By Ulya Aligulova
In Maine, not all immigrants are treated the same when it comes to access to healthcare. Asylum seekers and undocumented immigrants, for example, are eligible for fewer health benefits than refugees and asylees. Yet many refugees, asylees, asylum seekers, and undocumented people all suffer from very similar health concerns.
Dr. Jessie Schaumburg, a physician at Greater Portland Health, a federally qualified health center, noted that health conditions within immigrant communities in Maine are most often chronic conditions such as diabetes, high blood pressure, and hypertension – illnesses that are also common in the general population, though usually in older people.
“One unusual thing is that I see hypertension and high blood pressure in younger people than I’d typically see. It’s hard to say why immigrants might have these conditions at a much younger age, but we do know that high blood pressure is associated with stress and having a high-salt diet, and the New Mainer community is subject to undue stress and pressures associated with their immigration journeys and with their immigration status.”
She points to shelter life as possibly contributing to chronic illness. “When it comes to access to food, some of our New Mainers who are living in hotels due to the housing shortage only have access to food that’s pre-packaged and canned, which tends to be high in sodium. My patients tell me it’s difficult to get healthy food, and that they’re unable to cook for themselves.”
Inza Ouattara, State Refugee Health Coordinator at the Office of Maine Refugee Services, Catholic Charities Maine, added mental health issues to the list of health conditions plaguing immigrants. “In addition to chronic conditions like diabetes, high blood pressure, and hypertension that the refugees coming to Maine are prone to have, our data also shows that they are at higher risk of having or developing mental health issues. Almost 30% of these populations that get screened for mental health have some form of depression, anxiety, or post-traumatic stress disorder. But due to cultural considerations and stigma, not all of them seek treatment or accept referrals to mental health providers who could diagnose and provide treatment.”
It’s no surprise that the COVID-19 pandemic has hit the various immigrant populations in Maine and the rest of the country particularly hard. This is due to a variety of factors including crowded living conditions and the types of jobs immigrants tend to have, often in hospitality and service industries and other essential worker positions.
“I think an important factor that puts immigrant populations at higher risk of all kinds of health concerns, including COVID-19, is the limited amount of health information available in the various languages these populations speak,” said Ouattara.
Schaumburg agreed that barriers to accessing healthcare exist for most immigrants, and that language is a barrier for many. She also noted that other significant impediments to getting care are the result of tangled bureaucracies, which can be daunting to navigate for people whose first language is not English, who are unfamiliar with our healthcare system in the U.S., or who are living with trauma. She also pointed out that the barriers are higher for some groups of immigrants than for others.
People with refugee and asylee status, or those who are pregnant or under 21 years of age, automatically qualify for full MaineCare health insurance if they live in the state. However, undocumented immigrants and asylum seekers are only eligible for Emergency MaineCare, which covers health services that are needed to stabilize a very serious health problem in an emergency, but does not provide preventative care or even treatment for many illnesses.
“While undocumented people and asylum seekers can access healthcare here, at clinics and other free or low-cost community centers, there are a lot more barriers that are difficult to overcome, financial and otherwise,” said Schaumburg. “There is a lot more work to do, and applications to fill out, in order to receive care. So, these patients have to use the assistance of financial counselors to apply for certain programs – such as, for example, the sliding scale system at Greater Portland Health.”
A number of organizations help immigrants overcome the barriers to getting care. For example, the Maine Access Immigrant Network bridges language barriers by providing multilingual access to health and social services for immigrants. Gateway Community Services provides important outpatient addiction services and started a yoga class for New Mainer women last year in partnership with Greater Portland Health. Schaumburg explained that many immigrant women who face health concerns need a safe space to exercise, and trauma-sensitive yoga can be helpful for them. These services are all available to any immigrant.
The Office of Maine Refugee Services, Catholic Charities Maine, on the other hand, is primarily responsible for administering domestic medical screening and for ensuring that medical service providers across Maine are providing client-centered and culturally and linguistically appropriate services for refugees and asylees. Ouattara said,“I personally go to providers and facilities where I can talk about the needs of the refugee population and provide best practices on working with them.”
But Ouattara’s work also benefits other immigrants. “Currently, I’m part of an ECHO [Extension for Community Healthcare Outcomes] project with MaineHealth, where we talk about all the barriers, including linguistic and cultural, to healthcare access of all immigrants.” said Ouattara.
Until 2011, Maine used to extend full MaineCare health insurance to all immigrants who were income eligible, but under the administration of former Gov. Paul LePage, the rules were changed and that insurance was denied. Advocates have been working hard to pass LD 718, which would close that healthcare gap again, and allow people suffering from very similar histories to access the healthcare they need.