When Diana Loyuk arrived in Springfield, Massachusetts, from Russia in the early 1990s she struggled to communicate with those around her.
"The hardest thing for me was learning English," said Loyuk, who now serves as the coordinator for Caring Health Center's refugee health program.
Caring Health Center, based in Springfield, offers refugee health assessment services in Massachusetts. The assessments are funded by the state Department of Public Health making it free for the patient.
Loyuk said they work with the three local agencies who refer newly arrived refugees to Caring Health Center like Jewish Family Services, Ascentria Care Alliance and Catholic Charities.
"The normal process is when we receive referrals from resettlement agencies, we schedule appointments for the whole family," Loyuk said. "We schedule appointments for kids with the pediatric providers as soon as possible because...they need to be registered at school."
Dr. Siobhan McNally, chief of pediatrics for Caring Health Center and director of pediatrics for the refugee health program, sees children with a wide range of needs from basic vaccines to treatment for malnutrition to more serious conditions like meningitis, cerebral palsy, lead poisoning and parasites.
"We do a basic medical screening that involves two visits. The first visit is the physical exam and some routine lab work. We also review all the documents that they come with and focus on immediate needs," she said. "And we also make sure from a public health standpoint that it's safe for them to go to school, that there's no concerns like tuberculosis or anything else that could be contagious."
Caring Health Center accepts cases from all over the world including Ukraine, Russia, Moldova, Albania and Vietnam when they started offering the assessments more than 20 years ago. Most recently, the agency has assisted refugees from Afghanistan, Syria, Ukraine, Moldovia, Congo, Russia and El Salvador.
"It's all over the map. Some refugees come with complete vaccines and then there's others that have absolutely nothing or they have nothing recorded," McNally said. "(Their) documents were lost during war or as they fled. So we do our best to determine what they need to fulfill school requirements," she said.
In 2021, Caring Health Center provided services to 326 refugees and helped nearly 400 new refugees in 2022.
Language barriers and communication
Communication is an important part of the work done by the physicians and intake staff at Caring Health Center. McNally said many families are skeptical of vaccines or medical treatments and language is key to ensuring parents can make the right decisions for their children. That's where Diana Loyuk's team comes in.
Beyond being the coordinator of the refugee health program, Loyuk is a Russian interpreter and works with 17 interpreters who speak languages including Spanish, Vietnamese, Arabic, Polish and many others. The interpreters can attend the health assessments with patients.
"If we don't have interpreters, we can use an iPad to communicate with the patients through an interpreter on a video chat," Loyuk said. "Lately we have seen a lot of patients who came from Haiti, and they speak Creole language, and we don't have a Creole interpreter, so we use our iPads."
Loyuk said bridging the language barrier provides a sense of safety and comfort to patients.
"When the people come into a new country, everything is new for them. And I see the expression on their face when they come into the clinic and they can see an interpreter who can speak in their own language, and they feel more comfortable with us," she said.
McNally said having live interpreters is an essential part of providing quality and equitable care for patients.
"So much of what I obtain from a family in terms of their history and how they're feeling, and what's bothering them the most has a lot to do with their facial expressions and their body movements. And I think it's very difficult sometimes for a telephone translator to try to interpret that stuff," she said.
Following their second appointment, refugees can choose a primary care provider. Approximately 75% of those refugees choose to remain with Caring Health Center.
Needs beyond healthcare
McNally said many of the staff members at Caring Health Center, including the interpreters, are also community health workers, helping families with needs beyond healthcare.
"They're connected with the community so… simple things like making sure that a family knows where the WIC (Women, Infants and Children's Nutrition Program) office is, that can make a huge difference in whether or not a child continues to gain weight. It's those little things, connecting the dots that are so imperative for a child's health," she said.
Loyuk said the agency also conducts regular food drives and can direct refugees to agencies that help with clothing, housing and employment.
"For example we see a lot of people from the Congo, they speak Swahili. A lot of people, a lot of kids, don't have any winter clothes because it's not winter in Africa. We collect clothing for kids or we help them to get the services they need," she said.
Both women said while the work they do can present many challenges, it's rewarding to help refugee families find their way in an unfamiliar new place.
"The main reason I love working with refugees is that we witness incredible courage on the part of families - to risk everything to give their children the very things we often take for granted. The basics, access to nutritious food, education, health care. It inspires me on a daily basis," McNally said.
While it was a long time ago for her, Loyuk said she still remembers arriving in the U.S. without a grasp of the language. Having others help her inspired her to do the same.
"When Caring Health Center provided a refugee coordinator job for me I was happy to do that because when I came to the United States, a lot of people helped me and now I want to help all of the refugee and immigrant community," she said.
