Many countries today, including the United States, are experiencing the arrival of refugees. Differences in culture and not knowing the language of the host country create barriers for the refugees in accessing resources to meet their needs and become independent. One critical area is managing healthcare, including making an appointment, completing patient forms, using medical vocabulary, and going to the pharmacy.

Helping Refugees Manage Healthcare

Making an Appointment

One of the common challenges refugees face because of their language barrier is simply making a medical appointment. Many refugees come from countries where it is common practice to get a walk-in appointment. Furthermore, in home countries, patients can see whatever doctor they want, even a specialist, without having to go through a primary care physician or a referral list from an insurance company. Also, a fee for missing an appointment is probably not charged in their home country like it is in the United States.

Perhaps the biggest frustration, source of panic, or even danger happens when a refugee reaches an automated message service instead of a human voice right away. Regardless of how the call is answered, mastering vocabulary and using role-playing can help refugees know what to expect.

Try the “Making an Appointment Activity” (.docx) with your refugee students.

Patient Forms

Not all hospitals and clinics provide interpreter services, and this can make it difficult for ESL refugees to get access to quality health care—from accurately completing patient forms to communicating symptoms they are experiencing. In addition, because they are refugees, many may not have a medical history file, and this creates additional difficulties in getting help. (In refugees’ home countries, many doctors do not request written medical history.)

One activity you can do with your students is learning how to complete new patient forms. This allows students to practice essential reading comprehension and vocabulary skills, familiarizing them with phrases and words such as:

• “During my visit, I would like to discuss. . .”
• allergies
• medications
• surgical history

Teach two forms: a medical history form, which includes contact information and insurance and a HIPPA form for confidentiality. Many doctors’ offices provide forms online that you can use in your classroom.

You can use the “New Patient Form” (.pdf) from Heritage Medical with your students.

This activity will take several classes because so much information is requested on the form. Explain to your students that many offices encourage patients to complete new patient forms before their first office visit to save time. Some of the doctors’ offices will ask the new patient to download or complete a form online and other offices will mail forms to a patient’s home.

Medical Vocabulary

ESL refugees may not always know how to provide specific details to their doctor about their health. For example, one of the refugees I was helping asked me if I knew a “head doctor” he could take his son to for care. I asked him, “What do you mean by ‘head doctor’?” to try to get him to be more descriptive.

He just replied, “A head doctor. I need a doctor for the head.”

So, I then asked him more questions. “Does your son’s head hurt? Does he have a headache? Is he very sad?”

He said, “No.” He then started to use gestures to try and explain to me that his son had had cranial surgery when he was a baby. I was able to infer that he probably meant he wanted to take his son to a neurologist. To help students develop their communication skills and empower them to know which specialist they need to request help from, you can play charades or have a role-playing activity in class where one student is the patient and the other is the doctor.

It would be a good idea to provide students with a list of phrases and vocabulary to help get them started. For example, it will be helpful for them to learn the difference between words and phrases like nausea and cramps, blurry vision and blind, and dizzy and tired.

See the “Medical Specialist Vocabulary Sheet” (.docx) as an example to help the students determine what kind of doctor they need. A good page to use with your students that focuses on medical terms is the “At the Doctor Dialogue and Vocabulary List” from myenglishteacher.org; it contains an excellent image to help students describe symptoms to the doctor.

Note: Remind your students that they can ask their doctor to write down a diagnosis and follow-up instructions to avoid mistakes.

Pharmacy

ESL refugees also face difficulty when going to get medicine from the pharmacy. In some countries, a patient can just walk into a pharmacy and get many drugs that require a prescription in the United States. The cost of medicine can also be a shock for refugees. Many refugees have little or no income and often cannot afford the medicine they need to take. Therefore, teaching refugees pharmacy-related vocabulary phrases can help them get access to more affordable medication. Here are a few phrases that might be helpful to them:

• Is there a generic brand?
• I have a prescription from my doctor.
• Can you recommend anything for a cold/flu/sore throat/cough/etc.?
• Does it have any side effects?
• Can I buy this without a prescription?
• I am also taking [X medication]. Is that okay?

Other Language and Culture Areas to Develop

Focusing on healthcare is just one area you can consider starting with in your classroom. You can also think about developing language activities that address other challenges refugees face.

Work Culture

Teach your students the importance of arriving to work on time every day and how to call the supervisor when running late or when needing to miss work for a legitimate reason. You can practice how to do this by reading a list of excuses on a comprehension worksheet and discussing which ones are appropriate reasons for missing work.

School Policies

Teach students that in the United States, parents are expected to be involved in their children’s education—attending school meetings, helping children with homework, participating in after-school activities and events, and so on. It is not unusual for teachers to report suspected abuse, so teach the importance of how discipline is practiced in North America. Consider showing your class short videos of parent-teacher conferences. Allow students to ask questions and give feedback about any concerns. Consider inviting an immigrant to talk about his or her experience as a parent with a child in the school system.

Police, Fire Safety, and Emergencies

Teach students police and fire safety protocol (do not run from the police, keep your hands visible, know your address and phone number and teach it to all family members) and how to use 911. Remind students that the emergency room is only for emergencies; it is expensive. Help students create an emergency information sheet to put on the wall of their home so they will not be confused in an urgent situation.

Voicemail

Help students to distinguish between a voice message they need to respond to like a message from a doctor’s office, and one they can ignore, like a solicitor trying to sell them something. Write messages on pieces of paper and put them in a bag. Students take turns selecting a phrase to read and see if the rest of the class can understand the message and how to follow up.

Housing

Get copies of utility bills. Help students to identify due dates and how to process the payment. Remind students to never put cash in the mail. Tell them they can go to the bank and get checks to help process bill payments. Many will not be eligible for a credit card.

Conclusion

Refugees have lost everything, not just their homes and their livelihood, but a familiarity of functioning. Language is the first step toward giving them a voice, but without understanding the system in their new land, they still will not be able to advocate for themselves. Both refugees and immigrants in better circumstances are urged to assimilate into their new culture. The activities discussed in this article can help meet basic needs to get them on their way.

Sarah Kassas earned her MA in TESOL from the University of Alabama. She works at the Vanderbilt University Kennedy Center, and she has taught at Qatar University, the University of Iowa, and the University of Alabama.