Fletcher Njororai, PHD, CHES Assistant Professor, Health Sciences Department of Health and Kinesiology The University of Texas at Tyler APHA 2013 Annual

Resettlement, Health and well-being among Elderly Burundian Refugees in East Tennessee: Implications for

Health Interventions and Policy

Fletcher Njororai, PHD, CHESAssistant Professor, Health Sciences

Department of Health and KinesiologyThe University of Texas at Tyler

APHA 2013 Annual Conference, Nov 2- 6, Boston, USA.

© Fletcher Njororai 2013

Purpose: An exploratory study assessing health disparities among Burundian refugees within 6 years of arrival in the US resettling in Knoxville, a small mid-southern rural city. Older refugees are particularly vulnerable to poverty, abuse, neglect or exploitation, depression, chronic health and emotional problems stemming from: the conditions of refugee flight, family loss and separation, an inability to advocate for themselves because of cultural, language, or educational barriers; limited access to appropriate health and social service agencies. Methods and Data: A mixed method research design was used for data collection. A convenient sample of fifty adults recently resettled (n=50) participated in the study between September 2011 – May 2012. A structured interview was administered with question items for quantitative data; and open-ended questions for qualitative data; items elicited information on pre-immigration and migration experiences, initial resettlement experiences, size and content of refugee social networks; and accessing resources for resettlement, health and well-being. Findings: Descriptive statistics, correlations and independent samples t-tests were run. Mean age was 44 years, ranging from 20 -78 years and the elderly, age ≥ 50 were 17 (34%). As age increased, overall connectedness decreased (r= -.287, ρ=.246); English speaking was significant to overall connectedness (Yes = 3.27, No = 2.93, ρ = .013); 36 (72%) were in good and 14 (28%) were fair or poor health. Conclusions: Identifying health protective and risk factors within the context of refugee resettlement by health professionals and policy makers is crucial to the health outcomes and overall health status of resettling elderly refugees.

Key words: Social capital, refugee, Burundians, resettlement, health, well-being, policy

Abstract


Background cont.


Population: 10.2 million (2011)

Capital City: Bujumbura (pop 300 000)

Burundi is one of the five poorest countries in the world.

It has one of the lowest per capita GDPs of any nation in the world

The country has suffered from warfare, corruption, poor access to education and the effects of HIV/AIDS

Burundi is densely populated and experiences substantial emigration

According to a 2012 DHL Global Connectedness Index, Burundi is the least globalized of 140 surveyed countries

Background


http://www.nationsonline.org/oneworld/population-by-country.htm

http://en.wikipedia.org/wiki/List_of_countries_by_GDP_(PPP)_per_capita

http://en.wikipedia.org/wiki/Per_capita_GDP

http://en.wikipedia.org/wiki/Emigration

Most of the Burundian refugees fled war in 1972 to different countries like Congo and Rwanda and Tanzania

Globally, over 500,000 Burundians have been granted refugee status

In 2006, 10,000 Burundians were approved for asylum to the US.

Since 2007, the US has received over 10,000 Burundian refugees.

Most of the Burundian refugees arrived with little exposure to education and they are also illiterate in their own national language, Kirundi

Background cont.


UN definition of refugee:

On arrival in Knoxville these group were the first refugees from Burundi in this rural mid-southern city in TN.

Arrival of 189 Burundian refugees resettling in Knoxville starting the year 2007 faced systems unprepared for their arrival

Background cont.


Assess the early resettlement experiences of elderly (≥50 years) Burundian refugees in Knoxville TN.

Identify their perceptions on resettlement with a focus on their health and health needs

Purpose of the Study


Currently over 300 Burundians have settled in Knoxville within a short timeframe.

Older refugees are particularly vulnerable to poverty, abuse, neglect or exploitation, depression, chronic health and emotional problems stemming.

Conditions of refugee flight, family loss and separation.

Inability to advocate for themselves because of cultural, language, or educational barriers.

Limited access to appropriate health and social service agencies

Rationale


An exploratory study assessing health disparities among Burundian refugees within 6 years of arrival in the US resettling in Knoxville, a small mid-southern rural city.

A mixed method research design was used for data collection. A convenient sample of fifty adults recently resettled (n=50) participated in the study between September 2011 – May 2012.

Methods


Healing Transitions- is an initiative by UT grounded in Community Based Participatory Research (CBPR) approach in helping understand the Burundians’ migration and resettlement experiences in Knoxville.

50 participants were selected for the study for the overall study.

This was a convenient sample given that they are a hard-to-reach population

A structured interview was administered with question items for quantitative data.

Open-ended questions for qualitative data; items elicited information on pre-immigration and migration experiences, initial resettlement experiences, size and content of refugee social networks; and accessing resources for resettlement, health and well-being

Methods


Dependent variable (DV) in this study is well-being measured through self-rated perceptions of health and well-being (poor, good, very good, excellent)- presence/absence of illnesses, quality of life.

Independent variables (IVs) included – family size, Other contacts, size and content of social networks; strengths of network ties; and functions of social networks.

