Interviewer: Understanding some of the barriers that prevent refugees from receiving equal medical care up next on The Scope.
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Interviewer: Debra Penney is an associate professor in the College of Nursing. She's investigating the barriers to providing standard health care to Iraqi Muslim women including refugees. Before you started this study, why did you suspect that Iraqi women did not receive the same quality of care as, say you or I would?
Debra: I have given care to a lot of different women, and I find that language is one of the biggest barriers for getting good care. It inhibits that data that you can collect from the women, their histories. It inhibits to a great degree the amount of education you can give and the depth of education.
Interviewer: So, how did you go about doing this study and what were you hoping to find out?
Debra: Well, I was really curious if the recent war and the previous Gulf War had an influence on providers' attitudes towards Muslims, in general, just because there had been so much negativity in the media. And I wanted to know if women felt that repercussion in the health care encounter.
The other part is there are very few studies done on women and Muslim women seem to be a curiosity for most Americans, so I was really curious to see if some of the discrimination that had been going on in public was actually transferred to the health care encounter. And I found that it wasn't as far as providers, but there were subtle forms of racism and stereotyping bias that are just common to human nature that did exist. And I wanted to know what their barriers were in accessing health care.
Interviewer: So, what were some of the main themes that came out of these interviews?
Debra: One of the main things that Iraqi women struggled with was they're familiar with western medicine basically. They have MRIs and they go to the doctor to get whatever they treatment they need, and their health care system was pretty comparable before to the wars to ours. When they came here they are taken by either international Rescue Committee or Catholic Community Services as an agency with an interpreter who picks them up, usually drives them to their appointment.
It's a great service, at least they have somebody there, but they were really floored because they could only mention two things that were wrong with them or that were a problem. And then the health care visit itself is limited by time. So not only do you need more time to interpret, but at the same time they were cut short because the need for interpretation and how much time that takes.
Interviewer: And you were talking earlier about just who is doing the interpreting can really affect the outcome of this visit.
Debra: Women, several women had said that they were stifled because not just the time limits, but they didn't have a female interpreter. And they came right out and said, "We're going to express a lot more if we have a female interpreter." So, actually, in their whole description of their interpreter, once they had kind of a regular one from one of these agencies, they really found that that personal interpreter was a friend, an advocate and a support person for them in the visit. And they did trust them and that was a really good thing.
Sometimes families would opt out. They had a car, they knew how to drive and get around after a few years, and they didn't want a stranger, an interpreter that they didn't know so they would take one of their kids who knew English a little better, or say a husband interpreting for a wife. And that worked fine until they got to personal questions of either gynecological nature or something like that because in their families they don't mention that. And for a daughter to hear about her mother's menstrual problems or something was very disconcerting for them. So, I term that cultural distress.
Other things that might be just common place that we need to ask as women's health providers are, "Do you have any sexual problems that you want to talk about?" because a lot of times patients aren't willing to bring these up on their own. So, we ask this question and we work from a template sometimes on an annual exam, and sometimes we forget that, oh gee, this question might be really offensive to someone who just doesn't normally think like we would in the US about people having sexual preferences.
Interviewer: So, the standard questions that you're supposed to ask, as a health care provider, just may be totally offensive in this case?
Debra: Yeah, and it's hard to filter that all the time and to know enough about a culture to know what is going to be offensive and what isn't.
Interviewer: Yeah, right. And what about from ... well, I guess that touches on the health care provider's side. I mean what did you learn from them about barriers to proper care?
Debra: So, the knowledge that the providers had was pretty good. They understood Ramadan, they understood fasting. They adjusted medicines to that. I was pretty impressed, but the depth of what they knew of the individual woman and how it might have differed from the majority was still lacking. These providers saw lots of refugees.
So we have Afghani and Somali and Sudanese and Iranian and Jordanian, and they may all wear the headscarf or the hijab. So, a lot of providers got them a little bit confused as far as their identity. They may have mixed up the fact that most Iraqi women are fine with birth control whereas Somali women aren't. So, they would get some of the characteristics confused, and wearing that headscarf did label them as Muslim and kind of put them in a little box.
Interviewer: So, now that you kind of have this understanding that there are specific issues with these women and receiving the care they need, I mean, what we can do with this information, how can we move forward?
Debra: One of the things that women complained about was the repetitive nature of questions, and that means a medical assistant comes in and take questions, then the doctor comes in and repeats the questions. So, precious time in the encounter is used up by repeating questions. So, I think somehow streamlining that and also having more times for patients. Maybe having an initial visit where the whole family comes and they get to know them a little better so they'll have a basis to work from.
The whole concept of having like a health care guide or a health care worker, that's actually part of the clinic that speaks the language that sees these people on a regular basis and is part of the clinic would be really helpful. And I believe that is covered under the Affordable Care Act. So, that's something that needs to be instituted to give these women better care. And also the providers are at a loss a lot of times. They do the best they can with the time limit, but this could be a really good asset to the health care encounter.
Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.
