Authors: Daniel Te, Patricia Chen, Mimi Chung, Andy Zheng For our final day of the trip, we met up with La Puerta Abierta, an organization that focuses on mental health for immigrants. The other Breakout Trip in Philadelphia joined us for this meeting, since they are focusing on mental illness.
Cathi Tillman, the founder of LPA, briefly discussed the organization’s goals. LPA works with many organizations in the area, most notably HIAS-PA, which we visited yesterday. Unlike organizations we had visited previously, LPA does not focus on refugees. Rather, Cathi specified that there is no such thing as a “deserving” immigrant that should be treated over another; all immigrants are equally qualified for assistance. Many of the immigrants treated at La Puerta Abierta are Latinx, since LPA specializes in assisting this community. In particular, Cathi cited three countries in the “Northern Triangle” - Guatemala, El Salvador, and Honduras - as places in which many recent immigrants have come from, especially with a recent upsurge in 2014. These are often children who are fleeing from unsafe conditions, most notably from gang violence. If these children are not with their parents or have abusive or neglectful parents when they immigrate to the United States, they may be qualified to apply for Special Immigrant Juvenile Status, allowing them to then apply for a green card and eventually, citizenship. However, the parents lose legal custody of those with SIJS, and this is not a guaranteed path to citizenship. Even when these children are in the United States, they have not necessarily escaped stress. The current political climate adds to the already large number of psychosocial stressors on all immigrants. Undocumented immigrants experience even more pressure, since they fear deportation as well. In addition to ICE raids that may occur throughout the city, undocumented immigrants also have to avoid committing any kind of crimes, even misdemeanors; if they are detained in any kind of way, they are at a much higher risk for deportation. LPA considers these conditions when they treat immigrants. As such, they try to reduce stressors as much as possible. All of their services are free, since LPA knows that any kind of extra monetary burden may negatively affect these already financially-strapped immigrants. In addition, their mental health services use both culturally-informed and trauma-informed lenses, which are layers of consideration beyond most conventional mental health services. LPA does not use a traditional mental health treatment method, which would usually include an intake, subsequent diagnosis and treatment of an identified problem. Instead, LPA focuses on providing a welcoming and safe environment in which immigrants can express themselves and their stories; Cathi said that LPA seeks to understand the problem and listen to the immigrants. As such, there are after-school activities, such as “Compás de Viaje,” that children can attend, which often involve engaging exercises such as art, creative writing, and storytelling. Cathi also mentioned a particularly impactful artist who works with the organization, named Carlos, who contributes to create a supportive environment with his art and welcoming presence. Although LPA may be a small grassroots organization, they are growing and hope to serve even more people in the future. At first, they had a rather small budget and office, but over the years, they have moved into a larger office and now work with over 100 different providers, with new ones contacting them nearly every week. They will likely continue to grow. Organizations like LPA provide hope for the future that more immigrants’ needs will be met. It’s been an eventful week on this breakout trip, featuring visits and talks with NSC, AFRICOM, HIAS-PA, Jefferson Health Center, and LPA. All of these organizations provided a different perspective on immigrant issues and access to healthcare, giving us a holistic view of such complex topics. Even after the trip is over, we’ll continue to think about the challenges that these organizations and communities face, and as the current situation continues to evolve, we’ll be ready with an informed viewpoint and a deeper understanding than before.
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Authors: Andy Zheng, Mimi Chung, Daniel Te, and Patricia Chen We started our Thursday at HIAS Pennsylvania, another refugee resettlement agency like the NSC. Meeting with Kerry Coughlin, we first learned about the refugee resettlement agency, which does similar work to that of NSC. Coughlin was kind enough to take the time to explain the exact role that refugee resettlement agencies, like their organization, did. Logistically, accepted refugee applications in the US are sent to Volunteer Agencies (VolAgs) in the US to determine specifically where the refugees would resettle, using a number of determinants such as family ties or presence of specific large communities. Then, the local chapter has 10-14 days to coordinate logistics to help welcome the refugees. Specifically in Philly, most of the refugees are settled in South Philly or Northeast Philly depending on their demographics. For example, most of the Congolese populations are settled in South Philly while the Syrians settle mainly in Northeast Philly. By settling in areas with concentrated demographics, the refugees have a built-in network of support within the community to ease their transition process.