Quantitative data was sought on socio-demographic characteristics and the IVs


The average length of living in Knoxville is 3 years with a range of less than ½ yr to 5 years.

Primary resettlement? Secondary migration?

Descriptive statistics, correlations and independent samples t-tests were run.

Mean age was 44 years, ranging from 20 -78 years

The elderly Age ≥ 50 were 17 (34%)

Data Analysis and Results


A measure of overall density of connectedness was derived by averaging the values for items on the question relating to strength of networks ties.

As age increased, overall connectedness decreased (r= -.287, ρ=.246)

English speaking was significant to overall connectedness (Yes = 3.27, No = 2.93, ρ = .013);

36 (72%) were in good and 14 (28%) were fair or poor health –focus on elderly health.

None of the adults and elderly refugees had an education

Data Analysis and Results


Perceptions– Resettlement & self-rated health

No assistance from the resettlement agency, Catholic Charities, sponsors or other.

Perceived and actual needs◦ Loneliness example – 72 year-old lady living alone.◦ Emotional- separation from family left behind◦ Poor health (state examples/ and disability)◦ Unfamiliar foods◦ Cultural shock

Qualitative results


Need community gardens Idleness and stress Disconnect with host community Complex system to understand/navigate Not catered for in welfare benefits (how

many)? Why?(age faulted??) Resettlement policies were indiscriminate of

age and gender

Qualitative Results cont.


Migration e.g. ran from war 1972 as young woman – Congo –Tanzania

Secondary migrations (US) –family, resources, friends.

Injuries from cleaning house/falling

Language barrier -inability to read labels on medicines

Going to nursing home- (mixed feelings)

Place for burial – should be free



Apprehension on how to qualify for citizenship – unable to read

Scared of shootings in the neighborhood –one went through house

Widowed women Desire to resettle as family units especially

the elderly Lack of time to go for ESL for those around

50 years able to work.



Desire to re-unite with those left behind.

Need for translators

Experience evictions – rent default

Poor houses/neighborhoods – danger for raising young children

Send remittances to those left behind

Expenses – live in cold house to save on cost (suspect taken advantage of by owner).

Desire to visit Africa one day



Caregivers – children; one with a grown child with mental health issues

Common sicknesses diabetes, arthritis, high BP, back pain :

1. Diabetes

2. Arthritis

3. High Blood pressure

4. Bones injuries/fractures

5. Eyesight Stressful memories Painful family (permanent) separation e.g. older men refusing

asylum and remain behind, going to other countries e.g South Africa



Good experiences:1. Relative safety, rest and peace2. Treatment and healthcare available e.g.

eye-care3. Good houses compared to life in camps4. Better life generally5. Cultural events – preserve culture6. Grandparents teaching language to the

children



Smaller sample size

Convenient sampling

Interview questions were mainly at nominal scale – causal relationships cannot be inferred.

Limitations


Refugee resettlement institutions/organizations should provide tailored programs that cater for age and gender differences

Culturally sensitive programs should be designed

Resettlement policies should focus on the health of the elderly in the short-term as well as long-term provisions

(Re)consider the role of secondary migration and implications for elderly refugees

Identifying health protective and risk factors within the context of refugee resettlement by health professionals and policy makers is crucial to the health outcomes and overall health status of resettling elderly refugees

Conclusions


Multi-disciplinary longitudinal studies using multiple methods –the role of social capital in relation to health disparities among refugees and also assess secondary migration.

Studies to identify negative outcomes of social capital among the refugees

Studies focused on identifying evidence-based best or promising practices

Further Research


1.UNHCR (2007). Group resettlement of “1972” Burundians from Tanzania available at:

http://www.refugees.org/atf/cf/Burundifactsheet.pdf,

2. U.S. Department of State, Bureau of Population, Refugees and Migration. (2010). Proposed refugee admissions for year 2011. Retrieved January 2013 from http://www.state.gov/documents/organization/148671.pdf

Sirven, N., & Debrand, T. (2008). Social Participation and healthy ageing: An international comparison using SHARE data. Social Science & Medicine, 67(12), 2017 -2026.

Unsworth, C.G., & Goldenberg, E. (1998). Psychological sequelae of torture and organized violence suffered by refugees from Iraq: Trauma-related factors compared with social factors in exile. The British Journal of Psychiatry, 172, 90-94.

Ott, E. (2011). Get up and go: Refugee resettlement and secondary migration in the USA. Monograph: Research Paper no.219. New Issues in Refugee Research Series. Policy Development and Evaluation Service. UNHCR, Geneva,

Switzerland. Retrieved July 1st, 2012 at www.unhcr.org

References


http://www.refugees.org/atf/cf/Burundifactsheet.pdf

http://www.state.gov/documents/organization/148671.pdf

http://www.unhcr.org/

Documents

Fletcher Njororai, PHD, CHES Assistant Professor, Health Sciences Department of Health and Kinesiology The University of Texas at Tyler APHA 2013 Annual