Figuring out America's health care system can be hard for anyone. It can be especially challenging for refugees, who often face significant language and cultural barriers. But one group is trying to bridge that gap by training refugees as health navigators in their own communities.
At a small, sparsely-furnished apartment in south Des Moines, Sipo Ra sits in the middle of the living room's brown carpet, carefully settting out stacks of papers.
"We have pre- and post test and then intake, sign in sheet," she said.
Twenty-three year old Ra is in the home of a middle-aged refugee couple from Burma. She's here to teach them -- and their elderly neighbor -- about the flu and the common cold.
"What kind of symptoms, how can this spread, this kind of stuff," Ra said.
The couple are dressed in colorful longyi, a piece of fabric worn around the waist that's common in Burma. Their neighbor is still in her pajamas. They sit in a circle on the floor as Ra speaks.
This small circle -- as it's called -- is part of Ra's job as a health outreach coordinator for a local non-profit called the Ethnic Minorities of Burma Advocacy and Resource Center, or EMBARC.
Ra is also from Burma — she came to the United States through the official refugee program about 10 years ago. Like these refugees, she's Karen, one of the country's many ethnic minorities.
"My family was first resettled in Lakewood, Ohio. We lived there for three years," she said. "I liked it there a lot but they don't really have a lot of refugee organizations or support."
Now, Ra teaches Karen refugees about topics like the flu -- and mental health, which is rarely discussed in her culture. She has to explain concepts like "stress" and "trauma."
"Many times if you bring up mental health, people will only think you are crazy and stuff, but in America it’s a big topic," she said.
Last year, more than 500 refugees were resettled in Iowa--including 128 from Burma. There are large groups in other Midwestern states as well.
It's important refugees get extra help, because they may face major health issues from living in war torn countries and refugee camps, said Nola Aigner, the health educator for the Polk County Public Health Department.
"It's a lot of just chronic health conditions," she said. "There's a lot of medical issues. Lot of times we're seeing individuals that are coming from the worst of the worst."
According to the Centers for Disease Control, refugees from Burma are susceptible to complex issues like Hepatitis B, internal parasites and malnutrition. They often have limited knowledge about these conditions but may need immediate attention.
There are health workers statewide to assist them, but EMBARC's approach is unique.
"The big thing is that our health workers are actually from the community," Moriah Morgan said, the advocate program manager for EMBARC's health program.
She said refugee workers can catch assumptions and misunderstandings that American-born workers, like herself, might not get.
"I might not realize that I need to take a couple extra minutes to define what you know tartar build up is for your teeth, whereas they'll know immediately that this is going to be a new concept for my community. And I should probably take an extra minute to define it," Morgan said.
To become a community health worker with EMBARC, refugees first learn to be a medical interpreter. Then they go through a forty hour training program that was created by EMBARC.
Ra says health coordinators like her are able to quickly gain refugees' trust.
"Because we speak the language, and we know the culture," she said.
And this relationship can help refugees handle many details of their new lives.
At the small circle in Des Moines, one of the Karen women asks Ra to translate a letter from a local hospital. Her daughter was recently was in a car accident.
"I was telling her this letter is to inform you that for her daughter she had a little injury," Ra explained.
On home visits, Ra spends a lot of time doing extra things like translating mail and making doctor's appointments. She likes doing it.
"I understand what it's like to be there in their place," Ra said. "When I first came to the United States I don't know any English and all the culture and everything is very new to me."
EMBARC has eight health workers who work with refugees from Burma -- and more recently -- from the Democratic Republic of the Congo.
Natalie Krebs is IPR's health reporter. Funding for her work is provided by the Mid-Iowa Health Foundation.