Almost immediately after settling the housing situation, a case worker starts working with the refugee to get various necessary documents such as a medical examination, vaccination, physicals, and school registration. Additionally, they enroll in ESL courses, find employment, and register for Keystone First, Philly's own medical assistant program that lasts for 8 months. Since the resettlement period is only 3 months, little time can be spared to adjust to the new environment. Even after 3 months, HIAS (and NSC) often refer refugees to other support groups to help them acclimate to Philly. Interestingly, the ESL classes at HIAS are pro bono, and refugees do not get benefits, unlike at NSC, where they receive welfare benefits for attending ESL classes. HIAS provides better legal services while NSC works more heavily with social work, including robust ESL classes and a small army of interpreters covering over 150 languages. Because of their respective strengths, the two organizations often work together through cross referrals to provide the best care for these refugees. For HIAS-PA, their strong legal team helps with a range of refugee populations, including conventional refugees fleeting violence or natural disasters in their home country, those applying for Special Immigrant Visas, unaccompanied minors, and victims of domestic violence. The process for conventional refugees is commonly heard, but we were not as familiar with other types of refugees. For 10,000 Iraqis and Afghans who helped the US government through services such as translational or military services, Special Immigrant Visas allow them to come to the US to escape persecution. Unaccompanied minors often come from gang-prone countries such as Honduras, El Salvador, and Guatemala. Lastly, the victims of domestic violence, often women whose legal status is tied to their partners, can apply for a U-Visa so they can have independent legal status. One interesting population that was mentioned was the Rohingya minority in Burma. Though current news focuses on the recent human rights violations against this Muslim minority, the increase in Burmese presence is actually due to the second wave of emigrants from Burma who left multiple years ago, and who mostly stayed at Australian islands as detainees. This shows the lengthy bureaucratic barrier that refugees must face which inevitably increases distress in this population. Another recently emerging population is the Ugandan LGBT+ population, which is not often discussed in current events. Apart from the difficulties faced by the refugee immigrants, HIAS and other similar organization face their own challenges in receiving refugees. Funding is a constant source of concern for non-profits, even causing competition between similar organizations for the same grants. This means that it is harder to deliver comprehensive care for the refugees, adding more burden for both parties. The current political climate has made it increasingly difficult to continue daily operations. With the record low cap on refugees and the travel ban affecting Syrian and Iranian refugees, HIAS received only 15 refugee resettlement cases in the first quarter of the 2018 fiscal year, compared to the 150-200 previous yearly norm. Since funding is provided on a per case basis, the amount of funding has subsequently decreased. Partly due to the decrease in funding as well as the aim to provide more comprehensive care for the immigrant population, HIAS-PA is now considering a new model of operation that would synthesize the resettlement agency with its legal service team. They aim to provide both services to everyone. This change would integrate the organization by incorporating social and legal services to each department, like healthcare, employment, and naturalization. We look forward to the new development in infrastructure to help the immigrant population in Philly! ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ On the latter half of the day, we talked to Dr. Marc Altshuler, the director of the Jefferson Center for Refugee Health, which is part of the Philadelphia Refugee Health Collaborative. It consists of the 3 resettlement agencies (HIAS, NSC, and Bethany Christian Services) and the 8 refugee health clinics. The Jefferson Center for Refugee Health mainly focuses on expediting the wait time for refugees to receive their initial medical examination since the refugees only get 8 months of health insurance when they initially arrive. Since the formation of the Collaborative, the average wait time has decreased from 130 days to around 20 days, with most of the appointments at academic centers instead of the community health centers. The major system that the organization follows is the medical home framework, which incorporates as many services at one place to make medical care more inclusive. This means that the providers not only care for the medical needs but also encourage follow-ups by easing the process for these appointments and receiving prescriptions. Medical interpreters on the phone are paid for out-of-pocket by the Jefferson health system. To facilitate more inclusive access, the center is the only clinic in Philadelphia that offers home visits, which allows easier access to health resources. Finally, they require culturally informed training for all family medicine residents at Jefferson. Apart from the medical home framework, the Center also aims to accommodate demographic differences among these populations. Dr. Altshuler mentioned that they mainly serve people from Burma, Nepal, and Iraq. However, different groups required different care: for example, the violence in Burma necessitates mental health screenings; Iraqis and Afghans have higher socioeconomic status, which makes hypertension, lung cancer, and heart disease to be a major source of concern. Finally, screening for B12 deficiencies is done for Nepalese refugees. Looking forward, Dr. Altshuler hopes to increase services for free health clinics throughout the city. Though often understaffed, the organization wants not only to provide care for a wide range of immigrants, but also to act as advocates for them throughout the country. Thanks for reading! On our last day, we'll head to La Puerta Abierta. Authors: Daniel Te, Andy Zheng, Mimi Chung, Patricia Chen A beautiful flurry of March snow and sleet woke us up on our fourth full day in Philly. After a late-morning brunch of pancakes and strawberries while watching snow slowly pile up, we had a video call with Dr. Eric Edi, the current COO and president of the Coalition of African and Caribbean Communities (AFRICOM) as well as a lecturer at Philadelphia University, College of Science, Health and Liberal Arts. He spoke to us about a variety of issues, ranging from health policy to advocacy.
