Sudan native Samir Abdo arrived in the U.S. 10 months ago as a refugee from Libya, first living in Houston. Alone, he adjusted to life in a new country with help from the federally-funded Refugee Resettlement program.

As part of the program, Abdo’s refugee medical assistance card covered basic health care needs for eight months. He had friends in Garden City who invited him to live with them.

Now living in Garden City at age 25, Abdo’s eight months have run out and he is without health insurance. Abdo, who said he visited a doctor in Libya when needed, said he is focused on getting a job and will worry about health care later.

“I’m good. I’m healthy,” he said.

Abdo has been working with an instructor at the Garden City Community College Access and Opportunity Center to find a job. With the job, he hopes, will come health insurance.

Refugees in Garden City

Many refugees over the years have relocated to Garden City to work at the Tyson Fresh Meats plant near Holcomb, which provides health insurance. However, many go without health insurance for a period of time between when the federal program ends and a job begins.

Refugees often rely on the emergency room when a medical need arises because they do not have health insurance. This leaves hospitals to absorb the costs. According to the CDC, in 2015, 15 percent of emergency room visits in the U.S. were uninsured.

The American College of Emergency Physicians reports that hospitals and physicians absorb uncompensated care, which reaches about $86 million a year.

Shawna Deal, community relations coordinator at St. Catherine Hospital, which treats uninsured patients, said the hospital is focused on meeting community needs and increasing the community’s access to health care.

“We balance these costs by being part of a system like Centura Health, which affords us ‘economies of scale’ and a lower operating cost, attracting a disproportionately larger insured population and philanthropy from generous, supportive and like-minded residents across western Kansas,” said Scott Taylor, CEO and president of St. Catherine.

The total cost of charity care for the fiscal year through March 31, 2016, was $2.75 million, according to Deal.

Approximately 770 refugees resettle in Kansas annually, according to the U.S. Office of Refugee Resettlement. Sister Janice Thome with the Dominican Sisters Ministry of Presence, said most of the recent refugees in Garden City come from Somalia, Myanmar (formerly Burma) and Sudan.

These refugees often live in refugee camps for a period of time before resettling in the U.S. Many refugees’ health suffers as they flee their countries and live in refugee camps, often in poor conditions.

A 2015 United Nations High Commissioner for Refugees report on displaced persons in Africa states that “emergency situations saw refugees arriving in countries of asylum in poor health and nutritional status.” It reports that “non-communicable diseases have become an increasing public health problem among refugees,” and that they require “expensive treatments.”

“(Refugees’ health) has to be good before they can leave the refugee camp and enter the U.S.,” Thome said. “When they arrive, their first stop is the health department, where their health history gets checked and they get up-to-date shots.

Health Care Assistance

Kur Shida Binti Zahir Ahmad traveled to the U.S. from Malaysia in September 2015 with her husband and three children. In her home country, her family did not have health insurance. They would pay out-of-pocket or rely on home remedies.

In the U.S., Ahmad’s children and husband receive health care through his job at Tyson. But she is not covered.

“I’m frustrated because it is hard to get access to health care,” said Ahmad, who has had trouble applying for health care and understanding how to fill out forms.

Genesis Family Health in Garden City supports refugees that may not have insurance or are not making enough income to pay for their service. According to Sarah Trapp, Genesis chief development officer, the agency operates on a sliding fee scale, which evaluates a person or family’s income and provides reduced fees based on that. The health clinic also offers fee forgiveness for those who have absolutely no income.

“Everyone is welcome, whether they have insurance or not,” Trapp said.

Health Care Culture Clash

Linda Miller, coordinator of the GCCC Adult Learning Center who also works with the Access and Opportunity Center, sees many of the refugees when they arrive in Finney County. Regardless of health care availability, she said, cultural differences affect curing the ill or injured.

Miller said many of her students would prefer to use home remedies to cure ailments instead of visiting the doctor. She described how some extract sap from certain tree leaves sent from their home countries to be used as a cure. Others use camel milk as a cure but cannot access it here.

“That’s really hard for them,” Miller said. “They ask, ‘Why don’t we have this here?’ They say those things have certain nutrients they need. They don’t think about taking vitamins or pills. It is all home health care.”

Miller said many Burmese women want to give birth at home, a common practice in Myanmar. She said they had to teach them to go to the hospital.

During classes at the Access and Opportunity Center, refugees learn about U.S. health care. The program covers when to call 911 and when not to, symptoms of various medical emergencies, where doctor’s offices and hospitals are located, and even simple things such as using deodorant and basic dental care. Refugees also are taught about nutrition and the My Plate system, the government’s nutrition standards, which replaced the food pyramid.

“We are always pushing to get more refugees in school because we know how important it is for them to get the education,” Miller said.

Ikran Said, a 19-year-old Somali refugee, learned how important that education could be. She fell into a two-day coma after mistakenly drinking a household-cleaning product. She did not understand the cleaner was harmful. Said went to the emergency room at St. Catherine before being airlifted to a Wichita hospital. She eventually made a full recovery.

Said does not have health insurance and pays out of pocket for health care and medicine. Her mother helped pay for some of her medical costs and medicine.

Ahmad from Malaysia is currently in an ESL program taught at her apartment complex. She said she is grateful for the opportunity to receive an education.

“I’m really grateful to have this kind of opportunity to learn so I can have a better opportunity for me and my kids,” she said.

Aleah Milliner is a University of Kansas senior journalism student from Wichita.