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Refugee Women’s Health

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Refugee Health Care

Abstract

Refugees are resilient survivors who have been displaced from war-torn countries where there was limited access to quality medical care and preventive health. Moreover, possessing low socioeconomic status, malnutrition, infectious diseases, and poor social support may have a deleterious impact on their health. Thus, caring for refugees provides an opportunity to provide culturally-sensitive care while addressing the unique cultural, linguistic, and literacy challenges which may impact their psychosocial adjustment, mental as well as physical health and well-being in their host country of resettlement. For refugee women, cultural and/or religious beliefs around sexual behavior, prenatal care, breastfeeding, cancer screening, contraception, intimate partner violence, and such traditional practices as Female Genital Cutting, may influence decisions that they make regarding their health care. Furthermore, health care providers should be prepared to address mental health concerns such as depression, anxiety, and posttraumatic stress disorder (PTSD), which often occurs within the context of immigration, acculturation, and rapid changes in family and social structures. Refugee women are a vulnerable population for whom culturally-informed care can promote health and wellness, as well as a trusting patient-provider relationship.

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Correspondence to Geetha Fink M.D., M.P.H. .

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Appendix: Suggested Assessment Questions and Strategies for Routine Screening of Violence Against Women

Appendix: Suggested Assessment Questions and Strategies for Routine Screening of Violence Against Women

The following sample assessment questions can also be used to develop a strategy most comfortable for each individual:

Framing Questions

  • “Because violence is so common in many people’s lives, I’ve begun to ask all my patients about it.”

  • “I am concerned that your symptoms may have been caused by someone hurting you.”

  • “I don’t know if this is (or ever has been) a problem for you, but many of the patients I see are dealing with abusive relationships. Some are too afraid or uncomfortable to bring it up themselves, so I’ve started asking about it routinely.”

Direct Verbal Questions

  • “Are you in a relationship with a person who physically hurts or threatens you?”

  • “Did someone cause these injuries? Was it your partner/husband?”

  • “Has your partner or ex-partner ever hit you or physically hurt you?”

  • “Do you (or did you ever) feel controlled or isolated by your partner?”

  • “Do you ever feel afraid of your partner? Do you feel you are in danger?”

  • “Is it safe for you to go home?”

  • “Has your partner ever forced you to have sex when you didn’t want to? Has your partner ever refused to practice safe sex?”

  • “Has any of this happened to you in previous relationships?”

Effective Assessment Strategies When Working Cross-culturally

It is important to adapt your assessment questions and approach in order to be culturally relevant to individual patients. Listen to patients, pay attention to words that are used in different cultural settings and integrate those into assessment questions. Focusing on actions and behaviors as opposed to culturally specific terminology can also help, or some groups may be more willing to discuss abuse if you use general questions. Be aware of verbal and nonverbal cultural cues (eye contact or not, patterns of silence, spacing, and active listening during the interview).

Some examples include:

  • Use your patient’s language: “Does your boyfriend disrespect you?”

  • Be culturally specific: “Abuse is widespread and can happen even in lesbian relationships.

  • Does your partner ever try to hurt you?”

  • Focus on behaviors: “Has you partner ever hit, shoved, or threatened to kill you?”

  • Begin by being indirect: “If a family member or friend was being hurt or threatened by a partner, do you know of resources that could help them?”

(Adapted from the National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings. The Family Violence Prevention Fund, 2004. Accessed 2/12/2013: http://www.futureswithoutviolence.org/userfiles/file/Consensus.pdf )

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Fink, G., Helm, T., Belknap, K., Johnson-Agbakwu, C.E. (2014). Refugee Women’s Health. In: Annamalai, A. (eds) Refugee Health Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0271-2_15

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