Our meeting began with a brief historical overview of the start of the organization. Due to an upsurge in Sudanese and Liberian immigrants in 2000, many different African civil societies joined at the Balch Institute, today known as the Historical Society of Pennsylvania, to form AFRICOM. The networking roles of AFRICOM included outreach to resources of healthcare, legal care, trauma care, mental health, anti-human trafficking, political advocacy, and social and religious centers. The organization, though not a direct service provider, hopes to empower immigrants and to build their internal capacity. AFRICOM mainly operates through referrals to many essential services. In Philadelphia, West and Central Africa are most represented, with fewer Southern and Eastern Africans. Through social media posts and radio announcements in five different language, they reach out to African immigrants. Pro-bono lawyers and medical providers can be reached through AFRICOM's services. Staffing their organization are highly competent members who can speak many different African languages, many operating on a completely volunteer basis. They also offer leadership assistance and partner with researchers interested in this immigrant population. Some major problems recognized by AFRICOM in their communities includes a generally low socio-economic status, an often large language barrier, and cultural differences between immigrants and legal/medical providers. We specifically focused on medical problems commonly seen. African immigrants are less likely to come in for preventable cancer screenings, such as for prostate and cervical cancer. AFRICOM also addresses chronic health issues, HIV and sickle cell disease. Additionally, to de-stigmatize mental health, the organization trains community leaders through health forums, for example, to understand autism. Interestingly, AFRICOM recently partnered with researchers at the African Family Health Organization (AFHO) to study culturally appropriate questions. Another partnership with UPenn medical students helped assess the needs of immigrants. Dr. Edi also discussed the effect of the current political climate on the work that AFRICOM does. One of the most noticeable impacts is the decrease in attendance for legal clinics, which offer pro bono legal services intended to naturalize African immigrants. This is likely due to the increased xenophobia fostered by the current administration exacerbated through travel bans around the Middle East and Northern Africa region and the controversy around DACA. An initiative to combat this is embedded in the upcoming agenda of AFRICOM of empowering community leaders through various trainings and health forums. These trainings are meant to encourage activism in various communities to advocate for their own voices through political involvement. Since African immigrants, and citizens at large, are often politically inactive, this initiative will hopefully bring about a louder voice for the African immigrants. AFRICOM wants to work more on their community outreach efforts. As of now, they use social media in order to reach out to a larger number of immigrants, with Dr. Edi citing platforms such as WhatsApp and Facebook as services that many immigrants have access to. In addition, they actively work with religious organizations such as churches and mosques. These institutions not only provide for the varied religious needs of the immigrants, but they also provide space for community activities and help foster a sense of togetherness. For the future, Dr. Edi said that AFRICOM wants to offer more training classes to raise awareness and to get more involved with community leaders and lawmakers. Hopefully the snow melts tomorrow! We really appreciated meeting with Dr. Edi, who had such an interesting perspective on the Philly immigrant community. Come back tomorrow for more about our Breakout trip! 3/20/2018 0 Comments Tuesday, March 20-Immigration TourAuthors: Andy Zheng, Patricia Chen, Mimi Chung Today we got the chance to learn more about historical immigration and healthcare practices in Philly. We spent the day on the immigration tour, stopping by historical taverns, museums, churches and other relevant landmarks. The first museum we visited was the Independence Seaport Museum. The museum had exhibits on the formation of the US Navy, shipbuilding, and perhaps most interestingly, the forced immigration of slaves. We gained perspective on the slave trade and the subsequent effects of discrimination, especially the formation of Jim Crow laws following Reconstruction until the Civil Rights Movement. One of the most powerful displays was a story about an 18-year-old slave girl who escaped through the Underground Railroad in a cargo box. A reconstruction of this box allowed us to physically experience the claustrophobic environment she was subjected to, enabling us to imagine the hardships she endured in the eighteen fearful hours until she could reach the free state of Pennsylvania. Another compelling exhibit dealt with the slave auction. Visitors were invited to stand on a mock platform that reflected how slaves were bought and sold on the port. The only way to hear the audio recording was to stand in the footprints on the platform. Despite the fact that no one was around, it felt extremely uncomfortable and dehumanizing to be presented as nothing but a product. We couldn't imagine how confused and scared the slaves were, not understanding the language or what the future held for them and their family.
