Empathy helps providers guide others through healthcare system

In one day, Chandra Acharya saw 75 people die and be cremated by the riverside at Beldangi II refugee camp, in Maidhar, Nepal,

“Kids, older folks, all because of dysentery and diarrhea from the dirty river,” Acharya said.

Several years later, Acharya is now living in Fargo, where he works at Family HealthCare Center part time as a medical interpreter and full time at Sanford.

When Ram Adhikari lived in Sanischare refugee camp in Sanischare, Kosi, Nepal, so close was his hut to the family next door he avoided looking through the gaps in the wall.

“The houses were built with bamboo and the roof I made was out of bushes. You see hundreds of houses made in a single lot,” Adhikari said.

Now, Adhikari sits in his office and consults patients on the Affordable Healthcare Act at Family HealthCare center.

Hari Subedi and his family received the minimal food and primary care they needed while living in Nepali refugee camp, Beldangi II. If Subedi or his family got sick, he knew of medication he could buy, but all of it was pretty basic: fever or cough, it doesn’t matter—the same medication is prescribed.

After living in Fargo for four years, Subedi is a medical interpreter at Family HealthCare Center.

Archarya,  Adhikari and Subedi went into healthcare in the U.S. despite the odds they faced in Bhutan and Nepal. They will never forget where they came from and the struggles they faced, but are grateful they have made it to a place they can call home, while working in a field they didn’t think could exist. Archarya,  Adhikari and Subedi went into healthcare because they realized the importance of it when they were without it in Nepal. They went into healthcare to help New Americans who, like them, are just hoping to start fresh.

According to Saurav Dahal, Health Coordinator at Lutheran Social Services, it is pretty common for New Americans to go into the healthcare field. Right now, a lot of Fargo-Moorhead New Americans are working with Sanford Health in the Environmental Health department. In addition to New Americans in Sanford, there are a number of students attending college for nursing, especially Bhutanese New Americans.

Health checks are vital to New Americans

Archarya,  Adhikari and Subedi play integral roles in healthcare for New Americans—and healthcare is among the most important things they have to deal with when they arrive in Fargo. Dahal said when refugees arrive in the US, the most common health issues seen among them are heart related , including hypertension. Vision and hearing impairment are also main health issues. When refugees go through their first medical screening, they go through examinations like the one Acharya referred to. LSS works with federally qualified health centers such as Family HealthCare in Fargo-Moorhead and Valley Community Healthcare in Grand Forks to conduct the first medical screening. At the screening testing is done to make sure there are no active diseases present and if there are any behavioral issues. The refugees then receive vaccinations they need and preemptive treatment for worms. Refugees are also tested for a tuberculosis infection or active disease by public health centers.

“Everyone might have dormant stage germ in their body so we provide preventive treatment,” Dahal said. “The cases for active tuberculosis is very rare because [refugees] go through a double screening process.”

Once the screening is complete, Dahal said the medical documents are scanned and sent to the Center of Disease Control and Prevention. The results are then sent to LSS through an electronic notification system. This system guarantees that everything is normal and if medics have to follow up on examinations with their patients.

“We provide them with initial screening when they get here within thirty days of arrival. Any specialized needs or special visits will be referred to them,” Dahal said.

Once the screenings are done, according to Dahal, in the initial months of being in the U.S., New Americans are below poverty level because they don’t have jobs and are new to the U.S. This status makes New Americans eligible for medical assistance or Medicaid. Once a New American starts working however, the Medicaid goes away and they have to find their own insurance in the Marketplace. Dahal said that what Adhikari does at Family HealthCare is navigate and guide New Americans through the Marketplace while they pay a monthly fee.

Working in the healthcare field

For seven years, Acharya has worked part-time at Family HealthCare as a medical interpreter. Acharya starts in the main lobby and helps patients get registered for their appointment, guide them through the clinic and sit in on their appointments to help interpret.

He also works full-time at Sanford, from 5 a.m. to 1:30 p.m. in Environmental Services.  He shows people what to do when they arrive at Sanford for the first time, escorting them to their appointments and letting them know what they are to do at that particular appointment.

“I love this job because I inform all people what is going on,” Acharya said.  “We get to know people in all fields and we get to help people. This field is more respectable than other fields. We become friends with many good people.”

Hari Subedi fled from  Beldangi II refugee camp in Nepal and has been in the U.S. for four years. He was one of the many New Americans who worked at Sanford. He also worked at Integrity Windows and Doors, Cultural Diversity (a non-profit organization) and ended up at Family Healthcare as a medical interpreter.

“I was just trying to find a job that fits for me,” Subedi said.

