Courtesy of Johnny HuSan Francisco State University researcher Kwee Say (right) interviews Tha Mee (center) and Mu Doe (left), Karen refugees from Myanmar, at a health fair.
Htoo Mlar’s son was born in a Thai refugee camp, and inexplicably, he never learned to walk. There weren’t any Western-trained doctors at the camp, so it wasn’t until Mlar’s family – refugees from rural Myanmar, formerly known as Burma – came to Oakland in 2009 that they visited a doctor and learned the boy has cerebral palsy.
Doctors are hopeful that with spinal surgery and physical therapy, Mlar’s now 10-year-old son will one day learn to walk. But because Mlar is Karen, an ethnic minority that does not speak Burmese, he and his family often have difficulty communicating with American doctors' offices and social service agencies.
“It’s hard because they call a Burmese interpreter, but I don’t speak Burmese,” Mlar, whose village was raided by Myanmar's military in the mid-1990s, said through an interpreter. “I don’t understand thoroughly.”
According to a new study issued last week, Mlar and his son are among the dozens of recent refugees from Myanmar – many of them ethnic minorities who don't speak Burmese – who have limited access to English classes and interpreters in Oakland. That has repercussions on employment prospects and health care, the report said, and the situation is most dire for ethnic minorities like the Karenni, who come from primarily rural settings, often have little formal education and began arriving in the U.S. only within the past four years.
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“This is a community that is small in numbers, but the need is high,” said Dr. Joan Jeung, a pediatrician with Asian Health Services in Oakland, who worked on the refugee study. “One thing that stands out is the degree of linguistic isolation, and their access in a health care setting is a challenge because they speak multiple languages.”
It’s an issue affecting other California communities where Burmese refugees have recently been resettled.
“Language would be the biggest thing,” Lejla Voloder, resettlement program manager at Catholic Charities Diocese of San Diego, said of challenges that newer refugees from Myanmar face.
California receives the most refugees in the country, and a total of 3,204 migrants from Myanmar have been resettled in the state since 1990, largely in San Diego and the San Francisco Bay Area. Burmese refugees came to the U.S. in the second-highest numbers last year, behind only those from Iraq. These later waves of immigrants tend to be ethnic minorities from south and east Myanmar.
The recent report on Burmese refugees in Oakland found that language barriers posed the biggest challenges for recent arrivals, creating serious impediments as they seek jobs and health care.
The study was conducted by San Francisco State University, Asian Health Services and the Burma Refugee Family Network. It found that 60 percent of the 194 refugees surveyed lived in extreme poverty, with household incomes of about $1,000 per month. The survey found 63 percent of refugees were unemployed, and 32 percent said language barriers prevented them from accessing health care. Although two nonprofits offer English classes to Burmese refugees in Oakland, most adult English language classes were cut in Oakland in 2010 due to state budget cuts.
“The report paints a whole picture of all the issues that are going on in the Burmese community,” said David Sein-Lwin, chairman of the newcomers assistance committee at the Oakland Burmese Mission Baptist Church. “In my experience, health is one of the biggest issues because of language limitations. The Karenni have even less interpreters. I have helped several times with social services, and it’s pretty tough to do that translation to Karenni. It takes two translators, it takes more time, and it can be frustrating.”
In these scenarios, one interpreter translates from Karenni to Burmese, and the second from Burmese to English.
The report cites examples of the health consequences for refugees who have limited or no access to translation services. Lia Tluang, for example, arrived in Oakland at age 16 with an eye injury that he’d sustained while working in Malaysia. Although he needed surgery to save the sight in his left eye, his Medi-Cal benefits were terminated after eight months. Tluang, who is of the Chin ethnic minority group, initially didn't have the language skills to reapply on his own. He was able to get an operation at age 18, after he figured out how to sign up for Medi-Cal, but now, the vision in his left eye is limited to a distance of 1 foot.
Because of translation problems with a Burmese interpreter, a pregnant Karen woman living in Oakland who wanted to keep her baby was mistakenly referred for an abortion. A translator and doctor at Asian Health Services was able to intervene before the woman went in for the procedure.
The availability of Karen and Karenni interpreters is also a concern in San Diego, where the most Burmese refugees have been resettled in California.
“When Burmese refugees walk through the door, my mindset changes,” says Dr. Timothy Rodwell, an assistant professor at the UC San Diego School of Medicine who screens recently arrived refugees. “I’m more concerned that they are less well-adapted to function well in our medical society. Health literacy is a concern straightaway. They seem really overwhelmed, and part of the problem is translation.”
Asian Health Services’ Jeung agrees that in addition to interpretation, newer refugees from more rural areas need help navigating the American medical system.
“Our system is so fragmented, and it’s difficult to access care if you are English-speaking and insured,” Jeung said. “So if you are low-income, non-insured and non-English-speaking, this system makes no sense to you, especially if insurance didn’t exist where you came from. They need help in making appointments. If we refer them elsewhere, interpretation in a specialty setting is a challenge, and even physically getting to the clinic and affording bus fare – these are all the barriers that my patients encounter along the way.”
In Oakland, the burden of translation falls on a handful of people like Kwee Say, an interpreter at Asian Health Services who worked on the refugee report and who is seemingly always on call. She has rushed to the hospital in the middle of the night as a volunteer translator when no one else was available. She is also literally putting out fires – once, a family called her when their apartment was burning down because they didn’t know who else to contact.
Zar Ni Maung, a co-founder of the Burma Refugee Family Network in Oakland, also volunteers his translation skills six hours a week. On Wednesdays, local refugees can visit him at the Vietnamese Community Center so he can help them read their mail.
“They are mostly on public benefits, and they receive letters from the county a lot,” he said. “They get water bills and sometimes credit card offers, and they think it’s free money. I show them that letters from the county have certain designs, and they know it’s important and they shouldn’t throw it away.”
Mlar, the recent Karen refugee, said he has a hard time learning English because classes are usually held when he’s working at a pizza manufacturer. He doesn’t have a car, so he walks 50 minutes each way to work each day; his manager will take him home if he finishes his shift after 11 p.m.
Others, like Groto Ni, 52, said he’s tried for two years to master English, but he’s still having problems. Ni spent 30 years in the Karenni army, and he held a job at a Richmond bakery for three months before he got laid off.
“I’d love to work, but to get a job, you need to know basic English, and I can’t because of my age,” Ni, who has eight years of schooling, said through an interpreter.
Mlar, 58, considers himself lucky because he has a job, and he'd love to see his friends find work, too. “We are farmers,” he said. “We would love to work with crops. If someone could provide land, that would be great. Then we wouldn’t have to worry about language. All of the refugees could get together and work.”
Mlar said that in Myanmar, he "lived in constant fear.” "We were always running around in the jungle (to get away from the military)," he said. "In the refugee camp, you can’t leave the camp. Here, it is better.”
But living in Oakland comes with its own set of challenges. Foremost on Mlar's mind is earning enough money to pay rent and electricity bills, which is something he never conceived of in Myanmar.
“If you want to build a house, you go to the jungle and cut some wood," he said. "You plant some vegetables and potatoes, and you don’t have any need to worry. If you want fish, you go fishing. Before the military damaged our village, it was nice; we didn’t have to worry.”
California Lost is an occasional series examining challenges facing neglected communities around the state.