54But I'm trained both the subprime Medicare darken it psychiatrist so I'm kind of an integrated provider.
34:54 --> 34:58Uhm but that's not a sustainable model because you know,
34:58 --> 35:04there's only so many people that are actually trained in these 2 different disciplines,
35:04 --> 35:08So what we do try to do in clinic is we do have primary care.
35:08 --> 35:18Residents who come and see the patients to the initial health assessments and then follow them longitudinally overtime.
35:18 --> 35:20But then we also have a psychiatry.
35:20 --> 35:22Fellows are residents in training.
35:22 --> 35:25Sometimes, who are in the clinic at the same time,
35:25 --> 35:36and who are basically sort of consulting with the primary care residents when there's a potential issue that comes up that the primary care restaurant does not know what to
35:36 --> 35:42do with and then the psychiatry training is there to like talk through it with them and then see if any,
35:42 --> 35:48additional assessments are needed, and then also to see potentially where they need to be.
35:48 --> 35:54Triaged out too, and where they could go for lanja tude inal care if they do need such care.
35:54 --> 36:01Um in doctor, Brown can in a minute speak to what they do in the pediatric clinic.
36:01 --> 36:06But oftentimes as I was saying earlier in terms of access to resources.
36:06 --> 36:09We don't always have the capacity.
36:09 --> 36:16But we have enough training is interested that we managed to have some sort of combined.
36:16 --> 36:20Method of assessment and treatment planning in the clinic in general.
36:20 --> 36:23I don't think in the refugee literature,
36:23 --> 36:26an in other clinics across the country.
36:26 --> 36:30People have necessarily tried to make this an integrated model.
36:30 --> 36:37But there is clear recognition that there is a need to integrate mental health better into primary care services,
36:37 --> 36:42especially for refugees even though that's true for the general population as well,
36:42 --> 36:45and people are really trying to work on that,
36:45 --> 36:47but I don't think there's any like.
36:47 --> 36:52Established models per say that you know,
36:52 --> 36:58we could portray and find consistent funding for.
36:58 --> 37:01I think in regards to children,
37:01 --> 37:16especially school, aged children. We need more resources within the schooling system to be able to bring some more mental health resources within actually the schooling system.
37:16 --> 37:21And to give them the supports where they're spending a majority majority of their day.
37:21 --> 37:32Ultimately, they to be able to have social workers or trained mental health providers within the schools would be fantastic.
37:32 --> 37:37We run into problems with interpretation within schools.
37:37 --> 37:40So it may be that children.
37:40 --> 37:47Once they have strong enough or acquired enough English will start expressing some.
37:47 --> 37:57You know, kind of some thoughts or some feelings or some memories and experiences that will be picked up at school and then they will be able to access the
37:57 --> 38:01mental health resources or the behavioral health resources at school.
38:01 --> 38:06However, at the beginning. The access to appropriate interpreting services.
38:06 --> 38:13Not there within the school Department so that is definitely an area of high need for all of our children.
38:13 --> 38:16Coming here with English as a second language,
38:16 --> 38:19who've had having adjustment or having had passed.
38:19 --> 38:23Traumatic experiences with in our clinic.
38:23 --> 38:30I think for children taking care of that development and well being is very important.
38:30 --> 38:44So we will try to talk a lot about healthy nutrition and exercise and sleep and routines and another part that we struggle struggle with with in more isolated and
38:44 --> 38:49displaced populations is some of the parent child dynamics.
38:49 --> 38:53Things that we would kind of define as discipline.
38:53 --> 38:55Indiana Pediatrics that a lot of times.
38:55 --> 39:07These families had been separated from that their sources of support and a lot of times parenting skills will be learned from their family members from their mother in laws
39:07 --> 39:19or their mothers and these families have been displaced away from these areas of Education and support and so another thing we struggle with is is parental education,
39:19 --> 39:24especially for. Children under under under school age.
39:24 --> 39:28I'm trying to integrate that a little bit into our clinic,
39:28 --> 39:35but timing is we do not have enough time to do all of this with in our clinic and so we have short short appointment times.
39:35 --> 39:42And so being able to integrate kind of Education and therapy into our clinic is Unfortunately we do as much as we can,
39:42 --> 39:44but not possible right now,
39:44 --> 39:50so that's really relying as best as we can about community with community resources.
