Healthcare Challenges Among Refugees from Burma: An Explorative Study

Background and Purpose: Buffalo has recently become home to more than 8,000 refugees from Burma. Given the political turmoil in their homeland and protracted stay in refugee camps, their health status warrants closer attention. While current literature indicates that refugees with limited English proficiency and unfamiliarity with western-based healthcare system face significant barriers accessing healthcare services, little is known about how recent refugees from Burma manage and navigate U.S. healthcare systems. The purpose of this study is to fill this gap by examining the accounts of Burmese- and Karen-speaking community leaders who regularly facilitate healthcare access as interpreters, healthcare professionals, and paraprofessionals.

Methods: Eleven in-depth, semi-structured interviews were conducted with Burmese and Karen community leaders (6 men and 5 women) in Buffalo. Participants were recruited through ethnic community-based organizations and professional contacts. Interviews elicited community leaders’ views based on their experiences working with community members, either as an interpreter at healthcare settings or as staff at local health and social service agencies. Interviews were transcribed verbatim and independently analyzed by two researchers using open and focused coding approach guided by the principles of grounded theory. Concepts, categories and themes were identified through a constant comparison method, and the relationships between themes were represented through a conceptual diagram.

Findings: Data analysis revealed five themes related to the challenges in available healthcare services use among refugees from Burma. Theme 1 (unfamiliar healthcare system) identifies that the U.S.  healthcare system is complicated for refugees to navigate. The requirement in the system create logistic obstacles such as filling out paperwork and making appointments. Theme 2 (knowledge gap) suggests a need for essential health information, such as promoting a healthy life style, recognizing medical symptoms and side effects. Issues with Themes 1 & 2 may occur before, during and/or after a doctor visit. Theme 3 (interpretation) refers to issues that arise when refugees interact with physicians. It highlights the importance of well-trained interpreters who can act as cultural brokers, aid in information flow, and facilitate clear communication. Theme 4 (expectations) uncovers specific experiences about healthcare in Burma that involve immediate relief of symptoms through medications or injections. Refugees also expect doctors to demonstrate caring and nurturing attitudes like the ones they had during their visits in Burma. Finally, theme 5 (self-medication) includes alternative methods refugees rely on, such as use of antibiotics or herbal medicine obtained from Burma.

Conclusion and Implications: This study expands the understanding of the unique and specific healthcare access issues that refugees from Burma encounter. Healthcare providers lack culturally specific information about these refugees, which limits their ability to deliver optimal care possible. Based on this study’s findings, best practices for healthcare providers are recommended to improve the quality of healthcare services to this vulnerable refugee population. In addition, useful information and appropriate support are identified for refugees in utilizing healthcare services. These findings will help advocate for policy changes that will minimize – and ultimately remove – existing disparities in healthcare utilization.