Refugees are men, women and children who have left their country of origin because of a well founded fear of persecution because of their race, religion, ethnic group, or membership in a social or political group. In the last five years, refugees from Burma, Bhutan, Somalia, and the Democratic Republic of Congo have arrived to Fort Worth, Tarrant County. Traumatic experiences, cultural and religious beliefs, language, literacy, poverty and transportation difficulties isolate refugees from mainstream sources of health care and information. Health care provider and health system level factors pose additional barriers such as costs, cultural insensitivity, long wait periods, and inadequat...

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Refugees are men, women and children who have left their country of origin because of a well founded fear of persecution because of their race, religion, ethnic group, or membership in a social or political group. In the last five years, refugees from Burma, Bhutan, Somalia, and the Democratic Republic of Congo have arrived to Fort Worth, Tarrant County. Traumatic experiences, cultural and religious beliefs, language, literacy, poverty and transportation difficulties isolate refugees from mainstream sources of health care and information. Health care provider and health system level factors pose additional barriers such as costs, cultural insensitivity, long wait periods, and inadequate medical interpretation. As a result, refugee women have low screening rates for breast and cervical cancer and lack access to culturally and linguistically appropriate cancer prevention information and services. Refugee women migrate from countries with endemic hepatitis B, increasing their risks of liver cancer.

Refugee women’s needs require tailored intervention approaches. The project’s aim is to expand the net of breast, cervical and liver cancer prevention efforts, activities and clinical services to include refugee women—a vulnerable and underserved population in Texas. The University of North Texas Health Science Center, Catholic Charities, UNT Health Nurse Midwife Group and refugee leaders have partnered to create an integrated approach for refugee women’s cancer prevention. The model includes: 1) Lay Health Advisor Outreach and Community Education, 2) Midwife Model of Care 3) Medical Case Management, 4) Ethnic Community Leader Guidance, 5) Health Provider Awareness and Education and 6) Community Collaboration.

Lay health advisors (LHAs) will provide evidence-based breast, cervical and liver cancer prevention education to refugee women. A nurse midwife will provide cervical cancer screenings, clinical breast exams, HPV vaccines, assess the need for the hepatitis B vaccine and refer women to mammography services. Professional medical interpretation will be provided during all visits. A medical case manager will ensure that participants with abnormal results receive further diagnostics and treatment and participants establish a medical home. Through lectures and symposiums, health care professionals will learn about refugee women’s cancer prevention needs. The project will also convene a group of stakeholders to collaboratively address barriers to services and contributors to cancer in this population.

The project will reach at least 1600 refugee women (and their household contacts) and 300 health professionals through the following goals: Goal 1: To provide linguistically and culturally appropriate education to refugee women resettled in Tarrant County on breast, cervical, and liver cancer and the role of preventative health screenings, health behaviors and vaccinations to reduce the risk of developing these diseases. Goal 2: To use the midwife model of care to increase cervical cancer screenings, clinical breast exams, uptake of mammograms and risk and age appropriate human papillomavirus (HPV) and hepatitis B vaccines among refugee women. Goal 3: Ensure follow up care for abnormal screening results and assist refugee women to establish a medical home for continuity of care and future preventative screenings. Goal 4: To increase health providers’ awareness of the preventative health needs of refugees. Goal 5: To establish a collaboration of refugee community leaders and key stakeholders to identify needs and address refugee health in Tarrant County.

This approach uses existing resources and relationships to “build bridges” between services. Ethnic community leaders and organizations guided the proposal development and will continue to advise the project during implementation. This project adapts two RTIPs for use with four ethnic groups. The education component is enhanced by including HBV education, providing screening services, HPV vaccines, completed mammograms, and medical case management. While using the midwife model of care to create a positive culturally sensitive and woman-focused clinical experience is a proven approach world-wide, it is a new approach in Tarrant County.

In Texas, the goal is that all citizens receive culturally appropriate information on how to reduce their risks of developing and dying from cancer and that everyone have access to “high quality cancer prevention, screening, diagnosis, treatment and rehabilitation information and services.” This goal can be reached by providing appropriate outreach, education, clinical, and assistive services. The approach offered in this proposal builds “bridges” between services to increase the likelihood of early cancer detection and treatment resulting in a healthier life for women who have sought sanctuary in the United States.

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