Experiences with the medical and health systems for somali refugees living in Hamilton

New Zealand Journal of Psychology, Jun 2003 by Guerin, Bernard, Abdi, Abdirizak, Guerin, Pauline

With the open-ended question relating to the one biggest problem about going to the doctors, 20 said language, 11 said there were no real problems, 11 said medical costs, 7 said transportation, 2 specifically mentioned problems of translators, and one each said the long time it takes to see specialists and not knowing where to go in the hospital. When asked specifically whether or not in the last year they had not gone to the doctors because they could not pay, 26 said yes and 28 said no.

For the specific questions about barriers to accessing medical care, the greatest barriers were reported for payment of medical care, the doctor understanding them, availability of interpreters, satisfaction with communication, and their understanding the doctor. These five questions were the only ones in which more than ten participants made a rating of 3 on the 3-point scale. The main concerns, then, were about money, language, communication and understanding, including their understanding of the doctor. The four language-related questions were all rated higher for females than for males, and all four had negative correlations with English proficiency. These findings need further research to examine the contexts for the gender differences and English proficiency issues.

In both the open and specific questions, money or medical costs came up as a barrier. It turned out to be more difficult to identify exactly what the barrier was since many of the participants have community services cards for reduced medical charges, many go to a particular Hamilton doctor who often does not charge for his services, medical services for children are usually free, and specialist and hospital services are free. Even so, repeated visits for chronic conditions to a GP who does charge for services, some prescriptions, transportation, and childcare, can all be costs associated with health care. These need to be clearly separated out in future research rather than being posed as a unitary "monetary cost" barrier as was done here.

Conclusions

Overall, our sample from the Somali community in Hamilton reported themselves as being in good health with few special health problems. The main problems relate only indirectly to health, but are perhaps just as important for that reason and are therefore of specific concern to health and community psychologists. Most significant is the impact that lack of English proficiency has upon all aspects of utilising health services. The implication for health is that more effort should be put into teaching English, since weak English either requires funding for trained interpreters or puts stress on the already busy volunteer interpreters and family members, and decreases the effectiveness of most public health messages (Preciado & Henry, 1997). Most people interviewed, and our informal experience with the community, suggests they are keen to learn English but many did not have the time to learn properly and consistently and there are not enough English classes available that are both appropriate and affordable. Even as refugees, there are not specific English classes for them after their 6-week orientation period, but are rather informally organised through non-governmental organisations, voluntary groups or individuals.