Perceptions and Barriers to Care for Burmese Refugees, a multi-method qualitative study

Abstract

BACKGROUND Since 2015, Indiana has been home to over 40,000 Burmese refugees (1). Although the Model Minority Myth would lead U.S. policymakers to believe that all Asian Americans are wealthy, overwhelmingly have college degrees, and have access to health insurance, this is a fallacy (2). According to the Pew Research Center, only 38% of Burmese residents in the U.S. speak English and 25% of Burmese residents experience poverty. Although there is little research on Burmese health outcomes in the U.S., research points to poor health outcomes (3). STUDY OBJECTIVE/HYPOTHESIS This research project aims to identify the barriers and perceptions to healthcare for Burmese refugees and provide plausible solutions. This project includes a narrative review of the existing literature combined with interviews with physicians who specialize in immigrant care. METHODS A narrative review was conducted via PubMed and Google Scholar to analyze the research published on the healthcare of Burmese refugees in the United States. Search terms and MESH terms like refugees, Myanmar, Burma, southeast Asian people, Rohingya, health services accessibility, health status disparities, social determinants of health, and socioeconomic factors were used. Ultimately, 40 articles were included. Interviews with physicians specializing in immigrant care in Indianapolis were also conducted and included in this study. The project includes interviews from Dr. Ashley Overley, CEO of Sandra Eskenazi Mental Health Center, and Dr. Maurice Henein, a family medicine physician at Community Health Network's Center for International Health. RESULTS 40 articles, published in 2005-2023, were included and analyzed for themes. The barriers to care for Burmese refugees are related to languages & communication, healthcare structure, pediatric care, reproductive care, and mental health. Many articles expressed a dire need for reliable interpreters and trauma-informed care (4,5). Moreover, cost and the concept of preventative care are the largest barriers relating to healthcare structure. For pediatric care, research indicates that Burmese parents feel that physicians do not obtain proper consent before treating their children. (6,7,8). Mental health is often equated to craziness when translated and is difficult to navigate with patients (11). Lastly, research found that Burmese women wanted to talk about sex during their health visits, but did not want to initiate the conversation themselves (14,15). Interviews with expert physicians were included in this study. The interviewers expressed that physicians should mobilize community partners and take part in cultural trainings. CONCLUSION AND RECOMMENDATIONS This project aimed to evaluate healthcare for Burmese refugees and provide solutions accordingly. After analyzing the research, it is critical we advocate for reliable interpreters for our patients. Without proper communication, it is impossible to build rapport and trust. Moreover, physicians should educate their patients about the importance of preventative care, mental health, and reproductive health screenings. To improve the quality of care they provide, physicians should initiate workshops and empower community organizations that are providing help to their patients. Indianapolis is home to one of the largest populations of Burmese refugees; it is time we provide the best healthcare for them.