The Incompetent Healthcare and Wellbeing: African Immigrants & Refugees 1

The Incompetent Healthcare and Wellbeing: African Immigrants & Refugees

Bryce Madrid
Portland State University

The Incompetent Healthcare and Wellbeing: African Immigrants & Refugees 2

The Incompetent Healthcare and Wellbeing: African Immigrants & Refugees
Bill Gates once said, The U.S. immigration laws are bad - really, really bad. I'd say
treatment of immigrants is one of the greatest injustices done in our government's name.(Bill
Gates,n.d). The purpose of this paper is to enlighten those on the healthcare or lack thereof for
African immigrants and refugees. First the key term wellbeing will be analyzed in to get an
accurate understanding of the term in that what is the meaning in it for healthcare. It is critical of
this paper to provide the whole picture of the issue at hand thus a brief history. Next the
following topics with be discussed: education of immigrants and refugees on U.S life, cultural
competency of health care professionals and gaining access to healthcare. Ultimately, coming to
the conclusion that the definition of wellbeing for African immigrants and refugees is in all
actuality not being achieved according to its definition of being in a state of happiness
physically,mentally,socially,etc.
History
Obviously there is a lot more history that went down during these times; I only wish to
focus on the immigration laws, trends and underlying causes to immigration through The African
Immigrant and Refugee Community in Multnomah County: An Unsettling Profile. Africans have
existed since whites have existed. It should come as no surprise that earliest contact of Africa and
the United States was slave trade. Many troubles of the continent of Africa leave it seen as a
place of weakness and a place to take advantage of. I believe Africas troubles were caused by
the colonization and slave trade. It can be shown through the words of the authors To begin,
men and women in feeding and caring for each others communities deteriorated, so too did
networks of information sharing, political organization and local trade. (Curry-Stevens, A. &
Coalition of Communities of Color, 2013, p. 16). This caused the domino effect historically as

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slavery and colonization set the stage for debt, political disputes, government instability, etc. for
Africa. Africa has stayed impoverish and unstable making it the biggest humanitarian project in
the world. With that said this has led to a lot of Africans wanting to immigrate or seek asylum.
Initially, Africans migrated to the old colonial powers however that changed when the colonial
countries but that all changed when recessions in economy left the U.S as an only option of
migration. African immigration only increased with the U.S Immigration Reform and Control
Act of 1986 allowing legalized status of eligible undocumented individuals. The number of
African immigrants and refugees coming to the U.S every year is ever increasing with their
hopes of a better future and hoping for respect and dignity, aiming to take part as equals in the
American way of life. (Curry-Stevens, A. & Coalition of Communities of Color, 2013, p.15).
An interesting question and often enlightening question posed by the authors of The
African Immigrant and Refugee Community in Multnomah County Coalition of Communities of
Color & Portland State is What does it take for someone to leave ones country and travel 9,000
miles to Portland, Oregon?(Curry-Stevens, A. & Coalition of Communities of Color, 2013,
p.15). The U.S gives out a 50,000 permanent diversity visas every year to promote immigration
for countries that have low immigration rates. This is all fine and dandy until you see the fees of
the visa; $745. More than half the countries of Africa are poor and impoverish! An accurate
definition of poor and impoverish can be seen through:
Desperate for food and water, many have spent up to three weeks walking across the drought
ravaged northeast corner of Africa searching for help. Their crops have withered, their cattle and
children have died. In fleeing their homes, some families have been robbed of what little they
have left. Women have been raped by bandits and sick children have been hunted by packs of

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wild hyenas. Some of the ill and malnourished were left to die alone in the open.(CurryStevens, A. & Coalition of Communities of Color, 2013, p.28-29).
If Africans do by chance get to the USA they do not get any financial aid or support.
Dont take your citizenship here in the U.S for granted. To gain citizenship here you must live
here 5 years minimum, pass an english and US history tests without any schooling on that I
might add and be of good moral character. That description of character is biased and
unnecessary. Its all based on the government looking at you, and judging you. When an
immigrant gains citizenship, it really only means granted access to benefits that are ours as a part
of society. Any offspring are automatic U.S. citizens, food stamps, Medicaid, disability, etc. all
become available to you as a citizen. Shouldnt these public service benefits be available to
immigrants/refugees should they need it? These services all contribute to the wellbeing and
success of all communities within the world it should not be limited to someone who can pass
multiple tests and jumped through hoops. In the table below, is a profile of the Sub-Saharan
African community in Multnomah County and their citizenship status in the United States. While
it seems to be 50/50 on resident versus citizenship this table lies more with the fact that there are
more people who have for ten years been in the U.S and not gained citizenship. What is the
problem? So what they arent a citizen? The big deal about this is how are this community is
living? Without legal documentation papers they are not given access to government benefits.
Citizenship should be enforced because it helps with wellbeing however gaining citizenship
should not be this hard. Anyone who wants citizenship should have the right to pursue and have
aid in gaining it. The benefits that come with citizenship might come in handy when the
employment of an immigrant is scarce that means the jobs they do secure are low wage lacking
in health insurance and many other things that aid in the communitys wellbeing.

