Reaching Toward a Healthier Community
During the COVID-19 pandemic, our culture has become consumed with the topic of good health. But here at EMBARC, we’ve been focused on healthy communities for a long time. In fact, one of our first programs provided health education to refugees in Iowa.
“Just because somebody doesn't have English skills doesn’t mean they don’t want to try,” says Moriah Morgan, REACH Advocate Program Manager with EMBARC. “Refugees are often very interested to learn about health care. They just don’t have access to it.”
There is no widespread data collection on the health status of refugees and immigrants in the United States. But the National Survey of Children’s Health found that immigrant parents were 2.2 times more likely than U.S.-born parents to rate their children’s general health as fair or poor. They also rated their own health worse.
Some of the barriers refugees and immigrants face in this area include:
Lack of health insurance
Limited English skills, making if difficult to communicate with health care providers, schedule appointments, or take prescriptions correctly
Inexperience with technology, which became more relevant as appointments went virtual during the pandemic
Cultural miscommunication and lack of education on topics that many U.S.-born Americans are accustomed to, such as:
Mental health
Dental health
Preventive appointments and screenings
Diabetes prevention and treatment
Education First
To address these barriers, EMBARC launched the REACH program, which stands for Refugee Empowered Access to Community Health, in 2015. The original goal was to provide basic education on health care topics, such as calling 911, getting a flu shot, and treating the common cold.
That education became more interactive in 2017, with REACH launched an annual flu shot clinic and established a mental health care curriculum on stress and healthy connections for resilience.
“In a survey of REACH clients, 90% said the program was their only source of health education in their native language.”
But EMBARC wasn’t satisfied with that outcome. Although refugees had gained more knowledge, they still struggled to make doctor’s appointments and interact with providers. It was time to try something that wasn’t being done anywhere else in the county.
A Unique Model
In researching community health care trainings across the U.S., EMBARC staff found that none of the programs were designed to train refugees themselves. Since EMBARC is grassroots, community-based, and refugee-led, the organization wanted to invest in the refugees, not outsiders.
EMBARC began training and hiring refugees to provide wraparound case management services, especially for patients with chronic conditions like diabetes. These REACH advocates, located in Des Moines and Waterloo, are certified in medical interpretation and community health care.
One of their main roles is providing in-person interpretation during medical appointments, allowing patients to ask their doctor questions directly. Both medical providers and community members have expressed appreciation of this alternative to generic phone interpretation.
REACH Advocates also make reminder calls to patients about upcoming appointments and follow up after a few days. They arrange transportation to and from appointments, explain medications, and advise patients on diet and exercise.
The REACH program has expanded education efforts, setting up small learning circles for and hosting newcomer meetings every Friday in Waterloo, the latter in partnership with the Black Hawk County Health Department. In a typical year, REACH offers services and education to about 800 refugees and immigrants statewide.
COVID Calls
When the pandemic began to hit Iowa in spring 2020, REACH Advocates immediately began getting calls from community members with sick relatives. The program provided emergency response training for Advocates and other EMBARC staff on COVID-19 symptoms, when to call 911, and how to provide interpretation on a three-way call.
REACH Advocates began staffing EMBARC’s Crisis Helpline and Virtual Access Center, while also producing videos in 10 languages on COVID-19 and related topics. The program also hired a retired nurse, Arlene Prather-O'Kane, to speak with patients through an interpreter.
After calling 911 for community members with severe COVID symptoms, REACH Advocates monitored their progress over weeks and months, communicated with the family, arranged follow-up appointments and physical therapy, and even negotiated with employers for sick leave.
In 2020, REACH Advocates and supporting staff members handled more than 100 intensive cases of COVID-19, each of which required hundreds of hours of support. Overall, approximately 70% of clients were exposed to COVID-19 at some point.
“Supporting people in emergency moments has made a huge impact. We’re giving them somebody who understands them, who they can talk to.”
Check out Grace Htee’s story for an example of how EMBARC staff went the extra mile supporting sick community members during the pandemic.
Wide-Ranging Impact
Ironically, one sign of the program’s success has been REACH Advocates leaving EMBARC to become community health care workers for local health care providers and county health departments.
Morgan is pleased to see this shift toward large-scale change in Iowa. When more medical providers hire community health care workers, marginalized populations around the state are better represented and served.
“We want our team to train and then go on to take some of these roles. ”
Morgan has also been contacted by organizations across the country who are interested in starting similar programs in their local communities.
However, the most important measure of success is feedback from community members themselves. REACH clients say they feel empowered by their newfound knowledge of the medical system. Others made such positive behavior changes that they could stop taking their diabetes medication.
Although experimenting with a new model was a risk, the program’s success proves that EMBARC took the right approach to community health—one by refugees, for refugees.
“A lot of people are learning that if you want to make a difference in the refugee community, you have to have the refugee community involved,” says Morgan.
Help REACH provide more wraparound case management and health education to refugees and immigrants in Iowa.