After leaving the museum, we visited the first Catholic church in Philadelphia, a city originally settled by Protestant Quakers. This reinforced how important religious communities can be for new immigrants to assimilate to their new country - which reminded us of Merthus's similar experiences with his faith. The next museum, involving Polish American immigration, highlighted unique aspects of the Polish culture, like folk art, and Polish immigration to America. One interesting fact was that Polish immigrants first arrived in 1608 to Jamestown, much earlier than conventional understanding of Eastern European immigration to the US. Then, we were able to experience Philly's signature food item, the Philly cheesesteak! After lunch, we visited the Mütter museum, which was founded by the College of Physicians of Philadelphia by Thomas Mütter to express the oddities of the human body. There were fascinating exhibits of every organ and their possible pathologies. They had many exciting authentic artifacts and model recreations on display including the skeleton of the second tallest man in the world. There was also a cast made of a pair of conjoined twins who were mainly connected through their liver. The museum was an interesting perspective on medical history and how much healthcare has evolved. Thanks for tuning in. Tomorrow we're likely to be snowed inside. Author: Patricia Chen, Daniel Te, Andy Zheng, and Mimi ChungToday we spent our day at the Nationalities Service Center (NSC). Farhana, one of the volunteer coordinators at the center, showed us around the whole day. We started in the morning with a crash course on migrant terminology, services offered to refugees, and statistics of recent trends. One interesting activity that we did during the orientation was that we were given a hypothetical scenario of having to pack a suitcase with stuff that we would bring if we had to escape our home country immediately. This was to simulate the reality that many refugees must face. During the activity, she mentioned useful objects, some of which we did not consider, including IDs, government issued documentations, flashlights, knives, matches, guns, pets, and mementos. Family photos and mementos are especially important because they can help refugees unite with their family without having to overcome a language barrier. Another interesting item she mentioned to NOT bring was our phones because there is the risk of the government tracking the refugee.
After the orientation, we had the chance to help out at an ESL classroom, focusing on interviewing skills for the day. Each of us were paired with two or three refugees. Upon knowing them, we learned about the wide range of demographics represented by the refugees, including Myanmar, Uganda, Eritrea, New Guinea, Pakistan, Syria, Haiti, and DRC. We were surprised by the number of countries these refugees came from. Our conversations varied from communicating through drawings to discussing family and culture. We also had two refugees who opened up about their experiences as Christians living in Myanmar, being persecuted by the Buddhist government. There were two refugees who had more advanced English skills that were eager to learn more about interview techniques. Later, as we were helping sort kitchen appliances and clothing donations to the NSC, we realized the implications of donation. Before our work, we considered donating an overwhelmingly positive action without considering not only the work required to bring these items to those in need, but also how their quality can reflect how we might trivialize the necessities of these immigrants and refugees. When we were arranging the clothes for people served by the center, some of the jackets were in less-than-ideal condition. In a similar vein, some of the kitchen items given to NSC were of very limited use, such as a cookie dough scooper and a madeleine baking pan. This made us think about how we often donate items without considering the needs of the people who receive them and instead use donation as a more "ethical" disposal system. Finally, we spent the afternoon helping in the community garden plot by NSC. Many of the plots were designated for the refugee clients to plant seeds from their native countries. The garden manager had been a refugee who went through the services of NSC, and he had been managing the garden for two years. We really enjoyed his enthusiasm in showing us his work. He told us about his experiences in America, specifically his struggles with loneliness in the first few months and his appreciation of the people that he's met through his church. We helped him out by weeding out some of the plots, and in addition to that, we got the opportunity to talk more to Farhana about her work with NSC. Tomorrow, we have our immigration tour around Philly. Come back tomorrow for more about our trip! By Mimi Chung, Andy Zheng, Patricia Chen, and Daniel Te A sunny and cold morning opened our first full day in the City of Love! Along with the other group located in Philly on mental health, we helped our host site with gardening. Our wonderful host, Bob Zigmund, provided us with wheelbarrows, garden gloves, shovels, rakes, pitchforks, and the best stories. We managed not only to use a giant pile of mulch, but also got to work together and know each other better. Because our church is a heritage site for Philadelphia, we learned more about the history of the city as we wandered along the cobblestone road. Bob was gracious enough to provide us with a scrumptious pizza lunch. As we went to pick up a pizza, he also pointed out interesting historical landmarks only a couple of blocks away from the church.
After our day's work, Andy and Patricia went on a walking tour of Philly with some of the participants from Alexia's and Karina's group, while Mimi and Daniel stayed back to cook and reflect on our day. On the walking tour, we first explored the Liberty Bell. There, someone explained the history of the bell, from its construction in 1753 to how it cracked after it was struck twice. It is fascinating that the exact reason for the bell cracking remains unclear. Then, we went past Independence Hall and explored the scenery around City Hall. We also touched upon other landmarks such as the LOVE sign, Franklin Park, and the Art Museum. Our dinner of burgers and salad was a perfect way to debrief for the day and prepare for engaging in our topic with the community. Tomorrow, we're heading to the Nationalities Service Center bright and early to learn more about their work with providing immigrants with important resources. Catch us tomorrow to learn about our second service day! - The Care Past Customs Trip |
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