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Upon arriving in the US, the immigrants and refugees expectations plummet. As they
receive no assistance with money, help navigating, english classes, job search skills,etc.
Limitations of english, education, and health make finding adequate employment next to near
impossible. The African Immigrants and Refugee community has always been and still is noted
to seize the opportunity of education and work force here in the United States however that
rarely happens as they are restricted not only by citizenship status, healthcare, housing and
overall wellbeing. The once thought of the great U.S to the rescue now gone and replaced with
discrimination and neglect of not just African immigrants and refugee community, but many
other communities.
Wellbeing
What is wellbeing? What is the wellbeing of a population? According to the dictionary
wellbeing is defined as the state of being happy, healthy or successful(well-being, n.d). When

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African immigrant and refugees come into the USA, they are thrown into a completely different
world and culture. Being able to do things that werent allowed back home or not be able to do
things that were done back home. A new set of expectations of people. In addition to this high
stress, there may be past trauma from where they came from. According to BetterHealth,
wellbeing is not just the absence of disease or illness. It is a complex combination of a persons
physical, mental, emotional and social health factors.(Wellbeing, n.d). This means everything in
ones life contributes to their wellbeing on a macro-level. A job provides a sense of direction,
success, goals not just money to pay for things. Learning english doesnt just mean blending in,
it is a means of communication and expression. There are many things that are treated as just a
thing rather than an aspect of wellbeing. It seems to be a common misconception for the host
country to neglect what wellbeing truly means. A counterargument could be that it is not the job
of the government or the US to oversee the wellbeing of African immigrants and refugees. But if
the government did oversee, there would be a much different situation today.
A Multnomah County Survey
In African Refugee and Immigrant Health Needs and Barriers: Report from a
Community-Based House Meeting Project (2012), the authors recognize the lack of information
about the health needs of Africans in Portland, Oregon. The lack of this information is due to
lack of census, county, state, and federal health data on African population groups as the data
that does exist concerning them is embedded within data from the more numerous population
group, African Americans(Boise,Tuepker,Vigmenon, Soule ,Onadeko., 2012,p.2). What is
significant about what is stated is that it is a common misconception that African Americans and
Africans are the same community, which is not true. Researchers then conducted a survey of

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African immigrants and refugees and their family members in the Portland area. The goal of the
study was to compare healthcare experiences for Africans in the U.S. The house-meeting project
decided on the approach called popular education. Popular education is made to give rise to
empowerment within a disempowered community through education. This method notes that
knowledge is power that everyone has and implements strategies to get equal participation in the
topic at hand. The ultimate goal of this method is to connect peoples personal experiences to
larger social and political realities; increase peoples belief in their ability to bring about change;
and empower, build leadership, and enhance social capital.( Boise,Tuepker,Vigmenon, Soule
,Onadeko., 2012,p.4). The project commenced with a meeting in which house-facilitators were
asked to bring friends or people they knew through a social connection that were of African
descent.
At this meeting three main areas were focused on: the health care related concerns of
African immigrants and refugees, barriers Africans face in getting their health care needs met
and perceptions about the root causes of these barriers to health and
healthcare(Boise,Tuepker,Vigmenon, Soule ,Onadeko., 2012,p.6). After nine meetings, the
major themes that came about were the stressful lifestyle of the U.S, concerns with mental
health, difficulties in gaining access to health care, and the lack of cultural awareness. The most
significant discussion on theme number one, the stressfulness of life in the U.S, was that the U.S
did not live up to the expectations Africans had for it. Financial hardships, traumas experienced
from their home country contributed to loneliness and missing family member back home were
all discussed in theme one. A critical topic here was mental health in that with all this change in
life that Africans are going through, their mental health is compromised and linking people with
mental health counseling is a challenge as it is not receive very well by those in question of

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needing it. In theme number 2, difficulties in gaining access to health care, it was widely
discussed of the lack of education on the U.S health care system. Coming from another country,
they [African immigrants and refugees] spoke about a radically different set of principles,
structures and practices between the U.S and Africa( Boise,Tuepker,Vigmenon, Soule
,Onadeko., 2012,p.8). Things such as lack of insurance, lack of funds for health services,
knowing where to go for health services, etc. were all a source of confusion among many African
immigrants and refugees. Another significant problem in this theme was language barriers. This
barrier makes gaining access to healthcare a nightmare for Africans as it is time consuming to
find a interpreter and make appointments and it is rather uncomfortable which leads Africans to
not bother with healthcare all together. Lastly the third theme, lack of culturally responsive
health care, it was frequently pointed out lack of culturally aware knowledge of the doctors in the
healthcare system. Culturally aware knowledge is the knowledge of the beliefs, values and
perceptions of a specific ethnicity/community. As described by participants doctors often
appeared to have minimal knowledge about common diseases in Africa like malaria that might
still affect individuals after coming to the U.S and to be unaware of traditional health practices or
patients culturally-influenced expectations regarding the doctors
role(Boise,Tuepker,Vigmenon, Soule ,Onadeko., 2012,p.9). Again language barriers seem to be
a big part of the disconnection in communication within the healthcare system. It might not even
be the health care professionals fault as they are just trying to treat you but not knowing what
you are saying or describing to them makes it even more difficult and leads to error. While a lot
of Africans thought instead of it being miscommunication, it was rather that racial discrimination
being the key factor in all this.