39:50 --> 40:00And are you are do you see that in terms of lanja tude inal care that people that need it or actually coming back and like getting more comfortable with
40:00 --> 40:03the system and seeking more lanja tude inal.
40:03 --> 40:09Karen like continuity of care and things like that.
40:09 --> 40:11I think it's a process it is.
40:11 --> 40:15It is very new as doctor automatically.
40:15 --> 40:21I had mentioned before is accessing health when your health or health care.
40:21 --> 40:35When you're healthy is often a very novel experience for our families and so the understanding that we actually see you back on a routine basis is very is very
40:35 --> 40:41new and so it will take time to educate them on this and also when families.
40:41 --> 40:43Do not show up for appointments.
40:43 --> 40:53It's our job, then to reschedule and to bring them bring them back in so I think having a lot more oversight on their care.
40:53 --> 40:58You know with children we do have we do have immunizations that are required.
40:58 --> 41:00So we have set set touch points.
41:00 --> 41:09When we are seeing them in the clinic to be able to give them that immunizations and be able to do reminders about that and then at the same time,
41:09 --> 41:14we're doing a complete evaluation looking at their development and their their adjustments.
41:14 --> 41:24But having an appointment that is scheduled 3 months ahead of time or 6 months ahead of time is very unusual for these families and so I think clinics that
41:24 --> 41:35are following these families need to workout a system to be able to remind these families or just being able to help support bringing them bringing them back in.
41:35 --> 41:382. If they if they don't show up for for their visits.
41:40 --> 41:42I think what adults do I mean,
41:42 --> 41:45it's a process doctor, Brown said.
41:45 --> 41:52Overtime I mean, once the acute stressors of resettlement calm down like maybe they find a job.
41:52 --> 41:56Even if it's not to their full potential at least,
41:56 --> 42:00there able to financially sustain their families or you know kids.
42:00 --> 42:03Of course, school would be an issue,
42:03 --> 42:08but regardless of what the resettlement is once they?
42:08 --> 42:11Settle down and learn the system.
42:11 --> 42:19Little bit they are little bit more willing to think about their health and more willing to come for appointments.
42:19 --> 42:22An you know talk about some of the health issues.
42:22 --> 42:26We want to discuss with them and also in general.
42:26 --> 42:31We know that overall mental distress does reduce overtime over a period of years.
42:31 --> 42:37It's not just over a period of days to weeks and that also helps in them,
42:37 --> 42:41taking a different approach to their health and not necessarily think.
42:41 --> 42:46Looking at everything through the lens of their internal distress.
42:46 --> 42:50So I guess sort of the summary answer to what you're asking is I mean,
42:50 --> 42:56I think overtime. It does improve as they integrate more and more into the system.
42:56 --> 43:04And you'd mentioned previously that the government provides resources for refugees to access health care in the first eight months that they're here,
43:04 --> 43:08but what does access to healthcare following those 8 months look like?
43:08 --> 43:15Uhm it's variable the idea is that they become financially independent and pay for their own health care,
43:15 --> 43:17which absolutely does not happen.
43:17 --> 43:24It very, very rare cases that refugees find jobs that actually then they get employed sponsored insurance.
43:24 --> 43:29Some of them go through the Affordable Care Act Marketplace.
43:29 --> 43:43The resolve and agency staff workers help them navigate that and actually get healthcare as somebody who has no income and who is not getting any insurance and also Connecticut
43:43 --> 43:50at least. Compared to other states is actually quite generous in who it gives its Medicaid benefits too.
43:50 --> 43:53So a lot of the refugees who come with children.
43:53 --> 43:56The parents also as long as they have dependent children.
43:56 --> 44:05The adults also continued to receive the Medicaid benefits and that's a little bit unfair for the refugees that come without children.
44:05 --> 44:14But a large number of refugees do come with families and so they end up having that insurance for much longer while their kids are growing up.
44:14 --> 44:18So those are probably the major outcomes and then also the local hospital,
44:18 --> 44:22which is yellow, even health does have a free care program.
44:22 --> 44:24That's not geared for Refugees.
44:24 --> 44:28That's for any indigent person who does not qualify for Medicaid,
44:28 --> 44:38but at the same time cannot pay for their own health care and some of the refugees are older refugees who didn't have dependent children have signed up for the
44:38 --> 44:40free care program.
44:40 --> 44:43And in terms of social services?
44:43 --> 44:47What is access to those look like after 8 months.
44:47 --> 44:51Or I guess as as the refugees stay here for longer and longer.
