By Doyal D'angelo Bolin
Valleywise Health and El Rio Health take pride in delivering culturally sensitive healthcare to refugee communities. With support from The Burton Family Foundation (BFF), these organizations are changing and saving lives across the state through programs that combine medical expertise with cultural awareness. Through integrated healthcare services which address medical needs for refugees beyond a mere diagnosis, Valleywise and El Rio provide services that acknowledge and respond to the unique challenges refugees face – including trauma, torture, and sexual and gender-based violence.
Valleywise Health Center for Refugee and Global Health
Valleywise Health has become a national model for refugee healthcare delivery, providing care for over 18,000 refugee patients across the Phoenix metro each year.
Valleywise Health has acquired veteran status through service spanning over 150 years, conducting over 550,000 patient visits annually. The organization focuses on the cultural health navigation model, acknowledging the spectrum of patient language access needs and ensuring cultural understanding throughout the care process. This is achieved through deployment of cultural health navigators, individuals who serve as the point of contact between healthcare providers and refugee communities. They aren't just translators; they're cultural liaisons who understand the needs of the refugees they come in contact with.
"The system would collapse without them, I would not do this work if it wasn't for the navigators that are physically present in the system," explained Dr. Baharak Tabarsi, a family medicine physician at Valleywise. Dr. Tabarsi leads the efforts for refugee care at Valleywise Health.
Cultural health navigators are tasked with conducting health assessments, providing medication education through home visits and coordinating complex care plans. Jeanne Nizigiyimana, the lead of the Valleywise Center for Refugee and Global Health Center, puts a big emphasis on being knowledgeable and entrenched in the Valley's refugee community. "Through our network of community members, via our coalition, we identify mobilizers throughout each community,” Nizigiyimana said. “We have youth ambassadors, middle age group ambassadors, and elder adult ambassadors."
Moreover, these navigators often serve as trusted confidants in sensitive situations. One powerful example is illustrated by a patient who was experiencing ear pain. After a routine ear examination with multiple physicians taking a look, they concluded that her ear was fine. But Dr. Tabarsi wanted to make sure nothing else was going on, and after a cultural navigator's private conversation with the patient, it was revealed that the ear pain was the result of domestic abuse that might have otherwise gone undetected.
Dr. Tabarsi is grateful for the current medical infrastructure, and the reduction of communication barriers, which allows easier access to specialists – something that wasn’t available to her when she arrived in the US as a refugee herself.
"Valleywise Health has been a medical home to them through that caring infrastructure, culturally relevant infrastructure, with the cultural health navigators having shared norms, shared values, shared culture," reflected Nizigiyimana.
This sentiment captures the essence of what the organization strives to achieve: not just providing medical care, but creating true medical homes where refugee families feel welcomed.
Mwajuma Mkandama, a cultural health navigator at Valleywise, feels enlightened by her impact on refugee communities. "I didn't know how impactful and valuable I am in my community until I started working as a cultural health navigator. As much as they learned from us, we learn from them as well."
Cultural knowledge and sensitivity has a practical effect. Every refugee patient at Valleywise Health receives specialized mental health screening using culturally appropriate tools available in 15 different languages. The focus and attention to detail spans from head to toe, as illustrated by another patient interaction with Dr. Tabarsi.
"I was seeing multiple family members from the same family that day,” Dr. Tabarsi said. “I looked at the kid, and the kid had a rash, and then I looked at the dad, and the dad had a very short stature. Then I looked at the older brother, who also had a rash and a short stature. So I actually recognized a genetic disease that would have never been picked up if this family had been kind of sent every which way."
According to the American Psychiatric Association, around 1 in 3 asylum seekers and refugees experience high rates of PTSD, anxiety and depression. Despite that high number, a 2020 study found that only around 37% of newly-arrived refugees get mental health screening.
Valleywise Health understands that mental health is a major factor in the completeness of quality care, as well as understanding their needs as a collective. "We look at the population, we are following the trends of newly arrived refugees, and as we follow those trends, we are addressing the issues refugees face,” Nizigiyimana said. “Knowing the issues they have, we think of what could be the proper tools we are using to help these people out."
The refugee program extends far beyond the clinic walls. Health education sessions are conducted in apartment complexes where refugee communities live, covering everything from navigating the American healthcare system to specific health topics like car seat safety, knowledge that's crucial for families trying to integrate into American society.
