LAST WEEK WE WERE AT A branch of Sun Trust Bank helping P obtain past bank statements, a requirement for the Orange Card (indigent health care) issued by the Guilford Community Care Network. While we waited, our Montagnard community health worker (CHW) recognized a neighbor and they began to chat. N’s family had been here for a short while. He worked hard, saved thousands, and then spent it to get them here and settled in their new home. He looked slightly tired and a bit worried, but appreciative of our offer to come by his house and see what we could do to help. His English comprehension was rudimentary and communication would not have been possible without the CHW. He said his younger kids had been enrolled into Newcomers School but the oldest boy, in his twenties, needed to learn English and seek a job. We took down his details and promised to visit.
This week we planned to go to N’s apartment to interview the family and see what we could do. We knew he was on second shift so a 10 AM meeting would be convenient. Before going over, we reviewed the family’s information. We knew the location of the apartment complex and other families who lived there. We reviewed the Orange Card application form and decided to test our newest CHW member, a former doctor, and her abilities to complete the form.
We pulled up to the complex. The parking lot was poorly graded with litter on the ground, but this place was not as bad as some apartments which are battered and falling apart. We got a very friendly greeting as the apartment door opened. We pushed off our shoes and entered. Three men were playing cards on the living room floor. Another young man was lying down on a sofa bed watching the card game. One of the card players was holding a baby. Her sister lay snuggled in a child's chair that doubled as a cozy bed. N’s wife sat above the girl, watching her. Between the living room and the kitchen a portable heater glowed, making the room comfortable. The apartment was sparse but tidy and clean. The TV played “Slumdog Millionaire” with English captions. The volume was set low. We sat down. The three CHWs, all Montagnard women, began to chat and make introductions. As it turned out, N was related to the husband of our former doctor CHW. This made our conversation very easy.
We were told N was running errands and would soon return. Laughter and jokes and playing with the baby and little girl filled the time.
The oldest needed to find a job but also needed to learn English. We told him Reading Connections taught an ESOL class just a few blocks away, every Saturday. His friend explained he’d like to go to GTCC but he works ten hours a day and is usually too tired to go to night school. This started a general discussion about the importance of learning English. We encouraged the mom to go, too. We repeated the class time and emphasized that class is free. The younger children at Newcomers School don’t have Medicaid coverage. The father didn’t know why.
As the interview continued, the neighbors left. We encouraged the working boy as he said his goodbyes to make the effort to go to English class.
The little girl woke up. She and her sister are the daughters of a D. I hadn’t seen him in over a year, then saw him just recently at a Christmas pageant.
N arrived. He warmly greeted us and our former doctor CHW. Everyone sat and she started the interview. An Orange Card application usually requires ID, Social Security card, recent bank statements confirming assets, employment check stubs to prove work income, and a recent tax return. We checked their documentation. All of the family had green cards but not North Carolina ID. They didn't have their Social Security cards yet. N’s address on his ID was old and needed replacing. Did he think he could get it updated? Did he know how to get to the DMV? We discussed how much an updated ID costs. He felt sure he can do this on his own. His bank statements were missing. He said he didn’t inform his bank about his new address when he got this apartment for his family. This lead to a discussion about his food stamp application which is two months old. Maybe it was sent to his old address? We’re not sure. We decided we could help him check into this next week. He had his tax return in order and he has recent pay statements from his employer.
Before we left we told N about the proximity of ESOL class and repeated our encouragement to the oldest son and his mom in his presence. In the parking lot the CHWs talked to a young Montagnard couple who were getting in their car.
We then accompanied N to Sun Trust to get bank statement printouts. On the way we dropped off two of our CHWs, then went on to the bank. We made sure the bank clerk understood his request. The clerk updated his address and because his bank card was old, put in an application on his behalf for a new one. We said our goodbyes in the Sun Trust parking lot. The CHWs would follow up next week.
As I turned to my car, I greeted another refugee man I'd been meaning to talk to. We made a lunch date. Another guy pulled up and waved. We got his him an Orange Card last week.
Final note: The original CHW team has managed to stay together despite modest funding that’s been stop and go. As they introduce a third member, a former doctor, to their work, they stand a better chance of making an even greater impact in the lives of their neighbors. Through their sacrifices and hard work, we’ve gotten the help of more than 50 Montagnard families and learned about their struggles and lives in the Triad. As we learn more about how refugees make decisions, we see solutions that can reduce costs and improve health.
(See Part 1) |
Banks under-serve refugees by not communicating the range of their services.
The Network includes Moses Cone and High Point Regional health systems.