44:51 --> 44:54Um so a lot of the social services.
44:54 --> 44:59I think are awful like often excuse me like doctor,
44:59 --> 45:04Brown said community based an volunteer anyway.
45:04 --> 45:10An actually uhm doctor, Brown can speak to the resources available for Kids,
45:10 --> 45:13a little bit more because in general like clinics.
45:13 --> 45:23Pediatric clinics are better staffed with social work assistance and adult clinics are not so we actually don't get a lot of help.
45:23 --> 45:28Even initially we the Medicaid pays for the direct health services.
45:28 --> 45:33But for a lot of the other stuff that even stuff like you know,
45:33 --> 45:42maybe transportation or. Transportation actually is a little bit different in this state Medicaid recipients do get some assistance.
45:42 --> 45:49But a lot of the other social services that are people need to access like housing services or legal services.
45:49 --> 45:57There's not a lot. Even in the beginning and we basically go to people who do this as a volunteer effort or pro bono.
45:57 --> 45:59And we sort of keep doing that,
45:59 --> 46:08after the initial phase of resentment is over and likely mention earlier eras has some intensive case management services in the beginning,
46:08 --> 46:11but they're also not able to continue that indefinitely.
46:11 --> 46:15An Unfortunately we do lose a lot of those services overtime.
46:15 --> 46:21Many refugees are at least integrated enough that they're able to take on some of that themselves.
46:21 --> 46:28But some do not, and then it's just various combination combination and a mixture of volunteer effort.
46:28 --> 46:37And there are features becoming more independent and some refugees not receiving the optimal services that they need.
46:37 --> 46:47Thanks specifically for children they are able to get on the Connecticut specific Medicaid Husky insurance through the age of 18.
46:47 --> 46:52So we do not have the children losing their insurance after 8 months.
46:52 --> 46:54They're eligible for the WIC Services,
46:54 --> 47:00which is the supplemental nutrition services from birth through age 5.
47:00 --> 47:10And then after that through the school there eligible for schooling and free lunch at the schooling or at their schools.
47:10 --> 47:18We try to support the families as much as possible to utilize different community resources,
47:18 --> 47:21so accessing food banks, however,
47:21 --> 47:26talking a little bit about cultural sensitivity is trying to find.
47:26 --> 47:32You know feedback they're going to supply the type of foods that they will they will be using in that cooking?
47:32 --> 47:36There are some there's a diaper bank.
47:36 --> 47:38Some supports for for diapers,
47:38 --> 47:44which are very, very expensive for you know for all families to be able to buy.
47:44 --> 47:47And a lot of a lot of these services.
47:47 --> 47:56The case manager through iris will help them to get in contact with these services and then a lot of times.
47:56 --> 48:07We step in after the support from iris has started to decrease to help once again have the families become more self sufficient to be able to know how to
48:07 --> 48:17use these services services on these on their own and be able to how to apply or or get the services.
48:17 --> 48:24So one thing that I think is kind of clear from everything you've shared is that we need more volunteers.
48:24 --> 48:28Social services an funding to support refugee populations,
48:28 --> 48:35so could you speak a little bit about what some current efforts are in refugee advocacy and in your opinion?
48:35 --> 48:41What do you think is really important to prioritize in terms of advocacy?
48:41 --> 48:49I think one of the advocacy efforts that I see more of lately and just because of.
48:49 --> 48:58Sort of changes politically as people have been arguing for bringing more refugees an and you know have been advocating at that level.
48:58 --> 49:02Uhm I think more locally you know doctor Brown eyes.
49:02 --> 49:04Sort of almost advocate every day.
49:04 --> 49:08Even if it doesn't come under the umbrella of advocacy.
49:08 --> 49:20I mean, we're often like talking to the head of the interpreter service at the hospital like pleading for more in person interpreted time or continuing the interpreter time that
49:20 --> 49:24we do have which sometimes at risk of being cutoff.
49:24 --> 49:29I mean that's sort of an advocacy in itself and at one point we try to.
49:29 --> 49:41Contact actually one of mice medical students in the clinic try to contact sort of other local corporations who might be willing to pay just for interpreted time for those
49:41 --> 49:45providers in the community who are willing to see patients.
49:45 --> 49:48But just don't have the interpreter services.
49:48 --> 49:50There's sort of nothing came of it,
49:50 --> 49:55but that was something we tried for to make happen a little while.
