Most users find switching between an Apple product and Android product disorienting. The buttons are no longer in the same places, nor do they mean the same thing. Even more disconcerting is the differing built-in automatic functions that each device has. Simply put, the new device is incredibly unfamiliar. Most definitely, this experience of switching smartphones cannot be compared to the experience of refugee resettlement. However, it is a somewhat relatable illustration of the type of discomfort that refugees often face when resettling in the United States of America. As many refugee camps are temporary and ad hoc settlements, they often lack the basic infrastructure that US housing is generally equipped with. UNHCR estimates that 30% of refugee camps lack adequate latrine facilities and waste disposal. Thus even the operation of a toilet, which most of us take for granted, can prove to be a challenge for refugees who have spent decades or their entire lives living in camps.
In addition to this, subpar camp conditions and the lack of preventative health infrastructure in camps encourage the proliferation of many new illnesses and aggravate pre-existing conditions. Lastly, the physical and psychological trauma that is imposed on individuals by the experience of being persecuted and fleeing must be considered in caring for resettled refugees, who must often surmount various language and sociocultural barriers in the US. In this article, I will introduce these challenges in the context of the Bhutanese refugee crisis in order to increase awareness about a population that requires interdisciplinary assistance in order to realize the American dream.
In addition to this, subpar camp conditions and the lack of preventative health infrastructure in camps encourage the proliferation of many new illnesses and aggravate pre-existing conditions. Lastly, the physical and psychological trauma that is imposed on individuals by the experience of being persecuted and fleeing must be considered in caring for resettled refugees, who must often surmount various language and sociocultural barriers in the US. In this article, I will introduce these challenges in the context of the Bhutanese refugee crisis in order to increase awareness about a population that requires interdisciplinary assistance in order to realize the American dream.
Bhutanese refugees are mainly Hindu Nepali-speaking individuals who were forced out of southern Bhutan as a result of the “One People, One Bhutan” policy. After resisting several discriminatory policies, including being re-classified as illegal immigrants, prohibited from learning Nepali in school, and required to wear traditionally northern Bhutanese garb, they were deemed anti-nationals and faced arrest, detention, rape, and torture. As a result, the majority of them fled to refugee camps in Nepal, where they spent decades without successful repatriation, before beginning to resettle. Between 2007 and 2014, 88770 Bhutanese refugees were resettled, 75000 of whom immigrated to the United States. In this time period, the US accepted between 5000 and 15000 Bhutanese refugees each year, with 35% primarily resettled in Pennsylvania, Texas, New York, and Georgia.
Two major physical health concerns in the Bhutanese refugee population are vitamin B12 deficiency and anemia. Although rare in the US due to fortified and plentiful food, vitamin B12 deficiency was found in 30-60% of resettled refugees between 2008 and 2011. This is most likely due to a low dietary intake of the micronutrient while in refugee camps. A deficiency in vitamin B12 can manifest itself via neurological symptoms, peripheral neuropathy, and megaloblastic anemia. Iron deficiency can also cause anemia in the population, along with intestinal parasitic conditions, which are generally found in camp environments without adequate sanitation. Other conditions such as malaria, tuberculosis, and hemoglobinopathies, which may lead to anemia, are common in South Asia. Additionally, refugees commonly exhibit wasting from malnutrition, musculoskeletal pain, in part, from years of sleeping in uncomfortable positions, and dental caries, which result from the lack of dental hygiene in many refugee camps.
Lastly, mental health is a major concern in the Bhutanese refugee population, as suicide rates for resettled individuals are almost twice the US national average. This could be closely related to the prevalence of adjustment disorders and mood disorders, including depression, among resettled refugees, It is important for health and public health professionals to consider the low detection rate of psychological illness in this population due to the South Asian cultural stigmatization of mental health conditions when seeing Bhutanese refugees as patients or designing health interventions for them.
The journey of a refugee is unfathomable to those who have not experienced it. I cannot imagine the pain and suffering that the Bhutanese refugees I meet carry in their souls, yet I seek to alleviate it in a country that is as foreign to them as their experience is to me. However, as I learn more about their heritage, their culture, and the challenges they face in acclimating to daily life in the US, I learn how to better help them engage with their local community and I learn what the community can do to help them become a greater part of it. In smartphone terms, I may never be an Apple user, but I can certainly learn how an iPhone works.
Two major physical health concerns in the Bhutanese refugee population are vitamin B12 deficiency and anemia. Although rare in the US due to fortified and plentiful food, vitamin B12 deficiency was found in 30-60% of resettled refugees between 2008 and 2011. This is most likely due to a low dietary intake of the micronutrient while in refugee camps. A deficiency in vitamin B12 can manifest itself via neurological symptoms, peripheral neuropathy, and megaloblastic anemia. Iron deficiency can also cause anemia in the population, along with intestinal parasitic conditions, which are generally found in camp environments without adequate sanitation. Other conditions such as malaria, tuberculosis, and hemoglobinopathies, which may lead to anemia, are common in South Asia. Additionally, refugees commonly exhibit wasting from malnutrition, musculoskeletal pain, in part, from years of sleeping in uncomfortable positions, and dental caries, which result from the lack of dental hygiene in many refugee camps.
Lastly, mental health is a major concern in the Bhutanese refugee population, as suicide rates for resettled individuals are almost twice the US national average. This could be closely related to the prevalence of adjustment disorders and mood disorders, including depression, among resettled refugees, It is important for health and public health professionals to consider the low detection rate of psychological illness in this population due to the South Asian cultural stigmatization of mental health conditions when seeing Bhutanese refugees as patients or designing health interventions for them.
The journey of a refugee is unfathomable to those who have not experienced it. I cannot imagine the pain and suffering that the Bhutanese refugees I meet carry in their souls, yet I seek to alleviate it in a country that is as foreign to them as their experience is to me. However, as I learn more about their heritage, their culture, and the challenges they face in acclimating to daily life in the US, I learn how to better help them engage with their local community and I learn what the community can do to help them become a greater part of it. In smartphone terms, I may never be an Apple user, but I can certainly learn how an iPhone works.