A Lifelong COVID-19 Infection

Adia came from Rwanda about 10 years ago, she and her 4-year-old son had escaped the war raging there. Since then, she has faced obstacles such as raising her son by herself, learning English, holding down multiple jobs, and navigating the medical system. The list of challenges can go on and on, as it happens for many refugees. Since the mental health services in the outpatient clinic have switched to telemedicine, we are having phone sessions with our patients and today’s focus has been on information about COVID-19 prevention. Adia was the last patient; she says that she is washing her hands and staying indoors as much as she can, then adds: “this is not difficult, it feels as if I have been living in a world with this virus all my life.”

Adia is one of the many refugees that arrived in this country seeking a place to raise her family and live in peace. Refugees have lived through challenging times and many of them, without full awareness, have built a set of skills in resilience, coping, and strength. Being in isolation, away from loved ones, with restrictions on social events, food, or education, might not be something new for many refugee families. Despite the high levels of resilience, refugee populations are vulnerable and require that the health system continues to provide care during crises.

Issues such as language barriers in health encounters increase the challenges to provide standard of care services to this population. Some refugee resettlement agencies provide volunteer services that diminish the cost of hiring interpreters that would be working with patients to support the use of telemedicine, however, at this time many are too overburdened to offer direct support.

The use of telemedicine with interpreter support elevates the cost, creates extensive time requirements to provide adequate care, and increases the number of staff required per encounter. Additionally, utilizing telemedicine presumes that patients have access to technology such as reliable internet and a computer, which is often not the case. Extensive technical support is often needed to set up appropriate technological capabilities to enable video sessions with patients. Moreover, patients may have limited phone minutes or access to internet services due to financial hardship during this challenging time, making it harder to have lengthy sessions.

Other factors, affecting almost all families are education and meals for the children. At this time, all schools are closed and children are attempting to receive education at home via online classes. Some have been provided with portable devices, however, as in Adia’s case, some refugees and other vulnerable populations, do not have access to the internet at home or require help and assistance in taking care of homework and projects.

Schools are often a source of meals and a safe environment for children; during this crisis schools and other organizations are focusing on delivering and preparing meals for children. During COVID-19 many schools have been close, which may limit access to free meals for children. This can add an additional burden on refugee families to purchase and prepare food for their entire family when they are often limited by resources such as food stamp allocation and difficulty finding stable financial income due to language barriers. In some areas, schools continue to offer free meals during this time to ensure that food insecurity is not further exacerbated by the effects of the pandemic.

Adia’s confidence in overcoming the COVID-19 global crisis, as just another challenge in her life, is a mirror of the strength and resilience refugees bring to this country. Empowering refugees and helping them to be aware of their resilience is key. Supporting community organizations, keeping in constant contact with patients, and facilitating their access to basic needs, are some ways that we can help vulnerable communities in these overwhelming times. In Adia’s own words: “The COVID-19 has been striking the life of many, but one way or the other, this will have an end too.”

Disclosures:

Dr Mendiola is a Fellow, Connecticut Mental Health Center Hispanic Clinic, and Dr Balasuriya is a Fourth Year Resident, Department of Psychiatry, Yale University School of Medicine, New Haven, CT. The authors report no conflicts of interest concerning the subject matter of this article.