49:55 --> 50:06And then you know, we're often times we like talking to pharmacists trying to advocate for having a language interpreter in the pharmacy and actually legally.
50:06 --> 50:13They are required to but many pharmacies do not follow that so we have some friendly pharmacies that we use,
50:13 --> 50:19but and we try to interface with the pharmacist in our hospital who are interested.
50:19 --> 50:22A little bit and refugee Karen through them.
50:22 --> 50:26We try to get more volunteer pharmacy trainees to our clinics,
50:26 --> 50:28too. Help educate the refugees,
50:28 --> 50:38but we still have to then work with external pharmacies who are not part of our health system who may not be providing the services that need in the language.
50:38 --> 50:42They need so that's something we sort of do on a continual basis.
50:42 --> 50:48Uhm and then there are other.
50:48 --> 50:52You know community advocacy efforts.
50:52 --> 50:58Doctor Brown can probably talk a little bit about the what we call the sanctuary kitchen.
50:58 --> 51:02That's a local program. You know by community volunteers,
51:02 --> 51:04but I'll just mention that some clinicians.
51:04 --> 51:07In addition to provide clinical service.
51:07 --> 51:15Also like sort of right in the media and in the public domain just talking about personal experience treating refugees and how.
51:15 --> 51:19You know, we sort of need to be having more services.
51:19 --> 51:24That's another way, sometimes clinicians also advocate.
51:24 --> 51:34I agree I think one thing we do from our clinic is is going to be advocacy for our families within the schooling Department getting the supports the learning supports
51:34 --> 51:39that our children who are in the refugee families are getting at schools,
51:39 --> 51:41reaching out to the schools,
51:41 --> 51:53being present at their individual education plans or trying to get them educational plans through the through the schooling and that can that often needs more support than just families
51:53 --> 51:59who don't speak English. Being able to work with the schools and educating families that they are able.
51:59 --> 52:01To meet with the schools,
52:01 --> 52:06so I think there's a lot of outreach that we will do with the schools.
52:06 --> 52:11Once again, I think kind of working with the you know,
52:11 --> 52:20kind of local government national government with adequacy about about supporting bringing in all immigrants,
52:20 --> 52:31including refugees asylum seekers and kind of our undocumented children crossing the border and coming up to America as well.
52:31 --> 52:37So it's the advocacy really spreads out to all type of immigrants coming too.
52:37 --> 52:40To America and I really think you know,
52:40 --> 52:42kind of building up you know,
52:42 --> 52:50some of the OR trying to Educate the public and everyone around us,
52:50 --> 52:55either by. Just the work that we do,
52:55 --> 53:08or or writing about. The positive stories and how amazing all of our immigrants are that they're not a danger to society that they actually become productive.
53:08 --> 53:13Members of society and so really helping to to promote promote.
53:13 --> 53:21Keeping our doors open and in America and actually being a welcoming a welcoming community for refugees.
53:21 --> 53:22Yeah, so within our audience.
53:22 --> 53:31We have both future clinicians as well as basic scientists and what you guys have said is certainly relevant to other people who are working within healthcare in outside of
53:31 --> 53:41healthcare, but do you have any advice for students who are looking specifically to pursue serve your line of work and to work to help alleviate some of these disparities
53:41 --> 53:46that we see between refugee populations and people who were born here.
53:46 --> 53:54I think there's sort of multiple levels sort of building off on what we said about advocacy like you know,
53:54 --> 54:01I mean, you the students and future leaders of society can do this at multiple levels.
54:01 --> 54:04I mean, I briefly mentioned sanctuary kitchen,
54:04 --> 54:14which is basically a group of committee members who are helping refugees you know have their own kitchen and catering service,
54:14 --> 54:17which is you know in some sense empowerment,
54:17 --> 54:29but also advocacy so. Just community member you don't need any special training for this you're basically build bringing together a group of these people and helping them find employment
54:29 --> 54:31and you know the legal services.
54:31 --> 54:35One thing I mean, depending on what training the student isn't now.
54:35 --> 54:38You may or may not be going into the legal line.
54:38 --> 54:45But that's where all so you can really like help not just bring more people in but try to buy changing policy,
54:45 --> 54:49have more resources available that's an important area.
54:49 --> 54:51If you're a health care provider again,
54:51 --> 54:56you know you could depending on where you live which part of the country.
54:56 --> 55:02You're going to be in you could volunteer services to local organizations if your entrepreneurial and you have.
