Iraqi Refugees Face A Number Of Challenges In San Diego

clinic1_tx700.jpg.By Kenny Goldberg
SAN DIEGO — San Diego County has become the new home for thousands of Iraqi refugees. Many settle in El Cajon and nearby parts of East County, where they confront a new language and a new culture. And many of them carry deep emotional scars caused by years of war.

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Photo by Kenny Goldberg

Above: A Middle Eastern man checks in for his appointment at La Maestra Family Clinic in El Cajon.
At La Maestra Family Clinic in El Cajon, business is booming…literally.

The clinic has seen such a large influx of new patients, it is expanding its waiting room. Most of these new clients are refugees from Iraq. Luma came here from Iraq four months ago.

“Everything is different, everything is new, you know, the language, the city, everything,” Luma complains. “You don’t know how to go, where to go, you know, everything is difficult.”

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Photo by Kenny Goldberg

clinic2_tx700.jpgAbove: Women and their children line up for care at La Maestra Family Clinic in El Cajon. The clinic has eight doctors, nurses, or other staff who speak Arabic.
Back home, Luma was an executive secretary. Now, she’s scrambling for work. Like other newly arrived refugees, Luma gets financial help from the government, including Medi-Cal benefits. But only for a limited time.

“This is a nightmare, because after six months it will be cut off,” Luma says. “I will be without medical. I’m trying to find a job, I’m not sitting at home. I’m trying to find, at least to support myself and to have a medical benefit.”

Dr. Momtaz Almansour is La Maestra’s medical director. He says it’s tough for refugees when they first arrive in the U.S. because, regardless of their health status, refugees are not allowed to bring any medications with them.

“And from the first day they are expecting they will get medical care,” Dr. Almansour says. “But it will take at least a month until they get the Medi-Cal approved for them. Through this month, whatever emergencies, whatever urgent care problem, whatever medication need to be given or refilled, they are not able to get access through.”

La Maestra tries to help. The clinic offers care to anyone, regardless of ability to pay.

La Maestra has eight doctors, nurses, and other staff who are fluent in Arabic. They translate for other clinic providers that don’t speak the language.

“I can’t believe the baby’s so cute! So what day did you deliver…,” says Kathryn McCarthy, a nurse midwife. She’s noticed a disturbing trend among new Iraqi mothers.

“What I’m seeing is a lot of perinatal depression in this population,” McCarthy points out. “We’re getting scores on a validated tool that we’ve been using that far exceed the norms that we usually see in women in the U.S. and also our Spanish speaking women that attend this clinic.”

McCarthy says about 70 percent of new Iraqi mothers she sees suffer from depression. The normal rate is 10 percent. Emotional problems among refugees aren’t confined to new mothers.

“We are seeing many widows, who come in with several kids, and the husband has been killed,” Zina Asmar says. “People who have been kidnapped, people who have been tortured, people who have witnessed people being killed and tortured.

Zina Asmar is CEO of Chaldean-Middle Eastern Social Services in El Cajon. Her agency serves people from Iraq, Syria, Lebanon, and Jordan. It’s the only one in the County that provides outpatient counseling in Arabic for adults and children. The agency is overflowing with clients.

Asmar says refugees’ emotional wounds are deep and tough to treat. Then there’s the added burden of having to adjust to a completely different way of life.

“I can see the younger generation assimilating to this environment and to the new culture much faster than the older generation, who is still holding back to the previous culture,” says Asmar. “So, for the older ones it’s not as hopeful as it is for a younger generation.”

An estimated 20,000 Iraqi refugees have arrived in San Diego County since 2007. But other than a few agencies in El Cajon, there’s a dearth of services for this population. For example, the County Health and Human Services Agency has only one social worker who speaks Arabic.