CHWs often discover problems and issues by just talking to neighbors. They are the only regular contact we have into the lives of families and the status of neighborhoods. Male leaders — pastors, elders, etc — are too busy.
Because the CHWs speak 7+ languages, they can overcome the biggest obstacle to good Montagnard health: communication.
Every refugee kid we’ve talked to has spoken positively about Newcomers School.
Older kids who come to the US don’t benefit from intensive schooling and socialization. Located in the 27405 zip code. The form is 9-pages long and beyond the English skills of most refugees to complete on their own. Most families qualify for indigent health care. It is not free or comprehensive, but it’s better than nothing. The rent is cheap — enough for a working class family to save money — and the neighborhood appears safe. A Montagnard church is nearby. Montaganrd food stores are a 5-minute drive away. Walmart in ten minutes away. An American volunteer once came upon a similar scene and assumed the neighbors were freeloaders.
The air was clear and had no traces of cigarette smoke or old kitchen odors. Some refugees have a difficult time adjusting to our cold winters, keep the temperature exceedingly warm, and rarely vent the apartment.
Most people in the Montagnard community know one another by at least one or two connections. Even if there is not a blood relation, they may have come from adjacent villages. Women CHWs have a very easy way of connecting with the families we visit. The family can’t survive on one income.
A progressive nonprofit that has increased its class offerings to refugee and immigrant communities.
But without English skills, he’s likely to remain in a low-skill, low-pay job.
Mothers are often the least educated and burdened with raising family, cleaning the house and cooking, put English second.
Montagnard school kids are usually eligible for Health Choice, a Medicaid program.
We wish to make a good connection to the neighbors so we can interview them in the future. For the past year D has been doing well. With both parents employed, they can afford to pay A----’s wife to look after their kids. Although the requirements seem simple, functional families like A----’s can still have problems gathering documents together.
Outdated IDs are not unusual.
Costs are always important in refugee decision-making.
Some families throw them away because they don’t understand how to read them or why they should keep them, but not in this case.
Most families, even those that have been here for years, qualify for food stamps.
We take every opportunity to encourage mothers to get out of the house and socialize. At Montagnard Dega Association, we observed how important this was.
This branch serves a neighborhood that used to be mixed black and white working class, but is now more 50% Montagnard. |
The first mom is middle aged. Her husband worked but made poverty level (minimum) wages, easily qualifying her for the Orange Card. At the qualifying interview she failed to bring bank statements even though we explained their necessity. The family made it a regular habit to throw them away and because only her husband's name appeared on the statement, we couldn't go to the bank and get copies.
The second mom came from a very troubled home. She looks like she's sixty but her ID states she's in her early 50s. She has several grown kids back in Vietnam and lots of grandchildren there, too. Several months ago we tried to get her an Orange Card and failed. Then we tried again at a health fair. Her paper work was good and her son accompanied her to verify his wages. But she never got her card. By our third try her family's circumstances had changed. Her husband was out of jail but unemployed. The son was no longer being paid under the table by his employer. He had check stubs — proof of income — but now he was working out of state. He'd be back in another week, maybe. In the meantime, our second mom suffers from chronic pain.
The third mom is from a young family. The husband works sporadically and is now out of town. We'd like to get him to verify his wages (again, they're poverty level). The husband doesn't have a great reputation but we're trying to help his wife, not him. If we can get records of his recent wages she can get an Orange Card. We have asked a community leader for additional assistance.
The fourth mom is middle aged. Her husband is elderly but works part time. She is well liked by people in her community and has rudimentary writing skills. She has all her paper work in order and receives her Orange Card. Our lay health workers will follow up and schedule her first doctor's appointment at Healthserve with a call next week.
A. NCTraCS Pilot Program $2,000 health grantA grant to investigate a community health problem.
B. NCTraCS Community-Based Participatory Research charretteAn expertly facilitated meeting to generate a fundable, community-based health research project.
C. Montagnard Health Professional Study, Huaibo Xin, DrPH, MD, MPHA study to investigate the problems faced by Montagnard health professionals.
D. Montagnard Food Insecurity Study, Jigna Dharod, PhDAn expanded study of the food, diet, and health problems experienced by the Montagnard community.
A. The lay health team interprets and communicates effectively to a preliterate, multilingual population at 40% of the standard rate ($20 per hour compared to $50 per hour).
B. It frees scarce, highly qualified translators and interpreters to do more important work.
C. As a regular community presence, it reduces costs by making sure patients understand and follow basic instructions, arrive on time, bring essential documents, etc.
E. Montagnard former physicians and US-trained professionals are the final pieces to a permanent bridge to good health, patient compliance and reducing health costs.
F. Both require modest, stable funding.
