Refugees and healthcare providers in Anchorage, Alaska

141 Pages·2014·5.95 MB·English

by  Cornelia M. Jessen

REFUGEES AND HEALTHCARE PROVIDERS IN ANCHORAGE, I.LASKA:
UNDERSTANDING CROSS-CULTURAL MEDICAL ENCOUNTERS
By
Cornelia M. Jessen
RECOMMENDED:
StephenJ. Langdon PhD
Rhonda M. Johnson DrPH
Keny D. Feldman PhD
Advisory Committee Chair
Stephen J. Langdon PhD
Chair, Department ofAnthropology
APPROVED:
James Liszka PhD
Dean, Colleges ofArts and Sciences
Robert G. White PhD
Dean, Graduate School
Date
ARLIS
Alaska ResourcesLibrary& InformationServices
LibraJ)'Building,Suite111
321JProvidenceDrive
Anchorage,AK 99508-4614
REFUGEE AND HEALTHCARE PROVIDERS IN ANCHORAGE, ALASKA:
UNDERSTANDING CROSS-CULTURAL MEDICAL ENCOUNTERS
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THESIS
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co Presented to the Faculty
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ofthe University ofAlaska Anchorage
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in Partial Fulfillmentofthe Requirement
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MASTERS OF ARTS
By
Cornelia M. Jessen B.A.
Anchorage, Alaska
December2009
ARLIS
AlaskaResourcesLibrary& InformationServices
LibraryBuilding,Suite111
3211 ProvidenceDrive
Anchorage,AK 99508-4614
iii
Abstract
Refugees are partofthe increasing cultural and ethnic diversity ofAnchoragc's
population (over90 languages are now spoken in Anchorage homes), a trend that has
implications for the delivery ofculturally appropriatc healthcarc services. This pilot
study examined cross-cultural medical encounters bctween healthcare providers and
refugees inAnchorage. In-depth, semi-structured interviews were conducted with
hcalthcare providers (N=IO) and refugees, primarily from Laos (Hmong) and Africa
(Sudanese)(N=9). Thesequalitative data were analyzed for thematic contentregarding
healthc(are bar,riers cross-cultural challen=nes,keys to success and areas ofanreementand
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differences in perceptions. Refugees in Anchorage have a generally positive perception of
local hl;'althcare prmiderswho display cross-cultural empathy and take time to establish
trust despite time limits, lack ofmental health sen,ices, language difticuities and differing
health beliefs. P.ecommendations are offered for healthcareorganizations and providers
ill overcomingthe identified barriers and challenges for healthcare provision to these
populations.
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Table ofContents
Page
Signature Page i
Title Page ii
Abstract iii
'fable ofContents iv
L1·st fF'Igures ..
0 VII
ListofTables viii
Listoft.ppendiccs ix
Ackno\vledgments x
Cilaptcr 1 Illtroductiull _ "' 1
110••••••••
1.1 Background 1
J.2 Theoretical FralTIeWork 2
1.3 The Global Refugee Situation j
1.4 The Refugee Resettlement Process 12
1.5 Alaska's Refugee Population 14
1.6 Refugee Health Assessments 18
Cilaptcr 2 Litcratllrc Rcvielv 21
2.1 Refugee Heallhcarc in Anthropological Perspectivc 22
~',
2.2 Othcr Perspectives on Refugee Health 25
C11111>fcr3 i\1ctll()(lol()gy 32
3.1 Research Devc!opmcnt. 33
v
3.2 Research Design 34
3.3 Research Participa'lts 37
3.4 Informed Consent 38
3.5 Analysis 39
3.6 Limitations and Strengths 39
Chapter4 Provider Findings 41
4.I Demographics 41
4.2 Key Themes from Provider Interviews 41
4.2.1 Structural Dimension ofBarriers and Challenges 42
4.2.2 Cultural Dimension ofBarriers and Challenges 46
4.2.3 Structural Dimension ofHelpful Factors 52
4.2.4 Cultural Dimension ofHelpful Factors 55
4.2.5 Provider PerceptionsofRefugee Populations 57
4.2.6 Perceived ProviderNeeds to Improve Healthcare 6i
4.2.7 Keys to Success 64
4.2.8 Perceived Rewards for Serving Refugees 69
Chapter 5 Ref'ugee Filldings 72
5.I DelTIographics 72
5.2 Key Themes from Refugee Interviews 73
5.2.I Acute orChronic Health Problems 73
5.2.2 Refugee Perceptions ofHealthcarc Providers 74
vi
5.2.3 Satisfaction with Treatment 79
5.2.4 UnderstandingofDiagnosis and Treatment.. 80
5.2.5 Influence ofCultural and/or Religious Practices and Beliefs 82
5.2.6 Experience with Interpretation 85
5.2.7 Non-U.S. Healthcare Experience 87
5.2.8 Refugee Feedback for Healthcare Providers 89
Chapter6 Arlditional Context and Discussion ofFindings 91
6.1 Hmong Refugees in the United States 91
6.2 Sudanese Refugees in the United States 94
6.3 DiscussionofProviderand Refugee Findings 96
6.4 Research Findings and the Literature IOj
Cilaptcr 7Recommendations J10
7.1 Organization-CenteredRecommendations III
7.2 Provider-Centered Reconl1nend~ttions 112
Ret·crenccs Cited 114
.,,,.n.
A 1I~___
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ListofFigures
Page
Figure I: MajorRefugee HostingCountries, 2008 6
Fjgure 2: MajorSource Countries ofOrigin, 2008 6
Figure 3: NumberofRefugees per 1US$ GOP percapita, 2008 7
Figure4: Refugee AITivals FY 1980to 2008 9
Figure 5: Refugee Arrivals by Region 1999 to 2008 10
V111
List ofTables
Page
Table 1: Refugee Arrivals by State ofResidence FY 2006 to 2008 II
Table 2: Refugee Arrivals in Alaska by Country ofOrigin 2000 to 2008 18
Table 3: Juxtaposition ofProviderand Refugee Findings PartOne 98
Table 4: Juxtaposition ofProviderand Refugee Findings PartTwo 99
Table 5: Juxtaposition ofProviderand Refugee Findings PartThree 100
Table 6: Juxtaposition ofProviderand Refugee Findings PartFour 101
Table 7: Juxtaposition ofProviderand Refugee Findings Part Five 101
Table 8: Juxtaposition ofProviderand Refugee Findings PartSix 102
Table 9: Juxtaposition ofProviderand Refugee Findings PartSeven 103
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ListofAppendices
Page
Appendix A: Interview Protocols 120
Appendix B: Informed ConsentForms 126
Appendix C: Support Letter 130
Appendix D: UAA IRB Approval Letter 131
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Acknowledgements
Firstand foremost, Iwould like to thank all providers and refugees who were willing to
share theirstories with me. Thank you also to Karen Ferguson atthe RAIS Program for
her supportand guidanc~ throughout this project. I would like to extend sincere gratitude
to my professors Kerry Feldman and RhondaJohnson for theiradvice, direction and
encouragement in every step ofthe way. Andfinally, a special thankyou to my husband
Jeffand my parents who have beensteadfastat my side from beginning to end.