Creating a “community of solution” for refugees: diversity in approaches of local research responses

griswoldKim Griswold is Associate Professor of Family Medicine, Psychiatry, and Public Health and Health Professions at Jacobs School of Medicine and Biomedical Sciences in Buffalo, New York. Dr Griswold will be speaking at the forthcoming North American Primary Care Research Group (NAPCRG) annual meeting.

 

Communities in every nation are faced with providing competent, equitable and culturally appropriate services for resettling refugees. Health centric disciplines are not enough to meet the challenges presented by these newly arriving populations, nor to alleviate the disparities they face – such as isolation, limited English proficiency, differences in patients’ attitudes and health literacy levels, and a lack of cultural awareness on the part of providers.

Health inequity can be defined as: “unjust differences in health between persons of different social groups.” In 2015, at the University at Buffalo, a Community of Excellence was formed in Global Health Equity, with an emphasis on “leveraging underutilized domains” led by Principal Investigators in (Epidemiology and Environmental Health, P. Ram), (Architecture, K. Smith), (Industrial and Systems Engineering, L. Lin), and (Urban and Regional Planning, S. Raja).  The embracing goal is to create cross-disciplinary collaborations in research, education and engagement; by combining health sciences specialties with Architecture, Planning, Engineering, and X (Cross)-Synergizing Disciplines - (such as geography, anthropology, economics, history, law, music, art, drama, etc.). In effect, a Community of Solution comprised of a global disciplinary approach.

On-going projects include research on global drug stock-outs, sanitation, and neonatal health. Locally, investigators are looking at dealing with inequities of food access for refugees; and evaluating the use of interpreters and refugees as standardized patients for inter-professional education within our health science schools.

Like many of my colleagues, I have been involved since the late 1980’s with refugee health care and resettlement.  As a border town, Buffalo NY has a long tradition of serving refugees; with four refugee resettlement agencies, a Center for Survivors of Torture funded by the Office of Refugee Resettlement and one of the largest residential centers for asylum seekers in the US.  This cultural diversity has provided important educational opportunities for health trainees, such as studies looking at perceptions of health trainees participating in refugee health clinics, and the extent of their cultural awareness; and assessing how breast health education improves knowledge of mammograms and breast health among refugee and immigrant women.

In caring for individuals and families from all over the world, I have tried to comprehend the trauma and loss they have withstood; and have been captivated by their resilience and ability to transform their lives.  Within our local Refugee Health and Wellness Domain, we are encouraging scholarly work that includes refugee community partners and agencies.  One project used a systems engineering approach to facilitate transportation mapping for refugee and immigrants unfamiliar with public transport.  In annual Refugee Health Summits, we discuss and problem solve challenges encountered by patients and providers, and showcase local research endeavors. There are important research issues surrounding mental health, particularly within a cultural context.  For example, we need more evidence based work to assess how to meet the needs of individuals who have witnessed violence, and/or survived torture.

A vision of working in teams will help to address the gaps in science, socio-cultural barriers, unjust/ineffectual policies, and unequal practices affecting populations locally and around the world.  Learning to listen to people from different cultures will inform the questions we ask.  Healthy communities of solution for refugee populations can be achieved through research based in strong cross-disciplinary partnerships, person-centered health care and a focus on innovation. And working collaboratively will inspire our future trans-disciplinary thinkers!

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The North American Primary Care Research Group Annual Meeting is being held from November 12th to 16th 2016 in Colorado Springs, CO. CMAJ is a co-sponsor of the meeting.

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