55:02 --> 55:05You know organization building skills.
55:05 --> 55:08You could build your own clinic for Refugees.
55:08 --> 55:18You know we have student run free clinics here and you could have student run free clinics for refugees to that requires a different type of skill set but depending
55:18 --> 55:21on sort of your inclination you could do that,
55:21 --> 55:25too. For those who are currently sort of undergraduates or graduate students.
55:25 --> 55:28We get a lot of requests for volunteers.
55:28 --> 55:33It's sometimes difficult to know how to place them within a healthcare setting because.
55:33 --> 55:43As has been obvious I think in the last hour like we need a lot of external service is not necessarily the direct health care services so anything you can
55:43 --> 55:49do to you know, maybe bring more interpreter services together or organize other events for refugees.
55:49 --> 55:55I know the undergraduate school has some programs to help refugees and I believe a group of them,
55:55 --> 55:59actually do some one on one tutoring for refugee children in school,
55:59 --> 56:00you know that's another thing.
56:00 --> 56:03If you're still a student that you could do.
56:03 --> 56:07I've even had high school students asking to volunteer and?
56:07 --> 56:10I've sort of told them You know more to do.
56:10 --> 56:13Maybe in the fund raising range.
56:13 --> 56:15You know that sort of level of skill,
56:15 --> 56:20and age. Maybe that's where you could really contribute more.
56:20 --> 56:34So I think there's many different ways to help this population and it can range from just individual like community volunteering to like advocating at the government level there's a
56:34 --> 56:35wide range.
56:38 --> 56:45Doctor Brown would you like to add to that I think that really encompassed in most most things I think you know,
56:45 --> 56:49kind of volunteering without within the community.
56:49 --> 56:53Specifically, for children's summer programs for children.
56:53 --> 56:58We I know that the IRS are local resettlement agency will have a summer program.
56:58 --> 57:02It's important that the children continue with their.
57:02 --> 57:17English, as a second language education and also getting involved in community activities is really beneficial for the adjustment in the resettlement process so organizing and working with soccer teams.
57:17 --> 57:20I think the I think the tutoring is very,
57:20 --> 57:26very important both for the adult an for end for the young adults and children.
57:26 --> 57:32And so there's there's many options within within the community.
57:34 --> 57:38With that, um it's about time to wrap up I'd like to think doctor,
57:38 --> 57:44Brown and doctor Annamalai once again for taking your time to come speak with us and sharing your experience and knowledge.
57:44 --> 57:49I can definitely say I learned a lot from this one conversation an to the audience.
57:49 --> 57:54Thank you for tuning into this episode of the Yale Journal of biology and medicine podcast.
57:54 --> 57:59Thank you to the Yale School of Medicine for being a home for YJBM and the podcast.
57:59 --> 58:08Thank you to the Yale Broadcast Center for helping with recording editing and publishing our podcast into the YJBM editorial board for supporting this.
58:08 --> 58:10Effort the editors in chief of YJBM
58:10 --> 58:19Amelia Hallworth, and Devon Wasche and the podcast coordinator of our DPM is Kelsey Gazelle For more information on YJBM podcasts.
58:19 --> 58:22Please visit our website, medicine.yale.edu backslash
58:22 --> 58:31YJBM be sure to check out our Journal by searching Yale Journal of biology and medicine at pubmed.com you can also contact us by email at YJBM
58:31 --> 58:39at yale.edu or on Twitter would love to get your feedback and questions so feel free to send us your thoughts fire.
58:39 --> 58:44Email if you enjoyed our podcast make sure to share podcast on SoundCloud or Apple's podcast app.
58:44 --> 58:47See you for the next installment of the web podcast.

Information

For this special episode of the Yale Journal of Biology and Medicine Podcast, Kartiga & Wei host Dr. Camille Brown and Dr. Aniyizhai Annamalai. Dr. Camille Brown is the director of the Yale Pediatric Refugee Clinic & Assistant Clinical Professor of Pediatrics at the Yale School of Medicine. Dr. Aniyizhai Annamalai is the director of the Yale Adult Refugee Clinic, as well as Associate Professor of Psychiatry. We discuss the mental and physical health of resettled refugee populations, in addition to ways of addressing refugee health disparities and delivering culturally appropriate care. For more information about YJBM or to read our latest issues, visit medicine.yale.edu/yjbm.

4881

To Cite

DCA Citation Guide