“What does it mean to be a refugee?” is a question I often ask myself with the hope of engendering more compassion in my work and life. While I cannot answer from personal experience, over 65 million people can. That many are displaced globally, and numbers continue to rise.
By definition, every refugee is forced to leave their country because of war, persecution, or violence. However, each person’s experience is a unique quilt of history, family, and culture stitched with hope and stretched at its ends by geopolitical powers. The complexity of international humanitarian crises can quickly become muddled and overwhelming to naïve onlookers like me. World politics seem unfathomably large at times—only tangentially related to individual people and detached from direct human experience. Of course this is far from the truth. Refugees are not distant people living an esoteric reality; they are enriching the fabric of our own community here in Milwaukee, WI.
At the start of the summer, with an inter-professional team of health care professionals, researchers, and students, I embarked on a research project aimed at uncovering part of a refugee’s experience transitioning to the United States. The vast topic of refugee health crosses fields of study, sovereign borders, and ideological theories. For our purposes, it is an intentionally local approach to a global health issue. The study is ongoing and set to conclude later this calendar year, but several insights about my role as an aspiring clinician are already extractable from my experience working with the Aurora Research Institute and Milwaukee Global Health Consortium.
Among the many barriers associated with acculturation, women often experience additional gender-specific challenges. The interaction between gender, culture, and religious preferences introduces delicate intricacies to the provision of equitable and quality care to refugee women. Heretofore, we have known little about the patterns in nutritional and gynecological services provided to refugee women in Southeastern WI from a population health perspective. Welcoming refugees to the United States and Milwaukee is a complex undertaking; understanding how to improve requires knowledge of where we stand.
Meeting with health care providers, government employees, and VOLAGs (volunteer resettlement agencies) established an anecdotal concern early in the project: refugees enter a robust network of support while resettling, and the challenges they face require incredible coordination among case workers and health care providers who are devoted to easing the transition to self-sufficiency. The commitment all parties have shown to the refugee community in Milwaukee is exemplified by their acknowledgement of the process’s shortcomings and their desire to improve in the face of resource constraints. The diversity of languages spoken by refugees, for instance, barely scratches the surface of the inherent complexity and difficult nature of refugee resettlement work.
Admittedly, Rohingya, Burmese, and Karen are languages I had not heard of before starting this project, despite each being the vernacular of many of my neighbors here in Milwaukee. Other languages and dialects–as diverse as the regions from which refugees leave–are spoken by a growing population of Milwaukee residents. No longer are these ‘foreign languages’; they are part and parcel of Milwaukee’s voice. Each language carries an intrinsic cultural value, just as food is a vessel of tradition and reminder of home. However, linguistic barriers represent a common dimension of acculturation, as do barriers to navigating a new food environment.
Upon arrival to the US, refugees are exposed to an atmosphere characterized by high-calorie, low nutrient foods iconic of a stereotypical American diet. Navigating a new food environment, which may or may not contain familiar foods or methods of food preparation, encourages dietary changes. Likewise, BMI bracket-shifts from underweight toward obese are commonly reported in refugee populations arriving to high-income countries like the United States. The dietary habits of refugee women, who are often culturally or socially positioned to prepare meals for themselves and their family, may impact the family’s health profoundly. Yet little is known about the nutritionally-related services provided by health care providers—or the sustainability of their interventions or recommendations—during their first year in the country (arguably the most sensitive period for developing new habits). Our hypotheses currently under investigation hope to reduce this gap.
The lens of this project has an intentionally narrow field of view, focusing on two health issues specific to refugee women. But it offers a perspective that will hopefully lead to positive changes in the way we care for our globally-diverse local community. Every great seamstress has an acute awareness of how each thread is connected and intuitively understands each quilt stitch deserves great care. Milwaukee is a morphing quilt comprised of a unique history and people. As we rip out our hemming and incorporate new fabric, may we sew with care.
Keoni Bailey is a rising senior at Marquette, majoring in Biomedical Sciences with a minor in Psychology. Throughout summer and fall 2018, he is an Aurora Research Institute intern working in the Milwaukee Global Health Consortium office.