El Rio Health Center
El Rio Health Center annually serves over 128,000 people – approximately one in nine residents – in the Tucson area. Moreover, 712 medical screen appointments were conducted in 2023 for the local refugee population in their refugee clinic. “We are the largest federally qualified health center in the state of Arizona, and the 16th largest now in the country,” said Brenda Goldsmith, executive director of the El Rio Health Center Foundation.
With the help of BFF, El Rio has been able to allocate funding toward the acquisition of certified healthcare interpreters who speak an extensive group of languages — from Arabic and Swahili to Dari – to support communication with refugee patients.
This investment has enabled El Rio’s refugee program to provide more complete care.
Senior medical director Dr. Sonia Reidy described how her organization’s commitment to cultural understanding manifests in countless ways. When a recent influx of Afghan refugees arrived in Arizona, healthcare providers discovered that two children's dangerously high lead levels were caused by traditional eyeliner used on newborns, a cultural practice that, without proper medical screening and culturally sensitive communication, might have led to long-term learning difficulties for the children.
Situations like this allow the staff at El Rio Health to create comfortability with patients.
El Rio Health takes pride in its 84% patient retention rate among refugee families, as they help patients understand the depth of their care. "Sometimes patients want to talk about their back pain," Dr. Reidy said, "but really there's depression, anxiety, and unfulfilled mental health needs we have to work through before we can effectively address their physical symptoms."
The challenge is approaching these sensitive topics in culturally appropriate ways, especially when mental health carries stigma in certain communities. El Rio prefers to connect refugees with specialists who have been in their position before, or who understand their language and culture, much like Valleywise.
Take John Fung, now an El Rio staff member, who immigrated to Tucson in 1977. For eleven years after arriving, he had no health or dental insurance.
“I never went to see a dentist and I never went to see a primary care doctor,” Fung said.
When he finally received health insurance and went to see a primary care physician and a dentist, Fung had to battle with the newness of receiving care. Things like having blood drawn and getting a dental cleaning were big adjustments.
Today, Fung helps ensure other families don't face similar gaps in care that he experienced.
Goldsmith pointed to the many everyday luxuries most people don’t think twice about. "These are things we take for granted," Goldsmith said. "A toothbrush and toothpaste, floss, sunscreen – sometimes it's just such a simple thing.”
Navigating barriers to care
Both El Rio Health and Valleywise Health work tirelessly to remove obstacles that might prevent refugees from accessing care. Transportation remains one of the biggest challenges across the board, with both actively working to find solutions. El Rio Health provides rides through Uber Health, while Valleywise coordinates transportation logistics for entire families.
The challenge of transportation becomes particularly acute when dealing with large refugee families requiring multiple appointments.
Mwajuma Mkandama of Valleywise Health, a cultural health navigator, witnesses space becoming an issue for families.
Mkandama mentioned that despite the attempted coordination of transportation for refugees in need of care, plans sometimes fall through, causing patients to miss appointments, especially those that need special accommodations, like handicapped refugees for instance.
Both programs also tackle financial barriers. In 2023, El Rio Health provided approximately $19 million in unreimbursed charity care, which is aided by its willingness to take private insurance and by having revenue streams from different insurers, which helps to provide care for more patients.
Goldsmith mentioned that the healthcare system can be overwhelming and confusing even for those who speak English and have insurance, so navigating the system when you don't have either is especially challenging. Lack of transportation, insurance, and language barriers can all contribute to poorer health outcomes, which is why El Rio Health focuses on these things.
El Rio Health and Valleywise Health also maintain internal pharmacies and assistance programs that provide medications at drastically reduced costs — turning what might be a “$10 bottle of Tylenol into a 50-cent purchase.”
Both organizations have created systems to help patients navigate external referrals, which can be particularly challenging for refugee families. When patients need to see specialists outside the system, cultural navigators often accompany them to ensure proper communication and understanding.
Research points to health outcomes being deeply tied to social conditions. According to the World Health Organization, studies have found that social determinants of health can account for 30–55% of an individual’s health outcomes. This is why El Rio Health partners with food banks to address food deserts, to provide blood pressure cuffs for at-home monitoring to high-risk patients, and even to send healthcare teams into homeless encampments to care for people where they are.
“When you hand someone a gift card for food and they start tearing up, those are powerful moments,” Goldsmith said.
If you're interested in learning more about Valleywise Health, please visit https://valleywisehealth.org. To learn more about El Rio, please visit https://elrio.org.
Photos courtesy of Valleywise Health Foundation and El Rio Health Foundation.