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From Syria To Southern California: Refugees Seek Care For Wounds Of War

EL CAJON, Calif. — In his native Syria, Mahmoud spent months in captivity in a crowded room three flooring underground, by no means seeing the solar. Illness unfold rapidly among the many prisoners, he mentioned. Meals was scarce, usually spoiled.

Mahmoud mentioned his captors, foot troopers of Syrian President Bashar Assad, tortured him and shot him within the leg.

“I used to be in jail for seven months. They let me go, however I used to be bodily sick, and drained,” the 29-year-old refugee mentioned, talking inside a cheerful, trendy medical clinic right here with indicators posted in English and Arabic. “I had infections, irritation. I’m nonetheless making an attempt to get handled for all of it.”

Mahmoud, tall and pleasant, agreed to be interviewed on the situation that solely his first identify be used for worry of retaliation towards household again house. He settled in one of many largest Syrian refugee communities in the USA — a midsize California city close to San Diego.

And by advantage of this inflow of refugees, it has change into a well being care hub for a traumatized and bodily ailing inhabitants.

On an old school Major Road, amongst Western-themed murals, thrift outlets and halal markets, sits the bustling El Cajon Household Well being Middle, serving Mahmoud and different victims of the devastating civil conflict in Syria.

Halal markets in El Cajon cater to the Iraqi immigrants who’ve been coming to the realm for greater than 30 years. Immediately, the markets are additionally frequented by the rising Syrian refugee group.(Heidi de Marco/KHN)

The El Cajon Household Well being Middle is a group clinic that treats many Syrian refugees.(Heidi de Marco/KHN)

Syrian refugees wrestle disproportionately with post-traumatic stress dysfunction, anxiousness and melancholy due to their publicity to excessive violence and anxiousness about kin nonetheless in Syria, clinic workers and group volunteers say. Most who’ve fled spent years holed up in camps or flats, with little entry to routine medical look after conflict wounds or power situations similar to diabetes or coronary heart illness.

Nearly all the individuals who enter this nation as a part of the federal authorities’s refugee resettlement program qualify by earnings for Medicaid, the government-run medical insurance program for low-income individuals (generally known as Medi-Cal in California).

Physicians and others who work with Syrian sufferers say that the refugees expertise lengthy waits and should usually journey lengthy distances to see specialists — challenges shared by many different low-income teams.

However entry to medical interpreters is woefully inadequate, and refugees are sometimes stymied by the paperwork and forms so in contrast to what they’d again house. There, they had been accustomed to strolling in and seeing a physician with out having to attend, mentioned Suzanne Akhras Sahloul, founding father of the Syrian Neighborhood Community, a Chicago-based nonprofit that aids refugees.

Sufferers are sometimes confused by Medicaid and the managed-care plans that present it. They generally change well being plans inadvertently, which might result in delays in care, El Cajon Household Well being Middle physicians and caseworkers mentioned.

Of the 5.6 million individuals who have fled Syria since its civil battle broke out in 2011, solely a tiny fraction — round 21,000 — resettled within the U.S.

Extra Syrian refugees got here to San Diego County than another U.S. metro space — over 1,000 as of the primary quarter of 2017, based on the State Division. And greater than 80 p.c of them reside in El Cajon, the place county service suppliers and resettlement company workplaces abound, mentioned Chris Williams, government director of the Syrian Neighborhood Community-San Diego, a neighborhood department of the help group.

Medical assistant Lagham Katola speaks Arabic throughout a checkup with a Syrian affected person. Well being care amenities are required to offer medical interpretation companies, however they usually accomplish that over the cellphone.

Resettlement companies, which work with the State Division to clean entry into the U.S., typically assist refugees join Medicaid and get the care they want for his or her first three months on this nation. After that, they’re largely on their very own to take care of protection and get care.

“They may say, ‘Why do I want to go to the household physician? Why can’t I am going to the specialist?’” mentioned Aileen Dehnel, a case supervisor on the El Cajon Household Well being Middle.

“All over the place we go, persons are useful,” mentioned Mahmoud, who now lives in Anaheim, Calif. “However the No. 1 problem is the language.”

Comparatively few skilled interpreters within the space converse Arabic, and they’re in excessive demand. In a communication vacuum, Mahmoud mentioned, info will get handed from neighbor to neighbor, altering barely with every telling, as in a sport of phone.

“We don’t know what’s occurring,” he mentioned.

Translators don’t all the time assist, Mahmoud mentioned. One time, he needed to rush to the emergency room after a gallbladder assault, and an interpreter on the cellphone stored asking everybody to repeat themselves, blaming the issue on unhealthy audio tools. Mahmoud and his spouse, Noura, grew to become so annoyed that she used Google Translate to determine what the nurses and docs had been saying. (Noura additionally spoke on the situation her final identify not be used.)

Aileen Dehnel, a case supervisor on the El Cajon Household Well being Middle, helps a Syrian mom and daughter test in. Dehnel says refugees change into confused by the paperwork and generally change their well being plans with out realizing it. Dehnel writes detailed directions in Arabic for the sufferers she works with, however lots of them cannot learn in any language, she says.(Heidi de Marco/KHN)

The indicators within the El Cajon Household Well being Middle foyer are written in English, Spanish and Arabic.(Heidi de Marco/KHN)

One other refugee, 34-year-old Nisreen Tlaas, recalled having fainting spells after her arrival from Homs, Syria, in 2016. Two emergency rooms misdiagnosed her sickness earlier than the workers at a 3rd hospital carried out an MRI and noticed an aneurysm in her mind.

She lastly acquired lifesaving surgical procedure — however solely after a caseworker from the Syrian Neighborhood Community smoothed communications between a surgeon and a medical interpreter.

Dehnel, of the El Cajon Household Well being Middle, writes detailed directions in Arabic for the sufferers she works with, and lots of pharmacies in El Cajon now print prescription labels in Arabic as properly. However that’s not sufficient to verify a diabetic affected person will get his insulin or a pregnant girl takes her prenatal nutritional vitamins accurately, as a result of most of the sufferers can’t learn in any language, she mentioned.

Language frustrations apart, the principle problem dealing with many Syrian refugees is psychological misery.

PTSD amongst Syrian refugees contributes to bodily signs similar to power ache, mentioned Dr. Mai Duong, a household physician on the El Cajon Household Well being Middle.

Some sufferers have seen kin harm or killed in preventing. Others don’t know if their family and friends are secure. Syria is among the many international locations affected by the Trump administration’s “journey ban,” and the administration additionally just lately cracked down on refugee admissions usually.

Adjusting to life within the U.S. can also trigger monumental anxiousness. However many Syrian refugees resist asking for assist for worry that authorities will swoop in.

“Individuals all the time downplay their misery,” Duong mentioned. “They fear that their children will probably be taken from them.”

Mahmoud has tried speaking to psychologists. However they haven’t been capable of assist him escape his darkish ideas.

“Our households are in a conflict zone proper now,” he mentioned. “I’m all the time in worry that my household will probably be killed.”

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