When refugees escape from war, conflict, famine and other disasters, it’s not unusual for them to end up in King County. We are one of the nation’s major host communities for refugees. A well-organized local network of agencies helps refugees take the first steps into a new life. This network emerged in 1979, when an earlier wave of refugees came from Vietnam, Cambodia and other Southeast Asian countries.

One first step for every refugee is a visit to the Refugee Health clinic inside the Downtown Public Health Center, in Seattle’s Belltown neighborhood. We sat down with Refugee Health Program Manager Annette Holland to learn more about the refugee experience.

Why do all refugees need to come visit the Public Health clinic?
The first reason is to get screened for infectious diseases, ranging from TB to HIV to hepatitis-B, within 30 days of arrival.  We follow federal guidelines to make sure anyone with infectious diseases gets connected to medical care for prompt treatment, to prevent the spread of diseases in our community.  That’s a foundational role for the Public Health department. We also want to ensure that all of our newly arrived refugees are vaccinated so that they can make a healthy start to their new life in the U.S. This sets the refugees on a path toward citizenship.

But, we also learned over time that we can improve peoples’ lives if we use this one clinic visit to more broadly understand their health needs.  So, we also check for lead exposure, anemia, hypertension, diabetes, and a number of other conditions.

After they leave us, they’ll go to a primary care medical provider in the community, so we help explain how to navigate the American health-care system.  And we can transfer their test results so any needed treatments can start right away.

Over time, refugees have come from different parts of the world in crisis, so where are they coming from in recent years?  And how does your staff adjust to different languages and cultures?
The top five countries of origin in recent years have been Iraq, Ukraine, Burma, Somalia and Afghanistan. If you think about it, that’s a lot of different languages and cultures. So, we employ a talented and varied group of interpreters in our clinic. I can’t over emphasize the importance of having an interpreter present to greet our new arrivals, orient them to our clinic, interpret and help the families to navigate this new healthcare world, whilst ensuring that everything that is discussed is understood and that any cultural barriers are overcome or addressed.

In fact, many members of our refugee health team were once refugees themselves, so they have a deep understanding of the trauma and concerns that refugees may be experiencing.

Keep in mind that refugees are a small portion of the overall immigrant community, and they have some unique needs. About 2,000 per year settle in King County.  A refugee is defined by international treaty as someone who has a well-founded fear of being persecuted in his or her home country for reasons of race, religion, nationality, membership of a particular social group or political opinion.

How does the Refugee Health Clinic fit into the bigger picture of assimilating refugees into our communities?
The resettlement process starts long before a refugee comes to the U.S. It can take many years to obtain refugee status and permission to come to the U.S. There are many interviews, background checks and a health screening which take place overseas.  Once they’re here, a number of community organizations help refugees work toward self-sufficiency and become contributing members of American society.

In King County, there’s a well-established network, the New Arrivals Work Group, which meets bi-monthly to prepare for new groups of refugees and to collectively solve any problems that may be emerging.  There are a lot of partners!  The network is led by the Washington State Refugee Health Coordinator and the primary resettlement agencies (see sidebar for a list).  The group also includes medical providers, education and employment specialists and mental health counselors.

Following their health screening at the refugee health clinic, refugees have access to on-going healthcare services through community based partners such as HealthPoint, SeaMar, Harborview International Clinic and Valley Medical. Through our refugee health clinic they can get referrals to WIC, dental clinics, the supplemental nutrition program, food banks, and mental health services. We offer a discounted ORCA-LIFT transit pass so they can get to job interviews, class or work.

Our hope is that they are learning the value of preventive health care, so they use the health care system to stay healthy, so they can work and go to school.  This is working toward the resettlement program goal of helping refugees become self-sufficient and contributing members of our society.