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The authors stance on educating the African immigrant and refugee community is that
while yes it would help Africans learn about healthcare and its ins and outs but it will not solve
the problem of gaining access to healthcare. Another recommendation is the need for cultural
competency training about not only just African culture but others as well. It is truly staggering
that some of the most brilliant people and healers, doctors, are only seemingly attune to the
medical and cultural history of whites. With this research and survey, it is concluded that the
experiences heard through meeting in Portland, Oregon are consistent with those around the U.S
and that it is very true that at this moment in time African immigrants and refugees are at a major
disadvantage for healthcare and wellbeing as wellbeing doesnt just include physical health but
also mental health as well.
The Vulnerability of Immigrants
In Immigrants and Health Care: Sources of Vulnerability (2007), authors Derose, Escarce
and Lurie seek to discuss vulnerabilities among immigrants and how expanding legal residency
and citizenship can contribute to wide spread access of care. The basis for discuss of improving
immigrant findings conclude that immigrants have lower rate of health insurance, use less health
care, and receive lower quality of care than U.S born population. A vulnerable population is a
group at increased risk for poor physical, psychological, and social health outcomes and
inadequate health care(Derose,Escarce,Lurie., 2007, p.2). Political and social marginalization,
lack of socioeconomic and societal resources are factors that shape the term vulnerability. Why is
addressing the health care needs of immigrant populations challenging? Because of the diversity
of this group and the restrictions put in place by the government. The Personal Responsibility
and Work Opportunity Reconciliation Act (PRWORA) of 1996 have made it so immigrants

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cannot receive publicly funded services like Medicaid. States and local governments providing
funding/benefits to undocumented immigrants have to pass laws to implement eligibility as
requires by law. With all these restrictions in place, immigrants dont even bother to seek public
benefits. As far as socioeconomic background the education attainment, type of occupation and
earning directly and indirectly influence immigrants access to health care
resources.( Derose,Escarce,Lurie., 2007, p.2). Rather than just education and other things being
factors in an immigrants health care; another huge factor is their immigration status. Ones
immigration status is a limiting factor. The lower rates of health insurance stem from
immigration status, time in the United States and country of origin; Nearly half (45 percent) of
noncitizen immigrants living in the United States lack health insurance, whereas noncoverage for
naturalized citizens generally approximates that of the U.S.-born (1520
percent).( Derose,Escarce,Lurie., 2007, p.3). Again limited english proficiency applies to much
more than just health care in an immigrants life. However, increases have been made and it is a
work in progress; for example: Medicaid agencies are required by the federal law to overcome
language barriers. Stigmatization and marginalization take form in talking, writing, saying,
hearing and seeing about what immigrants get and dont get, what they wear, how they looked. It
spreads like a wild fire and mutates commonly into a census that immigrant take away from
deserving families of the U.S despite that not being the truth. PRWORA has contributed to this
greatly by its laws and control of eligibility of safety nets in the U.S for immigrants. The lack in
health care, healthcare profession performance is very serious as immigrants do make up a
significant amount of the U.S. Recommendations of these authors include: expanding health
insurance coverage to reduce immigrant vulnerability, address limited english proficiency and
expand and strengthen the safety net and lastly revise PRWORA.

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Conclusion
How do issues within healthcare counter the definition of wellbeing? Based on the
information I have provided, issues within healthcare counter the definition of wellbeing
multiple factors that discourage the African immigrant and refugee community from attempting
to gain access to healthcare. These factors are english proficiency, laws and acts that make
eligibility for healthcare difficult (i.e PRWORA) and lastly discrimination. Many efforts to
eliminate these factors have progressed; the results are still very low. Doing research on
healthcare for African immigrant and refugees has just made me realize even more that
discrimination and racism are still very much present. It is masked within society but nonetheless
racism and discrimination exist within the systems and workings of the United States.

References:

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Boise, L., Tuepker, A., Gipson, T., Vigmenon, Y., Soule, I., & Onadeko, S. (2013).
African Refugee and Immigrant Health Needs: Report From a Community-Based House
Meeting Project. Progress in Community Health Partnerships
Curry-Stevens, A. & Coalition of Communities of Color (2013). The African Immigrant and
Refugee Community in Multnomah County: An Unsettling Profile. Portland, OR:
Portland State University
Derose, K. P., Escarce, J. J., & Lurie, N. (2007).
Immigrants And HealthCare: Sources Of Vulnerability. Health Affairs.
Gates.B(n.d). Retrieved from http://www.brainyquote.com/quotes/quotes/b/billgates626126.html
Wellbeing (n.d). Retieved from
https://www.betterhealth.vic.gov.au/health/healthyliving/wellbeing
Well-being (n.d). Retrieved from http://www.merriam-webster.com/dictionary/wellbeing