While working at Family HealthCare, Subedi receives a schedule full of appointments for New American patients. Some of the appointments are in the Family HealthCare Center, where he will help the patients register and interpret for them when talking to medical providers. Other appointments sometimes require Subedi to travel to Sanford, Essentia or into Grand Forks. When Subedi is not working as a medical interpreter, he helps cover at the receptionist desk or in the pharmacy.

Subedi chose to work at Family HealthCare because he remembers being treated there when he first arrived in the U.S. and because he received medical and interpreter training there when he was interpreting for Cultural Diversity.

Adhikari lived in Sanischare Refugee camp for 21 years. Not too long after he settled in Fargo-Moorhead, Adhikari went into the healthcare field. He was told that healthcare was the best place to get a job during the recession because it is a continuously growing profession. Adhikari first worked at Altru Health in Grand Forks. Then, after taking two semesters of pharmacy tech classes, Adhikari decided to move to Fargo and ended up working at Family HealthCare as a consultant for health insurance. He has been working there for two years now.

As a consultant for health insurance, Adhikari helps people find health coverage through the Marketplace, where all insurance companies can sell product policy at discount prices.

“I was excited. I never thought I could make it there, to the position where I never knew about it [in Nepal],” Adhikari said.

Journeys they’ll never forget

Adhikari, Acharya and Subedi have come a long way to live the lives they live now. They all come from Bhutan, a small Buddhist country surrounded by India, China and Nepal. Four-hundred years ago, the king of Bhutan wanted to increase his population with more skilled people to provide services in carpentry, farming and other positions. As time passed, the newcomers grew in numbers and grew in influence and the king began to fear they would overthrow him. So, between 1989 and 1991, if a citizen was Hindu and a descendent of Nepal they had to leave the country or be sent to jail.

Many of the Bhutanese Nepali refugees who have fled Bhutan and Nepal have resettled in the Fargo-Moorhead area. According to Dahal , based off of 19 years of data, Bhutanese and Bosnians make up 52 percent of refugees resettling in Fargo, while the rest of the percentage covers Arabic, Somali, Congolese and Peruvian refugees.

When Acharya and his family arrived in the U.S. at the Fargo Hector International Airport they met Dahal and Whitney Fierce, then a case manager with LSS. Just three days after being in the U.S., Acharya and his family were then brought to Family HealthCare to The New American Clinic. There refugees report everything to the doctor, making a medical history. After two weeks they then had a physical exam where they were also able to look at the results of the blood work that was done at the first screening.

Acharya lived in Beldangi II refugee camp for five years and lived in Nepal for 20 years. Several refugees left Nepal, because of the poor healthcare resources. Acharya said that when he first arrived in Beldangi II there were no clinics. If people fell ill they were taken to local hospitals and clinics outside of the camp. This became a growing issue as the population grew in the refugee camp and sickness increased.

People were dying and children had a slim chance of surviving the refugee camp until health organizations started to assist. The U.K. organization Save The Children Fund came and established Basic Health Units and young refugees finally found hope for surviving.  There children 16 and younger were assessed and if their illnesses were severe, they were sent to other hospitals. The World Health Organization and AMDA, Association of Medical Doctors of Asia also pitched in. AMDA is an international organization dedicated to providing humanitarian efforts through the medical health care sector. Under AMDA, medical doctors from different countries in Asia worked in the camp.

However, according to Acharya, the hospital posts weren’t managed well and unqualified doctor assistants took on the doctor’s role and prescribed medication. So, health resources may have become more accessible, but deaths still happened on a daily basis.

“People went there to see the doctor only when they were seriously sick. Most people didn’t know [they were sick] and died in their home,” Acharya said.

The day Acharya left Bhutan, he and his three friends left to see what the refugee camp was like in Nepal. When they reached the settlement, most of the refugees were living along the river bank, where they saw 75 people die that day.

Despite the horrific first day in Nepal, Acharya went back for his family in Bhutan and was determined to take them with him to Nepal. When Acharya finally returned with his family, he was happy to see that the refugee camp had moved off of the river bank, and was regulated under the international non-governmental organization, Caritas. People were starting to receive government help with food and water supply and minimal medical attention. Once Caritas stepped in, more refugees started arriving and the government had to supply for the growing population in the camp. So they provided “tents” or sheets, and huts along with the minimal resources they had.

While living in Nepal Acharya taught refugee students at a local school, “but everything was becoming darker and no hope or future was there,” Acharya said.

He had some money saved up from Bhutan and with his uncle’s help, he bought a piece of land outside of the camp and built a small house to take care of his family. From there, Acharya traveled to India, where he received his bachelor’s degree. He then returned back to Nepal and became a principal at a school near his house. Yet, no matter where Acharya went and no matter what his job was, he knew that he and his family couldn’t stay.

“They would kick us out at any day. We had a big tag on our head that said refugee. They would find out that I was a refugee and then kick us out. Everything was just temporary there,” Acharya said.

Acharya, his mom, four brothers and his uncles made the decision that they had to leave their little plot of land in Nepal.

“If we wish to go back then we will, if not I think we can make it in America. They call it the land of opportunity and we get to do something,” Acharya said. “For dad leaving was hard. He said, ‘No, I am old. I will stay here with my brother, here with mom. But, finally he said yes.”

Bad memories of healthcare

Even when Bhutanese Nepali refugees come to the U.S, past experiences in Nepal can cause a reluctance to go to medical appointments. In Nepal, when individuals were desperate for medical attention they went to the agency trauma center where they had to deposit money before they could be seen. However, if someone didn’t have the money, they became desperate and used alternative avenues to get medical help.

“We need a force from politicians or armed forces,” said Acharya, holding out  his arm as if he was holding someone at gunpoint. If the hospital wouldn’t give people what they needed, people weren’t afraid to threaten the doctor’s life in exchange for theirs.

Acharya added that if there was a medical system in place in Nepal, it was often corrupt.

Acharya said their poor health education also poses a great challenge, to the point where individuals have to be convinced to go to the hospital. Some of the refugees don’t want to learn more about available healthcare or they do not have the education to know when they should go to a hospital.

“The other problem is people lack education on health care. The most remote villages on earth are away from towns. They haven’t seen hospitals, doctors,” Acharya said. “It is hard to educate them. They do not like it. There were no resources to help them.”

Bhutanese Nepali are also the most uneducated and illiterate group of refugees in the Fargo-Moorhead area and often times cannot or do not want to learn about the health care resources available to them in the area.

According to Acharya, from the age groups of 16 to 24, 90 percent of the people are literate, can read and write and speak English while half of 24-40 year olds are literate.

“People like me, we went to college and did so many things, learned a little English, but, there are folks who never went to college never went to school,” Acharya said. “These people find it really hard to get into English and they need interpreters.”

For Bhutanese Nepali’s in the 40-60 year old range, only five percent speak English and the rest of them are completely helpless.

“The older age group is illiterate, like my dad and mom, but we teach them and make them read and write. My mom speaks English, but dad doesn’t like it. He says ‘My tongue is not used to speak English,” Acharya said.

Subedi’s journey

Subedi was born in Bhutan and when he left for Nepal in 1992, he ended up living in the Beldangi II refugee camp for about 24 years.

The refugee camp held 70,000 refugees at one time, and while Subedi was there that number had grown to 230,000.

It was hard living in the camp. The temperature in Nepal was high and Subedi and his family lived in a one-room bamboo house with no electricity and little protection from the elements. As mentioned before, in Beldangi II there was also poor access to healthcare and the help provided for the sick was very basic.

Despite his hardships, Subedi was able to get a bachelor’s degree in physics and was a teacher for the camp’s high school for about five years. When he arrived in the U.S, however, his degree didn’t transfer well because the education system was different. However, Subedi carried with him knowledge of American healthcare terminology and science, guiding his interest to the American medical field.

Empathy comes from experience

In 2013, Adhikari made it to the U.S. and resettled in California before he came to the Fargo-Moorhead area. Adhikari studied in Sanischare Refugee camp and remembers learning little about healthcare. He studied business in Nepal and received his Bachelor’s degree. According to Adhikari, Nepal had a decent education, but the lessons they learned didn’t extend beyond the classroom. Now that he is in the U.S., Adhikari can’t express how grateful he is to have found healthcare here.

“It was totally different [in Nepal]. We never heard of healthcare.” Adhikari said. “I studied it in school but we didn’t have it in practical life …. We didn’t know how it worked…. and now I feel so proud being in it,” Adhikari said.

The reason there was no health care system in Sanischare is because no one set up the coverage. Adhikari said that if people needed medicine, they could buy it over the counter or if they needed a doctor, they could see them. People could do whatever they wanted to get help, but, because there was a lack of a system, it didn’t help much. Similar to Beldangi II, doctors would visit Sanischare and set up health posts, but they weren’t managed well. There were health assistants present, but they acted like doctors and gave out medication without doctor provision.

In 2005 the U.S. Embassy visited Sanischare to ask if refugees were interested in resettling. Adhikari applied with is little brother, starting the two-to-three-year process to make it to the U.S. Adhikari’s parents came one and a half month later. Now, Adhikari is taking his new life in America in full swing.

“I like to go to different places and talk, to listen to other people … and someone wants to meet you and talk to you about your past,” Adhikari said. “I love talking, because the place or the world that we are living now and the place I come from is totally opposite. I feel so good to make a living here, to work with other people who live and study here.”

 

This piece was completed for the Investigating and Narrating the News course where all students reported  on refugee issues and stories in Fargo-Moorhead.